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neuro/psych > Introduction to Drug Therapy in Psychiatry.pdf > Flashcards

Introduction to Drug Therapy in Psychiatry.pdf Flashcards

neuro psych

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1
Q

what is the definition of a drug?

A

An exogenous chemical that affects one or more biological process

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2
Q

why learn about psychiatric pharmacology ?

A
  1. In the US a majority of mental health services are provided by non-physician clinicians
  2. Majority of prescriptions written for psychotropic medications are written by family practice and primary care physicians
  3. Important to have a basic understanding of psychiatric medication treatment
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3
Q

what is the DSM-V?

A
  1. Provides a descriptive symptom based approach to the diagnosis of mental illness
  2. Defining disorders consistently allows for better prediction of prognosis and treatment response
  3. DMV-IV classifies disorders not individuals
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4
Q

what is the effects of pharmacodynamics ?

A

Biochemical, physiological, and neurobehavioral effects

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5
Q

what are the influencing factors of pharmacodynamics ?

A
  1. Concentration at the receptor
    2.Permeability
  2. Number of receptors
  3. Binding characteristics
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6
Q

what are the processes of pharmacokinetics ?

A

The process of absorption, distribution, metabolism, excretion and biotransformation.

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7
Q

what are the influencing factors of pharmacokinetics ?

A
  1. Age
  2. Kidney function/ Liver function
  3. Nutritional status
  4. Disease state, ect.
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8
Q

“what the human body does to the drug” ?

A

Pharmacokinetics

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9
Q

“what the drug does to the body”?

A

Pharmacodynamics

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10
Q

What does the medical model aim to do?

A

identifies pathology and attempts to fix it

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11
Q

what are the goals of medication management ?

A
  1. Treatment of acute disorder
  2. Prevent relapse after improvement
  3. Prevent future episodes
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12
Q

What substances were used in the history of the ancient world ?

A
  1. Alcohol (used amongst ancient greeks and romans)
    2.Cannabis ( Asia and middle east)
  2. Opium
  3. Nightshade (Ancient rome to china, used as a poison
  4. Atropine (Ancient rome to china, used as a poison
  5. Belladonna (to enlarge pupils to appear more attractive )
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13
Q

what were the drug developments and corresponding dates for Psychiatric Issues ?

A

1.1845 Hashish
2. 1875 Cocaine
3. 1892 Morphine, alcohol, ether
4. 1903 Barbiturates
5. 1927 Insulin Shock
6. 1936 Frontal Lobotomies
7. 1938 ECT
8. 1949 Lithium Introduced
9. 1950 Chlorpromazine (Thorazine)
10. 1955 Tricyclics & MAOs
11. 1990s SSRIs & SNRIs and Atypical Antipsychotics

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14
Q

What characterized the ‘Period of Trial and Errors’ in the 1920s and 1930s regarding the treatment of schizophrenia ?

A
  1. Treatment of schizophrenia was not well understood
  2. some treatments including cocaine, castor oil, manganese, injections of sulfur, and turpentine
  3. Some had partial remission with injections
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15
Q

what were the different therapeutic approaches of the 1930’s

A

1.Fever and Mental
Disease in 1917
2. The Insulin Shock
Therapy in 1927 (induced hypoglycemia to treat schizophrenia)
3. Chemical Convulsions
and Schizophrenia in
1934
4.The Electroconvulsive
Shock Therapy in 1937

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16
Q

what did the shift to Antipsychotic Psychopharmacology entail ?

A
  1. First time elimination of psychotic symptoms
    rather than alteration of body status was
    targeted
    2.Chlorpromazine (CPZ) was introduced on Jan 19, 1952. Within a period of 10 years 20 phenothiazines were in development, ranging from chlorpromazine to trifluoperazine to fluphenazine
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17
Q

What is another name for Rauwolfia serpentina and its uses?

A
  1. Reserpine
  2. Refractory psychosis refers to cases where traditional treatments are not effective. Despite falling out of favor as a first-line treatment, reserpine is still used in certain cases of refractory psychosis.
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18
Q

what was the role of nathan Kilfe in 1954?

A

wrote the first paper on rauwolfia serpentina, though it fell out of favor quickly

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19
Q

what were the developmental uses of butyrophenones and which 2 drugs are still clinically useful?

A
  1. Haloperidol, the parent substance of the butyrophenone antipsychotics , was synthesized on February 15, 1958.
  2. Based on its similarity of action with CPZ, Psychopharmacological research proceeded rapidly resulting by 1990 the development of
    13 products, of which 2, haloperidol and droperidol, are clinically useful.
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20
Q

Name the 2nd Generation or Atypical Antipsychotics

A

These medications are considered a newer generation compared to the first-generation antipsychotics. The term “atypical” is used because these drugs differ in their pharmacological profile from the earlier antipsychotics.
1. Clozapine (Clozaril)-80s in USA
2.Risperidone (Risperdal)-early 90s
3.Olanzapine (Zyprexa) late 90s
4.Quetiapine (Seroquel)-late 90s
5.Ziprasidone (Geodon)-2001
6.Aripiprazole (Abilify) in 2002
7.Paliperidone (Invega) in 2007
8.Asenapine (Saphris) in 2011
9.Iloperidone (Fanapt) in 2011
10.Lurasidone (Latuda) in 2012

21
Q

what was the first tricyclic antidepressant and its properties?

A
  1. Imipramine (tofranil)
  2. Originally developed as an anxiolytic for agitated psychosis but showed to have remarkable effects on patients with concomitant symptoms of depression
22
Q

what are some examples of tricyclic antidepressants TCAs?

A
  1. Imipramine
    2.Nortriptalyine
    3.Amitriptyline
    4.Doxepin
23
Q

what are some examples of monoamine oxidase inhibitors MAOIs?

A

1.Phenelzine isocarboxazid
2. Tranylcypromine

24
Q

what were the first 2 SSRI?

A
  1. Zimelidine 1971
  2. Indalapine 1978
    both not available in the US
25
Q

what is the brand name of fluoxetine and its properties ?

A
  1. Prozac
  2. weak inhibition of NE reuptake and has a very long half life
26
Q

What is the brand name of sertraline and its properties ?

A
  1. Zoloft
  2. Provides a weak inhibition of DA and NE reuptake and is the least sedating SSRI
27
Q

what is the brand name of Trazodone and its properties?

A
  1. Desyrel
  2. developed in italy in the 1960 approved by the fda in 1980
  3. Antidepressant
28
Q

what is the brand name of Bupropion and its properties?

A
  1. Wellbutrin
  2. weak DA reuptake inhibitor
  3. Antidepressant
29
Q

what is the brand name of Nefazadone and its properties?

A
  1. Serzone
  2. structurally similar to trazodone
  3. Better than SSRI’s at improving sleep and anxiety symptoms
  4. Antidepressant
30
Q

what is the brand name of Paroxetine and its properties?

A

1.Paxil
2. Moderately inhibits reuptake of NE and acts as a very mild acetylcholine antagonist
3. Antidepressant

31
Q

what is the brand name of Citalopram and its properties?

A
  1. Celexa
    2.Not as potent as paroxetine but it is the most selective SSRI besides escitalopram
  2. Antidepressant
32
Q

what is the brand name of Mirtazapine and its properties?

A

1.Remeron
2. Blocks the alpha 2 receptor which inhibits the release of NE and 5-HT
3. Sedative effects
4. Antidepressant

33
Q

what is the brand name of venlafaxine and its properties?

A

1.Effexor
2. resembles tricyclics but
lacks the anticholinergic and antihistaminergic side-effects of tricyclics.
3. Antidepressant

34
Q

what are the 3 antidepressants of the 21st century ?

A
  1. Escitalopram oxalate
  2. Duloxetine
  3. Desvenlafaxine
35
Q

what is the brand name of Escitalopram and its properties?

A
  1. Lexapro
  2. SSRI
  3. Antidepressant
  4. Derived from citalopram and is even more selective for the 5-HT receptor
36
Q

what is the brand name of Duloxetine and its properties?

A
  1. Cymbalta
  2. first time an antidepressant was approved for diabetic peripheral neuropathy
37
Q

what is the brand name of Desvenlafaxine and its properties?

A

1.Pristiq
2. Like venlafaxine but with once a day dosing
3. Antidepressant

38
Q

what does efficacy mean ?

A
  1. How good is the drug at diminishing the manifestations of the disorder
    2.Percent of patients responding to a medication in a controlled study
39
Q

what does effectiveness mean?

A
  1. How in the real world this treatment is effective
  2. Ease of administration
    3.side effects
  3. Patient compliance
    5.usefulness with real patients
40
Q

what are determines the effectiveness pharmacologic treatments ?

A

clinical response
Pharmacologic response
Placebo response
spontaneous remission

41
Q

what are the goals of pharmacotherapy ?

A
  1. Acute treatment (used to alleviate the symptoms of an actively occurring disorder)
    2.Continuation treatment (to prevent a relapse into the same episode for which the treatment began)
  2. Maintenance treatment (to prevent recurrences by the ongoing maintenance use of a medication)
42
Q

what is the definition of compliance ?

A

Adherence to the recommended treatment plan by a healthcare professional

43
Q

what are strategies to increase compliance ?

A
  1. Encourage active patient participation
    2.Adequate communication
    3.Empathetic approach trusting relationship
  2. Family and community involvement and support
    5.Emphasis on the positive effects of the medication
  3. Use the most simplified drug regime
44
Q

what does facing family expectations mean and why is it important?

A
  1. Families of many consumers with psychotic symptoms are not
    satisfied with their symptom improvement, regardless of how
    effective their medications may be.Unfortunately, most families do not accept the fact that
    medication may reduce but not eliminate psychotic symptoms.
    2.This frustration easily leads to discontinuation of medication,
    exposing the patient to a higher risk of relapse. Realistic goals
    need to be set for regarding the management of their
    symptoms with antipsychotic drug therapy
45
Q

What are some reasons for noncompliance ?

A
  1. Stigma of disorder
  2. Denial of illness
  3. Disruption in cognitive process
  4. Side effects of medication
  5. Slow onset of beneficial effects
  6. Cost
46
Q

what should be the main point of counseling on adverse effects ?

A

While counseling about adverse effects involves discussing a
negative aspect of drug therapy, the focus should be on
minimizing family’ s over concern.

47
Q

what should counseling on adverse effects include in the discussion?

A

Counseling must include discussion of the common,
expected adverse effects, and what to do if one occurs.
Families must understand that adverse effects can be treated
or minimized while drug therapy continues

48
Q

what are clinical characteristics that may suggest the need to start pharmacological treatment ?

A

Psychiatric Symptoms
– Sleep or Appetite Disturbance
– Fatigue
– Panic Attacks
– Ritualistic Behavior
– Cognitive Symptoms
– Psychosis such as Delusions or Hallucinations

49
Q

what are crucial points in medication counseling ?

A

1.Should avoid assuming a particular diagnosis when a
patient receives psychotropic medications
2. The use of certain medications does not necessarily
agree with FDA approved indications
3. Should ask open-ended questions, such as “what did
your physician tell you the medication is for?

neuro/psych (6 decks)

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