Rasool Soltani PharmD BCPS what to do what NOT to do DxTx sympathyempathy differences between professionals patients MRTwwwWin2Farsicom Company Logo Educating Patients ID: 774864
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Slide1
In the name of
GOD
1
Slide2Patients counseling
Rasool Soltani, PharmD, BCPS
Slide3what to do.
what NOT to do!Dx...Txsympathy....empathydifferences between professionals /patients
MRTwww.Win2Farsi.com
Company Logo
Slide4Educating Patients
When educating patients with psychiatric disorders, pharmacists should:inform the patients when they should expect the meds to begin working.inform the patients it may take weeks before the meds cause noticeable improvements in mood. inform patients that long-term therapy may be required to prevent the return of symptoms.
Slide5Educating Patients
When educating patients with psychiatric disorders, pharmacists should:inform the patients never to stop taking their meds abruptly, as withdrawal symptoms may occur.educate the patients not to change the dose without 1st talking to the physician. review the importance of avoiding interacting agents such as alcohol or other CNS depressants.
Slide6Antidepressants
All antidepressants almost the same efficacy. For reasons not yet understood, some people respond better to some antidepressants. Thus, some patients may need to try other antidepressants to find the one that works for them. It is important to take med at an adequate dose and over an extended period of time (often 4 to 6 weeks) to work.
Slide7Antidepressants
Once a patient start taking antidepressants, it is important not to stop them. Sometimes patients feel better and stop taking the meds & symptoms return. When it is time to stop the med, it should be slowly and safely decreased. When the patient stop taking the dose abruptly, withdrawal symptoms may be seen.
Slide8Antidepressants
Some antidepressants may cause more side effects than others. The most common observed side effects listed by the FDA include:Nausea and vomitingWeight gainDiarrheaSleepinessSexual dysfunction
Slide9Serotonin Syndrome
Usually MAOIs Combining SSRIs or SNRIs with one of TriptansLife-threatening conditionSymptoms: Agitationhallucinations high temperatureunusual blood pressure changes
Slide10Adverse effects (TCAs)
Sedation
Memory deficits
Agitation
Anticholinergic
effects
(transient or persistent)
Orthostasis
(
Imipramine
; less with
Nortriptyline
)
Cardiac arrhythmias
Sexual dysfunction
Weight gain
(
Amitriptyline
)
Slide11Adverse effects (SSRIs)
GI complaints
Nausea (transient or persistent)
Diarrhea
Constipation (
Paroxetine
)
CNS disturbances
Insomnia (
Fluoxetine
,
Sertraline
)
Sedation (
Paroxetine
)
EPS:
akatisia
,
dystonias
,
pakinsonism
Slide12Adverse effects
Sexual dysfunction
Not transient
Fluoxetine
,
Paroxetine
Headache
Dry mouth
Sweating
Weight gain
Teeth grinding
Slide13Slide14Slide15Antipsychotics
Certain symptoms (e.g. feeling agitated and having hallucinations) usually go away within days of starting an antipsychotic meds. Symptoms like delusions usually go away within a few weeks.Full effects of the meds may not be seen for up to six weeks.
Slide16Antipsychotics
Some people may develop a relapse. Usually relapses happen when people stop taking their meds, or when they only take it occasionally. Some patients stop taking the meds because they feel better & think they don't need them anymore, but anti-psychotics should not be discontinued without consulting a physician.
Slide17Antipsychotics
Many patients stay on antipsychotics continuously for months or years in order to control the symptoms, however treatment should be personalized for each individual.
Slide18Antipsychotics
Typical antipsychotic medications can cause additional side effects related to physical movement, such as:RigidityPersistent muscle spasmsTremorsRestlessness
Slide19Antipsychotics
Long-term use of typical antipsychotics may lead to tardive dyskinesia (TD). TD causes muscle movements, commonly around the mouth, that a person can't control. TD can range from mild to severe, and in some patients it cannot be cured. Sometimes people with TD have partial or full recovery after stopping to take typical antipsychotics. TD rarely occurs while taking atypical antipsychotics.
Slide20Adverse Effects
Autonomic nervous system:
Loss of accommodation, dry mouth, difficulty urinating, constipation,
o
rthostatic hypotension, impotence, failure to ejaculate
Central nervous system:
Parkinson's syndrome,
akathisia
,
dystonias
,
Tardive
dyskinesia
Slide21Torticollis
Slide22Retrocollis
Slide23Trismus
Slide24Tongue protrusion
Slide25Oculogyric crisis
Slide26Blepharospasm
Slide27Slide28Slide29Adverse Effects
Endocrine system:
Hyperprolactinemia
(Amenorrhea,
galactorrhea
, infertility, impotence)
Weight gain (Possibly combined H
1
and 5-HT
2c
blockade)
Other:
Seizures: chlorpromazine,
clozapine
Cardiac arrhythmia
Slide30Slide31Slide32Adverse Effects
Toxic or Allergic Reactions:
cholestatic
jaundice and skin eruptions
Agranulocytosis
:
clozapine
Ocular Complications:
Deposits in the cornea and lens:
chlorpromazine
retinal deposits:
thioridazine
(
browning
of vision)
Slide33Tardive dyskinesia
a late-occurring syndrome of abnormal
choreoathetoid
movements
relative cholinergic deficiency secondary to
supersensitivity
of dopamine receptors
20–40% of chronically treated patients
Early recognition is important
sometimes self-limited
Slide34Tardive dyskinesia
movements of the tongue
Lateral jaw movements
frequent blinking, grimacing
Restless
choreiform
(irregular spasmodic) or distal
athetosis
(slow, writhing movement) of limbs:
twisting, spreading, flexion (bending) and extension of fingers, toe tapping, and toe
dorsiflexion
Slide35Tardive dyskinesia
to discontinue
or
reduce the dose
of the current antipsychotic agent
switching to
quetiapine
or
clozapine
to eliminate all
anticholinergics
action
If they fail, the addition of diazepam (30–40 mg/day)
Valproate
Clonidine
Vit
E
Slide36Neuroleptic Malignant Syndrome(NMS)
life-threatening disorder
in patients who are extremely sensitive to the
extrapyramidal
effects of antipsychotic agents
muscle rigidity
fever
autonomic instability (altered blood pressure and pulse rate)
stress
leukocytosis
Slide37Neuroleptic Malignant Syndrome(NMS)
Management:
Muscle relaxants:
diazepam
,
dantrolene
, or dopamine agonists, such as
bromocriptine
Switching to an atypical drug after recovery
Slide38Mood Stabilizers
If a patient with bipolar disorder is on lithium (Li), blood levels of Li and kidneys and thyroid function should be checked regularly. Li is eliminated through the kidneys, so the dose should be lower in older people. Water loss (e.g. through sweating or diarrhea): Li level, necessitating a temporary lowering of the daily dose.
Slide39Pregnancy
While no med is considered perfectly safe for all women at all stages of pregnancy, this must be balanced for each woman against the fact that untreated serious mental disorders can pose a risk to both pregnant woman and fetus. Meds should be selected based on available scientific research & be taken at the lowest possible dose.
Slide40Pregnancy
The following should be avoided during pregnancy:Mood stabilizers are known to cause birth defects. Benzodiazepines and Li have been shown to cause "floppy baby” syndrome (i.e. baby is drowsy, limp, and cannot breathe or feed well). BZPs birth defects or other infant problems, esp if taken during the 1st trimester.
Slide41Pregnancy
SSRIs are considered to be safe during pregnancy. Antidepressants do cross the placental barrier and may reach the fetus. Birth defects or other problems are possible, but are very rare. Effects of antidepressants on childhood development remain under study.
Slide42Pregnancy
Studies have found that fetuses exposed to SSRIs during 3rd trimester may be born with withdrawal symptoms.These symptoms in babies are generally mild and short-lived & no deaths have been reported. Risks from the use of antidepressants need to be balanced with the risks of stopping meds; in many cases: it mean you must continue the medications.
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