PSYCHOPHARMACY and
ADVERSE EFFECTSRURAL NEVADA COUNSELING
DEVELOPED BY KAREN TORRY GREENE, DBH, LCSW
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This publication was supported in whole or in part by the BHPT –
Behavioral Health Prevention & Treatment/
through State General Funds and/or the Substance Abuse Prevention and Treatment
(SAPT) Block Grant from the Department of Health and Human Services (DHHS),
Substance Abuse and Mental Health Services Administration (SAMHSA).
Its contents are solely the responsibility of the authors and do not necessarily
represent the official views of the U.S. DHHS, SAMHSA, or the State of Nevada.
PSYCHOPHARMACY and
ADVERSE EFFECTS
is required
at Orientation and
annually
for all RNC clinical and
paraprofessional staff
(Note this may not meet CE requirements for
licensing boards.)
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Neurochemistry 101
Dopamine (DA) Neurotransmitter associated with reward-behaviors, learning, mood, and attention
Serotonin (5-HT) Neurotransmitter associated with well-being, mood, anxiety, arousal, cognition, appetite
Norepinephrine (NE) or Noradrenaline (NA) Neurotransmitter associated with fight/flight, mobilization, memory, mood, anxiety, and attention
gamma-Aminobutyric acid (GABA) Inhibitory neurotransmitter
Glutamate (Glu) Excitatory neurotransmitter
Acetylcholine (Ach) Neurotransmitter associated with muscle activation, memory, learning
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Psychopharm & Adverse Effects - Rural Nevada Counseling 6/13/2019
Neurochemistry 101, cont’d
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Psychopharm & Adverse Effects - Rural Nevada Counseling
Brain Scans
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Psychopharm & Adverse Effects - Rural Nevada Counseling
Pharmacokinetics: How drugs work
Different routes of administration
Different rates of absorption influenced by factors such as protein binding, drug half life, lipid solubility, metabolism
Different means of distribution throughout the system
Potentiation is when one drug enhances another, and Synergism is when one drug significantly enhances another
If a pt develops TOLERANCE for a drug, they’ll need more for the same effect
The “Therapeutic Index” is the ratio of “toxic dose” to “therapeutic dose”…basically the “sweet spot of rx’g”
Low tx’c index = more risk
High tx’c index = more desirable
Withdrawal is a set of symptoms that develops when the drug is discontinued
Discontinuation Syndrome is not medically dangerous (like Withdrawal can be) but can be uncomfortable
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Drug Abbreviations
ac before food
bid twice a day
cap capsule
c with a bar on top with
h hour
hs at bedtime
pc after food
po by mouth
prn as needed
Abbreviation Meaning
q4h every four hours
q6h every six hours
qd every day
qid four times a day
Rx prescription
stat immediately
tab tablet
tid three times a day
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Antidepressants
Tricyclic▪ Anafranil – clomipramine
▪ Ascendin – amoxapine
▪ Elavil – amitriptyline
▪ Ludiomil – maprotiline
▪ Norpramin – desipramine
▪ Pamelor, Aventyl – nortriptyline
▪ Sinequan – doxepin
▪ Surmontil – trimipramine
▪ Tofranil – imipramine
▪ Vivactil - protriptyline
SSRIs and MAOsSelective Serotonin Reuptake Inhibitors
▪ Celexa – citalopram
▪ Lexapro – escitalopram
▪ Luvox – fluvoxamine
▪ Paxil – paroxetine
▪ Prozac – fluoxetine
▪ Zoloft – sertraline
Monoamine Oxidase Inhibitors
(toxic food interactions)
▪ EMSAM – selegiline transdermal
system
▪ Marplan – isocarboxazid
▪ Nardil – phenelzine
▪ Parnate - tranylcypromine
Others and Herbs▪ Aplenzin – bupropion hydorbomide
▪ Cymbalta – duloxetine
▪ Desyrel, Oleptro – trazodone
▪ Effexor – venlafaxine - SNRI
▪ Pristiq - desvenlafaxine
▪ Remeron – mirtazapine
▪ Serzone – nefaxodone
▪ Wellbutrin – bupropion -SDRI
▪ St John’s Wort
▪ Ginkgo Biloba
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9*This is not an all-inclusive list
Potential Adverse Effects of Antidepressants
Sexual side effects
Headache, nausea, diarrhea, dry
mouth, anorexia, weight change,
restlessness, insomnia, tremor,
sweating, yawning, dizziness, high
blood pressure
SUICIDE
Serotonin Syndrome (may be life
threatening) agitation, confusion,
fever, muscle rigidity, hypotension
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10*This is not an all-inclusive list
Mood Stabilizers
Lithium and
anticonvulsants▪ Lithobid or Eskalith – lithium
▪ Depakote – valproate, valproic
acid
▪ Tegretol – carbamazepine
▪ Lamictal – lamotrigine
▪ Neurontin – gabapentin
▪ Topomax – topiramate
Atypical
Antipsychotics▪ Clozaril – clozapine
▪ Zyprexa –olanzepine
▪ Symbyax – olanzepine/fluoxetine
▪ Risperdal – risperidone
▪ Seroquel – quetiapine
▪ Geodon – ziprasidone
▪ Abilify – aripiprazole
▪ Fanapt – iloperidone (off label)
▪ Saphris – asenapine (off label)
Others▪ Gabitril – tiagabine
▪ Invega – paliperidone
▪ Klonopin – clonazepam
▪ Trileptal – oxcarbazepine
▪ Verelan – verapamil
▪ Zonegran – zonisamide
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11*This is not an all-inclusive list
Potential Adverse Effects of Mood Stabilizers
Aside from the typical possibilities of nausea, weight change, tremor, fatigue, diarrhea, dry mouth, headache, sexual side effects, and so on…
Tardive Dyskinesia: Involuntary Movement (AIMS Testing)
Clozaril may lead to orthostatic hypotension, bradycardia, syncope, and cardiac arrest, and most notably, severe neutropenia and agranulocytosis. Scheduled labs are required
Lithium toxicity can be fatal and may be characterized by seizures, agitation, hyperthermia, tachycardia, uncontrollable eye movements, delirium, or coma. Routine blood draws are required.
Lamictal can lead to a serious immune-related adverse reaction characterized by fever and rash.
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12*This is not an all-inclusive list
Antianxiety Medications
Sedative-hypnotics and Benzodiazepines▪ Ambien – zolpidem
▪ Ativan – lorazepam
▪ Centrax – prazepam
▪ Dalmane – flurazepam
▪ Doral – quazepam
▪ Halcion – triazolam
▪ Klonapin – clonazepam
▪ Librium – chlordiazepoxide
▪ Lunesta – eszopiclone
▪ Prosom – estazolam
▪ Restoril – temazepam
▪ Serax – oxazepam
▪ Sonata – zaleplon
▪ Tranxene – clorazepate
▪ Valium – diazepam
▪ Xanax - alprazolam
Other▪ Buspar – buspirone
▪ Catapres – clonidine
▪ Inderal – propranolol
▪ Rozerem – ramelteon
▪ Visken - pindolol
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13*This is not an all-inclusive list
Potential Adverse Effects of Antianxiety Meds
Abuse and/or addiction
Slurred speech, sedation,
dizziness, cognitive slowing, dry
mouth, distorted sense of taste,
insomnia
Ambulation difficulties can lead
to falls, especially with seniors
SUICIDE
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Antipsychotic Medications
Atypical▪ Abilify – aripiprazole
▪ Clozaril – clozapine
▪ Fanapt – iloperidone
▪ Geodon – ziprasidone
▪ Invega – paliperidone
▪ Risperdal – risperidone
▪ Saphris – asenapine
▪ Seroquel – quetiapine
▪ Symbyax – olanzepine/fluoxetine
▪ Zyprexa - olanzepine
Typical
(Conventional)▪ Haldol – haloperidol
▪ Loxitane – loxapine
▪ Mellaril – thioridazine
▪ Moban – molindone
▪ Navane – thiothixene
▪ Orap – pimozide
▪ Prolixin – fluphenazine
▪ Serentil – mesoridazine
▪ Stelazine – trifluoperazine
▪ Thorazine – chlorpromazine
▪ Trilafon - perphenazine
Antiparkinsonia and
AnticholinergeticThese are for side effects of
Antipsychotic Medications
▪ Artane – trihexyphenidyl
▪ Ativan – lorazepam
▪ Benadryl – diphenhydramine
▪ Cogentin – benztropine
▪ Inderal - propranolol
▪ Klonopin – clonazepam
▪ Symmetrel – amantadine
▪ Valium - diazepam
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15*This is not an all-inclusive list
Potential Adverse Effects of Antipsychotics
Tardive Dyskinesia (AIMS Testing)
Drowsiness, dizziness, restlessness,
weight gain, constipation, nausea, low
blood pressure
Clozaril may lead to orthostatic
hypotension, bradycardia, syncope, and
cardiac arrest, and most notably, severe
neutropenia and agranulocytosis.
Scheduled labs are required
Metabolic Syndrome and Diabetes
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Metabolic Syndrome and SGAs
SGAs: Second Generation Antipsychotics
Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
Metabolic syndrome is increasingly common, and up to one-third of U.S. adults have it. If a person has metabolic syndrome or any of its components, aggressive lifestyle changes can delay or even prevent the development of serious health problems.
Most of the disorders associated with metabolic syndrome don't have obvious signs or symptoms.
One sign that is visible is a large waist circumference.
If blood sugar is high, signs and symptoms of diabetes — such as increased thirst and urination, fatigue, and blurred vision may be noticed.
Mayo Clinic https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916
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SGAs and
Risk
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Psychopharm & Adverse Effects - Rural Nevada Counseling 6/13/2019
Apple and Pear Body Shapes
Apple and pear body
shapes. ... It's thought
that having a pear-
shaped body — that is,
carrying more of your
weight around your hips
and having a narrower
waist — doesn't increase
your risk of diabetes,
heart disease and other
complications
of metabolic syndrome.
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CCBHC Requirements
Screening
Diabetes
Cardiovascular health
Monitoring
Waist Circumference and Weight
BMI
Blood Pressure
Coordination of care
Triglycerides
Fasting Glucose
Cholesterol
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Metabolic Syndrome Interventions
Refer to CCBHC and/or
primary care provider
Educate regarding diet
and exercise
Educate regarding
tobacco use
Educate regarding stress
Use MI to promote
change
Document interventions
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Psychostimulants
Adderal – amphetamine
Cylert – pemoline
Dexedrine – dextroamphetamine
Desoxn – methamphetamine
Focalin – dexmethylphenidate
Ritalin – methylphenidate
Vyvanse - lisdexafetamine
Alternatives to psychostimulants
Catapres – clonidine
Effexor – venlaflaxine
Intuniv – guanfacine
Norpramin – desipramine
Pamelor – nortriptyline
Strattera – atomoxetine
Tenex – guanfacine
Wellbutrin -bupropion
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Considerations for Psychostimulants
May interfere with sleep
Many parents don’t want
to put their kids on meds
Elimination of sugars from
the diet may be adequate
in some cases
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Chemical Dependency Medications
Antabuse – disulfiram (alcohol)
Campral – acamprosate (alcohol)
Chantix – varenicline (nicotine)
Dolophine – methadone (opiates)
Kemstrol – baclofen (alcohol)
LAAM – l-alpha-acetyl-methadol (opiates)
Norpramin – desipramine (cocaine)
Parlodel – bromocriptine (cocaine)
Revex – nalmefene (alcohol)
Revia – naltrexone (alcohol)
Ritalin – methylphenidate (cocaine)
Sanorex – mazindol (cocaine)
Suboxone – buprenorphine/naloxone (opiates)
Subutex – buprenorphine (opiates)
Symmetrel – amantadine (cocaine)
Topomax – topiramate (alcohol)
Vivitrol – naltrexone (alcohol)
Wellbutrin – bupropion (nicotine)
Ibogain (cocaine)
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Medication Adherence
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The number one cause of treatment failure is not taking meds as prescribed
Psych meds can take up to six weeks for full effect
Adverse effects can be unpleasant
Missing doses especially when there are multiple medications
Financial concerns
Stigma
Symptoms such as amotivation and disorganization
Feedback from friends or family
Psychopharm & Adverse Effects - Rural Nevada Counseling 6/13/2019
Resources
Preston, J, and Johnson, J (2008). Clinical
psychopharmacology made ridiculously
simple. Miami: MedMaster.
Preston, J, and Talaga, C (2013). Handbook
of clinical psychopharmacology for therapists.
Oakland, CA: New Harbinger.
Sinacola, RS, and Peters-Strickland, T (2012).
Basic psychopharmacology for counselors and
psychotherapists. Boston: Pearson.
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Test
Name, email address, and date on a piece of paper
1. List the six neurochemicals you learned about today
2. True or false: The brain of a healthy person looks exactly like the brain of a person
who has depression.
3. True or false: Some psych meds can actually increase the risk of suicide
4. True or false: Medication side effects are uncomfortable, but they never lead to
death.
5. What is Metabolic Syndrome?
6. Turn in your answers to the Training Coordinator. You will receive a 1 hr. Certificate
of Completion, which will also be retained in your employee file.
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