Chapter 16 Psychotherapeutic Drugs Flashcards Preview

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Flashcards in Chapter 16 Psychotherapeutic Drugs Deck (63):
1

Psychotherapeutic Drugs

-Used in the treatment of emotional and mental disorders
-Ability to cope with emotions can range from
occasional depression or anxiety to constant
emotional distress.
-When emotions significantly affect an
individual’s ability to carry out normal daily
functions, treatment with a psychotherapeutic
drug is a possible option.

2

Three main emotional and mental disorders

Anxiety
Affective disorders
Psychoses

3

Types of psychotherapeutic drugs

-Anxiolytic drugs
-Mood-stabilizing drugs
-Antidepressant drugs
-Antipsychotic drugs

4

Anxiety

-Unpleasant state of mind characterized by a sense of dread and fear
-May be based on actual anticipated experiences or past experiences
-May be exaggerated responses to imaginary negative situations

5

Six major anxiety disorders (persistent anxiety)

-Obsessive-compulsive disorder (OCD)
-Posttraumatic stress disorder (PTSD)
-Generalized anxiety disorder (GAD)
-Panic disorder
-Social phobia (social anxiety disorder)
-Simple phobia

6

Affective Disorders (Mood Disorders)

-Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions)
-Some patients may exhibit both mania and depression: bipolar disorder (BPD)

7

Psychosis

-Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living.
-Hallmark: loss of contact with reality
-Examples:Schizophrenia, Depressive and drug-induced psychoses

8

Anxiolytic Drugs

Reduce anxiety by reducing overactivity in central nervous system (CNS)

9

Benzodiazepines

Depress activity in the brainstem and limbic system

10

Miscellaneous drug: buspirone (BuSpar)

-Nonsedating and non–habit forming
-May have drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)
-Do not administer with MAOIs

11

Benzodiazepines

-alprazolam (Xanax)
-diazepam (Valium)
-lorazepam (Ativan)

12

Benzodiazepines: Adverse Effects

Benzodiazepines’ adverse effects are an overexpression of their therapeutic effects
-Decreased CNS activity, sedation
-Hypotension
-Drowsiness, loss of coordination, dizziness, headaches
-Nausea, vomiting, dry mouth, constipation
Others

13

Benzodiazepines: Overdose

-Dangerous when taken with other sedatives or alcohol
-Treatment is generally symptomatic and supportive.
-Flumazenil (Romazicon) may be used to reverse benzodiazepines’ effects.

14

Benzodiazepines: Interactions

-Alcohol and CNS depressants can result in additive CNS depression and even death.
-More likely to occur in patients with renal or hepatic compromise

15

Alprazolam (Xanax)

-Most commonly used as an anxiolytic
-Indicated for GAD, short-term relief of anxiety symptoms, panic disorder, and anxiety associated with depression
-Adverse effects: confusion, ataxia, headache, and others
-Interactions: alcohol,oral contraceptives, and others

16

Diazepam (Valium) Indications

relief of anxiety, management of alcohol withdrawal, reversal of status epilepticus, preoperative sedation, and as an adjunct for the relief of skeletal muscle spasms

17

Avoid Diazepam (Valium) in what patients?

patients with hepatic dysfunction

18

Diazepam (Valium) Adverse effects:

headache, confusion, slurred speech, and others

19

Diazepam (Valium) Interactions:

alcohol, oral contraceptives, and others

20

Lorazepam (Ativan)

-Intermediate-acting benzodiazepine
-Can be given by IV push; useful in the treatment of an acutely agitated patient
-Continuous infusion for agitated patients who are undergoing mechanical ventilation
-Used to treat or prevent alcohol withdrawal

21

Mood-Stabilizing Drugs

-Lithium carbonate and lithium citrate
-Other drugs may be used in combination with lithium
Benzodiazepines
Antipsychotic drugs
Antiepileptic drugs
Dopamine receptor agonists

22

Lithium

-Drug of choice for the treatment of mania
-It is thought to potentiate serotonergic neurotransmission

23

Lithium Narrow therapeutic range:

-acute mania—lithium serum level of 1 to 1.5 mEq/L; maintenance serum levels should range between 0.6 and 1.2 mEq/L
-Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity, including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death.
-Keeping the sodium level in the normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels.

24

Lithium Adverse effects

-Most serious adverse effect is cardiac dysrhythmia
-Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension
-Long-term treatment may cause hypothyroidism.

25

Antidepressants

-Tricyclic antidepressants
-Monoamine oxidase inhibitors (MAOIs)
-Second-generation antidepressants
SSRIs
Serotonin-norepinephrine reuptake inhibitors
(SNRIs)

26

Tricyclic Antidepressants

-Have largely been replaced by SSRIs as first-line antidepressant drugs
-Considered second line
-For patients who fail with SSRIs or other newer
generation antidepressants
-As adjunct therapy with newer generation
antidepressants
-amitriptyline (Elavil)

27

Tricyclic Antidepressants: Mechanism of Action

-Block reuptake of neurotransmitters, causing accumulation at the nerve endings
-It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression

28

Tricyclic Antidepressants: Indications

-Depression
-Childhood enuresis (imipramine)
-OCDs (clomipramine)
-Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia

29

Tricyclic Antidepressants: Adverse Effects

-Sedation
-Impotence
-Orthostatic hypotension
-Others
-Older patients: Dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors

30

Tricyclic Antidepressants: Overdose

-Lethal: 70% to 80% die before reaching the hospital
-CNS and cardiovascular systems are mainly affected.
-Death results from seizures or dysrhythmias
-No specific antidote
Decrease drug absorption with activated charcoal.
Speed elimination by alkalinizing urine.
Manage seizures and dysrhythmias.
Provide basic life support.

31

Amitriptyline (Elavil)

-Oldest and most widely used of all the TCAs
-Original indication was depression
-Commonly used to treat insomnia and neuropathic pain
-Contraindications: known drug allergy, pregnancy, and recent myocardial infarction
-Adverse effects: dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias

32

Monoamine Oxidase Inhibitors (MAOIs)

-Nonselective: isocarboxazid, phenelzine, and tranylcypromine
-Selective: selegiline
-Rarely used for depression
-Used for Parkinson’s disease
-Disadvantage: potential to cause hypertensive crisis when taken with tyramine

33

MAOIs and Tyramine

Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death

34

Avoid foods that contain tyramine!

Aged, mature cheeses (cheddar, bleu, Swiss)
Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)

35

Selegiline Transdermal Patch (Emsam)

-Selective MAO-B inhibitor
-Indicated for major depression
-Contraindication includes known drug allergy.
-Adverse drug effects
-Avoid exposing the patch to external sources of heat or prolonged direct sunlight because heat speeds absorption.

36

Second-Generation Antidepressants

-vortioxetine (Brintelix)
-Fewer adverse effects than TCAs and MAOIs
-Very few drug–drug or drug–food interactions
-Still take about 4 to 6 weeks to reach maximum clinical effectiveness
-Now considered first-line drugs for depression
-Mechanism of action: inhibition of serotonin reuptake and possible effects on norepinephrine and dopamine reuptake

37

Second-Generation Antidepressants Indications

-Depression
-BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, PTSD, premenstrual dysphoric disorder, the neurologic disorder myoclonus, and various substance abuse problems such as alcoholism

38

Second-Generation Antidepressants Adverse Effects

insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction

39

Common Symptoms of Serotonin Syndrome

-Delirium
-Agitation
-Tachycardia
-Sweating
-Myoclonus (muscle spasms)
-Hyperreflexia
-Shivering
-Coarse Tremors
- Extensor plantar muscle responses

40

Bupropion

-Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation
-Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy

41

Zyban

approved for smoking cessation treatment and was the first nicotine-free prescription medicine used to treat nicotine dependence

42

Citalopram (Celexa)

-One of the most commonly used SSRIs
-Treatment of depression and OCD
-Discontinuation syndrome
-Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

43

Duloxetine (Cymbalta) Indications

depression, GAD and pain resulting from diabetic peripheral neuropathy or fibromyalgia

44

Duloxetine (Cymbalta) Adverse Effects

dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity

45

Duloxetine (Cymbalta) Drug Interactions

-SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury)
-Can worsen uncontrolled angle-closure glaucoma

46

Fluoxetine (Prozac)

-Prototypical SSRI
-Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder
-Contraindications: known drug allergy and concurrent MAOI therapy
-Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

47

Mirtazapine (Remeron)

-Promotes the presynaptic release of serotonin and norepinephrine in the brain
-Sedation

48

Mirtazapine (Remeron) Indications

depression, including that associated with BPD, reducing the sexual adverse effects in male patients receiving SSRI therapy, and appetite stimulant

49

Mirtazapine (Remeron) Contraindication

drug allergy and MAOIs

50

Mirtazapine (Remeron) Adverse Effects

drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia

51

Mirtazapine (Remeron) Drug interactions

additive CNS depressant effects with alcohol and CYP inhibitors

52

Antipsychotics

-Drugs used to treat serious mental illness
-Drug-induced psychoses, schizophrenia, and
autism
- Also used to treat extreme mania (as an adjunct
to lithium), BPD, depression that is resistant to
other therapy, certain movement disorders (e.g.,
Tourette’s syndrome), and certain other medical
conditions (e.g., nausea, intractable hiccups)
-Have been known as tranquilizers or neuroleptics

53

Antipsychotics: Mechanism of Action

-Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function
-Dopamine levels in the CNS are decreased.
-Result: tranquilizing effect in psychotic patients

54

Positive Symptoms of Schizophrenia

hallucinations, delusions, and conceptual disorganization

55

Negative Symptoms of Schizophrenia

apathy, social withdrawal, blunted affect, poverty of speech, and catatonia

56

Indications: Antipsychotic Drugs

-Psychotic illness, most commonly schizophrenia
-Anxiety and mood disorders
-Prochlorperazine: antiemetics

57

Adverse Effects: Antipsychotic Drugs

-Agranulocytosis and hemolytic anemia
-CNS effects:Drowsiness, Neuroleptic malignant syndrome (NMS), Extrapyramidal symptoms (EPS): pseudoparkinsonism-akathisia, acute dystonia-treated with benztropine (Cogentin) and trihexyphenidyl (Artane), Tardive dyskinesia
-Insulin resistance
-Weight gain
-Changes in serum lipid levels
-Metabolic syndrome

58

Haloperidol (Haldol)

-Indications: long-term treatment of psychosis
-Contraindications: hypersensitivity, Parkinson’s disease, and in patients taking large amounts of CNS depressants
-Oral, intramuscular, intravenous
-Useful in treating patients with schizophrenia who were nonadherent with their drug regimen

59

Atypical Antipsychotics:Mechanism of Action

-Block specific dopamine receptors: dopamine-2 (D2) receptors
-Also block specific serotonin receptors: serotonin 2 (5-HT2) receptors
-This is responsible for their improved efficacy and safety profiles.

60

Clozapine (Clozaril)

-Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
-Associated with minor or no EPS
-Adverse effects: blood dyscrasias

61

Risperidone (Risperdal)

-Indication: schizophrenia, including negative symptoms
-Adverse effects: minimal EPS at therapeutic dosages of 1 to 6 mg/day
-Risperdal Consta: long-acting injectable form; lasts approximately 2 weeks
-Invega Sustenna: long-acting injection; lasts 1 month

62

Herbal Products: St. John’s Wort

-Used for depression, anxiety, sleep disorders, nervousness
-May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity
-Severe interactions if taken with MAOIs and SSRIs; many other drug interactions
=Food–drug interaction with tyramine-containing foods

63

Herbal Products: Ginseng

-Three varieties; has been used for more than 5000 years
-Uses: stress reduction, improvement of physical endurance and concentration
-May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms
-Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs