A.

List names of antipsychotic medications and their usual range of daily

dose for adults.

GENERIC (TRADE) NAME DAILY DOSAGE

CONVENTIONAL ANTIPSYCHOTICS
Phenothiazines
 Chlorpromazine (Thorazine) 200-1600 mg/day
 Perphenazine (Trilafon) 16-32 mg/day
 Fluphenazine (Prolixin) 2.5-20 mg/day
 Thioridiazine (Mellani) 200-600 mg/day
 Mesoridazine (Serentil) 75-300 mg/day
 Trifluoperazine (Stelazine) 6-50 mg/day
Thioxanthene
 Thiothixene (Navane) 6-30 mg/day
Butyrophenones
 Haloperidol (Haldol) 2-20 mg/day
 Droperidol (Inapsine) 2.5 mg/day
Dibenzazepine
 Loxapine (Loxitane) 6-100 mg/day
Dihydroindolane
 Molindone (Moban) 50-100 mg/day
ATYPICAL ANTIPSYCHOTICS
 Clozapine (Clozaril) 150-500 mg/day
 Fazclo (Clozapine) 150-500 mg/day
 Risperidone (Risperdal) 2-8 mg/day
 Olanzapine (Zypreza) 5-15 mg/day
 Quetiapine (Seroquel) 300-600 mg/day
 Ziprasidone (Geodon) 40-160 mg/day
 Paliparidone (Invega) 6 mg/day
NEW GENERATION ANTIPSYCHOTIC
 Anripiprazole 15-30 mg/day

Source: Videbeck, Shiela. Psychiatric- Mental Health Nursing. 4th ED. 2008. Lippincott William and Wilkins.
 b. What are the target symptoms of antidepressants? List atleast 8
accurate examples.

 Anxiety
 Insomnia
 Hallucinations
 Delusions
 Disruptive behaviors that sometimes accompany Alzheimer’s Disease
 Schizoaffective disorder
 Depressed phase of bipolar disorder
 Psychotic depression
 Major depressive illness
Source: Videbeck, Shiela. Psychiatric- Mental Health Nursing. 4th ED. 2008. Lippincott William and Wilkins.

c. Below are list of drugs and foods that are contraindicated with each
other. Match which food that must be avoided when taking the medications
in column 2. You can match more than once.

DRUGS FOODS
Amphetamine Aged cheese, liver, fava beans, bologna, beer, more than one ounce
chocolate, smoked foods, sausages, snow pea pods, avocado,
brewer’s yeast, tofu, red wine
General anesthetic Pickled foods, liver, sausages, bologna, pepperoni, salami, fava
beans, aged cheese, red wine, beer, brewer’s yeast, more then one
ounce chocolate, sauerkraut, tofu
Asthma Medication Smoked food, more than one ounce chocolate, red wine, beer,
pepperoni, bologna, salami, sausages, tofu
Stimulants More than one ounce chocolate, beer, aged cheese, brewer’s yeast,
red wine
SSRI Beer, aged cheese, fava beans, more than one ounce chocolate,
hydrolyzed protein extracts, tofu, red wine, sausages, bologna,
salami, pickled foods, avocado, smoked foods, MSG, sauerkraut
Hydrocone Beer, brewer’s yeast
Percocet, Percodan Beer, red wine, more than one ounce chocolate
Morphine Beer, red wine, more than one ounce chocolate
Codeine Beer, red wine, more than one ounce chocolate
Nasal decongestants Beer, red wine, more than one ounce chocolate, aged cheese, tofu,
sauerkraut
Nonprescription sleeping pills Beer, red wine, more than one ounce chocolate
Local or spinal anesthetics containing Aged cheese, red wine, beer, more than one ounce of chocolate
epinephrine or levonodefrin
Source: Videbeck, Shiela. Psychiatric- Mental Health Nursing. 4th ED. 2008. Lippincott William and Wilkins.
D. Explain why Beta Blockers are used in Psychiatry? .
Beta blockers, also known as beta antagonists, are a class of drugs that were first
developed for the treatment of certain heart conditions and hypertension. Later, beta blockers
were also found to be useful in glaucoma, migraine, and some psychiatric disorders such as
performance anxiety, tremors secondary to lithium, and movement disorders that are caused by
some drugs used in the treatment of psychosis. In the United States, the most commonly used
beta blocker used in psychiatric practice is propranolol (Inderal). Nadolol (Corgard), metoprolol
(Lopressor), and atenolol (Tenormin) are also used in psychiatric practice but to a lesser degree.

Beta blockers are proven effective in the treatment of performance anxiety, lithium-
induced tremor, and neuroleptic-induced akathisia (a physical condition caused by certain
antipsychotic drugs). Beta blockers have sometimes been used with benzodiazepines in treating
alcohol withdrawal.

Beta blockers act on that part of the central nervous system that controls mental
alertness, lung function, heart rate, and blood vessels. Although there is more than one
mechanism by which beta blockers work in anxiety states, the most beneficial result probably
arises from the fact that beta blockers slow the heart to a normal rate and rhythm. Therefore,
persons with performance anxiety do not experience the usual chest tightness and rapid heart
rate that is associated with such acts as public speaking or acting.

Certain antipsychotic medications known as neuroleptics can cause an unwanted effect

called akathisia, which is the inability to sit, stand still, or remain inactive. Patients are
restless, and in severe cases, may pace constantly and forcefully and repeatedly stomp their feet.
Beta blockers can sometimes treat this condition with a lower incidence of side effects than any
other drugs used to treat this condition.

Source: Encyclopedia of Mental Ilness. 2011. Advameg, Inc.

E. Explain why Cholinergic Agonists are used in Psychiatry? .

It has long been known that acetylcholine plays an important role in cognition and that
impaired cholinergic transmission contributes to the cognitive deficits in Alzheimer’s disease. There
is evidence for decreased numbers of both muscarinic and nicotinic receptors in schizophrenia, and
a functional polymorphism of the 7 nicotinic receptor has been linked genetically to this disorder.
Moreover, acetylcholine modulates dopamine transmission in the striatum , where dopamine
dysregulation may contribute to both positive and negative symptoms , and in the cortex, where
dopamine transmission deficits have been postulated to contribute to cognitive deficits. These
findings, along with the heavy consumption of nicotine by patients with schizophrenia and the
suggestion that muscarinic receptor agonism by clozapine or its active metabolite may underlie its
potential amelioration of negative and cognitive symptoms, have raised interest in cholinergic
agonists to treat schizophrenia and its cognitive deficits .

Cholinergic transmission is mediated by two families of receptors: 1) nicotinic

acetylcholine receptors, which are ligand-gated ion channels formed by pentameric combinations of
different and β subunits, as well as homomeric 7 nicotinic receptors, and 2) the muscarinic
receptors M1–M5. Activation of nicotinic receptors leads to a rapid increase in sodium
and/or calcium conductance that increases neuron activity and neurotransmitter release.

Muscarinic receptor signaling, on the other hand, is mediated by G proteins exerting slower but potentially
moresustained effects. Acetylcholine is widely distributed in the brain; however, its actions in the
neocortex, hippocampus, and striatum, and at midbrain dopamine neurons, are of perhaps the greatest
relevance to cholinergic therapies in schizophrenia. The neocortex and hippocampus receive cholinergic input
from basal forebrain neurons located primarily in the nucleus basalis of Meynert and medial septum,
respectively The striatum, which receives massive cortical input, is highly concentrated in acetylcholine
that is released from local cholinergicinterneurons The neocortex, hippocampus, and striatum receive
dopamine input from midbrain dopamine cell groups, including the ventral tegmental area and
substantia nigra The activity of these dopamine neurons is potently regulated by a
cholinergic/glutamatergic input from the mesopontine tegmentum.

Source: Winkler J, Thal LJ, Gage FH, Fisher LJ: Cholinergic strategies for Alzheimer’s disease. J Mol Med 1998; 76:555–567[CrossRef][Medline]

F. Explain why Thyroid Medications are used in Psychiatry?

It is claimed that in the treatment of depression not related to any thyroid disturbance
the addition of thyroxine may hasten and augment the effects of antidepressant drugs.
Thyroxine was also found to be beneficial in the treatment of a rare condition call periodic
catatonia in which the patient's condition alternates periodically between states of apathy and
immobility and marked excitement.

The psychiatric disturbances which accompany hyperthyroidism and hypothyroidism, the two
commonest thyroid disorders, mimic mental illness. People with an overactive thyroid may exhibit marked
anxiety and tension, emotional lability, impatience and irritability, distractible overactivity, exaggerated
sensitivity to noise, and fluctuating depression with sadness and problems with sleep and the appetite. In
extreme cases, they may appear schizophrenic, losing touch with reality and becoming delirious or
hallucinating. An underactive thyroid can lead to progressive loss of interest and initiative, slowing of
mental processes, poor memory for recent events, fading of the personality's colour and vivacity, general
intellectual deterioration, depression with a paranoid flavour, and eventually, if not checked, to dementia
and permanent harmful effects on the brain. In instances of each condition, some persons have been
wrongly diagnosed, hospitalized for months, and treated unsuccessfully for psychosis.

Detection of the thyroid problem is complicated by the fact that everyone feels anxiety and
tension to some degree, that many thyroid symptoms are similar to those of other diseases, and that
hypothyroidism in particular often develops insidiously over a considerable time. But the results of
overlooking the thyroid can be serious. It is very important for the physician to explore fully and give the
tests for thyroid dysfunction, which today are relatively simple. When effective thyroid treatment is
begun, the general response is quite favorable. Vitality returns and the mental processes become efficient
again. If there is a residue of emotional difficulties, it may be related not to the thyroid gland but to
other aspects of life.

Source: Thyroid Foundation of Canada | Registered Charity - BN: 11926 4422 RR0001

G. Explain why Beta Blockers are used in Psychiatry?

Beta blockers, also known as beta antagonists, are a class of drugs that were first
developed for the treatment of certain heart conditions and hypertension. Later, beta blockers
were also found to be useful in glaucoma, migraine, and some psychiatric disorders such as
performance anxiety, tremors secondary to lithium, and movement disorders that are caused by
some drugs used in the treatment of psychosis. In the United States, the most commonly used
beta blocker used in psychiatric practice is propranolol (Inderal). Nadolol (Corgard), metoprolol
(Lopressor), and atenolol (Tenormin) are also used in psychiatric practice but to a lesser degree.

Beta blockers are proven effective in the treatment of performance anxiety, lithium-
induced tremor, and neuroleptic-induced akathisia (a physical condition caused by certain
antipsychotic drugs). Beta blockers have sometimes been used with benzodiazepines in treating
alcohol withdrawal.

Beta blockers act on that part of the central nervous system that controls mental
alertness, lung function, heart rate, and blood vessels. Although there is more than one
mechanism by which beta blockers work in anxiety states, the most beneficial result probably
arises from the fact that beta blockers slow the heart to a normal rate and rhythm. Therefore,
persons with performance anxiety do not experience the usual chest tightness and rapid heart
rate that is associated with such acts as public speaking or acting.

Certain antipsychotic medications known as neuroleptics can cause an unwanted effect

called akathisia, which is the inability to sit, stand still, or remain inactive. Patients are
restless, and in severe cases, may pace constantly and forcefully and repeatedly stomp their feet.
Beta blockers can sometimes treat this condition with a lower incidence of side effects than any
other drugs used to treat this condition.

Source: Encyclopedia of Mental Ilness. 2011. Advameg, Inc.

H. List at least 10 reasons clients fail to take medications correctly?

Pscyhologic Factors
o Lack of knowledge
o Client’s attitudes, values and beliefs
o Denial of illness or other defense mechanisms
 o Personality type
o Anxiety levels
Environmental and social factors
o Lack of support system, finances, transportation and housing

Characteristics of Regimen
o Not enough as benefit perceived by the client
o Demands too much change from the client
o Too difficult or complicated
o Distressing side effects
o Leads to social isolation or stigma
Characteristics of nurse-client relationship
o Faulty communication in which the client perceives the nurse as cold, uncaring or
authoritative
o Client feels discouraged or treated as an object
o Client and nurse are engaged in a struggle for control

Source: Schultz, Judith & Videbeck, Shiela. Lippincott’s Manual of Psychiatric Nursing Care Plans. 8th Ed. Lippincott William and Wilkins

j. List ideas how the nurse can do to improve compliance in mentally

challenged clients?

Observe the client closely to ensure that medications are ingested. Remain with the
clinet long enough to see that the medication was swallowed.
Explain the need for medications honestly and directly. Give client full explanations (eg,
“This is an antidepressant to improve you mood so you’ll feel less suicidal.”)
Help the client draw connection between non-compliance and exacercation of symptoms.
Encourage the clint to express his/her feelings about having a chronic illness and the
continued need for medication.
If the client expresses feelings of being stigmatized, assist the client to arrange dosage
schedules so that she can take medications unobserved.
If the client stops taking medications when he/she “feels better”, discuss the role of the
medication in keeping the client free of symptoms.
If the client is noncompliant because he/she feels dependent on the medication, assist
the client to gain a sense of control over the medication regimen. This may include
 supervised self-administration of medication, selecting convenient and acceptable times to
take the medication and setting limits on essentials and allowing control of nonessentials.
If the client still refuses to be compliant, encourage him or her to report this decision
accurately. Remain a matter-of-fact and nonjudgmental in your approach to the client
when he/she is discussing this decision.
Give positive feedback for honest reporting.
Teach the client and the family or significant others about the client;s illness, treatment
plan and medications.
Source: Schultz, Judith & Videbeck, Shiela. Lippincott’s Manual of Psychiatric Nursing Care Plans. 8th Ed. Lippincott William and Wilkins

K. What are sexual side effects of Antipsychotic Medications? List at least 3.

disturbances of erection and ejaculation,

changes in libido
priapism in men
decreased libido
orgasmic dysfunction
menstrual irregularities in women

Source: Greer Sullivan M.D., M.S.P.H.and David Lukoff Ph.D. Sexual Side Effects of Antipsychotic Medication: Evaluation and Interventions. American Psychiatric
Publishing. Inc.