Psychopharmacology Medication Management

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Psychopharmacology

(medication management)
Prepared by: JOEL N. NEBRES, RN
Types of Psychiatric Medications:

Antidepressants
> are the most commonly prescribed psychiatric medications.
> antidepressants work through the neurotransmitter serotonin and may also have effects
on norepinephrine and dopamine.
Example: SSRI (Selective Serotonin Reuptake Inhibitors)
1. Fluoxetine (Prozac)
2. Sertraline (Zoloft)
3. Escitalopram (Lexapro)
4. Citalopram (Celexa)
SNRIs (Serotonin-norepinephrine Reuptake
Inhibitors)
1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)

> These medications are first line choices for


depression and anxiety disorders
Benzodiazepines

1.Clonazepam (Klonopin)
2.Alprazolam (Xanax)
3.Lorazepam (Ativan)
> they are prescribed to treat severe anxiety,
panic attacks and at times insomnia
> these medications are controlled substances
with the potential to cause addiction, so they
require close monitoring.
Stimulants

1.Dextroamphetamine salts (Adderall)


2.Methylphenidate (Ritalin)
3.Lisdexamfetamine (Vyvanse)

> they are used predominantly to treat


ADHD
Mood Stabilizers

1.Lithium
2.Valproic Acid (Depakote)

> are commonly used to treat mood disorders such


as bipolar disorder and treatment-resistant
depression.
> some mood stabilizers require monitoring of
blood levels.
Antipsychotics

1. Aripiprazole (Abilify)
2. Lurasidone (Latuda)
3. Risperidone (Risperdal)
4. Perphenazine (Prolixin)
5. Haloperidol (Haldol)
➢ These are used to treat psychotic illness such as schizophrenia or
schizoaffective disorder.
➢ They also have FDA indications for treatment of bipolar disorder and in
some cases can be used to improve treatment for depression.
Anti-anxiety Drugs (Anxiolytics)

Also termed anti-anxiety or anti-panic


drugs
These are medications that are used to
treat a health condition called anxiety
The type of anxiety that requires
treatment is called generalized anxiety
disorder (GAD)
How do anti-anxiety drugs and
Benzodiazepines work?

Antidepressants reduce anxiety by


increasing the concentration of
chemicals (neurotransmitters) that the
brain uses to communicate.
These neurotransmitters include
serotonin, norepinephrine and
dopamine.
 Buspirone – may reduce anxiety by stimulating serotonin and
dopamine receptors on nerves, thereby altering the chemical
messages that nerves receive.
 Benzodiazepines –reduce symptoms of anxiety by increasing the
action of a brain chemical called gamma aminobutyric acid
(GABA).
 GABA is a chemical that nerve cells use to communicate with
each other and it reduces brain activity.
 It is believed that excessive activity in the brain may lead to
anxiety or other psychiatric disorders.
Pregabalin – is an anticonvulsant. Like
benzodiazepines, pregabalin also increases the
action of GABA, and this may be its main
mechanism for reducing anxiety.

Hydroxyzine – is an antihistamine that causes


sedation. It helps treat insomnia caused by
anxiety, and other medical conditions.
Medical uses for Anti-anxiety Drugs:

1. Depression
2. Insomnia
3. Alcohol withdrawal symptoms
4. Seizures
5. Panic disorder
6. Itching
7. Nausea
8. vomiting
Side Effects of Anti-anxiety Drugs:

1. Drowsiness 10. headache


2. Sedation 11. Suicidal thoughts
3. Confusion 12. elevated BP
4. Dependence and withdrawal symptoms 13. Dry mouth
5. Stomach upset 14. Blurred vision
6. Nausea 15. Constipation
7. Diarrhea 16. Orthostatic hypotension
8. Sexual dysfunction 17. Weight gain
9. Abnormal heart beat 18. Increase heart rate
Monoamine Oxidase Inhibitor (MAOI)

A class of drugs that inhibit the activity of


one or both monoamine oxidase enzymes:
monoamine oxidase A and monoamine
oxidase B
They are best known as effective
antidepressants, especially for treatment of
major depressive disorder, atypical
depression, Parkinson’s disease etc.
Maois – they block oxidative deamination
to cause the accumulation of
endogenous cathecholamines (serotonin,
norepinephrine, and dopamine) at
adrenergically active tissue sites
(e.g.,brain).
This is the proposal mechanism for the
antidepressant actions of MAOIs.
Medicine of MAOI approved by FDA:

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam) – transdermal
patch (skin)
Tranylcypromine (Parnate)
Side effects of MAOIs:

Dry mouth
Nausea, diarrhea or constipation
Headache
Drowsiness
Insomnia
Dizziness or lightheadedness
Skin reaction at the patch site
Other possible side effects:
Involuntary muscle jerks
Reduced sexual desire or difficulty reaching
orgasm
Weight gain
Difficulty starting a urine flow
Muscle cramps
Prickling or tingling sensation in the skin
(paresthesia)
Basic Intervention for Tobacco Control

Tobacco kills 8 million people worldwide each


year, mainly in low-and middle-income countries
where 80% of the world’s smokers live.
However, not only smokers are at risk, second-
hand smoking causes 1.2 million deaths per year.
Tobacco use is a leading cause of multiple
cancers such as oral cancers, lung, liver, stomach,
bowel and ovarian cancers, as well as some types
of leukaemia.
Quitting at any age can make an immense difference for
the user, increasing life expectancy and improving the
quality of life.
Tobacco use burdens the global economy with an
estimated US$ 1.4 trillion in healthcare costs and lost
productivity each year.
Has a negative impact on ecomies due to illicit trade, as
well as on the environment and climate change.
Tobacco production is also linked to human rights abuses
and child labours.
What is tobacco control?

Aims at reducing the use of tobacco and the


serious health risks and mortality it causes through
policies, laws and education.

Tobacco control is also one of the 16 essential


health services monitored by the WHO, to achieve
universal health coverage (UHC).
“It is essential for the promotion of better health as
part of UHC that people understand the risk of
smoking and tobacco use. Governments and
policy makers have a clear responsibility to protect
them from harm caused by tobacco”. (Sonali
Johnson, Head of Knowledge, advocacy and
Policy, Union for International Cancer Control
(UICC)).
UICC focus in three (3) key areas

Encouraging countries to raise the level of taxes,


charged on tobacco and nicotine products.
Pressing governments to introduce and enforce
bans on tobacco advertising, promotion and
sponsorship (including e-cigarettes).
Ensuring that more governments pass legislation
which protects people (particularly children) from
tobacco smoke.
What is Nicotine?

A stimulant drug that speeds up the messages travelling


between the brain and body it is the main psychoactive
ingredient in tobacco products.
A naturally produced alkaloid in the nightshade family
of plants and is widely used recreationally as a stimulant
and anxiolytic.
 (alkaloid) – is one of a group of nitrogenous organic
compounds that have marked physiological effects on
humans,
Nicotine occurs throughout the tobacco plant and
especially in the leaves.
Both the tobacco plant (Nicotiana tabacum) and the
compound are named for Jean Nicot, a French
ambassador to Portugal, who sent tobacco seeds to Paris in
1550.
Nicotine is a colourless, odourless liquid with an oily
consistency, but when exposed to light or air, it acquires a
brown colour and gives off a strong odour of tobacco.
Nicotine chemical formula is C10H14N2.
Nicotine is the chief addictive ingredient in the tobacco
used in cigarettes, cigars, and snuff.
In psychoactive effects, nicotine is a unique substance
with biphasic effect; when inhaled in short puffs it has a
stimulant effect, but when smoked in deep drags it can
have a tranquilizing effect.
Products such as cigarettes, cigars, pipe tobacco,
chewing tobacco, and wet and dry snuff and tge dried
leave from the tobacco plant contain nicotine.
Street names for cigarettes:
Ciggies
Darts
Durries
Rollies
Smokes
Fags
Butts
Cancer sticks
Other types of Stimulants:

Amphetamines
Dexamphetamine
Betel nut
Caffeine
Cocaine
Ice
Khat
Synthetic cathinones
Nicotine affects everyone differently,
based on the following:

Size, weight and health


Wether the person is used to taking it
Wether other drugs are taken around the same
time
The amount taken
The strength of the tobacco and how much is
contained in the product.
The effects experienced among people
who do not normally smoke:

Dizziness
Headache
Nausea
Abdominal cramps
Possibly vomiting or weakness
The people who smokes regularly:

Mild stimulation
Increase in heart rate
Increase the ability to concentrate
Relaxation
Temperature reduction in the urge to smoke
Coughing, dizziness, headaches, bad breath
Tingling and numbness in fingers and toes
Reduced appetite, stomach cramps and vomiting
Taking nicotine in large amount:

Confusion
Feeling faint
Seizures
Fast breathing
Respiratory arrest (stop breathing) and
death.
Long term effects of nicotine:

 Regular smoking of tobacco products which contain nicotine have


negative effects on health and is required as a major preventable
cause of premature death and disability.
 Stroke
 Blindness, cataracts
 Birth defects if the fetus is exposed to cigarettes.
 Periodontitis (yellowing teeth, gum disease)
 Aortic aneurysm (enlarging of major blood vessels)
 Coronary heart disease
 Pneumonia
 Diabetes
 Reduced fertility
 Various respiratory diseases (shortness of breath, asthma, coughing
fits)
 Male sexual dysfunction
 Rheumatoid arthritis
 Reduced immunie function (regular colds and flu)
 Overall diminished health (ageing, back pain, slower healing
wounds, mood swings)
Dependence on smoking
Financial, work and social problems
Smoking cigarettes containing nicotine are
casually linked to caused cancers

Passive smoking – is when someone breathes in


smoke from other people smoking.
Using Nicotine with other Drugs:

Nicotine + benzodiazepines – reduced effectiveness of


benzodiazepines.
Nicotine + contraceptive pill – increase risk of blood clots
forming.
Increase the amount of warfarin

> It is important to check a medical professional about


wether nicotine might affect any medications you are
taking.
Withdrawal
 Symptoms usually start within 2 to 3 hours after the last use of
tobacco. The symptoms may last from a few days to a few weeks.
1. Cravings
2. Restless sleep
3. Irritability, anxiety and depression
4. Eating more and putting on weight
5. Trouble concentrating
6. Headaches
7. Coughing and sore throat
8. Aches and pains
Treatment Strategies

Behavioral therapy
Cognitive therapy
Motivational interviewing – a distinct style of
counseling that is directive, patient centered,
nonconfrontational, non-judgemental, and highly
collaborative.
Acceptance and commitment therapy – focus
directly in psychological events
 Contingency management & monetary incentives – a large body of
evidence (Ainscough et al. 2017) supports contingency management,
which involves the use of incentives (including money, gift cards, or
other tangible goods) to motivate people to change health behaviors.
 Relapse prevention and recovery – most smokers make multiple quit
attempts before finally succeeding in quitting for good.
➢ indeed, one study estimated that smokers may make an average of 30
or more quit attempts before eventually succeeding (Chaiton et al.
2016)
➢ This means that most quit attempts end in relapse.
Intervention delivery modalities – research
demonstrates that behavioral therapy approaches
for smoking cessation can be delivered effectively
through face-to-face counseling (individually or in
groups) and brief clinical interventions (Fiore et al.
2008)
Self-help materials – have limited effectiveness when
they are not coupled with in-person or technology-
based interventions (Fiore et al. 2008)
Face-to-face counseling – wether delivered in
traditional health care settings, behavioral
health care settings, or community settings –
has traditionally been the gold standard for
behavioral treatment of nicotine dependence,
and its effectiveness is well-established in the
scientific literature (Fiore et al. 2008).
The 5A’s method as interventions:

Ask patients about tobacco use.


Advise tobacco user to quit (e.g., “quitting is the best
thing you can do for your health”).
Assess the patients willingness to make a quit attempt
(e.g., “have you thought about quitting or are you
interested in trying?”).
Assist in the quit attempt with medications, counseling,
and referrals to behavioral treatment programs, and
Arrange follow-up.
Technology-mediated delivery approaches – telephone
based quitlines and mHealth-based interventions.
Short message service texting interventions – based on SMS
texting-which involve sending automated, one-way
messages.
Web-based interventions – cessation interventions delivered
via internet.
Smartphone application – there 252 apps identified for
apple’s iOS and 148 apps for Google’s android operating
system.
Pharmacologic treatments

 Seven (7) FDA-approved, first-line medications have been found to


be safe and effective for treating nicotine dependence.
1. Nicotine patch
2. Gum
3. Lozenge
4. Nasal spray
5. Oral inhaler
6. Bupropion – seizure disorder
7. varenicline
a.Bupropion – a prescription medication that blocks
reuptake of dopamine into a lesser extent,
norepinephrine. It also has some nicotine receptor-
blocking activity (Slemmer et al. 2000)
> widely used as anti-depressant.
> thus, increases levels of dopamine and
norepinephrine in the brain, simulating nicotine’s
effects on these neurotransmitters.
Varenicline – a prescription medication
b.

marketed specifically for smoking cessation.


> a partial agonist of the a4B2 nicotinic
acetylcholine receptor subtype, which
mediates dopamine release and is thought to
be the major receptor involved in nicotine
addiction.
Holistic approach

Sauna therapy – detoxification abilities


Massage therapy – spa or home massage; finding time to
relax and reduces anxiety that may trigger the desire to
smoke.
Hypnotherapy
Aromatherapy
Acupuncture
Herbal treatments (green tea)
Lifestyle changes

Get plenty of fresh fruits and vegetables in the diet.


Avoid sugar and caffeine, since both can increase blood
acidity and elevate withdrawal symptoms.
Practice deep breathing or meditation technique
Exercise to reduce stress and promote relaxation.
Identify environmental triggers that induce cravings.
Make sure to drink plenty of water everyday.
Get a good night’s sleep every night.

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