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PSYC650 Psychopharmacology

PSYC650 Psychopharmacology. Drug Interactions and Prescriptive Authority for Psychologists. I got a grip of drugs…. 320 mg methadone (opiate; 40 mg/d max for opiate dependence) 32 mg clonazepam (Klonopin; Benzo, 20 mg/d max for seizure disorder)

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PSYC650 Psychopharmacology

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  1. PSYC650 Psychopharmacology Drug Interactions and Prescriptive Authority for Psychologists

  2. I got a grip of drugs… • 320 mg methadone (opiate; 40 mg/d max for opiate dependence) • 32 mg clonazepam (Klonopin; Benzo, 20 mg/d max for seizure disorder) • 160 mg temazepam (Restoril; Benzo, 30 mg for insomnia) • 290 mg propranolol (Inderal; Beta Blocker, 640 mg/day max for angina) • 2 tablets of Vicodin of unknown dose (probably 500/5) • Acetominophin and hydrocodone (max 8 tabs/24-h) • 1.5 g “Kind Bud” (Good quality marijuana) • 4 g “Mersh” (Poor quality marijuana) • “Some 151” (Usually rum)

  3. i told u i was hardcore

  4. 0 All Drug interactions are to be avoided • Strongly Agree • Agree • Disagree • Strongly Disagree What about naloxone or disulfiram?

  5. It’s sometimes okay to give/take drugs that you know will have negative interactions • Strongly Agree • Agree • Disagree • Strongly Disagree Careful dosing and timing

  6. Most interactions are immediate • True • False

  7. 0 Which of the following impact the significance of a drug interaction? • Dose • Route of administration • Kidney function • Liver function Actually, it’s all of the above…

  8. 0 To avoid drug interactions, use herbs instead because they are safer and do not interact with medications. • True • False

  9. Herbal Interactions • Black Cohosh • Increased SSRI and TCA ADRs • Ginko Biloba • Potentially dangerous rise in trazodone efficacy (Desyrel; SSRI) • Milk Thistle • Dangerous rise in efficacy and ADRs for “sedatives” • St. John’s Wort • Reduced efficacy in SSRIs • Increased ADRs for TCAs • Increaed ADRs for migraine meds

  10. Dealing with ADRs • Get current and detailed drug histories • Give least possible number of adjuncts • Avoid changing pharmacotherapy • Be careful with narrow TIs • Monitor for interactions whenever changing pharmacotherapy • Keep in touch with prescribers • Keep your patients informed!

  11. Pharmacodynamic Interactions • Occur at the site of action • Alcohol and barbiturates • Anticholinergic compound with drug that has anticholinergic ADRs • Naloxone and Heroin

  12. Pharmacokinetic Interactions: Input • Tetracycline is the classic example • Don’t take with food: cations bind and decrease free drug available • L-DOPA increases absorption • Nutrient • BRAT diet • pH changes • Affect bile secretion • Also goes the other way with foods • Alcohol altering B6 • Anorectics or nausea-inducing drugs • Constipation or diarrhea

  13. Distribution • Lithium and salts • Phenytoin displaces warfarin • Can also create greater concentrations in parts of the body, thus promoting hemorrhage

  14. Output • Enzyme induction • Increases hepatic metabolism • Takes 2-3 weeks to take full effect • Auto-induction (Tegretol & Trileptal) • Enxyme inhibition • MAOIs increase sympathomimetic amines (E, NE) • Prozac occupies enzymes that break down 5-HT (competition for enzymes) • Disufiram and alcohol • Kidney excretion • Competes for renal tubular secretion • Lithium and diuretics • Increases renal salts, decreases Lithium excretion, increases Lithium levels

  15. T’s and Blues • Pentazocine (Talwin; mild opiate) + tripelennamine (antihistamine) • Synergistic effect roughly equivalent to Heroin • Used when Heroin not available • Seizures and death • More prevalent in crowded living arrangements

  16. Phen-Fen • Fenfluramine • 5-HT releaser • Suppresses appetite • Drowsiness • Phentermine • Dopamine agonist • Suppresses appetite • Combats drowsiness

  17. Phen-Fen • 1992 study demonstrated a loss of 30 lbs on average for 121 obese patients • Starting shot for the Phen-Fen craze • No safety studies • Speeds up lungs • Increases gastric juices • Sped up heart rate • Irreversible and reversible pulmonary hypertension • Pulled off the market in 1997 • 24 cases of heart valve damage noted in women who had used Phen-Fen for 1 year

  18. 10 Common ADRs for stimulant medications include: • Weight gain • Apathy • Hallucinations • Insomnia

  19. 10 Your patient on Haldol appears sweaty, more confused than usual, has a high fever, and is experiencing painful muscle rigidity. What’s going on? • Serotonin Syndrome • Serum Sickness • Neuroleptic Malignant Syndrome • Extrapyramidal Side Effects

  20. I feel that, with sufficient training, Psychologists should be permitted the authority to prescribe psychoactive medications. • Strongly Agree • Agree • Disagree • Strongly Disagree

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