This document provides an introduction to psychotropic drugs, including their basic pharmacology and medications used to treat schizophrenia, depression/anxiety, and bipolar disorders. It discusses how psychotropic drugs work in the brain and body, principles of safe use and monitoring, and common drug classes and examples for each condition. Side effects are reviewed along with strategies for management. Choice of treatment considers efficacy, tolerability, comorbidities, and patient preferences.
This document provides an outline on depression, antidepressant drugs, and related nursing care. It discusses types of depression like major depressive disorder and dysthymic disorder. It then covers the four main classes of antidepressant drugs - SSRIs, TCAs, atypical antidepressants, and MAOIs. For each drug class, it discusses mechanisms of action, indications, dosages, drug interactions, side effects, and relevant nursing considerations. The document aims to inform nurses on properly assessing, treating and caring for patients taking antidepressants.
Schizophrenia is a complex psychiatric disorder characterized by disorganized thoughts, delusions, hallucinations, inappropriate affect, and impaired social functioning. The exact causes are unknown but likely involve genetic, brain chemical, environmental, and family history factors. Brain imaging shows enlarged ventricles and decreased cortical size, particularly in the left temporal lobe. Symptoms include positive symptoms like hallucinations, negative symptoms like loss of interest, and mood symptoms. Treatment involves pharmacological therapy with antipsychotics and non-pharmacological approaches like therapy, social skills training, and vocational rehabilitation.
Pharmacological treatment of schizophreniajoanna1956
This document discusses the pharmacological treatment of schizophrenia. It covers the classification and clinical use of antipsychotics, the development of typical and atypical antipsychotics, their mechanisms of action and side effect profiles. It summarizes key studies on the effectiveness of typical versus atypical antipsychotics and provides recommendations from the 2009 PORT treatment guidelines for using antipsychotics to treat acute episodes and as maintenance therapy for multi-episode and first-episode schizophrenia. Alternatives to antipsychotic medication like the Soteria paradigm are also discussed.
People with dementia may develop behavioral and psychological symptoms like depression, anxiety, or aggression. While non-drug interventions should be tried first, medication may sometimes be necessary, though drugs have side effects. Antipsychotics are commonly used but have risks and limited benefits, and should generally only be used for up to three months. Other options include anticonvulsants or antidepressants, which require specialist prescription. All drug treatment for dementia symptoms requires careful monitoring and review.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
This document provides an outline on depression, antidepressant drugs, and related nursing care. It discusses types of depression like major depressive disorder and dysthymic disorder. It then covers the four main classes of antidepressant drugs - SSRIs, TCAs, atypical antidepressants, and MAOIs. For each drug class, it discusses mechanisms of action, indications, dosages, drug interactions, side effects, and relevant nursing considerations. The document aims to inform nurses on properly assessing, treating and caring for patients taking antidepressants.
Schizophrenia is a complex psychiatric disorder characterized by disorganized thoughts, delusions, hallucinations, inappropriate affect, and impaired social functioning. The exact causes are unknown but likely involve genetic, brain chemical, environmental, and family history factors. Brain imaging shows enlarged ventricles and decreased cortical size, particularly in the left temporal lobe. Symptoms include positive symptoms like hallucinations, negative symptoms like loss of interest, and mood symptoms. Treatment involves pharmacological therapy with antipsychotics and non-pharmacological approaches like therapy, social skills training, and vocational rehabilitation.
Pharmacological treatment of schizophreniajoanna1956
This document discusses the pharmacological treatment of schizophrenia. It covers the classification and clinical use of antipsychotics, the development of typical and atypical antipsychotics, their mechanisms of action and side effect profiles. It summarizes key studies on the effectiveness of typical versus atypical antipsychotics and provides recommendations from the 2009 PORT treatment guidelines for using antipsychotics to treat acute episodes and as maintenance therapy for multi-episode and first-episode schizophrenia. Alternatives to antipsychotic medication like the Soteria paradigm are also discussed.
People with dementia may develop behavioral and psychological symptoms like depression, anxiety, or aggression. While non-drug interventions should be tried first, medication may sometimes be necessary, though drugs have side effects. Antipsychotics are commonly used but have risks and limited benefits, and should generally only be used for up to three months. Other options include anticonvulsants or antidepressants, which require specialist prescription. All drug treatment for dementia symptoms requires careful monitoring and review.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
9. Bipolar Disorder.pptx for pharmacy studentsemebetnigatu1
Bipolar disorder is a chronic mood disorder characterized by episodes of mania and depression. It is influenced by both genetic and environmental factors. During a manic episode, symptoms include abnormally elevated mood, decreased need for sleep, racing thoughts, distractibility, and increased goal-directed activity. Depressive episodes involve low mood, loss of interest, feelings of worthlessness, and thoughts of death or suicide. Treatment involves both pharmacotherapy and psychotherapy. Lithium, valproate, lamotrigine, and atypical antipsychotics are commonly used to treat and prevent mood episodes. The goals of treatment are to eliminate acute symptoms, prevent future episodes, and maximize psychosocial functioning.
Bipolar disorder is a mental illness characterized by periods of depression and periods of mania or hypomania. It is a lifelong condition that affects about 2% of the global population. The exact causes are unknown but include genetic and environmental factors. Treatment involves lifestyle changes and lifelong medication with mood stabilizers, antipsychotics, or antidepressants to reduce symptoms and prevent recurrence. Left untreated, bipolar disorder can lead to substance abuse, legal and financial problems, relationship issues, and increased risk of suicide.
This document summarizes research on using quetiapine as an augmentation strategy for treatment-resistant depression. Six studies are reviewed that examine adding quetiapine to ongoing antidepressant treatment. The studies generally found quetiapine augmentation led to greater improvement in depression symptoms compared to placebo, especially when starting at dosages of 150-300 mg/day. The most common side effects were dry mouth, drowsiness, and weight gain. Overall, the research suggests quetiapine may be a valid option for improving outcomes for patients with treatment-resistant depression.
This document discusses antidepressants and mood stabilizing drugs. It begins by defining affective disorders like major depressive disorder and bipolar affective disorder. It then discusses the causes, symptoms, and statistics of depression. The remainder of the document focuses on different classes of antidepressant drugs including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). It describes the mode of action, examples of drugs, side effects, drug interactions, and therapeutic uses for each class.
Anti - depressants September - 2023.pdfssuser504dda
The document discusses affective disorders and their treatment. It describes various types of affective disorders including depression, mania, and bipolar disorder. It then focuses on depression, outlining its symptoms, diagnostic criteria, causes and epidemiology. The document also discusses various treatment approaches for depression including psychotherapy, electroconvulsive therapy, and medications. It provides details on classes of antidepressant medications, their mechanisms of action, examples of drugs within each class, and their side effect profiles.
This document provides information about various psychiatric medications, including their purposes, common types, potential side effects, and precautions. It discusses medications used to treat psychosis (antipsychotics), side effects of antipsychotics, mood disorders (lithium, anticonvulsants), depression (SSRIs, tricyclics, MAOIs). Key points covered include the importance of adherence, monitoring side effects, blood tests where needed, and discussing any other medications or substances with doctors due to potential interactions.
Hanipsych, aripiprazole as antidepressantHani Hamed
This document discusses the use of aripiprazole as an adjunctive treatment for major depressive disorder.
1) A study found that adjunctive aripiprazole resulted in significantly greater improvement in depressive symptoms compared to placebo, as measured by the MADRS scale. Remission rates were also higher with aripiprazole.
2) Adjunctive aripiprazole was well tolerated with completion rates similar to placebo and lower discontinuation due to adverse events.
3) Aripiprazole's mechanism of action as a partial agonist at dopamine and serotonin receptors provides a unique pharmacological profile that may improve outcomes for patients with treatment resistant depression when used as an adjunct
This document provides an overview of psychopharmacology and the use of psychotropic medications to treat mental health disorders. It discusses the roles of psychiatrists and psychopharmacologists in treatment and outlines major drug categories including antipsychotics, antidepressants, mood stabilizers, anxiolytics, and stimulants. Key concepts covered include mechanisms of action, side effects, drug interactions, principles of pharmacologic treatment, and the nurse's role in patient education.
Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how we feel, think, and handle daily activities, such as sleeping, eating, or working.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression
This document discusses mood disorders, specifically depression. It provides the DSM-IV criteria for a major depressive episode, including symptoms such as depressed mood, diminished interest, changes in appetite, insomnia, fatigue, feelings of worthlessness, difficulty concentrating, and suicidal thoughts. It also discusses treatment options, focusing on pharmacotherapy. SSRIs are considered a first-line treatment and details are provided about specific SSRIs, their mechanisms of action, indications, and precautions. Risk factors for suicide are briefly covered.
This document discusses various screening models used to test potential antidepressant drugs. It begins by defining depression and its symptoms. It then discusses several theories of depression's mechanisms. Various in vivo animal models are described for screening antidepressants, including the forced swim test, tail suspension test, and learned helplessness test. The document provides details on procedures and evaluations for these and other models, such as amphetamine potentiation and NE toxicity tests in mice. The goal of screening models is to see how potential drugs correlate with known antidepressants' clinical efficacy and pharmacological effects.
Depression is a common and serious mood disorder that is characterized by depressed mood, loss of interest, feelings of guilt and low self-worth, sleep and appetite disturbances, low energy, and poor concentration. It affects over 121 million people worldwide and can be caused by genetic, environmental, biochemical and other factors. Symptoms of depression can interfere with daily life and functioning. Treatment options include antidepressant medications, psychotherapy, and electroconvulsive therapy for treatment-resistant cases.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
The document discusses various treatment approaches for substance use disorders. It covers assessment, detoxification, main treatment models including abstinence-based and drug maintenance programs, and relapse prevention. Detoxification is usually conducted as an inpatient for safety. Main treatment models discussed include therapeutic communities, Minnesota model, self-help groups, and drug maintenance using agonists like methadone or partial agonists like buprenorphine. Predictors of treatment outcome and the importance of continued care are also covered.
Major Depressive Disorder is characterized by one or more episodes of depression without a history of mania. Its etiology is complex with several factors like genetics, environment, and biology contributing. Symptoms include decreased levels of neurotransmitters like serotonin and norepinephrine. Treatment involves pharmacological therapies like SSRIs, TCAs, and MAOIs to reduce symptoms as well as psychotherapy. The goals are to reduce acute symptoms, facilitate a return to normal functioning, and prevent future episodes. Treatment is conducted over acute, continuation, and maintenance phases.
This document provides an overview of the management of alcohol dependence. It discusses the assessment, diagnosis and treatment of alcohol intoxication, withdrawal, and complications. It covers pharmacological management using benzodiazepines and other medications. It also discusses relapse prevention strategies like pharmacological deterrents/anticraving agents and psychotherapies including cognitive behavioral therapy, motivational interviewing, and group therapy. The goal is to safely detoxify patients, treat complications, prevent relapse, and support long term abstinence through an integrated treatment approach.
Major depressive disorder (MDD) is characterized by depressed mood and loss of interest in normally enjoyable activities for at least two weeks. The document discusses the epidemiology, risk factors, etiology, pathophysiology, diagnostic criteria, clinical presentation, treatment including pharmacologic and non-pharmacologic options, and duration of therapy for MDD. Treatment involves acute, continuation, and maintenance phases to achieve remission and prevent relapse and recurrence.
Major depressive disorder and its treatmentAmruta Vaidya
A concise presentation on major depressive disorder, the drug treatment options available i.e. conventional and emerging therapies which are available.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
9. Bipolar Disorder.pptx for pharmacy studentsemebetnigatu1
Bipolar disorder is a chronic mood disorder characterized by episodes of mania and depression. It is influenced by both genetic and environmental factors. During a manic episode, symptoms include abnormally elevated mood, decreased need for sleep, racing thoughts, distractibility, and increased goal-directed activity. Depressive episodes involve low mood, loss of interest, feelings of worthlessness, and thoughts of death or suicide. Treatment involves both pharmacotherapy and psychotherapy. Lithium, valproate, lamotrigine, and atypical antipsychotics are commonly used to treat and prevent mood episodes. The goals of treatment are to eliminate acute symptoms, prevent future episodes, and maximize psychosocial functioning.
Bipolar disorder is a mental illness characterized by periods of depression and periods of mania or hypomania. It is a lifelong condition that affects about 2% of the global population. The exact causes are unknown but include genetic and environmental factors. Treatment involves lifestyle changes and lifelong medication with mood stabilizers, antipsychotics, or antidepressants to reduce symptoms and prevent recurrence. Left untreated, bipolar disorder can lead to substance abuse, legal and financial problems, relationship issues, and increased risk of suicide.
This document summarizes research on using quetiapine as an augmentation strategy for treatment-resistant depression. Six studies are reviewed that examine adding quetiapine to ongoing antidepressant treatment. The studies generally found quetiapine augmentation led to greater improvement in depression symptoms compared to placebo, especially when starting at dosages of 150-300 mg/day. The most common side effects were dry mouth, drowsiness, and weight gain. Overall, the research suggests quetiapine may be a valid option for improving outcomes for patients with treatment-resistant depression.
This document discusses antidepressants and mood stabilizing drugs. It begins by defining affective disorders like major depressive disorder and bipolar affective disorder. It then discusses the causes, symptoms, and statistics of depression. The remainder of the document focuses on different classes of antidepressant drugs including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). It describes the mode of action, examples of drugs, side effects, drug interactions, and therapeutic uses for each class.
Anti - depressants September - 2023.pdfssuser504dda
The document discusses affective disorders and their treatment. It describes various types of affective disorders including depression, mania, and bipolar disorder. It then focuses on depression, outlining its symptoms, diagnostic criteria, causes and epidemiology. The document also discusses various treatment approaches for depression including psychotherapy, electroconvulsive therapy, and medications. It provides details on classes of antidepressant medications, their mechanisms of action, examples of drugs within each class, and their side effect profiles.
This document provides information about various psychiatric medications, including their purposes, common types, potential side effects, and precautions. It discusses medications used to treat psychosis (antipsychotics), side effects of antipsychotics, mood disorders (lithium, anticonvulsants), depression (SSRIs, tricyclics, MAOIs). Key points covered include the importance of adherence, monitoring side effects, blood tests where needed, and discussing any other medications or substances with doctors due to potential interactions.
Hanipsych, aripiprazole as antidepressantHani Hamed
This document discusses the use of aripiprazole as an adjunctive treatment for major depressive disorder.
1) A study found that adjunctive aripiprazole resulted in significantly greater improvement in depressive symptoms compared to placebo, as measured by the MADRS scale. Remission rates were also higher with aripiprazole.
2) Adjunctive aripiprazole was well tolerated with completion rates similar to placebo and lower discontinuation due to adverse events.
3) Aripiprazole's mechanism of action as a partial agonist at dopamine and serotonin receptors provides a unique pharmacological profile that may improve outcomes for patients with treatment resistant depression when used as an adjunct
This document provides an overview of psychopharmacology and the use of psychotropic medications to treat mental health disorders. It discusses the roles of psychiatrists and psychopharmacologists in treatment and outlines major drug categories including antipsychotics, antidepressants, mood stabilizers, anxiolytics, and stimulants. Key concepts covered include mechanisms of action, side effects, drug interactions, principles of pharmacologic treatment, and the nurse's role in patient education.
Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how we feel, think, and handle daily activities, such as sleeping, eating, or working.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression
This document discusses mood disorders, specifically depression. It provides the DSM-IV criteria for a major depressive episode, including symptoms such as depressed mood, diminished interest, changes in appetite, insomnia, fatigue, feelings of worthlessness, difficulty concentrating, and suicidal thoughts. It also discusses treatment options, focusing on pharmacotherapy. SSRIs are considered a first-line treatment and details are provided about specific SSRIs, their mechanisms of action, indications, and precautions. Risk factors for suicide are briefly covered.
This document discusses various screening models used to test potential antidepressant drugs. It begins by defining depression and its symptoms. It then discusses several theories of depression's mechanisms. Various in vivo animal models are described for screening antidepressants, including the forced swim test, tail suspension test, and learned helplessness test. The document provides details on procedures and evaluations for these and other models, such as amphetamine potentiation and NE toxicity tests in mice. The goal of screening models is to see how potential drugs correlate with known antidepressants' clinical efficacy and pharmacological effects.
Depression is a common and serious mood disorder that is characterized by depressed mood, loss of interest, feelings of guilt and low self-worth, sleep and appetite disturbances, low energy, and poor concentration. It affects over 121 million people worldwide and can be caused by genetic, environmental, biochemical and other factors. Symptoms of depression can interfere with daily life and functioning. Treatment options include antidepressant medications, psychotherapy, and electroconvulsive therapy for treatment-resistant cases.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
The document discusses various treatment approaches for substance use disorders. It covers assessment, detoxification, main treatment models including abstinence-based and drug maintenance programs, and relapse prevention. Detoxification is usually conducted as an inpatient for safety. Main treatment models discussed include therapeutic communities, Minnesota model, self-help groups, and drug maintenance using agonists like methadone or partial agonists like buprenorphine. Predictors of treatment outcome and the importance of continued care are also covered.
Major Depressive Disorder is characterized by one or more episodes of depression without a history of mania. Its etiology is complex with several factors like genetics, environment, and biology contributing. Symptoms include decreased levels of neurotransmitters like serotonin and norepinephrine. Treatment involves pharmacological therapies like SSRIs, TCAs, and MAOIs to reduce symptoms as well as psychotherapy. The goals are to reduce acute symptoms, facilitate a return to normal functioning, and prevent future episodes. Treatment is conducted over acute, continuation, and maintenance phases.
This document provides an overview of the management of alcohol dependence. It discusses the assessment, diagnosis and treatment of alcohol intoxication, withdrawal, and complications. It covers pharmacological management using benzodiazepines and other medications. It also discusses relapse prevention strategies like pharmacological deterrents/anticraving agents and psychotherapies including cognitive behavioral therapy, motivational interviewing, and group therapy. The goal is to safely detoxify patients, treat complications, prevent relapse, and support long term abstinence through an integrated treatment approach.
Major depressive disorder (MDD) is characterized by depressed mood and loss of interest in normally enjoyable activities for at least two weeks. The document discusses the epidemiology, risk factors, etiology, pathophysiology, diagnostic criteria, clinical presentation, treatment including pharmacologic and non-pharmacologic options, and duration of therapy for MDD. Treatment involves acute, continuation, and maintenance phases to achieve remission and prevent relapse and recurrence.
Major depressive disorder and its treatmentAmruta Vaidya
A concise presentation on major depressive disorder, the drug treatment options available i.e. conventional and emerging therapies which are available.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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4. BASIC PHARMACOLOGY
▰ Psychotropic drugs are chemical substances
that can change brain function and result in
alterations in perceptions, mood,
consciousness, cognition, or behaviour.
4
"CHAPTER 1 Alcohol and Other Drugs". ISBN 0-7245-3361-3. Archived from the original on 2015-03-28.
5. BASIC PHARMACOLOGY
• In general,medication should be started at the lowest
possible dose and gradually increased to the lowest
effective dose
– Many adverse effects are dose dependent
– Some medications require monitoring of blood levels
for effective levels and to prevent toxic levels
5
6. BASIC PHARMACOLOGY
• In general, when stopping a medication, slowly
decreasing the dose decreases the risk of
discontinuation symptoms
– In some cases of adverse reactions medications
must be stopped immediately.
6
7. BASIC PHARMACOLOGY
• Medications can interact with each other, some foods, or
street drugs in ways which change how they act, how
long or short they act, how toxic they are, and how high a
dose is needed
• Medications can act synergistically in causing adverse
effects including risk of overdose.
7
11. CHOICE OF ANTIPSYCHOTICS
▰ Should be based on the
agreement between people
with schizophrenia and
clinicians taking into
account the relative
benefits of the drugs and
their side-effect profiles.
11
Risks
Benefits
13. MECHANISM OF ANTIPSYCHOTICS
▰
13
FIRST GENERATION ANTIPSYCHOTIC SECOND GENERATION ANTIPSYCHOTIC
D2 Antagonism 5HT2A / D2 Antagonism
Meltzer HY, Matsubara S, Lee JC. The ratios of 5HT2 and D2 affinities differentiate
atypical and typical antipsychotic drugs. Psychopharmacol Bull. 1989;25(3):390-2.
14. D2
ANTAGONIST
Mesolimbic pathway
dramatic therapeutic action
on positive psychotic
symptoms
Tuberoinfundibular pathway
hyperprolactinemia (lactation,
infertility, sexual dysfunction)
Nigrostriatal pathway
extrapyramidal side effects
(EPS) and tardive dyskinesia
Mesocortical pathway
enhanced negative and
cognitive psychotic
symptoms
15. SIDE EFFECTS OF TYPICAL ANTIPSYCHOTICS
(1ST Generation)
MOTOR SIDE EFFECTS
▻ Tardive dyskinesia
▻ Parkinsonism
▻ Dystonia
▻ Akathisia
AUTONOMIC SIDE EFFECTS
▻ Othostatic hypotension
▻ Tachycardia
▻ Constipation
▻ Urinary retention
▻ Sexual dysfunction 15
PSYCHIATRIC SIDE EFFECTS
▻ Sedation
▻ Apathy
▻ Confusion
16. ATYPICAL ANTIPSYCHOTIC (2nd Generation)
▰ Atypical antipsychotics have mostly replaced the older
antipsychotic for treating schizophrenia, BD, and other
severe mental illness because of their many advantages.
▻ Lower tendency for causing parkinsonism
▻ More effective when treating the negative symptoms of
schizophrenia
▻ Better patient acceptability
▰ There are heterogeneous group of medicines with different
properties and side effects. 16
17. SIDE EFFECTS OF ATYPICAL ANTIPSYCHOTIC (2nd Generation)
ANTIPSYC
HOTICS
Aripiprazole Olanzapine Quetiapine Risperidone Clozapine Amisulpiride
Potential
advantage
- Very low
sedation
- Long Half-life
- Lower
metabolic
syndrome
- Possible
greater efficacy
- Sedating
- Low EPS
- Sedating
- Possible
greater
efficacy
- Effective in TR
schizophrenia
- Lower
metabolic
syndrome
Side effect - Highest
akathisia
- Worst
metabolic
profile
- High weight
gain
- Metabolic
profile
- Sedating
- Weight gain
- Postural
hypotension
- Highest
prolactin
elevation
-Parkinsonism
with high
doses
- Metabolic
profile
- Agranulositosis
- Hypersalivation
- Sedation
- Postural
hypotension
- Anticholinergic
side effects
- Parkinsonism
with high doses
-
Hyperprolactine
mia
- High sexual
dysfunction
18. “Choice of antipsychotic medication should be made
by the patient and physician TOGETHER, taking into
account views of a carer where appropriate.
Provide information and discuss the likely benefits
and side effects of each drug.
(NICE Guideline for Schizophrenia Treatment)
18
18
National Institute for Health and Care Excellence. Schizophrenia: core interventions in the treatment and management of
schizophrenia in adults in primary and secondary care (update). Clinical Guideline 82, 2009.
https://www.nice.org.uk/guidance/cg82.
20. PRINCIPLES OF PHARMACOLOGIC TREATMENT OF MDD
▰ General principles of MDD treatment are:
▻ to relieve symptoms
▻ to reduce the morbidity and disability
▻ to limit risks of self-harm and fatality
20
CPG of Management of Major Depressive Disorder (2nd Edition), June 2019
21. DRUGS USED IN THE TREATMENT OF MDD
21
CLASS EXAMPLES
Tricyclic Antidepressants Amitryptyline, Dothiepine, Clomipramine, Imipramine,
Mianserin, Nortriptyline
Monoamine Oxidase Inhibitors (MAOIs) Phenelzine, Moclobemide
Selective Serotonin Reuptake Inhibitors (SSRI) Sertraline, Fluvoxamine, Escitalopram, Fluoxetine,
Paroxetine
Serotonin Noradrenaline Reuptake Inhibitor (SNRI) Venlafaxine, Desvenlafaxine, Duloxetine
Noradrenergic and Specific
Serotonergic Antidepressants (NaSSAs)
Mirtazapine
Multimodal Serotonin Modulator Antidepressant Vortioxetine
Melatonergic Agonist and Serotogenic Antagonist
Antidepressant
Agomelatine
CPG of Management of Major Depressive Disorder (2nd Edition), June 2019
23. PRINCIPLES OF PHARMACOLOGIC TREATMENT OF MDD
▰ The choice of antidepressant medication will depend on
various factors including:
▻ efficacy and tolerability
▻ patient profile and comorbidities
▻ concomitant medications
▻ drug-drug interactions
▻ cost and availability
▻ patients’ preference
23
CPG of Management of Major Depressive Disorder (2nd Edition), June 2019
24. PRINCIPLES OF PHARMACOLOGIC TREATMENT OF MDD
▰ Most second-generation antidepressants namely
SSRIs, SNRIs, NaSSAs, melatonergic and multimodal
antidepressant may be considered as the initial
treatment medication.
▰ The older antidepressants such as TCAs and MAOIs
are considered for subsequent choice later.
24
CPG of Management of Major Depressive Disorder (2nd Edition), June 2019
25. PRINCIPLES OF PHARMACOLOGIC TREATMENT
▰Start low, go slow……BUT GET THERE!
▰Monitor ADHERENCE.
▰CYP 450 interactions, sedation, concomitant
medical illness are issues to consider.
25
Depression of the Elderly, Jackie L. Neel, D.O.
26. PHASES OF TREATMENT
A) Acute Phase
Antidepressants given until remission is achieved.
B) Continuation Phase
The duration of continuation phase treatment is generally 6-9 months
from the acute phase. With risk factors, > 2 years
C) Maintenance Phase
This is a period to prevent recurrence and the optimal duration is difficult
to determine because some patients require a longer period and some an
indefinite period.
26
Lam RW, Kennedy SH, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guide_x0002_lines for
the management of major depressive disorder in adults: III. Pharmacotherapy. J Affect Disord. 2009;117(Suppl 1):S26-S43.
27. ANTIDEPRESSANT SIDE EFFECTS & MANAGEMENTS*
27
Adverse Effect Coping Strategies
Nausea • Take with food or divide the dose (half with breakfast, half with lunch)
• Suck on sugarless hard candy
• Drink plenty of fluids
• Try antacids
Fatigue, drowsiness • Brief nap during the day
• Regular physical activity
• Avoid driving or operating dangerous machinery until the fatigue passes
• Take ATD 1 to 2 two hours before bedtime
Insomnia • Take ATD in the morning
• Avoid caffeinated food and drinks
• Regular physical activity
Dizziness • Rise slowly from sitting
• Use handrails, canes or other sturdy items for support
• Avoid driving or operating machinery
• Avoid caffeine, tobacco and alcohol
• Drink plenty of fluids
• Take the antidepressant at bedtime
28. ANTIDEPRESSANT SIDE EFFECTS & MANAGEMENTS*
28
Adverse Effect Coping Strategies
Dry mouth • Sip water regularly or suck on ice chips
• Chew sugarless gum or suck on sugarless hard candy
• Avoid caffeine
• Breathe through your nose, not your mouth
• Brush teeth twice daily, floss daily and see dentist regularly
• Consider a moisturizing mouth spray or another product that might stimulate saliva production
Blurry Vision • Consider use of eye drops to relieve dryness
• Get an eye exam to see whether blurred vision caused by an antidepressant may be worsened by an
underlying eye problem
• Consider alternative antidepressant
Constipation • Drink plenty of water
• Eat high-fiber foods or a fiber supplement
• Get regular exercise
• Consider stool softeners
Agitation,
restlessness, anxiety
• Get regular exercise
• Practice deep-breathing exercises, muscle relaxation or yoga
• Consider switching to an antidepressant that is not as stimulating
29. ANTIDEPRESSANT SIDE EFFECTS & MANAGEMENTS*
▰ Simon G, et al. Unipolar major depression in adults: Choosing initial treatment. https://www.uptodate.com/contents/search. Accessed Aug. 23, 2019.
▰ Tarleton EK, et al. Primer for nutritionists: Managing the side effects of antidepressants. Clinical Nutrition ESPEN. 2016; doi:10.1016/j.clnesp.2016.05.004
▰ Mental healthmedications. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml. Accessed Aug. 23, 2019.
▰ Morgan AJ, et al. Self-help strategies for sub-threshold anxiety: A Delphi consensus study to find messages suitable for population-wide promotion. Journal of Affective Disorders. 2018;
doi:10.1016/j.jad.2016.07.024.
▰ Nassan M, et al. Pharmacokinetic pharmacogenetic prescribing guidelines for antidepressants: A template for psychiatric precision medicine. Mayo Clinic Proceedings. 2016;
doi:10.1016/j.mayocp.2016.02.023.
▰ LeBlanc A, et al. Shared decision making for antidepressants in primary care: A cluster randomized trial. JAMA Internal Medicine. 2015; doi:10.1001/jamainternmed.2015.5214.
▰ Hirsch M, et al. Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. https://www.uptodate.com/contents/search. Accessed Aug. 23, 2019.
▰ Celexa (prescribing information). Allergan USA, Inc.; 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020822s047lbl.pdf#page=33. Accessed Aug. 27, 2019.
▰ Dry mouth. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/dry-mouth. Accessed Aug. 26, 2019.
▰ Kahl KG, et al. Effectsof psychopharmacological treatment withantidepressantson the vascular system. Vascular Pharmacology. 2017; doi:10.1016/j.vph.2017.07.004.
▰ Wang S-M, et al. Addressing the side effects of contemporary antidepressant drugs: A comprehensive review. Chonnam Medical Journal. 2018; doi:10.4068/cmj.2018.54.2.101.
▰ Postural hypotension: What it is and how to manage it. Centers for Disease Control and Prevention. https://www.cdc.gov/steadi/patient.html. Accessed Aug. 26, 2019.
▰ Constipation. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gi-disorders/constipation. Accessed Aug. 26, 2019.
▰ Tainted sexual enhancement products. U.S. Food and Drug Administration. https://www.fda.gov/drugs/medication-health-fraud/tainted-sexual-enhancement-products. Accessed Aug. 27, 2019.
29
31. PRINCIPLES OF PHARMACOLOGIC TREATMENT
OF BIPOLAR DISORDER
▰ The main biological treatments used are:
▻ Antipsychotic medications
▻ Mood stabilising agents
▻ GABA agonists (e.g., Benzodiazepines)
▻ Antidepressants
▻ Complimentary therapies
31
Goodwin, G.M., Haddad, P.M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., Holmes, E. A. (2016). Evidence-based
guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology.
Journal of Psychopharmacology, 30(6), 495-553.
32. TREATMENT OR BIPOLAR DISORDER
32
CPG of the Management of Bipolar Disorder
in Adults, 2014
35. “Both LITHIUM & SODIUM
VALPROATE require TDM to
ensure the safe and effective
use of the medicatios.
35
35
National Institute for Health and Care Excellence. Schizophrenia: core interventions in the treatment and management of
schizophrenia in adults in primary and secondary care (update). Clinical Guideline 82, 2009.
https://www.nice.org.uk/guidance/cg82.
36. LITHIUM
36
▰ Inhibits EXCITATORY neurotransmitters such as Dopamine and
Glutamate by blocking their receptors.
▰ Promotes GABA-mediated neurotransmission.
1) Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential mechanisms of action of lithium in bipolar disorder. CNS
drugs, 27(2), 135-153.
2) CPG of the Management of Bipolar Disorder in Adults, 2014
37. SODIUM VALPROATE
37
▰ Increasing GABAergic neurotransmission.
▰ As GABA is an inhibitory neurotransmitter, this increase results in increased
inhibitory activity.Promotes GABA-mediated neurotransmission.
1) Karlgren M, Vildhede A, Norinder U, Wisniewski JR, Kimoto E, Lai Y, Haglund U, Artursson P: Classification of inhibitors of hepatic organic anion transporting
polypeptides (OATPs): influence of protein expression on drug-drug interactions. J Med Chem. 2012 May 24;55(10):4740-63. doi: 10.1021/jm300212s. Epub 2012
May 15. [PubMed:22541068]
2) CPG of the Management of Bipolar Disorder in Adults, 2014
39. SODIUM VALPROATE
39
▰ Mood stabilisers can be teratogenic.
▰ Sodium valproate is of particular concern, as 10–11% of infants
exposed in utero will have major congenital malformations and
are at risk of significant intellectual impairment.
▰ Sodium valproate should not be used as a first line mood
stabiliser in women of child bearing age.
1. Khan SJ, Fersh ME, Ernst C, et al. (2016) Bipolar disorder in pregnancy and postpartum: Principles of management. Current Psychiatry Reports 18: 13.
2. Tomson T and Battino D (2012) Teratogenic effects of antiepileptic drugs. The Lancet Neurology 11: 803–813
3. Gentile S (2014) Risks of neurobehavioral teratogenicity associated with prenatal exposure to valproate monotherapy: A systematic review with regulatory
repercussions. CNS Spectrums 19: 305–315.
4. Malhi GS, Bassett D, Boyce P, et al. (2015) Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders.
Australian and New Zealand Journal of Psychiatry 49: 1087–1206.
44. SIDE EFFECTS OF BENZODIAZEPINES
44
• Headaches
• Confusion
• Ataxia (Disorders that affects coordination, balance and speech)
• Dysarthria (Difficulty speaking)
• Blurred vision
• GI disturbances
• Paradoxical excitement
• Impair cognition (e.g., memory, attention and processing speed)
23 Crowe SF et al. The residual medium and long‐term cognitive effects of benzodiazepine use: an updated
meta‐analysis. Arch Clin Neuropsychol 2017; doi: 10.1093/arclin/acx120. [Epub ahead of print]
45. APPROPRIATE USE OF BENZODIAZEPINES
● Benzodiazepines provide rapid symptomatic relief from
acute anxiety states.
● Only use for severe anxiety, disabling or in extreme
distress.
● Use lowest effective dose + shortest time (max 4 weeks).
● Caution in patients with substance misuse.
45
Department of Health (DoH). Benzodiazepines: Good Practice Guidelines for Clinicians (2002).Accessed at
www.health.gov.ie/wp-content/uploads/2014/04/Benzodiazepines-Good Practice-Guidelines.pdf on 14 February
2017.
47. PHARMACIST’S ROLES
▰ There is so much that we can do to improve patient’s
quality of life.
▰ It all begins with patient being able to adhere to
medication.
47
48. PHARMACIST’S ROLES
▰ Pharmacists have the potential to have a large effect in enhancing
patient’s quality of life through a variety of interventions such as :1
▻ reducing the number of medications taken
▻ reducing the number of doses taken, increasing patient adherence,
▻ preventing adverse drug reactions (ADRs),
▻ improving patient quality of life and
▻ decreasing facility and drug costs.
48
1. Chumney EC, Robinson LC. The effects of pharmacist interventions on patients with polypharmacy. Pharm Pract
(Granada). 2006 Jul;4(3):103-9. PMID: 25247007; PMCID: PMC4156841.