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Medication Review.pdf - N358 Mental Health and Illness...

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1N358 Mental Health and Illness across the LifespanDr. Stephen Strobbe, Winter 2017Medication ReviewDisclaimer: This medication review is intended for use as a study guide only. It is neither an exhaustiveresource, nor is it to be used to direct psychopharmacotherapy.General ConsiderationsOnly certain of these medications may be approved specifically for use in childrenFor female patients, always consider childbearing age, issues related to pregnancy andbreastfeeding, and associated risks and protections, including contraceptionAdditional cautions may apply to the use of these medications with older adultsPatients are often advised to carry a card indicating the use of these medicationsFor the most part, pharmacotherapy is intended to be part of a holistic, individual treatmentplan, and is often more effective when administered in conjunction with other forms ofbehavioral and/or psychosocial therapyI.Antidepressant medicationsA.Generally, increase levels of certain neurotransmitters, e.g., predominately serotonin,norepinephrine, and/or dopamineB.Monoamine oxidase inhibitors (MAOIs)1.Early 1950s, serendipitously discovered to decrease depression2.Serious, potentially fatal, drug-food and drug-drug interactionsa.Requires tyramine-free diet (includes, but not limited to avoidance of…)i.aged cheesesii.red winesiii.smoked and processed meatsiv.othersb.Drug-drug interactions (includes, but not limited to avoidance of…)i.all other antidepressant medicationsii.sympathomimeticsiii.stimulantsiv.antihypertensivesv.requires 2-week wash-out period from previously administeredantidepressant medications, 5 weeks after fluoxetinec.These drug-food, drug-drug interactions can result in hypertensive crisisd.Other contraindicationsi.post-acute myocardial infarction (MI)ii.narrow angle glaucomae.Examples of MAOIs: phenelzine (Nardil), tranylcypromine (Parnate)f.Dietary restrictions may not be necessary with newer MAOI,selegeline transdermal system (Emsam) at 6mg/24hr, but modificationsrecommended at 9mg/24 hr and 12mg/24 hrC.Tricyclic antidepressants1.Late 1950s2.Considered as efficacious as other, more modern, antidepressants3.Certain of these agents may also be effective in treatment of chronic pain
24.More pronounced side effects, and safety considerations, than later SSRIsa.anticholinergic effects, e.g., dry mouth, constipationb.orthostatic hypotensionc.photosensitivity (eyes and skin, so sunglasses, sunscreen when needed)d.risk of potentially fatal overdose in suicide attempts4.Common examplesa.amitriptylineb.imipramine (Tofranil)c.clomipramine (Anafranil), effective in treatment ofobsessive-compulsive disorder (OCD)D.Selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinehprinereuptake inhibitors (SNRIs)1.More benign side-effect profiles2.Also safer than earlier antidepressant medications3.May take a few weeks to achieve therapeutic response, and optimal responsemay not occur for some months4.Side effects can include sexual dysfunction5.Characteristics of specific agentsa.

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Term
Fall
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Tags
Antidepressant, Antipsychotic

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