Handbook of Essential Psychopharmacology

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ISBN: 9781585621682 | 1585621684
Cover: Hardcover
Copyright: 4/1/2005

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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.

Preface to the Second Edition

xvii

CHAPTER 1 Introduction to Pharmacodynamics and Pharmacokinetics

(18)

Pharmacodynamics

(4)

Ligands and Receptors

(1)

Neurotransmitters and Signal Transduction

(3)

Figure 1-1 Drug mechanism of action (pharmacodynamics)

(1)

Pharmacokinetics

(3)

Absorption

(1)

Distribution

(1)

Elimination

(1)

Drug Metabolism

(6)

General Issues

(1)

Cytochrome Families

(5)

Table 1-1 Selected substrates, inhibitors, and inducers of major cytochrome P450 enzymes

(4)

Glucuronidation

(1)

Drug-Drug Interactions

(1)

Conclusion

(1)

References

(2)

CHAPTER 2 Antidepressants

(120)

Overview

(8)

Drug Class

(1)

Indications

(1)

Mechanisms of Action

(1)

Pharmacokinetics

(1)

Main Side Effects

(1)

Drug-Drug Interactions

(1)

Potentiating Maneuvers

(1)

Use in Special Populations

(2)

Tables

(52)

Drug Class

(5)

Table 2-1 Classification of antidepressants by putative neurotransmitter effects

(1)

Table 2-2 Non-MAGI antidepressants: formulations, strengths, and usual maintenance dosage

(2)

Table 2-3 Monoamine oxidase inhibitors (MAOIs): tablet strengths and usual adult dosage

(1)

Table 2-4 Relative monthly cost of selected antidepressants (low/middle therapeutic dosage range)

(1)

Indications

(4)

Table 2-5 "Off-label" and non-mood disorder indications for antidepressants

(4)

Mechanisms of Action

(3)

Table 2-6 Neurotransmitter effects of selected antidepressants

(1)

Table 2-7 Effects of reuptake blockade and receptor antagonism

(1)

Table 2-8 Effects of serotonin (5-HT) receptor stimulation

(1)

Pharmacokinetics

(10)

Table 2-9 Pharmacokinetics of selected antidepressants

(3)

Table 2-10 Pharmacodynamic and pharmacokinetic profiles of newer antidepressants

(6)

Table 2-11 Putative optimal plasma levels for tricyclic antidepressants

(1)

Main Side Effects

(11)

Table 2-12 Side-effect profiles of commonly used antidepressants

(2)

Table 2-13 Side effects of tricyclic vs. selected nontricyclic antidepressants (% of patients reporting, placebo adjusted)

(1)

Figure 2-1 Cardiac and autonomic side effects of selected antidepressants

(1)

Figure 2-2 Gastrointestinal and sexual side effects of selected antidepressants

(1)

Figure 2-3 Neurobehavioral side effects of selected antidepressants

(1)

Table 2-14 Some comparative side effects of selective serotonin reuptake inhibitors (placebo-adjusted %)

(1)

Table 2-15 Basic management of antidepressant side effects

(3)

Table 2-16 Selected co-prescribed agents for antidepressant-induced sexual dysfunction

(1)

Drug-Drug Interactions

(11)

Table 2-17 Drug-drug interactions with tricyclic antidepressants (TCAs)

(1)

Table 2-18 Some drugs used in clinical practice that may interact with selective serotonin reuptake inhibitors (SSRIs) and related antidepressants

(4)

Table 2-19 Drug-drug interactions with monoamine oxidase inhibitors (MAOIs)

(1)

Table 2-20 Food restrictions for patients taking conventional monoamine oxidase inhibitors (MAOIs)

(1)

Table 2-21 The serotonin syndrome: differential diagnosis

(3)

Table 2-22 Serotonin syndrome

(1)

Potentiating Maneuvers

(4)

Table 2-23 Agents used to potentiate or augment antidepressants

(2)

Table 2-24 Psychostimulants and related agents: main features

(2)

Use in Special Populations

(4)

Table 2-25 Selection of nontricyclic antidepressants for patients with special needs or comorbid conditions

(3)

Table 2-26 Antidepressant dosing in children and adolescents

(1)

Questions and Answers

(38)

Drug Class

(1)

Indications

(6)

Mechanisms of Action

(5)

Pharmacokinetics

(4)

Main Side Effects

(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

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Handbook of Essential Psychopharmacology

Summary

Author Biography

Table of Contents

Supplemental Materials

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Handbook of Essential Psychopharmacology

Summary

Author Biography

Table of Contents

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