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Chapter 7
Psychiatric and
Related Drugs
© Paradigm Publishing, Inc.
1
Learning Objectives
• Differentiate the antidepressant, antipsychotic, and
antianxiety agents.
• Be prepared to discuss the antidepressant classes, their
uses, and their side effects.
• Know why and how lithium and other drugs are used in
treating bipolar disorders.
• Be familiar with antipsychotics and the drugs that prevent
their side effects.
• Define anxiety, learn its symptoms, and know the drugs
used in its treatment.
• Recognize the course and treatment of panic disorders,
insomnia and alcoholism.
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2
Depression and Mood
Disorders
• Clinical depression is the most
severe psychiatric disorder
• Women more likely than men to have
depression
• Depression occurs later in life in men
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3
Common Symptoms of
Depression
• Loss of interest in
usual activities
• Low self-esteem
• Self-pity
• Significant weight loss
or gain
• Insomnia or
hypersomnia
• Extreme restlessness
• Loss of energy
• Feelings of
worthlessness
• Diminished ability to
think
• Feelings of guilt
• Recurrent thoughts of
death
• Suicide attempts
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Mood Disorders
• Mania
– Mood of extreme excitement, excessive
elation, hyperactivity, agitation, and
increased psychomotor activity
• Bipolar disorder
– Mood swings that alternate between
major depression and mania
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Mood Disorders
• Unipolar depression
– Major depression with no previous occurrence
of mania
• Post-traumatic stress disorder (PTSD)
– Disorder characterized by persistent agitation
or persistent, recurrent fear after the end of a
traumatic event and lasting for over a month or
impairing work or relationships
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Mood Disorders
• Seasonal affective disorder (SAD)
– Form of depression that recurs in the fall
and winter and remits in the spring and
summer
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Discussion
What are the differences that may be
seen in patients with unipolar and
bipolar disorders?
Patients with unipolar disorder have
depression symptoms. Patients with
bipolar disorder have depression and
mania symptoms.
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Neurotransmitters and
Depression Therapy
• Neurotransmitters
– Chemicals produced by nerve cells
– Involved in transmitting information in the body
– Important in mood disorders and other mental
disorders
• Antidepressants change levels of two
neurotransmitters: serotonin,
norepinephrine
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Four Classes of
Antidepressants
• Selective serotonin reuptake inhibitor
(SSRI)
• Serotonin norepinephrine reuptake
inhibitor (SNRI)
• Tricyclic antidepressants (TCA)
• Monoamine oxidase inhibitors (MAOIs)
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How Antidepressants Work
• SSRIs block reuptake (reabsorption) of
serotonin, little effect on norepinephrine
• SNRIs increase both serotonin and
norepinephrine
• TCAs prevent reuptake of serotonin and/or
norepinephrine
• MAOIs inhibit enzymes that break down
serotonin and norepinephrine
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Dispensing Issues of
Antidepressants
• Delay of onset 10 to 21 days
• Never used on an “as needed” basis
• Antidepressants are not controlled
substances
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Dispensing Issues of
Antidepressants
Warning!
• Antidepressants as a class must include a
Medication Guide
– Give to all patients with every dispensing
– Pharmacy technicians make sure every
antidepressant has Medication Guide attached
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Side Effects of
Antidepressants
• SSRIs and SNRIs safer than TCAs
• Serotonin syndrome: combining
antidepressants that increase serotonin
levels with drugs that also stimulate
serotonin levels. Can be fatal.
– Could occur if patient is prescribed triptans
(migraines) with antidepressants
– Many people with migraines also depressed
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Dispensing Issues of
Antidepressants
Warning!
• Technicians—be aware of serotonin
syndrome. Will see warnings on computer
• Technicians should notify pharmacist and
prescriber if patient is prescribed drugs
that could cause such interactions
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Drug List
SSRIs and Related Drugs
– citalopram (Celexa)
– escitalopram (Lexapro)
– fluoxetine (Prozac, Sarafem)
– fluvoxamine (none)
– paroxetine (Paxil)
– sertraline (Zoloft)
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citalopram (Celexa)
• Approved for depression and obsessivecompulsive disorder (OCD)
• OCD: recurrent, persistent urges to
perform repetitive acts, e.g. hand washing
• Structurally different from other drugs in
the class
• Minimal drug interactions
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fluoxetine (Prozac)
• Indicated for major depression and
OCD
• Anorexia possible adverse effect
• Take in morning to avoid insomnia
• Fluoxetine and white light for SAD
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escitalopram (Lexapro)
• Similar to citalopram (Celexa)
• More potent with fewer side effects
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paroxetine (Paxil)
• Indicated for depression, obsessivecompulsive disorder, and panic
disorder
• Side effects: nausea, headache,
ejaculatory disturbances, sweating
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sertraline (Zoloft)
• Indicated for depression and
obsessive-compulsive disorder
• Nausea primary side effect
• Also can cause drowsiness
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Dispensing Issues of Celexa
Warning!
• Often confused
– Celexa
– Cerebyx (seizures)
– Celebrex (arthritis)
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Dispensing Issues of Prozac
Warning!
• Look-Alike
– Prozac
– Proscar (prostrate enlargement)
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Dispensing Issues of Paxil
Warning!
• Can be confused
– Paxil
– Pepcid (gastric acid reducer)
• Same strengths
• Brand names sound alike
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Dispensing Issues of Zoloft
Warning!
• Can be confused
– Zoloft
– Zocor (cholesterol reducer)
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Dispensing Issues of SSRIs
Warning!
• Do not discontinue abruptly
• Alcohol consumption should be avoided
while taking these medications
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SNRIs
• Used when SSRIs are not effective
• Affect both serotonin and
norepinephrine reuptake
• More effective for pain than drugs
affecting one neurotransmitter
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Drug List
SNRIs
– duloxetine (Cymbalta)
– venlafaxine (Effexor)
– desvenlafaxine (Pristiq)
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duloxetine (Cymbalta)
• Approved for major depression and pain
associated with diabetic neuropathy
• Potent serotonin and norepinephrine
inhibitor, weak inhibitor of dopamine
• More interactions than other drugs in class
• Do not discontinue abruptly
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venlafaxine (Effexor)
• Blocks reuptake of serotonin and
norepinephrine
– At lower dose affects serotonin
– At higher dose also affects norepinephrine
• Prescribed for depression
• Adverse effects: sustained increase in
blood pressure, may produce manic
episodes
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desvenlafaxine (Pristiq)
• Major metabolite of venlafaxine
• Approved for depression and hot flashes
– Only nonestrogenic drug available
• Works same way as venlafaxine, but less
side effects
• Also used for fibromyalgia and neuropathic
pain
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Cyclic Antidepressants
• Two varieties
– 3 fused carbon rings (tricyclic)
– 4 fused carbon rings (tetracyclic)
• Tricyclic antidepressants (TCAs)
– Produce response in 50+% of patients
– Also used in bed-wetting for children
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Drug List
Tricyclic Antidepressants (TCAs)
– amitriptyline (Elavil)
– clomipramine (Anafranil)
– desipramine (Norpramin)
– doxepin (Sinequan, Zonalon)
– imipramine (Tofranil)
– nortriptyline (Aventyl, Pamelor)
– protriptyline (Vivactil)
– trimipramine (Surmontil)
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Drug List
Tetracyclic Antidepressants
– maprotiline (Ludiomil)
– mirtazapine (Remeron)
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doxepin (Sinequan, Zonalon)
• Tricyclic antidepressant (TCA)
• Used to treat depression
• Cream used for pruritus (itching) in
adults, not more than 8 days
• Oral liquid used by dentists for
“burning mouth syndrome”
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Mirtazapine (Remeron)
• Used to treat mild to severe
depression, especially for patients
who suffer from nausea
• Blocks receptors that inhibit release
of serotonin and norepinephrine
• Some antianxiety effects
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Dispensing Issues of Cyclic
Antidepressants
Warning!
•
•
•
•
Improvements usually 10 to 21 days
Can be cardiotoxic in high doses
May cause postural hypotension
Do not discontinue abruptly
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Side Effects of Cyclic
Antidepressants
• Sedation is
common, but
tolerance usually
occurs
• Have many
anticholinergic
effects
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Monoamine Oxidase
Inhibitors (MAOIs)
• Second-line treatment because of
many interactions with food and other
drugs
• Most beneficial in atypical depression
• Currently used to treat conditions
other than depression
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Drug List
Monoamine Oxidase Inhibitors
(MAOIs)
– phenelzine (Nardil)
– selegiline (Eldepryl, Emsam)
– tranylcypromine (Parnate)
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Dispensing Issues of MAOIs
Warning!
• 2 weeks washout period before starting
new class of antidepressant
• Severe hypertensive reactions with food
containing high level of tyramine
– Aged cheeses, concentrated yeast extracts,
pickled fish, sauerkraut, broad bean pods
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Drug List
Other Antidepressant Drugs
– bupropion (Wellbutrin, Zyban)
– nefazodone (none)
– trazodone (Desyrel)
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trazodone (Desyrel)
• Prevents reuptake
of serotonin and
norepinephrine
• Better side effect
profile than TCAs
• Ginkgo—possible
interaction
• Priapism
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bupropion (Wellbutrin,
Zyban)
• Dopamine-uptake inhibitor
• Does not cause sedation, blood
pressure changes, or ECG changes
• Maximum daily dose of 450 mg
• Approved aid to smoking cessation
and SAD
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Dispensing Issues of
Wellbutrin
Warning!
• Wellbutrin
• Wellbutrin SR
Three times a day
dosing
Twice a day dosing
• Wellbutrin XL
Once a day dosing
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Dispensing Issues of
Wellbutrin
Warning!
Mistaking the dosing of
Wellbutrin forms could lead to
overdosing or underdosing
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Bipolar Disorders Mania
Episodes
• Decreased need
for sleep
• Distractibility
• Elevated or
irritable mood
• Grandiose ideas
• Increase in activity
• Racing thoughts
• Pressure to keep
talking
• Excessive
involvement in
pleasurable
activities with large
potential for painful
consequences
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Bipolar Disorders Depressive
Episodes
•
•
•
•
•
•
Sadness, excessive crying
Low energy
Loss of pleasure
Difficulty concentrating
Irritability
Thoughts of death or suicide
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Drug List
Drugs to Treat Bipolar Disorders
– carbamazepine (Epitol, Tegretol)
– divalproex (Depakote)
– lithium (Eskalith, Lithobid)
– olanzapine-fluoxetine (Symbyax)
– valproic acid (Depakene)
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lithium (Eskalith, Lithobid)
• Drug of choice to treat
– Bipolar disorder and acute mania
– Prophylaxis of unipolar and bipolar
disorders
• Patients taking lithium must have
frequent blood tests to assess lithium
levels and maintain therapeutic range
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Dispensing Issues of Lithium
Warning!
• Lithobid tablets are effective only for
6 months
• Highlight expiration dates on
containers
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carbamazepine (Tegretol) or
divalproex (Depakote)
• For patients who cannot tolerate
lithium, either drug can be
substituted:
• carbamazepine
• divalproex
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Neurotransmitters in
Schizophrenia
• Dopamine and, to lesser degree, serotonin
• Dopamine receptors in 4 pathways,
including limbic system
• Limbic system
– Controls emotions
– Psychotic experiences when dopamine levels
are excessive
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Terms to Remember
depression
mania
bipolar disorder
unipolar depression
post-traumatic stress disorder
(PSTD)
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Terms to Remember
seasonal affective disorder (SAD)
neurotransmitter
selective serotonin reuptake inhibitor
(SSRI)
serotonin norepinephrine reuptake
inhibitor (SNRI)
tricyclic antidepressant (TCA)
© Paradigm Publishing, Inc.
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Terms to Remember
monoamine oxidase inhibitor (MAOI)
serotonin syndrome
obsessive-compulsive disorder
(OCD)
anorexia
priapism
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Psychosis
• Antipsychotics or neuroleptics
• Schizophrenia is primary indication
–
–
–
–
–
–
Retreat from reality
Delusions
Hallucinations
Ambivalence
Withdrawal
Bizarre or regressive behavior
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Antipsychotics
• Older or typical antipsychotics: many side
effects, especially muscle control problems
• New or atypical antipsychotics
– Improved efficacy and reduced side effects
– Limit dopamine-blocking ability to the limbic
system pathway
– First-line agents
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Antipsychotics
• Help with thought disorders,
hallucinations, and delusions
• Do not help with emotional and social
withdrawal, ambivalence, or poor
self-care
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Drug List
Antipsychotic Drugs
– fluphenazine (Prolixin)
– haloperidol (Haldol)
– loxapine (Loxitane)
– molindone (Moban)
– perphenazine (Trilafon)
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Drug List
Antipsychotic Drugs
– prochlorperazine (Compazine)
– thioridazine (ceiling dose, not exceed
800 mg/day)
– thiothixene (Navane)
– trifluoperazine (Stelazine)
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Side Effects of
Antipsychotics
•
•
•
•
•
•
Anticholinergic
Cardiovascular
Dermatologic
Endocrine
Hematologic
Ophthalmologic
• Withdrawal
• Neurologic
– Dystonia
– Akathisia
– Pseudoparkinsonism
• Tardive dyskinesia
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Drug List
Agents to Minimize Side Effects of
Antipsychotics
– benztropine (Cogentin)
– diphenhydramine (Benadryl)
– meclizine (Antivert)
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Atypical Antipsychotics
• Improved efficacy and reduced side effects
• Better tolerated, but associated with
metabolic side effects
–
–
–
–
Weight gain
Hyperglycemia
New-onset diabetes
Dyslipidemia
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Drug List
Atypical Antipsychotic Drugs
– aripiprazole (Abilify)
– clozapine (Clozaril)
– olanzapine (Zyprexa)
– paliperidone (Invega)
– quetiapine (Seroquel)
– risperidone (Risperdal)
– ziprasidone (Geodon)
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aripiprazole (Abilify)
• Improves dopamine activity
• Low risk of motor and other side
effects
• Used mostly for bipolar disorder
• Also approved for major depressive
disorder
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clozapine (Clozaril)
• Used to manage schizophrenic
patients
• Reduces white blood cells. Black Box
warning.
• Leukocyte counts
– Should be taken weekly during therapy
– Pharmacy documents results
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Dispensing Issues of
clozapine (Clozaril)
Warning!
• Before dispensing, pharmacy must
receive blood work reports
• Pharmacy technician must document
– White blood count (WBC) > 3500/mm3
– Absolute neutrophil count (ANC)
> 2000/mm3
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Dispensing Issues of
clozapine (Clozaril)
Warning!
• Look-alike and sound-alike
– Clozaril (antipsychotic)
– Clinoril (sunlindac), rheumatoid arthritis
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olanzapine (Zyprexa)
• Used for schizophrenia
• Blocks dopamine and serotonin receptors
• Fewer movement disorders and more
effective than clozapine and risperidone
• Avoid alcohol
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Dispensing Issues of
olanzapine (Zyprexa)
Warning!
• Look-alike and sound-alike
– Zyprexa (antipsychotic)
– Zyrtec (antihistamine)
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paliperidone (Invega)
• Used in treatment of schizophrenia
• Few interactions with other drugs
• Uses OROS (osmotic-controlled
release oral delivery system)
– Drug dissolves through pores in shell
– When empty, ghost is excreted in stool
• Side effect: orthostatic hypotension
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quetiapine (Seroquel)
• Related to Clozaril
• Lower incidence of hematologic
toxicities
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risperidone (Risperdal)
• Indicated for management of
psychotic disorders and dementia in
elderly
• First drug approved for autism
• Serotonin-dopamine antagonist
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ziprasidone (Geodon)
• Used for schizophrenia
• Causes less weight gain than other
antipsychotic agents
– Some patients quit taking antipsychotic
agents if gain weight
• May lead to arrhythmia and death
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Terms to Remember
antipsychotic
narcoleptic
schizophrenia
tardive dyskinesia
osmotic-controlled release delivery
system (OROS)
ghost
autism
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Anxiety
• State of uneasiness characterized by
apprehension and worry about possible
events
• Two types of anxiety
– Exogenous: response to external stresses
– Endogenous: not related to external stresses,
result of abnormality in cellular function in CNS
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Antianxiety Agents
• Also called sedatives
• Include both noncontrolled and
controlled substances
• Benzodiazepines, buspirone, and to a
lesser extent, beta blockers are most
used for panic attacks
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Drug List
Antianxiety Agents
– amoxapine (none), TCA
– buspirone (azapirone) (BuSpar)
– hydroxyzine (Vistaril), antihistamine
– meprobamate (Miltown)
– paroxetine (Paxil), SSRI
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Drug List
Antianxiety Agents
– propranolol (Inderal), beta blocker
– trifluoperazine (Stelazine),
antipsychotic
– venlafaxine (Effexor), SNRI
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Drug List
Antianxiety Agents
Benzodiazepines
– alprazolam (Xanax)
– chlordiazepoxide (Librium)
– clorazepate (Tranxene)
– diazepam (Valium)
– lorazepam (Ativan)
– oxazepam (Serax)
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Benzodiazepines
• May cause physical or psychological
dependence or both, C-IV
• Should not be stopped abruptly
• Side effects
– Muscle relaxation
– Paradoxical excitement
– Sedation
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propranolol (Inderal)
• Beta blocker used to treat physical
symptoms of anxiety
• Not officially indicated for this use
• Reduces heart rate which decreases
nervousness due to stage fright or test
anxiety
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buspirone (Buspar)
• Selectively antagonizes serotonin
receptors
• Take with food
• Report changes in senses: hearing, smell,
or taste
• Also used for depression
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Dispensing Issues of
buspirone (Buspar)
Warning!
• Look-alike and sound-alike:
buspirone and bupropion
– Buspirone, antidepressant/antianxiety
– Bupropion, antidepressant
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Panic Disorders
• Panic: form of intense, overwhelming,
and uncontrollable anxiety
• Neither a controllable voluntary
emotion nor a condition that can be
avoided by ignoring it or wishing it
away
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Panic Disorders
• Can occur anywhere at anytime
• Criteria for diagnosis
– Three attacks in a three-week period
– At least four qualifying symptoms
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Pathophysiology of Panic
Disorders
• Result from neurochemical defect in
part of the brain
• Stimuli can be excessively amplified
and cause an overreaction
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Treatment of Panic Disorders
• Combination of antipanic medication
and behavioral therapy
• Psychotherapy preferred treatment
when symptoms cause significant
discomfort or impairment
• Antianxiety medications indicated for
short-term treatment
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Terms to Remember
anxiety
a state of uneasiness characterized
by apprehension and worry about
possible events
exogenous anxiety
anxiety caused by factors outside the
organism
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Terms to Remember
endogenous anxiety
anxiety caused by factors within the
organism
panic
intense, overwhelming, and
uncontrollable anxiety
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Sleep and Sleep Disorders
• Sleep is fundamental to human
health
• Four stages of sleep
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Four Stages of Sleep
• Stage I. Somewhat aware of
surroundings, relaxed, NREM
• Stage II. Unaware of surroundings.
Easily awakened, NREM
• Stages III and IV. Increased
autonomic activity, REM with dreams,
4 to 5 times a night
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Insomnia
• Difficulty falling or staying asleep, or
not feeling refreshed on awakening
• Treated with hypnotics (drugs that
induces sleep)
• Chronic, occasional, or short-term
insomnia
• Transient insomnia not sleep disorder
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Causes of Some Sleep
Disorders
• Situational: job stress, hospitalization,
travel
• Medical: pain, respiratory or GI problems
• Psychiatric: schizophrenia, depression,
mania
• Drug induced: alcohol, caffeine,
sympathomimetic agents
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Treatment for Sleep
Disorders
• Diagnosis and effective treatment can
often eliminate need for hypnotic
drugs
• For clearly defined insomnia,
hypnotics used as an adjunct
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Narcolepsy
• Recurring, inappropriate episodes of
sleep during the daytime hours
• No known cause
• Occurs four times more in men than
women
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Four Characteristics of
Narcolepsy
1. Patient feels sleepy during daytime
and immediately enters REM sleep
2. Patient experiences cataplexy with
sudden emotions
3. Sleep paralysis
4. Very vivid hallucinations at the onset
of sleep
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Treatment of Narcolepsy
• Nondrug Therapy
– Lifestyle changes
• Drug Therapy
– Stimulants
– Tricyclic antidepressants
– SSRIs
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Treatment of Sleep Disorders
• Pharmacological: hypnotics
• Nonpharmacological
–
–
–
–
–
–
Normalizing sleep schedule
Increase physical exercise
Discontinue alcohol as a sedative
Sleep only 7 to 8 hours in 24-hour period
Reduce caffeine and nicotine intake
Eliminate any drug that could lead to insomnia
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Sleep Agents
• Should be used in conjunction with
other medical therapeutics
• Take 1 hour before bedtime
• Take only a limited number of times
each week
• Duration of use: 4 to 6 week period
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Drug List
Sleep Agents
– alprazolam (Xanax)
– chlordiazepoxide (Librium)
– clorazepate (Tranxene)
– diazepam (Valium)
– estazolam (ProSom)
– flurazepam (Dalmane)
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Drug List
Sleep Agents
– lorazepam (Ativan)
– oxazepam (Serax)
– quazepam (Doral)
– temazepam (Restoril)
– triazolam (Halcion)
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Drug List
Sleep Agents
Barbiturates
– amobarbital (Amytal), C-II
– butabarbital (Butisol), C-III
– secobarbital (Seconal), C-II
Antihistamines
– diphenhydramine (Benadryl)
– hydroxyzine (Vistaril)
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Antihistamines
• Do not reduce REM sleep
• Safest drugs to use in treating
insomnia
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Drug List
Sleep Agents
Hypnotics
– chloral hydrate (none)
– ramelteon (Rozerem)
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chloral hydrate
• Does not reduce REM sleep
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ramelteon (Rozerem)
• Approved for sleep onset insomnia
• Not a controlled substance because
works in a different way than other
hypnotics
• Rapid onset, no next-day hangover
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Dispensing Issues of
Rozerem
Warning!
• Look-alike
– Rozerem
– Razadyne (galantamine), Alzheimer
disease
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Z Hypnotics
• Preferred treatment of sleep
disorders
• No seizures if drug abruptly
discontinued
• Relatively short half-life
• Do not significantly impact REM
sleep
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Drug List
Sleep Agents
Z Hypnotics
– eszopiclone (Lunesta)
– zaleplon (Sonata)
– zolpidem (Ambien)
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Side Effects of Z Hypnotics
• Sleepwalking, eating, or driving
(sleepdriving) with no recall of events
• FDA looking at side effects and
encouraging manufacturers to include in
labelingA
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eszopiclone (Lunesta)
• Approved for chronic insomnia
• Causes an unpleasant taste, usually
disappears after a couple of weeks
• Take immediately before bedtime
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zaleplon (Sonata)
• Shortest-acting hypnotic
• Duration of action 4 hours
• Can be taken in middle of night
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zolpidem (Ambien)
• Schedule IV drug
• Many of the same properties as
benzodiazepines, but structurally
different
• Approved for long-term use
• Prevents early awakening
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Dispensing Issues of
zolpidem (Ambien)
Warning!
• Watch prescriptions—should not be
used more than 10 days
• Alert pharmacist, but may be
exceptions
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Terms to Remember
insomnia
difficulty falling asleep or staying asleep or
not feeling refreshed on awakening
hypnotic
a drug that induces sleep
narcolepsy
a sleep disorder involving recurring
inappropriate attacks of sleep during the
daytime hours
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Alcoholism
• Disease can be arrested, not cured
• Lifetime disease, potentially fatal
• Can be controlled through behavioral
changes
• Complex genetic disease
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Effects of Alcoholism on
Metabolism
• Alcohol is an anesthetic and can
cause loss of consciousness
• Emetic action prevents death by
preventing absorption of lethal
concentrations
• Alcoholics metabolize alcohol rapidly,
which increases tolerance
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Side Effects of Alcoholism
•
•
•
•
•
Obesity with vitamin deficiency
Gastritis and loss of appetite
Organic brain damage
Alcoholic psychosis and dementia
Cirrhosis of the liver (irreversible
damage)
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Symptoms of Dependence
on Alcohol
• Blackouts or lapses of memory
• Concerns of family, friends, and employers
about the drinking
• Doing things that cause regret afterwards
• Financial or legal problems from drinking
• Loss of pleasure without alcohol
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Symptoms of Dependence
on Alcohol
• Neglecting responsibilities
• Trying to cut down or quit drinking, but
failing
• Using alone; hiding evidence
• Drinking to forget about problems
• Willingness to do almost anything to get
alcohol
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Four Steps Towards
Recovery from Alcoholism
1. Acknowledge the problem
2. Limit time spent with substance
abusers
3. Seek professional help
4. Seek support from recovering
alcoholics
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Alcohol Withdrawal
Symptoms
• Agitation
• Circulatory
disturbances
• Convulsions
• Delirium treatments
(DTs)
• Digestive disorders
• Disorientation
• Extreme fear
• Hallucinations
•
•
•
•
Mental disturbances
Nausea and vomiting
Restlessness
Sweating
• Temporary REM sleep
suppression
• Tremor and weakness
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Drug List
Alcohol Antagonists
– acamprosate (Campral)
– disulfiram (Antabuse)
– naltrexone (ReVia, Vivitrol)
– topiramate (Topamax)
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acamprosate (Campral)
• Moderately successful in clinical trials
• Combination of acamprosate and
disulfiram (Antabuse) may work
better than either drug alone
• Take with food
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disulfiram (Antabuse)
• Stops metabolism of alcohol
• When alcohol ingested, these side effects
–
–
–
–
–
–
Blurred vision
Chest pain
Confusion
Difficulty breathing
Face hot & scarlet
Nausea
–
–
–
–
–
Severe headache
Severe vomiting
Throbbing in head
Thirst
Uneasiness
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disulfiram (Antabuse)
• Patients must read labels to avoid
alcohol in everyday products
– Cough medicines
– Mouthwashes
– Flavorings
– Salad dressings
– Wine vinegars
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topiramate (Topamax)
• Anticonvulsant that reduces cravings
for alcohol
• 6 weeks to be effective
• Topamax with behavioral therapy
promising in treating alcoholism
• Must be taken daily, poor compliance
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Terms to Remember
delirium tremens (DTs)
a condition caused by cessation of
alcohol consumption in which coarse,
irregular tremors are accompanied by
vivid hallucinations
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Assignments
• Complete Chapter Review activities
• Answer questions in Study Notes
document
• Study Partner
– Quiz in review mode
– Matching activities
– Drug tables
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