Class Discussion 4-1

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maureen
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15611
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Class Discussion 4-1
Updated:
2010-04-21 20:36:40
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minorities antipsychotics
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  1. why will some tolerate different drugs from others?
    People metabolize differently-VERIATIONS IN THE GENE CONTROLLING LIVER ENZYMES (CYP SYSTEM) DIFFER IN FREQUENCY AMONG ETHNIC AND RACIAL GROUPS;
  2. Extensive vs. Poor metabolizors
    • The book said that
    • extensive metabolizers were at greater risk for the buildup of
    • intermediate toxic metabolies. I thought that a slower metabolizer
    • would be because the drugs stay in the system longer? Could you explain
    • this please. Apr 1, 2010 6:21:56 PM EDT
    • John Isaacs: GOOD QUESTION. Apr 1, 2010 6:22:10 PM EDT
    • John Isaacs: METABOLITES ARE BYPRODUCTS OF METABOLISM. Apr 1, 2010 6:22:26 PM EDT
    • John Isaacs: IN OTHER WORDS, AFTER THE DRUG IS METABOLIZED, IT CAN CHANGE INTO SOMETHING ELSE
  3. Race/metabolism
    • NOW, A PATIENT'S RACE OR ETHNIC BACKGROUND INFLUENCE HOW MEDICATIONS ARE METABOLIZED. Apr 1, 2010 6:25:30 PM EDT
    • John Isaacs: FOR
    • EXAMPLE, ONLY 3-5% OF CAUCASIANS ARE POOR METABOLIZERS OF DIAZEPAM OR
    • IMIPRAMINE (BENZOS OR TRICYCLICS), BUT 15-20% OF CHINESE AND jAPANESE
    • ARE POOR METABOLLIZERS OF CERTAIN ANTICONVULSANT S MEDS
    • ASIANS AND ESKIMOSE NEED, OVERALL, LOWER DOSES OF BENZOS THAT CAUCASIANS Apr 1, 2010 6:27:33 PM EDT
    • Kathryn Taylor: oh ok that makes sense and is important Apr 1, 2010 6:27:36 PM EDT
    • John Isaacs: ASIANS, INDIANS, AND PAKISTANIS REQUIRE LOWER DOSES OFLITHIUM AND ANTIPSYCHOTIC DRUGS Apr 1, 2010 6:27:53 PM EDT
    • John Isaacs: AFRICAN AMERICANS' SYMPTOMS GENERALLY IMPROVE FASTER AFTER TAKING NEUROLEPTICS AND BENZOS
    • John Isaacs: HISPANICS MAY REQUIRE LOWER DOSES OF ANTIDEPRESSANTS
  4. WHAT ANTICONVULSANTS ARE NOT INDICATED DURING PREGNANCY?
    (meds and pregnancy in general)
    • Sara Emery: carbamazepine Apr 1, 2010 6:39:00 PM EDT
    • Amber Nixon: valproic Apr 1, 2010 6:39:05 PM EDT
    • Christie Casciola: lamotrigine Apr 1, 2010 6:39:07 PM EDT
    • Lauren Barthelemy: lamotrigine Apr 1, 2010 6:39:08 PM EDT
    • Katherine Smithley: tegretol Apr 1, 2010 6:39:09 PM EDT
    • Sara Emery: valporic acid Apr 1, 2010 6:39:12 PM EDT
    • Carolyn Vorhes: carbamazepine Apr 1, 2010 6:39:14 PM EDT
    • Heather Crowe: valporic Apr 1, 2010 6:39:18 PM EDT
    • Kathryn Taylor: valproic acid Apr 1, 2010 6:39:20 PM EDT
    • Erinann Lindner: carmabamazampine Apr 1, 2010 6:39:21 PM EDT
    • Carolyn Vorhes: valproic acid Apr 1, 2010 6:39:22 PM EDT
    • Sara Emery: lamotrigin
    • NO BENZO's in FIRST TRIMESTER- fetus abnormalities, if already using may have to decrease dose
    • Antidepressants: SSRI's; Antipsychotics: high-potency.
    • 1st trimester most imp. because of fetal organ development;.
    • Address costs/benefits; risks assoc to fetal development.
  5. Elderly
    Age=less functioning of liver/kidneys.

    • John Isaacs: ALSO, WHEN WE GET OLDER, THERE IS A DECREASE IN ALBUMIN, AND SO BLOOD DISTRIBUTION IS EFFECTED. Apr 1, 2010 6:55:42 PM EDT
    • Kathryn Taylor: oh okay that makes sense Apr 1, 2010 6:55:58 PM EDT
    • John Isaacs: MORE DRUG IS FREE AND CAN BECOME QUITE TOXIC FOR THE ELDERLY IN "NORMAL" DOSES Apr 1, 2010 6:56:20 PM EDT
    • Christie Casciola: they take so many different medications, so the possibility for bad interactions is much greater too Apr 1, 2010 6:57:09 PM EDT
    • John Isaacs: ALSO, THE ELDERLY HAVE DECREASED CHOLINERGIC FUNCTION--YOU KNOW WHAT THAT MEANS Apr 1, 2010 6:57:14 PM EDT
    • John Isaacs: RIGHT CHRISTIE Apr 1, 2010 6:57:19 PM EDT
    • John Isaacs: DECREASED CHOLINERGIC FUNCTION--THE QUESTION I GET ASKED AT LEAST FIVE TIMES A DAY--CONSTIPATION PROBLEMS A
  6. WHY ARE INDIV.
    SCHIZOPHRENIC OR PSYCHOTIC? WHAT'S HAPPENING WITH NEUROTRANSMITTERS,
    AND WITH WHAT NEUROTRANSMITTER IN PARTICULAR?
    • Too much DA
    • TOO MUCH DA IN TEH
    • MESOLIMBIC AREA IS ASSOC. WITH POSITIVE SYMPTOMS, AND DECREASED
    • ACTIVITY IN THE PREFRONTAL CORTEX WITH NEGATIVE SYMPTOMS.
    • Positive; delusions, hallucinations, impaired emotion/control/impulses, anxiety. (easier to treat)
    • Negative: blunt affect, anhedonia, limited cognition, blunted perception
    • *Success with neg. sx: clozaril.*increased risk of that blood disease.
  7. Miscellaneous
    • John Isaacs: ZYPREXA CAUSES WEIGHT GAIN Apr 1, 2010 7:53:16 PM EDT
    • John Isaacs: SO, WHAT ARE THE OVERALL BENEFITS OF THE ATYPICALS? Apr 1, 2010 7:53:32 PM EDT
    • Heather Crowe: easy to tolerate
    • John Isaacs: AND REDUCTION OF SOME NEGATIVE SYMPTOMS,
    • John Isaacs: HOW LONG SHOULD A SCHIZOPHRENIC BE MEDICATED TO AVOID RELAPSE?
    • John Isaacs: AT LEAST 1 YEAR FOLLOWING THE REMISSION OF SYMPTOMS Apr 1, 2010 7:56:16 PM EDT
    • Carolyn Vorhes: long enough to prevent relapse as when meds are stopped too soon Apr 1, 2010 7:56:23 PM EDT
    • Christie Casciola: should be re-evaluated every 6 months Apr 1, 2010 7:56:23 PM EDT
    • John Isaacs: AS
    • YOU KNOW, COMPLIANCE IS A REAL PROBLEM HERE. LONG ACTING INJECTIONS
    • LIKE HALDOL (HALOPERIDOL) OR PROLIXIN (FLUPHENAZINE) ARE A GOOD OPTION
    • FOR REALLY NONCOMPLIANT PATIENTS
  8. Important notes:
    • IT IS IMPORTANT TO
    • DESCRIBE SIDEEFFECTS TO PATIENTS, ESPECIALLY AKATHISIA. THIS SIDE
    • EFFECT CAN BE EXTREMELY UNPLEASANT, YET OFTEN IT IS NOT SPONTANEOUSLY
    • REPORTED BY PATIENTS. IF IT OCCURS AND IS NOT TREATED, THIS WILL
    • GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS WELL AS INCREASING THE
    • PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY NOTICE AN INNER FEELING
    • OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO, PLEASE TELL ME. DO NOT JUST
    • DISCONTINUE THE MEDICATION. MOST SIDE EFFECTS CAN BE TREATED. IT IS
    • IMPORTANT TO DESCRIBE SIDEEFFECTS TO PATIENTS, ESPECIALLY AKATHISIA.
    • THIS SIDE EFFECT CAN BE EXTREMELY UNPLEASANT, YET OFTEN IT IS NOT
    • SPONTANEOUSLY REPORTED BY PATIENTS. IF IT OCCURS AND IS NOT TREATED,
    • THIS WILL GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS WELL AS
    • INCREASING THE PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY NOTICE
    • AN INNER FEELING OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO, PLEASE TELL
    • ME. DO NOT JUST DISCONTINUE THE MEDICATION. MOST SIDE EFFECTS CAN BE
    • TREATED. IT IS IMPORTANT TO DESCRIBE SIDEEFFECTS TO PATIENTS,
    • ESPECIALLY AKATHISIA. THIS SIDE EFFECT CAN BE EXTREMELY UNPLEASANT, YET
    • OFTEN IT IS NOT SPONTANEOUSLY REPORTED BY PATIENTS. IF IT OCCURS AND IS
    • NOT TREATED, THIS WILL GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS
    • WELL AS INCREASING THE PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY
    • NOTICE AN INNER FEELING OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO,
    • PLEASE TELL ME. DO NOT JUST DISCONTINUE THE MEDICATION. MOST SIDE
    • EFFECTS CAN BE TREATED.
    • John Isaacs: THE TOTAL LENGTH OF TREATMENT IS LIKELY TO BE AT LEAST ONE YEAR AND OFTEN LONGER FOR MORE CHRONIC SCHIZOPHRENIA. Apr 1, 2010 7:59:46 PM EDT
    • John Isaacs: ANTIPSYCHOTIC MEDS ARE NOT ADDICTIVE. Apr 1, 2010 7:59:59 PM EDT
    • John Isaacs: YOU
    • SHOULD AVOID PROLONGED EXPOSURE TO HIGH TEMPERATURES AND SUNLIGHT (SOME
    • ANTIPSYCHOTICS HAVE PHTOSENSITIVITY AS A SIDE EFFECT). Apr 1, 2010 8:00:18 PM EDT
    • John Isaacs: THAT'S PHOTOSENSITIVITY Apr 1, 2010 8:00:33 PM EDT
    • Cindy Pfrimmer: The medicine or the patient? Apr 1, 2010 8:00:37 PM EDT
    • John Isaacs: AVOID AMPHETAMINES, COCAINE, AND L-DOPA (PARKINSON DISEASE MED) BECAUSE THESE DRUGS ALWAYS EXACERBATE PSYCHOSES

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