Transcript Chapter 16 lesson 2 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
16
Psychiatric Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. When given the name of a well-known
psychiatric generic drug, identify its trade
name.
2. When given the generic and trade names of
a psychiatric drug, identify what drug
category it belongs to and what mental
disorder it is used to treat.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
3. Name and describe the therapeutic effects of
categories of drugs used to treat various
types of mental illness, including psychosis
and schizophrenia, depression, bipolar
disorder.
4. Give alternative names for the antianxiety
and antipsychotic categories of drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
5. When given a psychiatric drug category,
identify several generic and trade name
drugs in that category.
6. When given an ending common to several
generic drugs, identify the related drug
category.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Social Anxiety
Disorder
• Social anxiety disorder
 Characterized by fear of:
• Social situations
• Crowds, stores, meetings, parties
• Personal encounters
• On the telephone
• Meeting or greeting a new person
• Speaking
• To strangers or authority figures
• In front of a group
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Social Anxiety
Disorder
• Physical symptoms

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Extreme nervousness
Sweating
Blushing
Tremors
Nausea
Stammering
Inability to think clearly
Fear that everyone is looking at you
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Social Anxiety
Disorder
• Best treated with SSRI and SNRI
antidepressant drugs
• Professional actors, musicians, singers,
and others in the public eye take
propanolol (Inderal) to block the
physical effects of excess epinephrine
in response to performance anxiety.
 Not daily SSRI or SNRI
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Panic
Disorder
• Panic disorder
 Also known as panic attacks
 Characterized by sudden, overwhelming
sense of great fear in the absence of
any situation or reason that would
create anxiety or fear
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Panic
Disorder
• Physical symptoms are intense and can
even mimic a heart attack
• Disorder is treated with various types
of antianxiety and antidepressant drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Panic
Disorder
• Schedule IV drugs
 Alprazolam (Xanax)
 Clonazepam (Klonopin)
• Certain antidepressant drugs
 Tricyclic antidepressant drugs
 Selective serotonin reuptake inhibitor
(SSRI) antidepressant drugs
 Serotonin and norepinephrine reuptake
inhibitor (SNRI) antidepressant drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat ObsessiveCompulsive Disorder
• Obsessive-compulsive disorder (OCD) is
characterized by:
 Thoughts that cause anxiety
 Repetitive actions to relieve or escape
the anxiety of a perceived threatening
situation
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
OCD Video
Click on the screenshot to view a video on the topic of obsessive compulsive disorder.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat ObsessiveCompulsive Disorder
• Although the person knows the
behavior is excessive and
unreasonable, they are unable to stop
it.
• Treated with:
 Antidepressant drugs
 Antipsychotic drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Psychosis
 Loss of touch with reality, resulting in:
•
•
•
•
Delusions
Hallucinations
Inappropriate moods
Bizarre behaviors
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Psychosis
 Symptoms are based on an overactivity
of neurotransmitter dopamine either
from:
• an overproduction of dopamine, or
• from a hypersensitivity of dopamine
receptors
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Thought to play a role in psychosis are
imbalances in neurotransmitters and
histamine.
 Serotonin
 Acetylcholine
 Norepinephrine
• Schizophrenia is the most common
form of psychosis.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Treatment involves the use of
antipsychotic drugs, also known as
neuroleptic or major tranquilizer drugs.
 Block dopamine receptors in many
areas of the brain
• Includes the limbic system, which
controls emotion
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Antipsychotic drugs
 Without causing confusion or sedation,
decrease psychotic symptoms of:
• Hostility
• Agitation
• Paranoia
• These drugs are not schedule drugs
and are not addictive.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• Prior to the introduction of modern
antipsychotic drugs, barbiturate drugs
were used to sedate agitated, psychotic
patients.
• Barbiturate drugs have been replaced
by the phenothiazine group of
antipsychotic drugs.
• Phenothiazine was the original parent
drug for this group.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• It was first manufactured in 1883 as a
wormer for livestock.
• Some minor changes in its chemical
structure resulted in the creation of two
large, but very different categories of
phenothiazine drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• One category is composed of
phenothiazine drugs that act as
antihistamine drugs and are used to
treat allergies, itching, nausea, and
vomiting.
• The second category is composed of
phenothiazine drugs that are used to
treat psychosis and schizophrenia.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• Chlorpromazine (Thorazine), the first of
the modern antipsychotic drugs
developed from the original parent
molecule, is still one of the most widely
used antipsychotic drugs.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Phenothiazine drugs for psychosis and
schizophrenia
 Largest chemically-related class of
drugs used to treat psychosis and
schizophrenia
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Phenothiazine drugs for psychosis and
schizophrenia
 Block the following receptors in the
brain:
•
•
•
•
Dopamine
Histamine
Alpha
Serotonin
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Phenothiazine drugs for psychosis and
schizophrenia
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
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


Chlorpromazine
Fluphenazine
Perphenazine
Prochlorperazine
Thioridazine
Trifluoperazine
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Dibenzapine drugs for psychosis and
schizophrenia
 Block dopamine and serotonin receptors
in the brain
 Asenapine (Saphris)
 Clozapine (Clozaril, FazaClo)
 Loxapine (Loxitane)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 16–5 Olanzapine (Zyprexa) drug bottle. Olanzapine (Zyprexa) is used to
treat psychosis and schizophrenia, as well as manic-depressive disorder.
Source: Bloomberg/Contributor/Getty Images
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Zyprexa Zydis is the trade name for a
special tablet form of Zyprexa that
dissolves in the mouth within 5 to 15
seconds.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Because of their mental illness, many
psychotic patients are noncompliant in
taking their drugs as they do not
understand the importance of the drugs
or they feel someone is trying to poison
them.
• One study found that up to 75 percent
of schizophrenic patients do not take
their drugs regularly, or at all.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Psychotic patients commonly refuse
drugs or hide a tablet in their mouths
and later discard it.
• This drug form assures assure patient
compliance, as the entire dose
dissolves quickly in the mouth.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• These antipsychotic drugs are available
as an orally disintegrated tablets:
aripiprazole, clozapine, olanzapine, and
risperidone.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Benzisoxazole drugs for psychosis and
schizophrenia
 Block dopamine and serotonin receptors
in the brain
 Iloperidone (Fanapt)
 Paliperidone (Invega)
 Risperidone (Risperdal)
 Ziprasidone (Geodon)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Other drugs for psychosis and
schizophrenia
 Chemically unrelated drugs
 These drugs block dopamine and
serotonin receptors in the brain.
 Grouped together because each drug
category only includes one or two drugs
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Psychosis and
Schizophrenia
• Other drugs for psychosis and
schizophrenia





Aripoprazole (Abilify)
Haloperidol (Haldol)
Lurasidone (Latuda)
Reserpine
Thiothixene (Navane)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 16–6 Aripiprazole (Abilify). This drug is mainly used to treat psychosis and
schizophrenia in which there is a loss of touch with reality and delusions and
hallucinations. However, it has also been found useful in treating depression and manicdepressive disorder.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• The antipsychotic drugs, particularly
the phenothiazine drugs, cause a group
of adverse effects known collectively as
extrapyramidal side effects.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Symptoms of tardive dyskinesia include
involuntary, repetitive movements of
the face (grimacing, smacking the lips,
chewing, blinking the eyes, sticking out
the tongue, rocking back and forth,
marching in place, humming, or
grunting), but can also include athetoid
(writhing) movements of the arms,
legs, and fingers.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• The physician may recommend that the
patient take a drug holiday from his
or her antipsychotic drugs to lessen the
symptoms of extrapyramidal side
effects.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved