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STAFF’S ROLE WITH MEDICATION BIRTH RITALIN PROZAC VIAGRA DEATH C. Koblin 6/3/2016 CONTENTS THE MEDICATIONS MULTIPLE USES OF MEDICATIONS ABUSED MEDICATIONS THE PATIENTS GENDER AND OTHER GROUP DIFFERENCES PRESCRIBING FOR CHILDREN THE PROBLEMS SIDE EFFECTS MEDICATION-BORNE ILLNESSES TARDIVE DYSKINESIA SEROTONIN SYNDROME LONG QT SYNDROME OTHER DISCONTINUATION INTERACTIONS POTENTIAL FOR OVERDOSE (not included) THE SOLUTIONS LAB WORK AIMS TO EAT OR NOT TO EAT WHEN TO ACCESS THE NURSE THE ROLE OF STAFF NONCOMPLIANCE SUPPLY (running out) MEDICATION CHANGES MISCELLANEOUS PROBLEMS RESISTANCE COMPETING CHEMICALS ARE YOU OVERSTEPPING? GLOSSARY MEDICATION LIST - attached BRAND NAME and GENERIC - attached MULTIPLE USES OF MEDICATIONS DRUG USES Cymbalta – antidepressant chronic anxiety, low back pain, chronic pain, hot flashes, peripheral neuropathy, fibromyalgia, urinary retention (not in U.S.) (FDA approved) (close to FDA approval) Abilify – antipsychotic dementia, Alzheimer’s, irritability with autism Paxil - antidepressant premature ejaculation Lamictal - anti-seizure depression, bipolar disorder, mood stabilization Neurontin - anti-seizure depression, nerve pain, migraines Desyrel – antidepressant sleep aid, alcohol cravings, panic disorder, ED (adjunct) Inderal - high blood pressure and heart disease performance anxiety Risperdal – antipsychotic Alzheimer’s disease, dementia, eating disorders, irritability with autism Topamax - anti-seizure migraines, bipolar disorder, depression, nerve pain Gabitril - anti-seizure depression, mood stabilization Tegretol - anti-seizure Seizure disorder: adults and children Trigeminal neuralgia Glossopharyngeal neuralgia Manic and mixed episodes of Bipolar I Disorder (Equetro extended-release tablets only) Pain associated with shingles Alcohol and Cocaine withdrawal Abnormally aggressive behavior Migraine headaches Benedryl - antihistamine • • • • • • • Allergic symptoms Itchiness Common cold Insomnia Motion sickness Extrapyramidal symptoms Local anesthetic MULTIPLE USES OF MEDICATIONS Tofranil - antidepressant • Pain, bedwetting, urinary retention (Europe) Tricyclics – antidepressants • fibromyalgia, chronic tension headaches, diabetic neuropathy, post-herpetic neuralgia, cancer pain Desyrel 50 mg. & Tryptophan 500 mg. • aggressive behavior Anafranil – OCD • Autism, separation anxiety in dogs Vyvanse – ADD • Binge-Eating Disorder (January 2015) Haldol • • • • • • • • • • • • • Bipolar with mania – injectable Drug or alcohol-induced psychosis Psychosis associated with high fever or metabolic disease Hyperactivity, aggression Agitation component of delirium Uncontrollable, severe behavioral disorders in children and adolescents Agitation and confusion from cerebral sclerosis Alcohol and opioid withdrawal Severe nausea and emesis in postoperative and palliative care, especially for palliating adverse effects of radiation Chemotherapy in oncology Treatment of neurological disorders, such as tic disorders, Tourette’s, chorea Intractable hiccups Also used in aquaculture to block dopamine receptors to enable GNRHA function for ovulation use in spawning fish ABUSED MEDICATIONS TYPE OF DRUG Prescription Opiates NAMES Morphine, Hydrocodone, Fentanyl, Methadone, Oxycodone, Codeine Anti-Anxiety Xanax, Klonopin, Valium, Ativan, Buspar Stimulants Dextroamphetamine Methylphenidate Amphetamines NOTES • act on the same receptors as heroin • produce sedating or calming effects in the same manner as the club drugs GHB and Rohypnol • higher doses like PCP or ketamine, producing similar out-of-body experiences • When crushed it destroys the slowrelease mechanism allowing a rush similar to amphetamines or crack • Snorted or injected • When injected other ingredients that are meant to be processed by the digestive system goes into your bloodstream • Can cause embolisms (blood clots) or abscesses in the veins or at the site of injection • Can cause extreme depression, insomnia, confusion, hallucinations, seizures, and anxiety attacks. • Achieve their effects by acting on the same neurotransmitter systems as cocaine Antidepressants Wellbutrin MAOI’s Parnate Nardil Moban • Increase dopamine like stimulants if dose is 4-5 times higher, and won’t show on drug screens www.ctvnews.ca/healthheadlines GENDER DIFFERENCES • • • • • • • • • • • WOMEN Greater pain relief from opioids (estrogen modulates pain relief?) More likely to relapse—particularly in the middle of the menstrual cycle, when glucose in the brain is lower. Glucose is necessary for self-control 50 and 75 percent more likely to experience side effects Antidepressants • respond better to SSRI’S than men (particularly Zoloft) SSRI’s meds may be absorbed more quickly, which can increase their toxicity Body fat may trap antidepressants in the body longer Sleep aids More of the drug in their system the next morning—creating problems when they have to be alert for work and driving Stomachs are less acidic and feel the effects of antianxiety medication faster and more powerfully, and the drugs could be more toxic Women may need to wait longer before taking a second dose, especially of benzodiazepines Ambien was discovered to be doubly potent for women • www.scientificamerican.com Men • More likely to overdose on painkillers • May have better luck with tricyclics • Liver breaks down Ambien and other sleep aids faster • Kidneys filter out drug compounds faster • Men's kidneys filter out drug compounds faster NON-GENDER • For veterans wounded in the gut it is hard to treat PTSD because of impact on serotonin levels • Can be true possibly for some gastric procedures OTHER GROUP DIFFERENCES CHILDREN • NIMH funded the Preschoolers with ADHD Treatment Study (PATS), which involved 300 preschoolers (3 to 5 years old) diagnosed with ADHD. The study found that low doses of the stimulant methylphenidate are safe and effective for preschoolers • Children of this age are more sensitive to the side effects, including slower growth rates SENIORS • Even healthy older people react to medications differently than younger people because their bodies process it more slowly • Lower or less frequent doses may be needed PREGNANT/NURSING • • • Antidepressant medications DO cross the placental barrier and may reach the fetus Research is Research shows SSRI’s associated with miscarriage or birth defects interesting Research shows no support for this • Research shows fetuses exposed to SSRI’s during the third trimester may be born with "withdrawal" symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (low blood sugar) • Research shows most studies have found that symptoms in babies are generally mild and short-lived, no deaths have been reported • Women who stop taking their antidepressant medication during pregnancy may get depression again and may put both themselves and their infant at risk • Mood stabilizers are known to cause birth defects • Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester • Benzodiazepines and Lithium have been shown to cause "floppy baby syndrome," • Haloperidol has been studied more than others, and has been found not to cause birth defects • A small amount of the psychiatric medications pass into breast milk www.ncbi.nim.nih.gov PRESCRIBING FOR CHILDREN CONDITIONS 1. Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble concentrating and restlessness. The child is easily upset and frustrated, often has problems getting along with family and friends, and usually has trouble in school. 2. Bedwetting-if it persists regularly after age 5 and causes serious problems in low selfesteem and social interaction. 3. Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive thoughts) and/or compulsions (repetitive behaviors or rituals such as handwashing, counting, or checking to see if doors are locked) which are often seen as senseless but that interfere with a youngster's daily functioning. 4. Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness, guilt, inability to feel pleasure, a decline in school work and changes in sleeping and eating habits. 5. Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or posttraumatic stress disorders)-if it keeps the youngster from normal daily activities. 6. Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting (bulimia), or a combination of the two. 7. Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods, which may include irritability, "high" or happy mood, excessive energy, behavior problems, staying up late at night, and grand plans. 8. Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing sounds that don't exist) social withdrawal, clinging, strange behavior, extreme stubbornness, persistent rituals, and deterioration of personal habits. Psychosis may be seen in developmental disorders, severe depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse. 9. Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)characterized by severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed in early childhood. 10. Severe aggression-which may include assaultiveness, excessive property damage, or prolonged self-abuse, such as head-banging or cutting. 11. Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of separation, or anxiety. acap.org PRESCRIBING FOR CHILDREN ALLOWABLE AGE TO START DRUG haloperidol (FGA) paliperidone (SGA) perphenazine (FGA) Antipsychotic Medications [ABILIFY] 10 and older for bipolar disorder, manic, or mixed episodes; 13 to 17 for schizophrenia and bipolar; 6 to 17 for irritability associated with autistic disorder [HALDOL] 3 and older [INVEGA] 12 [TRILAFON] 12 pimozide (FGA) [ORAP] 12(for Tourette’s disorder) quetiapine (SGA) [SEROQUEL] risperidone (SGA) [RISPERDAL] 13 and older for schizophrenia; 18 and older for bipolar; 10 to 17 for treatment of manic and mixed episodes of bipolar disorder 13 for schizophrenia; 10 for bipolar mania and mixed episodes; 5 to 16 for irritability associated with autism aripiprazole (SGA) thioridazine (FGA) clomipramine (TCA) [MELLARIL] 2 Antidepressant and Mood Stabilizer Medications [ANAFRANIL] 10 (for OCD only) doxepin (TCA) escitalopram (SSRI) [SINEQUAN] [LEXAPRO] 12 12-17 (for major depressive disorder) [LITHIUM] 12 imipramine [TOFRANIL ] 6 (for bedwetting) sertraline [ZOLOFT ] 6 (for OCD only) valproic acid [DEPAKOTE] 2 (for seizures) oxcarbazepine [TRILEPTAL] 4 lisdexamfetamine dimesylate [VYVANSE] 6 fluoxetine [PROZAC] 8 fluvoxamine [LUVOX] FGA – 1st generation SGA – 2nd generation 8 (for OCD only) PRESCRIBING FOR CHILDREN lorazepam Anti-Anxiety Medications [ATIVAN] 8 atomoxetine [STRATTERA] 6 ADHD Medications clonidine extended release (ER) IR- not approved for children [CATAPRES, KAPVAY] ER - 6-17 years old methamphetamine (“Desoxyn is given out in controlled tablet doses, while Crystal Meth is a crystalline substance that is smoked, injected or swallowed in much larger doses”) 6 Amphetamine/extended release [ADDERALL] 3/ 6 (XR) dextroamphetamine [DEXEDRINE] 3 guanfacine [INTUNIV] 6 methylphenidate… [RITALIN, CONCERTA] 6 Ages listed may have dose ceilings, which will increase with age. nimh.nih.gov/health/publications/mental-health-medications SIDE EFFECTS Antidepressants Sexual Sedation modest weight • all phases of loss with sexual function, bupropion and including libido, modest weight arousal, and gain with orgasm mirtazapine and • both FGAs and paroxetine SGAs can impair (Ludiomil, Paxil) arousal and orgasm in men and women • FGAs especially have been found to cause erectile and ejaculatory dysfunction in men, including spontaneous, painful, or retrograde ejaculation, as well as priapism Remeron Fanapt Saphris Brintellix Clozaril Zyprexa Cymbalta Most tricyclics Weight gain Antipsychotics Wellbutrin Celexa Lexapro Prozac Zoloft Effexor XR Anticholinergic Some tricyclics (blocks activity of nerves responsible for control of heart rate, gut motion, and rate of saliva production ) http://www.aafp.org http://www.ncbi.nlm.nih.gov http://portal.mah.harvard.edu Mood Stabilizers ← 1st,2nd generation antipsychotics ← All Haldol Latuda Risperdal/Invega Zyprexa!!!!!!!! Seroquel Fanapt Risperdal especially prominent with weaker-binding first-generation antipsychotics, as well as with the secondgeneration antipsychotic clozapine high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine Trileptal does not seem to be dose dependent SIDE EFFECTS AIMS (vs. PARKINSONIAN vs. EXTRAPYRAMIDAL) : This is a collection of abnormal movements effecting voluntary muscles and coordination of the neck, spine, gait/walking, oral/facial, fingers, limbs. Also problems with eyes (oculogyric crisis), thick tongue, cogwheeling, vocalizations, breathing and swallowing. ANTICHOLINERGIC: Dry mouth, decreased sweating, headache, dilated pupils, blurred vision, urinary hesitancy & retention TOXIC ANTICHOLINERGIC: May resemble psychosis (disorientation, confusion, hallucination, delusions, anxiety, agitation, and restlessness); dilated, non-reactive pupils; blurred vision; hot, dry, flushed skin; dry mucous membranes; difficulty swallowing; decreased/absent bowel sounds; urine retention; hyperthermia; tachycardia; hypertension; increased respiratory rate. OBESITY SEIZURES MEMORY LOSS DIABETES SUNBURN ACNE HYPERTENSION ALLERGIC REACTIONS COGNITIVE IMPAIRMENT Partial list of psychiatric medications known to cause heat or sun sensitivity **Lithium causes excessive loss of fluids, such as through excessive sweating, and can cause the lithium level in your blood to become too high. Range is 0.5 – 1.5 **Drink plenty of liquids and use salt unless instructed not to do so. MEDICATION ILLNESSES (TARDIVE DYSKINESIA and GYNOMASTIA) DEFINITION TARDIVE – “describing a disease in which a period of time passes between exposure and the first symptoms.” DYSKINESIA – “Impaired ability to make voluntary movements” “Tardive dyskinesia is a serious side effect that occurs when you take medications called neuroleptics. Most often, it occurs when you take the medication for many months or years. In some cases, it occurs after you take them for as little as 6 weeks.” “If diagnosed early, the condition may be reversed by stopping the drug that caused the symptoms. Even if the drug is stopped, the involuntary movements may become permanent, and in some cases, may become worse.” EXTRAPYRAMIDAL SYMPTOMS •tremor •akathisia (motor restlessness) •slurred speech •dystonia (continuous spasms and muscle contractions, ex. oculogyric crisis) •bradyphrenia (slowed thought processes) •bradykinesia (slowed movement) •muscular rigidity • • • • • facial grimacing finger movement jaw swinging repetitive chewing tongue thrusting www.nlm.nih.gov GYNOMASTIA DEFINITION Hormonal imbalance resulting in a decrease in testosterone as compared to estrogen, resulting in enlarged male breast tissue. RISKS Possible pain, embarrassment CONTRIBUTING DRUGS Risperdal MEDICATION ILLNESSES (SEROTONIN SYNDROME and LONG QT SYNDROME ) SEROTONIN SYNDROME DEFINITION • Illness that occurs when medications cause high levels of serotonin to accumulate in your body. Symptoms usually occur within several hours of taking a new drug or increasing the dose of a drug. This includes prescribed drugs, street drugs and dietary supplements. • Milder - go away within a day of stopping the medications, taking drugs that block serotonin. • Severe - can be fatal CONTRIBUTORS – not all-inclusive • All antidepressants • Anti-migraine medications: Imitrex, Tegretol, Depakote • Pain medications: Flexeril, Fentanyl, Demerol, Tramadol (Ultram), Lithium • Illicit drugs: LSD, Ecstasy, cocaine, amphetamines • Herbal supplements: St. John's Wort, ginseng, nutmeg • Over-the-counter cough and cold medications containing dextromethorphan LONG QT SYNDROME DEFINITION • • Long QT syndrome (LQTS) is a heart rhythm disorder that can potentially cause fast, chaotic heartbeats. These rapid heartbeats may trigger a sudden fainting spell or seizure. In some cases, your heart may beat erratically for so long that it can cause sudden death. You can be born with a genetic mutation that puts you at risk of long QT syndrome. In addition, certain medications and medical conditions may cause long QT syndrome. www.currentpsychiatry.com www.mayoclinic.org SYMPTOMS INCLUDE: • HIGH FEVER • • • • SEIZURES IRREGULAR HEARTBEAT UNCONSCIOUSNESS agitation or restlessness • • • • • • • • • • confusion rapid heart rate high blood pressure dilated pupils loss of muscle coordination or muscle rigidity twitching muscles heavy sweating diarrhea Headache shivering/goose bumps GREATER IMPACT DUE TO • • • • • age >65 female electrolyte imbalances (specifically low serum potassium and magnesium levels) high or toxic serum levels of the suspected drug preexisting cardiovascular impairment, such as bradycardia ALSO DEPENDENT UPON • • • • overdose combined with other toxic levels predisposition DISCONTINUATION and INTERACTIONS DISCONTINUATION (Not always recognized for what it is) Antidepressants • sudden withdrawal include feeling sick, vomiting, loss of appetite, headaches, dizziness, chills, insomnia, anxiety and panic, brain zap Antipsychotics • earlier, and often more severe, illness episodes than are seen with gradual discontinuation • withdrawal dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome Antipsychotics and Lithium, or certain anticonvulsant drugs • rapid versus gradual discontinuation is more likely to lead to greater mood instability and manic relapse INTERACTIONS • May affect: absorption, distribution, metabolism, elimination • Can result in serum concentration changes are generally most relevant for drugs with a narrow therapeutic index such as lithium and clozapine, where increases or decreases play a role in worsening clinical condition or increasing the risk of serious adverse effects. • pharmacodynamic - result of the combined impact of medications on the body when there is no direct effect on absorption, distribution, metabolism, or excretion • pharmacokinetic - does affect the above • drugs act at the same or interrelated receptor sites, resulting in additive, synergistic, or antagonistic effects of each drug at the target receptor www.currentpsychiatry.com www.medscape.com www.ncbi.nim.nih.gov OVERDOSE KEEP IN MIND: • • • • • All physiologies are different (especially with tolerance) Interactions can make a big difference Therapeutic levels are likely true for most people There’s overdose and there’s overdose Potentiation can make an amount that seems small actually much stronger TOXIC LEVELS (not all inclusive) SSRI’s • rarely fatal in overdose when taken alone • far safer than the TCA’s in overdose minor or no symptoms to drowsiness, tremor, nausea, and vomiting to seizures, arrhythmia, renal and respiratory failure… ATYPICAL ANTIPSYCHOTICS • overdose of antipsychotics common “in Western society” • CNS depression, tachycardia and orthostasis STIMULANTS • result in blurred vision, spasms, heart irregularities, and respiratory failure BENZODIAZEPINES • extremely low risk of acute toxicity when they are used alone • with alcohol: can impair ability to breathe, dangerously lower blood pressure, result in coma and death www.toxipedia.org www.ncbi.nim.nih.gov OVERDOSE and LAB WORK MEDICATION TOXICITY LEVELS FREQUENCY Lithium (Eskalith, Lithobid) Flu-like symptoms, tinnitus, blurred vision, lack of coordination 1.0 - 2.0 6 months Depakote (Valproic Acid, Depokene) Hyperthermia/hypotherm ia, Tachycardia, Hypotension, cardiac arrest, respiratory depression 85 - 125 6 months Clozaril (Clozapine) Agranulocytosis, fever, weakness, lethargy, or sore throat, sore mouth and gums 250-350 ng.ml Weekly biweekly monthly Tegretol (Carbamazepine) Dizziness, uncoordinated movement, sleepiness, blurred or double vision, involuntary back and forth movement of the eyeball… 5 to 12 mcg/mL NOTES: • Depakote: recommended range for the treatment of epilepsy is 50-100 µg/ml. as compared to acute mania • Agranulocytosis is a rare condition that occurs when the bone marrow does not make enough neutrophils, the white blood cells needed to fight infections. Agranulocytosis can turn minor infections into serious ones. AIMS ABNORMAL INVOLUNTARY MOVEMENT SCALE *AIMS test has a total of twelve items rating involuntary movements. Facial and Oral Movements • Muscles of facial expression e.g., movements of forehead, eyebrows, periorbital area, cheeks. Include frowning, blinking, grimacing of upper face. • Lips and perioral area e.g., puckering, pouting, smacking. • Jaw e.g., biting, clenching, chewing, mouth opening, lateral movement. • Tongue Rate only increase in movement both in and out of mouth, not inability to sustain movement. Extremity Movements • Upper (arms, wrists, hands, fingers) Include movements that are choreic (rapid, objectively purposeless, irregular, spontaneous) or athetoid (slow, irregular, complex, serpentine). Do notinclude tremor (repetitive, regular, rhythmic movements). • Lower (legs, knees, ankles, toes) e.g., lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot. Trunk Movements • Neck, shoulders, hips e.g., rocking, twisting, squirming, pelvic gyrations. Include diaphragmatic movements Incapacitation due to abnormal movements 0 = none, normal 1 = minimal 2 = mild 3 = moderate 4 = severe Patient's awareness of abnormal movements 0 = no awareness 1 = aware, no distress 3 = aware, moderate distress 4 = aware, severe distress 2 = aware, mild distress TO EAT OR NOT TO EAT TAKE MEDS WITH FOOD Trazedone/Desyrel – 20% more absorption, amount not specified Geodon – 500 calories Latuda – amount not specified Viibryd - amount not specified Lithium – food or milk Grapefruit juice potentiates effects of certain drugs: Degree of the grapefruit effect can vary - just one serving like taking multiple doses Can occur when eaten many hours before the medication Example - Simvastatin, when taken with about a 7 oz. glass of grapefruit juice once a day for three days, produced a 330% greater concentration of the drug compared to taking it with water Some examples: MAJOR: BuSpar, Tegretol, Anafranil, benzodiazepines, MODERATE: Luvox, Elavil, Haldol MAOI’s: Avoid foods containing tyramine (matured cheese, some bananas, yogurt, shrimp paste, salami) May/will cause hypertensive crisis Don’t trust the transdermal patch Lithium Too much salt - level rises / too little salt – level falls Be careful with: processed cheeses , meats, ham, canned meats and fish; packaged mixes; most frozen meals; soups and broths, snack foods, soy sauce, smoked foods, olives, pickles, tomato juice, fast foods, salt, seasonings and condiments like ketchup and meat sauces. (I think Jello is okay) MISCELLANEOUS MEDICATION INFORMATION Difference between benzodiazepines and sleepers is how fast they work and how long they last Wellbutrin SR/XL is always prescribed early in the day, but takes 4-7 hours to get into the system and then may cause insomnia or waking during sleep. If taken HS will be ready to go to start the day. Sometimes if a client is showing signs of mania, skipping 1 or 2 doses of their antidepressant might be all that is needed (of course sleep is the most important concern) NURSE’S ROLE DO REFER CLIENT TO NURSE FOR: How to take medication as prescribed Severe side effects that need to be immediately discussed Possible allergic reaction Discontinuation problems To schedule an injection appointment Assistance finding the data necessary to fill out the YELLOW FORM DON’T REFER TO NURSE FOR: INSTEAD: Medication changes Schedule with psychiatrist, fill out a YELLOW FORM and place in psychiatrists box for review Counseling on non-CMH medications Advise them to take all medications as prescribed and refer to their prescribing physician Running out of medications Should first be evaluated for the necessity of an EMR, MAPS, complete YELLOW FORM ARE YOU OVERSTEPPING? / DID YOU KNOW ARE YOU OVERSTEPPING? 1. 2. 3. 4. 5. 6. 7. 8. Does it change the doctor’s prescription? Is it a decision left up to the client? If you talk about a side effect they will get it? Could there be an allergy? Have there been any changes? Side effects – what’s on print out Clients don’t hear everything the doctor tells them, is it medical advice to remind? Can you explain the purpose of medication? DID YOU KNOW? Nutmeg: contains the psychoactive substance myristicin in its aromatic oil. Chronic effects of nutmeg abuse resemble those of marijuana abuse and can present as a mood disorder resembling bipolar disorder Lithium, which is a naturally occurring metallic salt, was first used to treat gout Thorazine was first used for general anesthesia and as an antihistimine 1st antidepressant before 1980 – Valium, Librium, Phenobarbatal (another source said Dexedrine) Depression - official name in DSM-III (1980) – Melancholia Tryptophan is a monoamine The heart secretes serotonin during a heart attack A stingray attacks by injecting serotonin 95% of all serotonin is found in the intestines (humans, not stingrays) St. John’s Wort is the most often prescribed antidepressant in Germany (30) Tenex (guanfacine) for hypertension is $3.60 - $10 for generic – Intuniv for ADHD is $125 - $243 (30) Catapres (clonidine) for generic $3.60 – $1 http://www.currentpsychiatry.com GLOSSARY NEUROLEPTIC - term that refers to the effects of antipsychotic drugs on a patient, bringing about emotional quietening without impairing consciousness. PSYCHOTROPIC - mood-altering drug that affects mental activity, behavior, or perception PYRAMIDAL Abnormal Involuntary Movement Scale (AIMS) ANTICHOLINERGIC – blocks activity of nerves responsible for control of heart rate, gut motion, and rate of saliva production POTENTIATION - enhancement of one agent by another so that the combined effect is greater than the sum of the effects of each one alone TRICYCLIC – 3 chemical rings (tetracyclics – 4 rings) INTRACTABLE – no treatment works QD - every day QOD - every other day BID - twice a day TID - three times a day QID - four times a day PRN - as needed HS - at bedtime PO - by mouth SL- sublingual DAW – dispense as written (no generic) If no treatment helps to alleviate symptoms, is it because: 1. There are compliance issues 2. They have unusual biology/physiology 3. The psychosocial factors don’t allow for improvement 4. What they or the doctor defines as improvement isn’t realistic 5. Medication can’t remove trauma, ex. dissociation, hallucinations indicate psychosis but is the medication going to the same receptor sites as it would for schizophrenia 6. They are android and the medication ingested is clogging up their motors. PARKINSON’S DISEASE - a gradual loss of neurons that produce dopamine, resulting in insufficient dopamine to parts of the brain involved with movement PARKINSONIAN – similar symptoms, different origin WISH I HAD TIME FOR: More about drug interactions Overdose thresholds Street value Starting a new medication: overlap, not overlap, etc. When to take a missed dose “BETTER LIVING THROUGH CHEMISTRY” WHAT IS YOUR ROLE