Psychopharm Quiz 1

• 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.

Meds are used to enable the patient or client to engage in the change process and alleviate unnecessary suffering along the way.

• 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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• 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.”

It is the brain’s adaptation to the changes made by the medications that underlies the therapeutic effect.

• 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)

Individual differences are greater than known or in vitro effects

• 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

The majority of drug effects reflect enduring synaptic alterations

the action of the body on the medication (factors affecting drug availability).

the action of the medication on the body (the potential therapeutic effect).

steady state

ABSORPTION - getting the drug in.

DISTRIBUTION - passing the drug around.

METABOLISM - breaking the drug down.

EXCRETION - getting rid of the drug.

• ORAL: pills and capsules, liquids and gels
• INJECTIONS/IMPLANTS
• TRANSDERMAL: patches, ointments, balms
• MUCOSAL: Ophthalmic, nasal, vaginal, rectal
• INHALATION: pulmonary inhalers, vaporizers

the liver

drugs that require metabolism before they are active

the older, the slower and less reliable or efficient

males are generally faster, but women “store.”  Hormonal phase, menopause, and digestive factors   also concern women

higher temperature increases, lower temperature decreases/slows metabolism.

dieting/starvation dramatically slow metabolism to increase storage. Certain nutrients also needed for normal metabolism. ETOH & Nicotine increase metabolism.

the less intact the body, the less reliable the metabolism.

Primary route through urine or feces.

Also excreted through lungs, breast milk, and sweat.

• The relationship of the dose (amount) of drug and degree of effect.
• ranging from no response to death

• 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

a functional concept relating to all factors (absorption, distribution, binding, etc) working to reduce effective drug levels by half.

the amount of time it takes for the actual drug level to drop to half maximum.

terminal half life

• 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

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.).