Antipsychotic drugs

Generic Name: Risperidone

Brand Name: Risperdal

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Generic Name: Quetiapine

Brand Name: Seroquel

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Generic Name: Olanzapine

Brand Name: Zyprexa

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Generic Name: Ziprasidone

Brand Name: Zeldox

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Generic Name: Clozapine

Brand Name: Clozaril

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 Mechanism of Action:

The first-generation antipsychotics work by inhibiting dopaminergic neurotransmission; their

effectiveness is best when they block about 72% of the D2 dopamine receptors in the brain. They
also have noradrenergic, cholinergic, and histaminergic blocking action. Typical antipsychotics
act almost exclusively on the dopamine system. Atypical drugs, however, modulate serotonin (5-
HT), norepinephrine, and/or histamine neurotransmission as well. This multimodal mechanism
of action putatively underlies the beneficial effect of atypical antipsychotics in mood and anxiety
disorders.

Adverse effects:

All antipsychotic medications are associated with an increased likelihood of sedation, sexual
dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death. Primary care
physicians should understand the individual adverse effect profiles of these medications.
Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs
that is potentially fatal. Characteristic features of NMS are hyperthermia, muscular rigidity,
severe autonomic dysregulation and disturbed consciousness.

Indication

Atypical antipsychotics are used to relieve symptoms such as:

  delusions (mistaken beliefs),

 hearing voices,
 seeing things that aren't there (hallucinations),
 or paranoid or confused thoughts typically associated with some mental illnesses.
 severe anxiety.
 physical problems, such as persistent hiccups, problems with balance and nausea.
 agitation.
 problems with mood, thinking and socialising.
 mania.
 psychotic symptoms of depression.
 postpartum psychosis.

Contraindications:

First-generation antipsychotics are contraindicated in the following situations:

 History of severe allergy.
 Use of central nervous system (CNS) depressants like barbiturates, benzodiazepines, opioids.
 With anticholinergic medication like scopolamine or the use of phencyclidine.
 Severe cardiac abnormalities.
Nursing responsibilities (5)

 Provide different comfort measures to the client like positioning of legs and arms.
 Provide safety measures to client to minimize the injuries like raising side rails, adequate
lighting.
 Adequate and continuous monitoring of client after the drug is given to the client.
 Monitor vital signs including BP for hypotension.
 Weight, fasting plasma glucose/A1c, lipids, and BP should be routinely monitored in
patients taking antipsychotics.

Antianxiety agents

Generic Name: Clonazepam

Brand Name: Ritrovil

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Generic Name: Alprazolam

Brand Name: Xanax

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Generic Name: Lorazepam

Brand Name: Ativan

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Generic Name: Bromazepam

Brand Name: Lexotan

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 Generic Name: Oxazepam

Brand Name: Serax

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Mechanism of Action:

By acting on the limbic system and the reticular activating system (RAS), it causes the gamma-
aminobutyric acid (GABA) to be more effective in interfering neuron firing. GABA stabilizes
the postsynaptic cell which leads to an anxiolytic effect at a dose lower than required to induce
sedation and hypnosis.

Adverse effect:

Anxiety drugs may cause drowsiness or dizziness

lowered blood pressure

slowed breathing

problems with memory

 blurry vision.
 dry mouth.
 feeling agitated or restless.
 headaches.
 sexual problems or erectile dysfunction.

Indications:

Anxiolytic benzodiazepines are used in the treatment of anxiety. Nonmedical use has widely
developed, mainly because of their ability to generate addiction. Main indications are anxiety
 disorders with or without depressive symptoms. Action mechanisms include complex interaction
with GABA-receptor. If anxiety prevents you from going to work or otherwise participating in
your usual activities, your doctor may prescribe an antianxiety medication, such as alprazolam,
from a class called benzodiazepines. These medications calm the nervous system, providing
short term relief of anxiety and panic disorder symptoms.

Contraindications:

Contraindications and Cautions

 Allergy to barbiturates
 History of addiction to sedative-hypnotic drugs: barbiturates are more addicting than most other
anxiolytics.
 Latent or manifest euphoria
 Marked hepatic impairment or nephritis
 Respiratory distress and dysfunction
 Pregnancy
 Lactation
 Acute or chronic pain

Nursing Responsibilities (5)

 Monitor patient response to therapy (e.g. controlled anxiety, sleep, etc).

 Monitor for adverse effects (e.g. hypotension, dependence, hepatorenal dysfunction, etc).
 Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse effects to watch for.
 Monitor and record patient response to medication and level of sedation.
 Observe site closely for extravasation. 

Antidepressant agents

Generic Name: Citalopram

Brand Name: Celexa

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Generic Name: Escitalopram

Brand Name: Lexapro

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Generic Name: Fluoxetine

Brand Name: Prozac

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Generic Name: Fluvoxamine

Brand Name: Luvox

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Generic Name: Paroxetine

Brand Name: Paxil

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Mechanism of Action:

The antidepressants inhibit reuptake of neurotransmitters through selective receptors thereby

increasing the concentration of specific neurotransmitter around the nerves in the brain. One of
such antidepressant is selective serotonin reuptake inhibitor (SSRI), which affects the brain
serotonin level.

Adverse effect:

 feeling agitated
 shaky or anxious
 feeling and being sick
 indigestion and stomach aches
 diarrhoea or constipation.

Indications:

TCAs as a class have a wide range of indications, including major depressive disorder (MDD),
dysthymic disorder, neuropathic pain, and migraine or tension-type headache. Individual TCAs
may also have additional indications (e.g., imipramine for enuresis, clomipramine for obsessive
compulsive disorder).

Contraindications:

Cautions for specific antidepressants

a bleeding disorder. type 1 diabetes or type 2 diabetes. epilepsy – SSRIs should only be taken if
your epilepsy is well controlled, and the medicine should be stopped if your epilepsy gets worse.
kidney disease.

Nursing Responsibilities (5)

  Monitor for adverse effects (e.g. hypotension, suicidal thoughts, cardiac arrhythmias,
etc).
 Evaluate patient understanding on drug therapy by asking the patient to name the drug,
its indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.
 Instruct them to take their antidepressants regularly, without missing a dose.
 Ask how you and others can help. Ask what help they would find useful. Try to be
patient.

Mood stabilizers

Generic Name: Lithium Carbonate

Brand Name: Lithsag

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Generic Name: Valproic Acid

Brand Name: Depakene

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Generic Name: Valproate

Brand Name: Epilim

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Generic Name: Lamotrigine

Brand Name: Lamictal

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Generic Name: Carbamazepine

Brand Name: Tegretol

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Mechanism of Action:

Mood stabilizers have been shown to modulate the activity of enzymes, ion channels,
arachidonic acid turnover, G protein coupled receptors and intracellular pathways involved in
synaptic plasticity and neuroprotection.

Adverse effect:

Some of these side effects include: nausea, stomach cramps, thirst, fatigue, headache, and mild
tremor. If any of these side effects is severe, the person should consult the physician. Other side
effects may be more serious and should be reported to the physician immediately.

Indications:
 Mood stabilizers are used mainly to treat bipolar disorder, mood swings associated with other
mental disorders, and in some cases, to enhance the effect of other medications used to treat
depression.

Contraindications:

 significant renal or cardiovascular disease.

 severe debilitation or dehydration.
 sodium depletion, since the risk of lithium toxicity is high in these patients.

Nursing Responsibilities (5)

 Take as prescribed; do not crush or chew.

 Do not stop even if feeling better.
 Take with meals or milk.
 Regular monitoring of lithium levels required.
 Keep fluid and sodium balance consistent.

Stimulants

Generic Name: Methylphenidate LA

Brand Name: Ritalin LA

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Generic Name: dexymethylphenidate ER

Brand Name: Focalin XR

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Generic Name: Amphetamine salt combo ER

Brand Name: Adderall XR

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Generic Name: Lisdexamfetamine

Brand Name: Vyvanse

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Generic Name: Methylphenidate patch

Brand Name: Daytrana patch

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Mechanism of Action:

The general mechanism of stimulants revolves around increased catecholamine levels and

increased agonistic activity at adrenergic receptors. Caffeine has a unique mechanism as a
stimulant as it works as an inhibitor at the adenosine receptors

Adverse effect:

Even the short-term usage of stimulants can have adverse effects on your health. Many users
experience a loss of appetite, increased heart rate, elevated blood pressure and body temperature,
interrupted sleep patterns, panic, hallucinations, and irritability.

Indications:

Medical Indications
 Attention deficit hyperactivity disorder (ADHD)
 Narcolepsy.
 Asthma.
 Obesity.
 Nasal and sinus congestion.
 Hypotension due to anesthesia.

Contraindications:

Contraindications for stimulant treatment are: florid psychosis, bipolar I disorder, Tourette's

disorder, severe anorexia, and some medical condition such as hypertension, tachycardia, and
arrhytmias

Nursing Responsibilities (5)

 Arrange to interrupt the drug periodically in children to determine whether symptoms recur and
therapy should be continued.
 Arrange to dispense the least amount of drug possible to minimize risk of overdose and abuse
 Administer drug before 6 PM as ordered to reduce the incidence of insomnia.
 Monitor weight, CBC, and ECG to ensure early detection of adverse effects and proper
interventions.
 Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.