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7/6/2011

Medications: The Basics

David Gardner, PharmD,  MSc 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 But…. We know stuff about medication and mental illness

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

“Top of Mind” Issues Side effects Target Symptoms 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

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7/6/2011

Medications for Mental Illness and Symptoms

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7/6/2011

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  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,  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  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

Antidepressants

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Antipsychotics Uses

Time to See Effect Common  Side Effects 

•Positive symptoms of  psychosis  (hallucinations  and delusions)) • Psychotic  illnesses such as  schizophrenia,  delusional  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  interest in life):  months 

• Sedation   • Headache • Dry mouth • Constipation • Weight gain g g • Sexual  dysfunction

Serious Side Effects 

Other

• Severe muscle  spasms.  • Neuroleptic  Malignant  Syndrome (stiff  y ( muscles, sudden  confusion, high  fever, irregular  blood pressure  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.

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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 6 8 weeks weeks

• Sedation • Headache • Dizziness   • Nausea,  vomiting and vomiting and  diarrhea • Weight gain • Tremor  • Increased Thirst

Serious Side Effects 

Other

• Blood problems;  may present as  bleeding or  bruising easily.  • Severe skin rash  Severe skin rash with fever

• Patients will  likely be on  medications for  life • Some mood  Some mood stabilizers can  interact with   medication sold  without a  prescription (e.g.  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  Hyperactivity  Disorder (ADHD) • Aggression  • Help with social  interactions

• Efficacy can be  seen right away  with the first dose  (within 1 hour) • Non‐stimulants  used to treat  ADHD can take  longer (2‐4  weeks)

• Headache • Insomnia • Irritability  • Nausea,  vomiting and  diarrhea • Decreased  appetite 

Serious Side Effects 

Other

• Fast or  pounding heart  beat.  • Weight loss  • Slowed growth • Tics or abnormal  movements • Hallucinations 

• If problem with  early morning  symptoms – other  options may be  available  • If reduced  appetite or  weight loss – recommend high  calorie snacks or   take after meal • If swallowing is  a problem – some  medications can  be dissolved in  water

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Stimulants: Common Side Effects

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

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  • Serotonin  syndrome

• Can produce side  effects/ withdrawal  reaction when stopped  quickly • Activities that  require quick thinking  and reaction (e.g.  driving, bike riding,  snowboarding,  skateboarding, etc.)  can be very dangerous  while taking these  medications.

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Anti-anxiety & Sleep Medications: Common Side Effects

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Symptom Tracker

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Side Effect Tracker

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Activity Tracker

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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

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7/6/2011

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 F Face shows h little littl to t no emotion ti

A patient may be dosed too low if…. Only have a partial response to the medication – the medication has helped, but only a little

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

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 D IInteractions t ti Drug Pill identification Indications Time to … benefit/harm… Dosing information

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

School Time Dosing 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

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7/6/2011

QUESTIONS

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