This document discusses psychopharmacology and provides information on various types of psychiatric drugs. It begins with an introduction to psychopharmacology and the definition of psychotropic drugs. It then classifies psychiatric drugs and discusses specific drug classes in more detail, including antipsychotic agents, antidepressants, and mood stabilizers. For each drug class, it covers indications, mechanisms of action, classifications, pharmacokinetics, adverse effects, and nursing management considerations.

1. Psychopharmacology
Jisha srivastava
RNRM MBA HCS

2. Introduction
Psychopharmacology is the study of
drugs used to treat psychiatric disorders.
These medications affect psychic
functions, behaviour and experiences.
They have significant effects on higher
mental functions.

3. Definition
Psychotropic or psychoactive drugs can
be defined as chemicals that affect the
brain and nervous system, alter feelings
and emotions.

4. Classification
1. Antipsychotic agents
2. Antidepressants
3. Mood stabilisers
4. Anxiolytics and
hypnosedatives
5. Anti epileptics
6. Antiparkinsons
7. Miscellaneous-
Stimulants
Drugs used in eating
disorders
Drugs used in
deaddiction
Drugs used in child
psychiatry

5. Antipsychotic agents

6. History
Antipsychotics drugs have been used in
western medicine for more than 50 years
chlorpromazine(1952) and reserpine were
the first drugs found to be useful in
schizophrenia
Major novel antipsychotics are selective
serotonin reuptake inhibitors and has been
introduced in 1980s

7. Definition
Antipsychotic drugs also called as neuroleptics or
major tranquillisers are primarily used to treat
schizophrenia and other psychotic states including
mania with psychotic symptoms such as grandiosity,
paranoia, hallucinations and delusions
Antipsychotic drugs are not curative and do not
eliminate the chronic thought disorder however they
often decreases the intensity of delusions and
hallucinations and permit the person with
schizophrenia to function in a supportive environment

8. Mode of action
Antipsychotic agents function by blocking the
dopamine receptors or by both dopamine and
serotonin receptors
Increased production of dopamine and serotonin
produces psychotic thinking resulting in strange
thoughts, hallucination and bizarre behaviour.
Antiemetic is another property of antipsychotics
and are also used in hiccoughs.

9. Indications
Psychosis
Organic brain disorders
Drug induced psychosis
Schizophrenia
Mood affective
disorders- mania and
depression
Neurosis
Attention deficit
hyperactivity disorder
Autism
Anorexia nervosa
OCD
hiccoughs

10. Classification
1. Pharmacological classification
First generation
1.Low potency
• Chlorpromazine
• Prochlorperazine
• Thioridazine
2.High potency
• Haloperidol
• Fluphenazine
• Pimozide
• Thiothixene
• Loxapine
• Trifulperzine

11. Second generation
• Clozapine
• Olanzapine
• Quetiapine
• Risperidone
• Aripiprazole
• Asenapine
• Iloperidone
• Lurasidone
• Paliperidone
• Ziprasidone

12. 2.Chemical classification
1. Typical antipsychotics
Phenothiazines-chlorpromazines, triflupromazine, thioridazine,
fluphenazine decanoate
Butyrophenones-haloparidol, triperidol
Thioxanthenes- flupenthixol, thiothixene, chlorprothixene
Oxinodles - Molindone
Dibenzoxazipines -loxapines
2. Atypical antipsychotics-clozapine, risperidone, olanzaines, quetiapine,
ziprasidone

13. First generation
antipsychotics
Competitive blockers of dopamine
receptors
Other names for FGA are conventional,
Typical or traditional antipsychotics
Most commonly used for movement
disorders

14. Second generation
antipsychotic drugs
Also referred as atypical antipsychotics
Have unique activity to Blocks both
dopamine and serotonin
Have fewer EPS than first generation drugs
Associated with higher risk of metabolic side
effects, such as diabetes,
hypercholesterolemia and weight gain.

16. Pharmacokinetics
Antipsychotics when administered orally are absorbed
variably from GI tract with uneven blood levels.
They are highly bound to plasma as well as tissue proteins.
Brain concentration is higher than the blood concentration.
They are metabolised in the liver and excreted through
kidneys. The elimination half life varies from 10-24 hours.
Most of the antipsychotics tend to have a therapeutic
window. If the blood level is below this window, the drug is
ineffective. If the blood level is higher than the upper limit of
the window, there is toxicity.

17. Adverse drug reaction
Hormonal effects
• Decreased libido, gynecomastia
• Amenorrhea
• Infertility
• Weight gain
ECG changes
• Q-T prolongation and T wave suppression
Decreased threshold level
Agranulocytosis
Hypersalivation

18. Anticholinergic effects-
• Dry mouth
• Blurred vision
• Constipation
• Urinary retention
Nausea
GI upset
Skin rashes
Sedation
Photosensitivity
Orthostatic hypotension

19. Extrapyramidal symptoms
• Pseudo-parkinsonism (tremor, shuffling gait, drooling,
rigidity)
• Akinesia (muscular weakness)
• Akathisia (continuous restlessness and fidgeting)
• Dystonia (involuntary muscular movements [spasms] of face,
arms, legs, and neck)
• Oculogyric crisis (uncontrolled rolling back of the eyes)
Tardive dyskinesia (bizarre facial and tongue movements, stiff
neck, and difficulty swallowing)

20. Neuroleptic malignant syndrome (NMS) Symptoms include -
• Severe parkinsonian
• Muscle rigidity
• Hyperpyrexia
• Tachycardia
• Tachypnea
• Fluctuations in blood pressure
• Diaphoresis
• Rapid deterioration of mental status
• Stupor and coma.
•

21. Nursing management
• Provide the client with sugarless candy or gum, ice, and frequent
sips of water.
• Ensure that client practices strict oral hygiene.
• Explain that this symptom will most likely subside after a few weeks.
• Advise client not to drive a car until vision clears.
• Clear small items from pathway to prevent falls.
• Order foods high in fiber
• Instruct the client to report any difficulty urinating; monitor intake
and output.

22. • Tablets or capsules may be administered with food
to minimize GI upset.
• Concentrates may be diluted and administered with
fruit juice or other liquid.
• They should be mixed immediately before
administration.
• Avoid spilling any of the liquid concentrate on skin
since Contact dermatitis can occur with some
medications.

23. • Discuss with the physician the possibility of
administering the drug at bedtime.
• Discuss with the physician a possible decrease in dosage
or an order for a less sedating drug.
•Instruct client not to drive or operate dangerous equipment
while experiencing sedation.
• Instruct the client to rise slowly from a lying or sitting
position
• Monitor blood pressure (lying and standing) each shift •
Document and report significant changes.

24. • Ensure that the client wears a protective sunblock lotion,
clothing, and sunglasses while spending time outdoors
• Instruct the client to continue use of contraception,
because amenorrhea does not a cessation of ovulation.
• Caution is advised in prescribing this medication to
individuals with history of arrhythmias.
• Conditions that produce hypokalemia and/or
hypomagnesemia, such as diuretic therapy or diarrhea,
should be taken into consideration when prescribing.
• Routine ECG should be taken before initiation of therapy
and periodically during therapy. Monitor vital signs every
shift.
• Observe for symptoms of dizziness, palpitations, syncope,
or weakness.

25. For Agranulocytosis:
•There is a significant risk of agranulocytosis with clozapine.
A baseline white blood cell (WBC) count and absolute
neutrophil count (ANC) must be taken before initiation of
treatment with clozapine and weekly for the first 6 months of
treatment.
•Only a 1-week supply of medication is dispensed at a time.
•If the counts remain within the acceptable levels (i.e., WBC at
least 3,500/mm3 and the ANC at least 2,000/mm3) during the
6-month period, blood counts may be monitored biweekly,
and a 2-week supply of medication may then be dispensed
•If the counts remain within the acceptable level for the
biweekly period, counts may then be monitored every 4
weeks thereafter.
•When the medication is discontinued, weekly WBC counts
are continued for an additional 4 weeks.

26. For Extrapyramidal symptoms (EPS) :
•Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity) may
appear 1 to 5 days following initiation of antipsychotic medication;
occurs most often in women, the elderly, and dehydrated clients.
•Akathisia (continuous restlessness and fidgeting) occurs most
frequently in women, symptoms may occur 50 to 60 days following
initiation of therapy.
•Dystonia (involuntary muscular movements [spasms] of face, arms,
legs, and neck) and oculogyric crisis occurs most often in men and in
people younger than 25 years of age.
•Pseudoparkinsonism and akathisia can be treated with
anticholinergics, antihistamine and dopaminergic agents.
•Dystonia and oculogyric crisis should be treated as an emergency
situation.
•The physician should be contacted, and intravenous or intramuscular
benztropine mesylate (Cogentin) is commonly administered.
•Stay with the client and offer reassurance and support during this
frightening time.
•

27. For Tardive dyskinesia :
• All clients receiving long-term (months or years)
antipsychotic therapy are at risk.
• The symptoms are potentially irreversible.
• The drug should be withdrawn at the first sign, which is
usually
vermiform movements of the tongue
• Prompt action may prevent irreversibility.
For Hyper salivation (with clozapine) :
• A significant number of clients receiving clozapine
therapy experience extreme salivation.
• Offer support to the client because this may be an
embarrassing situation.
• It may even be a safety issue (e.g., risk of aspiration) if
the problem is very severe.

28. For Neuroleptic malignant syndrome (NMS) :
• This is a rare, but potentially fatal, complication of
treatment with neuroleptic drugs.
• Routine assessments should include temperature and
observation for parkinsonian symptoms.
• Onset can occur within hours or even years after drug
initiation, and progression is rapid over the following
24 to 72 hours.
• Discontinue neuroleptic medication immediately.
• Monitor vital signs, degree of muscle rigidity, intake
and output,
level of consciousness.
• The physician may order bromocriptine (Parlodel) or
dantrolene (Dantrium) to counteract the effects of
neuroleptic malignant syndrome

29. Antidepressants

30. Definition
Antidepressant agents are used in affective
disorders or disturbances mainly to treat
depressive disorders caused by emotional or
environmental stressors.
Several groups of affective disturbances are
treatable by antidepressants.

31. Action
Antidepressant drugs are classified as Tricyclics,
Tetracyclics & MAO inhibitors. Research studies have
shown reduced levels of norepinephrine (NE) & serotonin
(5-HT) in the space between nerve ending carrying
message from one nerve cell to another cause depression.
Tricyclic antidepressants & MAO inhibitors increase these
neurotransmitters i.e. norepinephrine & serotonin to the
synaptic receptors in the central nervous system. Tricyclic
inhibitors block the reuptake of NE & 5-HT & MAO
inhibitors block the action of MONOamine oxidize in
breaking down excess of NE

32. Indications
• Dysthymic disorder
• Major depression with melancholia or psychotic
symptoms
• Depression associated with organic disease,
alcoholism, schizophrenia, or mental retardation
• Depressive phase of bipolar disorder
• Depression accompanied by anxiety.

33. Classification
Class Example Dose mg/day
Tricylic antidepressants
Imipramine
Amitriptyline
Clomipramine
Dothiepin
75-300
75-300
75-300
30-120
Selective serotonin
reuptake inhibitors (SSRI)
Fluoxetine
Sertraline
10-80
50-200
Selective Norepinephrine
Reuptake inhibitors(SNRI)
Fluvoxamine
50-300
Atypical antidepressants Amineptine 100-400
Monoamine oxidase
inhibitors (MOI)
Trazodone
Isocarboxazid
150-600
10-30

34. Pharmacokinetics
• Lipophiloic and protein bound
• Half life long usually more than 1 day
• Metabolized in liver
• Excreted in urine
•

35. Adverse effects
1) Autonomic side-effects:
Dry mouth, constipation, cycloplegia, mydriasis, urinary
retention, orthostatic
hypotension, impotence, impaired ejaculation, delirium &
aggravation of glaucoma.
2) CNS effects:-
Sedation, tremor & other extrapyramidal symptoms, withdrawal
syndrome, seizures, jitteriness syndrome, precipitation of mania.
3) Cardiac side-effects:-
Tachycardia, ECG changes, arrhythmias, direct myocardial
depression, quinidine-like action(decreased conduction time).

36. 4) Allergic side-effects:-
Agranulocytosis, cholestatic jaundice, skin rashes,
systemic vasculitis.
5) Metabolic & endocrine side-effects:-
weight gain
6) Special effects of MAOI drugs:-
Hypertensive crises, severe hepatic necrosis,
hyperpyrexia.

37. Nursing management
Observation of the side-effects & monitoring the
changes noted are very significant to prevent
complications due to antidepressant agents.
Encourage the patient to take medicine at bed time
due to a sedative effect.
Dryness of mouth to decrease, Give plenty of fluids
orally. Lemonade or chewing gum should be given. A
few sips of water also help the patient.
Do not give medicine empty stomach as the patient
complains of nausea & vomiting.
•

38. Accurate recording of intake & output of the patient should be
maintained to check if he has retention of urine.
If the patient complains of dizziness or light headedness he/she
should be encouraged to get up slowly & sit in the bed before
standing. These symptoms may due to orthostatic hypotension.
The patient should be reassured that these symptoms are for a
short period only. Some patients may present hypertension.
Accurate recording of vital signs like B.P. & pulse.
The nurse should be able to interpret the blood reports specially
blood sugar level & W.B.C. count. If the patient complains of sore
throat, fever, malaise, it should be reported to the physician on
duty. These symptoms may be due to agranulocytosis or
hyperglycemia.

39. To relieve constipation plenty of fluids & roughage
should be encouraged in the diet.
If the patient complains of sexual dysfunction inform
the physician immediately & stop the drug.
If the patient is presenting symptoms of pressure of
speech, increased motor activity & elated mood, the
physician should be informed & the drug should be
stopped immediately.
Antidepressant tricyclic drugs begin therapeutic
effects within four to eight weeks.
Accurate recording of the observation made.

40. Mood stabilisers

41. Description
Mood stabilizers are used for the
treatment of bipolar affective
disorders. Some commonly used
mood stabilizers are:-
1. Lithium
2. Carbamazepine
3. Sodium Valproate

42. Lithium

43. Description
• Lithium is an element with atomic
number 3 & atomic weight 7.
• It was discovered by FJ Cade in
1949, & is a most effective &
commonly used drug in the
treatment of mania.
•

44. Mode of action
The probable mechanisms of action can be:
• It accelerates presynaptic re-uptake & destruction of
catecholamines, like norepinephrine.
• It inhibits the release of catecholamines at the synapse.
• It decreases postsynaptic serotonin receptor sensitivity.
All these actions result in decreased catecholamine
activity, thus ameliorating mania.

45. Indications
• Acute mania
•Prophylaxis for bipolar & unipolar mood disorder.
•schizoaffective disorder
• Cyclothymia
•Impulsivity & aggression
• Other disorders:
– Premenstrual dysphoric disorder
– Bulimia nervosa
– Borderline personality disorder
– Episodes of binge drinking
– Trichotillomania
– Cluster headaches

46. Pharmacokinetics
• Lithium is readily absorbed with peak plasma levels occurring
2-4 hours after a single oral dose of lithium carbonate.
• Lithium is distributed rapidly in liver & kidney & more slowly in
muscle, brain & bone. Steady state levels are achieved in about
7 days.
• Elimination is predominately via tubules & is influenced by
sodium balance. Depletion of sodium can precipitate lithium
toxicity.

47. Dose
• Lithium is available in the market in the form of the following
preparation:
– Lithium carbonate: 300mg tablet (eg. Licab); 400mg sustained
release tablets (eg. Lithosun-SR).
– Lithium citrate: 300mg/5ml liquid.
• The usual range of dose per day in acute mania is
900-2100mg given in 2-3 divided doses.
• The treatment is started after serial lithium estimation is done
after a loading dose of 600mg or 900mg of lithium to
determine the pharmacokinetics.

48. Blood lithium level
• Therapeutic levels = 0.8-1.2 mEq/L (for
treatment of acute mania)
• Prophylactic levels = 0.6-1.2 mEq/L (for
prevention of relapse in bipolar disorder)
• Toxic lithium levels>2.0 mEq/L

49. Side effects
• Neurological: Tremors, motor hyperactivity, muscular weakness cogwheel
rigidity, seizures, neurotoxicity (delirium, abnormal involuntary
movements, seizures, coma).
• Renal: Polydipsia, polyuria, tubular enlargement, nephritic syndrome.
• Cardiovascular: T-wave depression.
• Gastrointestinal: Nausea, vomiting, diarrhea,
abdominal pain & metallic taste.
• Endocrine: Abnormal thyroid function, goiter & weight gain.
• Dermatological: Acneiform eruptions, popular eruptions & exacerbation
of psoriasis.
• Side-effect during pregnancy & lactation: Teratogenic possibility, increase
incidence of Ebstein‘s anomaly (distortion & downward displacement of
tricuspid value in right ventricle) when taken in first trimester. Secreted in
milk & can cause toxicity in infant.

50. Sign & symptoms of lithium toxicity
(serum lithium
level>2.0 mEq/L):
– Ataxia
– Coarse tremor (hand)
– Nausea & vomiting
– Impaired memory
– Impaired concentration
– Nephrotoxicity
– Muscle weakness
– Convulsions
– Muscle twitching
– Dysarthria
– Lethargy
– Confusion
– Coma
– Hyperreflexia
– Nystagmus

51. Management of lithium
toxicity
Discontinue the drug immediately.
For significant short-term ingestions, residual gastric
content should be removed by induction of emesis, gastric
lavage adsorption with activated charcoal.
If possible instruct the patient to ingest fluids.
Assess serum lithium levels, serum electrolytes, renal
functions, ECG as soon as possible.
Maintenance of fluid & electrolyte balance.
In a patient with serious manifestations of lithium toxicity,
hemodialysis should be initiated.

52. Contraindication
• Cardiac, renal, thyroid or neurological dysfunctions
• Presence of blood dyscrasias
• During first trimester of pregnancy & lactation
• Severe dehydration
• Hypothyroidism

53. Nurses responsibility
• The pre—lithium work up: A complete physical
history, ECG, blood studies (TC, DC, FBS, BUN,
Creatinine, electrolytes) urine examination (routine
& microscopic) must be carried out.
• It is important to assess renal function as renal
side-effects are common & the drug can be
dangerous in an individual with compromised
kidney function.
• Thyroid functions should also be assessed, as the
drug is known to depress the thyroid gland.
•

54. •To achieve therapeutic effect & prevent lithium toxicity, the
following precaution should be taken:
•Lithium must be taken on a regular basis, preferably at the
same time daily (for example, a client taking lithium on TID
schedule, who forget a dose should wait until the next
scheduled time to take lithium & not take twice the amount at
one time, because toxicity can occur.
•When lithium therapy is initiated, mild side-effects such as fine
hand tremors, increased thirst & urination, nausea, anorexia etc
may develop, Most of them are transient & do not represent
lithium toxicity.
•Serious side-effects of lithium that necessitate its
discontinuance include vomiting, extreme hand tremor,
sedation, muscle weakness & vertigo. The psychiatrist should
be notified immediately if any of these effects occur.
•Since polyuria can lead to dehydration with risk of lithium
intoxication, patients should be advised to drink enough water
to compensate for the fluid loss.

55. •Various situations may require an adjustment in the
amount of lithium administered to a client, such as the
addition of the new medicine to the client drug regimen,
a new diet or an illness with fever or excessive sweating.
•They must be advised to consume large quantities of
water.
•A sudden decrease in salt intake maybe result in higher
serum lithium level.
• Frequent serum lithium level evaluation is important.
Blood for determination of lithium levels should be
drawn in the morning approximately 12-14 hours after
the last dose was taken.
• The patient should be told about the importance of
regular follow up. In every six months, blood sample
should be taken for estimation of electrolytes, urea,
creatinine, a full blood count & thyroid function test.

56. Carbamazepine

57. Description
It is available in the market under different
trade names like Tegretol, Mazetol, Zeptol &
Zen Retard.

58. Action
• Its mood stabilizing mechanism is not clearly
established.
• Its anticonvulsant action may however be by
decreasing synaptic transmission in the CNS.

59. Indications
• Seizures-complex partial seizures, GTCS,
seizures due to alcohol withdrawal.
• Psychiatric disorders- rapid cycling bipolar
disorder, acute depression, impulse control
disorder, aggression, psychosis with epilepsy,
schizoaffective disorders, borderline
personality disorder, cocaine withdrawal
syndrome.
• Paroxysmal pain syndromes- trigeminal
neuralgia & phantom limb pain.

60. Dose
• The average daily dose is 600-1800 mg
orally, in divided doses.
• The therapeutic blood levels are 6-12 μg/
ml.

61. Side effects
• drowsiness
• confusion
• headache
• ataxia
• hypertension
• arrhythmias
• skin rashes
• steven-Johnson syndrome
• nausea
• vomiting
• diarrhea
• dry mouth
• abdominal pain
• jaundice
• hepatitis
• oliguria
• leucopenia
• thrombocytopenia
• bone marrow depression
leading to aplastic anemia.
•

62. Nursing management
• Since the drug may cause dizziness & drowsiness advise
him to avoid driving & other activities requiring alertness.
• Advise patient not to consume alcohol when he is on the
drug.
• Emphasize the importance of regular follow-up visits &
periodic examination of blood count & monitoring of
cardiac, renal, hepatic & bone marrow functions.

63. Sodium valproate

64. Description
This drug is available in the
name of encore chromo,
valaparin, epilex and epival

65. Mechanism of action
• The drugs acts on gamma- aminobutyric
acid (GABA) an inhibitory amino acid
neurotransmitters.
• GABA receptors activation serves to reduce
neuronal excitability.

66. Indication
• Acute mania, prophylactic treatment of
bipolar disorder, rapid cycling bipolar
disorder.
• Schizoaffective disorder.
• Seizures.
• Other disorders like bulimia nervosa,
obsessive-compulsive disorder, agitation
& PTSD.

67. Dosage
The usual dose is 15 mg/kg/day with a
maximum of 60mg/kg/day orally.

68. Side effects
• Nausea
• vomiting
• diarrhea
• sedation
• ataxia
• dysarthria
• tremor
• weight gain
• loss of hair
• thrombocytopenia
• platelet
dysfunction.

69. Nursing management
• Explain to the patient to take the drug
immediately after food to reduce GI
irritation.
• Advise to come for regular follow-up &
periodic examination of blood count,
hepatic function & thyroid function.
• Therapeutic serum level of valproic
acid is 50-100 micrograms/ml.

70. Anti anxiety, Sedatives and
Hypnotics

71. Description
Anxiety is a state which occurs in all
human being at sometime or the other.
• It is also a cardinal symptoms of
many psychiatric conditions.
• The drugs used to relieve anxiety are
called ANTIANXIETY OR ANXIOLYTIC
AGENTS.
• Antianxiety drugs relieve moderate-
to-severe anxiety & tension

72. Mode of action
• These non-barbiturate benzodiazepines act as
CNS depressants.
• It is believed that these drugs increase or help
the inhibitory neurotransmitter action of gama-
aminobutyric inhibitor in all areas of CNS.
• So there is inhibition or control on the cortical
& limbic system of the brain, which is
responsible for emotions such as rage &
anxiety.

73. Indications
• Antianxiety agents are used to relieve mild, moderate & severe
anxiety associated with: emotional disorders physical disorders
excessive environmental stress neuroses & mild depressive
states without causing excessive sedation or drowsiness.
• For control of alcohol withdrawal symptoms.
• To control convulsions.
• To produce skeletal muscle relaxation.
• To provide short-term sleep preoperatively, prior to diagnosis &
insomnia.
• Antianxiety agents should always be used in time-limited
regimen.

74. Contraindications
Patients with renal or liver &
respiratory impairment are given
antianxiety drugs with caution.

75. Classification and dose
Class Dose
I. Non-Barbiturates
A. Benzodiazepines
Chlordiazepoxime
Diazepam
Oxazepam
Prazepam
Chlorazapate
Flurazepam
Nitrazepam
lorazepam
15-100
6-50
30-120
20-60
11.25-60
15-60
10-30
2-6

76. Class Dose
B. Non- Benzodiazepine
• Meprobamate
1.2-1.6
II. Antihistamines
• Hydroxyzine
30-200
III. Barbiturates
Amobarbidtal SA
Butabarbital SA
Pentobarbital LA
Phenobarbital LA
100-200
100-200
100-200
100-200

77. Class Dose
I
IV. Quinazolines
Methaquualone
V. Acetylinic Alcohols
Ethchlorvynol
VI. Acetylinic Alcohols
Ethchlorvynol
VII. Chloral Derivatives
Chloral hydrate
Chloral betaine
150-300
0.5gm-1gms
0.5gm-1gms
0.5gm-2gms
870mg-1gm

78. Side effects
1)Central nervous system: drowsiness, ataxia, confusion,
depression, blurred vision.
2)Cardiovascular system: hypotension, palpitation, syncope.
3)Endocrine: change in libido.
4)Allergic: skin rash.
5) Physical/psychological dependence non- benzodiazepines &
barbiturate group of drugs has a high risk of abuse & physical
dependence.
6) Acute toxicity of barbiturate that can be fatal when taken in
excessive dosage usually for suicide attempts. Overdose can
cause tachycardia, hypotension, shock, respiratory depression,
coma & death.

79. Nurses responsibility
• Assessment of the patient, prior to the use of antianxiety,
sedative-hypnotic agents. If the patient complains of sleep
disturbance the causative factor should be identified.
• Appropriate nursing measures to induce sleep should be
taken such as a calm & quite environment, a cup of hot
milk, good back care, allowing the patient to read
magazines, sitting with the patient for some time for
reassurance purpose.
• While administering the drug daily dose should be given
at bed time to promote a normal sleep pattern, so that
day-time activities are not affected.

80. • Give IM injection deep into muscles to prevent irritation.
• Look for side-effects, record & report immediately.
• If the patient complains of drowsiness tell him to avoid using
knife or any other dangerous equipment. He should be
instructed not to drive.
• Instruct the patient not to take any stimulant like coffee,
alcohol as they alter the effect of drugs.
• Avoid excessive use of these drugs to prevent the onset of
substance abuse or addiction.
• Drug should be reduced gradually, sudden stoppage of the
• drug may cause REM (Rapid Eye Movements), insomnia,
• dreams or nighmare, hyperexcitability, agitation or
convulsions.

81. .
.

84. Description
Antiparkinsonian agents are the
specific drugs to treat the
extrapyramidal side- effects of
antipsychotic agents like
parkinsonism, akathisia, acute
dystonia & tardive dyskinesia.

85. Mode of action
• Anticholinergic drugs block the secretion,
thereby reducing the symptoms of akathesia &
acute dystonia. It is not effective against tardive
dyskinesia.
• Antihistamines have effects like anticholinergic
drugs.
• Amantadines are dopamine-releasing agents
from central neurons. Studies show that this
drug may affect some clients with tardive
dyskinesia.

86. Classification
.
CLASS DOSE/ mg
I. Anticholinergic
• Benztropine
• Biperiden HCL Hydrochiride
• Trihexyphenidyl Hydrochiride
• Procyclidine hydrochiride
II. Antihistamine
• Diphenhydramine
III. Dopamine Drugs
• L. Dopa
• Amantadine Hydrochiride
• Selegline
• Carbidopa
0.5-6.0
2.0-8.0
2.0-12.0
5.0-20
75-100
2 -3
100-200
5-10
10-100

87. Indication
Antiparkinsonian drugs are used
to treat the extrapyramidal
symptoms.

88. Contraindication
• Patient with history of closed angle glaucoma,
urinary or intestinal obstruction, hypersensitivity,
prostatic hypertrophy, tachycardia are not given
these drugs.
• The drugs are given with caution to patients with
myasthenia gravis, artherosclerosis & chronic
respiratory problems.
• Anticholinergic drugs and Amantadine is given with
caution to patients with renal impairment as most of
the medication is excreted through the kidney.

89. Side effects
• Anticholinergic:- Side-effects are dry mouth, flushed,
dry skin, blurred vision, photophobia, increased heart
rate, constipation, urinary retention, mental confusion &
excitement.
• Antihistamines:- Side-effects are drowsiness, dizziness,
anorexia, nausea, vomiting, euphoria, orthostatic
hypotension, weight gain, weakness & tingling of hands.
• Amantadine:- Side-effects are mood changes, slurred
speech, insomnia, inability to concentrate, dry mouth,
livedo reticularis that is a red-blue netlike discolouration
of the skin which becomes worse in winter.

90. Nurses responsibility
• Observation of the patient for side- effects of anti-parkinsonian drugs
such as tachycardia, palpitation, sedation, drowsiness & blurred vision.
• Maintain an intake output chart in case the patient has urinary retention
or constipation.
• Encourage adequate intake of fluids & roughage in the diet.
• Record vital sign such as B.P., pulse & respiration every four hours.
• Advise the patient not to get up quickly from a lying- down position to
sitting because of orthostatic
• Educate the patient not to use hazardous machinery or driving when he
is on anticholinergic drugs.
• Encourage the patient to get his routine eye check-up done for early
detection of blurred vision or glaucoma.
• Record the medicine & side-effects accurately.
• Report & record any side-effects observed to the physician.

91. Drugs used in child psychiatry

92. 1. Clonidine
2. Methylphenidate(Ritalin)

93. 1.Clonidine

94. Mechanism of action
• Alpha2- adrenergic receptors agonist.
• The agonist effects of clonidine on
presynaptic alpha 2-adrenergic receptors
result in a decrease in the amount of
neurotransmitters released from the
presynaptic nerve terminals. This decrease
serves generally to reset the sympathetic
tone at a lower level & to decrease arousal.

95. Indication
• Control of withdrawal symptoms from opioids.
• Tourette‘s disorder
• Control of aggressive or hyperactive behaviour in
children
• Autism.

96. Dosage
Usual starting dosage is 0.1mg orally
twice a day; the dosage can be
raised by 0.3 mg a day to an
appropriate level.

97. Side effects
• Dry mouth
• dryness of eyes
• Fatigue
• irritability
• sedation
• dizziness
• nausea
• vomiting
• hypotension & constipation.

98. Nurses responsibility
• Monitor BP, the drug should be
withheld if the patient becomes
hypotensive.
• Advise frequent mouth rinses &
good oral hygiene for dry mouth.

99. 2.Methylphenidate
(Ritalin)

100. Description
• Methylphenidate ,
dextroamphetamine & pemoline
are sympathomimetics.

101. Mechanism of action
• Sympathomimetics cause the stimulation of alpha
& beta-adrenergic receptors directly as agonists &
indirectly by stimulating the release of dopamine &
norepinephrine from presynaptic terminals.
• Dextroamphetamine & methylphenidate are also
inhibitors of catecholamine reuptake, especially
dopamine reuptake & inhibitors of monoamino
oxidase.
• The net result of these activities is believed to be
the stimulation of the several brain regions.
•

102. Indication
• Attention-deficit hyperactivity disorder
• Narcolepsy
• Depressive disorders
• Obesity

103. Side effects
• Anorexia or dyspepsia
• weight loss
• slowed growth
• dizziness
• insomnia or nightmares
• dysphoric mood
• psychosis.
•

104. Dosage
Starting dose is 5-10 mg per day
orally, maximum daily dose is
80mg/day.

105. Nurses responsibility
• Assess mental status for change in mood, level of activity, degree of
stimulation & aggressiveness.
• Ensure that the patient is protected from injury.
• Keep stimuli low & environment as quiet as possible to discourage
over stimulation.
• To decrease anorexia, the medication may be administered
immediately after meals. The patient should be weighed regularly
during hospitalization & at home while on therapy with CNS
stimulants, due to the potential for anorexia/ weight loss & temporary
interruptions of growth & development.

106. • To prevent insomnia administer last dose at least 6 hours before
bedtime.
• In children with behavioural disorders a drug holiday should be
attempted periodically under the direction of the physician to
determine effectiveness of the medication & the need for continuation.
• Ensure that parents are aware of the delayed effects of Ritalin.
Therapeutic response may not seen for 2-4 weeks; the drug should not
be discontinued for lack of immediate results.
• Inform parents that OTC (over-the-counter) medications should be
avoided while the child is on stimulant medication. Some OTC
medications, particularly cold & hay fever preparation contain certain
sympathomimetic agents that could compound the effects of the
stimulants & create drug interactions that may be toxic to the child.
• Ensure that parents are aware that the drug should not be withdrawn
abruptly. Withdrawal should be gradual & under the direction of the
physician.

107. Questions?

108. Thank you