Psychotrophic drugs

1.
2.
3.
4.

Drugs that can:

Stimulate the release of
neurotransmitters
Block the receptor/activity of the
neurotransmitter= like dopamine
Stimulate the receptors in the CNS
Prevents the breakdown of the
neurotransmitters or the re-uptake
mechanism

Anti-Psychotics/Neuroleptics
Drugs used to treat PSYCHOSES
MAIN ACTION: Blockage of the
DOPAMINE receptor in the CNS

Anti-Psychotics/Neuroleptics
Class

Prototype

Others

Phenothiazines

Chlorpromazine

Thioridazine,
Fluphenazine,
Perphenazine

Haloperidol

droperidol

Thioxanthines

Chlorprothixene

thirothixene

Dibenzoxapine

Molindone

Diphenylbutlypipe
ridine

Pimozide

Atypical drugs

Clozapine

Olanzapine

Risperidone

quetiapine

Butyrophenones

Anti-Psychotics/Neuroleptics
1
2
3
4
5
6

Desired Effects
Reduced hallucination and illusions
CNS sedation and emotional slowing
Decreased ambivalence, reduced
delusion
Reduced agitation resulting to
calmness
Relief of emotional turmoil
Reduced flattening of affect

Anti-Psychotics/Neuroleptics
Common SE
Anticholinergic
effects
Photosensitivity
Postural
hypotension
Agranulocytosis

Nursing Interventions
Sugarless gum, bed rest
Sunglasses, sunscreen,
avoid sun
Change position slowly,
lie prone for 1 hour
after drug intake,
monitor BP
Instruct to report sore
throat and fever,
monitor WBC

Anti-Psychotics/Neuroleptics
Extra-Pyramidal
Syndrome

Nursing Intervention

Parkinsonism-Tremor,
rigidity, bradikinesia

Avoid abrupt withdrawal,

give anti-EPS drugs like
Cogentin

Dystonia- torticollis,
contraction of face and
tongue

Remain with client,

administer anti-EPS

Akathisia= motor
restlessness

Verbalize understanding of
the condition, administer
anti-EPS

Tardive Dyskinesia=
irreversible drooling,
tongue movement and

No treatment except
discontinue drug

The ANXIOLYTICS AND HYPNOTICS

These drugs are used to change
the individuals responses to the
environment.

The ANXIOLYTICS AND HYPNOTICS

The medications that can prevent
the feelings of tension and fear are
called ANXIOLYTICS.
Anti-anxiety drugs

The ANXIOLYTICS AND HYPNOTICS

The drugs that can calm
individuals making them unaware
of the environment are called
SEDATIVES.

The ANXIOLYTICS AND HYPNOTICS

The drugs that can induce sleep
are called HYPNOTICS.

The ANXIOLYTICS AND HYPNOTICS

The drugs in this class are the
BENZODIAZEPINES
BARBITURATES

Use of The Drugs

Clinical indications for the use of the
anxiolytics, sedatives and hypnotics
1. Prevention of anxiety
2. Formation of sedative state
3. Induction of sleep

The BENZODIAZEPINES
The benzodiazepines are the most
frequently used anxiolytic drugs.
These agents prevent anxiety states
without causing much sedation, with
less physical dependence than other
agents.

The BENZODIAZEPINES
The following are the benzodiazepines
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
clonazepam
clorazepate
Diazepam (Valium)
estazolam
flurazepam
lorazepam
midazolam
oxazepam
quazepam
temazepam
triazolam

The BENZODIAZEPINES
Special uses
Diazepam
(Valium)

Status epilepticus

Chlordiazepoxide Alcohol
(Librium)
withdrawal
Alprazolam
(Xanax)

Panic attack

The BENZODIAZEPINES
The Mechanism of Action of the Benzodiazepines

These agents act on the Limbic

system and the RAS (reticular
activating system) to make the
GABA ( Gamma-aminobutyric acid)
more effective causing interference
with neuron firing.

The BENZODIAZEPINES
The Mechanism of Action of the Benzodiazepines

The GABA is an inhibitory

neurotransmitter.
This will result to an
anxiolytic effect at lower
doses than required for
sedation/hypnosis.

The BENZODIAZEPINES
These agents are indicated for the
treatment of
1. anxiety disorders
2. alcohol withdrawal
3. hyperexcitability, and agitation
4. pre-operative relief of anxiety and
tension and in induction of
balanced anesthesia.

The BENZODIAZEPINES
Pharmacodynamics: The adverse effects
CNS effects= sedation, drowsiness,
depression, lethargy, blurred vision
GIT= dry mouth, constipation, nausea,
vomiting
CVS= Hypotension or hypertension,
arrhythmias, palpitations, and
respiratory difficulties.
Hematologic= blood dyscrasias and
anemia
GU= urinary retention, hesitancy, loss
of libido and sexual functions changes.

The BENZODIAZEPINES
Nursing Considerations:
Maintain patients on bed for
at least 3 hours after drug
administration.
Instruct to avoid hazardous
activities like driving and
machine operation.
Instruct to avoid consuming
ALCOHOL while taking the
drug.

The BENZODIAZEPINES
Nursing Considerations:
Provide comfort measures to
help patients tolerate drug
effects instruct to urinate before taking
drug
give high fiber foods
use side-rails and assistance with
ambulation.

Have available FLUMAZENIL as

an antidote for benzodiazepine
overdose.

The BARBITURATES
These are also anxiolytics and
hypnotics with a greater
likelihood of producing sedation,
with increase risk of addiction
and dependence.

The BARBITURATES
The following are the barbiturates

amobarbital
aprobarbital
butabarbital
mephobarbital
pentobarbital
Phenobarbital
secobarbital

The BARBITURATES
The Mechanism of Action of the
Barbiturates
They depress the motor output from
the brain.
The results of their MOA are
sedation, hypnosis and anesthesia,
and if extreme, coma.

The BARBITURATES
Clinical indications of the Barbiturates
1. Relief of anxiety manifestations
2. For sedation
3. For patients with insomnia
4. For pre-anesthesia
5. seizures/epilepsy
6. The rapid acting barbiturates are
also used for the treatment of
acute manic reactions and status
epilepticus

The BARBITURATES
Pharmacodynamics: The Adverse effects
CNS= CNS depression, somnolence,
vertigo, lethargy, ataxia, paradoxical
excitement, anxiety and hallucinations.
GIT= nausea, vomiting,
constipation/diarrhea and epigastric
pain
CVS= bradycardia, Hypotension and
syncope.
Respi= serious hypoventilation,
respiratory depression and
laryngospasms
Others= hypersensitivity and StevensJohnson syndrome.

The BARBITURATES
Nursing Considerations
Provide stand-by life support facilities
in cases of severe respiratory
depression or hypersensitivity
reaction.
Taper the drug gradually after longterm therapy to avoid withdrawal
syndrome.
Provide comfort measures including
small frequent meals, access to
bathroom facilities, high-fiber foods,
environmental control, safety
precaution and skin care.

The CNS stimulants

These are drugs used to treat
certain disorders
1. exogenous obesity
2. attention-deficit hyperactivity
disorders (ADHD)
3. narcolepsy

The CNS stimulants

What is unusual is the
ability of the CNS
stimulants to CALM
hyperactive children, which
allows them to focus on
one activity for a longer
period.

The CNS stimulants

The following are the CNS
stimulants:
1. Methylphenidate (Ritalin)= most
commonly used for ADHD
2. Dextroamphetamine= a CNS
stimulant that is used for short tem
therapy for obesity.
3. Modafinil= used for narcolepsy
4. Pemoline= used for ADHD

The CNS stimulants

The Mechanism of Action
These agents act as to stimulate the
cortical and reticular activating
system (RAS) of the brain.
This is by releasing neurotransmitters
from the nerve cells leading to
increased stimulation of the postsynaptic neurons.

The CNS stimulants

The paradoxical effect of calming
hyperexcitability through CNS
stimulation seen in ADHD is
believed to be related to the
increased stimulation of an
IMMATURE Reticular Activating
System leading to the ability to be
more selective in response to
incoming stimuli.

The CNS stimulants

Pharmacodynamics: Adverse effects of the
CNS stimulants
CNS= nervousness, insomnia, dizziness,
headache, and blurred vision
GIT= anorexia, nausea and weight loss
CVS= hypertension, tachycardia
arrhythmias, and angina
Others= rashes, physical/psychological
dependence.

The CNS stimulants

Implementation
The nurse must ensure that the drug is only
given to the indicated conditions
Administer the drug before 6 pm to
reduce the effect of insomnia
BEST given AFTER meals to prevent the
effect of anorexia
Consult with school personnel to monitor the
patient under therapy
Provide safety measures such as side-rails
and assisted ambulation

The CNS stimulants

Evaluation
Evaluate the effectiveness of the drug:
1. Calming effect in the patient with
ADHD
2. Alertness for patients with narcolepsy

The Anti-epileptics
These agents, also called
anticonvulsants, are used to treat
epileptic conditions.
Hydantoins, Barbiturates,
benzodiazepines, Succinimides and
many others are given to a specific
type of seizure.

Anti-epileptics
Agents for treating TONIC-CLONIC
SEIZURES
1. Hydantoins

Phenytoin
Ethotoin
Fosphenytoin
Mephenytoin

2. Benzodiazepines
Diazepam
Clonazepam
Clorazepate

3. Barbiturates
Phenobarbital

Anti-epileptics
Agents for treating ABSENCE SEIZURES
1. Succinimides
a. Ethosuximide
b. Methsuximide
c. Phensuximide
2. Valproic Acid
3. Zosinamide

Anti-epileptics
Agents for treating Partial FOCAL
SEIZURES
1. Carbamazepine
2. Gabapentin
3.Lamotrigine
4. Tiagabine
5. Topiramate

The hydantoins
These agents are utilized for general
seizures because they can depress
the central nervous system.
They affect the entire brain and
reduce the chance of sudden
electrical outburst that causes
seizures.
These agents generally are less
sedating than other anti-epileptics.

The hydantoins
Mechanism of Action of the Hydantoins
These agents STABILIZE the nerve
cell membrane throughout the
brain reducing and limiting the
excitability and conduction
through nerve pathways.

The hydantoins
Clinical Indications of the hydantoins
1. Tonic-clonic seizures
2. Status epilepticus
3. For the prevention of seizures in
neurosurgery
4. For muscle relaxation.

The hydantoins
Contraindications and Precautions
Hydantoins are NOT given to
pregnant patient because it can
cause fetal hydantoin syndrome.

The hydantoins
Pharmacodynamics: Adverse effects of the
Hydantoins
CNS effects- depression, confusion,
drowsiness, lethargy, fatigue
GIT- GI upset, constipation, dry mouth,
GINGIVAL HYPERPLASIA , severe liver
toxicity which are all related to cellular
toxicity.
SKIN- hirsutism and coarsening of the
facial skin
Bone Marrow depression

The hydantoins
Implementation
Administer the drug with food to
alleviate GI irritation
Discontinue the drug at any sign of
hypersensitivity reaction, severe liver
dysfunction and severe skin rashes.
Provide meticulous mouth oral care
Rule out pregnancy and advise
women to use contraceptive
measures to prevent pregnancy.