Clinician’s Guide to Psychopharmacology

Foreword......Page 5
Preface......Page 6
Legal Disclaimer......Page 7
Acknowledgments......Page 8
Contents......Page 9
About the Author......Page 21
1.3.1.2 Give Examples of How Drugs Cross Gut Wall?......Page 23
1.3.1.5 List Different Mechanisms by Which Drugs Cross the Gut Wall?......Page 24
1.3.2.1 Why Drug Distribution Is Important?......Page 25
1.3.3 Metabolism (Drug Biotransformation)......Page 26
1.3.3.3 What Are the Metabolic Processes Involved in the Hepatic Elimination of Drugs?......Page 27
Dosing in Liver Disease......Page 28
1.3.4.1 What Are the Routes of Excretion?......Page 29
1.3.4.2 What Are the Factors Affecting Renal Excretion?......Page 30
1.4.1.1 Definitions......Page 31
1.5.2 Describe the Grouping of Errors According to Reason’s Model of Accident Causation?......Page 34
1.5.5.1 Absorption Developmental Changes Include the Following......Page 35
1.5.5.4 Distribution......Page 36
1.5.9 List Some of the Risk Factors Related to Adverse Drug Reactions?......Page 37
1.5.10 Tips for Preventing Medication Errors......Page 38
2.1 How Does ICD-10 Classify the Depressive Disorders?......Page 39
2.3.1 Introduction......Page 40
2.3.4 What Are the Adverse Effects of MAOIs?......Page 41
2.3.7 What Are Some of the Key Points in Educating Patients on MAOIs?......Page 42
2.4.2 Describe the Mechanism of Action and Pharmacokinetics of TCA?......Page 43
2.4.2.4 Protriptyline......Page 44
2.4.4 What Are the Adverse Effects of TCAs?......Page 45
2.5.1 What Are the Indications of SSRIs?......Page 46
2.5.3 What Is the Dosing and Monitoring Requirements of SSRIs?......Page 47
2.5.4 Describe Some of the Adverse Effects of SSRIs?......Page 48
2.5.8 What Are Some of the Possible Strategies that May Be Useful in the Management of Sexual Dysfunction with SSRIs?......Page 49
2.5.10 What Are the Recommendations of the SSRI Use in Pregnancy and Lactation?......Page 50
2.6.1 Give Examples of SNRIs?......Page 51
2.6.4 Describe the Mechanism of Action of SNRIs?......Page 52
2.6.6 What Are the Dosing Requirements of SNRIs?......Page 53
2.6.7 What Are the Adverse Effects of SNRIs?......Page 54
What Is the Mechanism of Action of Bupropion (BPR)?......Page 55
What Are the Adverse Effects, Warning, and Contraindications of Bupropion (BPR)?......Page 56
2.7.4 What Is the Mechanism of Action and Pharmacokinetics of Trazodone?......Page 57
2.7.8.1 Nefazodone......Page 58
Drug Interactions......Page 59
What Is the Mechanism of Action and Therapeutic Use of Reboxetine?......Page 60
Drug Interactions......Page 61
2.8.1.1 Nonstimulant Medication Used in Treatment of ADHD......Page 62
2.8.1.4 Describe the Dosing and Monitoring Requirements of Atomoxetine?......Page 63
2.9.1.1 What Is the Mechanism of Action and Pharmacokinetics of Mianserin?......Page 64
2.9.1.4 What Are the Recommendations of Mianserin Use in Pregnancy and Lactation?......Page 65
Metabolism......Page 66
2.9.2.6 What Are Some of the Drug Interactions of Mirtazapine?......Page 67
2.10.3 Describe the Pharmacokinetics of Vortioxetine (Trintelix)?......Page 68
2.11.1.1 What Is the Mechanism of Action and Pharmacokinetics of Vilazodone (Vilbryd)?......Page 69
2.11.1.4 List Some of the Main Adverse Effects of Vilazodone (Vilbryd)?......Page 70
2.12.2.1 Dosage and Administration......Page 71
2.12.2.5 Warnings and Precaution......Page 72
2.12.2.9 Metabolism......Page 73
2.12.6 What Are Some of the Drug Interactions of Antidepressants?......Page 74
2.12.7 Describe the Differences Among Antidepressants with Respect to Their Effect on Sexual Function (Table 2.6)?......Page 75
References......Page 76
Further Reading......Page 77
3.2 What Is the Mechanism of Action of ECT?......Page 80
3.4 Other Indications......Page 81
3.7 How Many Treatments Should Be Considered for a Usual Course of ECT?......Page 82
3.10 How Do you Manage Medications and Medical Conditions Prior to ECT?......Page 83
3.11.2 Pacemakers and Dysrhythmias......Page 84
3.11.8 Cerebrovascular Disease......Page 85
3.12 Describe the Agents Used in Anesthesia in ECT?......Page 86
3.14 Other Agents......Page 87
3.18 Anterograde Memory Dysfunction (AMD)......Page 88
3.21 What Are the Autonomic Nervous System Changes that Occur While Delivering the Electric Stimulation in ECT?......Page 89
3.22 What Are the Stimulus Characteristics in ECT?......Page 90
3.25 Describe the Selection of the Dosing of the Electric Stimulus in ECT?......Page 91
3.26 Describe the Impedance or Resistance in ECT?......Page 92
3.28 Describe the Different Electrode Placement Locations in ECT?......Page 93
3.30 What Are the Regular Procedures in ECT?......Page 94
3.31 How to Monitor the Seizure in ECT?......Page 95
References......Page 96
Further Reading......Page 97
4.2 Is Bipolar Disorder (BD) Underdiagnosed or Overdiagnosed?......Page 99
4.3.1 Combination Therapy......Page 100
4.4 ICD 10 Classification of Mood Disorders......Page 101
4.5.1 What Is the History of Using Lithium in Bipolar Disorder?......Page 102
4.5.3 What Are the Psychiatric Indications for Lithium?......Page 103
Factors that Can Alter Blood Levels......Page 104
4.5.6 Responsiveness to Lithium Has Been Inferior Among the Following......Page 105
4.5.7 What Are the Adverse Effects of Lithium?......Page 106
4.5.8 Lithium Toxicity......Page 107
4.5.9.3 Pregnancy......Page 108
4.5.10 What Are Some of the Key Points in Educating Patients on Lithium?......Page 109
4.6.2 What Is the Mechanism of Action of Valproate?......Page 110
4.6.5 What Are the Adverse Effects of Valproate?......Page 111
4.6.8 What Are the Recommendations of Valproate Use in Pregnancy and Lactation?......Page 112
4.6.10 What Are the Possible Predictors of Response to Valproate?......Page 113
4.7.3 What Are the Psychiatric Indications for Lamotrigine?......Page 114
4.7.5 Describe the Pharmacokinetics of Lamotrigine?......Page 115
4.7.7 What Are the Adverse Effects, Warning, and Contraindications of Lamotrigine?......Page 116
4.7.9 What Are the Features Suggestive of Malignant Rash with Lamotrigine?......Page 117
4.8.2 Describe the Pharmacokinetics Carbamazepine?......Page 118
4.8.4.2 Dose and Monitoring......Page 119
4.8.6.1 Adverse Effects......Page 120
4.8.8 What Are the Possible Dose-Related Adverse Effects?......Page 121
4.8.10 What Are the Recommendations of Carbamazepine Use in Pregnancy and Lactation?......Page 122
4.9.2 What Are the Psychiatric Indications for Oxcarbazepine?......Page 123
4.9.4 What Is the Dosing and Monitoring Requirements for Oxcarbazepine?......Page 124
4.9.7 What Are the Specific Management Strategies of Adverse Effects of Mood Stabilizers?......Page 125
References......Page 128
Further Reading......Page 130
5.2 What Are the Common Indications for Antipsychotics?......Page 132
5.3.2 What Is the Mechanism of Action and Classification of Typical Antipsychotics?......Page 133
5.3.3 What Are the Major Adverse Effects of FGA Antipsychotics?......Page 134
5.3.4 Describe the Extrapyramidal Side Effects with High-Potency Typical Antipsychotics?......Page 135
5.3.7 Describe the Suggested Monitoring Prior to and during Treatment with FGAs?......Page 137
5.3.9 Compare FGA Equivalent Doses?......Page 138
5.4.2.1 How to Start and Maintain Patients on Oral Haloperidol?......Page 139
5.4.4.1 List Some of the Second-Generation or Atypical Antipsychotics?......Page 140
5.4.4.2 What Are the Proposed Mechanisms of Action of Atypical Antipsychotics that Were Modified by Horacek et al., in 2006?......Page 141
5.4.4.5 Describe the Suggested Monitoring Prior to and During Treatment with Atypical Antipsychotics?......Page 142
Aripiprazole (ABILIFY)......Page 143
5.4.5 Paliperidone (Invega): Oral Formulation......Page 144
5.4.6.1 Dosing Information......Page 145
5.4.8 Ziprasidone (Geodon)......Page 146
5.5.1 Lurasidone (LATUDA)......Page 147
5.5.1.2 Significant Drug-Drug Interactions......Page 148
5.5.4 Aripiprazole (ABILIFY)......Page 149
5.5.8 Risperidone (Risperdal)......Page 150
5.5.10.2 List the Adverse Effects of Clozapine......Page 151
5.5.10.4 Describe Clozapine Monitoring Based on Lab Results?......Page 152
5.7 Describe the Product Attributes of Paliperidone Palmitate?......Page 153
5.10 List the Warning and Precautions Associated with Atypical Antipsychotics?......Page 154
5.11 What Is the Impact of Antipsychotics on the Risk of Thromboembolism?......Page 155
5.13 Describe the Possible Mechanism of Sialorrhea During Treatment with Antipsychotics and Possible Pharmacological Management Strategies?......Page 156
5.15 Describe the Metabolic Syndrome with Atypical Antipsychotics?......Page 157
5.18 Type 2 Diabetes......Page 158
5.19.1 QTc Interval Prolongation......Page 159
5.20 What Are the Manifestations of Overdose of Atypical Antipsychotics? (Table 5.7)......Page 160
5.21 Describe the Additional Risk of Antipsychotic Treatment in Patients with Schizophrenia during Pregnancy and Lactation?......Page 161
References......Page 162
Further Reading......Page 163
6.2 General Recommendations......Page 165
6.3.1 General Information About Stimulant Medications......Page 166
6.3.2 Amphetamine-Based Psychostimulants......Page 168
6.4.1 Adderall XR® (Mixed Amphetamine Salts) (Source: CADDRA)......Page 169
6.4.2 Biphentin® (Source: CADDRA)......Page 170
6.5.2 Warnings and Precautions......Page 171
6.5.3 Adverse Events......Page 172
6.6 Dexedrine® and Dexedrine® Spansules (DEX)......Page 173
6.8.1 Product Summary......Page 174
6.9.1 Atomoxetine HCI: ATX Strattera® (ATX)......Page 177
6.10.2 Clonidine......Page 178
6.10.4 Modafinil (Alertec®)......Page 179
6.11.2 Contraindications to Atomoxetine (Strattera)......Page 180
6.11.5 Main Potential Drug Interactions for Atomoxetine (Strattera)......Page 181
6.13 Drug Interactions......Page 182
6.16 Management of Adverse Events of ADHD Medications......Page 183
6.17 Management of Side Effects......Page 184
6.19.2 ADHD Medication Effect Size......Page 188
6.20.1 What Is the General Approach to Pharmacotherapy for Borderline Personality Disorder (BPD)?......Page 190
6.20.3 What Are the Treatment Considerations in Comorbid ADHD and Anxiety Disorders?......Page 191
6.20.5 What Are the Specific Tapering Recommendations to Stop Atomoxetine and What Are the Withdrawal Symptoms?......Page 192
6.20.8 Describe Some of the Controversial Management Considerations that Clinicians Face when Using ADHD Medications in Individuals with ADHD and Addictions?......Page 193
6.20.9 Describe Some of the Factors that Help Make the Decision of How Long to Wait for SUD to Be Under Control Before Initiating Pharmacological Treatment of ADHD?......Page 194
6.20.12 What Are the Treatment Recommendations for Substance-Abusing Patients with ADHD?......Page 195
6.20.13.1 Atomoxetine......Page 196
6.20.14 What Do I Tell Patients and Families when Asked About Suicide and ADHD Medication?......Page 197
6.20.15.2 Neuroleptics......Page 198
6.20.16.1 Possible New Medications for ADHD (Investigational or Emerging)......Page 199
References......Page 200
Further Reading......Page 202
7.1 Describe Some of the Clinical Guidelines in the Evaluation and Pharmacological Management of Insomnia?......Page 208
7.2 Explain the Pharmacology of Nonbenzodiazepine Hypnotics?......Page 209
7.3 Describe the Pharmacology of Zolpidem [12–14]?......Page 210
7.3.1 Administration......Page 211
7.3.2 Monitoring......Page 212
7.4.1.1 Mechanism of Action......Page 213
7.4.3 Long Half-Life vs. Short Half-Life......Page 214
7.4.5 Midazolam Versed......Page 215
References......Page 216
8.1 Acetylcholinesterase Inhibitors (AChEIs)......Page 217
8.3.2 Donepezil and Galantamine......Page 218
8.3.4 Memantine N-Methyl-D-Aspartate Receptor Antagonist......Page 219
8.4 Potential Drug Interactions......Page 220
8.5 Overview on the Treatment of Frontotemporal Dementia (FTD)......Page 223
References......Page 224
9.2 What Are the Classes of Analgesics?......Page 226
9.3 Classification of Opioid by the Synthetic Process......Page 227
9.4 What Is the Starting Dose of Each Opioid Drug?......Page 229
9.5 How to Switch Opioids?......Page 230
9.7.1.2 Naltrexone (FDA Approved)......Page 231
9.7.2.2 Topiramate (TOPAMAX®) [7]......Page 232
9.7.2.4 Nalmefene [9]......Page 233
References......Page 234
Appendix 1......Page 235
Appendix 2: Pharmacology and Therapeutics Web Resources......Page 238