Download pharmacokinetics

PHARMACOKINETICS:
PSYCHOTROPIC DRUGS
ALLIE PUNKE ([email protected])
TCA
PSYCHOTROPIC DRUGS
TCA
• AB is a 75 YO patient who is going to be initiated on
a TCA. The physicians asks for your
recommendation on which TCA to initiate. What
class (secondary or tertiary) do you recommend?
TCA
• Secondary:
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Examples:
Primarily (NE or serotonin):
Metabolism:
Active or inactive metabolites:
• Tertiary:
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Examples:
Primarily (NE or serotonin):
Metabolism:
Active or inactive metabolites:
TCA
• A patient is admitted to the hospital due to
overdose of amitriptyline. Is hemodialysis an option?
• Distribution:
• Lipophilic or hydrophilic
• Plasma protein binding
TCA
• Increase or Decrease TCA levels?
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Carbamazepine
Promethazine
Elderly
Smoking
Fluoxetine
Chronic alcohol use
Birth control pills
Phenytoin
Barbiturates
TCA
• Due to your previous recommendation, AB was
initiated on nortriptyline (takes at 8 pm daily). When
should we schedule a follow up appointment with
him to draw a nortriptyline level?
• What is considered a therapeutic level?
• If the patient was on imipramine instead, what labs
would we want to order?
SSRI
PSYCHOTROPIC DRUGS
SSRI
SSRI’s are first line to use for anxiety; they are safer
than TCAs, especially if the patient overdoses.
• BK is a 25 YO female who balances working 2 part
time jobs and attends college. Due to her busy
lifestyle, she admits to not taking her medications at
the same time every day and occasionally forgets
her medications. Which SSRI (name and dose)
should we initiate for her?
SSRI
• BR is a 26 YO female who reports feeling very
anxious throughout the day which affects her
appetite (often doesn’t feel like eating).
Additionally, she notes that she has a hard time
sleeping due to not being able to “shut off her
brain” at night. Which SSRI should we initiate for
her?
• TR is a 30 YO male who recently moved back into
his parents house. He reports he has difficulty
getting out of bed and starting his day due to
depression. Which SSRI should we initiate for him?
SSRI
• Which enzyme are SSRIs metabolized by?
• Which SSRIs are responsible for drug-drug
interactions due to inhibition of a CYP enzyme?
SNRI
PSYCHOTROPIC DRUGS
SNRI
• What physiologic response can SNRIs cause that
should be monitored in patients (due to MOA)?
• Venlafaxine is metabolized by CYP 2D6 to what
active metabolite?
• Duloxetine also had indications for what other
conditions?
LITHIUM
PSYCHOTROPIC DRUGS
LITHIUM
• BZ is a 24 YO male who was diagnosed with bipolar
disorder. He comes to your pharmacy to pick up his new
prescription for lithium. What are some acute side effects
to counsel him about?
• What dose was he mostly likely prescribed?
• What is the goal therapeutic level?
• Ideally, how long should we wait after the patient took
the last dose to draw a level?
LITHIUM
• BZ is experiencing GI distress, lack of coordination,
and lethargic. Since the patient is on lithium, an
appropriately timed lithium level is ordered and
results as1.6. Which of the following is the patient
experiencing?
• Mild toxicity
• Moderate toxicity
• Life threatening toxicity
Can we consider using hemodialysis to lower the lithium
concentration?
LITHIUM
LITHIUM
• DY is a 35 YO male who was diagnosed with bipolar
disorder and is being managed on lithium. He
recently completed the Boston marathon. Due to
probable sodium depletion from running, what is
the effect on the lithium level (increased or
decreased)?
• A 24 YO female in pharmacy school has been
consuming extra caffeine in order to prepare for an
exam. How will this affect her lithium level?
LITHIUM
• Which of the following will result in a decreased
lithium concentration?
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A. NSAIDS
B. ACEI
C. Decrease in sodium intake
D. Increase in sodium intake
• What type of diuretic affects lithium? Does it
increase or decrease lithium levels?
SUMMARY
• TCAs= ___________ for elderly patients due to no
_______ metabolites.
• SSRIs= _________ if not adherent to medication
regimen. ___________ is the most sedating. ________
does NOT need to be tapered, due to the long halflife. If a drug is metabolized by ________, a drug
interaction is likely if combined with fluoxetine and
paroxetine. _______ is the starting dose for fluoxetine
with a max of ______. _______ is the starting dose for
sertraline for a young healthy patient, whereas the
starting dose for a geriatric patient is _____.
SUMMARY
• NSAIDS/ACEI, thiazides, and decreased sodium
intake all result in ________ lithium levels.
• Caffeine, theophylline, increased sodium intake all
result in _________ lithium levels.
• Patients should be counseled regarding _______
and _______ because these can affect lithium levels.
SUMMARY
• Mild toxicity= _______ lithium level
• Moderate toxicity=__________ lithium level
• Life-threatening toxicity= _________ lithium level
• Acute therapeutic range=______
• Chronic therapeutic range=______
QUESTIONS?
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