Handbook of Essential Psychopharmacology

by Pies, Ronald W.

• ISBN13: 9781585621682
• ISBN10: 1585621684
• Edition: 2nd
• Format: Hardcover
• Copyright: 2005-04-01
• Publisher: AMERICAN PSYCHIATRIC PUBLISHING INC

Summary

Handbook of Essential Psychopharmacology, Second Edition, provides an indispensable guide to vital information in the rapidly expanding field of psychopharmacology. The updated edition of this popular handbook will continue to be a reference that is simply the essential starting point in psychopharmacology for residents and experienced clinicians alike. Busy residents and clinicians will find a quick, current, and accessible guide to basic facts about psychotropic drugs, including dosages, indications, and drug interactions. As in the first edition, its structure is clear and easy to read, including An all-new introductory chapter, designed to equip the reader with a basic understanding of pharmacodynamics and pharmacokinetics Four main chapters covering the four main groups of psychotropic medications: antidepressants, antipsychotics, anxiolytics, and mood stabilizers A consistent format for all four chapters that summarizes critical information about each group of medications, including drug class, indications, mechanisms of action, pharmacokinetics, main side effects, drug-drug interaction, potentiating maneuvers, and use in special populations A wealth of tables and graphs for quick clinical consultation and unique self-instruction sets of questions and answers Fascinating and educational vignettes and puzzlers, extensive references for further reading, and-new to this edition-an invaluable appendix of fifty questions and answers, designed to test the reader's knowledge and comprehension of the text Densely informative and packed with practical material and special features, this truly essential guide is a handy clinical reference for experienced clinicians, an ideal teaching tool for educators, and a useful resource for residents, especially those preparing for the psychiatry board examinations.

Author Biography

Ronald W. Pies, M.D., is Clinical Professor of Psychiatry at Tufts University School of Medicine and Lecturer on Psychiatry at Harvard Medical School in Boston, Massachusetts.

Donald P. Rogers, Pharm.D., B.C.P.S., is Assistant Professor of Pharmacy at the Massachusetts College of Pharmacy in Manchester, New Hampshire.

Table of Contents

Preface to the Second Edition	xvii
CHAPTER 1 Introduction to Pharmacodynamics and Pharmacokinetics	1	(18)
Pharmacodynamics	2	(4)
Ligands and Receptors	2	(1)
Neurotransmitters and Signal Transduction	3	(3)
Figure 1-1 Drug mechanism of action (pharmacodynamics)	5	(1)
Pharmacokinetics	6	(3)
Absorption	6	(1)
Distribution	7	(1)
Elimination	8	(1)
Drug Metabolism	9	(6)
General Issues	9	(1)
Cytochrome Families	10	(5)
Table 1-1 Selected substrates, inhibitors, and inducers of major cytochrome P450 enzymes	11	(4)
Glucuronidation	15	(1)
Drug-Drug Interactions	15	(1)
Conclusion	16	(1)
References	17	(2)
CHAPTER 2 Antidepressants	19	(120)
Overview	19	(8)
Drug Class	19	(1)
Indications	20	(1)
Mechanisms of Action	20	(1)
Pharmacokinetics	21	(1)
Main Side Effects	22	(1)
Drug-Drug Interactions	23	(1)
Potentiating Maneuvers	24	(1)
Use in Special Populations	25	(2)
Tables	27	(52)
Drug Class	27	(5)
Table 2-1 Classification of antidepressants by putative neurotransmitter effects	27	(1)
Table 2-2 Non-MAGI antidepressants: formulations, strengths, and usual maintenance dosage	28	(2)
Table 2-3 Monoamine oxidase inhibitors (MAOIs): tablet strengths and usual adult dosage	30	(1)
Table 2-4 Relative monthly cost of selected antidepressants (low/middle therapeutic dosage range)	31	(1)
Indications	32	(4)
Table 2-5 "Off-label" and non-mood disorder indications for antidepressants	32	(4)
Mechanisms of Action	36	(3)
Table 2-6 Neurotransmitter effects of selected antidepressants	36	(1)
Table 2-7 Effects of reuptake blockade and receptor antagonism	37	(1)
Table 2-8 Effects of serotonin (5-HT) receptor stimulation	38	(1)
Pharmacokinetics	39	(10)
Table 2-9 Pharmacokinetics of selected antidepressants	39	(3)
Table 2-10 Pharmacodynamic and pharmacokinetic profiles of newer antidepressants	42	(6)
Table 2-11 Putative optimal plasma levels for tricyclic antidepressants	48	(1)
Main Side Effects	49	(11)
Table 2-12 Side-effect profiles of commonly used antidepressants	49	(2)
Table 2-13 Side effects of tricyclic vs. selected nontricyclic antidepressants (% of patients reporting, placebo adjusted)	51	(1)
Figure 2-1 Cardiac and autonomic side effects of selected antidepressants	52	(1)
Figure 2-2 Gastrointestinal and sexual side effects of selected antidepressants	53	(1)
Figure 2-3 Neurobehavioral side effects of selected antidepressants	54	(1)
Table 2-14 Some comparative side effects of selective serotonin reuptake inhibitors (placebo-adjusted %)	55	(1)
Table 2-15 Basic management of antidepressant side effects	56	(3)
Table 2-16 Selected co-prescribed agents for antidepressant-induced sexual dysfunction	59	(1)
Drug-Drug Interactions	60	(11)
Table 2-17 Drug-drug interactions with tricyclic antidepressants (TCAs)	60	(1)
Table 2-18 Some drugs used in clinical practice that may interact with selective serotonin reuptake inhibitors (SSRIs) and related antidepressants	61	(4)
Table 2-19 Drug-drug interactions with monoamine oxidase inhibitors (MAOIs)	65	(1)
Table 2-20 Food restrictions for patients taking conventional monoamine oxidase inhibitors (MAOIs)	66	(1)
Table 2-21 The serotonin syndrome: differential diagnosis	67	(3)
Table 2-22 Serotonin syndrome	70	(1)
Potentiating Maneuvers	71	(4)
Table 2-23 Agents used to potentiate or augment antidepressants	71	(2)
Table 2-24 Psychostimulants and related agents: main features	73	(2)
Use in Special Populations	75	(4)
Table 2-25 Selection of nontricyclic antidepressants for patients with special needs or comorbid conditions	75	(3)
Table 2-26 Antidepressant dosing in children and adolescents	78	(1)
Questions and Answers	79	(38)
Drug Class	79	(1)
Indications	79	(6)
Mechanisms of Action	85	(5)
Pharmacokinetics	90	(4)
Main Side Effects	94	(7)
Drug-Drug Interactions	101	(2)
Potentiating Maneuvers	103	(8)
Use in Special Populations	111	(6)
Vignettes/Puzzlers	117	(6)
References	123	(16)
CHAPTER 3 Antipsychotics	139	(114)
Overview	139	(9)
Drug Class	139	(1)
Indications	140	(1)
Mechanisms of Action	140	(2)
Pharmacokinetics	142	(1)
Main Side Effects	143	(1)
Drug-Drug Interactions	144	(1)
Potentiating Maneuvers	145	(1)
Use in Special Populations	145	(3)
Tables	148	(38)
Drug Class	148	(5)
Table 3-1 Dosages and putative therapeutic levels of currently available antipsychotics	148	(2)
Table 3-2 First-generation ("typical" or "neuroleptic") antipsychotic dosage equivalents of 10 mg of haloperidol	150	(1)
Table 3-3 Second-generation ("atypical") antipsychotic dosage equivalents of 10 mg of haloperidol	151	(1)
Table 3-4 Comparative costs of some atypical antipsychotics	152	(1)
Indications	153	(6)
Table 3-5 Indications for use of antipsychotics	153	(6)
Mechanisms of Action	159	(1)
Table 3-6 Relative receptor affinities of haloperidol versus available atypical agents	159	(1)
Pharmacokinetics	160	(2)
Table 3-7 Pharmacokinetic profiles of first-generation (neuroleptic) antipsychotics	160	(1)
Table 3-8 Pharmacokinetic profiles of second-generation (atypical) antipsychotics	161	(1)
Main Side Effects	162	(13)
Table 3-9 Comparative side effects among available first-generation (typical) antipsychotics	162	(1)
Table 3-10 Comparative side effects among selected second-generation (atypical) antipsychotics	163	(1)
Table 3-11 Motor and mental symptoms of neuroleptic-induced extrapyramidal side effects	164	(1)
Table 3-12 Selected agents for treatment of extrapyramidal side effects (EPS) of first-generation (neuroleptic) antipsychotics	165	(1)
Table 3-13 Neuroleptic malignant syndrome (NMS): differential diagnosis	166	(5)
Table 3-14 Management of antipsychotic (AP) side effects	171	(2)
Table 3-15 Clozapine and white blood cell count (WBC): managing abnormalities	173	(2)
Drug-Drug Interactions	175	(3)
Table 3-16 Antipsychotic (AP) drug interactions	175	(2)
Table 3-17 Second-generation (atypical) antipsychotics (APs): potential drug-drug interactions	177	(1)
Potentiating Maneuvers	178	(4)
Table 3-18 Potentiation of antipsychotics (APs)	178	(4)
Use in Special Populations	182	(4)
Table 3-19 Antipsychotics (APs) in special populations	182	(4)
Questions and Answers	186	(41)
Drug Class	186	(2)
Indications	188	(7)
Mechanisms of Action	195	(5)
Pharmacokinetics	200	(1)
Main Side Effects	201	(11)
Drug-Drug Interactions	212	(2)
Potentiating Maneuvers	214	(5)
Use in Special Populations	219	(8)
Vignettes/Puzzlers	227	(9)
References	236	(17)
CHAPTER 4 Anxiolytics and Sedative-Hypnotics	253	(84)
Overview	253	(7)
Drug Class	253	(1)
Indications	254	(1)
Mechanisms of Action	255	(1)
Pharmacokinetics	256	(1)
Main Side Effects	256	(1)
Drug-Drug Interactions	257	(1)
Potentiating Maneuvers	258	(1)
Use in Special Populations	258	(2)
Tables	260	(77)
Drug Class	260	(6)
Table 4-1 Commonly used benzodiazepine anxiolytics	260	(1)
Table 4-2 Commonly prescribed benzodiazepine and nonbenzodiazepine hypnotics	261	(1)
Table 4-3 Nonbenzodiazepine anxiolytics and hypnotics	262	(3)
Table 4-4 Dosage and cost of selected benzodiazepines	265	(1)
Indications	266	(6)
Table 4-5 Indications for benzodiazepines (BZDs)	266	(4)
Table 4-6 Selective serotonin reuptake inhibitors (SSRIs) or related antidepressants with FDA-approved labeling for use in treating DSM-IV-TR anxiety disorders	270	(1)
Table 4-7 Off-label uses for beta-blockers and clonidine for anxiety/agitation in selected disorders	271	(1)
Mechanisms of Action	272	(2)
Table 4-8 Effect of various agents on GABAA receptors	272	(1)
Table 4-9 Pharmacodynamic aspects of hypnotic agents	273	(1)
Pharmacokinetics	274	(4)
Table 4-10 Pharmacokinetics of orally administered benzodiazepine anxiolytics	274	(1)
Table 4-11 Pharmacokinetics of benzodiazepine hypnotics	275	(1)
Table 4-12 Pharmacokinetics of nonbenzodiazepine hypnotics	276	(1)
Figure 4-1 Simplified metabolic pathways of benzodiazepines	277	(1)
Main Side Effects	278	(4)
Table 4-13 Frequency (%) of benzodiazepine (BZD) and buspirone side effects (average for various BZDs)	278	(1)
Table 4-14 Side effects and management of benzodiazepines (BZDs)	279	(3)
Drug-Drug Interactions	282	(4)
Table 4-15 Benzodiazepine (BZD) drug interactions	282	(3)
Table 4-16 Nonbenzodiazepine (non-BZD) hypnotic drug interactions	285	(1)
Potentiating Maneuvers	286	(1)
Table 4-17 Agents used in combination with benzodiazepines (BZDs) for augmentation of effect	286	(1)
Use in Special Populations	287	(2)
Table 4-18 Potential concerns of benzodiazepine (BZD) use during pregnancy	287	(1)
Table 4-19 Risks of benzodiazepine (BZD) use in elderly and/or dementia patients	288	(1)
Questions and Answers	289	(31)
Drug Class	289	(1)
Indications	290	(12)
Mechanisms of Action	302	(2)
Pharmacokinetics	304	(2)
Main Side Effects	306	(4)
Drug-Drug Interactions	310	(3)
Potentiating Maneuvers	313	(2)
Use in Special Populations	315	(5)
Vignettes/Puzzlers	320	(4)
References	324	(13)
CHAPTER 5 Mood Stabilizers	337	(112)
Overview	337	(9)
Drug Class	337	(1)
Indications	338	(2)
Mechanisms of Action	340	(1)
Pharmacokinetics	340	(2)
Main Side Effects	342	(1)
Drug-Drug Interactions	343	(1)
Potentiating Maneuvers	344	(1)
Use in Special Populations	344	(2)
Tables	346	(43)
Drug Class	346	(3)
Table 5-1 Selected mood stabilizers: preparations, usual daily doses, and putative therapeutic blood levels	346	(3)
Indications	349	(8)
Table 5-2 Indications for lithium	349	(2)
Table 5-3 Preferred treatments of acute manic or mixed episodes in bipolar disorder	351	(2)
Table 5-4 Preferred treatments of acute depressive episodes in bipolar disorder	353	(2)
Table 5-5 Preferred treatments of rapid cycling in bipolar disorder	355	(1)
Table 5-6 Preferred maintenance treatments in bipolar disorder	356	(1)
Mechanisms of Action	357	(1)
Table 5-7 Mood stabilizer and anticonvulsant mechanisms of action	357	(1)
Pharmacokinetics	358	(2)
Table 5-8 Pharmacokinetics of selected mood stabilizers	358	(2)
Main Side Effects	360	(10)
Table 5-9 Lithium side effects	360	(1)
Table 5-10 Stages of lithium toxicity	361	(1)
Table 5-11 Five most common side effects of carbamazepine	362	(1)
Table 5-12 Management of common anticonvulsant mood stabilizer side effects (non-placebo-adjusted rates)	363	(3)
Table 5-13 Management of lithium side effects	366	(3)
Table 5-14 Potential risk factors for antidepressant-induced mania (AIM) or cycling	369	(1)
Drug-Drug Interactions	370	(11)
Table 5-15 Drug-drug interactions with lithium	370	(3)
Table 5-16 Drug-drug interactions with carbamazepine (CBZ)	373	(4)
Table 5-17 Drug-drug interactions with valproate	377	(2)
Table 5-18 Drug-drug interactions with lamotrigine	379	(2)
Potentiating Maneuvers	381	(6)
Table 5-19 Augmenting strategies in treating patients with bipolar disorder	381	(6)
Use in Special Populations	387	(2)
Table 5-20 Use of mood stabilizers in special populations	387	(2)
Questions and Answers	389	(39)
Indications	389	(14)
Mechanisms of Action	403	(4)
Pharmacokinetics	407	(3)
Main Side Effects	410	(6)
Drug-Drug Interactions	416	(4)
Potentiating Maneuvers	420	(3)
Use in Special Populations	423	(5)
Vignettes/Puzzlers	428	(6)
References	434	(15)
CME Questions and Answers	449	(20)
Index	469