Psychotropic Medications

Question 1

What are psychotropic medications?

Answer 1

meds that affect NTS, typically GABA, NE, DA, and 5HT receptors and are primarily used to manage thoughts and behaviours

Question 2

Psychotropic medications are used to treat…

Answer 2

depression
bipolar
schizophrenia 
anxiety 
sleep disorders

Question 3

____% of Canadiens are unsure whether they would socialize with a friend who has a mental illness

Answer 3

42

Question 4

___% of Canadians say they would be unlikely to enter a spousal relationship with someone who has a mental illness

Answer 4

55%

Question 5

In any given year, how many Canadians experience mental health or addiction problems

Answer 5

1/5

Question 6

Psychotropic medication use is how common?

Answer 6

10.1% of the general population

Question 7

most often often side effects are ______ and short lived and can be treated _________

Answer 7

minimal

symptomatically

Question 8

Classes of psychotropic meds

Answer 8

antidepressants
antipsychotics
mood stabilizers
antiolytics (anti anxiety)

Question 9

Types of antidepressants

Answer 9

SSRI (Selective Serotonin Reuptake Inhibitors

5HT and NE reuptake inhibitors

Question 10

SSRI

Answer 10

Selective Serotonin Reuptake Inhibitors

Celexa, Cipralex, Prozac, Zoloft, Paxil

Question 11

Serotonin and norepinephrine reuptake inhibitors

Answer 11

Effexor, Cymbalta, and Prestiq

often used for depression and anxiety and treats the general malaise associated with depressive symptoms, come in extended release formats

Question 12

Most common side effects with SSRIs and SNRIs

Answer 12

sexual side effects
Placid but flaccid
men have inability to have erection, women decreased libido, both have difficulties reaching climax

other side effects typically include nausea, headache, increased blood pressure, fatigue, sedation, dizziness

Often if a person has comorbid health issues they will be prescribed with caution

Question 13

Atypical Antidepressants

Answer 13

work on dopamine receptors

fewer side effects and are more commonly seen in the geriatric population

Wellbutrin, Remeron, Trazodone

Question 14

Most antidepressants take ______ to give full effect, this is called “therapeutic range”.
What hapnned when the therapeutic range is reached?

Answer 14

4-6 weeks

When the therapeutic range is reached most often the side effects are minimal and manageable:
e.g. using gum or candy to manage dry mouth, increase fiber intake to treat constipation

Question 15

Antipsychotic Medications

Answer 15

2 classes:
Typical or 1st generation:
- Haldol, Largactil, Nozinan, Loxapine

Atypical or 2nd generation:
- Abilify, Zyprexa, Seroquel, Clozapine, Risperidone

Question 16

How do antipsychotics work?

Answer 16

Most work on the brain’s ability to produce and absorb dopamine.
- Too much causes POSITIVE symptoms such as hearing voices, seeing things, hyper vigilance

• Too little casues NEGATIVE symptoms such as lack of motivation, poor self care, flat affect

Question 17

2nd Generation Antipsychotics

Answer 17

work well on both positive AND negative symptoms and can decrease suicidal and depressive thoughts in psychotic disorders/episodes

easier to take, last longer, increased compliance

less side effects involving movement and muscle spasms. Side effects do include hunger, which results in weight gain, sedation, increase risk of diabetes

Question 18

Long acting “depot” antipsychotics

Answer 18

used to manage people with severe and persistent mental health issues in a community setting.

Injection (given by a nurse) is typically given deep into muscle, and will last 1-4 weeks.

Works more quickly with severe psychosis due to depression, bipolar disorder and schizophrenia

Question 19

Mood Stabilizers

Answer 19

Often used to treat bipolar or manic episodes

Can have some moderate effect on depressive symptoms but are usually added to an antidepressant

Question 20

Lithium

Answer 20

mechanism of action not fully understood but used effectively for 70+ years

takes about 2-4 weeks to reach therapeutic level

regular blood tests to monitor lithium level, kidney and thyroid function

Question 21

lithium toxicity symptoms

Answer 21

unsteady gait, poor judgement, difficulties with memory and problem solving (cognitive function). Often if people present with these symptoms they are thoughts to be intoxicated

Question 22

Anxiolytics

Answer 22

some medications are used on an “as needed” basis to control acute episodes of panic or anxiety:
Benzodiazepines
Beta Blockers

Question 23

Benzodiazepines

Answer 23

work by quickly by slowing down the central nervous system

breath slower, more deeply, heart rate is reduced, and that “fight or flight” feeling is lessened, giving a sense of calm.
It can however impair judgement and slow reaction time, generally people will report feeling “tipsy”

If it ends in “PAM” it’s likely a Benzo

ativan, rivotril, valium, xanax, lorazepam, clonaazepam, diazepam, alprazolam

Question 24

Beta Blockers

Answer 24

Typically used for cardiac and blood pressure management

• can reduce anxiety by blocking the effects of norepinephrine, thus giving a short acting, feeling of calm without as much slowed reaction or recall as a benzo.
• Useful for managing social phobias, public speaking, specific anxieties

Question 25

Risks involved with Benzodiazepines

Answer 25

benzodiazepines work quickly and effectively and are highly addictive.

build tolerance quickly, thus requiring a greater dosage.

when mixed with alcohol or other medications and street drugs can have a fatal CNS depressant effect

Question 26

Stopping medications: Benzodiazepines

Answer 26

Abruptly stopping benzodiazepines can result in seizures, therefore tapering slowly is recommended

Question 27

Stopping medications:

antidepressants and mood stabilizers

Answer 27

result in withdrawal symptoms such as nausea, headaches, vomiting, diarrhea, achiness

more importantly rebound insomnia and rebound depression can occur with worsened onset and symptoms.

Question 28

ADHD is treated with…

Answer 28

stimulants or non-stimulants

Methylphenidates (stimulant): Ritalin (short-acting), Concerta (long-acting),

Amphetamines (stimulant): Dexedrine (short-acting), Adderall (long-acting)

Atomoxetine (non-stimulant): Strattera (24 hr. – takes about 4-6 weeks to see effect

Question 29

side effects with ADHD medication

Answer 29

Side effects: headaches, weight loss, insomnia,low appetite

Question 30

Eating disorders drugs

Answer 30

meds used to manage related depressive/anxious symptoms

Prozac approved for bulimia

Question 31

Personality disorders drugs

Answer 31

mood stabilizers, anti-depressants, anti-psychotics to treat related symptoms

Question 32

Geriatric/Pediatric considerations

Answer 32

Usually less of the drug is needed to be effective

Side effects typically happen more quickly and severely

can impeed cognitive functioning so require closer monitoring during initiation of treatment

Start Low - Go Slow

Question 33

Dementia

Answer 33

Acetylcholinesterase inhibitors are used for mild-moderate dementia and include donepezil (Aricept), rivastigmine (Exelon), and galatamine (Reminyl)
Increase the amount of acetylcholine in the brain

Question 34

How are they prescribed?

Answer 34

Most psychotropic drugs can be effectively managed by a family doctor who has a good relationship with the patient who can give a good history and self monitor symptoms

Question 35

Which medications are right?

Answer 35

person’s history, sleeping, eating, function, family history
availability
side effects
comorbid health issues
other medications
compliance
trial and error

Question 36

Will meds cure everything?

Answer 36

NO!
many people that require medications will benefit greatly from additional treatment such as talk therapy, socialization, lifestyle support such as healthy rest, eating, and stress management