Psychopharm Midterm Flashcards
Cost of bringing typical psychotropic drug to market
$1-2 billion
Time it takes a promising drug to be approved by the FDA
20 years
In order for a drug to be approved for a psychiatric condition, it must demonstrate safety and efficacy in ___ or more randomized placebo controlled trials regardless of the size of the study
2
- can have many failed trails and still get drug approved with 2 successful trials
- trials usually made up of young, healthy, etc. participants
FDA’s primary duty is to ______
Protect the public safety
Including: drug/food/cosmetic labels are accurate and drug is being used for/prescribed for given indication
Most commonly prescribed drug = ?
ADMs
The Split Model
Advantages:
Keeps psychotherapy focused on psychological issues.
Helps manage transference issues
Allows at least 2 observers to have input
May be superior to tx w/ different experts handling different aspects of care
May reduce cost
Disadvantages:
May undermine one modality of tx
May exacerbate splitting (e.g. w/ individual w/ BPD)
May retard integration through the dichotomy
May lead to a diffusion of responsibility (e.g. problematic if therapist thinks it’s prescribers job to handle meds only and don’t communicate when you see something that may be of concern and vice versa)
May be more expensive
Requires more work; communication
Possible patient responses to medication prescription/referral
Rejection
I’m too sick
This is a bio, not psych issue
I’m not in control
I’m cared for by powerful authority figures
It’s not my fault
I am one w/ my tx team as medication become a part of me
The medication = useful transitional object
Choosing a prescriber
Good working relationship (esp. regular communication)
Acceptance of role of psychotherapy
Clinically competent in psychopharm (won’t always be a psychiatrist, could be PCP or another med doctor)
Comfort w/ split tx
Personal style
How to:
Ask colleagues, university centers, ACNP/ACP, APA referral, phone book
At what points in time should you communicate with a psychopharmacologist?
At first consultation When pts condition changes acutely If the pt is significantly suicidal When a change in meds has occurred When there is a clinical question When there is significant splitting
Prescription privileges for psychologists offer what advantages (1) and what disadvantages (3)
Advantages:
Accessibility, esp. in rural areas
Disadvantages:
Can you feasibly train someone w/o medical background in 1-2 years?
Medicine is highly legislated
Malpractice issues
Define: Pharmacokinetics*
What the body does to the drug (to make use of it, then to eliminate it from the body). This includes the following processes: absorption, distribution, metabolism, and excretion.
Define: Absorption
the degree to which the drug is absorbed from the GI tract, affected by:
Solubility of the drug
Size of the drug
Presence of food in the GI tract
Will lessen presence of side effects such as nausea and vomiting
PH of the stomach
Blood flow in GI tract
Ex. taking antacids can impact absorption of drug
Define: Distribution
The degree to which a drug distributes itself throughout the body, affected by:
Membrane permeability
Plasma protein binding
Depot storage
Most drugs are lipophilic (love fat–chubby chasers)
Many drugs must be lipophilic to pass blood-brain barrier
Define: Metabolism*
Process by which the body transforms a drug to prepare it for removal. Process includes Phase I (liver oxidation) and Phase II (conjugation)
If there’s a liver issue, this can affect ability to break down drug → may need to avoid drugs, or reduce dose to accommodate
Define: Excretion
Removal of drug from the body, through urine (most commonly), as well as fecal and respiratory routes.
