Function and Activities of the Brain
Review: Cellular Composition of Brain
Theories behind use of psychotropic drugs focuses on neurotransmitters and their receptors
Visualizing the Brain
Therapeutic effects of Psychotropic meds
It’s important to remember that psychotropic medications (inform the client):-
There are many reasons why the client may not adhere to the medications which may include:-
Things to consider when giving medications
Role of the Nurse
Antianxiety Agents (Anxiolytics)
Drug trade/ Generic names
-Most widely prescribed in the world.
-Concerns of physiological dependence.
-Treatment with BZs generally should be brief, during time of specific stress or for specific indication.
Bind to specific GABA receptor sites resulting in a calming effect
Ataxia, drowsiness, confusion and orthostatic hypotension
Teach patient – do not combine with other anti-anxiety meds, and do not take with alcohol!
Alcohol and BZ’s together can cause extreme sedation.
Bind selectively to GABA receptor sites
Amnesia, ataxia, rapid onset
Take just before going to bed.
Not clearly understood; appears to be a serotonin agonist.
Takes 2-4 weeks for full therapeutic effect so cannot be taken prn (when necessary).
Headache, dizziness, light-headedness, nausea and insomnia.
(Not associated with sedation or withdrawal symptoms)
Take as directed; stand slowly.
Drug Interactions with SSRI
Buspirone (BuSpar), TCA’s (especially clomipramine), Selegiline (Eldepryl), Saint John’s Wort
Increased risk of bleeding
Lowered seizure threshold
Drug Interaction with TCA’s
High fever, convulsions, death
Saint John’s Wort, tramadol (Ultram)
Seizures, serotonin syndrome
Clonidine (Catapres), epinephrine
Alcohol and carbamezipine (Tegretol)
Block antidepressant action, increases sedation
Cimetidine (Tagamet), bupropion (BuSpar)
Increased TCA blood levels, increased side effects
Drug Interactions with MAOI’s
SSRI’s, TCA’s, atomoxetine (Strattera), duloxetine (Cymbalta), dextromethorphan (an ingredient in many cough syrups), venlafaxine (Effexor), St. John’s Wort, Ginkgo
Morphine and other narcotic pain relievers, antihypertensive
All other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (BuSpar)
Hypertensive crisis (these side effects can occur even if take with 2 weeks of stopping MAOI’s)
Psychosis, agitation, seizures
Fever, hypertension, seizures
Drug trade/ Generic names
Tofranil (Imipramine) Pamelor (Nortriptyline).
Blocks re-uptake of serotonin and nor-epinephrine.
Anti-cholinergic effects : dry mouth, blurred vision, urinary retention, sedation, and drowsiness
Not a first line treatment! Can overdose on these, and can cause cardiac conduction disturbances.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Celexa (Citalopram), Lexapro (Escitalopram), Luvox (Fluvoxamine)
(Most widely prescribed)
Blocks the re-uptake and thus the destruction of serotonin.
Apathy and low libido.
Difficult to overdose.
Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs)
In low doses blocks reuptake of Serotonin; in high doses blocks reuptake of Norepinephrine
Monoamine Oxidase Inhibitors (MAOIs)
Marplan (Isocarboxazid), Nardil (Phenelzine), Parnate (Tranylcpromine) Ensam (Selegiline).
Inhibits the action of Monoamine Oxidase (Oxidase destroys Monoamines such as Serotonin, Epinephrine, Dopamine, and Norepinephrine).
Do not take with other anti-depressants
Avoid foods containing tyramine such as wine, smoked fish and aged cheese!
Toxic effect can develop into hypertensive crisis. (headache, increased respirations, light headed, vomiting, and increased heart rate)
If so, hold med, call MD, and take client to the ER
Lithium, anticonvulsant medications, and second-generation atypical antipsychotics
Common causes for Increased Lithium levels
Educate client and family about the medication
Drug trade/ Generic names
First-line treatment for acute mania and for long-term prevention of recurrences
Lithium (Eskalith, Lithane, Lithobid, and Lithonate).
Interacts with sodium and potassium ions to stabilize electrical activity.
Fine hand tremors, polyuria, mild thirst, weight gain.
Early toxic – N, V, and D, thirst, polyuria, lethargy, slurred speech, muscle weakness
Advanced toxic – Course hand tremors, GI upset, confusion, sedation, incoordination
Severe toxic – Ataxia, confusion, large output of dilute urine, blurred vision, clonic movements, seizures, HTN, stupor and coma.
Therapeutic range of <0.4 to 1.5mEq/L
Frequent levels drawn
Toxicity- withhold med and draw level
Vigorously hydrate; use emetic, GI suctioning if overdose
Provide supportive nursing care for bedridden patient; may need peritoneal dialysis or hemodialysis
Depakote (Divalproex Sodium)
Tegretol (Carbamazapine) Lamictal (Lamotrigine).
Reduces the firing rate of high-frequency neurons. Is thought to reduce mood swings in patients with bipolar disorders.
Tremor, weight gain, sedation, anticholinergic side effects and rashes.
Liver panel and CBC with Depakote or Depakene.
CBC, electrolyte panel with Tegretol, along with an ECG.
Patients should report any rashes with Lamictal.