1. UNIT 19
Psychotropic Agents

2. Key Terms Adrenergic Affective Anticholinergic Anxiolytic
Bioavailability
Catecholamine
Dopamine
Endogenous
Extrapyramidal
Limbic system
Norepinephrine
Orthostatic hypotension
Serotonin
Tyramine

3. Causes of Mental Illness
Exact causes unknown
Contributing factors
Genetics
Environment
Drugs
Biochemical changes

4. Stress Common stressors Money Illness School Peer pressure Birth Death
Crime
Relationships
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5. Stress Financial costs
14% of all occupational disease claims are stress related
Approximately $34 billion annually
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6. Stress Physical costs Immune system dysfunction Cancer Hypertension
Heart disease
Ulcers
Migraine headaches

7. Common Stressors for the Older Adult
Increased cost of living
Decrease in income
Health problems
Loneliness/death of spouse
Loss of physical or mental abilities

8. Ways to Reduce Stress Make a budget Take control over situations
Get help
Healthy lifestyle
Find time for yourself
Think positive, but be realistic
Emotional fitness
Get a pet
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9. Ways to Reduce Stress Discussion Questions:
What are some ways that you use to reduce stress?
What could you do to help patients deal with stress?

10. Symptoms of Stress in Children
Vary with age
Toddlers: inactivity, stomachaches
School-age: decline in school, refusal to take part in activities
Adolescents: withdrawal, change in sleep or eating habits, frequent thoughts of suicide
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11. Symptoms of Stress in Children
Warning!
Suicidal thoughts seen frequently in adolescents, occasionally in school-age children.
School-age child may not realize permanence of death.
May want to “visit Grandma in heaven”
May consider suicide to punish parents
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12. Symptoms of Stress in Children
Discussion Questions: How should you respond if a child talks about suicide? How should you respond if a teenager talks about suicide?

13. Psychotropic Drugs Affect psychic function, behavior, or experience
Antianxiety (anxiolytic)
Antidepressant
Antimanic
Antipsychotic (neuroleptic)

14. Benzodiazepines Most widely prescribed for anxiety
Suppress response to conflict or aggression
May cause physical and psychological dependence
Did you know?
Many of the generic names for benzodiazepines end in –am.
This may help you to recognize these drugs when you encounter them.

15. Antidepressants
Indicated when depression interferes with ability to function properly
Affective disorder: disturbance of mood, with manic or depressive syndrome

16. Symptoms of Depression
Helplessness
Worthlessness
Guilt and sadness
Sleep changes
Weight or appetite changes
Loss of interest/pleasure in activities
Restlessness or irritability
Thoughts of death

17. Antidepressant Agents
SSRIs
SNRIs
TCAs
MAOIs
Lithium carbonate
Atypical antipsychotics
Miscellaneous drugs
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18. Antidepressant Agents
Did you know?
Tofranil (imipramine hydrochloride) is used to treat bedwetting in children.
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19. Antidepressant Agents
Warning!
FDA has requested additional suicide warnings on labels for
Lexapro
Luvox
Remeron
Wellbutrin
Effexor
Celexa
Prozac
Paxil
Zoloft

20. SSRIs Block reabsorption of serotonin
Includes Prozac, Zoloft, and Luvox
Contraindicated for use with MAOIs
Potentially fatal reactions

21. SNRIs Inhibit the reuptake of serotonin and norepinephrine
Includes Effexor
Warning!
Serotonin syndrome can result in patients taking triptans and SSRIs or SNRIs concomitantly. Careful observation is warranted.
Common symptoms include restlessness, hallucinations, coma, loss of coordination, nausea, vomiting, diarrhea, fast heartbeat, rapid changes in blood pressure, increased body temperature, and overactive reflexes.

22. Tricyclic Antidepressants
Three-ring (tricyclic) structure
Raise the levels of norepinephrine and serotonin
More likely to relieve endogenous depression
Includes Tofranil and Pamelor
Adverse actions include anticholinergic and alpha-adrenergic blocking activities, orthostatic hypotentions

23. MAOIs Block breakdown of norepinephrine and serotonin
Numerous contraindications
Must follow strict diet
Effects last for 2 weeks after discontinuance
Includes Nardil and Parnate
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24. MAOIs
Warning!
Patients taking MAOIs must be monitored for signs of hypertensive crisis.
If marked hypertension develops, drug should be discontinued and measures should be taken to reduce blood pressure.

25. Antimanic Agents Bipolar disorder Lithium commonly used for treatment
Three types
Manic
Depressive
Mixed

26. Lithium Does not produce sedation Alters sodium transport
Used for prophylaxis and treatment
Contraindications
Renal disease
Cardiovascular disease
Severe dehydration
Pregnancy
Severe debilitation

27. Laboratory Testing for Lithium
Lithium levels
Monthly during maintenance
Two to three times weekly during acute manic phase
Warning!
Inform patient and family of signs of lithium intoxication.
If signs are present, discontinue medication and contact physician.

28. Antipsychotic Agents Include Risperdol and Zyprexa Adverse effects
Drowsiness
Dry mouth
Constipation
Urinary retention
Blurred vision
Dizziness
EPS

29. EPS Appear to be dose related Includes Dystonia Akathisia
Pseudo-Parkinsonism
Tardive dyskinesias

30. Patient Teaching or Antipsychotic Agents
Avoid UV rays
Balanced diet
Adequate fluids
Avoid alcohol and CNS depressants
Take as ordered