Psychopharm MOST important

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maureen
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15622
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Psychopharm MOST important
Updated:
2010-04-21 21:40:33
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FINAL
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From last online class
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  1. KEY THINGS:
    • John Isaacs: LET’S
    • BEGIN WITH A DISCUSSION OF OTC SUPPLEMENTS AND HERBAL PRODUCTS.
    • REMEMBER, THESE PRODUCTS ARE NOT APPROVED FOR SAFETY OR EFFICACY BY THE
    • FDA, YET SOME HAVE DO HAVE BENEFIT FOR CERTAIN PSYCH. CONDITIONS. WHICH
    • OTCS ARE NOT RECOMMENDED BECAUSE OF DANGEROUS SIDE EFFECTS? Apr 15, 2010 6:12:35 PM EDT
    • Maureen Anders: kava kava Apr 15, 2010 6:13:01 PM EDT
    • Sara Emery: Yohimbine Apr 15, 2010 6:13:04 PM EDT
    • Sara Emery: kava kava AND VALERIAN ROOT
    • John Isaacs: WHICH HERBAL PRODUCTS DO SHOW PROMISE/EFFECTIVENESS Apr 15, 2010 6:14:14 PM EDT
    • Sara Emery: melatonin Apr 15, 2010 6:14:20 PM EDT
    • Heather Crowe: ginko biloba; st. johns wort
    • On melatonin: MANY INDIVIDUALS WOKE UP IN THE MIDDLE OF THE NIGHT WITH A REBOUND INSOMNIA THAT WAS WORSE THAN THE ORIGINAL INSOMNIA Apr 15, 2010 6:16:52 PM EDT
    • Maureen Anders: are you asking what it is no longer used for? Apr 15, 2010 6:16:53 PM EDT
    • John Isaacs: SO, OVERALL, DIPHENHYDRAMINE PRODUCTS OR BENZOS ARE MUCH MORE EFFECTIVE Apr 15, 2010 6:17:41 PM EDT
    • Christie Casciola: thats interesting since it is a natural chemical produced in the body Apr 15, 2010 6:17:50 PM EDT
    • John Isaacs: REMEMBER, ST JOHN'S WORT IS EFFECTIVE, BUT IT CAN AND DOES INTERACT WITH OTHER MEDS
    • John Isaacs: IN THE USA, HERBAL PRODUCTS ARE NOT REGULATED BY THE FDA. Apr 15, 2010 6:26:50 PM EDT
    • Maureen Anders: they are looking at contaminants though Apr 15, 2010 6:26:53 PM EDT
    • John Isaacs: THEY ARE TAKE AT YOU OWN RISK PRODUCTS
    • John Isaacs: THEY DO NOT HAVE TO FOLLOW FDA GUIDELINES FOR SAFETY OR EFFICACY
    • John Isaacs: IN WHAT WAYS MIGHT HERBAL PRODUCTS BE DANGEROUS/PROBLEMATIC? Apr 15, 2010 6:29:35 PM EDT
    • Erinann Lindner: they could interact with oher drugs Apr 15, 2010 6:29:58 PM EDT
    • Lauren Barthelemy: may contain arsenic Apr 15, 2010 6:29:59 PM EDT
    • Maureen Anders: effect on liver
    • *targets chronic conditions, "high" class, high education
    • John Isaacs: I
    • BELIEVE THAT WHAT WE WILL DISCUSS NOW FOCUSES ON YOUR POTENTIALLY
    • GREATEST CONTRIBUTION DURING THERAPY—HELPING TO DIFFERENTIATE
    • PSYCHOTROPIC SIDE EFFECTS FROM PSYCHIATRIC SYMPTOMS, AND YOUR ABILITY
    • TO RECOGNIZE RED FLAGS WHILE MONITORING PATIENT RESPONSE TO MEDICATIONS. Apr 15, 2010 6:38:39 PM EDT
    • Kathleen Ruscitto: yes Apr 15, 2010 6:38:40 PM EDT
    • John Isaacs: WHEN
    • YOU NOTICE, FOR EXAMPLE, THAT A PATIENT’S SYMPTOMS ARE WORSENING WHILE
    • ON MEDS, OR SIDE EFFECTS ARE DEVELOPING, OR THAT THE PHYSICIAN NEEDS TO
    • DIFFERENTIATE BETWEEN SIDE EFFECTS AND WORSENING DISEASE STATE—YOUR
    • REFERRAL TO THE PATIENT BACK TO THE PHYSICIAN FOR REEVALUATION CAN BE
    • CRITICAL TO THE MANAGEMENT OF THE PATIENT AND THE PATIENT’S ULTIMATE
    • OUTCOME
    • John Isaacs: YOUR TEXT LISTS SIX CIRCUMSTANCES IN WHICH A PATIENT RE-EVALUATION/RE-RE-REFERRAL IS NECESSARY. WHAT ARE THEY? Apr 15, 2010 6:40:17 PM EDT Carolyn Vorhes: new conditions appear Apr 15, 2010 6:40:47 PM EDT
    • Katherine Smithley: compliance Apr 15, 2010 6:40:48 PM EDT
    • Heather Crowe: increase in psychosocial stressors Apr 15, 2010 6:40:49 PM EDT
    • Lauren Barthelemy: "breakthrough symptoms"
    • fialure to respond, unexplained relapse
    • *adequate trial (right dx/ long enough on med
    • John Isaacs: IN
    • GENERAL, IF A PATIENT IS ON RECOMMENDED DOSES ON MEDICATION WITHOUT
    • NOTICEABLE IMPROVEMENT, AFTER HOW MANY WEEKS SHOULD YOU SUGGEST A MED
    • CHANGE OR DOSAGE INCREASE? Apr 15, 2010 6:43:10 PM EDT
    • Heather Crowe: 4 -5
    • John Isaacs: ARE THERE EXCEPTIONS TO THIS NUMBER OF WEEKS? WITH WHAT CLASS(ES) OF MEDS? Apr 15, 2010 6:43:58 PM EDT
    • Katherine Smithley: benzos Apr 15, 2010 6:44:31 PM EDT
    • Amber Nixon: antidepressants Apr 15, 2010 6:44:49 PM EDT
    • Erinann Lindner: benzos- due to their fast acting Apr 15, 2010 6:44:50 PM EDT
    • Saralynn Kramm: antidepressants Apr 15, 2010 6:44:50 PM EDT
    • John Isaacs: THINK ABOUT THE CLASSES OF MEDS WE DISCUSSED. WITH WHAT CLASSES OF MEDS TO YOU NEED TO BE MORE PATIENT AND W HY? Apr 15, 2010 6:45:03 PM EDT *buspar
    • John Isaacs: WHY ANTIDEPRESSANTS AND BUSPAR? Apr 15, 2010 6:45:40 PM EDT
    • Erinann Lindner: antidepressants may take some time to get steady state in the bloodstream Apr 15, 2010 6:46:05 PM EDT
    • Amber Nixon: it may take up to a few months for the meds to be fully effective
    • John Isaacs: WHAT
    • ARE POSSIBLE EXPLANATIONS FOR PATIENTS WHO RESPOND BEAUTIFULLY TO MEDS
    • FOR A GOOD PERIOD OF TIME, BUT THEN SUDDENLY HAVE RELAPSE—A REEMERGENCE
    • OF SYMPTOMS? Apr 15, 2010 6:48:57 PM EDT
    • Carolyn Vorhes: compliance problems; tolerance, stress, d/a
    • John Isaacs: GOOD--TOLERANCE CAN DEVELOP WITH WHAT MEDS, OR GROUP OF MEDS? Apr 15, 2010 6:50:16 PM EDT
    • Maureen Anders: change in thyroid function
    • ohn Isaacs: WHAT KINDS OF NEW MEDICAL CONDITIONS WARRANT A REEVALUATION OF MEDS? Apr 15, 2010 6:51:15 PM EDT
    • Heather Crowe: pregnancy Apr 15, 2010 6:51:20 PM EDT
    • Maureen Anders: kidney issues Apr 15, 2010 6:51:28 PM EDT
    • Sara Emery: epilepsy Apr 15, 2010 6:51:28 PM EDT
    • Kathryn Taylor: thyroid Apr 15, 2010 6:51:29 PM EDT
    • Erinann Lindner: liver problems Apr 15
  2. MORE key things..
    • John Isaacs: WHAT FACTORS HELP DECIDE WHEN A PATIENT, FULLY RECOVERED, SHOULD DISCONTINUE MEDS? Apr 15, 2010 6:52:45 PM EDT
    • Erinann Lindner: the patienrts feelings baout dicontinuation Apr 15, 2010 6:53:09 PM EDT
    • Amber Nixon: history of the med.. if they responded well to it in the past Apr 15, 2010 6:53:10 PM EDT
    • Sara Emery: vulnerability for relapse Apr 15, 2010 6:53:11 PM EDT
    • Carolyn Vorhes: their desire to stop/feelings about it Apr 15, 2010 6:53:11 PM EDT
    • John Isaacs: HOW SHOULD PSYCHOTROPIC MEDS BE DISCONTINED Apr 15, 2010 6:54:02 PM EDT
    • Lauren Barthelemy: weened off Apr 15, 2010 6:54:14 PM EDT
    • Sara Emery: slowly, carefully Apr 15, 2010 6:54:15 PM EDT
    • Katherine Smithley: tapered slowly Apr 15, 2010 6:54:15 PM EDT
    • John Isaacs: WHAT IS ANTICHOLINERGIC DELIRIUM? WHO IS ESPECIALLY AT RISK FOR THIS? Apr 15, 2010 6:56:45 PM EDT
    • Sara Emery: elderly
    • Christie Casciola: parasymathetic NS action Apr 15, 2010 6:58:02 PM EDT
    • Christie Casciola: constipation Apr 15, 2010 6:58:24 PM EDT
    • Carolyn Vorhes: dry mouth Apr 15, 2010 6:58:29 PM EDT
    • John Isaacs: CONFUSION, DISORIENTATION HALLUCINATIONS, MENTAL STATUS CHANGES
    • John Isaacs: WHAT IF PATIENT IS ON AN ANTICHOLINERGIC DRUG? Apr 15, 2010 6:59:21 PM EDT
    • Erinann Lindner: can ofset some of the sxs Apr 15, 2010 6:59:41 PM EDT
    • John Isaacs: AN ANTICHOLINERGIC DRUG WILL MAKE THE SYMPTOMS WORSE AND SHOULD BE D/C IF PATIENT HAS ANTICHOLINERGIC DELIRIUM
    • John Isaacs: IF
    • ANTICH. DELIRIUM IS CAUSED BY THE MED, AND THE PATIENT IS MISTAKENLY
    • DIAGNOSED FOR PSYCHOTIC DISORDER, AND A NEUROLEPTIC IS GIVEN WITH
    • ANTICHOLINERGIC SIDE EFFECTS, THIS WILL MAKE THINGS WORSE. SEE WHY IT
    • IS IMPORTANT TO DIAGNOSE WHAT IS CAUSING THE DELIRIUM?
    • SSRIS, ESPECIALL
    • PROZAC, AND DRICYCLICS SOMETIMES CAN CAUSE AKATHISIA. WHAT HAPPENS IF
    • MD DOES NOT RECONIZED NTIDEPRESSANT-INDUCED AKATHISIA AND RPESCRIBES A
    • NEUROLEPTIC?
    • Christie Casciola: could increase the akathisia and cause nonco\mpliance Apr 15, 2010 7:04:24 PM EDT
    • Sara Emery: could increase the the symptoms
    • John Isaacs: WHAT CONDITION DO THE PARKINSON SIDE EFFECTS OF NEUROLEPTICS OFTEN MIMIC? WHY IS A DIFFERENTIAL DIAGNOSIS IMPORTANT Apr 15, 2010 7:05:33 PM EDT
    • Maureen Anders: depression
    • John Isaacs: AND FINALLY, WHAT MAY ACCOUNT FOR REEMERGENCE OF DEPRESSIVE SYMPTOMS MONTHS OR YEARS AFTER SUCCESSFUL MEDICATION RESPONSE?
    • John Isaacs: VERY GOOD-NON COMPLIANCE, A POOR THERAPEUTIC RESPONSE, OR EVEN CNS TOXICITY OF THE MED Apr 15, 2010 7:09:07 PM EDT
    • John Isaacs: SO
    • HERE'S THE RUB--AFTER YEARS OF EFFECTIVE TREATMENT, THE DEPRESSIVE
    • SYMPTOMS RETURN, AND THE MD INCREASES DOSE OF ANTIDEPRESSANT Apr 15, 2010 7:09:56 PM EDT
    • John Isaacs: WHAT IF THE PATIENT HAS NOT BEEN TESTED FOR CNS TOXICITY AND IS GIVEN MORE ANTIDEPRESSANT (OD, toxic, fatal)
  3. From jeapordy...
    • John Isaacs: CATEGORY 1: COMMON BONDS—YOU TELL ME WHAT THE FOLLOWING LISTS HAVE IN COMMON—THEY ARE ALL John Isaacs: 1.ESTROGEN (HORMONE), DIAZEPAM, SEROTONIN (answer- ligands)
    • WORSENING OF TREMOR, STUPOR, CONFUSION, SLURRED SPEECH, NAUSEA, VOMITING, DIARRHEA. (toxicity-kidney)
    • John Isaacs: 3.AMITRIPTYLINE, IMIPRAMINE, TRAZODONE (tca's)
    • John Isaacs: 4.DRY MOUTH, BLURRED VISION, CONSTIPATION Apr 15, 2010 7:15:50 PM EDT
    • Kathryn Taylor: anticholinergi

    • John Isaacs: 5.ESTAZOLAM (PROSOM), ZOLPIDEM (AMBIEN), ZALEPLON (SOMATA) Apr 15, 2010 7:16:43 PM EDT (sedatives!)
    • John Isaacs: 6.PHENELZINE (NARDIL), TRANYCYPROMINE (PARNATE), SELEGILINE (DEPRENYL) (maoi's!)
    • John Isaacs: 7.SWEATING, SEXUAL DYSFUNCTION, ORTHOSTATIC HYPOTENSION (adronergic!)
    • John Isaacs: 8.SNS (SYMPATHETIC NERVOUS SYSTEM), HPA, H PT. Apr 15, 2010 7:19:41 PM EDT
    • Erinann Lindner: fight or flight respeoinse

    John Isaacs: 9.ARIPIPRAZOLE (ABILIFY), TRIFLUOPERAZINE (STELAZINE), HALOPERIDOL (HALDOL Apr 15, 2010 7:20:17 PM EDT (high potency antipsychotics)
  4. Questions from students..
    • Christie Casciola: renal side effects of lithium? Apr 15, 2010 7:37:26 PM EDT
    • Sara Emery: kidney failure A
    • Heather Crowe: during this period of development, the rate of hepatic metabolism slows. (puberty)
    • This area of the brain elicits and controls primitive threat appraisal and psychopathology here is related to impulse disorders. Apr 15, 2010 7:39:38 PM EDT
    • Katherine Smithley: amlgyda Apr 15, 2010 7:39:45 PM EDT
    • Saralynn Kramm: blocks the effects of NE at the receptor Apr 15, 2010 7:40:34 PM EDT
    • Amber Nixon: beta blockers ANTIADRENERGIC AGENTS MORE SPECIFICALLY BLOCK NE
    • Erinann Lindner: this is a first line antipsychotic for depression (lamictal!)
    • Kathleen Ruscitto: anhedonia, flat affect, blunting of perception (neg. sx of schizo)
    • Katherine Smithley: The ion channel can be activated when stimulated by this naturally occuring neurochemical? (gaba!)
    • Kathryn Taylor: what are neuronal pathways connecting limbic systme structures and prefrontal lobes. affect regulation (cingulate!)
    • Carolyn Vorhes: serious blood d/o that has caused several deaths, thought to be s/e of antipsychotic (agranulocytosis!)
    • John Isaacs: 2.
    • BETA BLOCKER USED TO REDUCE THE EXTERNAL MANIFESTATIONS OF ANXIETY,
    • SUCH AS SWEATING AND INCREASED HEART RATE. USED TO TREAT PUBLIC
    • SPEAKING ANXIETY. Apr 15, 2010 7:51:54 PM EDT
    • Christie Casciola: inderal
    • PHARMACOKINETIC PROPERTY MOST AFFECTED BY KIDNEY FAILURE (elimination/discretion)
    • HE COMPULSION TO BE IN MOTION, INTENSE FEELING OF RESTLESSNESS; EXTRAPYRIMIDAL SIDE EFFECT OF NEUROLEPTICS Apr 15, 2010 7:53:44 PM EDT
    • Kathryn Taylor: akinisia
    • BRANCH OF THE PERIPHERAL NERVOUS SYSTEM, FURTHER DIVIDED INTO THE SYMPATHETIC AND PARASYMPATHETIC SYSTEMS. Apr 15, 2010 7:54:17 PM EDT
    • Carolyn Vorhes: autonomic Apr 15, 2010 7:54:25 PM EDT
    • ACTIVATION OF
    • EXCITATORY RECEPTORS ON DENDRITES OR CELL BODY RESULTING IN A BRIEF
    • CHANGE IN THE NEURON’S ELECTRICAL STATE FROM THE RESTING STATE. Apr 15, 2010 7:54:49 PM EDT
    • Erinann Lindner: action potentia'
    • OLANZAPINE (ZYPREXA), QUETIAPINE (SEROQUEL), AND RISPERIDONE (RISPDERDAL), TO NAME A FEW (atypical antipsychotics)
    • CLASSES OF MEDICATIONS, BESIDES BIRTH CONTROL PILLS AND CORTICOSTEROIDS (HORMONES) THAT CAN CAUSE DEPRESSION. Apr 15, 2010 7:56:22 PM EDT
    • Katherine Smithley: antiparkinson drugs Apr 15, 2010 7:56:35 PM EDT
    • Kathryn Taylor: alcohol
    • John Isaacs: 10.ATOMOXETINE (STRATTERA), AND BUPROPION (WELLBUTRIN), TO NAME A FEW. *"ANTIDEPRESSANTS" USED TO TREAT ADHD. REMEMBER?
    • 1. TYPE OF MOOD
    • MORE COMMON IN CHILDHOOD-ONSET DEPRESSION THAN THE SAD/DEPRESSED MOOD
    • THAT MARKS ADULT ONSET DEPRESSION. Andehonia
    • John Isaacs: 12.CHOLINERGIC MEDICATION THAT MAY REVERSE CHOLINERGIC BLOCKADE AND ANTICHOLINERGIC SIDE EFFECTS Apr 15, 2010 7:59:27 PM EDT
    • Lauren Barthelemy: urecholine

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