Medication Related Problems

When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.

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Psychoactive Medications

10.2310/tywc.4335 ◽

2019 ◽

Author(s):

Mark J Neavyn ◽

Kavita M Babu

Keyword(s):

Serotonin Syndrome ◽

Lithium Concentration ◽

Signs And Symptoms ◽

Mood Stabilizers ◽

Prescription Drug Use ◽

Definitive Therapy ◽

Principal Source ◽

The Central Nervous System ◽

Sedative Hypnotics ◽

Psychoactive Medications

Psychoactive medications are defined as medications that affect the central nervous system neurotransmitter pathways with the intention to modulate mood or consciousness. This broad category of medications includes sedative-hypnotic agents such as benzodiazepines and barbiturates, antidepressants, neuroleptics, and mood stabilizers. The principal source of exposure for these medications is through prescription drug use and misuse. This review discusses the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to sedative-hypnotics, antidepressants, neuroleptics, and lithium. Tables include common benzodiazepine and barbiturate compounds, dosing instructions for multidose activated charcoal, flumazenil dosing recommendations, commonly available tricyclic and atypical (noncyclic) antidepressants, dosing recommendations for sodium bicarbonate in serum alkalinization, benzodiazepine dosing recommendations in serotonin syndrome, dosing recommendations for cyproheptadine, signs and symptoms that differentiate neuroleptic malignant syndrome from serotonin syndrome, and indications for renal replacement therapy based on lithium concentration and clinical setting. Figures show action potentials in the His-Purkinje syndrome, an electrocardiogram tracing demonstrating a terminal R wave, and a QT interval nomogram. This review contains 2 highly rendered figures, 9 tables, and 101 references.

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Psychoactive Medications

10.2310/em.4335 ◽

2015 ◽

Author(s):

Mark J Neavyn ◽

Kavita M Babu

Keyword(s):

Serotonin Syndrome ◽

Lithium Concentration ◽

Signs And Symptoms ◽

Mood Stabilizers ◽

Prescription Drug Use ◽

Definitive Therapy ◽

Principal Source ◽

The Central Nervous System ◽

Sedative Hypnotics ◽

Psychoactive Medications

Psychoactive medications are defined as medications that affect the central nervous system neurotransmitter pathways with the intention to modulate mood or consciousness. This broad category of medications includes sedative-hypnotic agents such as benzodiazepines and barbiturates, antidepressants, neuroleptics, and mood stabilizers. The principal source of exposure for these medications is through prescription drug use and misuse. This review discusses the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to sedative-hypnotics, antidepressants, neuroleptics, and lithium. Tables include common benzodiazepine and barbiturate compounds, dosing instructions for multidose activated charcoal, flumazenil dosing recommendations, commonly available tricyclic and atypical (noncyclic) antidepressants, dosing recommendations for sodium bicarbonate in serum alkalinization, benzodiazepine dosing recommendations in serotonin syndrome, dosing recommendations for cyproheptadine, signs and symptoms that differentiate neuroleptic malignant syndrome from serotonin syndrome, and indications for renal replacement therapy based on lithium concentration and clinical setting. Figures show action potentials in the His-Purkinje syndrome, an electrocardiogram tracing demonstrating a terminal R wave, and a QT interval nomogram. This review contains 2 highly rendered figures, 9 tables, and 101 references.

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Psychoactive Medications

10.2310/im.4335 ◽

2015 ◽

Author(s):

Mark J Neavyn ◽

Kavita Babu

Keyword(s):

Serotonin Syndrome ◽

Lithium Concentration ◽

Signs And Symptoms ◽

Mood Stabilizers ◽

Prescription Drug Use ◽

Definitive Therapy ◽

Principal Source ◽

The Central Nervous System ◽

Sedative Hypnotics ◽

Psychoactive Medications

Psychoactive medications are defined as medications that affect the central nervous system neurotransmitter pathways with the intention to modulate mood or consciousness. This broad category of medications includes sedative-hypnotic agents such as benzodiazepines and barbiturates, antidepressants, neuroleptics, and mood stabilizers. The principal source of exposure for these medications is through prescription drug use and misuse. This review discusses the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to sedative-hypnotics, antidepressants, neuroleptics, and lithium. Tables include common benzodiazepine and barbiturate compounds, dosing instructions for multidose activated charcoal, flumazenil dosing recommendations, commonly available tricyclic and atypical (noncyclic) antidepressants, dosing recommendations for sodium bicarbonate in serum alkalinization, benzodiazepine dosing recommendations in serotonin syndrome, dosing recommendations for cyproheptadine, signs and symptoms that differentiate neuroleptic malignant syndrome from serotonin syndrome, and indications for renal replacement therapy based on lithium concentration and clinical setting. Figures show action potentials in the His-Purkinje syndrome, an electrocardiogram tracing demonstrating a terminal R wave, and a QT interval nomogram. This review contains 2 highly rendered figures, 9 tables, and 101 references.

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Drug-Drug Interaction between Psychiatric Medications and Experimental Treatments for Coronavirus Disease-19: A Mini-Review

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5010 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 216-228

Author(s):

Hananeh Baradaran ◽

Nazanin Gorgzadeh ◽

Houman Seraj ◽

Anahita Asadi ◽

Danial Shamshirian ◽

...

Keyword(s):

Mental Illness ◽

Drug Interaction ◽

Severe Acute Respiratory Syndrome ◽

Clinical Care ◽

Mood Stabilizers ◽

Care Staff ◽

Experimental Drugs ◽

The World ◽

Sedative Hypnotics ◽

Experimental Treatments

The pandemic of coronavirus disease (COVID)-2019 has been affected many people all around the world. Patients with mental disorders are not as safe as others; also, they might be more vulnerable in such situations. These patients take various medications, which can lead to numerous drug-drug interactions with experimental drugs uses against COVID-19. According to the potential critical interactions, we reviewed the reputable databases to find the interactions between main categories of psychiatric medications (e.g., antidepressants, anti-psychotics, sedative/hypnotics, and mood stabilizers) when used in concomitant with COVID-19 experimental agents (e.g., hydroxychloroquine, lopinavir/ritonavir, atazanavir, and chloroquine). We hope the list provided in this review helps the clinical care staff in treating patients with mental illness infected with severe acute respiratory syndrome coronavirus 2 during the COVID-19 pandemic.

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Psychopharmacological Agents, Side Effects, and Black Box Warnings

10.1093/med/9780199374656.003.0015 ◽

2017 ◽

Author(s):

Manish A. Fozdar ◽

Jacob C. Holzer

Keyword(s):

Side Effects ◽

Elderly Population ◽

Treatment Options ◽

Management Strategies ◽

The Elderly ◽

Mood Stabilizers ◽

Pharmacological Management ◽

Risk Management Strategies ◽

Black Box Warnings ◽

Sedative Hypnotics

From a medical-legal viewpoint, psychopharmacological management in the elderly population requires a multifaceted, comprehensive approach, involving a detailed clinical diagnostic assessment, an awareness of a patient’s current medical status, risk factors, and an understanding of the risks and benefits of various treatment options. Several risk management strategies can be employed as part of the treatment process, which are reviewed in this chapter. Special attention is needed in the pharmacological management of the elderly population with respect to efficacy and risk as well as polypharmacy. It is important that clinicians have a broad understanding of the different medication classes, including antidepressants, antipsychotics, mood stabilizers, cognitive-enhancing medications, benzodiazepines, sedative-hypnotics, and stimulants; specific agents; indications; kinetics; and side effects in both the clinical management of elderly patients and in medical-legal consultation.

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Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits

BMJ ◽

10.1136/bmj.38623.768588.47 ◽

2005 ◽

Vol 331 (7526) ◽

pp. 1169 ◽

Cited By ~ 603

Author(s):

Jennifer Glass ◽

Krista L Lanctôt ◽

Nathan Herrmann ◽

Beth A Sproule ◽

Usoa E Busto

Keyword(s):

Older People ◽

Meta Analysis ◽

Risks And Benefits ◽

Sedative Hypnotics

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Claims Data Studies of Sedative-Hypnotics and Hip Fractures in Older People: Exploring Residual Confounding Using Survey Information

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2005.53303.x ◽

2005 ◽

Vol 53 (6) ◽

pp. 948-954 ◽

Cited By ~ 35

Author(s):

Sebastian Schneeweiss ◽

Philip S. Wang

Keyword(s):

Older People ◽

Hip Fractures ◽

Claims Data ◽

Sedative Hypnotics ◽

Residual Confounding

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PATTERNS OF PSYCHOACTIVE MEDICATION USE IN COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES IN 2015

Innovation in Aging ◽

10.1093/geroni/igz038.2608 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S710-S710

Author(s):

Rashmita Bajracharya ◽

Danya Qato

Keyword(s):

Older Adults ◽

Low Income ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Community Dwelling ◽

Medical Expenditure ◽

Cross Sectional ◽

Psychoactive Medication ◽

Community Dwelling Older Adults ◽

Psychoactive Medications

Abstract Per the 2015 Beer’s Criteria, most psychoactive medications are identified as potentially inappropriate for use in older adults as this population is especially vulnerable to the potential adverse effects associated with psychoactive medications, including sedation, anticholinergic effects, and falls. Past studies found increasing use of psychoactive medications in community-dwelling older adults; however, patterns of use by other sociodemographic, socioeconomic, and clinical subgroups have not been explored. This is a cross-sectional analysis of 2015 Medical Expenditure Panel Survey in a sample of 6122 older adults (60-85 years). We utilized Andersen’s Behavioral Model of Health Services Utilization to guide logistic regression model development and estimated odds ratios (OR) with 95% confidence intervals (CI) to quantify the association between psychoactive use and predisposing(sex and race); enabling(marital status, education, poverty, insurance); and need-based[multi-morbidity and activities of daily living (ADL) limitations] factors. Over 30% of older adults in the U.S. reported taking a psychoactive medication in 2015. Prevalence of use was significantly higher in women (35.9%), the unmarried(34.1%), low-income(35.7%), white(34.0%), multimorbid (32.0%), and ADL limitation groups (45.9%) compared to men, married, high-income, other races, not multimorbid, and no ADL limitations groups, respectively. Female sex [OR=1.62(1.38-1.91)], low-income [OR=1.30(1.04-1.6)], multimorbidity [OR=3.2(2.6-3.9)], and ADL limitations [OR=2.2(1.7-2.8)] were identified as independent predictors of psychoactive use. There is differential use of psychoactive medications by sociodemographic, socioeconomic, and clinical factors. Given the increased complexity of pharmacotherapy regimens, especially in those with multimorbidity and ADL limitations, improved efforts aimed at prudent use of psychoactive medications should be intensified.

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The Fundamentals of Brain Neurotransmission

10.1093/med/9780199362318.003.0002 ◽

2018 ◽

Author(s):

Robert O. Friedel ◽

Stephen M. Stahl

Keyword(s):

Synaptic Transmission ◽

Personality Disorders ◽

Pharmacological Treatment ◽

Brain Function ◽

Mechanisms Of Action ◽

Mood Stabilizers ◽

Neurotransmitter Systems ◽

Psychoactive Medications

This chapter outlines the fundamental principles underlying neuroscience, particularly as it relates to neurotransmission and neuropharmacology. It then reviews and synthesizes of the role of different neurochemical and neurotransmitter systems that underlie brain function and synaptic transmission, including GABA, glutamate, serotonin, dopamine, norepinephrine, acetylcholine, and histamine. In addition, it describes various psychoactive medications are used in the treatment of personality disorders, such as mood stabilizers and antipsychotics. Moreover, it describes how these agents target these systems by describing their different mechanisms of action. It provides a primer to better understand the pathophysiology and pharmacological treatment of personality disorders discussed in the book.

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