Mental Health Disorder Medications

anxiety

anxiety

A vague, uneasy feeling, the source of which is often nonspecific, or unknown to the individual

1. feeling of fear or dread

2. tremors and palpations

3. sweating

4. faintness

5. Symptoms of HPA axis

Defining characteristics of anxiety: [5]

De-realization

KNowing you are in a situation but it doesn’t feel like its happening to you

insomnia

Inability to sleep or remain asleep throughout the night

hypersomnia

too much sleep. Seen in teenage and young adults.

Parasomnia

Disorders associated with the sleep stages

sleep-wake schedule disorders

Normal sleep but at the wrong time

Breast cancer

females who work permanent night shifts are at increased risk for what?

the elderly. usually related to a medical condiitonthe

Most people diagnosed with insomnia are:

Benzodiazepines.

the drug of choice for anxiety and insomnia

has a large therapeutic index when used by themselves

Therapeutic range of benzodiazepines:

Diazepam (Valium)

Prototype drug for anxiety

GABA

Inhibitory neurotransmitter located throughout the CNS

Not direct agonists but amplifies the actions of endogenous GABA in limbic and cortical areas of the brain.

Benzodiazepines MOA:

Opens chloride channels

hyperpolarizes cell

slows firing in CNS to decrease anxiety

Diazepam (Valium) MOA:

Decreases neuron firing

How are benzodiazepines used for seizures?

1. general anesthesia

2. pre-op sedation

3. muscle spasms

4. panic disorders

5. withdrawal from alcohol

other clinical uses of benzodiazepines: [5]

Anterograde amnesia

blocked recall of events

1. drowsiness

2. lack of coordination

3. difficult concentrating

4. anterograde amnesia

5. paradoxical effect

6. respiratory depression

7. headache

8. nausea

adverse responses of benzodiazepines: [8]

1. orally, highly lipid soluble '

2. crosses the blood-brain-barrier

3. can be given IM or IV as well

How are benzodiazepines given (pharmacokinetics): [3]

Extensively metabolized.

half life is 2-3 hours but active metabolites is 50 hours

Metabolism of benzodiazepines:

Triazolam (Halicon): has a rapid onset

Recommended benzodiazepine for falling sleep:

Estazolam (ProSom): slower onset

Recommended benzodiazepine to avoid waking:

Lorazepam (Ativan)

Recommended benzodiazepine for anxiety with an intermediate duration:

Flumazenil

antidote for benzodiazepines. similar to naloxone:

Signs of drowsiness, lethargy, confusion.

Symptoms of benzodiazepine toxicity (rare): [3]

1. other CNS depressants (other benzos)

2. alcohol

Benzodiazepine interactions that can cause drug toxicity: [2}

1. use cautiously in suicidal patients

2. do not crush or chew sustained release

3. do not use alcohol or other CNS depressants

Warnings for benzodiazepines: [3]

Phenobarbital

non-selective barbiturate usually used for seizures

Acts as direct GABA agonist. MORE GABA
No limits on CNS depression, stimulates drug metabolizing enzymes

Phenobarbital MOA:

1. depressed mood

2. loss of pleasure or interest in all or nearly all past activities or pastimes

Diagnostic criteria for depression (some): [2]s

1. shock therapy

2. ECT

Somatic depression therapies: [2]

1. initial response in 1-3 weeks

2. maximal response may not be until 12 weeks

How long do depression pharmacotherapies take to work?

Selectively blocks the reuptake of serotonin

causing increased activation of post-synaptic receptors

Selective Serotonin reputake inhibitors (SSRIs) MOA:

MAOIs

SSRIs should not be used with what due to the risk of serotonin syndrome?

Serotonin syndrome

Altered mental state related to serotonin. Jitters, sweating, hallucinations, etc.

Fluoxetine (prozac)

Major depression SSRI that is widely distributed and highly bound to plasma protein

4 weeks

How long does it take for prozac to reach steady state plasma levels?

Well absorbed orallyO

how is prozac absorbed?

1. Citalopram (Celexa)

2. Paroxetine (Paxil)

Other examples of SSRIs: [2]

Causes powerful blockage of NE and serotnin reuptake

Keeps more epinephrine and serotonin in the brain (very similar to SSRIs)

Serotonin/Norepinephrine Reuptake inhibitors (SNRIs) MOA:

1. nausea

2. headache

3. sexual dysfunction

Adverse effects of Venlafaxine (Effexor) [3]

Venlafaxine (effexor)

SNRI prototype drug:

Blocks neuronal reuptake of norepinephrine and serotonin

among first antidepressants, not as safe as newer ones

Tricyclic antidepressant MOA:

can cause cardiac toxicity

Key danger of tricyclic antidepressants:

Amitriptyline (Elavil)

Tricyclic antidepressant prototype:

1. sedation

2. orthostatic hypotension

3. cardiac toxicity

Adverse effects of Amitriptyline (Elavil): [3]

1. bipolar syndrome

2. fibromyalgia

3. neuropathic pain

Other uses for amytryptiline (elavil) besides depression:. used as an adjunct medication [3]

biochemical effects occur within hours; therapeutic effects take several weeks

How long do the effects of amytryptiline (elavil) take to work?

8 times the therapeutic dose. Overdose can be life threatening.

lethal dose of amytryptiline (elavil)

Should not be combined with other drugs that cause CNS depression because this one causes CNS depression

amytryptiline (elavil) drug interactions:

Monoamine oxidase

enzyme that breaks down serotonin

inhibits the enzyme that breaks down serotonin

MAOI MOA:

Isocarboxazid (Marplan)

MAOI prototype:

they can cause hypertensive crisis, triggered by eating foods rich in tyramine

MAOIs are more dangerous antidepressants becuase:

1. mirtazepine (Remeron)

2. Buproprion (Zyban)

Atypical antidepressants [2]

Weight gain, the drug increases appetite

Mirtazepine (Remeron) side effect:

1. acute dystonia

2. parkinsonism

3. akathisia

4. tardive dyskinesia

First generation antipsychotics adverse effects:

Dystonia

Spasms of the back and neck

Parkinsonism

Parkinson-like sympoms including shuffling gat

Akathisia

uncontrolled need to be in movement

Chlorpromazine

Low potency first generation antipsychotic:

Haloperidol (Haldol)ot

high potency first generation antipsychotic:

1. neuroleptic malignant syndrome

2. orthostatic hypotension

3. anticholinergic effects

4. sedation

5. neuroendocrine effects

6. seizures

7. sexual dysfunction

8. agranulocytosis

9. severe dysrhythmias

other adverse effects of first generation antipsychotics: [9]

Blocks neurotransmitters (dopamine, NE, serotonin etc.)

First generation antipsychotic MOA:

increases risk of sedation

risk of CNS depressants and first gen antipsychotics interacting:

levodopa increases dopamine and cancels out antipsychotic

levodopa and first gen antipsychotic interaction:

Blocks receptors for dopamine and serotonin

Second generation antipsychotic MOA:

Clozapine (clozaril)

prototype second gen antipsychotic

1. agranulocytosis (can be fatal)

2. metabolic: weight gain, exaccerbates diabetes, dyslipidemia

3. seizures

4. EPS

5. Myocarditis

6. orthostatic hypotension

second generation antipsychotic adverse effects: [6]

1. pure manic episode (euphoric mania)

2. hypomanic episode (hypomania)

3. major depressive episode (depression)

4. mixed episode

types of bipolar episodes: [4]

1. mood stabilizers

2. antipsychotics

3. antidepressants

drug therapies for bipolar: [3]

1. lithium

2. divalproex sodium (Valproate)

3. Carbamazepine (Tegretol)

Mood stabilizers: [3]

Altered distribution of cerain ions (magnesium, sodium, calcium)

altered synthesis and release of NE, serotonin and dopamine

effects on second messengers (e.g. Cyclic AMP)

Lithium MOA:

Very narrow, requires lots of monitoring

Litium therapeutic range:

1. well absorbed orally

2. even distribution

3. short half life

4. excreted by kidneys

Litium pharmacokinetics: [4]Adverse efe

mild:
1. ine hand tremor

GI upset

Thirst

muscle weakness

adverse effects of lithium at toxic levels[4]

1. tremor

2. polyuria

3. renal toxicityt

4. goiter and hypothyroidism

5. teratogenesisLiti

Adverse effects of lithium at therapeutic range:

diuretics promote sodium loss and increase the risk of lithium toxicity

lithium and diuretic drug interaction

NSAIDs can increase lithium levels by increasing renal reabsorption

lithium and NSAID drug interaction

Anticholinergic drugs can cause urinary hesitancy (lithium is salt based. can be uncomfortable)

lithium and anticholinergic drug interactions:

Alcohol use disorder

chronic, relapsing disorder with impaired control over drinking. Has preoccupation with alcohol consumption and distortions of thinking (denial of a problem)

Helps with delirium tremins. When withdrawing from anything, you get jittery. Benzos help.

Benzodiazepines for alcohol withdrawal:

prevents delirium tremins

How does tegretol treat alcohol withdrawal:

helps with the cardiovascular symptoms of withdrawal (vasoconstriction, increased HR, etc.)

Atenolol and propanolol (Beta blockers) for alcohol withdrawal:

1. carbamazepine (Tegretol)

2. Clonidine

3. Atenolol and propanololdrugs used to maintain abstinence from alcohol

Drugs used to facilitate alcohol withdrawal [3]

1. disulfiram (makes you sick)

2. naltrexone

3. acamprosate

drugs used to maintain abstinence from alcohol: [3]

changes receptors, don’t get same pleasure from drinking alcohol

how do maltrexone and acamprosate maintain abstinence from alcohol?

Nicotine Chewing Gum

Nicotine Lozenges

Nicotine Transdermal Systems (Patches)

Nicotine Inhaler

Nicotine Nasal Spraya-typical antidepres

Pharmacologic Aids to Stop Smoking [5]

Buproprion (Zyban)

atypical antidepressant that changes receptors and decreases the urge to smoke:

Verenicline (Chantix, Champix)

Partial agonist at nicotine receptors. Take te drug and smoke for two weeks, eventually it takes the pleasure away from smoking

Methadone (Methadose)

drug creates tolerance so that opioid drugs have little effect:

Opioid agonist

Methadone (Methadose) MOA:

Buprenorphine (Suboxone)

Drug that alleviates cravings/suppresses cravings for opioids

Opoid agonist-antagonist (agonist at some opioid receptors and antagonist at others)

Buprenorphine (Suboxone) MOA: