Drugs for mental health chapter 31
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Drugs for Mental Health chapter-31. “ the Mentally Healthy person ” – one who can perceive reality accurately and has control over expression of emotions Mental Health : not a concrete achievable goal …but a lifelong process resulting in a sense of harmony and balance in a person’s life

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Drugs for mental health chapter 31

Drugs for Mental Healthchapter-31

“the Mentally Healthy person” – one who can perceive reality accurately and has control over expression of emotions

Mental Health: not a concrete achievable goal …but a lifelong process resulting in a sense of harmony and balance in a person’s life

-difficult to define, highly individualized

-varies from person-to-person


Medication in psychotherapy

Medication in Psychotherapy

  • Among the most prescribed drugs

  • Used to reduce/alleviate symptoms of STRESS …to allow the patient’s participation in other psychotherapies

  • DRUGS – temporarily change behavior, addiction/dependence are major concerns

  • PSYCHOTHERAPY – more long-term, but … the results are more permanent


Neurosis vs psychosis

Neurosis vs Psychosis

  • Neurosis: patient is still in contact with reality

  • Psychosis: patient is out of contact with reality, unable to communicate

  • DRUGs for Anxiety (see Table 31-1) known generally as ‘anxiolytics’ which literally means ‘to break apart, or dissolve anxiety’

  • Benzodiazepines – long and/or short-acting

  • Misc Anxiolytics – Buspar, Paxil, Effexor, Desyrel


Anxiolytics cont

Anxiolytics (cont)

  • Benzodiazepines - introduced in the 1960’s

  • Generic names end in ‘-pam’ - diazepam, lorazepam, clonazepam (exception: alprazolam, whose brand name is Xanax)

  • ‘drugs-of-choice’ – safer, lower abuse potential, less tolerance and dependence (again, except for Xanax!)

  • Effect: a calming-effect without extreme sedation

  • (2)general types: Short-acting and Long-acting


Benzodiazepines patient education

Benzodiazepines Patient-education

  • Take with food if GI symptoms occur

  • Take exactly as directed (don’t modify dose)

  • DO NOT mix with alcohol!

  • Drowsiness occurs … careful in hazardous situations, driving, machinery, etc

  • Physical dependence is rare, except Xanax !

  • Benzo’s should NOT be used in pregnancy!


Misc anxiolytics

Misc Anxiolytics

  • Buspar (buspirone)

  • Vistaril/Atarax (hydroxyzine pamoate/hcl)

  • Paxil (paroxetine)

  • Effexor (venlafaxine)

  • Desyrel (trazodone)

  • See “Facts about Anxiolytics” on p.662


Major tranquilizers neuroleptics

Major tranquilizers/ Neuroleptics

  • Drugs used to treat Psychosis(see Table 31-2) are also known as “Antipsychotics”

  • Antipsychotics are effective in 3 main areas:

    1)hallucinations,delusions,combativeness (psychosis)

    2)relief of nausea/vomiting (chemo, narcotic s/e)

    3)to increase potency of analgesics (ex: promethazine)

  • The two major forms of Psychosis are …

  • Schizophrenia and Depression


Anti mania bi polar drugs

Anti-Mania & Bi-polar drugs

  • Bi-polar Disorder (formerly referred to as Manic-Depression)

  • common meds used in the bi-polar patient:

  • Lithium (Lithobid, Eskalith) – mainstay

  • carbamazepine (Tegretol) – developed as an anti-seizure drug

  • valproic acid (Depakote, Depakene) –also originally for seizure disorders


Depression

Depression

  • !(study Box 31-3 on p. 668)

  • aka ‘mood-disorders’ or ‘affective-disorders’

  • Among the most common psychiatric disorders, and is of (2) major types …

  • Exogenous – “the blues”, a response to ‘external’ factors, normally self-limiting

  • Endogenous (unipolar) – no apparent ‘external’ cause, basis is typically genetic or biochemical …


Exogenous endogenous depression cont

Exogenous/Endogenous Depression (cont)

  • Exogenous Depression:

  • Caused by external factors such as - divorce, loss of loved one, job loss, serious illness, etc

  • Drug therapy often successful w/ Exogenous

  • Endogenous: seems to come from ‘within’ the person, biochemical imbalance, hereditary

  • Endogenous type DOES NOT respond well to medication therapy


Anti depressant drugs study box 31 4 on p 669

Anti-depressant Drugs(study Box 31-4 on p.669)

  • All major classes have a similar response rate …

  • So the choice-of-drug is based on things like: *side-effects *patient-history *if sedation is needed

  • MAOI’s(monoamine oxidase inhibitors)

  • TCA’s(tricyclic antidepressants)

  • SSRI’s (selective serotonin reuptake inhibitors)

  • SNRI’s (selective norepinephrine reuptake inhib)

  • NRI’s(natural reuptake inhibitors) –herbal, St.John’s wort for example


Maoi patient ed

MAOI – patient ed

  • Very high number of potentially dangerous DRUG and FOOD interactions!

  • Avoid TYRAMINE containing foods, such as *cheese *wine *beans *chocolate (31-4, p.672)

  • See DDI (Dangerous-Drug-Interactions) (31-5,p.672)

  • MAOI must be ‘cleared’ from body before starting any new antidepressant (taper)


Atypical antidepressants 2 nd generation

‘Atypical’ Antidepressants (2nd generation)

  • Introduced in the 1980’s

  • These will treat --- major depressions, reactive depressions, and anxiety disorders

  • Wellbutrin (bupropion)

  • Remeron (mirtazapine)

  • Desyrel (trazodone)


Alzheimer s disease 250 ooo new cases per year

Alzheimer’s disease ~ 250,ooo new cases per year!

  • Progressive (worsening) illness

  • Degradation of nerve pathways (cholinergic)

  • Impaired thinking, confusion, disorientation, ‘sundowning’ = symptoms worse in evening

  • No specific ‘test’ for this , can only be diagnosed with certainty by autopsy

  • Drugs are used to slow the deterioration and/or improve patient’s nerve function


Drug therapy for alzheimer s

Drug therapy for Alzheimer’s

  • See Table 31-6 on p.675

  • Cognex, Aricept: increases nerve-function only

  • Reminyl: slows disease progression AND improves nerve function (increased Ach)

  • Namenda: newest agent – ‘anti-Alzheimer’ agent, reduces deterioration of cholinergic nerve pathways in moderate-severe cases


Drugs for mental health chapter 31

ADHD

  • Common behavioral disorder (average of one ADHD child per classroom) – cause unknown!

  • Diagnosis usually based on symptoms that occur before age 7, and last > 6 months

  • Symptoms (begin from 3 – 7 yo, thru teenage)

  • Inattention

  • Hyperactivity

  • Impulsivity


Drugs for adhd study table 31 7 on p 677

Drugs for ADHD(study Table 31-7 on p.677)

  • CentralNervousSystem (CNS) Stimulants

  • Not to be given >1 year without a ‘break’ from the drug! …may suppress child’s growth

  • Break is known as ‘Drug-Holiday’

  • Suggested Drug-Holiday opportunities …

  • Weekends, summer-breaks, vacations, etc


Adhd drug names

ADHD drug names

  • Methylphenidate (Ritalin) – CII (schedule-2)

  • Dextroamphetamine (Dexedrine) -CII

  • Amphetamine (Adderall) -CII

  • Lisdexamfetamine (Vyvanse) -CII

  • Atomoxetine (Strattera) only one that’s not a ‘scheduled’ drug, also used as antidepressant


Adhd drug side effects

ADHD drug side-effects

  • CII’s (methylphenidate, etc) – insomnia, growth suppression, headache, abdominal pain, lethargy, weight loss, dry mouth, irritability

  • Strattera (lisdexamfetamine) – headache, dyspepsia, nausea/vomiting, fatigue, decreased appetite, dizziness, altered mood

  • Clonidine (HTN agent) – hypotension, sedation


Dosing calculations review chapter 9

Dosing calculations review (chapter-9)

  • LET’S REVIEW !!!

  • ANY QUESTIONS are fine …


Calculating doses oral nonparenteral

Calculating Doses (oral, nonparenteral)

  • 3 calculation methods

    --- Ratio-and-Proportion method

    --- Formula-Method

    --- Dimensional-analysis

  • Choose the ONE method that you’re most comfortable with … and stick with it !


Why just one method

Why just ONE method ?

  • …you will become very familiar with your ‘chosen’ method

  • … this will reduce the chance of medication errors that may occur from switching between calculation methods !


Basic rules for confident calculating see box 9 1 on p 166 dosage forms

Basic Rules for confident calculating (see Box 9-1 on p.166 … dosage-forms)

  • Always check UNIT’s (numerator/denominator)

  • Always work the problem ON PAPER, even the math seems EASY

  • Check and RE-CHECK all Decimals, Fractions

  • LOOK at the RESULT! …does it look reasonable?

  • Take ONE LAST LOOK to make sure you calculated dose in the correct units


Box 9 1 p 166 dosage forms

Box 9-1(p.166) Dosage-forms

  • What type of dosage-forms can be divided ?

  • Scored tablets

  • Oral – syrups, liquids

  • Time-release (sustained, delayed)


Labeling the math

“labeling” the math

  • “DA” = dose-available, what is ‘on-hand’

  • “DO” = dose-ordered, what you ‘want’

  • “DF” = dosage-form, of the ‘on-hand’

  • “DG” = dose-given, this is the unknown-amount of the on-hand drug that we are calculating


Ratio and proportion

Ratio-and-Proportion

  • Units must match … numerator/denominator

  • Ratio examples: 60-minutes/1-hour

  • Proportion examples: 60min/1hr = 120min/2hr

  • Let’s try one!: how many minutes in 2.5 hours ?

    a) we are looking for x minutes/2.5 hours

    b) we know that60min/hr(60min = 1hr, written as fraction)

    ( … see next slide … )


Ratio and proportion1

ratio-and-proportion

  • Let’s try one!: how many minutes in 2.5 hours ?

    1st: we are looking for x minutes/2.5 hours

    2nd:we know that60min/hr…(60min = 1hr, written as fraction) so set-up the problem as xmin/2.5hr = 60min/hr

    3rd: now we cross-multiplyx-min x 1-hr = 2.5hr x 60min

    4th: ‘hr’s cancel, leaving: x = (2.5)(60min) = 180 minutes … our final answer, which makes sense! 2-1/2 hours is 60min + 60min + 30min = 180 minutes.


Formula method

Formula - method

  • “DA” = dose-available, what is ‘on-hand’

  • “DO” = dose-ordered, what you ‘want’

  • “DF” = dosage-form, of the ‘on-hand’

  • “DG” = dose-given, this is the unknown-amount of the on-hand drug that we are calculating

  • Always check that the strengths of the drug-ordered (DO) and the drug-available (DA) are in the same-unit-of-measure!


Formula method cont

Formula-method cont.

  • Look at page-171

  • Example #3, then Example #4

  • Ask yourself … (also, page-171)

    --what the Dr. ordered (DO)?

    --what strength is available (DA)?

    --what is the unit of measure (DF)?

    --how much do we need to give (DG)?

  • REMEMBER … 1-grain = 60-mg (gr i = 60 mg)


Dimensional analysis

Dimensional - analysis

  • Look at page-173 of Textbook

  • Once learned, this is a very good system

  • Try a few examples in your Textbook

  • May be the ‘one for you’ !


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