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Pharmacology: Psychotropic Drugs
Terms in this set (75)
an unpleasant state of mind chiefly characterized by a sense of fear or dread
Anxiety is treated with
anti-anxiety agents, also called anxiolytic agents.
Anxiety is most commonly treated with.
either a class of drugs known as Benzodiazepines or buspirone.
Examples of benzodiazepines include
Miscellaneous drugs used to treat anxiety include
Other drugs that may rarely be used to treat anxiety include:
Benzodiazepines: Mechanism of action
depress activity in the brainstem and limbic system by increasing the action of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits nerve transmission in the CNS.
anxiety, ethanol withdrawal, insomnia, muscle spasms, seizure disorders, and used as adjuncts in anesthesia and depression.
allergy, angle-closure glaucoma, pregnancy, renal or liver dysfunction, chemical abuse, and history of seizure.
Benzodiazepines: Adverse Effects
Amnesia, anorexia, ataxia, cognitive impairment, confusion, depression, dizziness, drowsiness, GI disturbance, euphoria, headache, slurred speech, visual changes, CNS depression, hypotension, paradoxical reactions (opposite of those that would normally be expected), and rebound disinhibition (such as profound somnolence).
Highly habit-forming and addictive.
Benzodiazepines: Toxicity and Overdose
overdose results in somnolence, confusion, coma, respiratory depression.
Treatment is generally symptomatic and supportive; however a medication called flumazenil (Romazicon), a benzodiazepine receptor blocker, can be administered to reverse the effects.
Alcohol and other CNS depressants.
Oral contraceptives, azole antifungals, SSRIs, verapamil, diltiazem, opioids, valproic acid - increased sedation
Rifampin - benzo not as effective.
Theophylline - decreased sedation.
Phenytoin - digoxin and phenytoin toxicity.
buspirone (Buspar): Mechanism of Action
unknown, but appears to have agonist activity at the serotonin and dopamine receptors.
buspirone (Buspar): Indications
strictly for anxiety.
buspirone (Buspar): Interactions
risk for serotonin syndrome when used with antidepressants, MAOIs, ketaconazole, clarithromycin.
buspirone (Buspar): Contraindications
buspirone (Buspar): Adverse Effects
paradoxical anxiety, dizziness, blurred vision, headache, nausea.
buspirone (Buspar): Advantages over benzodiazepines
less sedative and non-habit forming.
buspirone (Buspar): Disadvantages over benzodiazepines
not immediate acting, takes 2-3 weeks before s/sx reside.
Affective disorders, also called mood disorders, are characterized by
changes in mood and range from mania to depression.
2 main drug categories used in the treatment of affective disorders include
mood-stabilizing drugs, and
Mood-Stabilizing Drugs include
Antidepressant Drugs include:
Monoamine Oxidase Inhibitors (MAOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
amitriptyline (Elavil) is what class of antidepressant
selegiline transdermal patch, and Emsam (for Parkinson's Disorder), are examples of which class of antidepressant?
Monoamine Oxidase Inhibitors (MAOI's)
fluoxetine (Prozac), and trazodone (Desyrel) are examples of which class of antidepressant?
Selective Serotonin Reuptake Inhibitors (SSRI's)
Lithium: Mechanism of Action
believed that lithium ions alter sodium ion transport in the nerve cells, which causes a shift in catecholamine metabolism.
Lithium: available routes
manic episodes in bipolar disorder and maintenance for prevention of such episodes
dehydration, known sodium imbalance, renal or cardiovascular disease.
Lithium: Adverse effects
drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements, ataxia, hypotension, GI discomfort, tremor, confusion, somnolence, seizures, cardiac dysrhythmias, and death.
thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, NSAIDS.
Serum Lithium and Sodium Levels must be monitored.
Lithium: Acute management has a target serum concentration of
Lithium: Maintenance therapy has a target serum concentration of
One major complication of management of Bipolar disorder with lithium is
noncompliance with medication regimen, due to side effects of medication and patient's perception of his or her illness.
Tricyclic antidepressants (TCA's)
one of the 1st generation antidepressants, but since the development of newer drugs, TCAs are rarely used for depression anymore.
Tricyclic antidepressants: Mechanism of Action
work by correcting imbalances of serotonin and norepinephrine at the nerve endings.
Tricyclic antidepressants: Indications
Indications - depression, neuropathic pain, insomnia, enuresis, OCD.
Tricyclic antidepressants: Contraindications
allergy, use of MAOIs, pregnancy, cardiac problems, history of seizures.
Tricyclic antidepressants: Adverse Effects
constipation, urinary retention, dysrhythmias, hypotension, sedation, seizures, sexual dysfunction,
, anticholinergic (drying) effects, etc.
Tricyclic antidepressants: Interactions
Anticholinergics and phenothiazides
- increased anticholinergic effects.
- increases effects.
- toxic effects.
- increased action of warfarin.
Tricyclic antidepressants: Toxicity and Management of Overdose
Overdoses with these meds are lethal. Death is more likely if the medication is taken with alcohol
There is no antidote.
-Sodium Bicarbonate, diazepam (Valium), and antidysrhythmics
-Basic Life Support.
Monoamine Oxidase Inhibitors (MAOIs)
One of the 1st generation antidepressants
Very potent, but rarely used.
4 MAOI's currently in use include
isocarboxazid, aka Marplan.
penelzine, aka Nardil.
tranylcypromine, aka Parnate.
selegiline, aka Eldepryl (oral) or Emsam (transdermal).
Monoamine Oxidase Inhibitors (MAOIs): Mechanism of Action
inhibits the MAO enzyme system in the CNS, which doesn't allow dopamine, serotonin, and norepinephrine to be broken down; thus increasing levels of these amines in the body.
Monoamine Oxidase Inhibitors (MAOIs): Indications
used for treatment of resistant depression and oral forms of Selegiline is used for Parkinson's Disease.
Monoamine Oxidase Inhibitors (MAOIs): Adverse effects
most occur as a result of interactions with food (tyramine) causes hypertensive crisis.
Orthostatic hypotension, tachycardia, palpitations, edema, dizziness, sedation, restlessness, insomnia, HA, anorexia, abd cramps, nausea, blurred vision, impotence.
Food the should be avoided for patients taking MAOI's include
Aged cheeses; smoked or pickled meats, aged or fermented meats, yeast extracts, red wines, Italian broad beans
Monoamine Oxidase Inhibitors (MAOIs): Interactions
OTC (especially cold and flu)
- adverse CV effects
Diphenhydramine and cetrizine
- increased CNS depression.
- hypertensive crisis
Potentiates effects of meperidine (CONTRAINDICATED)
cause increased risk of developing serotonin syndrome (washout period of 2-5 weeks between drugs is recommended).
Monoamine Oxidase Inhibitors (MAOIs): Toxicity and Overdose Management
Primary s/sx - tachycardia, circulatory collapse, seizures, coma, hyperthermia, miosis
Treatment - gastric lavage, urine acidification, hemodialysis, IV hypotensive med administration.
newer generation antidepressants (3 types)
Selective Serotonin Reuptake Inhibitors (SSRIs)
- first line therapy.
2nd generation antidepressants
3rd generation antidepressants, aka selective norepinephrine reuptake inhibitors (SNRI's).
Selective Serotonin Reuptake Inhibitors:
Mechanism of Action - slows or inhibits the reuptake of serotonin in the brain thus increasing the levels of serotonin.
Examples of Selective Serotonin Reuptake Inhibitors
fluoxetine, aka Prozac.
paroxetine, aka Paxil.
sertaline , aka Zoloft.
fluvoxamine, aka Luvox.
citalopram, aka Celexa.
escitalopram, aka Lexapro.
Second generation antidepressants: Mechanism of Action.
inhibit the reuptake of serotonin, norepinephrine, and to some degree dopamine .
Second generation antidepressants include
trazodone, aka Desyrel.
bupropion, aka Zyban or Wellbutrin.
Third generation antidepressants: Mechanism of Action
inhibit the reuptake of serotonin, norepinephrine, and to some degree dopamine.
Third Generation antidepressants include
venlafaxine, aka Effexor.
duloxetine, aka Cymbalta.
desvenlafazine, aka Pristiq.
Newer generation antidepressants: Indications
depression, bipolar disorder, obesity, eating disorders, OCD, panic attacks, social anxiety disorder, PTSD, premenstrual dysphoric disorder, myoclonus, and substance abuse problems.
Newer generation antidepressants: Contraindications
allergy, use of MAOI within 14 days, certain antipsychotic drugs, history of CV disease and seizures. Can't take Bupropion with eating disorders nor seizures.
Newer generation antidepressants: Adverse effects
insomnia, weight gain, sexual dysfunction, serotonin syndrome, treatment of which, is usually self-limiting on discontinuation of the causative drugs.
delirium, agitation, tachycardia, sweating, myoclonus, hyperreflexia, shivering, coarse tremors, hyperthermia, seizures, rhabdomyolysis, renal failure, cardiac dysrhythmias, and disseminated intravascular coagulation (DIC).
Newer generation antidepressants: Interactions
Warfarin and phenytoin
- higher levels of unbound drugs and produces more pronounced drug effects
- 2 to 5 week washout between
- enhances the action
- can cause serotonin syndrome.
Severe mental disorder that often impairs mental function to the point of causing significant disability in performing ADLs, such as drug induced psychoses, schizophrenia, autism, extreme mania, bipolar disorder, movement disorders (Tourette's), and some medical conditions (intractable hiccups).
Antipsychotic medications, typically called Phenothiazines, are divided into two classes
First generation antipsychotics
First generations antipsychotics: Mechanism of Action
Block dopamine in the CNS (limbic and basal ganglia
First generation antipsychotics include
Atypical antipsychotics: Mechanism of Action
block dopamine, serotonin, alpha receptors, and histamine receptors.
Atypical antipsychotics include
clozapine, aka Clozaril.
risperidone, aka Risperdal.
olanzapine, aka Zyprexa.
quetiapine, aka Seroquel.
ziprasidone, aka Geodon.
aripiprazole, aka Abilify.
Antipsychotic drugs: Indications
psychotic illnesses, primarily schizophrenia.
Antipsychotic drugs: Contraindications
allergy, comatose state, CNS depression, brain damage, liver or kidney failure, blood dyscrasias, and uncontrolled epilepsy.
Antipsychotic drugs: Adverse effects part 1
postural hypotension, lightheadedness, reflex tachycardia,
extrapyramidal movement disorders
, dystonia, parkinsonism,
tardive dyskinesia (will be treated with Cogentin)
, prolactin secretion, menstrual changes, sexual dysfunction, sedation, drowsiness,
, weight gain, blurred vision, worsening narrow angle glaucoma,
Antipsychotic drugs: Adverse effects part 2
dry mouth, tachycardia, constipation, urinary retention, decreased sweating, nocturia,
neuroleptic malignant syndrome, fever, and unstable blood pressure
, hepatotoxicity, leukopenia,
agranulocytosis (decreased white blood cells, weekly white blood cell counts)
, photosensitivity, rash, pruritis, polydipsia, impaired temperature regulation.
- additive hypotensive effects
- additive effects
- enhances effects of clozapine (Clozaril)
- reduces effects of clozapine (Clozaril).
Don't forget to review
the patient teaching tips and points to remember at the end of this chapter!!
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