 Hi everyone, it's Leah, your lead course instructor here at Advanced E-Clinical Training. So welcome back to our pharmacology lessons. Today we're gonna just briefly discuss some psychiatric medications. Now, I don't want you all to spend a lot of time memorizing all of these medications, what they are used to treat, their mechanisms of actions. That's not what this is about, but as a certified medical assistant, part of your job will be to take down people's medical history and take down a list of medications. And so a lot of people are on psychiatric medications these days, especially anti-depressants. So I really just wanted to give you an overview of some of these medications so you can start to familiarize yourself with what they are and some of their names. And also just keep in mind that as you gain more experience in the field and you start hearing these names more often, you'll start to memorize them more and know what they're used for. Okay, so let's move along here too. So classes of psychiatric medications. So the main classes of psychiatric medications include anti-anxiety medications or agents, of course anti-depressants, anti-psychotics, mood stabilizers, and then psychostimulants or otherwise known just as stimulants. So anti-depressants. So there are five main categories of anti-depressants. So they include the monamine oxidase inhibitors or otherwise known as MAOIs. We have the selective serotonin reuptake inhibitors, or SSRIs. We also have the serotonin norepinephrine reuptake and have inhibitors also known as SNRIs. And then we also have the tricyclic anti-depressants as well as a new group of anti-depressants. They're kind of thrown into this group called atypical anti-depressants. So we'll first begin talking about the MAOIs. So MAOIs is used to treat major depression or depression itself. And it's an older class of medications. It's not used as often these days anymore, but it works. There's an enzyme called monamine oxidase and it's involved in removing the neurotransmitters, norepinephrine serotonin and dopamine from the brain. So the MAOIs prevent this from happening because of course the nore serotonin you have in your brain, the happier you're gonna be. So there are four main MAOIs that are available here from the United States, listed first with their generic name and then the trade name. So those are here for you to see right here. And again, I don't want you to memorize all of these names. Just know that there's a class of medications for anti-depressants called MAOIs. And again, these are an older class of medication. You're not nearly gonna see these as often any longer. So some side effects of MAOIs include dry mouth, nausea, headache, drowsiness, insomnia, dizziness, or lightheadedness and skin reaction. Now moving along to the SSRIs or the selective serotonin reuptake inhibitors. So again, these medications are used to treat major depression. The anti-depressant effect of the SSRIs is mediated by the inhibition of the reuptake of serotonin in the synapses of the nerve. So effectively it helps to increase the serotonin levels in the brain. And again, the more serotonin you have in the brain, the happier your brain's gonna be. Some of these names you might be familiar with some of them, because again, these are more common than more commonly prescribed now than the MAOIs. But we have Cedalopram or Cilexam, Acetylopram or Lexapro, Fluoxetine or Prozac, Fluvoxamine or Luvox, Prooxetine or Paxil, and then Sertraline or Zoloft. So some side effects of the SSRIs include anxiety, drowsiness, headache, insomnia, some sexual dysfunction, weight gain, and then other less common adverse effects that can occur is the QT prolongation in our heart rhythm, or otherwise known as a long QT interval, an increased risk for suicidal behavior and suicidal ideation. And that's mostly could happen more commonly in patients that are under the age of 18 years old. So that's something to watch out for. Sometimes when people begin to take some antidepressants, they can experience an increase in their suicidal ideation if they had it prior. And then serotonin syndrome as well. Next, we're gonna talk about the serotonin norepinephrine reuptake inhibitors. So again, these medications are used to treat major depressive disorder or otherwise known as MDD. And so the antidepressant effects of the SNRIs are mediated by the inhibition of the reuptake of serotonin and norepinephrine. And again, the more serotonin and the more norepinephrine your brain has, the happier it's gonna be. So the five main SNRIs available here in the US and that we use. And again, you might be familiar with a few of these. The despenilexine, which is pristique, duloxetine or simbalta. We have fetsima, which I don't, I haven't really seen at all, if ever, in any of my patients. Cervilla and then the vanillaxapine or effectsor. And again, side effects with these SNRIs include anxiety, constipation, headache, insomnia, nausea, sexual dysfunction and increased blood pressure and heart rate. And that's because of the norepinephrine that's in these SNRIs. Norepinephrine will increase your blood pressure alone. It's used as a drug alone in medicine and your heart rate. Next, we have the tricyclic antidepressants. Again, tricyclic antidepressants are an order class of drug like the MAOIs. And we don't use these as often. You won't see these as commonly as the SSRIs or the SNRIs. So again, this medication is used to treat major depressive disorder. And so the effects of the TSAs are created by the inhibition of serotonin and norepinephrine reuptake. So here are some of the names for tricyclic antidepressants. I do see amitriptyline used commonly still. A lot of times patients are using or prescribed amitriptyline at bedtime. And that's a more common one. Amoxapine, anaphrano, this doxopin I still see used pretty often. And then these last few here, again, I don't see these ones as often for the TSAs. Mostly it's the amitriptyline and the doxopin. But that doesn't mean that you won't see these other names as well. And again, some side effects of the TSAs. The TCAs, I apologize, TCAs or tricyclic antidepressants include blurred vision, confusion, constipation, delirium, dry mouth, difficulty urinating or urinary retention. Also orthostatic hypotension and waking. Now moving on to the last category of the antidepressants is the atypical antidepressants. And again, as I said in the beginning, so these atypical antidepressants are kind of new medications that are labeled to treat major depressive disorder and have mechanisms of action that make them a little bit different from the last four classes of antidepressants that we talked about. But, and again, these are, we're starting to see these a lot more often now. So be appropriate or well-buttern is used pretty often. Sometimes this is prescribed for people that are trying to quit smoking. Mirtazepine or Remeron, I see a lot of elderly patients being prescribed this medication. Nephazone, Trazodone is one that's used, I see a lot in patients prescribed for them again at bedtime. Vibrid and then Trentalex is a new one as well. These two Vibrid and Trentalex are the most new that I am aware of. I see Trentalex and Vibrid also being used to treat people that have bipolar disorder as well as the major depressive disorder as well. So moving on here to, let me move my face so you can see these names. Okay. So some of these, so moving on to the next class of psychiatric medications known as anti-anxiety medications or anti-anxiety agents. Most of these medications are benzodiazepines and Boosprone and it's used to help reduce anxiety. So these benzodiazepines are used to treat and reduce anxiety as I said and also are used to treat GAD or otherwise known as general anxiety disorder. So some of these medications that's the names of these medications you might be familiar with some of them, Zanax. I see people, that's a pretty common one. Librium, not so much. Colonipin or clonazepan, pretty common. Diozepan or Valium. They give this medication pretty often to people who are withdrawing from alcohol. Let's see. Lorazepan or Ativan is pretty common one as well. Let's see. Restore, I do see this one as well. Pretty common. People are given Restore at bedtime to help them sleep. So those are the most common ones on this list that I tend to see in my daily practice with patients. And again, we have to of course talk about some of the adverse effects. So you have to be careful with benzodiazepines because they can be habit forming and they have some adverse effects especially with the central nervous system depression. So this can make these medications pretty dangerous especially for elderly adults. And so you also want to be conscientious if you have a patient that's prescribed one of these anti-exanity medications and then say they're also prescribed a narcotic pain medication like oxycodone. So some good teaching. If you see that and you will see it sometimes people will take anti-anxiety medications and then say they break their arm and so now they are on oxycodone for the pain. So some good teaching is you just want to make sure you let that patient know that you don't want to take the benzodiazepine at the same time as you're taking the oxycodone because of course it can suppress your central nervous system and depress your respiratory system and the breathing as well. So just keep that in mind. And of course when we're talking about the depression the central nervous system that can cause some cognitive impairment, drowsiness, delirium, falls, addiction and then of course there's always rebound anxiety after short term use of these benzodiazepines. Moving along to antipsychotics. So antipsychotic medications are used to treat psychosis. Now psychosis can be related or can happen due to several different things that could be related to someone abusing drugs or to drug use or to a mental health condition such as schizophrenia, bipolar disorder or severe, severe depression which can also be known as psychotic depression. So some healthcare providers may also with this population of patients you might see them on a combination of different medications. So if your patient has bipolar disorder you might see them on like a antipsychotic and an antidepressant. So that group of patients is sometimes prescribed a combination of some of these psychiatric medications. But these antipsychotics are divided into typical antipsychotics and the atypical antipsychotics also known as the first and second generation of these medications. So here is a list some typical antipsychotics. Here you can read these. Now I have to say how doll is probably the one you're going to see use the most that's used often working in the emergency department if somebody comes in and they are combative or very confused and psychotic we do give them how dolls also given in the inpatient healthcare setting as well for people that are hallucinating or in some psychosis state. So that is a common one you'll see as well. Now some of these atypical antipsychotics you might start to recognize some of these names. Abilify is one I'm seeing here pretty used I see commercials for it. It's being used more often. This Vraylar is another one being used pretty often. Now I see people with bipolar being prescribed Vraylar. In addition to other medications Latuda, Ziprexa is a pretty common one. Cerakwil is a pretty common one now especially for the adult population. You'll see a lot of times I'm elderly people on this at bedtime. Reciparital common, Gia did not so common. Gia didn't as I see that mostly prescribed to people with rapidly cycling bipolar disorder. Which is some of the main ones. And again, I don't want you all to memorize all of these names, but just some I wanted to I want you to just start to familiarize yourselves because again, as a medical assistant you will be taking medical histories. So you're gonna come into you're gonna have patients that have major depressive disorder or bipolar disorder or schizophrenia and these medications may be on their list. So some side effects of the antipsychotics of course is sedation. Anticolinergic effects, sexual dysfunction, weight gain and orthostatic hypotension. Moving on to mood stabilizers. So mood stabilizers are used to treat bipolar disorder and changes associated with other mental health conditions. In some cases, providers may prescribe mood stabilizers to increase the effect of other psychiatric medications and used to treat depression. So big one is lithium for these mood stabilizers. Also some anti-confalsants are used. So interestingly enough, Ted we're tall is one medication that you'll see and that's really classified as an anti-confalsant but you'll see that used as a mood stabilizer as well. The lithium, of course, or lamyctal is another one that's an anti-confalsant that is used as a mood stabilizer. So, but these are all used for treating mood disorders and bipolar patients mostly but also can be used and I've seen it being used to treat people that have personality disorders as well. So mood stabilizers to lithium. So here are some adverse effects of lithium, it's nausea, polyuria. So having to urinate often, polydipsia and that's feeling very thirsty, having tremors, weight gain. And then our last category for psychiatric medications are these CNS stimulants. So central nervous stimulants are the primary treatment for attention deficit disorder or ADHD and hyperactivity disorder in children and adults. Not so these medications are used to treat ADHD and adults as well, I just wanna make that clear. So again, here are some of the medications appropriately most familiar to you is Adderall and probably Ritalin. Vivians is a newer one and I see this mostly given to adults with ADHD, Ritalin, I see mostly in children given to children with ADHD. So and then of course we have the side effects or adverse effects of CNS stimulants, you have dizziness, dry mouth, insomnia, irritability, weight loss and then some less common but more serious adverse effects of these stimulants can include elevations in blood pressure heart rate of course, cardiovascular events, psychosis, prism, ticks and abuse or diversion. So thank you again for joining me here for this pharmacology series on psychiatric medications. Again, I just wanna make it clear I don't want you all to spend a lot of time memorizing all of these but just familiarize yourself with what kind of medications are used to treat the different mental health conditions here and just familiarize yourself with some of these names, okay? And if you have any questions or you need any clarification, of course, you know, you can always email me or schedule office hours with me as well. All right, I'll see you all again soon. Thanks so much.