8.2 Concepts Psych Portage Pharm

Neurotransmitters

Endogenous chemicals that conduct nerve impulses between nerve cells

Why are psychiatric disorders hard to dx?

Symptoms overlap each other & are subjective

Anxiety types

GAD, panic disorder, OCD, PTSD

Primary TX of anxiety (meds)

Anxiolytics - mostly benzos & buspirone

Sometimes antidepressants

Benzodiazepine		Onset of action
Intermediate acting (6-8 hours)
Alprazolam
Clonazepam
Lorazepam		Local: IV:
Oxazepam
Long action (12-24 hours)
Diazepam
Chlordiazepoxide

Fill in blanks!

Benzodiazepine		Onset of action
Intermediate acting (6-8 hours)
Alprazolam		15-30 minutes
Clonazepam		15-30 minutes
Lorazepam		15-30 minutes (local); within 15 minutes (IV)
Oxazepam		30-60 minutes
Long action (12-24 hours)
Diazepam		Within 15 minutes
Chlordiazepoxide		15-30 minutes

Benzos MOA

Increase action of GABA → reduce over-activity in brain that causes anxiety

Benzos Adverse Events

ADDICTIVE

CNS depression (symptoms include: sedation, lethargy, fatigue, confusion, drowsiness, and dizziness)

HypoTN

Benzos sched

IV

Benzos Drug interaction

CNS depressants

Buspirone vs Benzos

Buspar is daily, Benzos are PRN

Buspirone MOA

Work on both Serotonin and Dopamine receptors

Buspirone Adverse Events

Dizziness, blurred vision, headache, and nausea.

Buspirone Drug interactions

CYP3A4 inhibitors (ketoconazole, verapamil, and diltiazem): Buspar levels increase

MAOI: Increases risk of serotonin syndrome

Affective disorders

Mood disorders

Changes in mood, includes MDD and BPD

Major Depressive Disorder

Causes persistent feelings of sadness and loss of interest, interfere with one’s ability to do normal activities

Bipolar

Manic depressive illness

Episodes of mania or hypomania, cycling with depression

Mania

Acute illness characterized by expansive emotional state including:

Extreme excitement, elation, hyperactivity, agitation, talkativeness, flight of ideas, reduced attention span, increased psychomotor activity, impulsivity, insomnia, anorexia, and sometimes violent destructive and self-destructive behavior.

Depression

Abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness.

Signs include withdrawal from social contact, loss of appetite, and insomnia.

Which drugs primarily treat bipolar?

Mood stabilizers

There is evidence to suggest that episodes of mania are related to ___ and ____ levels in the brain.

dopamine

norepinephrine

What 3 classes of drugs can treat Bipoar disorder?

Mood stabilizers, Antiepileptics, Antipsychotics

Lithium MOA

Lithium Ions alter sodium ion transport

Alters the metabolism of both dopamine and norepinephrine

Why do blood levels need to be monitored with lithium use?

Therapeutic dose is similar to toxic dose

Adverse Effects of Lithium

GI discomfort
Tremor
Confusion
Somnolence
Slurred speech
Disturbances in muscle coordination
Seizure
Death-cardiac dysthymia

Drug interactions for Lithium

These drug classes can all increase the risk of lithium toxicity:
Thiazide
Diuretics
ACE-inhibitors
NSAIDs

Antiepileptics MOA

Stabilize neurons →

keep from being hyper-excited and generating excessive nerve impulses

Valproic Acid Adverse Events

Dizziness, drowsiness, GI upset, weight gain, hepatoxicity, pancreatitis

Valproic Acid Drug interactions

Aspirin: Increases depakote levels

Lamotrigine & Oxcarbazepine: reduce depakote’s efficacy

Topiramate adverse effects

Dizziness, drowsiness, GI upset and ataxia

Topiramate drug interactions

Reduces levels of:

OCP

Carbamazepine

Valproic Acid

Lamotrigine Adverse Effects

Drowsiness, ataxia, headache, nausea, blurred vision, Stevens Johnsons Syndrome*

Lamotrigine drug interacctions

Increases lamotrigine levels: Valproic acid

Reduces lamotrigine levels: OCP, Oxcarbazepine

Oxcarbazepine adverse events

Nausea, headache, dizziness, unusual eye movements, visual changes, behavioral changes, abdominal pain, GI upset

Oxcarbazepine drug interactions

Reduces effectiveness of oral contraceptives, and lamotrigine. When taken with valproic acid, oxcarbazepine levels are reduced