objective 2.1 (3)

Question 1

Used in the treatment of emotional and mental disorders

Answer 1

psychotherapeutic drugs

Question 2

what are the types of psychotherapeutic drugs?

Answer 2

Anxiolytic drugs
Mood-stabilizing drugs
Antidepressant drugs
Antipsychotic drugs

Question 3

Reduce anxiety by reducing overactivity in the central nervous system

Answer 3

anxiolytic drugs

Question 4

MOA: Depress activity in the brainstem and limbic system
Possible increase action of GABA thus blocking nerve transmission in the CNS.

Answer 4

benzos

Question 5

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

Answer 5

alpraxolam

Question 6

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

Answer 6

diazepam

Question 7

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

Answer 7

lorazepam

Question 8

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.

Answer 8

lithium

Question 9

what are the first gen antidepressants?

Answer 9

tricyclics
tetracyclics
MAOIs

Question 10

what are the second gen antidepressants?

Answer 10

SSRIs
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous

Question 11

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

Answer 11

tricyclic antidepressants

Question 12

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)

Answer 12

monoamine oxidase inhibitors (MAOIs)

Question 13

phenelzine sulphate and tranylcypromine sulphate

Answer 13

nonselective MAOIs

Question 14

selegiline hydrochloride

Answer 14

selective MAOIs

Question 15

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

Answer 15

second gen antidepressants

Question 16

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

Answer 16

bupropion hydrochloride

Question 17

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

Answer 17

dulozetine hydrochloride

Question 18

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)

Answer 18

antipsychotics

Question 19

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

Answer 19

haloperidol

Question 20

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.

Answer 20

antitypical antipsychotics

Question 21

Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
Associated with minor or no EPS
Adverse effects: blood dyscrasias

Answer 21

clozapine

Question 22

Indication: schizophrenia (including negative symptoms)
Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day.
Oral and long-acting injectable forms

Answer 22

risperidone

Question 23

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

Answer 23

St. Johns wort

Question 24

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

Answer 24

opioids

Question 25

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

Answer 25

stimulants

Question 26

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.

Answer 26

methamphetamine

Question 27

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”

Answer 27

methylenedioxymethamphetamine

Question 28

Drugs that relieve anxiety, irritability, and tension when used as intended
Also used to treat seizure disorders and induce anaesthesia

Answer 28

depressants

Question 29

anxiety, to induce sleep, to sedate, and to prevent seizures

Answer 29

benzos

Question 30

sedatives and anticonvulsants and to induce anaesthesia

Answer 30

barbiturates

Question 31

what are the AE of marihauana

Answer 31

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

Question 32

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

Answer 32

alcohol

Question 33

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.

Answer 33

nicotine