Mental Health Meds

What is the major target of drugs that are used to treat psychiatric disorders?

neurotransmitters and receptors

How do we believe most psychotropic medications act?

Most psychotropic medications act by either increasing or decreasing the activity of certain neurotransmitter-receptor systems.

What is the first pharmacological line of defense for anxiety and OCD disorders?

Selective serotonin reuptake inhibitors (SSRIs) are considered a first line of defense in most anxiety-related disorders

Exactly how do benzodiazepines work in the body to help with anxiety?

Increase the effects of GABA in the patient's brain and body to help the patient feel relaxed. These meds have a fast onset.

Why are benzodiazepines not recommended for the elderly?

increased risk for falls, delirium, and fractures

What are common SSRIs?

paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), and sertraline (Zoloft)

What drug class is evidenced-based for use in PTSD symptoms?

SSRIs

Which two SSRIs are FDA approved specifically to treat PTSD?

sertraline (Zoloft) and paroxetine (Paxil)

How does naloxone reverse opioid overdose?

Binds to opioid receptors and reverses or blocks the effects of other opioids

What is methadone -Methadose and how is it used to treat opioid addiction?

used to decrease the painful symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semisynthetic opioids like oxycodone and hydrocodone.

What is buprenorphine-Suboxone and how is it used to treat opioid addiction?

It is a fixed-dose combination medication that includes buprenorphine and naloxone used to treat opioid use disorder

What is naltrexone- Vivitrol and how is it used to treat opioid addiction?

Is an opioid antagonist that prevents intoxication.

For the prevention of relapse to opioid dependence following opioid detoxification.

if the person relapses and uses the drug, (they need to be actively taking this med) it blocks the euphoric and sedative side effects

What medication classes are used to treat depression?

SSRIs, SNRIs, NDRI, NaSSAs, TCAs, MAOIs

What class of anti-depressants is the first-line treatment for depression?

SSRIs

Why are TCA''s and MAOI's generally not used to treat depression if another drug class works?

Too many adverse effects. MAOIs also have too many dietary restrictions.

What is in the black box warning we see with antidepressants?

increased risk of suicidal thinking or attempts

What medication classes and medications may be used for severe agitation in a patient with Bipolar Disorder?

lithium, divalproex, second generation antipsychotics (olanzapine or risperidone), benzodiazepines.

Which benzodiazepines may be used to treat acute mania?

Clonazepam and lorazepam

What mood stabilizers are used to treat symptoms of bipolar disorder?

lithium

What is FDA approved to treat mania and bipolar maintenance and is also a chemical element on the periodic table?

lithium

What are special safety concerns for Lithium?

Baseline assessment of renal function, thyroid status, EKG must be completed. Cannot be given to patients with cardiovascular disease, brain damage, renal disease, thyroid disease, or myasthenia gravis, or if the patient is pregnant or breastfeeding, or if the patient is under the age of 12.

What are the therapeutic levels for Lithium?

0.6-0.8 mEq/L

What is the toxicity level for Lithium?

Over 1.5 mEq/L

What two 2nd generation antipsychotics are used to treat BPD?

Olanzapine and risperidone

What neurotransmitter do first-generation antipsychotics (FGA) block?

dopamine-2 (D2) receptors

What two neurotransmitters do second-generation antipsychotics (SGA) block?

Serotonin and dopamine

What are some examples of first generation antipsychotics?

chlorpromazine, thioridazine, loxapine, perphenazine, fluphenazine, haloperidol, pimozide, thiothixene, trifluoperazine.

What are some examples of second generation antipsychotics?

aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lumateperone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone.

How long does it take for antipsychotics to typically work?

2-6 weeks

What are LAI's?

Long-acting injectable (LAI) formulations only need to be administered every 2 to 4 weeks and in one case, every 3 months.

How soon might the benefits from medications to treat Alzheimer's start wane?

1-2 years

How do Cholinesterase inhibitors work?

function by inhibiting cholinesterase from breaking down acetylcholine into its components of acetate and choline.

What is Donepezil?

cholinesterase inhibitors, for mild-severe AD

side effects are nausea, diarrhea, insomnia, muscle cramps, fatigue, anorexia.

What is Rivastigimine?

cholinesterase inhibitors, for mild to moderate AD

side effects are nausea, vomiting, anorexia, indigestion, weakness.

What is Galantamine?

cholinesterase inhibitors, mild to moderate AD, nausea, vomiting, diarrhea, dizziness, headaches, decreased appetite, weight loss

What is Memantine?

NMDA receptor antagonist, for moderate to severe AD

side effects are dizziness, headaches, confusion, constipation.

What is Memantine/donepezil?

NMDA receptor antagonists/cholinesterase inhibitor, for moderate to severe AD after a trial of donepezil

side effects are same as memantine and donepezil.

What class of drug is no longer FDA approved to treat dementia-related psychosis?

Antipsychotics for dementia-related psychosis.

What is the newest drug for Alzheimer's Disease?

Aducanumab

What medications can be used to treat Tourette's syndrome ?

First-generation antipsychotics, haloperidol, pimozid, Second-generation antipsychotics, ariprazole, risperidone

What class of medications are prescribed for ADHD and which of these is most widely used?

STIMULANTS

methylphenidate (Ritalin and others)

adderall (mixed amphetamine salts)

What non-stimulant SNRI is FDA approved to treat ADHD?

atomoxetine (Strattera)

What are the side effects of atomoxetine?

gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, insomnia, liver injury, small increase in BP and HR