Psychotropics

How do we asses effectiveness of psychotropic drugs?

Cannot measure drug levels, so team “follows them clinically” and assesses for therapeutic and adverse effects

How long does it take to find a good psychotropic drug regimen?

Takes a long time, 6-24 months on average, there’s a LOT of trial and error

What is the main reasons for poor adherence of psychotropics?

Adverse effects and disease aspects itself

Underlying problem of depression?

imbalance: neurotransmitter terminals are insufficient in quantities because there is poor production, excessive reuptake, and excessive deactivation of neurotransmitters

What are some physiological problems that can look like depression?

Low estrogen/testosterone, low thyroid levels, and tumors

Biggest dangers in depression?

lack of self-care, lack of ability to take care of others (children/elders), suicide

Most antidepressants affect CNS and have ___________ effects

anticholinergic

cholinergic = __________ effects

parasympathetic

anticholinergic = ____________ effects

inhibits parasympathetic

Anti depressants have a _______ half life

long

Onset of antidepressants can take ________

2-3 weeks

Outcome/goal of antidepressants

improved mood and improved functionality

Anticholinergic central effects can:

mimic the signs of aging

What is one major effect that over half of the 25 most prescribed meds to the elderly have?

anticholinergic effects

anticholinergic adverse effects need to managed by:

need to be identified, may need to decrease dosage, may need to pair with a cholinergic drug

Drug categories with anticholinergic effects include

most psyche drugs and antiseizure medications

Treating sleep or alertness problems can include

timing dose appropriately; if sedation/drowsiness take at night, if insomnia take in morning

Treating weight changes (most often gained) adverse effects can include

monitor diet, and increase activity

Treating dry mouth adverse effect can include

increasing fluids, gum, treat bad breath

What is a key problem in non-adherence of anticholinergic drugs?

sexual dysfunction adverse effect

SSRIs stands for

selective serotonin reuptake inhibitors

Can SSRIs be combined with other SSRIs?

Yes, they often are used in combination

What is one issue that needs to be watched after starting SSRIs?

suicide, it may give enough energy for suicide because they only treat depression symptoms and is not a cure for depression

Important teaching points with SSRIs?

Discuss adverse effects before they occur, takes a long time for onset of relief, noi abrupt withdrawal, need to re-evaluate after 7-10 days

What does SNRI stand for?

Serotonin Norepinephrine Reuptake Inhibitor

SNRIs mechanism depends on

dosage

Low dose SNRIs primarily affect

serotonin

Moderate dose SNRIs affect

NE and serotonin

High dose SNRIs affect

NE serotonin and dopamine

Primary reason for non-adherence for SNRIs and SSRIs

sexual dysfunction

Who should not take SNRIs?

People with hypertension

Main drug interaction with tricyclics?

other antidepressants, can be fatal with MAOIs

What is one focal point in assessing people taking tricyclics?

It can mask suicidal tendencies

What does MAOI stand for?

Monoamine oxidase inhibitor

MAOIs are the _____ drug of choice

LAST

SIgnificant drug interactions with MAOIs

other antidepressants, opioids, antihypertensives

What antidepressant has a significant food-drug interaction? with what foods?

MAOIs, foods with tyrosine/tyramine

Foods that have tyramine in them?

banana, cheese, avocado, sour cream, beer, wine, cured meats

What referral is needed when a patient is taking an MAOI?

Nutritionist

Main benefits of atypical antidepressants?

cost/coverage and less adverse effects (sexual problems being a main one)

What herbal supplement is associated with causing serotonin syndrome when taking it with a serotonin drug?

St. John’s Wort

How can lithium affect pregnancies?

It decreases hormonal birth control efficiency and is a category D teratogen

What labs can we do when assessing lithium toxicity?

serum lithium levels, liver enzymes, BUN/creatinine, serum thyroid hormone levels

Food interactions when taking lithium?

table salt can increase drug excretion in high use

What is the reversal drug of choice for benzodiazepines?

flumazenil

What non-benzodiazepine can decrease anxiety?

antihistamines (e.g. diphenhydramine (Benadryl))

What is the mechanism behind psychosis?

excessive dopamine in the blood

What preparations can be used to increase adherence for antipsychotics?

IM depot

Extrapyramidal effects include

tardive dyskinesia, dystonia, parkinsonism, akathisia, neuroleptic malignant syndrome, tremors

Antipsychotics can have _______ effects with other CNS depressants

additive