PSYCHOPHARMACOLOGY

• The study of the regulation and stabilization of emotions, behavior, and cognition through the interactions of endogenous signaling substances or chemicals in the brain.

Psychopharmacology

Pharmacodynamics

The study of the biochemical and physiologic effects of drugs and the mechanisms by which the effects are produced.

Potency

Refers to the relative dosage of a drug that is required to achieve a desired effect.

Clinical efficacy

Refers to the maximum clinical response achievable by the administration of a specific drug.

Tolerance

Refers to the need for markedly increased amounts of a specific drug over time to achieve the same desired effect.

Pharmacokinetics

The study of movement of drugs absorption, distribution, metabolism and excretion.

Peak Plasma Concentration

Defined as the greatest accumulation of the drug in the plasma.

Half-life

Refers to the amount of time it takes for metabolism and excretion to reduce the plasma concentration of a specific drug by half.

Factors affecting Pharmacodynamics

Environment, Culture, Genetic.

Clinical efficacy max response

The maximum clinical response achievable by the administration of a specific drug.

Elderly medication dosage

Elderly persons require lower doses of medication to produce therapeutic effects.

Neurotransmitter classes

Includes Amino Acids, Catecholamines, Indolamines, Soluble Gases, and Neuropeptides.

Excitatory Neurotransmitters

Include Acetylcholine, Glutamate, Norepinephrine, Dopamine, and Epinephrine.

Inhibitory Neurotransmitters

Include GABA, Glycine, and Serotonin.

Antipsychotic drugs

Also known as Neuroleptics, used primarily to treat symptoms of psychosis such as hallucinations and delusions.

Typical Antipsychotic Drugs

Examples include Fluphenazine, Haloperidol, and Chlorpromazine.

Atypical Antipsychotic Drugs

Examples include Clozapine, Risperidone, and Olanzapine.

Extrapyramidal Symptoms (EPS)

Includes acute muscular rigidity and cramping, symptoms resulting from D2 receptor blockade.

Neuroleptic Malignant Syndrome (NMS)

A potentially fatal reaction to antipsychotic drugs characterized by rigidity, high fever, and autonomic instability.

Tardive Dyskinesia

A syndrome of permanent, involuntary movements caused by long-term use of antipsychotic drugs.

Anticholinergic side-effects

Includes dry mouth, constipation, blurred near vision, and urinary hesitance.

Lithium therapeutic level

0.6-1.2 mEq/L for normal therapeutic effect.

Valproic Acid function

Stabilizes mood through kindling effect, helpful in bipolar disorder.

Benzodiazepines use

Used to treat anxiety and anxiety disorders, mediating the action of GABA.

SSRIs function

Prevent reuptake of serotonin at the synapse, typically taking 2 to 4 weeks to show effectiveness.

MAOIs function

Inhibit the enzyme monoamine oxidase, increasing serotonin and norepinephrine activity.

Common side effects of MAOIs

Include anticholinergic effects, cardiovascular effects, and CNS stimulation.

Tricyclic Antidepressants (TCAs)

The first choice of drug to treat depression, available since the 1950s.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Antidepressants that selectively affect serotonin, with fewer side effects compared to TCAs.

Bupropion concern

Use with trazodone may increase the risk of seizures.

Anticonvulsants used as mood stabilizers

Include carbamazepine and valproic acid.

Buspirone

A non-benzodiazepine alternative for treating anxiety.

Nursing considerations for antipsychotics

Monitor for side effects and ensure adherence to treatment.

Client education for antidepressants

Inform patients of possible side effects and the time needed to see benefits.

Glutamate

An excitatory neurotransmitter involved in cognitive functions.

GABA

The primary inhibitory neurotransmitter in the nervous system.

Dopamine

A neurotransmitter primarily affected by antipsychotics.

Serotonin

A neurotransmitter primarily involved in mood regulation and affected by antidepressants.

Overdose treatment for TCAs

Monitor vital signs, maintain airway, and use gastric lavage if necessary.

Monitoring lithium levels

Blood levels should be taken 12 hours after the last dose.

Acetylcholine effects

Affected by anticholinesterase agents and involved in muscle activation.

Clozapine precautions

Weekly blood checks for WBC counts to monitor for agranulocytosis.

Psychotropic drug compliance

Follow-up care is essential to ensure adherence to medication regimens.

Setting of psychiatric nursing standards

Guides assessment, diagnosis, outcome identification, planning, and implementation.

Psychobiological interventions

Incorporate knowledge of psychobiology to restore patient health.

Counseling in psychiatric nursing

Interventions to assist clients in improving or regaining coping abilities.

Milieu Therapy

Creating and maintaining a therapeutic environment for patients.

Client education on benzodiazepines

Advise against alcohol use and to avoid abrupt discontinuation.

Effectiveness of antidepressants

Therapeutic effects may take 2-3 weeks to manifest.

Severe headache sign in MAOIs

May indicate hypertensive crisis, requiring immediate intervention.

• acetylcholine

• aspartate

• dopamine

• histamine

• norepinephrine

• epinephrine

• glutamate

• serotonin

Enumerate the excitatory neurotransmitters in the nervous system

• GABA

• Glycine

enumerate the inhibitory neurotransmitters in the nervous system.

1. Fluphenazine (Prolixin)

2. Haloperidol (Haldol)

3. Pherphenazine (Trilafon)

4. Chlorpromazine (Thorazine)

5. Thioridazine (Mellaril)

Typical anti-psychotic drugs

1. Clozapine (Clozaril)

2. Risperidone (Risperdal)

3. Olanzapine (Zyprexa)

4. Quetiapine (Seroquel)

5. Ziprasidone (Geodon)

Atypical antipsychotic drugs

Generic Name	Brand Name
Benzodiazepines
Alprazolam	Xanax
Diazepam	Valium
Lorazepam	Ativan
Triazolam	Halcion
Non-benzodiazepines
Buspirone	Buspar

Anti Anxiety Drugs

Standard I. Assessment

Standard II. Nursing diagnosis

Standard III. Outcome identification

Standard IV. Planning

Standard V. Implementation

Standard VI. Counseling

Standard VII. Milieu Therapy

Standard VIII. Self-care Activities

Standard IX. Psychobiologic Interventions

Standard X. Health Teaching

Standard XI. Case Management

Standard XII. Health Promotion and Maintenance

Enumerate the standards of psychiatric mental health clinical nursing practice

0.6 - 1.2 mEq/L

1.5 - 2.0 mEq/L

2.3 mEq/L and above

Therapeutic level

Mild to moderate

Moderate to severe