-
why will some tolerate different drugs from others?
People metabolize differently-VERIATIONS IN THE GENE CONTROLLING LIVER ENZYMES (CYP SYSTEM) DIFFER IN FREQUENCY AMONG ETHNIC AND RACIAL GROUPS;
-
Extensive vs. Poor metabolizors
- The book said that
- extensive metabolizers were at greater risk for the buildup of
- intermediate toxic metabolies. I thought that a slower metabolizer
- would be because the drugs stay in the system longer? Could you explain
- this please. Apr 1, 2010 6:21:56 PM EDT
- John Isaacs: GOOD QUESTION. Apr 1, 2010 6:22:10 PM EDT
- John Isaacs: METABOLITES ARE BYPRODUCTS OF METABOLISM. Apr 1, 2010 6:22:26 PM EDT
- John Isaacs: IN OTHER WORDS, AFTER THE DRUG IS METABOLIZED, IT CAN CHANGE INTO SOMETHING ELSE
-
Race/metabolism
- NOW, A PATIENT'S RACE OR ETHNIC BACKGROUND INFLUENCE HOW MEDICATIONS ARE METABOLIZED. Apr 1, 2010 6:25:30 PM EDT
- John Isaacs: FOR
- EXAMPLE, ONLY 3-5% OF CAUCASIANS ARE POOR METABOLIZERS OF DIAZEPAM OR
- IMIPRAMINE (BENZOS OR TRICYCLICS), BUT 15-20% OF CHINESE AND jAPANESE
- ARE POOR METABOLLIZERS OF CERTAIN ANTICONVULSANT S MEDS
- ASIANS AND ESKIMOSE NEED, OVERALL, LOWER DOSES OF BENZOS THAT CAUCASIANS Apr 1, 2010 6:27:33 PM EDT
- Kathryn Taylor: oh ok that makes sense and is important Apr 1, 2010 6:27:36 PM EDT
- John Isaacs: ASIANS, INDIANS, AND PAKISTANIS REQUIRE LOWER DOSES OFLITHIUM AND ANTIPSYCHOTIC DRUGS Apr 1, 2010 6:27:53 PM EDT
- John Isaacs: AFRICAN AMERICANS' SYMPTOMS GENERALLY IMPROVE FASTER AFTER TAKING NEUROLEPTICS AND BENZOS
- John Isaacs: HISPANICS MAY REQUIRE LOWER DOSES OF ANTIDEPRESSANTS
-
WHAT ANTICONVULSANTS ARE NOT INDICATED DURING PREGNANCY?
(meds and pregnancy in general)
- Sara Emery: carbamazepine Apr 1, 2010 6:39:00 PM EDT
- Amber Nixon: valproic Apr 1, 2010 6:39:05 PM EDT
- Christie Casciola: lamotrigine Apr 1, 2010 6:39:07 PM EDT
- Lauren Barthelemy: lamotrigine Apr 1, 2010 6:39:08 PM EDT
- Katherine Smithley: tegretol Apr 1, 2010 6:39:09 PM EDT
- Sara Emery: valporic acid Apr 1, 2010 6:39:12 PM EDT
- Carolyn Vorhes: carbamazepine Apr 1, 2010 6:39:14 PM EDT
- Heather Crowe: valporic Apr 1, 2010 6:39:18 PM EDT
- Kathryn Taylor: valproic acid Apr 1, 2010 6:39:20 PM EDT
- Erinann Lindner: carmabamazampine Apr 1, 2010 6:39:21 PM EDT
- Carolyn Vorhes: valproic acid Apr 1, 2010 6:39:22 PM EDT
- Sara Emery: lamotrigin
- NO BENZO's in FIRST TRIMESTER- fetus abnormalities, if already using may have to decrease dose
- Antidepressants: SSRI's; Antipsychotics: high-potency.
- 1st trimester most imp. because of fetal organ development;.
- Address costs/benefits; risks assoc to fetal development.
-
Elderly
Age=less functioning of liver/kidneys.
- John Isaacs: ALSO, WHEN WE GET OLDER, THERE IS A DECREASE IN ALBUMIN, AND SO BLOOD DISTRIBUTION IS EFFECTED. Apr 1, 2010 6:55:42 PM EDT
- Kathryn Taylor: oh okay that makes sense Apr 1, 2010 6:55:58 PM EDT
- John Isaacs: MORE DRUG IS FREE AND CAN BECOME QUITE TOXIC FOR THE ELDERLY IN "NORMAL" DOSES Apr 1, 2010 6:56:20 PM EDT
- Christie Casciola: they take so many different medications, so the possibility for bad interactions is much greater too Apr 1, 2010 6:57:09 PM EDT
- John Isaacs: ALSO, THE ELDERLY HAVE DECREASED CHOLINERGIC FUNCTION--YOU KNOW WHAT THAT MEANS Apr 1, 2010 6:57:14 PM EDT
- John Isaacs: RIGHT CHRISTIE Apr 1, 2010 6:57:19 PM EDT
- John Isaacs: DECREASED CHOLINERGIC FUNCTION--THE QUESTION I GET ASKED AT LEAST FIVE TIMES A DAY--CONSTIPATION PROBLEMS A
-
WHY ARE INDIV.
SCHIZOPHRENIC OR PSYCHOTIC? WHAT'S HAPPENING WITH NEUROTRANSMITTERS,
AND WITH WHAT NEUROTRANSMITTER IN PARTICULAR?
- Too much DA
- TOO MUCH DA IN TEH
- MESOLIMBIC AREA IS ASSOC. WITH POSITIVE SYMPTOMS, AND DECREASED
- ACTIVITY IN THE PREFRONTAL CORTEX WITH NEGATIVE SYMPTOMS.
- Positive; delusions, hallucinations, impaired emotion/control/impulses, anxiety. (easier to treat)
- Negative: blunt affect, anhedonia, limited cognition, blunted perception
- *Success with neg. sx: clozaril.*increased risk of that blood disease.
-
Miscellaneous
- John Isaacs: ZYPREXA CAUSES WEIGHT GAIN Apr 1, 2010 7:53:16 PM EDT
- John Isaacs: SO, WHAT ARE THE OVERALL BENEFITS OF THE ATYPICALS? Apr 1, 2010 7:53:32 PM EDT
- Heather Crowe: easy to tolerate
- John Isaacs: AND REDUCTION OF SOME NEGATIVE SYMPTOMS,
- John Isaacs: HOW LONG SHOULD A SCHIZOPHRENIC BE MEDICATED TO AVOID RELAPSE?
- John Isaacs: AT LEAST 1 YEAR FOLLOWING THE REMISSION OF SYMPTOMS Apr 1, 2010 7:56:16 PM EDT
- Carolyn Vorhes: long enough to prevent relapse as when meds are stopped too soon Apr 1, 2010 7:56:23 PM EDT
- Christie Casciola: should be re-evaluated every 6 months Apr 1, 2010 7:56:23 PM EDT
- John Isaacs: AS
- YOU KNOW, COMPLIANCE IS A REAL PROBLEM HERE. LONG ACTING INJECTIONS
- LIKE HALDOL (HALOPERIDOL) OR PROLIXIN (FLUPHENAZINE) ARE A GOOD OPTION
- FOR REALLY NONCOMPLIANT PATIENTS
-
Important notes:
- IT IS IMPORTANT TO
- DESCRIBE SIDEEFFECTS TO PATIENTS, ESPECIALLY AKATHISIA. THIS SIDE
- EFFECT CAN BE EXTREMELY UNPLEASANT, YET OFTEN IT IS NOT SPONTANEOUSLY
- REPORTED BY PATIENTS. IF IT OCCURS AND IS NOT TREATED, THIS WILL
- GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS WELL AS INCREASING THE
- PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY NOTICE AN INNER FEELING
- OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO, PLEASE TELL ME. DO NOT JUST
- DISCONTINUE THE MEDICATION. MOST SIDE EFFECTS CAN BE TREATED. IT IS
- IMPORTANT TO DESCRIBE SIDEEFFECTS TO PATIENTS, ESPECIALLY AKATHISIA.
- THIS SIDE EFFECT CAN BE EXTREMELY UNPLEASANT, YET OFTEN IT IS NOT
- SPONTANEOUSLY REPORTED BY PATIENTS. IF IT OCCURS AND IS NOT TREATED,
- THIS WILL GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS WELL AS
- INCREASING THE PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY NOTICE
- AN INNER FEELING OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO, PLEASE TELL
- ME. DO NOT JUST DISCONTINUE THE MEDICATION. MOST SIDE EFFECTS CAN BE
- TREATED. IT IS IMPORTANT TO DESCRIBE SIDEEFFECTS TO PATIENTS,
- ESPECIALLY AKATHISIA. THIS SIDE EFFECT CAN BE EXTREMELY UNPLEASANT, YET
- OFTEN IT IS NOT SPONTANEOUSLY REPORTED BY PATIENTS. IF IT OCCURS AND IS
- NOT TREATED, THIS WILL GREATLY INCREASE THE RISK OF NONCOMPLIANCE, AS
- WELL AS INCREASING THE PATIENT’S SUFFERING. SO TELL PATIENTS, “YOU MAY
- NOTICE AN INNER FEELING OF RESTLESSNESS OR NERVOUSNESS. IF YOU DO,
- PLEASE TELL ME. DO NOT JUST DISCONTINUE THE MEDICATION. MOST SIDE
- EFFECTS CAN BE TREATED.
- John Isaacs: THE TOTAL LENGTH OF TREATMENT IS LIKELY TO BE AT LEAST ONE YEAR AND OFTEN LONGER FOR MORE CHRONIC SCHIZOPHRENIA. Apr 1, 2010 7:59:46 PM EDT
- John Isaacs: ANTIPSYCHOTIC MEDS ARE NOT ADDICTIVE. Apr 1, 2010 7:59:59 PM EDT
- John Isaacs: YOU
- SHOULD AVOID PROLONGED EXPOSURE TO HIGH TEMPERATURES AND SUNLIGHT (SOME
- ANTIPSYCHOTICS HAVE PHTOSENSITIVITY AS A SIDE EFFECT). Apr 1, 2010 8:00:18 PM EDT
- John Isaacs: THAT'S PHOTOSENSITIVITY Apr 1, 2010 8:00:33 PM EDT
- Cindy Pfrimmer: The medicine or the patient? Apr 1, 2010 8:00:37 PM EDT
- John Isaacs: AVOID AMPHETAMINES, COCAINE, AND L-DOPA (PARKINSON DISEASE MED) BECAUSE THESE DRUGS ALWAYS EXACERBATE PSYCHOSES
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