Week 6 Part 1: Psychopharmacology Flashcards
What is the predominant goal for medication getting to the public
Safety
Before 1950s what drugs were usually used for psychiatric illnesses? What has it expanded to since then?
1950s - Sedatives and Amphetamines
Now - antipsychotics, antidepressants, anti anxiety meds
Psychotropic medications are intended to be utilized…
with adjunct therapies - individual and group psychotherapy
combo therapies and meds lead to best results
___ have become the dominant treatment of psychiatric disorders
medications
What is the purposes of psychotropic drugs
relieve or reduce symptoms of dysfunctional thoughts, moods, or actions, mental illness or disorder
improve client functioning
increase clients adhered or compliance to other therapies
increase productivity and independence - the end goal!
Reasons for Nonadherence to Psychotropic Med Regimen
Expensive - Unaffordable
Unpleasant or distressing SE
Stopping because they feel they no longer need them
May not believe they have an illness warranting the meds
Stigma
denial or fears about medication usage from mental illness like paranoia
Pharmocodynamnics
study of mechanisms of acton and biochemical and physiologic effects of drugs
What is the main basic principle of psychopharmacology
mental illness symptoms result from chemical imbalances within the nervous system (CNS - brain and spinal cord)
Neurotransmission
process in which the interactive systems help the brain navigate the internal and external stimuli and allows the brain to create consciousness awareness of sensory perceptions
the brain decides how to respond to the stimuli, stores the memories of the response, and then subsequent responses are usually behavioral with some accompanied emotions
Any disruption in neurotransmission…
can affect cognition or the ability to accurately perceieve, or process incoming information or stimuli
4 Sites of Pharmacodynamic Action
Receptors
Ion Channels
Enzymes
Carrier Proteins: Uptake Receptors
Where are neurotransmitters stored and release
in the axon terminals of the presynaptic neuron
electrical impulses through the neuron wil; stimulate NT release into the synaptic cleft which determines whether another electrical impulse is generated
Reuptake
the process of NT inactivation by which the NT is reabsorbed into the presynaptic neuron form which it had been released
The funamental action of psychotropic medications is to…
alter either the transmission or reception of nerve impulses resulting in the increasing or slowing of nervous system functions
3 types of Psychotropic Meds
- Antidepressants
- Antipsychotics
- Benzodiazepines (Anti-Anxiety)
Antidepressants
class of psychotropic drugs that block reuptake of NT
Antipsychotics
class of psychotropic drugs that block dopamine and other receptors
Benzodiazepines
class of anti anxiety drugs
facilitates transmission of GABA to decrease excitability
How long does relief of symptoms take with antidepressants
initial improvement for some in 7 days but takes several weeks to get complete relief
Why should antidepressants never be discontinued abruptly
uncomfortable symptoms such as depression and anxiety from withdrawal, which are often worse than the original depression leading to a vicious cycle
Why is there an increased risk of suicidal behavior sometimes associated with anti depressants
increased in children and adolescents
but risk for suicide increases because they feel better and gain energy before they are fully relieved of depression
Types of Antidepressants
SSRI
SNRI
NDRI
NaSSA
SARI
SSRIs
selective serotonin reuptake inhibitors - antidepressant
inhibit serotonin reuptake by blocking presynaptic neuron increasing serotonin concentration
ex: Prozac, Selexa, Lexapro, Zoloft, Paxil, Luvox
SE of SSRIs
HA
anxiety
insomnia
transient nausea and vomiting
diarrhea
sedation
sexual dysfunction
diastolic HTN
increased perspiration
SNRIs
serotonin norepinephrine reuptake inhibitors - antidepressant
prevent reuptake of serotonin and NEP at presynaptic site
ex: Effexor, Serzone, Cymbalta, Norpramin
Side Effects of SNRIs
same as SSRIs + increased blood pressure
NDRI
NEP Dopamine Reuptake INhibitor - antidepressant
INhibits reuptake of dopamine NEP and serotonin
ex: Wellbutrin, Zyban
SE of NDRIs
agitation
anxiety
insomnia
appetite suppression
psychosis
increased seizures
It is very important to do what prior to giving NDRIs
VERIFYING PREVIOUS SEIZURE HX SINCE IT INCREASES INCIDENCE
NaSSA
alpha 2 antagonists - antidepressants
boosts NEP/Noradrenaline serotonin by blocking alpha 2 adrenergic presynaptic receptors on a serotonin receptor
ex: Remeron
SE of NaSSA
sedation (at lower doses)
dizziness
weight gain
dry mouth
constipation
change in urinary fxn
SARI
serotonin 2 antagonist/reuptake inhibitor - antidepressant
blocks serotonin 2A receptor potently and serotonin reuptake less potently
ex: Deyrel
SE of SARIs
sedation
weight gain
NV
constipation
dizziness
fatigue
incoordination!
tremor!
What can cause a toxic, sometimes fatal, reaction when used with an SSRI
MAOIs
SSRI use can boost the effects of what drugs
Tricycle antidepressants
hydantoin
clozapine
haloperidol
beta blockers
st johns worts (EVEN OTC!!!)
warfarin
etc
SSRI can decrease effects of ___ and ___
digoxin and buspirone
What popular psych drug can increase effects of SSRI
lithium
What can occur when SSRIs are used with other drugs that increase serotonin
Serotonin Syndrome - emergency!
S/S of Serotonin Syndrome
mental status change - hallucination, agitation, coma
Autonomic instability - tachycardia, hyperthermia, BP changes
Neuromuscular problems - hyperreflexia, incoordination
GI disturbance - NVD
Serotoning syndrome can be __ ___
life threatening
The effects of SSRIs are generally not seen for ___-___ days and it will take how long to reach full client benefit?
10-21 days
takes weeks longer after the first 10-21 days to reach full benefit
What is important to teach the patient regarding SSRI/SNRI
relief not immediate - will be experienced in time
skipping a dose can cause withdrawal symptoms
low to medium dose may cause sexual SE
Tricyclic Antidepressants
TCAs
Made in 60s - first drug to treat major depression
blocks NEP and serotonin and AcH - works on a lot of NT systems and serotoning reuptake
ex: Elavil, Tofranil, Asendin, Norpramin, Vivactil
TCA S/S
Early Morning Wakening, Anxiety, Weight Loss Panic, Compulsive Disorders - for those responding well
Blocking NEP, Serotonin and AcH has cholinergic effects = dry mouth, blurred vision, Urinary retention, delayed micturation, confusion, constipation, hypotension
others: tremors, restlessness, insomnia, NV, confusion, pedal edema, HA, seizures, blood dyscrasia
The most common side effects of TCAs are
sedation
orthostatic Hypotension
anticholinergic SE like dry mouth, blurry vision, urinary retention and delay, confusion, constipation, and hypotension
the biggest s/s of TCAs is
early morning awakening
TCAs are as effective as ___, but…
SSRIs, but have more serious side effects and a higher lethal potential
If the TCA causes sedation….
dose should be given at bedtime
The more sedating the TCA…
the more anticholinergic properties it has
TCA dosage for elderly is ___ adult dose
1/2
Alcohol intake in conjunction with TCA causes ___ and ___
sedation and ataxia
Why can’t suicidal clients take TCAs
because of fatal cardiac and cerebral toxicity in overdoses of TCA
___ and ___ are effective in treating depression, but are not as safe or well tolerated as antidepressants like SSRI, SNRI, NDRI
MAOI and TCAs
2 Important OTC Anti Depressants
St Johns Wort
Kava
St Johns Wort (SJW)
used for depression, pain anxiety, insomnia, and premenstrual syndrome
modulates serotonin, dopamine, and NEP
Risk of developing serotonin syndrome when taken with other serotonergic drugs
Kava
used for anxiety reduction
interacts with dopaminergic transmission, inhibits MAO-B enzyme system and modulates GABA receptors
risk for severe liver injury, thrombocytopenia, leukopenia, and hearing impairment