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Pharmacy Tech Chapter 7 Antidepressants, Antipsychotics, Antianxiety Agents and Alcoholism Topics Antidepressants ________________________ Antianxiety Agents ________ Disorders _________ Disorders Alcoholism 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. Antidepressants IFU - Used to treat depression _________________, common feelings Pessimism Worry Intense sadness Loss of concentration Slowing of mental processes Problems with eating and sleeping Common Symptoms of Depression Loss of ___________ in usual activities Low ___________-________________ Self-pity Pharmacy Tech Significant weight loss or gain __somnia or _______somnia Extreme restlessness Loss of _________ Feelings of _________________ Diminished ability to ______________ Feelings of __________ Recurrent thoughts of _________ Suicide attempts Depression • Women are affected ___________________ than men • When men are affected, it is usually ______________________ • Levels of neurotransmitters in the brain may be a ________________ factor ______________ Disorders • • • _____________ Mood of extreme excitement, excessive elation, hyperactivity, agitation, and increased psychomotor activity _____________ Disorder Mood swings alternate between major depression and mania _____________ Disorder Major depression with no previous occurrence of mania Describe the differences that may be seen in patients with unipolar and bipolar disorders. _______________________________________________________________________ Treatment for Depression _____________________________Therapy • Introduction of brief, but convulsive electrical stimulation through the brain • Can induce ________________. • Effective for ____________________ and __________________ depression ___________________________ • Selective ______________________ Reuptake Inhibitors (_________) Pharmacy Tech • Cyclic Antidepressants • ______________________ Oxidase Inhibitors (____________) ___________________________________________ (SSRIs) – _________the reuptake of ______________________, with little effect on norepinephrine – Fewer side effects than _____________ meds ____________________________ Antidepressants – Two Types • _______________ antidepressants (________) • _____________________ antidepressants – Prevent reuptake of _______________________ and/or serotonin – Agents in this class differ in adverse effects, cost, and response – _________________________ Oxidase Inhibitors (MAOIs) – Allows for buildup of ___________________________ at the ____________________ Drug list SSRIs for Depression • citalopram (____________) • escitalopram (__________________) • fluoxetine (______________________,) • paroxetine (_____________________) • sertraline (_______________________) • venlafaxine (_______________________) Dispensing Issues Pharmacy Tech Look-Alike Drugs – Prozac and Proscar (urinary drug) – Zoloft and Zocor (high cholesterol) – Celexa and Cerebyx (seizures) and Celebrex (arthritis) SSRI Dispensing Issues • Do not discontinue ______________________ • Alcohol consumption should be ________________ while taking these medications fluoxetine (______________) • Indicated for major depression and ______________-______________ disorder (OCD) • ______________ is a possible adverse effect • Take in the morning to avoid insomnia ____________________(Paxil) • Indicated for depression, obsessive-compulsive disorder, and panic disorder Venlafaxine (___________________________) • Blocks reuptake of serotonin and Norepinephrine • Indicated for depression • May cause increase in blood pressure and _____________________________ • Sertraline (__________________) • Indicated for depression and obsessive-compulsive disorder • Primary side effect is ________________ • May also cause drowsiness Pharmacy Tech Citalopram (__________________) • • Indicated for depression and obsessive-compulsive disorder Minimal drug interactions Escitalopram (___________________) • Similar to Celexa • More ____________ with fewer side effects Cyclic Antidepressants Tricyclic • amitriptyline (___________) • nortriptyline (Pamelor) • Improvements are usually seen in _______________________ • Can be cardiotoxic in high doses • May cause _________________ hypotension • Do not _________________________________. Cyclic Antidepressants Side Effects • Sedation is common, but ______________ usually occurs • Have many ____________________________ effects Why would cyclic antidepressants be prescribed for bed wetting in children? ________________________________________________________________________ Pharmacy Tech MAOIs • phenelzine _____________________ • selegiline (Eldepryl) • tranylcypromine (____________) MAOI Dispensing Issues Be cautious of many interactions with ____________ such as aged ______________, concentrated yeast extracts, _____________ fish, sauerkraut, ______________, _________________, and ____________l. If changing to another class of antidepressant, patient must have a _________-_________ “wash out” period before starting the new medication Other Antidepressants • bupropion (________________, Zyban) Dopamine-uptake inhibitor Does not cause sedation, blood pressure changes, or ECG changes Do not discontinue ____________ Approved in the aid of smoking ___________ • mirtazapine (Remeron) • trazodone (Desyrel) Prevents reuptake of serotonin and Norepinephrine Has a better side effect profile than TCAs Caution: possible interaction with _________________ • Wellbutrin ___ = BID dosing • Wellbutrin ___ = QD dosing Bipolar Disorders Signs or Symptoms Pharmacy Tech – Decreased need for ____________ – Elevated or irritable _____________ – ___________________ involvement in pleasurable activities with a big potential for painful ____________________ – _________________ ideas – Pressure to keep __________________ – _________________ thoughts What is the drug of choice for treating bipolar disorders? _______________________________________________ What is the two-fold objective of drug therapy for bipolar disorder? _____________________________________________________ Drugs to Treat Bipolar Disorders • carbamazepine (Tegretol) • divalproex (Depakote) • lithium (Lithobid) • olanzapine-fluoxetine (Symbyax) • valproic acid (Depakene) Lithium Side Effects • Gastrointestinal • Dermatologic • Hematologic • Neuromuscular • Weight • Renal • Teratogenic Pharmacy Tech • Beneficial for patients with rapid mood changes • Take with food or milk, but not _______________ drinks • Beware of symptoms of thrombocytopenia ____________________________________ • Also called neuroleptics • ________________________ is the primary indication • Retreat from reality • .________________ • Hallucinations • .___________________ • Withdrawal • Bizarre or _________________ behavior Antipsychotics • Helps with thought disorders, hallucinations, and delusions • Does not help with emotional and social withdrawal, ambivalence, or poor ________-________ aripiprazole (______________) clozapine (Clozaril) fluphenazine (Prolixin) haloperidol (_____________) loxapine (Loxitane) molindone (Moban) olanzapine (Zyprexa) prochlorperazine (Compazine) quetiapine (_____________) Pharmacy Tech risperidone (________________ thioridazine Antipsychotic Side Effects • ____________________ • Cardiovascular • Dermatologic • Endocrine • Hematologic • Ophthalmologic • Withdrawal • Neurologic ______________ - _____________________________________________________ ________________- _____________________________________________________ Pseudoparkinsonism Tardive dyskinesia __________________________________________________ Atypical Antipsychotics • Have improved _____________________ and reduced side effects • Better tolerated, but associated with ____________________ side effects risperidone (_____________________) • Indicated for management of psychotic disorders and dementia in the elderly • It is a serotonin-dopamine _____________________ Clozaril (antipsychotic) and Clinoril (antibiotic) are look-alike/sound-alike drugs. olanzapine (Zyprexa) Pharmacy Tech • Used for ________________________ • _______________ dopamine and serotonin receptors • Causes fewer movement disorders and is more effective • Alcohol must be avoided Zyprexa (antipsychotic) and Zyrtec (antihistamine) are look-alike/sound-alike drugs. quetiapine (__________________) • Related to Clozaril • Lower incidence of hematologic toxicities Minimizes Side Effects of Antipsychotics • benztropine (________________) • diphenhydramine (______________) • meclizine (________________) Antianxiety Agents Anxiety • State of uneasiness characterized by apprehension and worry about possible events Two Types of Anxiety • _____________________/ Response to external stresses • _____________________ /Not related to external stresses, result of abnormality in cellular function in the CNS What is the most common self-prescribed treatment for anxiety? ___________________________________________________ Antianxiety Agents • amoxapine • buspirone (BuSpar) Pharmacy Tech • hydroxyzine (Vistaril), antihistamine • paroxetine (Paxil), SSRI • propranolol (Inderal), beta blocker • venlafaxine (Effexor) Antianxiety Agents Benzodiazepines, C-IV • alprazolam (__________________ • chlordiazepoxide (__________________) • clorazepate (Tranxene) • diazepam (_____________) • lorazepam _________________ • oxazepam (Serax) • • • May cause _________________ dependence, C-IV Should not be stopped ____________________ Side Effects Muscle relaxation ______________________ excitement Sedation Xanax (antianxiety) and Zantac (H2 Antagonist for the stomach) are look-alike/sound-alike drugs propranolol (______________) • Beta blocker used to treat _________________ ______________ of anxiety • Not officially indicated for this use Pharmacy Tech • Lowers heart rate which decreases nervousness due to stage fright or test anxiety buspirone (______________) • Selectively ______________________ serotonin receptors • Take with food • Report changes in the senses Buspirone (antidepressant/antianxiety) and bupropion (antidepressant) are look-alike/sound-alike drugs. Panic Disorders Panic • Intense, overwhelming, and uncontrollable anxiety • Neither a controllable voluntary emotion nor a condition that can be avoided by ignoring it or wishing it away • Can occur anywhere at anytime • Criteria for Diagnosis Three attacks in a _________________ _____________ period At least four qualifying ______________________ Pathophysiology • Result from a _____________________ defect • The brain stem is a pathway for sensory information • If there is a defect in the brain stem, stimuli can be excessively amplified and cause an ___________________________ Treatment • ______________________ of antipanic medication and behavioral therapy Pharmacy Tech • Psychotherapy is preferred treatment when symptoms cause significant discomfort or impairment • Antianxiety medications are indicated for short-term treatment • What fraction of Americans 18 and older have a sleep disorder? ____________________________________________________ Sleep Disorders Insomnia • Difficulty falling or __________ asleep or not feeling refreshed on awakening • Treated with _________________ (to induce sleep) Causes – Situational – Medical – Psychiatric – Drug induced Stages of Sleep • • • Stage 1 Somewhat aware of surroundings, but _______________ Stage 2 Unaware of surroundings, but can easily be _______________ Stage 3 Deep sleep (_________________); dreams occur Sleep Disorders Narcolepsy • Involves recurring, ____________________ episodes of sleep during the daytime hours • No known cause • Occurs four times more in __________ than ___________ Characteristic Symptoms 1. Patient feels sleepy during the daytime and then enters into __________ sleep 2. Patient experiences _________________ with sudden emotions Pharmacy Tech 3. Sleep paralysis 4. Very vivid _________________________ at the onset of sleep Treatment of Narcolepsy • Nondrug Therapy Lifestyle changes • Drug Therapy – ______________________ – Tricyclic antidepressants – SSRIs Sleep disorders • Pharmacological Treatment ______________________ • Nonpharmacological Treatment – Normalizing sleep schedule – Increases physical __________ – Discontinuing alcohol use as a sedative – Sleep only 7-8 hours/24 hr – Reducing __________________ and _______________ intake Treatment • ____________ should be used in conjunction with other medical therapeutics • ________________are the preferred agents • Hypnotics should not be taken every night, only as needed Diazepam, lorazepam, and alprazolam can be misread and misheard. Sleep Agents Pharmacy Tech Benzodiazepines, C-IV • alprazolam (____________) • chlordiazepoxide (Librium) • clorazepate (Tranxene) • diazepam (_______________) • estazolam (ProSom) • flurazepam (Dalmane) • lorazepam (___________________) • oxazepam (Serax) • temazepam (________________) • triazolam (_________________) Barbiturates • amobarbital (Amytal), C-II • butabarbital (Butisol), C-III • secobarbital (Seconal), C-II Antihistamines • diphenhydramine (_____________________) • hydroxyzine (_____________________) Hypnotic • chloral hydrate Others • zaleplon (Sonata) • zolpidem (______________) zolpidem (________________) Pharmacy Tech • Targets benzodiazepine receptors with less effects on skeletal muscles and seizure threshold • Short-term treatment only – Should not be used for more than 10 days – Alert the pharmacist, but realize there are exceptions Alcoholism • ______________is one of the major roadblocks for a patient to overcome before getting help • Linked to _______________ • No cure, but can be arrested Effects on Metabolism and Excretion • Alcohol is an _______________ and can cause loss of consciousness • ______________ action prevents death by preventing absorption of lethal concentrations • Habitual drinkers metabolize ETOH _______________, which increases ________________ Alcoholism Side Effects • Vitamin deficiency • Gastritis • Organic brain damage • Alcoholic psychosis and dementia • Cirrhosis of the liver (irreversible damage) Symptoms of Dependence on Alcohol • _______________ or lapses of memory • Concerns of family, friends, and employers about the substance use • Doing things that cause ________________ afterwards • Financial or legal problems from substance use • Loss of ________________ with the substance • Neglecting responsibilities Pharmacy Tech • Trying to cut down or quit using a substance, but failing • Using alone; hiding evidence • Using to forget about problems • Willingness to do almost anything to get the substance Steps towards Recovery 1. Acknowledge the problem 2. Limit the time spent with substance __________ 3. Seek professional help 4. Seek support from recovering alcoholics Withdrawal Symptoms • Agitation • Circulatory disturbances • Convulsions • Delirium treatments • Digestive disorders • Disorientation • Extreme fear • Hallucinations • Mental disturbances • Nausea and vomiting • Restlessness • Sweating • Temporary suppression of REM sleep • Tremor and weakness Alcohol Antagonists Pharmacy Tech • disulfiram (________________) • naltrexone (Revia) • topiramate (_________________) – not approved yet disulfiram (_________________) • Stops the _______________________ of alcohol • Upon consumption of alcohol, side effects are immediate: • – Blurred vision – Difficulty breathing – Chest pain – Severe headache – Nausea – ___________________ – Uneasiness – Face becomes hot & scarlet – Confusion – Thirst Patients must read labels to avoid ETOH: – Cough medicines – Mouthwashes – _______________ – _________________ topiramate (_______________) • ____________________________ that can reduce cravings for alcohol • Takes _________________ to be effective • Topamax mixed with behavioral therapy looks promising in the treatment of alcoholism Pharmacy Tech
