pharm: psych meds

what is anxiety

• uncomfortable state with psychological and physical components

• fear, apprehension, dread, and uneasiness

types of anxiety

• generalized anxiety disorder

• panic disorder

• OCD

• social anxiety

• PTSD

generalized anxiety disorder

uncontrollable anxiety that lasts 6 months or longer and that is not situational

drug therapy for GAD

• benzodiazepines

• buspirone - interacts with both serotonin and dopamine receptors

  • not a CNS depressant, no abuse

SSRIs

• selectively inhibits reuptake of serotonin

• fluoxetine

• fluvoxamine

• citaprolam

• escitaprolam

• paroxetine

• sertraline

venlafaxine uses

• SNRI

• first antidepressant approved for GAD

• used for major depression and social anxiety

treatment of panic disorder

• CBT

• antidepressants (SSRIs, TCAs and MAOIs)

OCD + treatment

• potentilly disabling

• persistent obsessions (thought) and compulsions(behavior)

• SSRIs first line of drug treatment

Social anxiety + treatment

• intense and irrational fear that one will be scrutinized

• treatment: psychotherapy and SSRIs (paroxetine and sertraline)

PTSD treatment

• psychotherapy

• SSRIs (fluoxetine, paroxetine and sertraline)

• SNRI (venlafaxine)

depression

• most common psych disrorder

• only 40% have sought treatment

• 2x as high in women

S/s of depression

• loss of pleasure

• insomnia/ hypersomnia

• anorexia/ hyrerphagia

• mental slowing and loss of concentration

• feelings of guilt, worthlessness and helpnesses

• suicidal thoughts/ behavior

risk of taking antidepressants

• may increase suicidal tendencies during early treatment

adverse effects of SSRIs

• sexual dysfunction

• weight gain

• serotonin syndrome

serotonin syndrome

• begins 2-72 hours after treatment

• AMS

• incoordination

• possible death

• resolves after discontinuing drug

• increased risk with MAOIs

drug interactions with SSRIs (5)

• MAOIs

• anitplatelets/ anticoagulants

• aspirin/ NSAIDs

• TCAs

• lithium

most widely prescribed SSRI

fluoxetine (prozac)

TCAs

• imipramine

• block reuptake of norepinephrine and serotonin

• long and variable half lives

• used for depression, Bipolar, fibromyalgia

adverse effects of TCAs

• may cause sedation, orthostatic hypertension, cardiac toxicity and increased risk of suicide

MAOIs

• phenelzine

• irreversibly inhibits MAOs, which convert monoamine transmitters (norepinephrine, serotonin, dopamine) into inactive products

• 2nd or 3rd choice - more hazardous

• must avoid foods with tyramine - risk of hypertensive crisis

S/s of hypertensive crisis

• headache

• tachy

• hypertension

• nausea/vomiting

• confusion

• diaphoreses

• stroke

• death

bupropion

• atypical antidepressant

• inhibits reuptake of dopamine and norepinephrine

• acts as stimulant - supresses apetite

• effects begin in 1-3 weeks

what is a common nonconventional drug for depression

st johns wort

cognitive symptoms of schizophrenia

• disordered thinking

• reduced ability to focus

• learning and memory difficulties

acute episodes of schizophrenia

delusions and hallucinations are frequently prominent

residual symptoms of schizophrenia

• suspiciousness

• poor anxiety management

• diminished judgement and inshg t

• lack of motivation

• capacity for self care

long term course of schizophrenia

acute exacerbations separated by intervals of partial remission

• exact cause is unknown

first gen antipsychotics

• blocks dopamine (D2) receptors in the mesolimbic area of the brain

• can cause EPS

EPS symptoms

• Parkinsonism - drooling, bradyknesia, tremor, shuffling gait

• akathisia - motor restlessness

• acute dystonia - acute onset of muscle spasm of tounge, face, neck or back

• tardive dysknesia - twisting/ wormlike movements of tounge and face

• oculogyric crisis- involuntary upward deviation of eyes

• opisthotonus - trunk lodges forward but head and limbs go back

• laryngal dystonia

drug interactions of antipsychotics

• anticholinergic drugs

• CNS depressant

• Levodopa and direct dopamine agonists

chlorpromazine

low potency first gen antipsychotic

haloperidol

high potency first gen antipsychotic

• may cause EPS, QT prolongation or neuroendocrine effects

2nd gen antispychotics

• moderately block dopamine receptors

• strongly block serotonin

• fewer EPS symptoms

clozapine

• 2nd gen antipsychotic

• may cause agranulocytosis

fluphenazine

• 2nd gen antipsychotic

• piperazine class