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ANTIPSYCHOTIC:
Types of Antipsychotics
a. Mesocortical pathway.
Research on schizophrenia pathophysiology suggests that a dysfunction of this pathway is associated
with cognitive impairments and disturbances of emotions and affect (negative symptoms). Blockade of
the mesocortical pathway by high doses of first-generation antipsychotics can induce secondary negative
symptoms and cognitive effects.
2. Atypical Antipsychotics, or Second Generation Antipsychotic Drugs. These new medications were
approved for use in the 1990s. Clozapine, asenapine, olanzapine, quetiapine, paliperidone, risperidone,
sertindole, ziprasidone, zotepine, and aripiprazole are atypical antipsychotic drugs. With the discovery of
clozapine in 1959, it became evident that this drug was less likely to produce extrapyramidal effects (physical
symptoms such as tremors, paranoia, anxiety, dystonia, etc. as a result of improper doses or adverse reactions
to this class of drug) in humans at clinically effective doses than some other types of antipsychotics. Clozapine
was categorized as the first atypical antipsychotic drug. This category of drugs has also been of great value in
studying the pathophysiology of schizophrenia and other psychoses.
MOA: Atypicals clinically help patients by transiently occupying D2 receptors and then rapidly dissociating to
allow normal dopamine neurotransmission. This keeps prolactin levels normal, spares cognition, and obviates EPS.
One theory of atypicality is that the newer drugs block 5-HT2A receptors at the same time as they block dopamine
receptors and that, somehow, this serotonin-dopamine balance confers atypicality.
3. Dopamine System Stabilizers, Dopamine system stabilizers are a potential new class of antipsychotic agents
without motor side effects. All known effective antipsychotics act at D2 receptors. A novel concept for an
antipsychotic without motor side effects is to stabilize these receptors rather than block them harshly.
MOA:
Extrapyramidal Symptom:
Extrapyramidal symptoms (EPS) are side effects of antipsychotic medicines. EPS can cause movement
and muscle control problems throughout your body.
Symptoms may be noticed after you take one dose of medicine or after long-term use. You may not be
aware of these symptoms, but others close to you may notice any of the following:
People who take antipsychotic medications may experience negative side effects, such as:
NSG Responsibilities:
Assess for the mentioned cautions and contraindications (e.g. drug allergies, CNS depression, CV
disorders, glaucoma, respiratory depression, etc.) to prevent any untoward complications.
Perform a thorough physical assessment (other medications taken, CNS, skin, respirations, and
laboratory tests like thyroid, liver, and renal functions tests and complete blood count or CBC) to
establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to
evaluate for occurrence of any adverse effects associated with drug therapy.
B. ANTICONVULSANTS:
Valproic Acid:
Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is
also used to treat mania (episodes of frenzied, abnormally excited mood) in people with bipolar
disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania,
and other abnormal moods). It is also used to prevent migraine headaches, but not to relieve
headaches that have already begun. Valproic acid is in a class of medications called anticonvulsants. It
works by increasing the amount of a certain natural substance in the brain.
MOA:
Valproic Acid dissociates to the valproate ion in the gastrointestinal tract and then binds to and
inhibits GABA transaminase. The drug's anticonvulsant activity may be related to increased brain
concentrations of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the CNS, by
inhibiting enzymes that catabolize GABA or block the reuptake of GABA into glia and nerve endings.
Valproic Acid may also work by suppressing repetitive neuronal firing through inhibition of voltage-
sensitive sodium channels. It is also a histone deacetylase inhibitor.
Carbamazepine:
Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and
pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic
neuropathy. Carbamazepine is also used to treat bipolar disorder.
MOA:
The specific mechanism of action of carbamazepine in stabilizing mood is unknown. It exerts effects by
decreasing dopamine turn over, enhancement of brain ?-aminobutyric acid (GABA) levels via multiple actions
of synthesis and degradation, and modulation of other neurotransmitters, voltage sensitive Na+ channels, extra
hypothalamic neuropeptides, secondary messenger systems, and neuro protection.
Side effects
respiratory depression
aplastic anemia
gingival hypertrophy
ataxia (aka uncoordinated movements)
Nursing considerations
do not discontinue anticonvulsants abruptly
monitor I&Os
careful when using medications that lower seizure threshold (ex: MAOIs, antipsychotics)
take with food
provide oral care - be gently
avoid alcohol (may cause severe respiratory depression)
C. ANTIDEPRESSANT:
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They
can ease symptoms of moderate to severe depression, are relatively safe and typically cause fewer side
effects than other types of antidepressants do.
MOA:
SSRIs ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical
messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption
(reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because
they seem to primarily affect serotonin, not other neurotransmitters.
SSRIs also may be used to treat conditions other than depression, such as anxiety disorders.
SSRIs work by enhancing the function of nerve cells in the brain that regulate emotion. Information is
communicated between your brain cells with signals. The chemical messengers that deliver these signals are
called neurotransmitters. Serotonin is one type of neurotransmitter.
When these brain cells (called neurons) send signals to one another, they release a little bit of a neurotransmitter
so that the message can be delivered. They then have to take back the neurotransmitter they released so they can
send the next message. This process of replacing the neurotransmitter is called reuptake.
If youre struggling with depression, the areas of your brain that regulate mood and send messages using
serotonin might not function properly. SSRIs help make more serotonin available by blocking the reuptake
process. This allows serotonin to build up between neurons so messages can be sent correctly. Theyre called
selective serotonin reuptake inhibitors because they specifically target serotonin.
Nursing Responsibilities:
Monitor patient response to therapy (e.g. alleviation of signs and symptoms of depression).
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.
D. ANTIANXIETY:
MOA: