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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