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Psychotherapeutic Drugs

Psychotherapeutic Drugs. Kim Edward Light, Ph.D. Professor, College of Pharmacy University of Arkansas for Medical Sciences. Objectives. Identify the different categories of drugs having therapeutic value in treating CNS disorders. Identify the spectrum of disorders of brain function

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Psychotherapeutic Drugs

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  1. Psychotherapeutic Drugs Kim Edward Light, Ph.D. Professor, College of Pharmacy University of Arkansas for Medical Sciences

  2. Objectives • Identify the different categories of drugs having therapeutic value in treating CNS disorders. • Identify the spectrum of disorders of brain function • For each category of drugs not previously discussed • Identify therapeutic uses and indications • Present pharmacological mechanisms • Discuss specific features of drug action • Present adverse reactions and side effects • Identify contraindications and complications

  3. Antipsychotics / Neuroleptics Antimanic Antidepressants Alzheimer's Antiparkinsonian Anticonvulsants Stimulant Medications Antianxiety Medications Hypnotics Narcotics - Opioid Analgesics Addiction Treatment Medications Drug Categories

  4. Attention Deficit Hyperactivity Disorder (ADHD, ADD) Autism Spectrum Disorders (Pervasive Developmental Disorders) Bipolar Disorder (Manic-Depressive Illness) Borderline Personality Disorder Depression Eating Disorders Spectrum of Disorders1

  5. Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder (PTSD) Social Phobia (Social Anxiety Disorder) Schizophrenia Seizure Disorders Spectrum of Disorders2

  6. Traditional Antipsychotic Drugs • chlorpromazine Thorazine®, Largactil® • fluphenazine Prolixin®, Permitil® • haloperidol Haldol® • loxapine Loxitane, Daxolin® • mesoridazine Serentil® • molindone Moban, Lindone® • perphenazine Trilafon®, Etrafon® • pimozide Orap® • thioridazine Mellaril® • thiothixene Navane® • trifluoperazine Stelazine ®

  7. Atypical Antipsychotic Drugs • aripiprazole Abilify® • clozapine Clozaril® • olanzapine Zyprexa®, Zyprexa®, Zydis® • quetiapine Seroquel® • risperidone Risperdal® • ziprasidone Geodon®

  8. Tardive Dyskinesia Involuntary movements Long-term use and older patients Women > men Neuroleptic Malignant Syndrome Blood pressure up and down Dazed and confused Difficulty breathing Muscle stiffness Rapid heart rate Sweating and shakiness Temperature above normal Antipsychotic DrugAdverse Reactions

  9. Antipsychotic DrugSide Effects • Blurred vision, Dry mouth • Drowsiness, Slurred speech, Dizziness • Muscle rigidity • Nasal congestion, Lowered blood pressure • Restlessness, Slowed heart rate • Sensitivity to bright light • Upset stomach, Constipation • Weight gain

  10. Lithium Carbonate - Eskalith®, Eskalith CR®, Lithane®, Lithobid®, Lithonate®, Lithotabs® Citrate - Cibalith® Anticonvulsants Neuroleptics – atypical olanzapine Zyprexa®, Zyprexa®, Zydis® quetiapine Seroquel® risperidone Risperdal® ziprasidone Geodon® Bipolar Disorder Drugs

  11. Lithium Side Effects • ataxia, fine hand tremor, hyperactive reflexes • blurred vision, drowsiness, diarrhea, vomiting • muscular weakness, dry mouth, polyuria, • cardiac arrhythmia, hypotension, • epileptiform seizures, coma • large output of dilute urine Regular monitoring of blood levels necessary

  12. MAO Inhibitors isocarboxazid Marplan® phenelzine Nardil® tranylcypromine Parnate® Tricyclics & Quarta-cyclics amitriptyline Elavil® amoxapine Asendin® clomipramine Anafranil® desipramine Norpramin® doxepin Sinequan® imipramine Tofranil® maprotiline Ludiomil® nortriptyline Pamelor® protriptyline Vivactil® Antidepressant DrugsOlder

  13. SSRIs citalopram Celexa® escitalopram Lexapro® fluoxetine Prozac® fluvoxamine Luvox® paroxetine Paxil® sertraline Zoloft® SNRIs venlafaxine Effexor®, Effexor ER® nefazodone Serzone® mirtazapine Remeron® Others bupropion Wellbutrin® trazodone Desyrel® Antidepressant DrugsNewer

  14. MAO Inhibitors Foods containing tyramine at high levels Serotonin Syndrome Produced by combination of products that act to increase serotonin Similar to Neuroleptic Malignant Syndrome Euphoria, drowsiness, exaggerated reflexes, sweating,hyperthermia, mental status changes Antidepressant Drugs Adverse Reactions

  15. Older agents Dry mouth, dizziness, constipation, blurred vision, cardiac arrhythmias Orthostatic hypotension, sexual dysfunction, weight gain Newer agents Headache, nausea, nervousness, agitation, Sexual dysfunction, insomnia, weight gain Seizure risk (bupropion) Suicide or aggressive acts especially in adolescents Antidepressant Drugs Side Effects

  16. DA Boosters L-DOPA L-DOPA / carbidopa Sinemet® or Atamet® entacapone Comtan® MAO-B Inhibitor SelegilineEldepryl® Atapryl® Carbex® DA Agonists bromocriptine Parlodel® pergolide Permax® pramipexole Mirapex® ropinirole Requip® amantadine Symmetrel®, Symadine® Anti-Parkinsonian Drugs

  17. Anticholinergics benztropine Cogentin® trihexyphenidyl Artane® Anti-Parkinsonian DrugsAdjuncts

  18. Donepezil Aricept® Galantamine Reminyl® Rivastigmine Exelon® Tacrine Cognex® Memantine Namenda® Side Effects Dizziness, Confusion, Sleep problems Increased respiratory secretions, Urinary frequency Cardiovascular problems Anti-Alzheimer's Drugs

  19. Anticonvulsant Drugs • carbamazepine Tegretol® • divalproex sodium Depakote®, • valproate Depacon®, Depakene® • gabapentin Neurontin® • lamotrigine Lamictal® • levetiracetam Keppra® • oxcarbazepine Trileptal® • tiagabine Gabitril® • topiramate Topamax®

  20. Anticonvulsant DrugsSide Effects • weight gain, • memory and cognitive function disturbances, • photosensitivity, • dermatological sensitivity leading to rashes, • sinus congestion, • hair thinning, • impaired absorption of B vitamins.

  21. Summary • Discussed the various major classes of drugs used to treat various mental disorders including: • Antipsychotic drugs • Bipolar disorder drugs • Antidepressant drugs • Anti-Parkinsonian drugs • Anti-Alzheimer’s drugs • Anticonvulsant drugs Psychotherapeutic Medications Information http://www.nimh.nih.gov/healthinformation/index.cfm

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