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ROLE OF PSYCHIATRIC MEDICATIONS
- Stabilize the client so they can engage the change process (therapy).
- Reduce or eliminate troublesome symptoms.
- Correct underlying physiological problems.
- Influence or modify other physical processes.
- Sedate or “handcuff” 5150 clients for safety.
- Provide psychological “growth” experiences.
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What is PRINCIPLE ONE?
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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PROs and CONs of MED USE
- In emergencies there is no quicker way of calming a client and easing acute pain.
- Meds relieve unnecessary or excessive suffering until more adaptive coping 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 and medication regimens make it easier to systematize and standardize treatment
- Problems with treatment efficacy can be more easily identified.
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Placebo rates average about ______%
33
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Ways to enhance Placebo value
- Capsules are better than pills
- Recognized professional administering capsules
- Complex but plausible explanations
- Complex or technical looking devices
- Capsules producing salient, mildly negative effects
- Describe effect in hypnotic manner emphasizing non-specific effects
- After administration, let client sit with effects; let them feel the capsule “working.”
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what is PRINCIPLE TWO?
It is the brain’s adaptation to the changes made by the medications that underlies the therapeutic effect.
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INDIVIDUAL DIFFERENCES with meds
- AGE produces substantial changes in drug effects.
- GENDER males and females react to meds differently.
- HISTORY with meds produces idiosyncratic responses.
- DIET and medication history, especially influenced by ethnicity; associated with different liver enzymes.
- PHARMACOKINETICS vary substantially from person to person on basis of genetics and all of the above. (Kinetics refers to what your body does to the drug)
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What is PRINCIPLE THREE?
Individual differences are greater than known or in vitro effects
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COURSE OF TREATMENT
- Determination of dose and adequate trial of
medication. Initial trial is often 2-4 weeks.
- Education about side-effects is essential.
- Maintenance of dose can go 6 months. Adherence to regimen can be problematic. Evaluation of progress and consideration of drug “holiday” strongly recommended.
- Close monitoring of symptoms and lifestyle informs either resumption of med, or discontinuation
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What is PRINCIPLE FOUR?
The majority of drug effects reflect enduring synaptic alterations
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Pharmacokinetics
the action of the body on the medication (factors affecting drug availability).
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Pharmacodynamics
the action of the medication on the body (the potential therapeutic effect).
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The prerequisite task of drug treatment is to achieve a ______ _______ of the drug in the blood stream.
steady state
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four factors of PHARMACOKINETICS
ABSORPTION - getting the drug in.
DISTRIBUTION - passing the drug around.
METABOLISM - breaking the drug down.
EXCRETION - getting rid of the drug.
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ROUTES OF ADMINISTRATION
- ORAL: pills and capsules, liquids and gels
- INJECTIONS/IMPLANTS
- TRANSDERMAL: patches, ointments, balms
- MUCOSAL: Ophthalmic, nasal, vaginal, rectal
- INHALATION: pulmonary inhalers, vaporizers
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Where does metabolism primarily occur?
the liver
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What are prodrugs?
drugs that require metabolism before they are active
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METABOLISM: Age
the older, the slower and less reliable or efficient
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METABOLISM: sex
males are generally faster, but women “store.” Hormonal phase, menopause, and digestive factors also concern women
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METABOLISM: body temperature
higher temperature increases, lower temperature decreases/slows metabolism.
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METABOLISM: nutritional status
dieting/starvation dramatically slow metabolism to increase storage. Certain nutrients also needed for normal metabolism. ETOH & Nicotine increase metabolism.
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METABOLISM: disease status
the less intact the body, the less reliable the metabolism.
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routes of EXCRETION
Primary route through urine or feces.
Also excreted through lungs, breast milk, and sweat.
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what is the DOSE-RESPONSE CURVE
- The relationship of the dose (amount) of drug and degree of effect.
- ranging from no response to death
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What is the Therapeutic Index
- reflects the ratio of the effective dose (ED50) and the lethal dose (LD50) using blood concentration
- The lower the T.I., the more dangerous the drug. The higher the T.I., the “safer” the med, because there are more doses to “play with;” it’s harder to accidentally overdose
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What is Terminal half life
a functional concept relating to all factors (absorption, distribution, binding, etc) working to reduce effective drug levels by half.
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What is Plasma/distribution half life
the amount of time it takes for the actual drug level to drop to half maximum.
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Dose schedule is based on what?
terminal half life
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WHEN TO RE-EVALUATE
- The client fails to respond after an adequate trial.
- The client experiences an unpredicted relapse.
- The client develops a new medical condition
- The client has too many problems with side-effects
- The client’s lifestyle changes dramatically
- The client experiences dangerous effects
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How do we proper;y PREPARE THE CLIENT for meds?
Effects of drugs are not immediate.
Side effects are immediate and can be distressing.
Positive effects of meds are not always subjectively obvious – they may need to be pointed out.
Adherence to regimen is, therefore, problematic. Between 10 - 20% of people never fill prescription.
Maintenance on meds after acute problem abates is important.
Most Meds cannot be taken as needed (p.r.n.).
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