Neurobiologic Theories and Psychopharmacology

Neurotransmitters

Chemical substances manufactured in neurons that aid in the transmission of information throughout the body.

Dopamine

An excitatory neurotransmitter that controls complex movements, motivation, cognition, and emotional response.

Serotonin

An inhibitory neurotransmitter that controls food intake, sleep, temperature regulation, pain control, and regulation of emotions.

Psychoimmunology

The study of the effect of psychosocial stressors on the body's immune system.

Psychopharmacology

The use of medications to treat mental illness.

Efficacy

The maximal therapeutic effect that a drug can achieve.

Potency

The amount of a drug needed to achieve its maximum effect.

Half-life

The time it takes for half of a drug to be removed from the bloodstream.

Off-label use

The use of a drug for a disease or condition that differs from the one it was originally tested and approved for.

Black Box Warning

A warning on a drug label indicating serious or life-threatening side effects.

Antipsychotic Drugs

Medications used to treat symptoms of psychosis, such as delusions and hallucinations.

Mechanism of Action

The way in which a drug works in the body to produce its therapeutic effects.

Extrapyramidal Symptoms (EPS)

Side effects of antipsychotic drugs that affect motor function, such as dystonia, pseudoparkinsonism, and akathisia.

Neuroleptic Malignant Syndrome (NMS)

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

Tardive Dyskinesia (TD)

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

Tardive Dyskinesia

Other excessive unnecessary facial movements

Irreversible

After its development, it becomes irreversible

Antipsychotic Medications

Decreasing or discontinuing antipsychotic medications can arrest its progression

Masking

Antipsychotic medications can mask the beginning symptoms of TD

Increased Dosages

Increased dosages of the antipsychotic medication cause the initial symptoms to disappear temporarily

Breakthrough

As it worsens, they "break through" the effect of the antipsychotic drug

Valbenazine (Ingrezza)

Drug treatment includes Valbenazine (Ingrezza) with a dosage range of 40 to 80 mg

Deutetrabenazine (Austedo, Teva)

Drug treatment includes Deutetrabenazine (Austedo, Teva) with a dosage range of 12 to 48 mg daily

Nausea, Vomiting, Headache, Balance Disturbances

Valbenazine (Ingrezza) may cause nausea, vomiting, headache, and balance disturbances

NMS, Increased Depression, Increased Suicidality

Deutetrabenazine (Austedo, Teva) may cause NMS, increased depression, and increased suicidality with Huntington chorea

VMAT2 Inhibitors

First drugs to treat TD are vesicular monoamine transporter 2 (VMAT2) inhibitors

Decrease Activity

VMAT2 inhibitors decrease activity of monoamines, such as dopamine, serotonin, and norepinephrine, thereby decreasing the abnormal movements associated with Huntington chorea and TD

Somnolence, QT Prolongation, Akathisia, Restlessness

Effects of the drugs include somnolence, QT prolongation, akathisia, and restlessness

Anticholinergic Side Effects

Often occur with the use of antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, and decreased memory

Weight Gain, Metabolic Syndrome

Antipsychotics, except Ziprasidone (Geodon), are associated with weight gain and metabolic syndrome, which increase the risk for heart disease, diabetes, and stroke

Cardiovascular Adverse Effects

Cardiovascular adverse effects may include postural hypotension, palpitations, tachycardia, and increased QT intervals

Thioridazine, Droperidol, Mesoridazine

Drugs such as thioridazine, droperidol, and mesoridazine may cause QT interval prolongation and life-threatening dysrhythmias

Clozapine

Clozapine can cause agranulocytosis, characterized by fever, malaise, ulcerative sore throat, and leukopenia

Client Teaching

Nurse informs clients taking antipsychotic medication about the types of side effects that may occur and encourages clients to report such problems to the physician instead of discontinuing the medication

Antidepressant Drugs

Antidepressant drugs are primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, psychotic depression, and off-label uses such as chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, panic disorder, and eating disorders

Mechanism of Action

Antidepressant drugs interact with the neurotransmitters norepinephrine and serotonin, regulating mood, arousal, attention, sensory processing, and appetite

Tricyclic and Related Cyclic Antidepressants

Tricyclic and related cyclic antidepressants were the first choice of drugs to treat depression, but they have varying degrees of sedation, orthostatic hypotension, and anticholinergic side effects

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs replaced cyclic drugs as the first choice in treating depression, as they are equal in efficacy and produce fewer troublesome side effects

MAO Inhibitors (MAOIs)

MAOIs have a low incidence of sedation and anticholinergic effects but must be used with extreme caution due to the risk of hypertensive crisis with certain foods or drugs

Other Antidepressants

Other antidepressants include desvenlafaxine, venlafaxine, bupropion, duloxetine, trazodone, and nefazodone

Side Effects of SSRIs

Side effects of SSRIs include anxiety, agitation, akathisia, nausea, insomnia, sexual dysfunction, and less weight gain compared to other antidepressants

Side Effects of Cyclic Ant

Appetite

The desire or craving for food.

Nausea

A feeling of sickness or discomfort in the stomach, often accompanied by the urge to vomit.

Agitation

Restlessness or irritability, often characterized by excessive movement or emotional distress.

Insomnia

Difficulty falling asleep or staying asleep, resulting in inadequate rest.

Venlafaxine

An antidepressant medication that may be prescribed to treat depression, anxiety, and other mood disorders.

Dizziness

A sensation of lightheadedness or unsteadiness, often accompanied by a spinning or whirling sensation.

Sweating

The production of perspiration, often as a response to physical exertion, heat, or stress.

Sedation

A state of calmness or relaxation induced by medication, often resulting in drowsiness or sleepiness.

Drug Interactions

The effects that occur when two or more medications interact with each other, potentially altering their effectiveness or causing adverse reactions.

Serotonin Syndrome (Serotonergic Syndrome)

A rare but potentially serious drug interaction that can result from taking certain medications, such as MAOIs and SSRIs, together or too close in time. Symptoms may include agitation, sweating, fever, rapid heartbeat, low blood pressure, muscle rigidity, hyperreflexia, and in extreme cases, coma or death.

Coma

A state of prolonged unconsciousness, often caused by severe illness or injury.

Death

The permanent cessation of all vital bodily functions, resulting in the end of life.

Client Teaching

The process of providing information and instructions to clients regarding their medication, including dosing, timing, potential side effects, and precautions.

MAOIs (Monoamine Oxidase Inhibitors)

A class of antidepressant medications that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.

Hyperadrenergic Crisis

A life-threatening condition characterized by excessive release of adrenaline (epinephrine) and other stress hormones, often triggered by the interaction of certain foods or medications with MAOIs.

Dietary Restrictions

Specific foods and beverages that should be avoided while taking MAOIs to prevent dangerous interactions and the risk of a hyperadrenergic crisis.

Nefazodone

An antidepressant medication that may cause rare but potentially life-threatening liver damage, leading to liver failure.

Bupropion

An antidepressant medication that may increase the risk of seizures, especially when taken at high doses or in combination with certain other factors such as a history of seizures, cranial trauma, substance abuse, or certain medical conditions.

Mood-Stabilizing Drugs

Medications used to treat mood disorders, such as bipolar disorder, by helping to stabilize and regulate mood swings.