PSYCHOTHERAPEUTIC AGENTS

-used to treat psychoses (perceptual and behavioral disorders)

Mental Disorders:
>Schizophrenia
>Bipolar Disorder
>Narcolepsy
>Attention Deficit Disorder

Classification: Antipsychotic/ Neuroleptic Drugs

-essentially dopamine receptor blocker
-used to treat disorders that involve thought processes

a. Typical Antipsychotics (2nd generation)

-blocks dopamine receptors

b. Atypical Antipsychotics (1st generation)

-blocks both dopamine and serotonin receptors

Indication:
>Schizophrenia
>Hyperactivity
>Combative Behavior
>Severe Behavioral Problems in Children
>Bipolar Disorder

Pharmacokinetics:
-absorbed from the GI tract
-metabolised in the liver
-excreted through the bile and urine
-crosses the placenta and enters breast milk

Contraindications:
>CNS depression
>Circulatory collapse
>Parkinson’s disease
>Coronary disease
>Elderly with Dementia
>Bone marrow suppression
>Prolonged QTs interval

Adverse Effects:
- CNS: Sedation, weakness, tremor, drowsiness, pseudoparkinsonism, dystonia, akathinia
- CV: Hypotension, cardiac arrhythmias, congestive heart failure, pulmonary edema
- Respiratory: Laryngospasm, dyspnea, bronchospasm
- Gynecomastia
- Dry mouth, constipation, photophobia
*Atypical antipsychotics can cause risk of weight gain and diabetes*

Nursing Considerations:
-Assess for contraindications/cautions for the use of the drug.
-Determine baseline status before beginning therapy and for any potential adverse effects.
-Do not crush/chew sustained release capsules.
-Caution patient about the risk of gynecomastia when using these drugs.
-Monitor blood glucose levels with long-term use.
-Provide sugarless candy and ice chips.
-Monitor patient response to the drug.

Central Nervous System Stimulants

Classification: Central Nervous System Stimulants

Therapeutic Actions and Indications: Cortical and RAS stimulants, that increases
catecholamines leading to an increased stimulation of the postsynaptic neurons. In ADHD
patients, the immature RAS leads to a paradoxical effect making the client more calm and
focused. On the other hand the effect of the drug to people with various sleep disorders like
narcoleptic patients will have an improved wakefulness.

Medications:
❖ Methylphenidate
❖ Dexmethylphenidate

Pharmacokinetics:
These drugs are rapidly absorbed in the GI tract, reaching peak levels of 2 to 4 hours with half
lives ranging from 2 to 15 hours depending on the drug. Like most drugs, these are metabolized
in the kidneys and excreted in the urine

Contraindications and Cautions:

● Hypersensitivity to the drug
● Anxiety
● Agitation
● Fatigue
● Glaucoma
● Tension
● Cardiac disease
● History of seizures
 ● History of drug dependence
● Alcoholism

Adverse Effects:
CNS effects include:
● Nervousness
● Insomnia
● Dizziness
● Headache
● Blurred vision
● Difficulty with accommodation
GI effects include:
● Anorexia
● Nausea
Cardiovascular effects include:
● Hypertension
● Arrhythmias
● Angina
● Sudden cardiac death

Drug to Drug interaction:

X Monoamine oxidase inhibitor - increase risk of toxicity and adverse effects due to its
potentiating actions
X Guanethidine - results in a decrease in antihypertensive effects
X Tricyclic Antidepressants or Phenytoin - risk of increase drug levels thus, drug toxicity

Nursing Considerations:
❏ Electrocardiogram (ECG) test should be done prior to administration
❏ Teach patient about controlled substances
❏ Administer drug before 6pm to prevent insomnia
❏ Assess for allergies
❏ Assess for cardiac disease
❏ Ensure proper diagnosis of behavioral syndrome and narcolepsy
❏ Check vital signs before, during and after medication due to hypertension
❏ Arrange to dispense the least amount of drugs possible to reduce the risk of overdose
and abuse

Drugs for Bipolar Disorder

-Bipolar disorder is a behavioral disorder that involves extremes of depression alternating with
hyperactivity and excitement
-Mania, at the opposite pole from depression, occurs in individuals with bipolar disorder who
experience a period of depression followed by a period of mania. It it is thought to be an over-
stimulation of certain neurons in the brain.
Lithium salts (lithobid)

Classification: Mood stabilizers

Actions:- It alters sodium transport in nerve and muscle cells
- inhibits the release of norepinephrine and dopamine by increasing the intraneuronal stores
. -May selectively modulate the responsiveness of hyperactive neurons that might contribute to
the manic state.

Indication: Treatment of manic episodes of bipolar disorder and maintenance treatment of

bipolar disorder

Contraindication: -hypersensitivity to lithium

- Significant renal or cardiac disease
- leukemia
-metabolic disorder
- Pregnancy and lactation,
● breastfeeding should be discontinued while using Lithium,
● women of childbearing age should be advised to use birth control while taking this drug.

Adverse effects:The adverse effects associated with lithium are directly related to serum levels
of the drug. Normal serum level is at 0.6 to 1.2mEq/L
- Serum levels of < 1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle
weakness, and fine tremor;polyuria, with nausea, vomiting, and diarrhea.
- Serum levels of 1.5 to 2 mEq/L: Intensification of all of the foregoing reactions, with ECG
changes.
- Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS effects to ataxia, clonic
movements, hyperreflexia, and seizures; possible CV effects such as severe ECG
changes
- Serum levels >2.5 mEq/L: Complex multiorgan toxicity

Nursing considerations:
-Monitor daily the serum lithium levels
-Administer drug with food or milk to alleviate G.I. upset
- Ensure the patient takes adequate amount of salt and fluid
-Arrange for small frequent meals; sugarless lozenges to suck; and frequent mouth care to
increase secretions and decrease discomfort as needed

Pharmacokinetics: Lithium is readily absorbed from the GI tract, reaching levels in 30 minutes
to 3 hours.Lithium is excreted from the kidney.

Clinically important Drug to Drug interactions

● Lithium-haloperidol- may result to encephalopathic syndrome
 ● Lithium-carbamazepine- increased CNS toxicity
● Lithium-iodide salt- increase risk of hyperthyroidism
● Thiazide diuretic-lithium- risk for lithium toxicity
● Lithium- indomethacin- higher plasma levels of lithium may occur

Other drugs for bipolar disorder

❖ Aripiprazole(Abilify)
❖ Lamotrigine(lamictal)
❖ Olanzapine(Zyprexa, Zyprexa zydis)
❖ Quetiapine(seroquel)
❖ Ziprasidone(Geodon)