7/6/2011
Medications: The Basics
David Gardner, PharmD, MSc Jonathan Melong Jonathan Melong
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Declaration We don’t know what you know We don’t know what you do day to day We don’t know what you want to know But…. We know stuff about medication and mental illness
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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“Top of Mind� Issues Side effects T Target tS Symptoms t Time to onset Chance of benefiting/being harmed Interaction with licit and illicit substances Monitoring Tools/resources Case Examples
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Medications for Mental Illness and Symptoms
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Antidepressants Uses
Time to See Effect
Common Side Effects
Serious Side Effects
Other
• Depression • Anxiety disorders • Obsessive compulsive disorder • Panic disorder, • Eating disorders • Sleep problems
• Improved sleep, appetite, energy: 2‐4 weeks • Depressed mood, loss of pleasure, pessimism, irritability: 4‐8 irritability: 4 8 weeks • Return of functioning: months
• Sedation • Headache • Dizziness • Dry mouth • Nausea, vomiting and diarrhea • Sweating
• Thoughts of hurting oneself or suicide • Abnormal bleeding • Serotonin syndrome (rapid onset of fever, sweating, problems with reflexes, with reflexes, shaking, problems with balance and movements, and confusion)
• Health providers should be informed about thoughts of hurting oneself or suicide. • Can produce side effects/ withdrawal withdrawal reaction when stopped quickly
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Antidepressants: Common Side Effects
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Antidepressants
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Antipsychotics Uses
Time to See Effect Common Side Effects
Serious Side Effects
Other
•Positive symptoms of psychosis (hallucinations and delusions) • Psychotic illnesses such as schizophrenia, delusional disorders disorders, psychotic depression, mania, and Tourette’s syndrome. • Aggression
• Hyperactivity, hostility, agitation and aggression: 1 week • Delusions, hallucinations: 4‐8 weeks • Negative symptoms (eg. like a lack of like a lack of interest in life): months
• Severe muscle spasms. • Neuroleptic Malignant Syndrome (stiff muscles, sudden confusion, high fever, irregular blood pressure and heart rate) and heart rate) • Seizures • Movement Problems
• Although symptoms may resolve in weeks, patients will be on these medications for years or possibly for their entire life to prevent relapse.
• Sedation • Headache • Dry mouth • Constipation • Weight gain • Sexual dysfunction
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7/6/2011
Antipsychotics: Common Side Effects
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Mood Stabilizers Uses
Time to See Effect Common Side Effects
• Bipolar disorder • Acute mania: • Agitation 7‐28 days • Aggression • Antidepressant effects: 6‐8 weeks
• Sedation • Headache • Dizziness • Nausea, vomiting and diarrhea • Weight gain • Tremor • Increased Thirst
Serious Side Effects
Other
• Blood problems; may present as bleeding or bruising easily. • Severe skin rash with fever
• Patients will likely be on medications for life • Some mood stabilizers can interact with medication sold without a prescription (e.g. i ti ( pain relievers like Advil)
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
Mood Stabilizers: Common Side Effects
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Stimulants Uses
Time to See Effect Common Side Effects
• Attention Deficit A i D fi i Hyperactivity Disorder (ADHD) • Aggression • Help with social interactions
• Efficacy can be Effi b seen right away with the first dose (within 1 hour) • Non‐stimulants used to treat ADHD can take longer (2‐4 weeks)
• Headache H d h • Insomnia • Irritability • Nausea, vomiting and diarrhea • Decreased appetite
Serious Side Effects
Other
• Fast or F pounding heart beat. • Weight loss • Slowed growth • Tics or abnormal movements • Hallucinations
• If problem with If bl ih early morning symptoms – other options may be available • If reduced appetite or weight loss – recommend high calorie snacks or calorie snacks or take after meal • If swallowing is a problem – some medications can be dissolved in water
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7/6/2011
Stimulants: Common Side Effects
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Anti-anxiety and Sleep Medications Uses
Time to See Effect
Common Side Effects
Serious Side Effects
Other
• Sleep • Anxiety • Agitation • Treat side effects of antipsychotics.
• Antidepressants: 4‐8 weeks • Benzodiazepines: 1‐2 hrs; however they are not recommended for long term use
• Sedation • Headache • Dizziness • Dry mouth • Nausea, vomiting and diarrhea • Sweating
• Seizures • Confused thinking •Thoughts of hurting oneself or suicide • Abnormal bleeding bleeding • Serotonin syndrome
• Can produce side effects/ withdrawal reaction when stopped quickly • Activities that require quick thinking and reaction (e.g. driving, bike riding, snowboarding, snowboarding, skateboarding, etc.) can be very dangerous while taking these medications.
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7/6/2011
Anti-anxiety & Sleep Medications: Common Side Effects
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Symptom Tracker
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Side Effect Tracker
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Activity Tracker
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Can side effects of the medication interfere with school work? Sedation and Drowsiness A common side effects of many drugs that treat mental illnesses. Can vary from slight sedation to some patients sleeping >18 hrs a day
Cognitive Impairment Difficulty concentrating Difficulty paying attention Memory impairment – verbal memory impairment Retrograde amnesia
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
How do you know if a patient is dose too high/too low? A patient may be dosed too high if…. They are highly sedated – look like a zombie Have problem with movements – moving too slowly, have trouble initiating movement, have abnormal movements, tics Face shows little to no emotion
A patient may be dosed too low if…. Only have a partial response to the medication – the medication has helped, but only a little
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Are these medications addictive? NO! Addiction is when: There is psychological dependence – want the drug even though they don’t need it and/or know that it is harming them. Drug seeking behavior is related to getting “a high”.
Medications can cause physical dependence Body gets used to the medication – abruptly stopping the medication can cause unwanted side-effects. Not unique to drugs that treat mental illness – eg. Beta-blockers
Taking these medications have not been shown to lead to illicit drug use Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Resources
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Prescriber Checklist Tool
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Role of the Pharmacist When would you call a pharmacist? Side effects Drug Interactions Pill identification Indications Time to ‌ benefit/harm‌ benefit/harm Dosing information
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
School Time Dosing arise Issues that may arise‌ Treatment refusal (overt/covert but suspected) Side effects (eg., zombie) Street drugs (eg., high) Responsibility Communications
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
QUESTIONS
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