1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 16Psychopharmacology

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins In contemporary (psychiatric) treatment, psychological and psychopharmacologic models are highly compatible. When used in a combination or matrix model, the clinical outcomes are positive and powerful in enhancing quality of life for both the client and family and improving functional status. Krupnick, 1996 The use of drugs to treat psychiatric disorders is often the foundation for a successful treatment approach that can also include other types of interventions such as psychotherapy or behavioral therapies. Sadock & Sadock, 2008

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Articulate how the terms pharmacodynamics and pharmacokinetics relate to the science of psychopharmacology Differentiate primary, secondary, and tertiary effects of psychotropic drugs Discuss the implications of drug polymorphism and discontinuation syndrome, neuroleptic malignant syndrome, serotonin syndrome, and metabolic syndrome in the psychiatric setting Understand the rationale for the administration of each of the following: antipsychotic agents/neuroleptics, antianxiety agents and hypnotics, antidepressants, stimulants used as mood elevators, antimanic agents used as mood stabilizers, anticonvulsants used as mood and behavior stabilizers, and antiparkinsonism or anticholinergic agents to treat medication- induced movement disorders

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Recognize the contraindications for and possible adverse effects of the following: antipsychotic agents/neuroleptics, antianxiety agents and hypnotics, antidepressants, stimulants, antimanic agents, anticonvulsants, and antiparkinsonism or anticholinergic agents Explain the nursing implications when administering various classifications of psychotropic drugs Demonstrate an understanding of the importance of client and family education regarding psychotropic drugs

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Psychopharmacology Clinical psychopharmacology is the study of drug effects in clients and the expert use of drugs in the treatment of psychiatric conditions. Abnormalities in emotions, behavior, and cognition are assumed to be caused by biochemical alterations of neurotransmitters and their functions in the brain. Clinical symptoms are generally lessened when the biochemical alterations are corrected by pharmacotherapy.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Science of Psychopharmacology How do neurotransmitters (eg, dopamine, glutamate, and serotonin) function? What are the six steps in the synaptic transmission? How do drugs block, inhibit, or enhance neurotransmitter functioning? How does the interconnectedness of various neural subsystems help explain pharmacologic data and the pathophysiology of mental illness?

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins How Neurons Communicate

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychotropic Drugs and Changes in Emotions, Behavior, and Cognition Primary effects Secondary effects Tertiary effects

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacodynamics Key Terms Potency Clinical efficacy Median effective dose Median toxic dose Therapeutic index Tolerance

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacokinetics Key Terms Movement of drugs and their metabolites through the body by the process of drug absorption, distribution, metabolism, and excretion or elimination Metabolism – Peak plasma concentration – Drug half-life – First-pass effect – Clearance

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacokinetics and Pharmacodynamics of Drug Therapy

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Factors Affecting Pharmacodynamics and Pharmacokinetics Drug polymorphism can be based on the following: – Age – Gender – Size – Body composition – Genetic endowment – Environment – Culture – Genetics Discontinuation (withdrawal) syndrome

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Classifications of Psychotropic Agents This chapter focuses on the following classifications: Antipsychotic agents/neuroleptics Antianxiety agents and hypnotics Antidepressants Stimulants as mood elevators Antimanic agents or mood stabilizers Anticonvulsants Antiparkinsonism agents

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Explain the Following for Each of the Drug Classifications Listed Principles or rationales for therapy Contraindications Precautions and adverse effects Implications for nursing actions Client and family education

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Acute dystonia Acute dyskinesia Akathisia Atypical antipsychotics Clearance Clinical efficacy Clinical psychopharmacology Conventional antipsychotics Discontinuation (withdrawal) syndrome Drug half-life Drug polymorphism Extrapyramidal adverse effects (EPS) First-pass effects Median effective dose Median toxic dose

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms (cont.) Metabolic syndrome Neuroleptic malignant syndrome (NMS) Neuroleptics Parkinsonism Peak plasma concentration Pharmacodynamics Pharmacokinetics Potency Primary effects Psychopharmacology Secondary effects Tardive dyskinesia (TD) Tertiary effects Therapeutic index Therapeutic window Tolerance Typical antipsychotics

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection ? ? Reflect on the opening quote by Sadock and Sadock, “The use of drugs to treat psychiatric disorders is often the foundation for a successful treatment approach that can also include other types of interventions such as psychotherapy or behavioral therapies.” Explain how the use of drugs provides a foundation for a successful treatment approach for a specific disorder, such as depression. What information could you provide to a client who is resistant to trying a psychotropic drug? How would you present the information? Would you include any other staff members in the presentation? If so, who and why?