psychopharmacy and adverse effects - mycasat › wp-content › uploads › 2019 › 06 ›...

PSYCHOPHARMACY and

ADVERSE EFFECTSRURAL NEVADA COUNSELING

DEVELOPED BY KAREN TORRY GREENE, DBH, LCSW

6/13/2019Psychopharm and Adverse Effects - Rural Nevada Counseling

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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.)

6/13/2019Psychopharm & Adverse Effects - Rural Nevada Counseling

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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


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



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



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.



http://www.cqaimh.org/pdf/tool_aims.pdf

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



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



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



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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http://www.cqaimh.org/pdf/tool_aims.pdf

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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https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916

SGAs and

Risk

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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)



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


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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psychopharmacy and adverse effects - mycasat › wp-content › uploads › 2019 › 06 ›...

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