psyc650 psychopharmacology drug interactions and prescriptive authority for psychologists
TRANSCRIPT
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PSYC650 Psychopharmacology
Drug Interactions and Prescriptive Authority for
Psychologists
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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)
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i told u i was hardcore
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All Drug interactions are to be avoided
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1. Strongly Agree2. Agree3. Disagree4. Strongly
DisagreeWhat about naloxone or disulfiram?
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It’s sometimes okay to give/take drugs that you know will have negative
interactions
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Disagree
Careful dosing and timing
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Most interactions are immediate
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Which of the following impact the
significance of a drug interaction?
Dose
Route
of a
dmin
istra
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Kid
ney fu
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Liv
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40%
20%
0%
40%1. Dose2. Route of
administration3. Kidney function4. Liver function
Actually, it’s all of the above…
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To avoid drug interactions, use herbs instead because they are safer and do not
interact with medications.
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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
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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!
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Pharmacodynamic Interactions
• Occur at the site of action• Alcohol and barbiturates• Anticholinergic compound with drug
that has anticholinergic ADRs• Naloxone and Heroin
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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
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Distribution
• Lithium and salts• Phenytoin displaces warfarin
– Can also create greater concentrations in parts of the body, thus promoting hemorrhage
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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
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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
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Phen-Fen
• Fenfluramine– 5-HT releaser– Suppresses appetite– Drowsiness
• Phentermine– Dopamine agonist– Suppresses appetite– Combats drowsiness
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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
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Common ADRs for stimulant
medications include:1. Weight gain2. Apathy3. Hallucinations4. Insomnia
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Your patient on Haldol appears sweaty, more confused than usual,
has a high fever, and is experiencing painful muscle rigidity. What’s going on?
Ser
otonin
Syn
drom
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Ser
um S
ickn
ess
Neu
role
ptic M
alig
nan...
Ext
rapyr
amid
al S
ide
E...
25% 25%25%25%1. Serotonin Syndrome
2. Serum Sickness3. Neuroleptic
Malignant Syndrome
4. Extrapyramidal Side Effects
1010
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I feel that, with sufficient training, Psychologists should be permitted the authority to
prescribe psychoactive medications.
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25% 25%25%25%1. Strongly Agree2. Agree3. Disagree4. Strongly
Disagree
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