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.
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.
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.
Placebo rates average about ______%
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.”
what is PRINCIPLE TWO?
It is the brain’s adaptation to the changes made by the medications that underlies the therapeutic effect.
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)
What is PRINCIPLE THREE?
Individual differences are greater than known or in vitro effects
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
What is PRINCIPLE FOUR?
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).
The prerequisite task of drug treatment is to achieve a ______ _______ of the drug in the blood stream.
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.
ROUTES OF ADMINISTRATION
- ORAL: pills and capsules, liquids and gels
- TRANSDERMAL: patches, ointments, balms
- MUCOSAL: Ophthalmic, nasal, vaginal, rectal
- INHALATION: pulmonary inhalers, vaporizers
Where does metabolism primarily occur?
What are prodrugs?
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
METABOLISM: body temperature
higher temperature increases, lower temperature decreases/slows metabolism.
METABOLISM: nutritional status
dieting/starvation dramatically slow metabolism to increase storage. Certain nutrients also needed for normal metabolism. ETOH & Nicotine increase metabolism.
METABOLISM: disease status
the less intact the body, the less reliable the metabolism.
routes of EXCRETION
Primary route through urine or feces.
Also excreted through lungs, breast milk, and sweat.
what is the DOSE-RESPONSE CURVE
- The relationship of the dose (amount) of drug and degree of effect.
- ranging from no response to death
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
What is Terminal half life
a functional concept relating to all factors (absorption, distribution, binding, etc) working to reduce effective drug levels by half.
What is Plasma/distribution half life
the amount of time it takes for the actual drug level to drop to half maximum.
Dose schedule is based on what?
terminal half life
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
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.).