Psychopharm

Question 1

Main Drug Categories

Answer 1

Antidepressants
Anxiolytics
Bipolar medications (Mood stabilizers + antidepressants; anxiolytics)
Antipsychotics
Analgesics (painkillers)
Psychostimulants
Dementia medication (2) (cholinesterase inhibitors, monoclonal antibodies that bind to beta amyloids)

Question 2

Major Side Effects (Drug categories)

Answer 2

Antidepressants: initial increased suicidality, nausea, headache?

Anxiolytics: benzos (addiction), initial increased anxiety?

Bipolar meds
- mood stabilizers: lithium must be monitored regularly for toxicity
- anti depressants
- anxiolytics (benzo)

Antipsychotic: increased appetite & weight gain, TD

Analgesics: NSAID increase likelihood of bleeding, some are addictive (opioids) and deadly with combined with alcohol

Psychostimulants: addictive

Dementia medication

Question 3

Major Interactions

Answer 3

Opioids and alcohol
SSRIs + St John, serotonin syndrome
SSRIs + alcohol = lesser effect
Anticonvulsant antipsychotics can cause birth defects
Older adults and anyone taking multiple medications should be careful about interactions

Question 4

Important things to communicate to ct: antidepressants

Answer 4

May take 2-4 weeks to start noticing improvement, typically starting with somatic symptoms (energy, improved sleep, appetite). mood symptoms tend take longer.

length of treatment varies, typically 6-8 weeks for depressive episode. taper off, consulting with provider. never stop cold turkey.

antidepressants are not addictive

avoid alcohol, may block effect of some antidepressants

two bx that always improve depression: exercise and reducing intake of substances that impair sleep (alcohol & caffeine)

Question 5

important things to communicate to ct: anxiolytics

Answer 5

2-6 weeks to notice improvement from medication. Medication is ongoing, not just when feeling anxious.

Medication alone is not enough, must be combined with therapy, biofeedback, stress management, relaxation training, exercise.

Do not discontinue meds or tranquilizers cold turkey.

Avoid alcohol if taking tranquilizers.

Strong evidence that panic disorder is biochemical not psychological, so medication treatment is highly effective (benzo). Meds must be taken daily, only phase 1 of treatment. Phase 2 involves exposure.

Question 6

important info to communicate to ct: bipolar meds

Answer 6

Medication is important for preventing relapse; continue taking meds after episode has ended.

If taking lithium, must monitor often to prevent toxicity (blood levels)

bipolar meds are not addictive

bipolar often runs in families. bipolar is a biological disorder, not a character flaw. person must have safety/protection plan.

support groups are available. provide ct’s with local or online support group information

anticonvulsant mood stabilizers can cause birth defects, consult provider if planning to get pregnant

lifestyle management is essential for stability: regular sleep schedule, avoid sleep deprivation, avoid drugs and alcohol

Question 7

important info to communicate to ct: antipsychotics

Answer 7

Side effects must be discussed (akathysia: restlessness, tardive dynskinesia TD)

Continue taking after episode to prevent relapse. Treatment lasts at least 1 year, longer for chronic schizophrenia.

Avoid uppers; can lead to psychosis

Antipsychotics can cause sun sensitivity

Antipsychotics are not addictive

Question 8

important info to communicate to ct: analgesics

Answer 8

Opioids are addictive. Must avoid alcohol! Avoid strong opioids whenever possible. Side effects: respiratory suppression, drowsiness, constipation

Morphine: end of life, heart attack, cancer, trauma pain

Pain should be treated. Try weakest drug that can achieve desired results.

NSAID can cause stomach side effects, can cause bleeding. Affect CNS

Non-analgesics sometimes used
- antidepressants for neuropathic pain and fibromyalgia
- anticonvulsants (gabapentin) for neuropathic non-chronic pain