PSYCHOTHERAPEUTIC DRUGS

Antipsychotics / Neuroleptics / Heavy Tranquilizer

• Side Effects:
• Extrapyramidal Symptoms (EPS)
• Acute Dystonia – opisthotonus (arching back), oculogyric crisis (upward rolling of eyes), torticollis (neck rotation to one side)
• Akathisia – inability to “stay put”
• Pseudoparkinsonism (Parkinson-like symptoms)
• Tardive Dyskinesia – repetitive movements, difficulty NOT moving, continues to appear even after discontinuing drug
• Neuroleptic Malignant Syndrome (NMS)
• F – fever
• E – encephalopathy (leads to delirium)
• V – vital signs unstable
• E – elevate CPK (creatinine phosphokinase)
• R – rigidity of muscles 
• Typical Antipsychotics
• Chlorpromazine (Thorazine) & Haloperidol (Haldol)
• Treats (+) symptoms of schizophrenia
• Work as dopamine antagonists
• Atypical Antipsychotics
• Clozapine & Risperidone (Risperdal)
• Treat (+) & (-) symptoms of schizophrenia
• Work as dopamine & 5-HT antagonists

Antidepressants

• Selective 5-HT Reuptake Inhibitor (SSRI)
• 1^st line antidepressants because they have fewer side effecs
• Blocks reuptake of serotonin
• Sertraline (Zoloft) & Fluoxetine (Prozac)
• Tricyclic Antidepressants (TCA)
• 2^nd line antidepressant
• Has many side effects because it is nonselective with receptors  
• Amitriptyline - blocks reuptake of serotonin and norepinephrine
• Monoamine Oxidase Inhibitor (MAOI)
• 3^rd line antidepressants
• Inhibits monoamine oxidase - enzyme that metabolizes neurotransmitters
• Very, very many interactions
• BEWARE: TYRAMINE (especially avocado, soy, liver, cheese, purple fruits & veggies)
• Phenelzine & Tranylcypromine

Anti-Manic / Mood Stabilizers

• Lithium (Eskalith)
• FOR ACUTE MANIA - increases norepinephrine, decrease serotonin
• Therapeutic Index: 0.6-1.2 mEq/L
• Patient must be well hydrated
• Patient must take in enough sodium
• Valproic Acid
• FOR PREVENTION OF MANIA

Antianxiety / Anxiolytics

• Benzodiazepines
• First line drug for anxiety disorders
• Reduces overactivity in the CNS (in the limbic system & RAS)
• Potentiates GABA (gamma-aminobutyric acid)
• Chlordiazepoxide – alcohol withdrawal
• Alprazolam – anxiety
• Lorazepam – preOP sedation
• Diazepam – seizure disorders
• BEWARE: MAOI usage within the last 2 weeks
• Nursing Considerations:
• Caution patient when driving
• Allow adequate rest especially when patient is sedated
• Have FLUMAZENIL on standby for benzodiazepine toxicity