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Mental Health Nursing
Psychopharmacology Worksheets
There are 4 drug worksheets in all:
1.
2.
3.
4.
Anxiolytics, hypnotics & sedatives (6 questions) – Week 5
Antidepressant (10 questions) – Week 6
Mood stabilisers (10 questions) – Week 6
Antipsychotic (9 questions) – Week 7
Student Name:
Student Number:
Lab Group / Day:
Tutor:
ANXIOLYTIC WORKSHEET
(Incorporating anxiolytics, hypnotics &
sedatives)
OBJECTIVES:
At the completion of this worksheet, the student will be able to:
1. State 5 disorders for the use of anxiolytic drugs.
2. List the generic name and trade name & dosages for at least 5 anxiolytic drugs.
3. Summarise the precautions to be observed when a person is to receive anxiolytic
drugs.
4. Outline the nursing management for a person receiving anxiolytic medication.
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ANTI ANXIETY MEDICATIONS
(ANXIOLYTICS : MINOR TRANQUILLISERS)
This group of drugs include Benzodiazepines, Barbiturates, bromides and
Meprobamate. This worksheet will concentrate on the Benzodiazepines as they are the
most widely used group of drugs in the treatment of Anxiety.
The Benzodiazepine group of drugs is used in the treatment of anxiety, tension and
aggression. Treatment is commenced only if the anxiety is severe enough to interfere
with a persons' activities of daily living.
They are not appropriate for relieving chronic anxiety or the anxieties of everyday living.
These drugs should be only an adjunct to other non-pharmalogic therapies eg. Psychotherapy, Relaxation Therapy, Hypno-therapy.
The Benzodiazepines have a very real possibility of fostering dependency, therefore, all
benzodiazepines should be withdrawn gradually.
Question 1
Briefly state a definition of Anxiety:
Actions & Uses
Mode of action largely unknown; some suggestion of their action on the limbic system
and on the brain stem reticular system and at the myoneural junction which produces
its muscle relaxant properties.
Question 2
List five (5) disorders/conditions for which Benzodiazepines may be prescribed.
1.
2.
3.
4.
5.
3
QUESTION 3
Complete the following table:
GENERIC
BRAND
DAILY DOSE RANGE
(MG) oral
Alprazolam
0.5 – 5
Bromazepam
3 – 30
Clobazam
10 – 30
Clonazepam
0.5 – 6
Clorazepate
5 – 30
Chlordiazepoxide
10 – 50
Diazepam
*
*
2 - 25
Flunitrazepam
1–2
Flurazepam
15 – 30
Lorazepam
1–6
Nitrazepam
*
*
5 - 10
Oxazepam
*
*
10 – 90
Temazepam
*
*
*
10 – 20
0.125 –0.25
Triazolam
NON – BENZODIAZEPINE
ANXIOLYTIC
Buspirone
15 - 60
FOR AKATHISIA, ANXIETY
TREMOR
Propranolol
40 - 160
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CONTRAINDICATIONS AND PRECAUTIONS
QUESTION 4
List 5 contraindications / precautions with the use of Benzodiazepines:
1.
2.
3.
4.
5.
ADVERSE REACTIONS
Adverse Reactions tend to be rare, but can range from mild discomfort to gross
pathological changes which needs termination of treatment.
QUESTION 5
List ten (5) adverse reactions / side effects that may occur with the use of
Benodiazepines:
1.
2.
3.
4.
5.
The safety margin for Benzodiazepines is wide, they are comparatively safe in
overdose eg. a suicide attempt using 2250 mg of Chlordiazepoxide remain
unsuccessful.
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QUESTION 6
Outline the nursing implications related to the use of Benzodiazepines.
BIBLIOGRAPHY:
 Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:
Pearson.
 MIMS Annual 2006 - Supplement No. 1 Sydney : MIMS Australia, 2006.
 Pharmacology and drug information for nurses / Society of Hospital Pharmacists of Australia.
(4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,
 Treatment Protocol Project 2000. Management of Mental Disorders (third edition), Sydney, World
Health Organisation Collaborating Centre for Mental Health and Substance Abuse, Volumes 1 & 2.
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OBJECTIVES
Upon completion of this worksheet, the student will be able to:
1. Distinguish between the major drug classes used in the treatment of depression.
2. List the disorders for which they may be prescribed.
3. Name drugs from each group and the average daily dose.
4. Outline the possible adverse reactions that can occur with each drug group.
5. Describe the medical and nursing precautions needed for each group.
6. Propose the nursing management of a client receiving antidepressants.
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INTRODUCTION
There are a number of drug classes used in the treatment of depression:
1. Tricyclic antidepressant.
2. Tetracyclic antidepressant.
3. Selective Serotonin Reuptake Inhibitors (SSRIs)
4. Monoamine Oxidase Inhibitors (MOAIs).
5. Serotonin – noradrenaline reuptake inhibitors (SNRIs)
6. Post – synaptic serotonin receptor blockers & reuptake inhibitors
These drugs elevate the mood of the depressed patient. There are different types of
depression with different symptoms and each type would have a different treatment.
Tricyclic Antidepressants
Question 1
List the disorders for which tricyclic antidepressants may be prescribed:
1.
2.
3.
4.
5.
MODE OF ACTION
The antidepressant activity of the tricyclics is thought to be due to the inhibition of the
synaptic re uptake of amines such as noradrenaline and serotonin. This increases the
neurotransmitter concentration in the brain. Other actions of these drugs include
anticholinergic, antihistamine, hypothermic and antiemetic reactions.
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Question 2
Complete the following table:
GENERIC
TRADE /
Daily dose range
SEDATION
ANTICHOLINERGIC
BRAND
MG
Amitriptyline
*
*
100 - 250
xxxx
xxxx
Imipramine
*
*
100 - 250
xxx
xxx
Desipramine
100 - 250
x
x
Clomipramine
100 - 250
x
x
100 - 300
xxxx
xxx
Nortriptyline
50 - 150
xxx
xxx
Trimipramine
100 - 300
xxxx
xxxx
Dothiepin
100 - 200
xxx
xxx
Doxepin
*
*
Adverse Reactions / Side effects
Many adverse reactions have been reported during Tricyclic Antidepressant therapy.
However, serious adverse reactions mainly occur with higher doses ie. over
200mg/day) and in the elderly. The most common reactions that may occur are
sedation and anticholinergic reactions.
Question 3
List possible adverse reactions that may occur with the use of Tricyclic
Antidepressants, under the following headings:
Autonomic Nervous System:
Cardiovascular:
Other:
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Question 4
Outline the nursing implications for Tricyclic Antidepressants.
TETRACYCIC ANTIDEPRESSANTS
Mianserin
Tolvon
30 - 120mg daily.
It is effective in all types of depression, has minimal cardiovascular effects, it reduces
anticholigenic symptoms, it produces no significant cognitive impairment, it is relatively
safe with the elderly. But adverse reactions still occur.
Question 5
List the possible adverse reactions of Mianserin.
IRREVERSIBLE MONOAMINE OXIDASE INHIBITORS (MAOIs)
These are not the drug of choice in depressive illness, usually reserved when other
drug treatment and other forms of therapy have not worked.
Mode of Action
The drugs act by decreasing the metabolism of certain neuro-transmitters in the brain,
thereby making more biogenic amines available for release in the brain.
Question 6
Complete the following table:
GENERIC NAME
TRADE NAME
USUAL DAILY
DOSE
Tranylcypromine
20 - 60
Phenelzine
30 - 90
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Question 7
List the possible adverse reactions that may occur with the use of the MAOI's:
Question 8
List the contra-indications and nursing implications for MAOI's:
REVERSIBLE MAOI
Effective as irreversible MAOIs for treatment of depression, much safer in overdose,
and Tyramine-free diet is not required.
Generic
Moclobemide
Trade
300 – 900 mg
Aurorix
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SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI’S)
Question 9– complete table:
Generic
Brand / Trade name
Daily Dosage mg
Citalopram
20 - 60
Fluoxetine
20 - 80
Fluvoxamine
100 - 300
Paroxetine
20 – 60
Sertraline
50 - 200
Effectiveness of these agents is considered equivalent to that of tricyclic
antidepressants, and in clinical use have:
* lack of CVS effects (orthostatic hypotension); * few extra-pyramidal effects
* less sedation, weight gain or impairment of cognitive or psychomotor
function; * less dry mouth, * constipation
Question 10:
List common Adverse Reactions / side effects of SSRIs:
** They must not be given with an irreversible MAOI as DEATH MAY OCCUR from
“serotonergic syndrome”.
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BIBLIOGRAPHY:
 Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:
Pearson.
 MIMS Annual 2000 - Supplement No. 1 Sydney : MIMS Australia, 2000.
 Pharmacology and drug information for nurses / Society of Hospital Pharmacists of Australia.
(4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,
 Treatment Protocol Project 2000. Management of Mental Disorders (third edition), Sydney, World
Health Organisation Collaborating Centre for Mental Health and Substance Abuse, Volumes 1 & 2.
 Various Australian Pharmacology handouts and booklets.
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MOOD STABILISERS
WORKSHEET
OBJECTIVES:
At the completion of this worksheet, the student will be able to:
1.
Name the trade names of different mood stabilisers used in Australia
2.
List the disorders for which they can be used and the adverse reactions a person may experience.
3.
Evaluate the medical and nursing procedures that should be preformed when a person is prescribed this
medication.
4.
Outline the nursing precautions and management for a person receiving mood stabilisers.
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Mood stabilisers
Mood stabilisers are drugs used for use in people with bipolar illnesses: mixed, manic or depressed for long term
prophylaxis. The main drug used is Lithium. In the 1880s, Lithium Salts were used for gout treatment and also in
the 1940s as a salt substitute, but because of serious toxic problems, both were discontinued. In 1949, Australian
John Cade discovered its antimanic properties. Since the 1960s, it has been used as the main antimanic drug of
choice.
Question 1 – complete the table and answer the following questions:
Generic name
Lithium carbonate
Brand / trade name
Usual daily dose mg
Lithium carbonate has a therapeutic range of _______________ mmol/L. For prophylaxis treatment in bipolar
disorders, the common range is _____________ mmol/L . Symptoms of Lithium toxicity occur above __________
mmol/L .
Question 2:
List at least 4 uses of Lithium Carbonate:
Question 3:
List common side effects or adverse reactions that a person may experience when receiving Lithium Carbonate:
Question 4:
Describe Lithium toxicity and the symptoms that can occur:
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Question 5:
Outline the medical and nursing procedures that should be preformed prior to a person commencing on Lithium
Carbonate:
Question 6:
Summarise the nursing management and precautions for a person receiving Lithium Carbonate:
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Question 7: Complete the following:
Generic name
Brand / trade name
Carbamazepine
Sodium Valproate
Usual daily dose mg
List the psychiatric uses for Carbamazepine and Sodium Valproate:
Question 8: List the adverse reactions / side effects for Carbamazepine:
Question 9:
List the adverse reactions / side effects for Sodium Valproate:
Question 10:
Summarise medical and nursing precautions prior to taking Carbamazepine and Sodium Valproate:
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BIBLIOGRAPHY:
 Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:
Pearson.
 MIMS Annual 2000 - Supplement No. 1 Sydney : MIMS Australia, 2000.
 Pharmacology and drug information for nurses / Society of Hospital Pharmacists of
Australia. (4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,
 Treatment Protocol Project 2000.
Management of Mental Disorders (third edition),
Sydney, World Health Organisation Collaborating Centre for Mental Health and Substance
Abuse, Volumes 1 & 2.
 Various Australian Pharmacology handouts and booklets.
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OBJECTIVES
1. Identify the generic and trade / brand names of Neuroleptic drugs.
2. Outline the mode of action.
3. Select (5) disorders for which neuroleptics may be used.
4. Identify and define adverse reactions of neuroleptics.
5. Evaluate the nursing management of a person receiving neuroleptic drugs and
precautions to be observed when a person is receiving neuroleptics.
6. Identify neuroleptic malignant syndrome.
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NEUROLEPTICS
 Also known as major tranquillisers or anti psychotic medication.
Prior to their inception, barbiturates and some Rauwolfa Agents were used for psychotic disorders.
These had many disadvantages (eg. general sedation and depression) and resulted in a search for other
drugs to use.
Chlorpromazine, introduced in 1952, revolutionised the treatment of psychotic disorders. It belongs to the
Phenothiazine class of Neuroleptics. Other classes include the Butyrophenones introduced after
successful trails, in 1958. The anti psychotics tend to be divided into low potency drugs – which are more
sedating and more likely to have anticholinergic side effects than the high potency drugs which produce
more extrapyramidal side effects, but tend to be less sedating – see table.

Neuroleptics alleviate symptoms of psychotic disorders, they DO NOT cure mental illness.
Question 1:
Complete the following table:
GENERIC
TRADE or
ORAL
SEDATION
HYPO-
ANTI -
EXTRA
BRAND
DAILY
-
TENSION
CHOLINERGIC
PYRAMIDAL
DOSE
SIDE
RANGE
EFFECTS
(MG)
Chlorpromazine
*
75 - 1000
XXX
XXX
XX
x
Thioridazine
*
50 - 800
XXX
XXX
XXX
X
*Anatensol
2.5 - 20
xx
x
x
xxx
*
12.5 - 100 IM
*
Fluphenazine
every 14 to
35 days
Trifluoperizine
10 - 60
xx
x
x
xxx
Droperidol
10 - 60 IM
xx
x
x
xxx
*
25 - 300
x
x
x
xxx
*Haldol
IM every 4
depot inj.
weeks
Haloperidol
20
Pimozide
2 - 20
X
x
x
xxx
Clozapine
25 - 600
Xxx
xx
xx
x
Risperidone
2-8
Little
xx
not common
x
Thiothixene
6 - 50
X
x
x
xxx
X
x
x
xx
X
X
X
x
ATYPICAL
Zuclopenthixol
Clopixol depot
200 – 400
decanoate
inj.
every 2 - 4
weeks
Flupenthixol
20 – 80
every 2 - 4
weeks
Mode of Action
Neuroleptics are thought to act by blocking dopamine, the chemical neurotransmitter in the basal ganglia.
The drugs reduce or minimise the occurrence of cognitive dysfunction, without clouding of consciousness
- clients seem to have intact intellectual function and are less agitated, restless and impulsive. Sedative
properties are secondary to the anti-psychotic effects.
Question 2
List five psychiatric uses and non-psychiatric uses for which an antipsychotic / neuroleptic may be
prescribed.
PSYCHIATRIC
NON-PSYCHIATRIC
1
2
3
4
5
Adverse Reactions
21
During the course of treatment, adverse effects may occur depending on the dose, length of time and
frequency of use of the drug. A long list of possible reactions under different heading follows:
Question 3
Using the following headings, list the most common possible adverse effects of antipsychotic /
neuroleptic drugs.
AUTONOMIC (more common with chlorpromazine and thioridazine)
CARDIOVASCULAR
DERMATOLOGICAL
HEPATIC
OCULAR
SEIZURES
SEDATION
OTHERS
EXTRAPYRAMIDAL REACTIONS
22
All antipsychotic / neuroleptics cause some extrapyramidal effects possibly due to their dopamine blocking action. They may start after only a few hours but are usually from long term use.
Question 4
Define and describe the clinical picture of each of the following extrapyramidal reactions:
Akathesia:
Dyskinesia:
Dystonia:
Pseudo-Parkinsonism:
Tardive Dyskinesia:
Question 5
Outline the medical and nursing precautions that should be observed when a person is to receive
neuroleptic drugs.
Question 6
Summarise the nursing management of a person receiving neuroleptic drugs
ANTICHOLINERGICS - (ANTIPARKINSONIAN AGENTS)
These are potent anticholinergic medication and are often used to treat most of the extrapyramidal
effects. Benztropine tends to be the most commonly used (probably as it is available as an injection and
has a longer duration of action).
Question 7
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Complete the following table:
(GENERIC
TRADE NAME
USUAL DAILY DOSE
SEDATION
NAME
MG
Benztropine
0.5 to 6 oral, 1 to 2 IM/IV
Sedating
Benzhexol
5 to 15 oral
Stimulating
Orphenadrine
100 to 300 oral
Sedating
Procyclidine
5 to 60 oral, 5 - 20 IM
Sedating
Question 8
List some of the possible adverse reactions of Anticholinergic drugs.
Question 9
What is neuroleptic malignant syndrome (NMS)? List common features and symptoms of this syndrome.
BIBLIOGRAPHY:
 Bullock, S., Manias, E., & Galbraith, A. (2007). Fundamentals of Pharmacology (5th ed.). Sydney:
Pearson.
 MIMS Annual 2000 - Supplement No. 1 Sydney : MIMS Australia, 2000.
 Pharmacology and drug information for nurses / Society of Hospital Pharmacists of Australia.
(4th ed.) 1995. Sydney : W.B. Saunders/Baillière Tindall,
 Treatment Protocol Project 2000. Management of Mental Disorders (third edition), Sydney, World
Health Organisation Collaborating Centre for Mental Health and Substance Abuse, Volumes 1 & 2.
 Various Australian Pharmacology handouts and booklets.
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