Psychopharmocology

Question 1

Treatment of anxiety in pulmonary dz patients: buspirone, alprazolam, lorazepam, oxazepam, zolpidem, diazepam, promethazine, chlorpromazine, SSRIs, Beta blockers

Answer 1

-Buspirone is preferred for treatment of anxiety for patients with hypercapnia., but it can have a slow onset of action.
-COPD patients who do not retain CO2, benzos can decrease breathlessness
-Elderly or debilitated patients: use benzos with no active metabolites such as alprazolam, lorazepam, and oxazepam.
-Zolpidem does not alter respiratory drive in COPD patients, but rebound insomnia can occur.
Diazepman has no effect on breathlessness and can decrease exercise tolerance.
-Promethazine has same negative side effects as chlorpromazine.
-SRRIs can be helpful in treating panic disorders.
- Beta-blockers should NOT be used for anxiety in asthma patients.

Question 2

Drugs causing anxiety as a side effect: Theophylline and Beta-adrenergic bronchodilators

Answer 2

• Theophylline: causes anxiety, nausea, tremor, restlessness

- Beta-adrenergic bronchodilators: cause marked anxiety, tachycardia, and tremor.

Question 3

Treatment of Depression: SSRIs, Fluvoxamine, nortriptyline, desipramine, protriptyline

Answer 3

• When choosing an antidepressant, the side-effect profile and cytochrome P450 interactions with pulmonary drugs should be considered.
• SSRIs other than fluvoxamine are effective and have few DI.
• Many elderly pulmonary patients have comorbidities, so it is important to consider which drugs would prolong the QT interval.
• In elderly patients, nortriptyline or despipramine are preferred.
• Protriptyline may be helpful in sleep apnea by increasing respiratory drive.

Question 4

Treatment of Psychosis: cycloserine, isoniazid, corticosteroids

Answer 4

-Some pulmonary patients can become psychotic because of medications such as beta-agonist, cycloserine, isoniazid, or corticosteroids. The incidence of steroid psychosis is dose-related, seen in less than 1% of patients taking 40 mg or less of prednisone.

Question 5

Drug Interactions: theophylline, rifampin, amitriptyline, imipramine, fluoxetine, sertraine, buproprion, venlafaxine, and trazodone.

Answer 5

• Theophylline may be reduced from 50-80% by tobacco smoking.
• Alcohol can reduce clearance of theophylline as much as 30% in 24 hours.
• Most pulmonary meds do not affect lithium levels, except Theophylline, which can lower lithium levels by 20-30%
• Rifampin is a cytochrome P450 3A4 substrate and so may compete with many psychotropic drugs, including the antidepressants amitriptyline, imipramine, fluoxetine, sertraine, buproprion, venlafaxine, and trazodone.