Psychopharm Flashcards
Mental Health disorder symptoms are thought to occur because of…
changes in levels of neurotransmitters
The aim of medical treatment is to…
restore levels of neurotransmitters to a level at which patient no longer experiences symptoms
Antidepressants action
elevate serotonin and/or norepinephrine
Antidepressants indications
- depression
- anxiety disorders
- OCD
- PTSD
- Panic disorder
SSRI’s
Selective Serotonin Re-uptake Inhibitors
fluoxetine paroxetine fluvoxamine citalopram sertraline escitalopram vilazodone
SSRI Side Effects
- mild overall side effect profile
- may report GI symptoms
- change in appetite/weight loss
- HA
- sexual dysfunction
- may give person enough energy to act on thought os suicide
Serious Side Effects of SSRIs
Serotonergic Syndrome
Serotonergic Syndrome
- caused by mixing MAOIs and SSRIs
- overdose of SSRIs
- Taking two antidepressants at once
Symptoms of Serotonergic Syndrome
- agitation
- sweating
- fever
- rigidity
- tachycardia
- hypotension
- hyperreflexia
- extreme conditions=coma/death
SNRIs
- venlafaxine
- desvenlafaxine
- duloxetine
Other commonly used Antidepressants
- bupropion (Wellbutrin)
- mirtazapine (Remeron)
- desyrel (Trazodone)
Tricyclic antidepressants
(TCA)
increase levels of serotonin and norepinephrine
TCAs
amitriptyline (Elavil)
imipramine (Tofranil)
doxepin (Sinequan)
desipramine (Norpramin)
nortriptyline (Pamelor)
Main Side effects of TCAs
*Anticholinergic
- blurred vision
- dry mouth
- urinary hesitancy or retention
- constipation
Other side effects of TCAs
- orthostatic hypotension
- EKG changes due to cardiotoxicity
- sedation: due to blocking histamine
- memory and concentration disturbances
- HA
- fatigue
- impotence
**There is increased risk of fatal overdose with TCAs
MAOIs
Monoamine Oxidase Inhibitors
- inhibit the breakdown of monoamines, specifically Serotonin and Norepinephrine by inhibiting the catabolic enzyme
- also inhibits the metabolism of Tyramine (potent vasopressor
- foods containing Tyramine may stimulate hypertensive events, possibly hypertensive crisis
MAOI names
- isocarboxazid
- phenelzine
- tranylcypromine
Restricted Foods
- aged cheeses
- aged and cured meats
- dried or pickled fish
- liver
- bananas
- broad bean pods
- sauerkraut
- soy sauce and other soy condiments
- draft beer
- vitamins with Brewer’s yeast
Consume in Moderation
- red or white wine
- bottled or canned beer
- chocolate
- yogurt
Antipsychotics indication
treatment of acute and chronic psychosis
Antipsychotics action
dopamine antagonist
-blocks dopamine
Commonly Used Antipsychotics Atypicals
- clozapine
- risperidone
- olanzapine
- quetiapine
- ziprasidone
- aripiprazole
- lurasidone
Atypical/SGA: Clozaril
- most effective for + and - sx’s
- first a typical–very effective but some serious adverse rxns
- bone marrow suppression–can cause leukopenia–need weekly CBC with Diff q week for 1st 6 months–then q2wks
- increased risk of Szs
Interdisciplinary collaboration
- clozapine monitoring
- physician enrolls patient in registry, orders lab work (weekly WBC/ANC)
- nurse faxes lab work to pharmacy/physician as needed, monitors for symptoms of immunosuppression and delivers med
- pharmacist does not dispense med until new lab values are rec’d
SE for Clozaril & Zyprexa
- sedation
- constipation
- orthostasis
- low EPS
Zyprexa may cause…
appetite increase and is contraindicated with DM
Risperdal
- sedation
- orthostasis
- moderate EPS
- anticholinergic–low
- can cause elevated Prolactin levels
Seroquel
- orthostasis
- somnolence
- wt gain
Geodon
nausea
-somnolence
Abilify
nausea
- HA
- somnolence/insomnia
Typical antipsychotics
first generation antipsychotics
- effective only for POSITIVE sx’s of schizophrenia
- may mask or worsen NEGATIVE Sx’s
- classified as to potency (low, mid, high)
Commonly Used Typical Antpsychotics
- haloperidol
- fluphenazine
- trifluoperazine
- thiothixene
- loxapine
- perphenazine
- thioridazine
- chlorpromazine
Side effects of typical antipsychotics
Anticholinergic
General side effects of typical antipsychotics
- sedation (low)
- postural hypotension (low)
- dizzy (low)
- lightheadedness (low)
- decreased sweating
- potentiation of CNS depressants
Extrapyramidal Side Effects
- akathisia
- dystonias (cogwheeling test) (high)
- Parkinsonian Sx’s
Parkinson-like sx’s
- blunted affect
- mask-like expression
- tremor
- shuffling gait
Tardive Dyskinesia
- may be irreversible, may be prevented by use of low doses
- vitamin E, valproate, clonidine, clozapine, cholinergic drugs
gabaminergic drugs may be useful in treating
- discontinuation of the drug may lessen or reverse
- AIMS test (standardized exam)
NMS
Neuroleptic Malignant Syndrome
- idiosyncratic rxn to an antipsychotic drug
- potentially fatal
- all psychotropics seem to have the potential to cause NMS
- high dosages of high potency antipsychotic drugs have increased risk
- poor nutrition, dehydration, and concurrent medical illness
Major symptom of NMS
- rigidity
- high fever
- elevated level of enzymes (particularly CPK)
- diaphoresis
- pallor
- delirium
- autonomic instability (such as unstable BP)
Tx of NMS
- immediate discontinuation of all antipsychotic meds
- supportive medical care–rehydration and hypothermic measures
Depot Therapy
- Haldol and Prolixin (Decanoate)
- Risperdal now available
- long half life (they are active for 2-4 weeks due to slow release from muscle tissue
- called depot due to cyclical nature of tx
Medications used for EPS/Acute Dystonia
- Benztropine
- Diphenhydramine
- Lorazepam
Antimanics
mood stabilizers
-indicated for bipolar 1 (chronic manic episodes)
Lithium action
stabilizes the activity of electrolytes at the cell membrane and reduces cell excitability
Lithium indication
- prevention of manic episodes
- for many years, drug of choice–very safe
- eliminated by the kidneys in original form
- need to ensure good kidney fx
Need for lithium and sodium balance
- lithium has a chemical structure that is similar to sodium
- may compete at some sites
- if sodium intake is decreased, lithium is reabsorbed by the kidneys
- this leads to an increased risk of lithium toxicity
Lithium can be…
nephrotoxic/thyrotoxic
Need to monitor what with lithium
serum levels as well as periodic kidney/thyroid studies
Therapeutic Window for lithium
Narrow therapeutic window
0.5-1.5 mEq/L
Expected Side effects of Lithium
- tremors
- polydipsia
- polyuria
- dry mouth
- GI upset
- pulse irregularities
- wt gain
ADRs of Lithium
- electrolyte imbalance
- sodium balance important
- S/E’s worsen as level rises
- more severe sx’s usually correlated to levels from 2-3 mEq/L
Lithium toxicity
- vomiting
- diarrhea
- lethargy
- ataxia
- slurred speech
- blurred vision
- confusion
- sz
- coma
- death
Atypical Antipsychotics
indicated for bipolar 1
(acute manic episodes)
- aripiprazole
- olanzapine
- quetiapine
- risperidone
- ziprasidone
Anticonvulsants
These anticonvulsants have shown varied levels of effectiveness in management of bipolar illness and some are indicated for acute manic episodes as well as maintenance therapy.
Anticonvulsants may raise…
the threshold at which neurobiological messages can trigger mood changes
_______ and _________ required periodic serum levels
valproic acid and cabemazepine
-both have undesirable side effects and idiosyncrasies
Anxiolytics
antianxiety agents
Primary class anxiolytics
benzos
benzo’s action
inhibit CNS excitability by binding to the benzo-GABA-chlorider receptor complex
-enhance the activity of GABA at the GABAa receptor
Benzo indications
- anxiety
- agitation
- insomnia
- tension
- panic disorder
- agoraphobia
- Szs
- muscle spasms
- dystonias
- restless leg syndrome
Benzo names
- lorazepam/Ativan
- alprazolam/Xanax
- clonazepam/Klonopin
- chloridiazepoxide/Librium
- diazepam/Valium
Benzo side effects
- drowsy
- fatigue
- decreased concentration
- confusion
- disorientation
- decreased coordination
Major drawback to Benzos
- tolerance and dependence
- serious W/D complications
- recommended for short term use only
Benzo has synergistic effects when combined with….
ETOH
Benzos not to be used for…
sleep apnea; use cautiously in COPD due to depression of the respiratory center of the brain
buspirone
for anxiety
- works on serotonin
- also NE and DA
- takes up to four weeks to reach effectiveness (no good for prn use)
hydroxyzine
short term anxiety treatment
propranolol
used sometimes for performance anxiety
stage fright
Anti-aggression agents
- antianxiety
- antipsychotic
- tegretol
- lithium
- beta blockers
Augmentation
variety of meds can be used along with the primary pharmacological agent that may serve to boost its effect
commonly used: lithium, antianxiety, desyrel, antipsychotic, anticonvulsants
Patient Education: Depression
- take daily
- 2-4 weeks to see noticeable effect
- continue to take even after you feel better
- do not stop without checking with HCP
- contact HCP when questions arise
Preventing noncompliance: schizophrenia
- discuss adherence in nonthreatening nonjudgmental way
- remember persuasion is better than coercion
- focus on any possible day to day benefit of the drug
- match idea of taking drug with achieving life goals
