Chapter 7 Psychiatric and Related Drugs

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Selective Serotonin Reuptake Inhibitors (SSRI)

Blocks the reuptake (i.e reabsorbtion) of serotonin, thus increasing concentration of that neurotransmitter with little effect on another important neurotransmitter, norepinephrine

Clinical Depression

most common severe psychiatric disorder. Men experience depression later in life and effects more women than men experience depression

Tricyclic Antidepressants (TCA) (have anticholergenic SE)

Prevents neuron reuptake of norepinephrine and/or serotonin, many unusual dosing forms; cream (Zonalon) is used for pruritus (itching) in adults and elderly. Topical form should not be used for more than 8 days. Oral liquid is used by dentists for "burning mouth syndrome"

Monoamine Oxidate Inhibitors (MAOI) (Used when other antidepressants fail)

Inhibits enzymes that breakdown norepinephrine and serotonin. Second-line treatment because of their many interactions with foods and other drugs. Most beneficial in atypical depression and used to treat conditions other than depression

Selective Serotonin Reuptake Inhibitors (SSRI) Drug of Choice

Prozac (Fluoxetine) - Depression, Bulimia, OCD and PMDD

Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)

Increases both serotonin and norepinphirine; when SSRI's do not work

Cyclic Antidepressant (TCA) Drug of Choice

Doxepin (Sinequan, Zonalon) - Capsule, Cream or Oral Liquid

TOFRANIL (Cyclic Antidepressant)

Imipramine - Antidepressant; Used mostly for bedwetting

Drug of Choice for Bipolar

Divalproex (Depakote) and valproic acid (Depakene) - Particularly effective in patients with rapid changes of mood (rapid cyclers). May replace Lithium

Drug of Choice for Bipolar Disorders

Lithium (Eskalith, Lithobid)

Mania

Mood of extreme excitement, excessive elation, hyperactivity, agitation and increased psychomotor activity

Bipolar Disorder

a mood disorder in which the person alternates between periods of major depression and periods of mild to severe chronic agitation (mania)

Antidepressants

drugs that combat depression by affecting the levels of activity of neurotransmitters, specifically serotonin and norepinephrine

Cyclic Antidepressants

Include varieties that contain 3 fused rings of carbon atoms (tricyclic) and 4 fused rings (tetracyclic). Tricyclic antidepressants (TCA's) produce a response in greater than 50% of patients

Bupropion (Wellbutrin, Zyban)

Been approved as an aid to smoking cessation as well as for seasonal affective disorder (SAD)

Lithium (Eskalith, Lithobid)

take 2 to 3 times a day, salt intake should remain constant during treatment, treating bipolar (manic-depressive) disorder, acute mania and prophylaxis of unipolar and bipolar disorder. Only mood stabilizer that has consistently shown to decrease the risk of suicide for bipolar patients

Schizophrenia

a chronic psychotic disorder manifested by retreat from reality, delusions, hallucinations ambivalence, withdrawal and bizarre or regressive behavior; primary indication for using antipsychotic drugs (or neuroleptic drugs as they are sometimes called)

The "older" or "typical" antipsychotic drugs

antagonize dopamine receptors in all four of the dopamine pathways, leading to negative side effects and causes muscle control problems

The "new" or "atypical" antipsychotic drugs

limit dopamine-blocking ability to the limbic system pathway; considered first-line agents; chosen on the basis of cost, limited adverse effects and a patients response history; symptoms such as emotional and social withdrawal, ambivalence and poor self-care usually do not respond to drug treatments

Atypical Antipsychotic Drugs Side Effects

weight gain, hyperglycemia, new-onset diabetes and dislipidemia

Endocrine

patients on antipsychotics should be monitored closely for weight gain, development of diabetes and an increase in cholesterol levels

Tardive dyskinesia

late-onset neurologic side effects occur after 6 months of treatment; involves involuntary movements of mouth, lips and tongue that are sometimes accompanied by involuntary movements of limbs or trunk

Atypical Antipsychotic Drug of Choice

Olanzapine (Zyprexa)

Sleep and Sleep Disorder

fundamental to human health, research has recognized 4 stages

4 Stages of Sleep

Stage I: involves nonrapid eye movements (NREM), subject is somewhat aware of their surroundings and is relaxed
Stage II: also involves nonrapid eye movements (NREM), subject is unaware of surroundings but can be easily awakened
Stages III & IV: involves nonrapid eye movements (NREM), increased autonomic activity and by episodes of REM sleep with dreaming, if possible; this deep sleep occurs 4 to 5 times per night. Approximately 6% seek physician's help

Alcoholism

disease that can be arrested but not cured, lifetime disease and is potentially fatal, a complex genetic disease

Effects of Alcohol on Metabolism

Ehtanol (alcohol) is an anesthetic, causes loss of consciousness

Dependence and Withdrawal from Alcohol

Benzodiazapines will also prevent detoxification-related seizures and delirium tremens ("DTs"), a condition caused by cessation of alcohol consumption, in which coarse, irregular tremors are accompanied by hallucinations

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