Psychopharmacology for Physical Therapists

Why should physical therapists understand pharmacology for their practice?

-So we can understand the consideration of its impact on health, function, and or disability and how well a patient can participate in therapeutic exercise

What are pharmacotherapeutics?

Use of drugs to prevent, treat, or diagnose disorders with minimal adverse effects

What is toxology?

The study of harmful effects of chemicals

-Environmental toxins, poisons, and therapeutic agents

What are pharmacokinetics?

The process by which a drug is absorbed, distributed, metabolized (degraded), or eliminated (excreted)

What are pharmacodynamics?

What the drug does to body and the receptors responsible for this reaction

What are ways drugs are absorbed?

-Oral

-Sublingual

-Rectal

-IV

-Intramuscular

-Subcutaneous

-Intrathecal

-Inhalation

-Topical

-Iontophoresis

-Transdermal

What affects the amount of the drug that reaches the bloodstream?

-Route of administration

-Physical properties of the drug

-Drug formulation of immediate or delayed release

-Patient nutritional status

-Gastric emptying rate

-Interactions with other drugs

-Age

-Diet

-Gender

-Disease state

How are drugs metabolized?

-Liver: enzymes transform drugs into more water soluble metabolites

-Kidneys: Traps water soluble compounds for elimination

-Drugs may be stored in the body in adipose, bone, muscle, liver, and kidney

How are drugs eliminated?

-Liver: repeated drug exposure increases efficiency (increased drug tolerance)

-Water soluble compounds released from kidneys: urine, feces, air, and sweat

-Lungs, breast milk, bile, skin, and saliva

What do drugs do to interact with the body?

Interact with receptors, affinity, selectivity, agonists, and antagonists

What are neurotransmitters drugs interact with?

-Dopamine

-Serotonin

-Norepinephrine

-Gamma Amino Butyric Acid (GABA)

-Acetylcholine

-Glutamate

What are the functions or norephinephrine?

-Alertness

-Concentration

-Energy

-Attention

-Anxiety

-Impulse

-Irritability

-Mood

-Cognitive function

What are the functions or serotonin?

-Obsessions and compulsions memory

-Appetite

-Sex

-Aggression

-Anxiety

-Impulse

-Irritability

-Mood

-Cognitive function

What are the functions or dopamine?

-Pleasure

-Reward

-Motivation/Drive

-Attention

-Cognitive function

-Mood

-Appetite

-Sex

-Aggression

What are Beers criteria for potentially harmful meds?

-Anticonvulsants

-Antipsychotics

-Benzodiapenes

-Tricyclic antidepressant agents

-Selective serotonin re-uptake inhibitors (SSRIs)

-Opioids (except for fractures and joint replacements

What is psychopharmacology?

-Study of medicine for the brain

What are psychotropic drugs?

-Artificially created chemicals that alter brain chemistry

-A class of drugs used to treat symptoms of psychiatric illnesses

What are the classes of psychotropic drugs?

-Anti-anxiety (anxiolytics)

-Antipsychotics

-Antidepressants

-Mood stabilizers

-Anti-epilepsy drugs

-Psychostimulants

-Antiparkinsonian

What are Anti-anxiety (anxiolytics) drugs?

-Benzodiazepines: for panicking

-Non-benzodiazepines (Ambien, Restoril)

-Buspar

-Beta blockers to reduce physiological symptoms of anxiety for sweating, tremulousness, shallow/rapid breathing, elevated HR

-Rizulole: Antiglutamatergic drug used to treat ALS demonstrating effectiveness in treating, refracotry, anxious depression, and GAD

-Pagoclone: Treatment of PDS mediated anxiety and panic, especially in PTSD

What are PT implications for anxiolytics?

-Drowsiness

-Decreased motor performance

-Anterograde amnesia

-Dizziness, headache, nausea, and restlessness

-Tolerance and physical dependence for sleep disturbance

-Complex behaviors

-Peak effect takes 2-4 hours

-Increases fall risk

-Exercise routine, massage, relaxation techniques and yoga for non-pharmaceutical interventions

What are antipsychotic drugs?

Treat psychosis to split off reality function, disruption in mood/thought and impaired cognition

-Causes: schizophrenia, psychotic depression, acute mania, TBI, drug intoxication/withdrawal, severe personality disorder, sleep deprivation

What do first gen antipsychotic drugs do?

-Manage hallucinations, agitation, paranoia, disorganization, delusions, thought disorder, serious side effects, tardive dyskinesia

-Prolixin, haldol, stelazine, mellarial, navene

What do second gen antipsychotic drugs do?

Manage emotional withdrawal, lack spontaneity, isolation, poverty of speech and action, flat affect, anhedoina, inanition, less serious side effects

-Clozaril, risperdal, invega, zyprexa, seroquel, geodon, serlect, zomaril, saphris, latuda

What do anti-depressants meds treat?

-Depression

-Dysthymia

-Anorexia nervosa

-Bullimia nervosa

-Generalized anxiety disorder

-Social anxiety

-PTSD

-Insomnia

-Borderline personality disorder

-PMDD

-Post-menopausal symptoms

-ADHD

-Chronic pain syndromes

-Tourette's disorder

-Compulsive disorder

-Drug craving/withdrawal

-Body dysmorphic disorder

-Conduct disorder

-Impulse control disorders

-Smoking cessation

What are the 5 categories for anti-depressants?

-Tricyclic antidepressants

-Selective serotonin reuptake inhibitors

-Monoamine oxidase inhibitors

-SNRIs

What are characteristics of tricyclic antidepressants?

Lethal in moderate doses

-Prescriber must be careful if patient has suicidal ideation

What characteristics of selective serotonin reuptake inhibitors (SSRIs)?

-Widely prescribed, lower side effect profile

-New concerns with pregnancy

-Withdrawal syndromes, osteoporosis in older adults, weigth gain, and sleep disturbances

What characteristics of monoamine oxidase inhibitors (MAOIs)?

-Suppresses MAO from degrading serotonin- critical to follow dietary restrictions

-Now being developed as transdermal- less concern with diet

What are mood stabilizer drugs used for?

-Bipolar disorder

-May be used alone or with other therapies

-Lithium carbonate has high toxicity for liver/kidney, weight gain, edema, tremor, GI upset, best drug for mania

-Anticonvulsants and atypical antipsychotics

What is the complication of taking meds with alcohol?

-Alcohol potentiates effect of antidepressants

-Alcohol may wash out a drug before its effect

-Alcohol can increase of decrease levels of effectiveness for meds taken

What are other drugs that alter drug efficacy?

-Alcohol

-Marijuana

-Cocaine

-Opiates

-Homeopathics

-Over the counter cold and cough remedy antiacids, diet pills

-Nicotine

-Caffeine

What are side effects of psychotropics?

-Sedation

-Anticholinergic: dry mouth, blurred vision, urinary retention, constipation, painful intercouse

-Tachycardia, arrythmia, orthostatic hypotension

-Sun poison with minimal exposure

-Decreased WBC count, agranulocytosis

-Neoleptic malignant syndrome: high fever, muscle rigidity, AMS, autonomic dysfunction

What are metabolic and endocrine side effects if psychotropics?

-Anorgasmia

-Amenorrhea

-Gynecomastia

-Premature/retrograde ejaculation

-Priapism

-Erectile dysfunction

-Loss of libido

-Galactorrhea, lactation, hair growth

-Elevated plasma prolactin can lead to diabetes, glaucoma, osteoporosis

-Truncal obesity

-Elevated triglycerides

-Elevated HDL cholesterol

-High blood pressure

-High fasting glucose

-Diabetic ketoacidosis

-Tremors, shuffling gait, muscle rigity, cogwheeling

-Spasms of neck, face, tongue, and back

-Motor restlessness, acute dystonia

-Dyskinesias of jerky movments

-Tardive dyskinesa with constricted ROM, curling movements of tongue, abnormal head/neck movements