objective 2.1 (3) Flashcards
Used in the treatment of emotional and mental disorders
psychotherapeutic drugs
what are the types of psychotherapeutic drugs?
Anxiolytic drugs
Mood-stabilizing drugs
Antidepressant drugs
Antipsychotic drugs
Reduce anxiety by reducing overactivity in the central nervous system
anxiolytic drugs
MOA: Depress activity in the brainstem and limbic system
Possible increase action of GABA thus blocking nerve transmission in the CNS.
benzos
Commonly used for panic disorders
Indicated for generalized anxiety disorder (GAD), short-term relief of anxiety symptoms, panic disorder and anxiety associated with depression
Adverse effects: confusion, ataxia, headache, and others
Interactions: alcohol ,antacids, oral contraceptives, and others
alpraxolam
reduced use and replaced with shorter acting benzo’s.
Indications: relief of anxiety, management of alcohol withdrawal, reversal of status epilepticus, preoperative sedation, and as an adjunct for the relief of skeletal muscle spasms
Avoid in patients with hepatic dysfunction.
Adverse effects: headache, confusion, slurred speech, and others
Interactions: alcohol, oral contraceptives, and others
diazepam
intermediate acting benzo. Given to agitated clients, and for treatment or prevention of ETOH withdrawal.
Intermediate-acting benzodiazepine
Can be given intravenously or intramuscularly; useful in the treatment of an acutely agitated patient
Continuous infusion for agitated patients who are undergoing mechanical ventilation
Used to treat or prevent alcohol withdrawal
lorazepam
MOA: not fully understood, lithium ions are thought to alter NA ion transport in nerve cells, which results in a shift in catecholamine metabolism.
Narrow therapeutic range: acute mania—lithium serum level of 1 to 1.5 mmol/L. Maintenance serum levels should range between 0.6 mmol/L and 1.2 mmol/L.
Levels exceeding 1.5 to 2.0 mmol/L begin to produce toxicity (severe reaction exceeding 2.0 mmol/L), including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death.
Keeping the sodium level in the normal range (135 to 145 mmol/L) helps maintain therapeutic lithium levels.
lithium
what are the first gen antidepressants?
tricyclics
tetracyclics
MAOIs
what are the second gen antidepressants?
SSRIs
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous
Have largely been replaced by SSRIs as first-line antidepressant drugs
Now considered second line drugs
Example: amitriptyline (Elavil® )
MOA: Block reuptake of neurotransmitters, causing accumulation at the nerve endings. It is thought that these drugs may help regulate malfunctioning neurons.
Indications: Neuropathic pain, insomnia, Childhood enuresis (imipramine), Obsessive compulsive disorders (OCDs) (clomipramine), Sometimes, anorexia
Adverse Effects: Sedation, Impotence, Orthostatic hypotension
Interactions: Increased anticholinergic effects when taken with anticholinergics and phenothiazines -When taken with MAOI’s, there may be increased therapeutic and toxic effects. Including excessive fever
tricyclic antidepressants
Rarely used for depression
Used for Parkinson’s disease
Disadvantage: potential to cause hypertensive crisis when taken with tyramine
MAOIs and Tyramine
Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death
Patients must avoid foods that contain tyramine!
Aged, mature cheeses (cheddar, blue, Swiss)
Smoked, pickled, and aged meats, fish, and poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (e.g., Chianti, burgundy, sherry, vermouth) * Italian broad beans (fava beans)
monoamine oxidase inhibitors (MAOIs)
phenelzine sulphate and tranylcypromine sulphate
nonselective MAOIs
selegiline hydrochloride
selective MAOIs
MOA: :SSRI’s: Inhibition of serotonin reuptake
SNRI’s: inhibit the reuptake of both serotonin and norepinephrine, with the exception of bupropion ( a weak norepinephrine-dopamine reuptake inhibitor)
Indications: Depression
SSRIs & SNRI’s: BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, the neurologic disorder myoclonus, and various substance misuse problems such as alcoholism
Bupropion (Zyban) is used for smoking cessation
Adverse effects: insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction, serotonin syndrome (delirium, agitation, tachycardia, etc, box 17.1)
Interactions: 2 nd gen highly bound to albumin, when given with other drugs that are highly bound to protein, they compete for binding sites on the surface of albumin (warfarin, phenytoin)-leads to more free drug/more pronounced drug effect
second gen antidepressants
Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation. Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy
Zyban® : approved for smoking cessation treatment and was the first nicotine-free prescription medication used to treat nicotine dependence
bupropion hydrochloride
Indications: depression, generalized anxiety disorder (GAD), and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis
Adverse effects: dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity. Drug interactions: SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury). Can worsen uncontrolled angleclosure glaucoma
dulozetine hydrochloride
Drugs used to treat serious mental illness
Drug-induced psychoses, schizophrenia, and autism
Also used to treat extreme mania (as an adjunct to lithium), BPD, depression that is resistant to other therapy, certain movement disorders (e.g., Tourette’s syndrome), and certain other medical conditions (e.g., nausea, intractable hiccups)
Conventional, or first-generation antipsychotics: phenothiazines (largest chemical class)
Second-generation antipsychotics
Atypical antipsychotics (newest, not as severe adverse effects)
Mechanism of Action: Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function. Dopamine levels in the CNS are decreased. Result: tranquilizing effect in psychotic patients
Indications: Psychotic illness, most commonly schizophrenia, Anxiety and mood disorders, prochlorperazine (antiemetics)
antipsychotics
Indications: long-term treatment of psychosis
Contraindications: hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken
Oral, intramuscular
Useful in treating patients with schizophrenia who were nonadherent to their drug regimen
haloperidol
Mechanism of Action: They have a reduced effect on prolactin levels and improvement in the negative symptoms associated with schizophrenia
Block specific dopamine receptors: dopamine-2 (D2 ) receptors
Also block specific serotonin receptors: serotonin-2 (5-HT2 ) receptors
this is responsible for their improved efficacy and safety profiles.
antitypical antipsychotics
Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
Associated with minor or no EPS
Adverse effects: blood dyscrasias
clozapine
Indication: schizophrenia (including negative symptoms)
Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day.
Oral and long-acting injectable forms
risperidone
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; many other drug interactions
Food–drug interaction with tyramine-containing foods
St. Johns wort
Adverse Effects
CNS: Drowsiness, Diuresis, Miosis, Convulsions Nausea, vomiting
Non-CNS: Hypotension, Constipation, Decreased urinary retention, Flushing of the face, neck, and upper thorax, Sweating, urticaria, and pruritus, Respiratory depression
opioids
Elevation of mood, Reduction of fatigue, Increased alertness, Invigorated aggressiveness
Adverse Effects: CNS: Restlessness, Syncope (fainting), Tremor, Talkativeness, Irritability, Insomnia, Fever, Euphoria, Confusion, Suicidal or homicidal tendencies. Cardiovascular: Headache, Pallor or flushing, Palpitations, Tachycardia, Cardiac dysrhythmias, Hypertension or hypotension, . Gastrointestinal: Dry mouth, Metallic taste, Anorexia, Nausea, Vomiting, Diarrhea, Abdominal cramps. Fatal hyperthermia
Overdose: Death results from Convulsions, Coma, Cerebral hemorrhage
May occur during periods of intoxication or withdrawal
Withdrawal: Peak period 1 to 3 days; Duration 5 to 7 days
Signs: Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
Symptoms: Depression, suicidal thoughts and behaviour, paranoid delusions
No specific pharmacological treatments
stimulants
Pill form/Powder form: snorted or injected
Crystallized form
Also known as “ice,” “crystal,” “glass,” “crystal meth”
Smokable; more powerful form
Sales of over-the-counter ephedrine, pseudoephedrine, and red phosphorus are now restricted to be beyond the counter in pharmacies only.
methamphetamine
Also known as “ecstasy” and “E”; “Raves”
Usually prepared in secret home laboratories. More calming effects than other amphetamine drugs , Usually taken by pill
Cocaine: From the leaves of the coca plant, Snorted or injected intravenously
Highly addictive—physical and psychological dependence
Powdered form
Also called “dust,” “coke,” “snow,” “flake,” “blow,” “girl”
Crystallized form (smoked)
Also called “crack,” “freebase rocks,” “rock”, “candy”
methylenedioxymethamphetamine
Drugs that relieve anxiety, irritability, and tension when used as intended
Also used to treat seizure disorders and induce anaesthesia
depressants
anxiety, to induce sleep, to sedate, and to prevent seizures
benzos
sedatives and anticonvulsants and to induce anaesthesia
barbiturates
what are the AE of marihauana
Adverse Effects
CNS: Drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, and paradoxical reactions
Gastrointestinal: Nausea, vomiting, constipation, dry mouth, and abdominal cramping
Pruritus and skin rash
Marihuana: “amotivational” syndrome
More accurately known as ethanol
Causes CNS depression by dissolving in lipid membranes in the CNS
Few legitimate uses of ethanol and alcoholic beverages
Used as a solvent for many drugs
Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution)
Drug Effects:
CNS depression: Respiratory stimulation or depression , Vasodilation, producing warm flushed skin, Increased sweating, Diuretic effects
alcohol
Many smoke to “calm nerves.”
Releases epinephrine, which creates physiological stress rather than relaxation
Tolerance develops
Physical and psychological dependency
Withdrawal symptoms occur if stopped.
No therapeutic uses
Drug Effects: Transient stimulation of autonomic ganglia, Followed by morepersistent depression of all autonomic ganglia; CNS and respiratory stimulation followed by CNS depression; Increased heart rate and BP; Increased bowel activity; Nicotine found in nature (i.e., tobacco plants) has no known therapeutic uses; Nicotine is medically significant because of its addictive and toxic properties.
nicotine
