Term
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Definition
| Meds are used to enable the patient or client to engage in the change process and alleviate unnecessary suffering along the way. |
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Term
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Definition
In emergencies: quickly calms a client and eases acute pain.
Relieve unnecessary or excessive suffering until more adaptive strategies can be realized.
Meds can be more effective than traditional therapies for people who have mental, social, or physical limitations.
Meds can help bridge the gap for clients who cannot attend therapy regularly.
Meds can make it easier to systematize and standardize treatment.
Problems with treatment efficacy can be more easily identified.
Some meds can, in some cases, can "cure" the underlying problems. |
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Term
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Definition
Meds can foster passive dependence, and can encourage a "patient" mentatlity.
Meds can act against personal responsibility.
Meds can reduce the motive to explore personal growth.
Meds are seen, by some, to reinforce the client's inherently weak character.
Meds are preferred by many physicians and are both over-prescribed and recommended instead of therapy.
Ethical and legal concerns about pharmaceutical companies.
Meds do not provide better coping and adaptive skills.
Meds are often loaded with potentially dangerous side effects.
Meds can foster physical dependence and addictive use that compound the client's problems. |
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Term
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Definition
| It is the brain's adaptation to the changes made by the medications that underlies the therapeutic effect. |
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Term
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Definition
| Individual differences are greater than known or in vitro effects. |
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Term
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Definition
| The majority of drug effects reflect enduring synaptic alterations (at times, however, this can be counter-therapeutic as in the development of tolerance). |
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Term
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Definition
| The action of the body on the medication (factors affecting drug availability). |
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Term
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Definition
| The action of the medication on the body (the therapeutic effect). |
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Term
| Pharmacokinetics include... |
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Definition
| Absorption, distribution, metabolism, excretion. |
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Term
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Definition
| Relates to solubility, acidity, type of membrane, and route of administration. |
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Term
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Definition
| Oral, Injections/Implants, Transdermal, Mucosal, Inhalation |
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Term
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Definition
| How effectively the drug reaches various parts of the body, but drugs may bind to body tissue. Binding occurs to body fat, plasma proteins, muscle tissue, or glands. |
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Term
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Definition
| The transformation of active to inactive compound. Occurs primarily through the liver, but also within blood, and sometimes the kidneys. |
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Term
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Definition
| Require metabolism before they are active. |
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Term
| What can effect metabolism? |
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Definition
| Age, sex, body temperature, nutritional status, and disease status. |
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Term
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Definition
| The elimination of either whole drug or drug metabolites, generally through urine/feces, but also through lungs, breast milk, and sweat. |
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Term
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Definition
| The relationship of the dose of drug and degree of effect. The degree of rise in the slope of the drug response suggests the relative "safety" of the medication. |
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Term
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Definition
| Reflects the ratio of the effective dose threshold and the lethal dose threshold using blood concentration. The lower the TI the more dangerous the drug. |
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Term
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Definition
| Sedative Hypnotics, Benzodiazepines, Atypical Benzos, Tricyclic Antidepressants, SSRIs, Beta Blockers, Buspar, Antihistamines |
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Term
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Definition
| Problems with tolerance and dependence, and cognitive impairments. Include alcohol (often makes the situation worse), Barbiturates (over-kill and possibly increase suicidality), older dangerous meds. Tolerance, intoxication, and dependence make this class impractical and potentially dangerous. |
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Term
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Definition
| Problems with tolerance and dependence, and cognitive impairments. Include alcohol (often makes the situation worse), Barbiturates (over-kill and possibly increase suicidality), older dangerous meds. Tolerance, intoxication, and dependence make this class impractical and potentially dangerous. |
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Term
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Definition
| Safer, by far, than the sedatives, and extremely popular - default medications. Dependence after a few days for most - with prolonged withdrawal. Reduce cognitive "presence" and have been associated with accelerating dementia. Prolonged use reduces 5HT and leads to anhedonia. |
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Term
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Definition
| Sedating, serious anticholinergic side-effects preclude abuse; some of these may be enduring. Also good for sleep and chronic pain. Not very popular due to side-effects and cardio-toxicity. |
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Term
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Definition
| More popular than tricyclics, not pron to abusive use, IMPORTANTLY: SSRIs often make anxiety worse before alleviating it. Usually, initially given in either very low doses or with a TCA or Benzo for the initial period. Often preferred with elderly patients. |
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Term
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Definition
| Beta-adrenergic receptor blocking agents - take the peripheral sympathetic nervous system off line. Does not alter consciousness, but can be damaging to body. Used for situational, short-term problems. |
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Term
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Definition
| Buspirone is a 5HT partial agonist and DA antagonist. Used primarily for refractory GAD or social phobia and a good, general anxiolytic. Effects take several weeks to establish, side effects are typical, but sedation is low. |
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Term
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Definition
| Benadryl is often used for panic attacks (not great), social phobia (also not great), and general anxiety. For acute use, is ok. Tolerance develops quickly, but dependence is idiosyncratic. Sedation is primary side effect. |
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Term
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Definition
| Sleepers produce tolerance, dependence and can be used addictively with the exception of Rozerem which triggers natural sleep. These can significantly complicate therapy and further pharm treatment. Lifestyle needs to be looked at for improvement of sleep. |
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Term
| Sedative Hypnotics - Barbiturates |
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Definition
| Alcohol Barbiturates act as CNS depressant, slowing activity in pre-frontal and brain stem. Increasing doses can cause inattention, disinhibition, reduced judgement, motor impairment, confusion, analgesia, sedation, respiratory arrest, death. Absorbed through all tissues easily. Most commonly used with other drugs in suicide attempts. Usually not used therapeutically except for sleep on a one or two night basis. |
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Term
| Sedative Hypnotics/Benzodiazepines |
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Definition
| "Minor" Tranquilizers. Augment brain's own inhibitory mechanism through GABA. Very high TI. Increasing doses produce: lowered anxiety, disinhibition, sedation, confusion, poor coordination, euphoria, and amnesia. Lethal doses are enormously high unless mixed with other meds, these are relatively safe. Can accumulate in system with repeated administration, stress can release these bound meds producing overdose. Tolerance for sedative effect occurs within several days and can produce strong dependence with notable and prolonged withdrawal. |
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Term
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Definition
| Most are antihistamines or antihelmintics (worm killer). These produce the side effect of sedation or drowsiness in at least 10% of the population. Most do not work for more than two sequential nights. |
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Term
| Anti-depressant Discontinuation Syndrome |
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Definition
F - Flu like symptoms
I - Insomnia
N - Nausea
I - Imbalance
S - Sensory (paresthesias, brain "zaps")
H - Hyperarousal |
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Term
| Antidepressants (General) |
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Definition
| Most work to enhance either NE and/or 5HT. Vegetative signs affects first, cognitive effects do not occur for several weeks. Affective improvement occurs with life changes. Meds DO NOT make person happy, but enable the person to change their lifestyle, which is essential to long-term improvement. Therapy helps person make lifestyle changes. |
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Term
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Definition
| Increase levels of NE, DA, and 5HT. Suicide watch indicated. Most have a low TI and can be extremely dangerous when mixed with other drugs, certain foods, or certain health issues. High chance of stroke and should be used with extreme caution. |
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Term
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Definition
| Two basic types: sedating (tertiary) and stimulating (secondary). Basically NE reuptake inhibitors. |
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Term
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Definition
| Primary complaints are sedation and enduring anticholinergic effects; dry mouth, dry eyes, constipation, dizziness, and disorientation. Weight gain, erectile dysfunction/delayed ejaculation, restlessness, anxiety, and night sweats. Bad drug interactions are common. Block the effects of antihypertensives. Serial EKGs are recommended because of possible cardiac toxicity. |
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Term
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Definition
| SSRIs increase 5HT directly and NE indirectly. SNRIs elevate both 5HT and NE directly. Generally work faster than tricyclics with fewer side effects. |
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Term
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Definition
| Nausea, headache, sexual dysfunction, mild anticholinergic effects, anorexia or weight gain, constipation or diarrhea and rarely tremors. Usually subside shortly, milder than with tricyclics, and generally less troublesome for older clients. |
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Term
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Definition
| Can occur when two SSRIs or an SSRI and a SRNI or any other med that increases 5HT activity interact. |
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Term
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Definition
| Often misdiagnosed and mistreated, highly associated with suicide attempts (usually during transitions), likely has a genetic component, typically appears before age 35, cannot be comorbid with ADHD, biological rule-outs MUST be done, positive med response is used to confirm diagnosis but is NOT valid. |
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Term
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Definition
| Cycles not necessary for dx., single manic episode without other explanation is sufficient, cycling bipolar responds best to meds, mania can escalate into delirium and psychosis, inflated self-esteem, sense of desperation, increased activity, hyper-verbality, flooding of ideas, impulsivity, decreased need for sleep, poor judgement, hypersexuality, etc. |
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Term
| Bipolar Differential Diagnoses |
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Definition
Bipolar I: Six subtypes, full mania
Bipolar II: Recurrent depression with hypomania
Cyclothymia: Depressed mood and hypomania for at least 2 years
Rapid Cycling: Bipolar that shifts within days
Seasonal Affective Disorder or Post-Partum Bipolar: Neurohormonal dysfunctions |
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Term
| Essential Bipolar Rule-Outs |
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Definition
| Drug related mood disorders, endocrine dysfunctions, brain tumors, brain injury |
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Term
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Definition
| Gold standard of mood stabilizers, first of its kind and still most commonly used, extremely toxic (renal damage), lowest TI of all psychiatric meds, overdose or discontinuation syndromes common, indirectly stabilizes NE activity via 5HT synthesis modification, works best if mania is dominant, people become "flattened" while on it, sudden withdrawal can provoke non-terminating seizure state, lots of side effects. |
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Term
| Antidepressants for Bipolar |
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Definition
| Initially thought that by reducing depression mania would be attenuated and therefore these could be used with lithium, however, no advantage has been found. MAOIs can help with rapid cycling, however, are a poor choice. |
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Term
| Minor Tranquilizers (Benzo's) for Bipolar |
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Definition
| Initially thought useful to reduce manic episodes, did not reduce many elements of mania such as grandiosity, impulsivity, over indulgence, etc., increased tendency for self-injury, high abuse potential. Poor choice. |
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Term
| Anticonvulsants for Bipolar |
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Definition
| Can be as effective as Lithium and works for those that do not respond to Lithium, suggests a neuro reason for some mania, especially good for rapid cycling bipolar, three main ones, tegretol, depakote, neurontin. |
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Term
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Definition
| Granddady of anticonvulsants, appears to increase activity of GABA networks that can increase inhibitory functioning and self-regulation. Effects noted relatively quickly, about one week, can damage bone marrow or loss of white blood cells within 3 months of taking but not after 3 months, blood chemistry eval required during this time. |
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Term
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Definition
| Safer and better tolerated than Tegretol, also increases GABA, works for patients that don't respond to Lithium or Tegretol, not appropriate for those with liver damage or for children (can be fatal), pancreatitis also occurs and can be fatal. |
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Term
| Anticonvulsants - Neurontin |
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Definition
| Chemically similar to GABA, but actual mechanism is not known, works for refractory cases and is very useful for rapid cycling and mixed bipolar, has more anxiolytic and anti-agitation effects than the other anticonvulsants or lithium, has fewer side effects and is tolerated by most, very sensitive to use with OTC antacids and birth control pills, VERY high dosage required, withdrawal can produce status epilepticus. |
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Term
| Anticonvulsant - Lamictal |
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Definition
| Relatively safe and effective with several mood disorders, well tolerated and often given with depakote lowering the dose of each and minimizing side effects, this and lithium are currently the primary meds FDA approved for bipolar, can result in severe rash, withdrawal can provoke seizures, warnings of increased suicidality also noted. |
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Term
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Definition
| Often used for managing pain syndromes, frequently used with other stabilizer, but good evidence for single use, the only stand alone stabilizer reducing mania and depression, also good for anger management, PTSD, and other externalizing disorders, relatively benign side-effects, one of the least troublesome stabilizers. |
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Term
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Definition
| Newer stabilizer, also used as anti-psychotic and to augment depression, operates through dopamine and serotonin receptor blocking, runs risk of producing Parkinsonian signs, very side effect heavy, cardiac and renal toxic, anti-cholinergic effects, sexual dysfunction, weight gain, insomnia, hair loss, etc. |
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Term
| Anticonvulsant - Gabitril |
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Definition
| Appears to work through GABA augmentation, relatively benign side-effects, used primarily as an anticonvulsant rather than a stabilizer. |
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Term
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Definition
| Positive Symptom type and Negative Symptom type |
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Term
| Schizophrenia Characteristics |
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Definition
| Symptoms grossly interfere with the person's ability to function, cannot cope with the demands of daily life, indistinct boundaries in reality testing, substantial dysfunction in social relationships often misperceiving facial expressions, voice tone, and intent, grossly disturbed memory and information processing |
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Term
| Schizophrenia Differential Diagnosis |
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Definition
| Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder, Affective Psychosis, Delusional Disorder, Shared Psychotic Disorder, Drug-induced Psychosis, Organic Psychosis |
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Term
| Causes of Schizophrenia - Dopamine hypothesis |
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Definition
| Excessive dopamine, irregular dopamine metabolites, dopamine blockers acting as antipsychotics |
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Term
| Causes of Schizophrenia - Serotonin hypothesis |
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Definition
| Based on psychedelics (LSD, mescaline, peyote, psilocybin) dream-like state while awake - not much evidence for this theory |
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Term
| Causes of Schizophrenia - Phencyclidine hypothesis |
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Definition
| Activation of PCP receptors in the brain, these associated with memory and learning |
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Term
| Causes of Schizophrenia - Hippocampal Malformation |
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Definition
| Second trimester trauma can lead to abnormal organization of hippocampal cell architecture |
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Term
| Neuroleptics - The Traditionals |
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Definition
| Consist of several drug types that all work through dopamine suppression, potency referred to in "Thorazine Equivalents", very toxic to liver and heart and eventually damage Basal Ganglia, using combinations generally is not more effective than single meds, tissue binding is a big problem, as needed use is not indicated, anticholinergic and anti-adrenergic side effects, extrapyramidal effects that can be devastating and permanent |
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Term
| Neuroleptic "Rule of Thumb" |
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Definition
| Describes the relationship among potency, extrapyramidal risk, sedation, and anticholinergic effects. High potency means high extrapyramidal risk with low sedation and low anticholinergic effects. Low potency goes with low EP risk, but with high sedation and AntiACh effects. |
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Term
| High Potency Neuroleptics |
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Definition
| Stellazine (can cause dancing gait), Loxitane, Prolixin, Navane, Haldol, Orap, Trilafon, and Moban |
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Term
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Definition
| Thorazine, Mellaril (can turn you blue), and Serentil |
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Term
| Neuroleptic Malignant Syndrome |
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Definition
| Can occur after too much, too long, or too many combined meds, especially a concern with liver damage, not common but easily fatal, if signs of severe muscle rigidity, fever, reduced mental status, autonomic instability appear than immediate medical attention is required. |
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