Psychopharmacology Flashcards
4 principal parts or the brain:
Cerebrum
Dienchephalon
Brain stem
Cerebellum
4 stages of pharmacokinetics
Absorption
Distribution
Metabolism
Elimination
The common medical issue that caused depression - 10-% of MDD
Hypothyroidism
3 treatment of depression
Acute treatment - 6 to 8 weeks
Continuation treatment - minimum 6 months
Maintenance treatment - continued and lifelong
Acute treatment
begins with first dose until the patient is asymptomatic (6-8 weeks in best scenario$
Continuation treatment:
- To avoid acute relapse, strongly suggested that patients continue treatment for minimum of 6 months
- Should be maintained on the same dosage as the acute treatment phase.
Maintenance treatment
- For relapse prevention
- Subsequent episode of depression tend to be more severe and resistant to treatment.
- Continued and lifelong treatment provides the best outcome and protects chronic sufferers from recurrent major depression.
Common errors in medication treatment of depression
- under dosing
- poor compliance
-misdiagnosis (esp problematic with bipolar)
-co-morbid substance abuse (reduces effectiveness of meds) - longer term use of benzo
- premature discontinuation
- rapid discontinuation ( esp problematic with venlafaxine and paroxetine)
- serotonin syndrome
Primary medication for bipolar
Lithium - providing long term mood stabilisation.
7-fold reduction in suicide rates
What medications increase the risk of Parkinson’s
Lithium and antidepressants
Medication for GAD
SSRI - if not responding to psychotherapy
Benzo - if not history of alcohol/substance abuse (severe symptoms)
Benzo/diazepam - Valium
Medication for stress related anxiety/adjustment disorders, if severe
Benzo
Medication for panic disorder
Benzo, antidepressants, MAO inhibitors - eliminate frequency and intensity of panic attacks through anti-panic drugs
Medication for social phobia/anxiety
- Sensitive to rejection : MAO inhibitors, venlafaxine, SSRI’s
- Stage fright/public speaking : beta blockers (propanolol/inderal)
Treatment errors
- SSRI’s present with increased anxiety as a side effect in the first few weeks of tx can lead to discontinuation
- Prescribing benzo to patient with personal of family history with substance abuse
- Benzo in use with elderly can cause cognitive impairments and contribute to unsteady gait and falls
Side effects of antipsychotics
- Sedation
- Anticholinergic
- Extrapyramidal (EPS): parkinson-like side effects, akathisia, acute dystonias, tardive dyskinesia
- weight gain
-metabolic effects
Medication for OCD
Serotinergic antidepressants (with behaviour therapy)
Medication for borderline personality disorder - only target symptoms not the personality
SSRI’s : for anger, sensitivity to rejection and impulsivity
Low dose of antipsychotics : for emotional instability and peculiar thinking
Medication for ADHD
Newest research targets dopamine dysregulation in the frontal cortex.
Main treatment - stimulants (methylphenidate/ritalin)
but antidepressants (wellbutrn/strattera) and alpha-adrenergic agonists (catapress, intuniv) can also support these primary meds or used as monotherapy.
Medication for eating disorders
Atypical antipsychotics to reduce delusional thinking
Bulimia treated like depression
Medication for PTSD
SSRI’s - target anxiety/depression
**Benzo’s are ineffective and contribute to worse outcomes
