Psychopharm MOST important

• John Isaacs: LET’S
• BEGIN WITH A DISCUSSION OF OTC SUPPLEMENTS AND HERBAL PRODUCTS.
• REMEMBER, THESE PRODUCTS ARE NOT APPROVED FOR SAFETY OR EFFICACY BY THE
• FDA, YET SOME HAVE DO HAVE BENEFIT FOR CERTAIN PSYCH. CONDITIONS. WHICH
• OTCS ARE NOT RECOMMENDED BECAUSE OF DANGEROUS SIDE EFFECTS? Apr 15, 2010 6:12:35 PM EDT
• Maureen Anders: kava kava Apr 15, 2010 6:13:01 PM EDT
• Sara Emery: Yohimbine Apr 15, 2010 6:13:04 PM EDT
• Sara Emery: kava kava AND VALERIAN ROOT
• John Isaacs: WHICH HERBAL PRODUCTS DO SHOW PROMISE/EFFECTIVENESS Apr 15, 2010 6:14:14 PM EDT
• Sara Emery: melatonin Apr 15, 2010 6:14:20 PM EDT
• Heather Crowe: ginko biloba; st. johns wort
• On melatonin: MANY INDIVIDUALS WOKE UP IN THE MIDDLE OF THE NIGHT WITH A REBOUND INSOMNIA THAT WAS WORSE THAN THE ORIGINAL INSOMNIA Apr 15, 2010 6:16:52 PM EDT
• Maureen Anders: are you asking what it is no longer used for? Apr 15, 2010 6:16:53 PM EDT
• John Isaacs: SO, OVERALL, DIPHENHYDRAMINE PRODUCTS OR BENZOS ARE MUCH MORE EFFECTIVE Apr 15, 2010 6:17:41 PM EDT
• Christie Casciola: thats interesting since it is a natural chemical produced in the body Apr 15, 2010 6:17:50 PM EDT
• John Isaacs: REMEMBER, ST JOHN'S WORT IS EFFECTIVE, BUT IT CAN AND DOES INTERACT WITH OTHER MEDS
• John Isaacs: IN THE USA, HERBAL PRODUCTS ARE NOT REGULATED BY THE FDA. Apr 15, 2010 6:26:50 PM EDT
• Maureen Anders: they are looking at contaminants though Apr 15, 2010 6:26:53 PM EDT
• John Isaacs: THEY ARE TAKE AT YOU OWN RISK PRODUCTS
• John Isaacs: THEY DO NOT HAVE TO FOLLOW FDA GUIDELINES FOR SAFETY OR EFFICACY
• John Isaacs: IN WHAT WAYS MIGHT HERBAL PRODUCTS BE DANGEROUS/PROBLEMATIC? Apr 15, 2010 6:29:35 PM EDT
• Erinann Lindner: they could interact with oher drugs Apr 15, 2010 6:29:58 PM EDT
• Lauren Barthelemy: may contain arsenic Apr 15, 2010 6:29:59 PM EDT
• Maureen Anders: effect on liver
• *targets chronic conditions, "high" class, high education
• John Isaacs: I
• BELIEVE THAT WHAT WE WILL DISCUSS NOW FOCUSES ON YOUR POTENTIALLY
• GREATEST CONTRIBUTION DURING THERAPY—HELPING TO DIFFERENTIATE
• PSYCHOTROPIC SIDE EFFECTS FROM PSYCHIATRIC SYMPTOMS, AND YOUR ABILITY
• TO RECOGNIZE RED FLAGS WHILE MONITORING PATIENT RESPONSE TO MEDICATIONS. Apr 15, 2010 6:38:39 PM EDT
• Kathleen Ruscitto: yes Apr 15, 2010 6:38:40 PM EDT
• John Isaacs: WHEN
• YOU NOTICE, FOR EXAMPLE, THAT A PATIENT’S SYMPTOMS ARE WORSENING WHILE
• ON MEDS, OR SIDE EFFECTS ARE DEVELOPING, OR THAT THE PHYSICIAN NEEDS TO
• DIFFERENTIATE BETWEEN SIDE EFFECTS AND WORSENING DISEASE STATE—YOUR
• REFERRAL TO THE PATIENT BACK TO THE PHYSICIAN FOR REEVALUATION CAN BE
• CRITICAL TO THE MANAGEMENT OF THE PATIENT AND THE PATIENT’S ULTIMATE
• OUTCOME
• John Isaacs: YOUR TEXT LISTS SIX CIRCUMSTANCES IN WHICH A PATIENT RE-EVALUATION/RE-RE-REFERRAL IS NECESSARY. WHAT ARE THEY? Apr 15, 2010 6:40:17 PM EDT Carolyn Vorhes: new conditions appear Apr 15, 2010 6:40:47 PM EDT
• Katherine Smithley: compliance Apr 15, 2010 6:40:48 PM EDT
• Heather Crowe: increase in psychosocial stressors Apr 15, 2010 6:40:49 PM EDT
• Lauren Barthelemy: "breakthrough symptoms"
• fialure to respond, unexplained relapse
• *adequate trial (right dx/ long enough on med
• John Isaacs: IN
• GENERAL, IF A PATIENT IS ON RECOMMENDED DOSES ON MEDICATION WITHOUT
• NOTICEABLE IMPROVEMENT, AFTER HOW MANY WEEKS SHOULD YOU SUGGEST A MED
• CHANGE OR DOSAGE INCREASE? Apr 15, 2010 6:43:10 PM EDT
• Heather Crowe: 4 -5
• John Isaacs: ARE THERE EXCEPTIONS TO THIS NUMBER OF WEEKS? WITH WHAT CLASS(ES) OF MEDS? Apr 15, 2010 6:43:58 PM EDT
• Katherine Smithley: benzos Apr 15, 2010 6:44:31 PM EDT
• Amber Nixon: antidepressants Apr 15, 2010 6:44:49 PM EDT
• Erinann Lindner: benzos- due to their fast acting Apr 15, 2010 6:44:50 PM EDT
• Saralynn Kramm: antidepressants Apr 15, 2010 6:44:50 PM EDT
• John Isaacs: THINK ABOUT THE CLASSES OF MEDS WE DISCUSSED. WITH WHAT CLASSES OF MEDS TO YOU NEED TO BE MORE PATIENT AND W HY? Apr 15, 2010 6:45:03 PM EDT *buspar
• John Isaacs: WHY ANTIDEPRESSANTS AND BUSPAR? Apr 15, 2010 6:45:40 PM EDT
• Erinann Lindner: antidepressants may take some time to get steady state in the bloodstream Apr 15, 2010 6:46:05 PM EDT
• Amber Nixon: it may take up to a few months for the meds to be fully effective
• John Isaacs: WHAT
• ARE POSSIBLE EXPLANATIONS FOR PATIENTS WHO RESPOND BEAUTIFULLY TO MEDS
• FOR A GOOD PERIOD OF TIME, BUT THEN SUDDENLY HAVE RELAPSE—A REEMERGENCE
• OF SYMPTOMS? Apr 15, 2010 6:48:57 PM EDT
• Carolyn Vorhes: compliance problems; tolerance, stress, d/a
• John Isaacs: GOOD--TOLERANCE CAN DEVELOP WITH WHAT MEDS, OR GROUP OF MEDS? Apr 15, 2010 6:50:16 PM EDT
• Maureen Anders: change in thyroid function
• ohn Isaacs: WHAT KINDS OF NEW MEDICAL CONDITIONS WARRANT A REEVALUATION OF MEDS? Apr 15, 2010 6:51:15 PM EDT
• Heather Crowe: pregnancy Apr 15, 2010 6:51:20 PM EDT
• Maureen Anders: kidney issues Apr 15, 2010 6:51:28 PM EDT
• Sara Emery: epilepsy Apr 15, 2010 6:51:28 PM EDT
• Kathryn Taylor: thyroid Apr 15, 2010 6:51:29 PM EDT
• Erinann Lindner: liver problems Apr 15

• John Isaacs: WHAT FACTORS HELP DECIDE WHEN A PATIENT, FULLY RECOVERED, SHOULD DISCONTINUE MEDS? Apr 15, 2010 6:52:45 PM EDT
• Erinann Lindner: the patienrts feelings baout dicontinuation Apr 15, 2010 6:53:09 PM EDT
• Amber Nixon: history of the med.. if they responded well to it in the past Apr 15, 2010 6:53:10 PM EDT
• Sara Emery: vulnerability for relapse Apr 15, 2010 6:53:11 PM EDT
• Carolyn Vorhes: their desire to stop/feelings about it Apr 15, 2010 6:53:11 PM EDT
• John Isaacs: HOW SHOULD PSYCHOTROPIC MEDS BE DISCONTINED Apr 15, 2010 6:54:02 PM EDT
• Lauren Barthelemy: weened off Apr 15, 2010 6:54:14 PM EDT
• Sara Emery: slowly, carefully Apr 15, 2010 6:54:15 PM EDT
• Katherine Smithley: tapered slowly Apr 15, 2010 6:54:15 PM EDT
• John Isaacs: WHAT IS ANTICHOLINERGIC DELIRIUM? WHO IS ESPECIALLY AT RISK FOR THIS? Apr 15, 2010 6:56:45 PM EDT
• Sara Emery: elderly
• Christie Casciola: parasymathetic NS action Apr 15, 2010 6:58:02 PM EDT
• Christie Casciola: constipation Apr 15, 2010 6:58:24 PM EDT
• Carolyn Vorhes: dry mouth Apr 15, 2010 6:58:29 PM EDT
• John Isaacs: CONFUSION, DISORIENTATION HALLUCINATIONS, MENTAL STATUS CHANGES
• John Isaacs: WHAT IF PATIENT IS ON AN ANTICHOLINERGIC DRUG? Apr 15, 2010 6:59:21 PM EDT
• Erinann Lindner: can ofset some of the sxs Apr 15, 2010 6:59:41 PM EDT
• John Isaacs: AN ANTICHOLINERGIC DRUG WILL MAKE THE SYMPTOMS WORSE AND SHOULD BE D/C IF PATIENT HAS ANTICHOLINERGIC DELIRIUM
• John Isaacs: IF
• ANTICH. DELIRIUM IS CAUSED BY THE MED, AND THE PATIENT IS MISTAKENLY
• DIAGNOSED FOR PSYCHOTIC DISORDER, AND A NEUROLEPTIC IS GIVEN WITH
• ANTICHOLINERGIC SIDE EFFECTS, THIS WILL MAKE THINGS WORSE. SEE WHY IT
• IS IMPORTANT TO DIAGNOSE WHAT IS CAUSING THE DELIRIUM?
• SSRIS, ESPECIALL
• PROZAC, AND DRICYCLICS SOMETIMES CAN CAUSE AKATHISIA. WHAT HAPPENS IF
• MD DOES NOT RECONIZED NTIDEPRESSANT-INDUCED AKATHISIA AND RPESCRIBES A
• NEUROLEPTIC?
• Christie Casciola: could increase the akathisia and cause nonco\mpliance Apr 15, 2010 7:04:24 PM EDT
• Sara Emery: could increase the the symptoms
• John Isaacs: WHAT CONDITION DO THE PARKINSON SIDE EFFECTS OF NEUROLEPTICS OFTEN MIMIC? WHY IS A DIFFERENTIAL DIAGNOSIS IMPORTANT Apr 15, 2010 7:05:33 PM EDT
• Maureen Anders: depression
• John Isaacs: AND FINALLY, WHAT MAY ACCOUNT FOR REEMERGENCE OF DEPRESSIVE SYMPTOMS MONTHS OR YEARS AFTER SUCCESSFUL MEDICATION RESPONSE?
• John Isaacs: VERY GOOD-NON COMPLIANCE, A POOR THERAPEUTIC RESPONSE, OR EVEN CNS TOXICITY OF THE MED Apr 15, 2010 7:09:07 PM EDT
• John Isaacs: SO
• HERE'S THE RUB--AFTER YEARS OF EFFECTIVE TREATMENT, THE DEPRESSIVE
• SYMPTOMS RETURN, AND THE MD INCREASES DOSE OF ANTIDEPRESSANT Apr 15, 2010 7:09:56 PM EDT
• John Isaacs: WHAT IF THE PATIENT HAS NOT BEEN TESTED FOR CNS TOXICITY AND IS GIVEN MORE ANTIDEPRESSANT (OD, toxic, fatal)

• John Isaacs: CATEGORY 1: COMMON BONDS—YOU TELL ME WHAT THE FOLLOWING LISTS HAVE IN COMMON—THEY ARE ALL John Isaacs: 1.ESTROGEN (HORMONE), DIAZEPAM, SEROTONIN (answer- ligands)
• WORSENING OF TREMOR, STUPOR, CONFUSION, SLURRED SPEECH, NAUSEA, VOMITING, DIARRHEA. (toxicity-kidney)
• John Isaacs: 3.AMITRIPTYLINE, IMIPRAMINE, TRAZODONE (tca's)
• John Isaacs: 4.DRY MOUTH, BLURRED VISION, CONSTIPATION Apr 15, 2010 7:15:50 PM EDT
• Kathryn Taylor: anticholinergi

• John Isaacs: 5.ESTAZOLAM (PROSOM), ZOLPIDEM (AMBIEN), ZALEPLON (SOMATA) Apr 15, 2010 7:16:43 PM EDT (sedatives!)
• John Isaacs: 6.PHENELZINE (NARDIL), TRANYCYPROMINE (PARNATE), SELEGILINE (DEPRENYL) (maoi's!)
• John Isaacs: 7.SWEATING, SEXUAL DYSFUNCTION, ORTHOSTATIC HYPOTENSION (adronergic!)
• John Isaacs: 8.SNS (SYMPATHETIC NERVOUS SYSTEM), HPA, H PT. Apr 15, 2010 7:19:41 PM EDT
• Erinann Lindner: fight or flight respeoinse

John Isaacs: 9.ARIPIPRAZOLE (ABILIFY), TRIFLUOPERAZINE (STELAZINE), HALOPERIDOL (HALDOL Apr 15, 2010 7:20:17 PM EDT (high potency antipsychotics)

• Christie Casciola: renal side effects of lithium? Apr 15, 2010 7:37:26 PM EDT
• Sara Emery: kidney failure A
• Heather Crowe: during this period of development, the rate of hepatic metabolism slows. (puberty)
• This area of the brain elicits and controls primitive threat appraisal and psychopathology here is related to impulse disorders. Apr 15, 2010 7:39:38 PM EDT
• Katherine Smithley: amlgyda Apr 15, 2010 7:39:45 PM EDT
• Saralynn Kramm: blocks the effects of NE at the receptor Apr 15, 2010 7:40:34 PM EDT
• Amber Nixon: beta blockers ANTIADRENERGIC AGENTS MORE SPECIFICALLY BLOCK NE
• Erinann Lindner: this is a first line antipsychotic for depression (lamictal!)
• Kathleen Ruscitto: anhedonia, flat affect, blunting of perception (neg. sx of schizo)
• Katherine Smithley: The ion channel can be activated when stimulated by this naturally occuring neurochemical? (gaba!)
• Kathryn Taylor: what are neuronal pathways connecting limbic systme structures and prefrontal lobes. affect regulation (cingulate!)
• Carolyn Vorhes: serious blood d/o that has caused several deaths, thought to be s/e of antipsychotic (agranulocytosis!)
• John Isaacs: 2.
• BETA BLOCKER USED TO REDUCE THE EXTERNAL MANIFESTATIONS OF ANXIETY,
• SUCH AS SWEATING AND INCREASED HEART RATE. USED TO TREAT PUBLIC
• SPEAKING ANXIETY. Apr 15, 2010 7:51:54 PM EDT
• Christie Casciola: inderal
• PHARMACOKINETIC PROPERTY MOST AFFECTED BY KIDNEY FAILURE (elimination/discretion)
• HE COMPULSION TO BE IN MOTION, INTENSE FEELING OF RESTLESSNESS; EXTRAPYRIMIDAL SIDE EFFECT OF NEUROLEPTICS Apr 15, 2010 7:53:44 PM EDT
• Kathryn Taylor: akinisia
• BRANCH OF THE PERIPHERAL NERVOUS SYSTEM, FURTHER DIVIDED INTO THE SYMPATHETIC AND PARASYMPATHETIC SYSTEMS. Apr 15, 2010 7:54:17 PM EDT
• Carolyn Vorhes: autonomic Apr 15, 2010 7:54:25 PM EDT
• ACTIVATION OF
• EXCITATORY RECEPTORS ON DENDRITES OR CELL BODY RESULTING IN A BRIEF
• CHANGE IN THE NEURON’S ELECTRICAL STATE FROM THE RESTING STATE. Apr 15, 2010 7:54:49 PM EDT
• Erinann Lindner: action potentia'
• OLANZAPINE (ZYPREXA), QUETIAPINE (SEROQUEL), AND RISPERIDONE (RISPDERDAL), TO NAME A FEW (atypical antipsychotics)
• CLASSES OF MEDICATIONS, BESIDES BIRTH CONTROL PILLS AND CORTICOSTEROIDS (HORMONES) THAT CAN CAUSE DEPRESSION. Apr 15, 2010 7:56:22 PM EDT
• Katherine Smithley: antiparkinson drugs Apr 15, 2010 7:56:35 PM EDT
• Kathryn Taylor: alcohol
• John Isaacs: 10.ATOMOXETINE (STRATTERA), AND BUPROPION (WELLBUTRIN), TO NAME A FEW. *"ANTIDEPRESSANTS" USED TO TREAT ADHD. REMEMBER?
• 1. TYPE OF MOOD
• MORE COMMON IN CHILDHOOD-ONSET DEPRESSION THAN THE SAD/DEPRESSED MOOD
• THAT MARKS ADULT ONSET DEPRESSION. Andehonia
• John Isaacs: 12.CHOLINERGIC MEDICATION THAT MAY REVERSE CHOLINERGIC BLOCKADE AND ANTICHOLINERGIC SIDE EFFECTS Apr 15, 2010 7:59:27 PM EDT
• Lauren Barthelemy: urecholine