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

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N358 Mental Health and Illness across the Lifespan
Dr. Stephen Strobbe, Winter 2017
Medication Review
Disclaimer: This medication review is intended for use as a study guide only. It is neither an exhaustive
resource, nor is it to be used to direct psychopharmacotherapy.
General Considerations
• Only certain of these medications may be approved specifically for use in children
• For female patients, always consider childbearing age, issues related to pregnancy and
breastfeeding, and associated risks and protections, including contraception
• Additional cautions may apply to the use of these medications with older adults
• Patients are often advised to carry a card indicating the use of these medications
• For the most part, pharmacotherapy is intended to be part of a holistic, individual treatment
plan, and is often more effective when administered in conjunction with other forms of
behavioral and/or psychosocial therapy
I. Antidepressant medications
A. Generally, increase levels of certain neurotransmitters, e.g., predominately serotonin,
norepinephrine, and/or dopamine
B. Monoamine oxidase inhibitors (MAOIs)
1. Early 1950s, serendipitously discovered to decrease depression
2. Serious, potentially fatal, drug-food and drug-drug interactions
a. Requires tyramine-free diet (includes, but not limited to avoidance of…)
i. aged cheeses
ii. red wines
iii. smoked and processed meats
iv. others
b. Drug-drug interactions (includes, but not limited to avoidance of…)
i. all other antidepressant medications
ii. sympathomimetics
iii. stimulants
iv. antihypertensives
v. requires 2-week wash-out period from previously administered
antidepressant medications, 5 weeks after fluoxetine
c. These drug-food, drug-drug interactions can result in hypertensive crisis
d. Other contraindications
i. post-acute myocardial infarction (MI)
ii. narrow angle glaucoma
e. 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 modifications
recommended at 9mg/24 hr and 12mg/24 hr
C. Tricyclic antidepressants
1. Late 1950s
2. Considered as efficacious as other, more modern, antidepressants
3. Certain of these agents may also be effective in treatment of chronic pain

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4. More pronounced side effects, and safety considerations, than later SSRIs
a. anticholinergic effects, e.g., dry mouth, constipation
b. orthostatic hypotension
c. photosensitivity (eyes and skin, so sunglasses, sunscreen when needed)
d. risk of potentially fatal overdose in suicide attempts
4. Common examples
a. amitriptyline
b. imipramine (Tofranil)
c. clomipramine (Anafranil), effective in treatment of
obsessive-compulsive disorder (OCD)
D. Selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinehprine
reuptake inhibitors (SNRIs)
1. More benign side-effect profiles
2. Also safer than earlier antidepressant medications
3. May take a few weeks to achieve therapeutic response, and optimal response
may not occur for some months
4. Side effects can include sexual dysfunction
5. Characteristics of specific agents
a.