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Mod 3 Psychotherapeutic Drugs Flashcards

1
Q

Psychotherapeutic Drugs

A

Used in the treatment of emotional and
mental disorders
 Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress
 When emotions significantly affect an individual’s
ability to carry out normal daily functions,
treatment with a psychotherapeutic drug is a possible option

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2
Q

Psychotherapeutic Drugs (cont’d

A 
Three main emotional and mental disorders:
 Anxiety
 Affective disorders
 Psychoses
Types of psychotherapeutic drugs
 Antianxiety drugs
 Antimanic drugs
 Antidepressant drugs
 Antipsychotic drugs
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3
Q

Biochemical Imbalance

A 
Other biochemicals are necessary for normal
mental function
 GABA
 Acetylcholine (ACh)
 Sodium, potassium, magnesium
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4
Q

Anxiety

A

Unpleasant state of mind, characterized by a
sense of dread and fear
 May be based on actual anticipated
experiences or past experiences May be exaggerated responses to imaginary
negative situations

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5
Q

Anxiety Disorders

A 
Six major anxiety disorders (persistent anxiety)
 Obsessive-compulsive disorder (OCD)
 Posttraumatic stress disorder (PTSD)
 Generalized anxiety disorder (GAD)
 Panic disorder
 Social phobia
 Simple phobia
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6
Q

Affective Disorders

Mood Disorders

A

Changes in mood that range from mania
(abnormally pronounced emotions) to
depression (abnormally reduced emotions) Some patients may exhibit both mania and
depression: bipolar disorder (BPD)

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7
Q

Psychosis

A

Severe emotional disorder that impairs the
mental function of the affected individual to
the point that the individual cannot participate
in activities of daily living
 Hallmark: loss of contact with reality
 Examples
 Schizophrenia
 Depressive and drug-induced psychoses

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8
Q

Psychotherapeutics:

Pathophysiology

A 
Biochemical imbalance theory
 Mental disorders are associated with
abnormal levels of endogenous chemicals,
such as neurotransmitters, in the brain
Biochemical imbalance theory (cont’d)
 Brain levels of certain neurotransmitters play an
important role in maintaining mental health
 Catecholamines
 Dopamine
 Norepinephrine
 Indolamines
 Serotonin
 Histamine
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9
Q

Antianxiety Drugs

A

Reduce anxiety by reducing overactivity in
CNS
Benzodiazepines
• Depress activity in the brainstem and limbic system
Miscellaneous drug: Buspirone (BuSpar)
• Nonsedating and non–habit forming
• May have drug interaction with SSRIs (serotonin
syndrome)
• Do not administer with MAOIs

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10
Q

Antianxiety Drugs: Indications

A 
Anxiety
 Insomnia
 Sedation
 Muscle spasms
 Seizure disorders
 Adjuncts in anesthesia
 Adjuvant therapy for depression
 Alcohol (ethanol) withdrawal
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11
Q

Common Benzodiazepines

A 
diazepam (Valium)
 lorazepam ( Ativan)
 alprazolam (Xanax)
 clonazepam (Klonopin)
 chlordiazepoxide (Librium)
Midazolam (Versed)*
 Reduces anxiety and patient’s memory of painful
procedures that do not require general anesthesia
(moderate sedation)
 Injection only
*Limited to use as sedative and anesthetic during invasive medical or
surgical procedures
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12
Q

Benzodiazepines

A

Potentially habit-forming and addictive
Should be used at lowest effective dosages
and frequencies needed for symptom control

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13
Q

Benzodiazepines:

Adverse Effects

A

Benzodiazepine adverse effects are an
overexpression of their therapeutic effects
 Decreased CNS activity sedation
activity, Hypotension
 Drowsiness, loss of coordination, dizziness, headaches
 Nausea, vomiting, dry mouth, constipation

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14
Q

Benzodiazepines: Overdose

A 
Dangerous when taken with other sedatives
or alcohol
 Treatment is generally symptomatic and
supportive
 Flumazenil may be used to reverse
benzodiazepine effects
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15
Q

Affective Disorder Drugs

A 
Mood stabilizers
 Used to treat bipolar disorder
• Involves cycles of mania, hypomania, and depression
 Antidepressants
 Used to treat depression
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16
Q

Mood Stabilizers:

Antimanic Drugs

A

Lithium is the drug of choice for the treatment
of mania
 It is thought to potentiate serotonergic
neurotransmission
 May be used with other medications to stabilize
mood
 Narrow therapeutic range: maintenance serum
levels should range between 0.6 and 1.2 mEq/L
Monitor sodium levels
Low TI

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17
Q

Depression

A

Etiology (cont’d)
 Permissive hypothesis
 Affective disorders are caused by decreased
concentrations of serotonin
• Depression results from decreases in both serotonin and
catecholamine levels
• Mania results from increased catecholamine but decreased serotonin levels

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18
Q

Antidepressants

A

Tricyclic antidepressants
 Monoamine oxidase inhibitors (MAOIs)
 Newer-generation antidepressants
 Selective serotonin reuptake inhibitors (SSRIs) Second- and third-generation antidepressants

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19
Q

Tricyclic Antidepressants:

First-Generation Antidepressants

A

Have largely been replaced by SSRIs as
first-line antidepressant drugs
 Considered second-line
 For patients who fail with SSRIs or other newer-generation antidepressants
 As adjunct therapy with newer-generation
antidepressants

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20
Q

Common Tricyclics

A 
amitriptyline (Elavil, Endep)
 doxepin (Sinequan)
 imipramine (Tofranil)
 desipramine (Norpramin)
nortriptyline (Aventyl, Pamelor)
21
Q

Mechanism of Action

A

Block reuptake of neurotransmitters, causing
accumulation at the nerve endings
 It is thought that increasing concentrations of
neurotransmitters will correct the abnormally low levels that lead to depression

22
Q

Drug Effects

A 
Blockade of norepinephrine reuptake
 Antidepressant,* tremors, tachycardia
 Blockade of serotonin reuptake
 Antidepressant,* nausea, headache, anxiety, sexual dysfunction
*Desired therapeutic effects
23
Q

Indications

A 
Depression
 Childhood enuresis (imipramine)
 Obsessive-compulsive disorders
(clomipramine)
 Adjunctive analgesics for chronic pain
conditions, such as trigeminal neuralgia
24
Q

Adverse Effects

A 
Sedation
 Impotence
 Orthostatic hypotension
 Dysrhythmias
 Seizures
 Older patients
 Dizziness, postural hypotension, constipation,
delayed micturation, edema, muscle tremors
25
Overdose
Lethal—70% to 80% die before reaching the hospital  CNS and cardiovascular systems are mainly affected  Death results from seizures or dysrhythmias No specific antidote  Decrease drug absorption with activated charcoal  Speed elimination by alkalinizing urine  Manage seizures and dysrhythmias  Basic life support
26
MAOIs
``` Highly effective  Considered second-line treatment for depression, not responsive to cyclics Disadvantage: potential to cause hypertensive crisis when taken with tyramine Examples phenelzine (Nardil) tranylcypromine (Parnate ```
27
MAOIs: Mechanism of Action
``` Inhibit MAO enzyme system in the CNS Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain Result: alleviation of symptoms of depression ```
28
MAOIs: Indications
Depression, especially types characterized by increased sleep and appetite Depression that does not respond to other antidepressants
29
Hypertensive Crisis | and Tyramine
Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death Avoid foods that contain tyramine! Aged, mature cheeses (cheddar, blue, Swiss) Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté) Yeast extracts Red wines (Chianti, burgundy, sherry, vermouth) Italian broad beans (fava beans)
30
MAOIs
``` Concurrent use of MAOIs and SSRIs may lead to serotonin syndrome If the decision is made to switch to an SSRI, there must be a 2- to 5-week “wash-out” period between MAOI therapy and SSRI therapy ```
31
Newer-Generation | Antidepressants
Fewer adverse effects than tricyclics and MAOIs Very few drug-drug or drug-food interactions Still take about 4 to 6 weeks to reach maximum clinical effectiveness  Now considered first-line drugs for depression
32
Newer-Generation | Antidepressants (cont’d)
``` trazodone (Desyrel)  bupropion (Wellbutrin)  SSRIs  fluoxetine (Prozac)  paroxetine (Paxil)  sertraline (Zoloft)  fluvoxamine (Luvox)  citalopram (Celexa)  escitalopram (Lexapro ```
33
Newer-Generation | Antidepressants (cont’d)
``` venlafaxine (Effexor)  nefazodone (Serzone)  mirtazapine (Remeron)  duloxetine (Cymbalta)  desvenlafaxine (Pristiq) ```
34
SSRIs
Mechanism of action  Selectively inhibit serotonin reuptake  Little or no effect on norepinephrine or dopamine reuptake Result in increased serotonin concentrations atnerve endings Advantage over tricyclics and MAOIs: little or no effect on cardiovascular system
35
Newer-Generation | Antidepressants: Indications
``` Depression Bipolar disorder   Obesity  Eating disorders  Obsessive-compulsive disorder Panic attacks or disorders  Social anxiety disorders Posttraumatic stress disorders (PTSDs)  Treatment of various substance abuse problems (bupropion [Zyban] is used for smoking cessation treatment ```
36
Newer-Generation | Antidepressants: Adverse Effects
``` Body System Effects CNS Headache, dizziness,tremor,nervousness,insomnia,* fatigue GI Nausea diarrhea Nausea, diarrhea,constipation, dry mouth Other Sexual dysfunction,weight gain*, weight loss*, sweating ```
37
Serotonin Syndrome
Signs/symptoms  Delirium, tachycardia, hyperreflexia, shivering,agitation, sweating, muscle spasms, coarse tremors Signs/symptoms of severe cases Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC)
38
Newer-Generation Antidepressants: Drug Interactions
Highly bound to plasma proteins  Compete with other protein-binding drugs, resulting in more free, unbound drug to cause a more pronounced drug effect Inhibition of cytochrome P-450 system MAOIs
39
Antipsychotics
Drugs used to treat serious mental illness  Behavioral problems or psychotic disorders  Have been known as tranquilizers or neuroleptics Thioxanthenes: thiothixene (Navane)  Butyrophenones: haloperidol (Haldol)  Dihydroindolones: molindone (Moban)  Dibenzoxazepine: loxapine (Loxitane)  Phenothiazines: three structural groups  Atypical antipsychotics: new class
40
Mechanism of Action
Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function Result: tranquilizing effect in psychotic patients
41
Atypical Antipsychotics: Second-Generation Antipsychotics
``` clozapine (Clozaril)  risperidone (Risperdal)  olanzapine (Zyprexa)  quetiapine (Seroquel)  ziprasidone (Geodon)  aripiprazole (Abilify)  paliperidone (Invega) ```
42
Atypical Antipsychotics: | Mechanism of Action
Block specific dopamine receptors: DA-2 (D2) receptors Also block specific serotonin receptors: 5HT 2 5HT-(5HT2) receptors This is responsible for their improved efficacy and safety profiles
43
Antipsychotics: Indications
``` Treatment of serious mental illnesses  Bipolar affective disorder  Depressive and drug-induced psychoses  Schizophrenia Autism  Movement disorders (such as Tourette’s syndrome) Some medical conditions  Nausea, intractable hiccups ```
44
Adverse Effects
``` Body System Adverse Effects CNS Sedation, delirium Cardiovascular Orthostatic hypotension, syncope, dizziness, ECG changes Dermatologic Photosensitivity, skin rash, hyperpigmentation, pruritus ```
45
Adverse Effects (cont’d)
``` Body System Adverse Effects GI Dry mouth, constipation GU Urinary hesitancy or retention, impaired erection Hematologic Leukopenia and agranulocytosis Body System Adverse Effects Metabolic/endocrine Galactorrhea, irregular menses, increased appetite, polydipsia ```
46
Adverse Effects (cont’d)
Neuroleptic malignant syndrome (NMS)  Potentially life threatening  High fever, unstable BP, myoglobinemia  Extrapyramidal symptoms (EPS)  Involuntary muscle symptoms similar to those of Parkinson’s disease Akathisia (distressing muscle restlessness) Acute dystonia (painful muscle spasms)  Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
47
Adverse Effects (cont’d
Tardive dyskinesia (TD) Involuntary contractions of oral and facial muscles Choreoathetosis (wavelike movements of extremities) Occurs with continuous long-term antipsychotic therapy
48
Herbal Products: St. John’s Wort
Used for depression, anxiety, sleep disorders, nervousness May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity Severe interactions if taken with MAOIs and SSRIs Food-drug interaction with tyramine containing foods

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