Psychopharmacology
Erin Kibbey, RN, BS, CCRN
Learning Objectives
› From a historical perspective, reflect on how
psychopharmacology has changed mental health nursing
› Explore why patients may refuse or not follow treatment
plants (e.g., non-adherence)
› Illustrate the neurobiological mechanism for various
psychotropic medications
› Construct a teaching plan to help patients manage their
medications and increase adherence
› Explain the primary clinical indications, major side effects, and
significant nursing implications for each of the drug categories
Student Assignments
› Read Ch. 7 & 31 from textbook
› Watch YouTube video on movement
disorders associated with
psychopharmacology
› Review drug handout
Historical Perspectives
› Before 1950s
– Sedatives and amphetamines were the only significant
psychotropic drugs available
› Since 1950s, psychopharmacology has expanded to
include antipsychotic, antidepressant, and
antianxiety drugs
› Psychotropic drugs are intended to be used as an
adjunct to individual or group psychotherapy
Townsend, 2006; Trigoboff, 2013b
How Psychopharmacological Agents Work
› Neurotransmitters
– Chemicals stored in axon
terminals of presynaptic
neuron
› Receptors
– Molecules situated on cell
membrane that are binding
sites for neurotransmitters
› Reuptake
– Process of neurotransmitter
inactivation by which the
neurotransmitter is reabsorbed
into the presynaptic neuron from
which it had been released
Townsend, 2006
Nursing Implications
› Ongoing assessment
–
–
–
–
side effects/client response
drug interactions
psychosocial implications
educational activities
› Advocate to reduce stigma
› Holistic function
– Goal is to promote clients physiologic stability so they
can achieve psychological, social, and spiritual growth
Trigoboff 2013a, 2013b
Why treatment of mental illness can be
challenging
› Nonadherence
– YouTube video
› Debilitating side effects
› High Costs
› Toxicity
› Stigmas
› Polypharmacy
› Right to refuse
Bonnivier & Magoteaux, 2012; Townsend, 2006;
Trigoboff 2013a, 2013b
Medication Teaching Checklist
› Keeping all medications and information about them together
in one dry, cool, place
› When to report side effects
› How to report side effects
› Strategies and tools for managing side effects
› Strategies and tools for managing residual symptoms
› The effect of mental illness and psychiatric medications on life
goals
› Reinforce learning by providing an opportunity at some point
for the client to teach others about medications
Townsend, 2006; Trigoboff, 2013a, 2013b
Major Drug Categories
› Antipsychotics
– Drugs to treat side effects of antipsychotics
› Antidepressants: Tricyclics, MAOIs, SSRIs, SNRIs,
› Anxiolytics: Benzodiazepines & Nonbenzodiazepines
› Mood-stabilizing agents: Lithium, Anticonvulsant agents &
atypical agents
› Drugs to treat ADD/ADHD
› Drugs to treat DAT: Atypical antipsychotics,
acetylcholinesterase inhibitors, Glutamate pathway modifier
Bonnivier & Magoteaux, 2012; Townsend, 2006; Trigoboff 2013a, 2013b
Review
› Antianxiety medications produce a calming effect by:
–
–
–
–
A. Depressing the CNS
B. Decreasing levels of norepinephrine and serotonin in the brain
C. Decreasing levels of dopamine in the brain
D. Inhibiting production of the enzyme MAO
Answer
› Antianxiety medications produce a calming effect by:
– A. Depressing the CNS
– B. Decreasing levels of norepinephrine and serotonin in the brain
– C. Decreasing levels of dopamine in the brain
– D. Inhibiting production of the enzyme MAO
Review
› Antipsychotic medications are thought to decrease psychotic
symptoms by:
–
–
–
–
A. Blocking reuptake of norepinephrine and serotonin
B. Blocking the action of dopamine in the brain
C. Inhibiting production of the enzyme MAO
D. Depressing the CNS
Answer
› Antipsychotic medications are thought to decrease psychotic
symptoms by:
– A. Blocking reuptake of norepinephrine and serotonin
– B. Blocking the action of dopamine in the brain
– C. Inhibiting production of the enzyme MAO
– D. Depressing the CNS
Potential Adverse Side Effects of Drugs
› Anticholinergic delirium
› Agranulocytosis
› Neuroleptic malignant syndrome
› Extrapyramidal symptoms/EPSEs
– Tardive dyskinesia, drug induced
Parkinsonism, akathesia, akinesia,
bradykinesia
› Serotonin syndrome (p. 688)
› Cardiac effects/Hypertensive
crisis/Orthostatic hypotension
Trigoboff, 2013a
Review Question
› Part of the nurse’s continual assessment of the client taking
antipsychotic medications is to observe for extrapyramidal
symptoms. Examples include:
– A. Muscular weakness, rigidity, tremors, facial spasms
– B. Dry mouth, blurred vision, urinary retention, orthostatic
hypotension
– C. Amenorrhea, gynecomastia, retrograde ejaculation
– D. Elevated blood pressure, severe occipital headache, stiff neck
Answer
› Part of the nurse’s continual assessment of the client taking
antipsychotic medications is to observe for extrapyramidal
symptoms. Examples include:
– A. Muscular weakness, rigidity, tremors, facial
spasms
– B. Dry mouth, blurred vision, urinary retention, orthostatic
hypotension
– C. Amenorrhea, gynecomastia, retrograde ejaculation
– D. Elevated blood pressure, severe occipital headache, stiff neck
Alternative Medicine Approaches
› Herbals, minerals, vitamins, &
complementary treatment
– Herbs and plants usually take longer to work and
few have the potency of a prescription
› Benefits
› Potential problems
Trigoboff, 2013b
Online Resources
› http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyI
nformationforPatientsandProviders/ucm111085.htm#top
› http://www.healthline.com/
› http://www.mentalhelp.net/
› http://www.nami.org/
› http://www.bipolarbrain.com/meds.html
› http://www.psychnet-uk.com/
References
› Bonnivier, J. F., & Magoteaux, A. L. (2012). Innovative teaching strategy
for pharmacology in psychiatric-mental health nursing: Moving from
content to concepts. Journal of Psychosocial Nursing & Mental Health
Services, 50(12), 22-29. doi:
http://0dx.doi.org.libcat.ferris.edu/10.3928/02793695-20121107-03
› Townsend, M. (2006). Psychiatric mental health nursing (5th ed.).
Philadelphia, PA: F. A. Davis
› Trigoboff, E. (2013a). Psychopharmacologic nursing interventions. In C. R.
Kneisl & E. Trigoboff (Eds.), Contemporary psychiatric-mental health
nursing (3rd ed.). (pp. 672-696). Upper Saddle River, NJ: Prentice Hall
› Trigoboff, E. (2013b). The science of psychopharmacology. In C. R. Kneisl
& E. Trigoboff (Eds.), Contemporary psychiatric-mental health nursing (3rd
ed.). (pp. 113-138). Upper Saddle River, NJ: Prentice Hall