Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
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1 Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
2 Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder *Anxiety *Attention Deficit Hyperactivity Disorder
3 General Notes on Psychiatric Treatment *Medications treat symptoms, not cure disorder *Medications work differently for different people *Side Effects can differ based on the following: -type of medication -liver/kidney function -sex of patient -genetics -body size -other treatments -physical illness -diet -lifestyle habits -dose of medication
4 General Notes Continued.. *Monitoring signs/symptoms every 2 weeks and reassess response at 4-8 weeks & if -clear response: continue treatment 4-8 weeks until symptoms in remission -partial response: (no side effects) - increase dose and reassess in 4 weeks -no response: (or side effects too great) - change medication to different class, and reassess in 4-8 weeks Goal of Remission: no symptoms for 2-6 months
5 General Notes Continued.. *Treatment Duration find -No one should stop medications abruptly -Acute treatment phase: 6-12 weeks - goal is to decrease symptoms & dose that works -Continuation phase: 6-9 months -Maintenance Therapy considered if: *History of 3+ episodes *Severe Episodes *Psychotic features (hear/see things) *Pt with chronic depression 2-5 years
6 Schizophrenia Schizophrenia is a mental disorder that makes it hard to: Tell the difference between what is real and not real; Think clearly; Have normal emotional responses; Act normally in social situations. Treatment with Typical or Atypical Antipsychotics
7 Schizophrenia Treatment (Typical Antipsychotics) Brand Generic Thorazine Haldol Trilafon Prolixin Clozaril Chlorpromazine Haloperidol Perphenazine Fluphenazine Clozapine
8 Schizophrenia Treatment (Atypical Antipsychotics) Brand Generic Risperdal Zyprexa Seroquel Geodon Abilify Invega Saphris Latuda Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Asenapine Lurasidone
9 Schizophrenia Treatment Side Effects Typical: physical movement changes varying from tremors and spasms to more severe tardive dyskinesia and pseudoparkinsonism. (involuntary movements) Atypical: Weight gain Both Types: drowsiness, dizziness, blurry vision, rapid heartbeat, sensitivity to sunlight, skin rashes, and menstrual problems in women Clozaril: agranulocytosis (WBC loss)
10 Schizophrenia Treatment Patient Information *Takes up to 4-6 weeks to see optimum effects *May be sensitive to weather changes due to decrease in sweat production. *Clozapine - WBC checked on a routine basis
11 Depression Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
12 Depression Treatment (4 Classes) 1.SSRI - Selective serotonin reuptake inhibitors 2.SNRI - Serotonin-norepinephrine reuptake inhibitors 3.TCA - Tricyclic antidepressants 4.Others
13 Depression Treatment - SSRI Brand Generic Prozac Celexa Lexapro Zoloft Paxil Fluoxetine Citalopram Escitalopram Sertraline Paroxetine
14 Depression Treatment - SNRI Brand Generic Effexor Cymbalta Pristiq Venlafaxine Duloxetine Desvenlafaxine
15 Depression Treatment - TCA Brand Generic Elavil Tofranil Sinequan Pamelor Amitriptyline Imipramine Doxepin Nortriptyline
16 Depression Treatment - Others Brand Generic Remeron Desyrel Wellbutrin Mirtazapine Trazodone Bupropion
17 Depression Treatment - Side Effects Nausea: Bupropion, Mirtazapine, SNRI s, SSRI s Agitation: Bupropion, Mirtazapine, SSRI s Fatigue/Sedation: Bupropion, Mirtazapine, Trazodone, SSRI s, TCA s Sexual Dysfunction: SSRI s, TCA s, SNRI s Weight Gain: Bupropion, Mirtazapine, SSRI s, TCA s Anticholinergic effects: Bupropion, Mirtazapine, SSRI s, SNRI s Hypotension: TCA s
18 Depression Treatment - Patient Information *Reassure Depression is a common condition and can be successfully treated *Consider drug interactions with other treatment, that can cause increased serotonin and/or dopamine, such as the following: -Clonidine -Birth Control -Beta Blockers -High-dose Steroids -Alcohol -CNS Depressants
19 Bipolar Disorder Bipolar disorder is a condition in which a person has periods of depression and periods of being extremely happy or being cross or irritable.
20 Bipolar Disorder Treatment Mood Stabilizers (or anticonvulsants) alone or in combination with antidepressants) Brand Generic Mood Stabilizers Eskalith Lithium Carbonate AntiConvulsants Depakote Divalproex Tegretol Lamictal Trileptal Carbamazepine Lamotrigine Oxcarbazepine
21 Bipolar Treatment Common Side Effects Lithium: loss of coordination, excessive thirst, frequent urination, hallucinations, vision changes, edema Anticonvulsants: weight gain, dizziness, drowsiness, nausea Divalproex: females can develop polycystic ovarian syndrome Lamotrigine: skin rash that can be very severe
22 Bipolar Treatment - Patient Information *No cure of Bipolar Disorder, treatment is available and can be successful *Regular monitoring of drug levels, thyroid level, liver and kidney function is recommended *Keep regular visits with physicians for side effects monitoring & dose escalations or changes *Have close family member or friend to help monitor on a daily to weekly basis
23 Anxiety Disorder Stress can come from any event or thought that makes you feel frustrated, angry, or nervous. Anxiety is a feeling of fear, unease, and worry. The source of these symptoms is not always known.
24 Anxiety Disorder Treatment (Benzodiazepines) Brand Generic Klonopin Ativan Xanax Valium Librium Serax Clonazepam Lorazepam Alprazolam Diazepam Chlordiazepoxide Oxazepam
25 Benzodiazepine Side Effects Blurred Vision Upset Stomach Headache Drowsiness Confusion
26 Anxiety Disorder - Patient Information *Buspirone (Buspar) is an alternative option. Has less sedative side effects. *Beta-Blockers (Propranolol) also an option *High chance of dependence with Benzodiazepines, therefore these medications should be tapered down instead of being stopped abruptly
27 Attention-Deficit/Hyperactivity Disorder Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.
28 ADHD Treatment Brand Generic Methylphenidates Ritalin, Methylin Methylphenidate Metadate ER, Ritalin SR, Methylin ER Focalin Concerta, Metadate CD, Ritalin LA, Daytrana Methylphenidate Dexamethylphenidate Methylphenidate Amphetamines Dexadrine Dextroamphetamine Vyvanse Lisdexampetamine Adderall Dextramphetamine / Amphetamine
29 ADHD Treatment Side Effects *Decreased appetite *Insomnia *Abdominal pain *Headaches *Tics *Cardiac Issues
30 ADHD - Patient Information *Strattera (Atomoxetine) - also approved for ADHD, but has an increased risk of suicide in children *Long-acting should be taken in the morning to prevent lack of sleep/insomnia *Determine if only needed during school/work or all the time
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