Slides explains the classification and uses of psychotropic medications.

2. At the end of the unit the leaners will be able to
 define psychoactive drug
 describe the classification, action, indication, contra-
indication, side effects, nurses responsibilities of psychoactive
drugs Such as
• Antipsychotics
• Antidepressants
• Mood stabilizers
• Anxiolytics
• Stimulants
• Depressants

3.  A psychoactive drug: is a chemical substance
acts upon central nervous system where it
alters brain functions resulting in changes in
perception, mood, consciousness and
behavior.

4.  Antipsychotics
 Antidepressants
 Mood stabilizers
 Anxiolytics
 Stimulants
 Depressants

5. ANTI-PSYCHOTICS

6.  Antipsychotics (also known as neuroleptics or
major tranquilizers) are a class of psychiatric
medication used to manage psychosis
particularly in schizophrenia and bipolar
disorder, and is increasingly being used in
the management of non-psychotic disorders

7.  Schizophrenia and psychotic symptoms
(hallucinations and delusions) are caused by
increased levels of dopamine in the limbic
system of the brain.
 Antipsychotic drug block dopamine
receptor, thus psychotic symptoms are
brought under control.

8. Classification based on chemical class:
1-Standard or typical neuroleptic drugs.
2-Atypical neuroleptic drugs.

9. Usual Dose
Trade Name
Generic Name
30-800 mg.
42-1200 mg.
60 – 150 mg
200-600 mg.
2 – 40 mg.
0.5 – 40 mg
6-20mg
50-400
8 – 30 mg.
60 – 100 mg.
10 – 200mg
Thorazine or largactil
Sparine
Vesprin
Mellaril
Stelazine
Prolixin
Haldol
Taractan
Navane
Loxitane
Moban
Typical Antipsychotic
Chlorpromazine
-Promazine
-Triflupromazine
-Thioridazine
-Trifluoperazine.
-Fluphenazine.
-Haloperidol
-Chlorprothixene
-Thiothixene
-Loxapine
-Molindone

10. Generic Name Trade Name Usual Dose
II- Atypical Anti-
psychotics
-Clozapine
-Risperidone
-Olazepine
-Quetiapine
–Amisulpride
Clozaril
Risperdal
Zyprexa
Seroquel
Solian
2 – 8 mg.
5-20 mg
150-750 mg
150-750 mg
400
-
1200 mg

11. [1] Symptomatic indication:
-Hallucination and delusions, Severe anxiety, restlessness,
agitation, hyperactivity, aggression.
[2] Indications related to diagnosis:
A-Idiopathic Psychosis: Disorders of unknown cause
which include:
1- Schizophrenia 2- Schizo -affective disorder.
3- Delusional disorder. 4- Recurrent relapse.
5- Depressive disorder associated with psychotic features.
6- Manic episodes associated with psychotic features
Indications of typical Antipsychotic:

12. B-Secondary psychosis:
There are psychotic symptoms that are associated with
identified organic causes such as:
• Brain tumor.
• Dementia of Alzheimer type.
• Withdrawal period during treatment of drug addiction.
• Mental deficiency associated with aggressive and
destructive type.

13. Contra-indications of typical anti-psychotic drugs:
1-Cardiovascular disease especially persons with severe hypotension,
heart failure, or history of arrhythmia.
2-Hypo or hypertension.
3-Liver disease or jaundice.
4-Enlarged prostate.
5-Bone marrow disease.
6-Pulmonary diseases.
7-Pregnant women.
8- Epilepsy because drugs will increase seizures

14.  I. Central nervous systems:
 Extra-pyramidal side effects (antidopaminergic): They are
subdivided into two groups early and delayed (tardive).
 [1] The early manifestations: are much commoner and occur
few days or weeks after the administration of the drug. It
includes:
 A-Acute dystonic reaction
 B-Pseudo-parkinsonism
 C-Akathesia
 D- Tardive Dyskinesia:
 E-Anti-cholinergic side effect:

15. A-Acute dystonic reaction:
 *It is a long lasting contractions or spasm of muscles.
It involves:-
 Eye: Oculogyric crises in which the eyes are pulled up or to the side
or forced eye closure.
 Jaw: Forced jaw closure (trismus).
 Neck: Torticollis :stiffness of the neck, which draws the head to one
side. Or Opisthotonous: spasm in which the head is pulled back.
 Tongue: Involuntary protrusion of tongue.

17. B-Pseudo-parkinsonism (Parkinson's like syndrome):
characterized by masked like face, rigidity and
tremors, excessive salivation.
• Notify the physician,
Anticholinergic agents as
 cogentin,
 parkinol,
 Artane,
 Akineton will be indicated.

19. C-Akathesia: (motor restlessness)
It is a state of motor restlessness characterized by
restlessness, Inability to sit still, strong urge to move
about.
D- (Tardive Dyskinesia):
It occurs at least after 6 – 24 months from
administrations. It is stereotyped involuntary movements
sometimes reversible, such as (tongue protrusion, lip
smoking, chewing)
E-Anti-cholinergic side effect:
Dry mouth, blurred vision, urinary retention, constipation,
orthostatic hypotension, tachycardia, nasal congestion.

20.  Neuroleptic malignant syndrome
(NMS) is a life-threatening idiosyncratic
reaction to neuroleptic medications.
NMS typically consists of
 muscle rigidity,
 fever, >38°C (>100.4°F
 cognitive changes such as delirium, and
is associated with elevated plasma
creatinine phosphokinase
 Confused or altered consciousness
 Diaphoresis "sweat shock
 Autonomic imbalance

21. „ Stop drug and transfer to ICU
„ Treat symptoms
„ Bromocriptine (Parlodel)
„ Dantrolene (Dantrium)
„ Amantadine (Symmetrel)
„ Antipyretics
„ Heparin
„ Hydration and electrolyte balance

22. II- Cardio – vascular system: -
-Orthostatic hypotension.
-Dizziness or weakness.
-Tachycardia or palpitation when sudden change of position.
V- Skin:
-Early toxic allergic reaction with rashes.
-Photosensitivity reaction.
- dermatitis.
IV- Ophthalmologic:
-Pigmentation of cornea and lens → opacity.
-The conjunctiva is discolored by brown pigmentation.

23. VI Endocrine:
-amenorrhea, breast enlargement, decreased
sexual drive, and menstrual irregularities, -Weight
gain due to increased appetite.

24. Atypical anti-psychotic drugs
Mode of action:
Atypical Antipsychotic blocks both serotonin and
dopamine receptors. It is hypothesized that the improved
negative symptom response and minimal extrapyramidal
side effects are due to this combination of receptor
blockade.

25. Advantages of the Atypical antipsychotic:
• Effective for both negative and positive symptoms of
schizophrenia
• Absence of many side effects of the standard neuroleptic
drugs.
• improvement occurred after 6 weeks.

26. Client education
1- The nurse should inform clients about the
planned drug therapy, length of time it takes to
achieve therapeutic results, and possible side
effects of drug therapy
2- Client should be instructed to report any
physical illness or unusual side effects and to
avoid taking over the counter drugs or
medications prescribed by another physician.

27. 3-Alchol and sleeping pills cause drowsiness and decrease
one's awareness of environmental hazards. Sleeping pills,
alcohol, and other medication should be avoided during drug
therapy
4-Driving or operating hazardous machinery also should be
avoided while taking antipsychotic drugs
5-Clients should avoid being in direct sunlight for an extended
time to prevent sun burn or pigmentation of the skin.

28. 6-Client should not increase, decrease, or cease
taking drugs with out discussing this step with
the physician. The drug should be withdrawn
slowly to avoid nausea or seizures.
7-The client should avoid taking antacids during
antipsychotic therapy because antacids might
decrease the absorption of antipsychotic drugs
from the intestinal tract.

29. 8-Good oral hygiene should be practiced to avoid mouth
infections; dental caries .annual dental examination
should be performed
9-Continue to take medication, ever if feeling well.
10-Carry card describing medication of giving medication
11- Ask patient to get out of bed or chair slowly.
12-Check blood pressure before each dose is given

30. ANTI DEPRESSANTS

31.  Antidepressants are used to treat depressive
disorders caused by emotional or
environmental stressors, losses, disease state
such as cerebral vascular accidents or
depression that can not be related to an
identifiable cause.

32.  1-Primary indication is depression
 2- Relieve of symptom such as
 - Depressed mood - Lethargy
 - Decrease energy - Insomnia
 - Decrease concentration - loss of
appetite
 - Suicidal ideation
 - Loss of interest in the person usual
activities.

33.  3- Some antidepressant are used to treat anxiety
disorder include panic attacks.
 4- Relieve ruminations and repetitive behaviour
of eating disorder and obsessive compulsive
disorder.
 5- Antidepressants are used to treat the
symptoms of social phobia, chronic pain disorder
and premenstrual syndrome.
 6- psychiatric disorder of childhood such as
attention deficit hyperactivity disorder, enuresis,
school phobia respond antidepressant.

34. Classification
1- Typical antidepressant 2-Atypical antidepressant
Monoamine oxidise Cyclic Selective
Inhibitors (MAOI) compounds serotonin reuptake
Inhibitors (SSRI)

35.  Selective serotonin reuptake inhibitors(SSRIs)
 Tricyclic antidepressants
 Monoamine Oxidase inhibitors(MAOIs)

36. These drugs include
 Prozac (fluoxetine)
 Zoloft (sertraline)
 Celexa (citalopram)
 Paxil (paroxetine)

37. Mechanism of action:
Prevents the reuptake of serotonin by the
presynaptic neuron, thus maintaining high
levels of 5-HT in the synapse

38.  Nausea
 diarrhea
 agitation
 head ache
 suicidal tendencies
 drowsiness
 Dry mouth
 anxiety
 insomnia
 decreased appetite

39.  Explain adverse effects
 Increase fluid intake
 observe psychomotor activity
 Provide small and frequent diet
 Maintain I/O chart

40.  Older drug
 Less commonly used.
 Used in severe cases of major depression
 More serious adverse effects especially
anticholinergic and cardiac effects, weight
gain and sedation
These drugs include:
 Imipramine ( Tofranil )
 amitriptyline (Elavil)
 doxepin (Sinequan )
 Desipramine (Norpramin)

41. Mechanism of action:
Tricyclics blocks the reuptake of
neurotransmitters such as nor-epinephrin and
serotonin.

42.  drowsiness,
 anxiety,
 emotional blunting,
 confusion,
 restlessness,
 dizziness,
 hypersensitivity,
 changes in appetite and weight, sexual
dysfunction, muscle twitches, weakness,
nausea and vomiting, hypotension,
tachycardia,.

43.  Observe for adverse effects
 Increase fluid intake
 Fiber rich diet
 Watch for urinary retention
 Administer medication at night time to avoid
drowsiness.

44.  Used when other antidepressants are
ineffective.
 Potentially fatal interaction with certain
foods.
 Rarely prescribed
These drug includes:
 Isocarboxazid (Marplan)
 Phenelzine (Nardil)
 Tranlcypromine (Parnate)

45.  MAOIs work by blocking the enzyme
monoamine oxidase which breakdown the
neurotrasmitters dopamine, serotonin and
norepinephrin

46.  1- Ant cholinergic
 Blurred vision
 Dry mouth
 Constipation
 Urine retention
 Increased respiration
 Mental clouding, confusion & delirium
 Insomnia and restlessness
 Hypomania in patient with bipolar disorder
 Myoclonic jerks during sleep
 Hypertensive crisis
 a) May occur after patient ingests food that contain
tyramine or take drug with sympathomimetic properties
 b) Can be life threatening if not treated

47. Food to be avoided
All matured or aged cheeses Ex: cheddar
Broad bean
Meat extract
Dried salted fish
Yoghurt sour cream
Tea, coffee, cola
Chocolate
Overripe fruit
Snails, tinned fish

48.  History of liver disease and abnormal function test of liver.
 Impaired renal function hyperthyroidism.
 Paranoid schizophrenia.
 Epilepsy.
 Cardiovascular disease.
 Cerebral or generalized arteriosclerosis.
 Elderly people.
 Debilitated patient.
 Pregnancy.
 Child under age 16 years.
 Patient receiving cyclic compounds.

49.  Avoid ingestion of any other drug while on MAOIs
therapy for 2-3 weeks after discontinuance
 Avoid food rich in tyramine .
 Limit excessive drinking of coffee, tea or cola
because excessive caffeine with MAOIs cause
hypertensive crisis which characterized by occipital
Headache, elevation of BP, Palpitation, stiffness,
tachy or Bradycardia, nausea, vomiting, sweating,
photo phobia and dilated pupils.

50. The nurse should measure blood pressure and pulse at
regular intervals.
Check for peripheral edema which indicate chronic Heart
Failure CHF
Should check for red green vision which is the first
indication of optic damage.
She should make intake and out put chart to check on
possible urinary retention
Should encourage patient to rise slowly from supine
position and to dangle his feet before standing

51. She should observe patient closely for any attempt to
suicide as these patients are more prone to suicide when
they emerge from deepest phase of depression then they
are before therapy.
The nurse should teach patient the proper use of
prescribed medication and explain their adverse effects.
She should advise patient to take these medication early
in the day to avoid insomnia
She should make liver function test before therapy
Drug should be discontinued at least 3 weeks before
surgery.

52. MOOD
STABILIZERS

53. Anti manic Agents or Mood Stabilizers..
Refer to agents that prevent or diminish the
frequency and intensity of manic behavior,
mood swings, aggressive behavior. Lithium has
long been considered the treatment of choice
for the manic phase of bipolar disorder.

54. 1. Lithium carbonate
2. Anti-convulsants.
Examples:
◦ Valporic acid (Depakene)
◦ Sodium valporate (Depacon,Epilim)
◦ Carbamazepine(Tagretol)
◦ Topiramate (Topamax)
3. Atypical antipsychotics
Lithium is considered the drug of choice for treatment and
management of bipolar disorder mania.

55. 1- Long-term control or prophylaxis of manic
depressive disorders.
2- prevention of the intensity of subsequent
episodes of mania and depression.
3- treatment of acute mania.
4- treatment of chronic aggression and antisocial
behavior

56. 1- Brain damage, hypertension.
2- Renal disease.
3- Cardiovascular disease
4- it should be avoided during pregnancy
especially in the first trimester because of the
probability of malformation.
5- Lactation (present in breast milk at
concentration of 30-100% of mother’s serum
discourage breast feeding.

57. 6-Children under 12 years
7- dehydration
8- Sodium depletion
9- brain damage
10- Urinary retention
11 – history of seizures
12-the elderly

58.  Dose is usually guided by level of plasma
 Acute treatment 900-1800 mg daily (0.8-1.2 m
mol/L.
 Maintenance: 400-1200 mg daily (0.6- 1.0
mmol/L).
 Once patient is stabilized, once- daily dosing is
preferable (if patient can tolerate).

59. The commonest side effect
• Polyuria, Weight gain may result from 
lithium – induced thirst and increase fluid
intake
• Nausea and diarrhea usually pass after 2-3
weeks of treatment but may be signs of
impending intoxication.
• tachycardia , increased weakness
• respiratory difficulties " on excretion "
• fainting and irregular pulse.

60.  Therapeutic range: 0.6or 0.8 -1.2 mEq/ L
 Maintenance range: 0.8 -1 mEq/ L
 Toxic range: more than 2 mEq/ L

61. Mild toxicity:
Tremors, ataxia, arrhythmias, Muscle weakness,
allergic reaction, blurred vision, glycosuria and
polyuria
Severe Toxicity:
Cerebral ataxia, seizures, hypotension and coma

62.  Explain adverse effects
 Monitor serum lithium level
 Observe for toxicity
 Increase fluid intake
 Monitor intake and output.

63. ANXIOLYTICS

64.  An anxiolytic (also antipanic or antianxiety
agent) is a drug used for the treatment of
anxiety, and its related psychological and
physical symptoms.
 Anxiolytics have been shown to be useful in
the treatment of anxiety disorders.
 Also known as minor tranquilizers.

65. Classification:
• Benzodiazepines.
• Non- Benzodiazepine.
1- Benzodiazepines:
They are the most common & widely
used. They are classified according to duration
of action into short acting and long acting.

66. Generic name
Anxiolytic-Benzo.
- Alprazepam
- Lorazepam
- Chloradiazepoxide
- Diazepam
Trade
name
Xanax
Ativan
Librium
Valium
Duration of
action
Short
Short
Long
Long
Dose
0,5mg/day
2-6 mg/day
15-100 mg/day
2-60 mg/day

67. 11- Non- Benzodiazepine:
Generic name Trade name Duration of action
a- Barbiturates
- Secobarbital
- Amobarbital
- Phenobarbital
Seconal
Amytal
Lminal
100-200mg/day
100-200mg/day
100-200mg/day
b- Meprabamate Miltown
equdril
1200-1600 mg/day
c- Hydroxyzine Atarax
Vistaril
50-100mg/day
d- Beta-adrenergic propranolol Indral 10mg/day
Buspar 10-60 mg/day

68. 3. Action:
Depression of the central nervous system (CNS).
4 .Contraindications/precautions:
contraindicated in known hypersensitivity and in combination
with other CNS depressants. Caution with elderly and debilitated clients,
clients with renal or hepatic dysfunctional, clients with a history of drug
abuse or addiction, and those who are depressed or suicidal.
-Coma -Premature labor
-During pregnancy 1st
trimester leads to cleft lip &
3rd
trimester leads to congenital anomalies

69.  CNS: depression, fatigue, drowsiness, muscle
weakness, dysarthria, ataxia
 Anti cholinergics: blurred vision, confusion
 Others: insomnia, nightmares, hallucination,
respiratory depression, toxicity.

70.  Sleep apnea
 Liver disease
 Alcohol or drug abuse

71.  Explain adverse effects
 Not to use with CNS depressants
 Avoid caffeine
 Avoid driving
 Not to adjust the drug dosage

72. THANK YOU