Transcript Drugs for Mental Health chapter-31

Week 9 Seminar
Chapter 31: Drugs for Mental Health and
Behavioral Disorders, p 656- 678
Chapter 10: Calculating Doses of Nonparenteral
Medications
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Drugs for Mental Health
chapter-31
“the Mentally Healthy person” – one who can
perceive reality accurately and has control
over expression of emotions
Mental Health: not a concrete achievable goal
…but a lifelong process resulting in a sense of
harmony and balance in a person’s life
-difficult to define, highly individualized
-varies from person-to-person
Medication in
Psychotherapy
• Among the most prescribed drugs
• Used to reduce/alleviate symptoms of STRESS
…to allow the patient’s participation in other
psychotherapies
• DRUGS – temporarily change behavior,
addiction/dependence are major concerns
• PSYCHOTHERAPY – more long-term, but …
the results are more permanent
Neurosis vs Psychosis
• Neurosis: patient is still in contact with reality
• Psychosis: patient is out of contact with reality,
unable to communicate
• DRUGs for Anxiety (see Table 31-1) known
generally as ‘anxiolytics’ which literally means ‘to
break apart, or dissolve anxiety’
• Benzodiazepines – long and/or short-acting
• Misc Anxiolytics – Buspar, Paxil, Effexor, Desyrel
Anxiolytics (cont)
• Benzodiazepines - introduced in the 1960’s
• Generic names end in ‘-pam’ - diazepam,
lorazepam, clonazepam (exception: alprazolam,
whose brand name is Xanax)
• ‘drugs-of-choice’ – safer, lower abuse potential,
less tolerance and dependence (again, except for
Xanax!)
• Effect: a calming-effect without extreme sedation
• (2)general types: Short-acting and Long-acting
Questions?
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Benzodiazepines
Patient-education
• Take with food if GI symptoms occur
• Take exactly as directed (don’t modify dose)
• DO NOT mix with alcohol!
• Drowsiness occurs … careful in hazardous
situations, driving, machinery, etc
• Physical dependence is rare, except Xanax !
• Benzo’s should NOT be used in pregnancy!
Misc Anxiolytics
• Buspar (buspirone)
• Vistaril/Atarax (hydroxyzine pamoate/hcl)
• Paxil (paroxetine)
• Effexor (venlafaxine)
• Desyrel (trazodone)
• See “Facts about Anxiolytics” on p.662
Major tranquilizers/
Neuroleptics
• Drugs used to treat Psychosis (see Table 31-2) are also
known as “Antipsychotics”
• Antipsychotics are effective in 3 main areas:
1)hallucinations,delusions,combativeness (psychosis)
2)relief of nausea/vomiting (chemo, narcotic s/e)
3)to increase potency of analgesics (ex: promethazine)
• The two major forms of Psychosis are …
• Schizophrenia and Depression
Anti-Mania & Bi-polar
drugs
• Bi-polar Disorder (formerly referred to as
Manic-Depression)
• common meds used in the bi-polar patient:
• Lithium (Lithobid, Eskalith) – mainstay
• carbamazepine (Tegretol) – developed as an
anti-seizure drug
• valproic acid (Depakote, Depakene) –also
originally for seizure disorders
Questions?
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Depression
• !(study Box 31-3 on p. 668)
• aka ‘mood-disorders’ or ‘affective-disorders’
• Among the most common psychiatric disorders,
and is of (2) major types …
• Exogenous – “the blues”, a response to ‘external’
factors, normally self-limiting
• Endogenous (unipolar) – no apparent ‘external’
cause, basis is typically genetic or biochemical …
Exogenous/Endogenous
Depression (cont)
• Exogenous Depression:
• Caused by external factors such as - divorce,
loss of loved one, job loss, serious illness, etc
• Drug therapy often successful w/ Exogenous
• Endogenous: seems to come from ‘within’ the
person, biochemical imbalance, hereditary
• Endogenous type DOES NOT respond well to
medication therapy
Anti-depressant Drugs
(study Box 31-4 on p.669)
• All major classes have a similar response rate …
• So the choice-of-drug is based on things like:
*side-effects *patient-history *if sedation is needed
• MAOI’s (monoamine oxidase inhibitors)
• TCA’s (tricyclic antidepressants)
• SSRI’s (selective serotonin reuptake inhibitors)
• SNRI’s (selective norepinephrine reuptake inhib)
• NRI’s (natural reuptake inhibitors) –herbal,
St.John’s wort for example
MAOI Medication
• Phenelzine (Nardil),
• Tranylcypromine (Parnate)
• Selegiline (Selegiline, Eldepryl, Emsam),
• MOA: increases the concentration of
epinephrine, norepinephrine, and serotonin in
storage sites throughout the nervous system
MAOI – patient ed
• Very high number of potentially dangerous
DRUG and FOOD interactions!
• Avoid TYRAMINE containing foods, such as
*cheese *wine *beans *chocolate (31-4, p.672)
• See DDI (Dangerous-Drug-Interactions) (31-5,p.672)
• MAOI must be ‘cleared’ from body before
starting any new antidepressant (taper)
‘Atypical’ Antidepressants
(2nd generation)
• Introduced in the 1980’s
• These will treat --- major depressions, reactive
depressions, and anxiety disorders
• Wellbutrin (bupropion)
• Remeron (mirtazapine)
• Desyrel (trazodone)
• MOA: increase of norepinephrine and dopamine, and does not
inhibit monoamine oxidase or the reuptake of serotonin
Questions?
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Alzheimer’s disease
~ 250,ooo new cases per year!
• Progressive (worsening) illness
• Degradation of nerve pathways (cholinergic)
• Impaired thinking, confusion, disorientation,
‘sundowning’ = symptoms worse in evening
• No specific ‘test’ for this , can only be
diagnosed with certainty by autopsy
• Drugs are used to slow the deterioration
and/or improve patient’s nerve function
Drug therapy for
Alzheimer’s
• See Table 31-6 on p.675
• Cognex, Aricept: increases nerve-function only
• increasing the concentration of acetylcholine through
reversible inhibition of its hydrolysis by
acetylcholinesterase
• Reminyl: slows disease progression AND improves nerve function
(increased Ach)
• Namenda: newest agent – ‘anti-Alzheimer’ agent, reduces
deterioration of cholinergic nerve pathways in moderate-severe
cases
ADHD
• Common behavioral disorder (average of one
ADHD child per classroom) – cause unknown!
• Diagnosis usually based on symptoms that occur
before age 7, and last > 6 months
• Symptoms (begin from 3 – 7 yo, thru teenage)
• Inattention
• Hyperactivity
• Impulsivity
Drugs for ADHD
(study Table 31-7 on p.677)
• CentralNervousSystem (CNS) Stimulants
• Not to be given >1 year without a ‘break’ from
the drug! …may suppress child’s growth
• Break is known as ‘Drug-Holiday’
• Suggested Drug-Holiday opportunities …
• Weekends, summer-breaks, vacations, etc
ADHD drug names
• Methylphenidate (Ritalin) – CII (schedule-2)
• Dextroamphetamine (Dexedrine) -CII
• Amphetamine (Adderall) -CII
• Lisdexamfetamine (Vyvanse) -CII
• Atomoxetine (Strattera) only one that’s not a
‘scheduled’ drug, also used as antidepressant
ADHD drug side-effects
• CII’s (methylphenidate, etc) – insomnia,
growth suppression, headache, abdominal
pain, lethargy, weight loss, dry mouth,
irritability
• Strattera (Atomoxetine) – headache,
dyspepsia, nausea/vomiting, fatigue,
decreased appetite, dizziness, altered mood
• Clonidine (HTN agent) – hypotension, sedation
Questions?
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Dosing calculations
review (chapter-9)
•LET’S REVIEW !!!
•ANY QUESTIONS are
fine …
Basic Rules for confident calculating
(see Box 9-1 on p.166 … dosage-forms)
• Always check UNIT’s (numerator/denominator)
• Always work the problem ON PAPER, even the
math seems EASY
• Check and RE-CHECK all Decimals, Fractions
• LOOK at the RESULT! …does it look reasonable?
• Take ONE LAST LOOK to make sure you calculated
dose in the correct units
Let Review Examples
Ordered: Docusate sodium syrup 60mg PO prn
to soften stool
Available : Docusate sodium syrup 20mg/5ml
Dose to be given :
• Steps
• We need to find out how many ml we need to equal
60mg(ordered)
• We have Doscusate sodium syrup 20mg/5ml
(Available)
• So set up the ratio
• Ensure units are equal in numerator/denominator
Cont.
• 20mg
5ml
60mg
x ml
• Cross multiply
• 20mg(xml)=5ml*60mg)
• Solve for X find out how many ml’s are
required per dose (60mg)
• X= 15ml
Length Conversions
An abdominal cavity was opened with a 14-inch incision.
Convert this measurement into cm (centimeters)
• Use this conversion factor: 2.5 cm = 1 inch
• 2.5 cm / 1 in = x cm / 14 in
2.5 cm
x cm
1 in
14 in
• 2.5 x 14 = 35
• 1 x x = 35
• x = 35
• 14 inches = 35 cm
Length Conversions
Question for the class
Would you be able to convert 35cm to Micometers?
cross-multiplying
• A physician orders Tylenol 0.65 gram but when you
check your inventory you notice you have Tylenol 325mg
tablets. How can you fill this prescription?
• 1. How can we make our units equal?
• 0.65g => 650mg (move decimal 3 units to the right)
• 2.Cross multiply & divide (650mg*1tab / 325mg) to solve for X
• X = 2 tab =dose
• in other words, 2 of the (325mg tablets) = 650mg =0.65 grams
1 tab
325mg
X tab
650mg
x = 2 tab
• MD orders penicillin 500mg tid. You check your inventory
and have 250mg/5mL solution available. How many
teaspoonfuls of medication are needed per dose? Per day?
• 1. Ensure units are equal (both are mg’s)
• 2. Cross multiply to find out how many ml’s are required
per dose (5mL * 500mg / 250mg =10ml’s)
5 ml
250mg
x mL
X = 10 ml’s
500mg
3. To find out how many teaspoonfuls are needed, convert
mL to tsp
Remember 5mL=1 tsp, so 10mL = 2tsp
4. 2 tsp’s per dose
5. Since dose is 500mg (2tsp’s) tid  need 6 tsp’s per day
Volume Conversions
• MD orders Zithromax 250mg po stat for 5year old child. You
check the office inventory and have 100mg/5mL solution
available. How many teaspoonfuls of medication are needed
for dose?
• 1. Ensure units are equal (both are mg’s)
• 2. Cross multiply to find out how many ml’s are required per
dose (5mL * 100mg / 250mg =10ml’s)
X = 12.5 ml’s
5 ml
x mL
100mg
250mg
3. To find out how many teaspoonfuls are needed, convert
to tsp
Remember 5mL=1 tsp, so 12.5mL = 2&1/2 tsp
4. 2 & ½ tsp’s per dose
mL
Please solve this ?
• Ordered: Heparin 5000 units SC Q12h
• Available: Heparin 2000 units/ml
How many ml do you have to draw to administer
5000 units?
• Answer = 2.5ml
• 5oooUnits
X
2000 Units =
1ml
• Step up
• 2000Units(X)= 5000Units(1ml)
• Solve x=
5000 Units (ml)
2000Units
Practice Problems
• Md writes prescription for metoprolol 12.5mg bid, you have
on hand metoprolol 25mg scored tablets. How many tablets
would be required for a one month supply (30 days)?
• How can you make a 12.5mg dose from 25mg ‘scored’
tablets ? Split them in half each half ( ½ tab) =12.5mg
• 12.5mg bid x 30 days  ½ tablet bid x 30 days
• ½ tab* 2 (twice daily) = 1 whole tablet per day x 30days = 30
whole tablets for a one month supply
Do not forget to
• Review all your assignment on
• Conversion between the metric
• And the common conversion (ie 1m=1000mg,lbs
to kg, ml to tsp)
• Dosing calculation
• Review all the example in my power point
Questions?
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Measuring Liquid Medications
• Pour at eye level
• Read bottom of meniscus
Meniscus
Figure 9-3. The meniscus
Liquid Measurement Instruments
• Oral dispenser (A)
• Oral syringe (B)
• Liquid dropper (C)
Figure 9-4.
Final Project
• This Project is for you to use your Critical thinking Skills
• There are 4 cases
• Case One
• Discuss the patient concern (question to ask)
• Possible reason for difference
• What resource to ID pills
• Case Two
• Review antibiotic
• Review the calculation
Final Project
• Case Three
• Review Pepto Bismol ( ingredient)
• Option for constipation
• Rx vs OTC
• Case Four
• Review her concerns
• Review her concerns about the medication
Final Exam Information
• Access Date(s): See Announcement
• Pharmacology Portion
• Time allowed for Pharmacology: 1 Hour 30 minutes
• Calculation Portion
• Time allowed for Calculations: 1 Hour 15 minutes
• Each portion of the exam can be completed on
different days.
• Both portion done by June 26, 2012 at 11:59 EST****
Thank you class
• It was great to have all of you in class
• The weekly seminar and discussion board
response goes by so quickly
• A very interactive group of students
• The best of luck in your education endeavors
• Good luck on the final exam
• Have all you material ready for the final
• Books and PowerPoint , Quiz and assignments
Class dismissed