Pharmacology Chapter 5
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Questions and Answers

What form of medication is Cloral hydrate available in?

  • Patch and oral solution
  • Capsule and oral solution only
  • Oral solution, tablets, injection
  • Oral solution tablets, oral solution (correct)

    • Which group of patients is advised to take caution when using Cloral hydrate?

  • Young adults and those with low blood pressure
  • Vegetarians and patients who smoke
  • Elderly patients and those with excessive sedation (correct)
  • Patients with a history of insomnia

    • What is the recommended dosage of melatonin for adults aged 55 years and over for short-term use?

  • 2 mg once daily for up to 13 weeks (correct)
  • 1 mg once daily for up to 4 weeks
  • 3 mg once daily for 8 weeks
  • 5 mg once daily for 12 weeks

    • What should be avoided during the first and third trimesters of pregnancy?

    <p>Cloral hydrate</p> Signup and view all the answers

    Which of the following is a side effect of Cloral hydrate?

    <p>Hangover effect</p> Signup and view all the answers

    What dosage of melatonin should adults take for jet lag?

    <p>3 mg once daily for up to 5 days</p> Signup and view all the answers

    In which scenario is melatonin NOT licensed for use?

    <p>For short-term use in learning disabilities</p> Signup and view all the answers

    What is a primary contraindication for prescribing Cloral hydrate?

    <p>Acute pulmonary insufficiency</p> Signup and view all the answers

    Which condition is NOT a contraindication for melatonin use?

    <p>Mild depression</p> Signup and view all the answers

    What is the standard dosage of melatonin for elderly patients?

    <p>5 mg daily for up to 4 weeks</p> Signup and view all the answers

    What is a common side effect of melatonin?

    <p>Excessive tearing</p> Signup and view all the answers

    What is the main indication for the use of zopiclone?

    <p>Short-term insomnia management</p> Signup and view all the answers

    Which of the following medications is NOT recommended during pregnancy?

    <p>All of the above</p> Signup and view all the answers

    Which statement is accurate regarding the alcohol and CNS depressant interaction with zopiclone?

    <p>It can enhance the effects of zopiclone.</p> Signup and view all the answers

    Which of the following forms of melatonin is NOT mentioned?

    <p>Sublingual tablet</p> Signup and view all the answers

    For which specific age group is Circadin® licensed?

    <p>Adults aged 55 and over</p> Signup and view all the answers

    What duration of treatment is recommended for both adults and elderly patients using melatonin?

    <p>Up to 4 weeks</p> Signup and view all the answers

    What potential side effect is linked to prolonged use of hypnotic Z-drugs?

    <p>Anterograde amnesia</p> Signup and view all the answers

    Which demographic should be particularly counseled on the administration of melatonin?

    <p>Elderly patients and their carers</p> Signup and view all the answers

    What effect can melatonin have on urine?

    <p>Increased frequency of abnormal urine output</p> Signup and view all the answers

    Which medication is indicated for treating insomnia associated with behavioral disorders in children?

    <p>Slenyto®</p> Signup and view all the answers

    What is the starting dose adjustment for zopiclone in patients with mild to moderate impairment?

    <p>3.75 mg daily</p> Signup and view all the answers

    What is the initial recommended daily dose of sodium oxybate for adults?

    <p>2.25 g</p> Signup and view all the answers

    Which of the following conditions is NOT a caution when prescribing sodium oxybate?

    <p>History of diabetes mellitus</p> Signup and view all the answers

    What is a potential serious risk associated with the use of modafinil during pregnancy?

    <p>Congenital malformations</p> Signup and view all the answers

    What is the main mechanism of action for solriamfetol?

    <p>Inhibition of norepinephrine reuptake</p> Signup and view all the answers

    Which of the following statements about pitolisant is true?

    <p>It is a histamine H3-receptor antagonist.</p> Signup and view all the answers

    How should patients be advised to handle the effects of sodium oxybate before performing skilled tasks?

    <p>Leave at least 6 hours between taking and performing tasks.</p> Signup and view all the answers

    Which side effect is associated with both sodium oxybate and modafinil?

    <p>Dizziness</p> Signup and view all the answers

    What dosage of modafinil is recommended for elderly patients?

    <p>100 mg daily</p> Signup and view all the answers

    Which medication requires effective contraception for women of childbearing potential for at least 21 days after discontinuation?

    <p>Pitolisant</p> Signup and view all the answers

    What is a contraindication for solriamfetol?

    <p>Cardiac arrhythmias</p> Signup and view all the answers

    Which of the following side effects is NOT associated with pitolisant?

    <p>Seizure</p> Signup and view all the answers

    What can sodium oxybate potentially cause in patients with a history of drug abuse?

    <p>Withdrawal symptoms</p> Signup and view all the answers

    Which medication may potentially alter the efficacy of hormonal contraceptives?

    <p>Modafinil</p> Signup and view all the answers

    What is the most common adjustment required for sodium oxybate dosing?

    <p>Increase in steps of 1.5 g daily</p> Signup and view all the answers

    Which side effect is specifically noted for solriamfetol?

    <p>Teeth grinding</p> Signup and view all the answers

    What is the role of Solriamfetol in treating sleep disorders?

    <p>It treats excessive daytime sleepiness associated with certain conditions.</p> Signup and view all the answers

    Which symptom is NOT commonly associated with the use of Solriamfetol?

    <p>Tachycardia</p> Signup and view all the answers

    What should patients be advised regarding driving when starting treatment with Solriamfetol?

    <p>Driving should be avoided, especially initially or after a dose change.</p> Signup and view all the answers

    What is a characteristic of buprenorphine compared to methadone hydrochloride?

    <p>Buprenorphine can be given on alternate days in higher doses.</p> Signup and view all the answers

    When should the first dose of buprenorphine be given to mitigate the risk of precipitated withdrawal?

    <p>When withdrawal symptoms become evident, or after a specified time post-use.</p> Signup and view all the answers

    What is a key aspect of managing opioid withdrawal effectively?

    <p>Gradual withdrawal after stabilization to avoid relapse.</p> Signup and view all the answers

    What is NOT a reason for counseling patients on the effects of driving when using opioids?

    <p>Opioids enhance driving skills and focus.</p> Signup and view all the answers

    What is the consequence of missing three days of regular opioid maintenance therapy?

    <p>Risks of overdose due to loss of tolerance.</p> Signup and view all the answers

    Why is opioid substitution therapy recommended during pregnancy?

    <p>It generally has a lower risk to the fetus than continued illicit drug use.</p> Signup and view all the answers

    What type of therapy is advised for treating opioid dependence?

    <p>Medical, social, and psychological treatment is essential.</p> Signup and view all the answers

    What is a critical consideration when restarting opiate substitution therapy for a patient who previously used buprenorphine?

    <p>Assessing for any illicit drug use is necessary beforehand.</p> Signup and view all the answers

    What can define the early withdrawal symptoms of untreated heroin dependence?

    <p>Symptoms manifest within the first 8 hours of cessation.</p> Signup and view all the answers

    Which of the following medications is commonly used in opioid substitution therapy?

    <p>Methadone hydrochloride</p> Signup and view all the answers

    What is a significant aspect of methadone treatment for patients with a long history of opioid misuse?

    <p>Methadone often provides a more pronounced sedative effect.</p> Signup and view all the answers

    What does NOT characterize buprenorphine in the context of opioid dependence treatment?

    <p>Leads to a higher risk of overdose than methadone.</p> Signup and view all the answers

    What is one of the potential severe symptoms of the disulfiram-alcohol reaction?

    <p>Hypotension</p> Signup and view all the answers

    What are the potential outcomes of maternal withdrawal during the third trimester of pregnancy?

    <p>Fetal distress and stillbirth</p> Signup and view all the answers

    Which medication is NOT typically prescribed for controlling opioid withdrawal symptoms?

    <p>Zaleplon</p> Signup and view all the answers

    Which of the following is NOT a side effect associated with nalmefene?

    <p>Increased libido</p> Signup and view all the answers

    In what circumstance should lofexidine hydrochloride be prescribed?

    <p>As an adjuvant to opioid substitution therapy</p> Signup and view all the answers

    For what duration should patients be monitored during the initial phase of disulfiram treatment?

    <p>Every 2 weeks for 2 months</p> Signup and view all the answers

    What action should patients take if they experience symptoms of hepatotoxicity while on disulfiram?

    <p>Seek immediate medical attention</p> Signup and view all the answers

    What is the recommended treatment for managing delirium tremens?

    <p>Oral lorazepam followed by haloperidol</p> Signup and view all the answers

    Which of the following is a contraindication for prescribing nalmefene?

    <p>Recent opioid use</p> Signup and view all the answers

    Which statement is true about benzodiazepine treatment for alcohol withdrawal?

    <p>Inpatient regimens may last for 2-3 weeks or longer.</p> Signup and view all the answers

    What is one of the psychological side effects of disulfiram mentioned?

    <p>Fatigue</p> Signup and view all the answers

    What is the role of naloxone hydrochloride in opioid dependence treatment?

    <p>It prevents accidental overdose.</p> Signup and view all the answers

    When should parenteral thiamine be administered?

    <p>To patients at risk of Wernicke's encephalopathy</p> Signup and view all the answers

    What is the recommended dosage of nalmefene for adults initially?

    <p>25 mg daily</p> Signup and view all the answers

    During assisted alcohol withdrawal, what is the general duration for which a fixed-dose regimen is implemented?

    <p>7-10 days</p> Signup and view all the answers

    Which drug is noted for helping with maintenance of abstinence in alcohol dependence in adolescents aged 16 and over?

    <p>Acamprosate calcium</p> Signup and view all the answers

    Which temporary withdrawal symptom may people experience during smoking cessation?

    <p>Irritability</p> Signup and view all the answers

    What should be monitored in breast-fed babies of mothers taking opioid substitutes?

    <p>Increased sleepiness and breathing difficulties</p> Signup and view all the answers

    Which side effect is NOT typically associated with smoking cessation?

    <p>Heightened athletic performance</p> Signup and view all the answers

    Which of the following is an appropriate psychological intervention for alcohol dependence?

    <p>Cognitive behavioral therapy</p> Signup and view all the answers

    What should be prioritized in patients with severe alcohol-related hepatitis?

    <p>Treatment for active infections or bleeding before corticosteroids</p> Signup and view all the answers

    What should be done if a patient tries to overcome the blockade of opioid receptors while taking naltrexone?

    <p>Seek emergency medical help</p> Signup and view all the answers

    What is the maximum weekly dosage of nalmefene?

    <p>350 mg</p> Signup and view all the answers

    What defines alcohol dependence?

    <p>Strong desire to consume alcohol and tolerance to its effects</p> Signup and view all the answers

    Which medication can reduce alcohol consumption in patients without physical withdrawal symptoms?

    <p>Nalmefene</p> Signup and view all the answers

    Which health risk is associated with smokeless tobacco use?

    <p>Oropharyngeal cancers</p> Signup and view all the answers

    For which group is maintenance treatment with opioid substitution therapy usually controversial?

    <p>Young people with mild dependence</p> Signup and view all the answers

    What is the advice regarding smoking during pregnancy?

    <p>Complete cessation is required</p> Signup and view all the answers

    What is the initial treatment approach for an individual who smokes fewer than 10 cigarettes daily seeking nicotine replacement therapy?

    <p>Begin with a medium-strength patch for 6-8 weeks</p> Signup and view all the answers

    What potential serious condition should be closely monitored before administering nicotine replacement therapy?

    <p>Uncontrolled hyperthyroidism</p> Signup and view all the answers

    Which route of administration is NOT utilized for nicotine replacement therapy?

    <p>Intravenous injections</p> Signup and view all the answers

    What is the advised action if a patient experiences withdrawal symptoms during nicotine replacement therapy?

    <p>Increase the patch strength or maintain current strength</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with nicotine replacement therapy?

    <p>Visual disturbances</p> Signup and view all the answers

    What formulation of nicotine replacement therapy requires administration under the tongue?

    <p>Sublingual tablets</p> Signup and view all the answers

    Which condition is regarded as a risk factor for patients utilizing nicotine replacement therapy?

    <p>Severe arrhythmias</p> Signup and view all the answers

    Prior to using oral nicotine replacement therapy, what should patients avoid for 15 minutes?

    <p>Acidic beverages</p> Signup and view all the answers

    During which circumstance is nicotine replacement therapy considered particularly safe?

    <p>During pregnancy alongside behavioral support</p> Signup and view all the answers

    What is the greatest risk of continuing to smoke while undergoing nicotine replacement therapy?

    <p>Higher risk of cardiovascular events</p> Signup and view all the answers

    How long should a patient on nicotine patches avoid using them before going to bed?

    <p>Should not be applied before bed</p> Signup and view all the answers

    What method of delivery for nicotine replacement therapy involves the use of a device for inhalation?

    <p>Inhalation cartridges</p> Signup and view all the answers

    For which specific situation should transdermal nicotine patches NOT be used?

    <p>On broken skin or skin disorders</p> Signup and view all the answers

    What type of patient's blood glucose should be monitored while using nicotine replacement therapy?

    <p>Those with diabetes mellitus</p> Signup and view all the answers

    What duration of a course is recommended for Varenicline treatment in smoking cessation?

    <p>12 weeks</p> Signup and view all the answers

    What is a common side effect associated with Varenicline?

    <p>Insomnia</p> Signup and view all the answers

    Which form of nicotine replacement is available in a 24-hour patch?

    <p>Nicotinell TTS</p> Signup and view all the answers

    What is the nicotine content of Nicorette invisi 16-hour patches that is highest?

    <p>25 mg</p> Signup and view all the answers

    Which medication is prescribed to manage opioid dependence?

    <p>Methadone hydrochloride</p> Signup and view all the answers

    Which common condition should be cautiously monitored when prescribing Methadone?

    <p>Cardiac conduction abnormalities</p> Signup and view all the answers

    What dosage adjustment is required for patients with renal impairment when using Varenicline?

    <p>Decrease the dose</p> Signup and view all the answers

    What is a key requirement when prescribing Methadone oral solution for opioid drug addiction?

    <p>The final strength must be specified</p> Signup and view all the answers

    In what situation should nursing mothers use Methadone?

    <p>Breastfeeding is safe during maintenance at a low dose</p> Signup and view all the answers

    What is a significant risk associated with abruptly stopping opioid treatment?

    <p>Withdrawal symptoms</p> Signup and view all the answers

    What is one precaution that should be taken when using Varenicline?

    <p>Caution due to potential seizure threshold effects</p> Signup and view all the answers

    What is the maximum frequency for administering Methadone oral solution in the treatment of severe pain?

    <p>Every 12 hours</p> Signup and view all the answers

    Which nicotine replacement offers no nicotine content?

    <p>Nicorette Icy White</p> Signup and view all the answers

    What is an important side effect of treatment with Buprenorphine for opioid dependence?

    <p>Hyperprolactinaemia</p> Signup and view all the answers

    What is the maximum daily dose of ZUBSOLV® for adults aged 18-65 years?

    <p>17.2 mg</p> Signup and view all the answers

    Which of the following statements about Suboxone® sublingual tablets and films is true?

    <p>Patients must be monitored for overdose symptoms.</p> Signup and view all the answers

    What is Lofexidine primarily used for in patients with opioid withdrawal?

    <p>To manage withdrawal symptoms</p> Signup and view all the answers

    Which of the following is a recommended monitoring practice when initiating Lofexidine treatment?

    <p>Blood pressure and pulse monitoring</p> Signup and view all the answers

    What should be the duration of treatment with Lofexidine if no opioid use is indicated?

    <p>7-10 days</p> Signup and view all the answers

    What form of medication can Zubsolv® NOT be interchanged with?

    <p>Other buprenorphine products</p> Signup and view all the answers

    What significant approach is recommended when withdrawing from treatment with Lofexidine?

    <p>Gradual withdrawal over 2-4 days</p> Signup and view all the answers

    What common side effect might patients experience with Suboxone® sublingual films?

    <p>Bradycardia</p> Signup and view all the answers

    Which organization has recommended Buprenorphine/naloxone as a treatment for opioid drug dependence?

    <p>Scottish Medicines Consortium (SMC)</p> Signup and view all the answers

    The use of which medication highlights the need for consideration of dose reduction due to potential interactions?

    <p>Lofexidine</p> Signup and view all the answers

    Which pharmacological property initiated by Galen pertains to psychiatric care?

    <p>Introduced the concept of 'incurable insanity'</p> Signup and view all the answers

    What specific population does Lofexidine have a usage indication for?

    <p>Children over 12 years</p> Signup and view all the answers

    What is a possible consequence of altered pharmacokinetics in elderly patients?

    <p>Reduced efficacy of medications</p> Signup and view all the answers

    What is the most effective approach for smokeless tobacco cessation?

    <p>A combination of drug treatment and behavioral support</p> Signup and view all the answers

    Which drug should not be combined with varenicline for smoking cessation?

    <p>Bupropion hydrochloride</p> Signup and view all the answers

    What should be offered to individuals who have successfully stopped smoking to help prevent relapse?

    <p>Further course of varenicline, NRT, or bupropion hydrochloride</p> Signup and view all the answers

    How long are nicotine transdermal patches typically applied?

    <p>16 hours</p> Signup and view all the answers

    Which substance has been shown to interact with drugs by inducing hepatic enzymes due to tobacco smoke exposure?

    <p>Polycyclic aromatic hydrocarbons</p> Signup and view all the answers

    What adverse effect should patients prescribed bupropion hydrochloride be closely monitored for?

    <p>Clinical worsening of depression or suicidal thoughts</p> Signup and view all the answers

    What is one of the first actions recommended for pregnant females who smoke?

    <p>Completely cease smoking and refer to local stop-smoking services</p> Signup and view all the answers

    What should be avoided when prescribing nicotine replacement therapy with respect to patient readiness?

    <p>Combining it with bupropion hydrochloride</p> Signup and view all the answers

    What type of support is recommended alongside drug treatments like varenicline and NRT?

    <p>Behavioral support</p> Signup and view all the answers

    What approach can be beneficial for individuals who are not ready to stop smoking?

    <p>Harm reduction approach using NRT</p> Signup and view all the answers

    What is recommended regarding the timing of treatment when drug therapy for smoking cessation is started?

    <p>Treatment should be available before the stop date</p> Signup and view all the answers

    What common misconception about nicotine replacement therapy is incorrect?

    <p>NRT can be prescribed for pregnant women without caution</p> Signup and view all the answers

    What is a key contraindication for the use of bupropion hydrochloride?

    <p>Severe hepatic cirrhosis</p> Signup and view all the answers

    What method of nicotine delivery is NOT supported for public smoking cessation services?

    <p>E-cigarettes</p> Signup and view all the answers

    Which type of therapy has shown equal or greater benefits compared to pharmacotherapy for adults?

    <p>Interpersonal psychotherapy</p> Signup and view all the answers

    What is a significant concern regarding medication adherence in psychiatric patients?

    <p>High rates of nonadherence among patients</p> Signup and view all the answers

    What type of interventions may improve patient autonomy and satisfaction with care?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    Which of the following is a primary challenge when using medication in elderly patients?

    <p>Frequent interactions with other CNS-acting substances.</p> Signup and view all the answers

    What is the primary therapeutic target of most current antipsychotic drugs?

    <p>Dopaminergic D2 receptors</p> Signup and view all the answers

    What is a significant challenge associated with the oral intake of small molecule drugs for CNS effects?

    <p>Inefficient transport across membranes</p> Signup and view all the answers

    Which treatment approach is commonly overlooked but has shown efficacy in managing depression?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    What role do antidepressants primarily play in treating the elderly?

    <p>They are the mainstay in treating anxiety and depressive disorders.</p> Signup and view all the answers

    Which of the following is essential when prescribing medications for elderly patients with cognitive disorders?

    <p>Monitoring treatment response closely</p> Signup and view all the answers

    What is a major concern during the prescription of CNS-active medications in elderly patients?

    <p>Increased risk of mental health disorders</p> Signup and view all the answers

    Which psychological approach addresses issues such as patient insight and adherence among the elderly?

    <p>Individual counseling</p> Signup and view all the answers

    What is a key factor in determining the effectiveness of pharmacological agents in mental health treatment?

    <p>Compliance and adherence</p> Signup and view all the answers

    What patient management strategy is recommended before resorting to pharmacological interventions for behavioral disturbances?

    <p>Exploring non-pharmacologic management strategies</p> Signup and view all the answers

    What characteristic of small molecule compounds aids in targeted pharmacotherapy?

    <p>Selective binding to specific target regions</p> Signup and view all the answers

    Which type of therapy may show a decrease in symptom severity between 35-50%?

    <p>Behavioral therapies</p> Signup and view all the answers

    What can significantly hinder the effectiveness of prescribed medications for patients with peripherally mediated D2 inhibition?

    <p>Poor blood-brain barrier penetration</p> Signup and view all the answers

    What is often a risk associated with pharmacological treatments in elderly patients?

    <p>Unjustified use without proper evaluation</p> Signup and view all the answers

    What aspect of non-pharmacological interventions is frequently lacking, impacting patient access?

    <p>Public knowledge and awareness</p> Signup and view all the answers

    Why is it essential to accurately diagnose dementia subtypes in elderly patients?

    <p>To implement effective non-pharmacologic treatment plans</p> Signup and view all the answers

    Which treatment strategy is crucial in preventing suicide or homicide in psychiatric patients?

    <p>Adherence to treatment regimens</p> Signup and view all the answers

    Which component of care is observed to be an essential part of psychiatric services for older adults?

    <p>Psychotherapy</p> Signup and view all the answers

    What is the main reason for the increasing risk of polypharmacy in the elderly population?

    <p>The prescription of multiple medications for different health conditions.</p> Signup and view all the answers

    Which factor does NOT influence the reliability of prevalence studies in medical settings?

    <p>Duration of the study.</p> Signup and view all the answers

    What aspect of aging affects drug metabolism in elderly patients?

    <p>Slower hepatic clearance.</p> Signup and view all the answers

    Which statement best describes the representation of mental health problems in hospitalized patients?

    <p>Patients with mental health issues are overrepresented for certain health problems.</p> Signup and view all the answers

    Which of the following is crucial for improving the quality of life for elderly patients with mental illness?

    <p>Individualizing treatment and interactions.</p> Signup and view all the answers

    What is one of the primary ethical considerations in pharmacotherapy for the elderly?

    <p>Ensuring personalized care plans.</p> Signup and view all the answers

    Which misconception about pharmacotherapy in elderly patients often leads to adverse effects?

    <p>All elderly patients respond the same to medications.</p> Signup and view all the answers

    How can genetic interventions improve the treatment of severe mental illness?

    <p>By addressing neurotransmitter dysfunction linked to symptoms.</p> Signup and view all the answers

    Which aspect of physical changes in the elderly must be considered when prescribing drugs?

    <p>Changes in the volume of distribution of drugs.</p> Signup and view all the answers

    What is a common gap in the research regarding quality of life in people with severe mental illness?

    <p>The relationship between quality of life and neurocognitive impairment.</p> Signup and view all the answers

    What often leads to missed opportunities in diagnosing mental health problems in elderly patients?

    <p>Atypical presentation of physical illnesses.</p> Signup and view all the answers

    How do physiological changes in aging specifically affect drug absorption in elderly patients?

    <p>Increased gastric pH can lead to altered drug absorption.</p> Signup and view all the answers

    What percentage of the general hospital population is estimated to have a mental health problem at any given time?

    <p>30%</p> Signup and view all the answers

    Which factor most significantly impacts the therapeutic response to medications in elderly patients?

    <p>Age-related physiological changes.</p> Signup and view all the answers

    What is a major consequence of nonadherence to antipsychotic medications in patients with schizophrenia?

    <p>Higher rates of relapse and hospitalization</p> Signup and view all the answers

    Which factor predominantly contributes to reduced adherence to medication among patients with schizophrenia?

    <p>Associated cognitive and emotional deficits</p> Signup and view all the answers

    What is a critical legal consideration when treating mentally ill adults?

    <p>Mentally ill patients have the right to refuse treatment</p> Signup and view all the answers

    What demographic considerations must be taken into account when treating elderly patients with medications?

    <p>They may demonstrate decreased responsiveness to certain drugs</p> Signup and view all the answers

    What is a significant issue related to the management of mentally ill individuals with substance abuse histories?

    <p>They may struggle to differentiate cravings from mental illness symptoms</p> Signup and view all the answers

    What are future research directions for pharmacological therapy in mentally ill adults, particularly the elderly?

    <p>Studying drug interactions and collaborative practices</p> Signup and view all the answers

    What is critical when developing treatment regimens for the elderly?

    <p>Balancing benefits against potential adverse reactions</p> Signup and view all the answers

    Why might managed care efforts negatively impact treatment for comorbid diagnoses?

    <p>Focusing on short-term benefits over long-term commitment</p> Signup and view all the answers

    What role do advancements in neurobiology play in treating mental disorders?

    <p>They facilitate the discovery of targeted treatment agents</p> Signup and view all the answers

    Which emerging technology is noted for its potential in the generation of new CNS-active medicines?

    <p>Nanotechnology</p> Signup and view all the answers

    What is a significant challenge for doctors treating an aging population?

    <p>Lack of awareness about the elderly's medication needs</p> Signup and view all the answers

    What distinguishes the concept of capacity in mental health treatment?

    <p>The ability to appreciate the consequences of treatment choices</p> Signup and view all the answers

    What strategy is encouraged to improve medication adherence for patients with schizophrenia?

    <p>Matching treatment to the patient’s daily routine</p> Signup and view all the answers

    What implication does the increase in elderly patients have for mental health care providers?

    <p>Need for specialized training in geriatric psychiatry</p> Signup and view all the answers

    What is the primary benefit of personalized dosing in elderly patients regarding drug treatment?

    <p>Reduced rates of adverse drug reactions</p> Signup and view all the answers

    Which factor is most significantly correlated with poor medication adherence in elderly patients?

    <p>Cognitive impairment</p> Signup and view all the answers

    What is the main metabolic pathway affected by age-related changes in drug metabolism?

    <p>Hepatic cytochrome P450 enzyme system</p> Signup and view all the answers

    Which potential side effect is commonly associated with atypical antipsychotic drugs in elderly patients?

    <p>Cerebrovascular events</p> Signup and view all the answers

    How does the activities of CYP isoenzymes in elderly patients typically change compared to younger adults?

    <p>They are reduced</p> Signup and view all the answers

    What other health issue often complicates the treatment of mental disorders in elderly populations?

    <p>Coexistence of general medical disorders</p> Signup and view all the answers

    What is a common characteristic of depressive symptoms in elderly patients?

    <p>They increase risk for suicide</p> Signup and view all the answers

    How should antidepressants like selective serotonin reuptake inhibitors be used in treating elderly patients?

    <p>As a first-line long-term treatment</p> Signup and view all the answers

    What is a major caution when prescribing benzodiazepines for anxiety in elderly patients?

    <p>They may have rapid prescribing and dosing challenges</p> Signup and view all the answers

    What type of assessment tools are suggested for differentiating between psychological and medical conditions in elderly patients?

    <p>Standardized assessment methods and scales</p> Signup and view all the answers

    Which of the following is a common mental health disorder seen in elderly patients?

    <p>Schizophrenia</p> Signup and view all the answers

    What is a primary reason for the increased risk of adverse drug events in elderly patients?

    <p>Higher prevalence of polypharmacy</p> Signup and view all the answers

    Which behavioral symptom is considered a significant health problem in the elderly, especially with dementia?

    <p>Agitation</p> Signup and view all the answers

    What is a critical aspect of maintaining adherence to medications in elderly patients with cognitive issues?

    <p>Stabilization of mental health statuses</p> Signup and view all the answers

    Study Notes

    ### Cloral Hydrate

    • Less suitable for insomnia
    • Available in tablet, oral solution forms
    • Elderly patients should take 192-384 mg once daily at bedtime
    • Contra-indications include acute pulmonary insufficiency and alcohol-dependent patients who continue to drink
    • Cautions include prolonged use, cardiac disease, chronic pulmonary insufficiency, elderly patients, excessive sedation, history of drug abuse, marked personality disorder, respiratory disease, sleep apnea syndrome, and pregnancy
    • Side-effects include agitation, increased bronchial secretion, confusion, conjunctival irritation, drug dependence, excessive sedation, gastrointestinal disorder, hangover, nasal complaints, skin reactions, and upper airway secretion
    • Pregnancy should be avoided, especially during the first and third trimesters
    • Breastfeeding should only be used if the benefit outweighs the risk

    Melatonin

    • Used for short-term insomnia in patients with learning disabilities and challenging behaviors
    • Not licensed for this indication, as it may cause increased cerebral sensitivity and drowsiness the next day
    • Available in oral solution and capsule forms
    • For short-term use, adults aged 55 years and over should take 2 mg once daily for up to 13 weeks, taking 1–2 hours before bedtime
    • For jet lag, adults should take 3 mg once daily for up to 5 days, taking the first dose at the habitual bedtime after arrival at the destination
    • Doses should not be taken before 8 p.m. or after 4 a.m., and doses may be increased to 5 or 6mg once daily if necessary or reduced to 1 or 2mg once daily if sufficient

    Zopiclone

    • Recommended for short-term insomnia management
    • Adults should take 7.5 mg once daily for up to 4 weeks at bedtime
    • Elderly users should take 3.75 mg once daily for up to 4 weeks, increasing if necessary to 7.5 mg daily
    • Contraindications include marked neuromuscular respiratory weakness, myasthenia gravis, respiratory failure, severe sleep apnea syndrome
    • Pregnancy is not recommended due to the risk of neonatal withdrawal symptoms, and use during late pregnancy or labor may cause neonatal hypothermia, hypotonia, and respiratory depression
    • The manufacturer advises caution in mild to moderate impairment and avoids severe impairment (risk of decreased elimination)

    Sodium Oxybate

    • Used for narcolepsy with cataplexy
    • Adults should take 2.25 g daily, increasing in steps of 1.5 g daily in 2 divided doses
    • Contra-indications include major depression, succinic semialdehyde, and dehydrogenase deficiency
    • Cautions include body mass index of 40 kg/m2 or greater, elderly, epilepsy, heart failure, history of depression, drug abuse, hypertension, respiratory disorders, risk of discontinuation effects, rebound cataplexy, and withdrawal symptoms

    Pitolisant

    • Used to treat narcolepsy with or without cataplexy
    • Dosage can be adjusted according to response and tolerance
    • Common side effects include anxiety, asthenia, depression, dizziness, gastrointestinal discomfort, headaches, mood altered, nausea, sleep disorders, tremor, vertigo, vomiting, and rare behavior abnormalities
    • The manufacturer advises effective contraception in women of childbearing potential for at least 21 days after treatment discontinuation

    Modafinil

    • Used to treat excessive sleepiness associated with narcolepsy
    • Adults should take 200 mg daily in two divided doses, adjusted according to response to 200–400 mg daily
    • Elderly patients should take 100 mg daily
    • Healthcare professionals are advised not to use modafinil during pregnancy;
    • Modafinil may also reduce the effectiveness of some hormonal contraceptives

    Solriamfetol

    • Used to treat excessive daytime sleepiness caused by narcolepsy, obstructive sleep apnea, and other sleep disorders
    • Indications and doses include 75 mg once daily for adults, increased if necessary up to 150 mg once daily, and 37.5 mg once daily for adults with moderate impairment
    • Contra-indications include cardiac arrhythmias, hypertension (uncontrolled), myocardial infarction, unstable angina pectoris, and cardiovascular events

    Substance Dependence

    • Opioid dependence requires medical, social, and psychological treatment
    • Treatment should be initiated under the supervision of an appropriately qualified prescriber
    • Opioid substitution therapy, such as methadone hydrochloride and buprenorphine, is used to achieve stability, reduce drug use and crime, and improve health
    • Buprenorphine is a less sedating drug than methadone hydrochloride
    • Methadone hydrochloride is usually administered in a single daily dose as methadone hydrochloride oral solution 1 mg/mL
    • Opioid substitution during pregnancy should be avoided due to the risk of fetal death

    Opioid Substitution Therapy

    • Opioid substitution therapy is preferred during pregnancy to continuous use of illicit drugs as it carries a lower risk to the fetus.
    • Methadone hydrochloride or buprenorphine should be continued during pregnancy if the woman was stabilized on them.
    • Withdrawal of methadone hydrochloride or buprenorphine in the third trimester is not recommended as it is associated with fetal distress, stillbirth, and the risk of neonatal mortality.
    • Doses of methadone and buprenorphine should be kept as low as possible in breast-feeding mothers.
    • Increased sleepiness, breathing difficulties, or limpness in breast-fed babies of mothers taking opioid substitutes should be reported urgently to a healthcare professional.

    Management of Opioid Withdrawal

    • Adjunctive therapy and symptomatic treatment are essential for managing opioid withdrawal symptoms.
    • Loperamide hydrochloride, mebeverine hydrochloride, paracetamol, non-steroidal anti-inflammatory drugs, metoclopramide hydrochloride, or prochlorperazine can be prescribed for managing diarrhea, stomach cramps, muscular pains, headaches, nausea or vomiting, and muscle pain associated with methadone hydrochloride withdrawal.
    • Short-acting benzodiazepines or zopiclone can be prescribed for insomnia but should be limited to a short course of a few days only due to potential for abuse.
    • Lofexidine hydrochloride can alleviate some physical symptoms of opioid withdrawal.
    • Lofexidine can be prescribed as an adjuvant to opioid substitution therapy or instead of an opioid substitute for patients with mild or uncertain dependence, including young people and those with a short history of illicit drug use.

    Opioid-receptor Antagonists

    • Opioid receptor antagonists like naloxone hydrochloride can be given to patients dependent on opioids to be used in case of accidental overdose.
    • Naloxone hydrochloride is prescribed as an aid to prevent relapse in formerly opioid-dependent patients.
    • Maintenance treatment with opioid substitution therapy is usually controversial in young people but may be useful for older adolescents who have a history of opioid use to undergo a period of stabilization before starting a withdrawal regimen.

    Alcohol Dependence

    • Alcohol dependence is a cluster of behavioral, cognitive, and physiological factors including a strong desire to drink alcohol, tolerance to its effects, and difficulties controlling its use.
    • Abrupt reduction in alcohol intake in severely dependent patients may result in the development of an alcohol withdrawal syndrome, which, in the absence of medical management, can lead to seizures, delirium tremens, and death.
    • Assisted alcohol withdrawal is recommended for patients with mild, moderate, severe alcohol dependence, and decompensated liver disease.
    • Long-acting benzodiazepines like chlordiazepoxide hydrochloride or diazepam are recommended to attenuate withdrawal symptoms.
    • In primary care, fixed-dose reducing regimens are used, followed by dose reduction to zero over 7-10 days.
    • In inpatient or residential settings, a fixed-dose regimen or a symptom-triggered regimen can be used.
    • When managing withdrawal from co-existing benzodiazepine and alcohol dependence, the dose of benzodiazepine used for withdrawal should be increased.
    • Inpatient withdrawal regimens should last for 2-3 weeks or longer, depending on the severity of benzodiazepine dependence.
    • If alcohol withdrawal seizures occur, a fast-acting benzodiazepine should be prescribed to reduce the likelihood of further seizures.
    • Delirium tremens is a medical emergency that requires specialist inpatient care. Oral lorazepam should be used as first-line treatment, followed by parenteral lorazepam or haloperidol as adjunctive therapy.

    Management of Alcohol Dependence

    • Alcohol dependence is another medical emergency that requires specialist inpatient care.
    • Psychological interventions, such as cognitive behavioral therapy, should be offered to harmful drinkers or mild alcohol dependence patients.
    • Acamprosate calcium or oral naltrexone hydrochloride can be used in combination with a psychological intervention for relapse prevention in moderate and severe alcohol dependence patients.
    • Disulfiram is an alternative for patients who prefer disulfiram and understand the risks of taking the drug.
    • Nalmefene is recommended for the reduction of alcohol consumption in patients with high drinking risk levels, without physical withdrawal symptoms, and do not require immediate detoxification.
    • Patients with severe alcohol-related hepatitis with a discriminant function of 32 or more can be given corticosteroids, but only after any active infection or gastrointestinal bleeding is treated, any renal impairment is controlled, and following discussion of the potential benefits and risks of treatment.
    • Patients with chronic alcohol-related pancreatitis should be offered nutritional support.
    • Patients with chronic alcohol-related pancreatitis with symptoms of steatorrhoea or poor nutritional status due to exocrine pancreatic insufficiency should be prescribed pancreatic enzyme supplements.
    • Wernicke's encephalopathy is at risk in patients with alcohol dependence, particularly those who are malnourished, at risk of malnourishment, or have decompensated liver disease.
    • Parenteral thiamine followed by oral thiamine should be given to patients with suspected Wernicke's encephalopathy, malnourished or at risk of malnourishment, decompensated liver disease, or attending hospital for acute treatment.
    • Prophylactic oral thiamine should also be given to harmful or dependent drinkers if they are in acute withdrawal or before and during assisted alcohol withdrawal.

    Disulfiram

    • Disulfiram is an adjunct in the treatment of alcohol dependence (under expert supervision) and has side effects such as allergic dermatitis, breath odour, depression, drowsiness, encephalopathy, fatigue, hepatocellular injury, libido decreased, mania, nausea, nerve disorders, paranoia, psychotic disorder, vomiting, pregnancy, breastfeeding, hepatic impairment, renal impairment, and pre-treatment screening.
    • During treatment with disulfiram, patients should be monitored at least every 2 weeks for the first 2 months, then each month for the following 4 months, and at least every 6 months thereafter.
    • The manufacturer advises patients and their carers on the disulfiram-alcohol reaction, which may occur following exposure to small amounts of alcohol found in perfume, aerosol sprays, or low alcohol and "non-alcohol" beers and wines.
    • Symptoms of disulfiram-alcohol reaction can be severe and life-threatening, including nausea, flushing, palpitations, arrhythmias, hypotension, respiratory depression, and coma.
    • Patients and their carers should be counselled on the signs of hepatotoxicity, such as discontinuing treatment and seeking immediate medical attention if they feel unwell or symptoms such as fever or jaundice develop.

    Acamprosate Calcium

    • There can be variation in the licensing of different medicines containing the same drug.
    • Gastro-resistant tablets, such as Acamprosate calcium, have been used for the maintenance of abstinence in alcohol dependence in children aged 16 years and over.
    • The manufacturer advises against continued alcohol abuse and lists side effects such as abdominal pain, diarrhea, flatulence, nausea, sexual dysfunction, skin reactions, and vomiting.
    • It is advised to avoid pregnancy unless the potential benefit outweighs the risk.

    Nalmefene

    • Opioids receptor antagonists like nalmefene are recommended for reducing alcohol consumption in patients with alcohol dependence who have a high drinking risk level without physical withdrawal symptoms and do not require immediate detoxification.
    • Adults should take 18 mg daily if required, taken 1-2 hours before the anticipated time of drinking, preferably taken 1-2 hours before the anticipated time of drinking.
    • Contra-indications include a recent history of acute alcohol withdrawal syndrome, recent or current opioid use, and continued treatment for more than one year.
    • Nalmefene has side effects such as decreased appetite, asthenia, concentration impaired, confusion, diarrhoea, dizziness, drowsiness, dry mouth, feeling abnormal, headache, hyperhidrosis, libido decreased, malaise, muscle spasms, substance dependence, and psychiatric illness.
    • The manufacturer advises against pregnancy, breastfeeding, hepatic impairment, renal impairment, and pre-treatment.
    • Before initiating treatment for opioid dependence, prescribers should evaluate the patient's clinical status, alcohol dependence, and level of alcohol consumption.
    • Nalmefene should only be prescribed for patients who continue to have a high drinking risk level two weeks after the initial assessment.
    • During treatment, patients should be monitored regularly and the need for continued treatment assessed.

    ### Naltrexone

    • Nalmefene is an opioid-receptor antagonist and is recommended for preventing relapse in formerly opioid-dependent patients who have remained opioid-free for at least 7-10 days.
    • Adults should start with 25 mg daily, then increased to 50 mg daily, with a total weekly dose divided and given on three days of the week for improved compliance.
    • The maximum dosage is 350 mg per week.
    • Contra-indications include patients currently dependent on opioids, which should avoid concurrent use of opioids but may require an increased dose of opioid analgesic for pain.
    • Side effects of naltrexone include abdominal pain, anxiety, appetite abnormal, chest pain, chills, constipation, diarrhea, dizziness, eye disorders, headache, hyperhidrosis, mood altered, myalgia, nausea, palpitations, sexual dysfunction, skin reactions, sleep disorders, tachycardia, thirst, vomiting, alopecia, confusion, cough, depression, drowsiness, dry mouth, dysphonia, dyspnoea, ear discomfort, eye discomfort, eye swelling, feeling hot, fever, flatulence, flushing, hallucination, hepatic disorders, lymphadenopathy, nasal complaints, oropharyngeal pain, pain, paranoia, peripheral coldness, seborrhoea, sinus disorder, sputum increased, tinnitus, tremor, ulcer, urinary disorders, vertigo, vision disorders, weight changes, yawning, rare or very rare immunothrombocytopenic purpura, rhabdomyolysis, suicidal behaviors, frequency not known withdrawal syndrome, and pregnancies using only if benefit outweighs risk.
    • Liver function tests are needed before and during treatment.
    • Patients should be warned that an attempt to overcome the blockade of opioid receptors by overdosing could result in acute opioid intoxication.
    • National funding/access decisions for Nalmefene for reducing alcohol consumption in people with alcohol dependence (November 2014) NICE TA325 are recommended with restrictions.

    Smoking Cessation

    • Smoking tobacco is the leading cause of preventable illness and premature death in the UK, linked to various diseases such as cancer, chronic obstructive pulmonary disease, and cardiovascular disease.
    • It can also lead to complications during pregnancy.
    • Smoking cessation reduces the risk of developing or worsening smoking-related illnesses, and benefits begin as soon as an individual stops smoking.
    • Smoking cessation may be associated with temporary withdrawal symptoms caused by nicotine dependence, such as nicotine cravings, irritability, depression, restlessness, poor concentration, light-headedness, sleep disturbances, and increased appetite.
    • Weight gain is a concern for many people who stop smoking but is less likely to occur when drug treatment is used to aid smoking cessation.
    • Smokeless tobacco, placed in the nose or mouth and not burned, is also associated with significant health risks such as oropharyngeal cancers, cardiovascular disease, and periodontal disease.
    • Smokeless tobacco cessation reduces the risk of tobacco-related health problems but may cause withdrawal symptoms.
    • Individuals who use smokeless tobacco should be advised to stop and be offered referral to local specialist tobacco cessation services for interventions and support.
    • A combination of drug treatment and behavioral support is likely to be the most effective approach.

    Treatment and Support for Smoking Cessation

    • Individuals who wish to stop or reduce their harm from smoking should be referred to local stop-smoking services where they will be provided provided with advice, drug treatment, and behavioral support options such as individual counselling or group meetings.
    • If referral to local stop-smoking services is declined, individuals should be referred to a suitable healthcare professional who can also offer stop-smoking interventions.
    • Follow-up appointments should be offered to individuals attempting to stop smoking and those reducing their harm.

    Effective Drug Treatments for Smoking Cessation

    • Nicotine replacement therapy (NRT), varenicline, and bupropion hydrochloride are effective drug treatments for smoking cessation.
    • These treatments should be offered alongside behavioral support and consider the individual's adherence, preferences, and previous experience of smoking cessation aids.
    • Varenicline, or a combination of long-acting NRT and short-acting NRT, are the most effective options.
    • If these options are not appropriate, bupropion hydrochloride or single therapy NRT should be considered.
    • Nicotine transdermal patches are generally applied for 16 hours, with the patch removed overnight.
    • Short-acting nicotine preparations are used whenever the urge to smoke occurs or to prevent cravings.
    • There is no evidence that one form of NRT is more effective than another.
    • Combining NRT with varenicline or bupropion hydrochloride is not recommended, and both should not be prescribed together.
    • A quit date should be agreed when drug treatment is prescribed for smoking cessation, and treatment should be available before the individual stops smoking.
    • For those who have successfully stopped smoking, offer the opportunity for a further course of varenicline, NRT, or bupropion hydrochloride to prevent a relapse.
    • NRT may also be beneficial for individuals unwilling or not ready to stop smoking as part of a harm reduction approach.

    E-cigarettes

    • E-cigarettes deliver nicotine without the toxins found in tobacco.
    • E-cigarettes are likely less harmful to health than tobacco smoking but their long-term effects are still largely unknown.
    • E-cigarettes can help individuals stop smoking but cannot be prescribed or supplied by smoking cessation services.

    ### Pregnancy in relation to smoking cessation

    • Pregnant females should be advised to stop smoking completely and be informed about the risks to the unborn child of smoking during pregnancy and the harmful effects of exposure to second-hand smoke for both mother and baby.
    • All pregnant females who smoke or have stopped smoking in the last 2 weeks should be referred to local stopsmoking services, and ongoing intensive support should be offered during and following pregnancy.
    • For pregnant females who are reluctant or unable to attend stop-smoking services, alternative options such as home visits, telephone quitlines, or online stopsmoking support should be considered.
    • Smoking cessation should also be encouraged for all members of the household.
    • Nicotine replacement therapy (NRT) should be considered along with behavioral support at the earliest opportunity in pregnancy.
    • NRT has much lower risks and is less addictive because of the much lower amount of nicotine in NRT and the way these products deliver nicotine.
    • NRT may be continued after pregnancy, if needed, to prevent a relapse to smoking.

    Polycyclic Aromatic Hydrocarbons

    • Polycyclic aromatic hydrocarbons found in tobacco smoke can increase the metabolism of some drugs by inducing hepatic enzymes, often requiring an increase in dose.
    • Information about drugs interacting with tobacco smoke can be found under Interactions of the relevant drug monograph.

    Bupropion Hydrochloride

    • Bupropion hydrochloride (Amfebutamone hydrochloride) is an antidepressant used to aid smoking cessation in combination with motivational support in nicotine-dependent patients.
    • Indication for bupropion is 150 mg daily for 6 days then 150 mg twice daily (max. per dose 150 mg), minimum 8 hours between doses; period of treatment 7-9 weeks, start 1-2 weeks before target stop date, discontinue if abstinence not achieved at 7 weeks, consider maximum 150mg daily in patients with risk factors for seizures; maximum 300 mg per day.
    • Contra-indications of bupropion include acute alcohol withdrawal, acute benzodiazepine withdrawal, bipolar disorder, CNS tumor, eating disorders, history of seizures, severe hepatic cirrhosis, and contraindications include alcohol abuse, diabetes, elderly, history of head trauma, predisposition to seizures.

    Nicotine

    • Nicotine is a medication used to treat various conditions, including confusion, tachycardia, tinnitus, vasodilation, visual impairment, angioedema, arthralgia, behavior abnormality, bronchospasm, delusions, depersonalization, dyspnoea, hallucination, hepatic disorders, irritability, memory loss, movement disorders, muscle complaints, palpitations, paraesthesia, parkinsonism, postural hypotension, seizure, sleep disorders, Stevens-Johnson syndrome, syncope, urinary disorders, and frequency not known.
    • Pregnancy and breastfeeding should be avoided due to lack of information available.
    • The manufacturer advises use with caution, monitoring closely for adverse effects and avoid in severe cirrhosis.
    • Dose adjustments are advised, and blood pressure should be monitored before and during treatment.
    • Patients and carers should be instructed to report any clinical worsening of depression, suicidal behavior or thoughts, and unusual changes in behavior.

    ### Nicotine Replacement Therapy (NRT)

    • Nicotine replacement therapy can be administered through oral chewing gum, simultaneous administration using identical tablets, nicotine replacement therapy using an inhalator, oral lozenges, intraNASAL administration using nasal sprays, and transdermal application using patches.
    • Indications and doses vary between individuals, with lower-strength lozenges used for those who smoke less than 20 cigarettes daily, higher-strength lozenges for those who smoke more than 20 cigarettes daily, and nasal sprays for those who smoke more than 10 cigarettes daily.
    • In addition to oral chewing gum, nicotine replacement therapy can be administered via injection using an inhalator, oral lozenges, intraNASAL administration using nasal sprays, and transdermal application using patches.
    • The dosage and frequency of these medications should be carefully monitored and adjusted as needed.

    Nicotine Replacement Therapy (NRT) Patches

    • Nicotine replacement therapy is a treatment method that involves the use of nicotine patches to help individuals quit smoking.
    • The process involves a series of titrations, starting with a medium-strength patch for 6-8 weeks, followed by a medium-strength patch for 2-8 weeks, and finally a low-strength patch for 2-4 weeks.
    • Individuals who smoke fewer than 10 cigarettes daily can usually start with the medium-strength patch for 6-8 weeks, followed by the low-strength patch for 2-4 weeks.
    • If abstinence is not achieved or withdrawal symptoms are experienced, the strength of the patch used should be maintained or increased until the patient is stabilized.

    ### Risks associated with Nicotine Replacement Therapy (NRT)

    • There are several potential risks associated with nicotine replacement therapy, including diabetes mellitus, haemodynamically unstable patients, patients hospitalized with cerebrovascular accidents, myocardial infarction, severe arrhythmias, phaeochromocytoma, and uncontrolled hyperthyroidism.
    • Specific risks include bronchospastic disease, chronic throat disease, obstructive lung disease, bronchial asthma, gastroritis, oesophagitis, and peptic ulcers.
    • Transdermal use patches should not be placed on broken skin, especially for patients with skin disorders.

    Nicotine Replacement Therapy

    • Nicotine replacement therapy is safe and effective for quitting smoking.
    • Monitor blood glucose levels when using nicotine replacement therapy.
    • Avoid certain side effects of nicotine replacement therapy, including dizziness, headache, nausea, and palpitations.
    • Consult with a healthcare professional before starting or continuing nicotine replacement therapy.
    • Nicotine replacement therapy is a preferred method for smoking cessation during pregnancy.
    • Behavioral support is recommended alongside nicotine replacement therapy.
    • Continue nicotine replacement therapy after pregnancy if needed.
    • Remove nicotine patches before bed.
    • Nicotine is present in breast milk but in a small amount and less hazardous than secondhand smoke.
    • Intermittent therapy is preferred.
    • Caution is advised for individuals with moderate to severe impairment due to the risk of decreased clearance.
    • Caution is also advised for individuals with severe renal impairment.

    Nicotine Replacement Therapy Administration

    • Avoid acidic beverages for 15 minutes before using oral nicotine replacement therapy.
    • Apply transdermal patches on waking to dry, non-hairy skin on the hip, trunk, or upper arm.
    • Hold patches in place for 10-20 seconds to ensure adhesion.
    • Use nasal spray in both nostrils, gradually reducing the dose when withdrawing from therapy.
    • Release oral spray into the mouth holding it as close to the mouth as possible, avoiding the lips.
    • Place sublingual tablets under the tongue and allow them to dissolve.
    • Slowly dissolve lozenges in the mouth, moving them periodically from one side to the other.
    • Insert inhalation cartridges into the device and draw in air through the mouthpiece.
    • Each inhalation session can last for approximately 5 minutes.
    • The amount of nicotine from one puff of the cartridge is less than that from a cigarette.
    • It is necessary to inhale more often than when smoking a cigarette.
    • A single 15 mg cartridge lasts for approximately 40 minutes of intense use.
    • Medicated chewing gum and lozenges may include mint, fresh fruit, fresh mint, icy white, or cherry flavours.
    • Patients or carers should receive advice on how to administer nicotine chewing gum, inhalators, lozenges, sublingual tablets, oral spray, nasal spray, and patches.

    Nicotine Replacement Therapy Medications

    • Medicinal forms may vary in licensing with some medications containing the same drug, but having different excipients.
    • Nicorette, Nicorette QuickMist, Nicorette Microtab, and NiQuitin are some of the medications available.
    • Nicotine Clear contains 7 mg of nicotine per 24-hour patch and is available in various dosages and strengths.
    • Nicorette invisi contains 10 mg, 15 mg, and 25 mg of nicotine per 16-hour patch.
    • Nicotinell TTS contains 7 mg, 14 mg, 20 mg, and 21 mg of nicotine per 24-hour patch.
    • Nicorette Icy White contains 2 mg of nicotine-free gum and is available in different sizes and flavours.
    • Nicotinel contains nicotine inhalers used to help manage nicotine dependence and is available in various dosages.
    • Nicotine is also available in liquid, spray, and inhaler forms, with various sizes and flavours.

    Varenicline

    • Varenicline is a selective nicotine-receptor partial agonist used to aid smoking cessation in adults.
    • It is prescribed by mouth and can be started 1 to 2 weeks before the target stop date.
    • A 12-week course is repeated in abstinent individuals to reduce the risk of relapse.
    • Caution is advised for conditions that may lower seizure threshold, such as a history of cardiovascular disease or psychiatric illness.
    • Common side effects include appetite abnormalities, asthenia, chest discomfort, constipation, diarrhea, dizziness, drowsiness, dry mouth, gastrointestinal discomfort, headache, joint disorders, muscle complaints, nausea, oral disorders, pain, skin reactions, sleep disorders, vomiting, weight increased, allergic rhinitis, anxiety, arrhythmias, behavior abnormality, burping, conjunctivitis, depression, eye pain, fever, fungal infection, haemorrhage, hallucination, hot flush, hyperglycaemia, influenza-like illness, malaise, menorrhagia, mood swings, numbness, palpitations, seizure, sexual dysfunction, suicidal ideation, sweat changes, thinking abnormal, tinnitus, tremor, urinary disorders, and frequency not known loss of consciousness.
    • Pregnancy and breastfeeding should be avoided due to toxicity in animal studies.
    • Renal impairment can be treated with dose adjustments if creatinine clearance is less than 30 mL/minute.
    • Treatment discontinuation risks relapse, irritability, depression, and insomnia.
    • Consider dose tapering on completion of the 12-week course.
    • Patients and caregivers should be cautioned about the effects on driving and performing skilled tasks due to an increased risk of dizziness, somnolence, and transient loss of consciousness.

    Opioid Dependence Medications

    • Other drugs used for opioid dependence include Buprenorphine, Naltrexone hydrochloride, and Methadone hydrochloride.

    Methadone Hydrochloride

    • Methadone is a long-acting opioid with effects that may be cumulative.
    • It poses a special hazard to children, non-dependent adults, and dependent adults if tolerance is incorrectly assessed during induction.
    • Overdoses may require long-term monitoring.
    • Breastfeeding is permissible during maintenance but the dose should be as low as possible and monitored to avoid sedation.
    • Caution is advised and Methadone should be avoided in severe impairment due to increased exposure risks.
    • Consider dose reduction in the treatment of opioid dependence as it can lead to increased opioid effects and prolonged cerebral sensitivity.
    • Treatment cessation should be avoided abruptly.
    • The final strength of the methadone mixture to be dispensed to the patient must be specified on the prescription.
    • Care is required in prescribing and dispensing the correct strength as any confusion could lead to an overdose.
    • This preparation should be dispensed only after dilution as appropriate with Methadose® Dilutient (life of diluted solution 3 months).

    Buprenorphine/Naloxone

    • National funding/access decisions for methadone and buprenorphine for the management of opioid dependence are recommended by NICE TA114.
    • Methadone linctus is less suitable for prescribing for cough in terminal disease as it has a tendency to accumulate.
    • Medication forms available from special-order manufacturers include tablets, capsules, oral suspension, oral solution, and solution for injection.
    • Suboxone® sublingual tablets and sublingual film are not bioequivalent and patients should be monitored for symptoms of overdose or withdrawal.
    • ZUBSOLV® is an adjunct in the treatment of opioid dependence (dose expressed as buprenorphine) (under expert supervision) for adults aged 18-65 years.
    • Zubsolv® is not interchangeable with other buprenorphine products on a milligram-for-milligram basis due to differences in bioavailability.
    • Patients should not be switched between products

    Lofexidine

    • Lofexidine is an alpha2-adrenergic agonist used to manage symptoms of opioid withdrawal.
    • The dosage is 800 micrograms daily in divided doses, increasing in steps of 400-800 micrograms daily.
    • The recommended duration of treatment is 7-10 days if no opioid use is required, with a maximum of 2.4 mg per day.
    • Lofexidine has been used in children over 12 years in the management of symptoms of opioid withdrawal.
    • The patient should take part of the dose at bedtime to offset insomnia associated with opioid withdrawal.
    • Monitoring blood pressure and pulse rate is recommended on initiation, for at least 72 hours or until a stable dose is achieved, and on discontinuation.
    • Treatment should be withdrawn gradually over 2-4 days (or longer) to reduce the risk of rebound hypertension and associated symptoms.

    Mental Illness: Challenging Definitions and Prevalence

    • It is difficult to define "who is mentally ill" in medical practice due to cultural, religious, and social value differences in the definition of sanity.
    • Patients requiring psychiatric care often have social and individual problems, display inflammatory behaviours, and have difficulties with daily life activities due to conditions related to brain injury or deterioration, chemical abuse, or socio-cultural deprivation.
    • Psychiatric disorders can be caused by numerous neurobiological, genetic, psychological, and social factors or their combinations.
    • Mental illnesses constitute a major chunk of the world's health problems, but patients often face stigma and services deprivation.
    • Prevalence rates of mental health problems vary significantly, ranging from 9% to 75% in different studies.
    • Factors influencing the reliability of prevalence studies in medical settings include: patient selection, definitions of mental health problems, study design, and screening and diagnostic methods.
    • Referral bias is present before patients enter the hospital, suggesting that patients with mental health problems are more likely to be admitted for specific health problems than those without current mental health difficulties.
    • The second bias is driven by the study's design, which is generally dictated by resources and time available rather than carefully considered methodology.
    • The presentation of acute physical illness in elderly psychiatric patients is often atypical, and the opportunity to observe mental health problems in these older patients may be missed if outdated or inflexible reporting methods and systems are favoured.

    Mental Illness: Quality of Life and Treatment

    • Quality of life incorporates an individual's well-being, including health, functional status, personal and social resources, and subjective sense of well-being.
    • Research on quality of life for people with mental illness has contributed to understanding subjective quality of life and how to measure it meaningfully.
    • Subjective quality of life constructs and measures have been extensively studied in diverse conditions, but there are still gaps in understanding the relationship between subjective quality of life and other clinical indicators.
    • The contribution of genetic interventions for neurotransmitter dysfunction in treating associated risk factors of severe mental illness to subjective quality of life measures is unclear.
    • Pharmacotherapy of mental illness has revolutionized treatment but concerns remain regarding its proper usage, efficacy, and safety.
    • It is crucial to prioritize the elderly and adults when prescribing, dispensing, and monitoring these medications.
    • Pharmacists, nurses, and physicians should accept, recognize, and manage mentally ill adults and the elderly, promoting their quality of life.
    • Integrating and harmonizing mental illness pharmacotherapy into health systems and daily lives is essential.
    • The interaction between patients and medical personnel should be individualized, case by case, and caregivers should respect the irrational actions and decisions of elderly patients with mental illness.
    • Physiological changes with aging increase susceptibility to various diseases, particularly degenerative ones.

    Mental Illness: Treatment Considerations for Elderly Patients

    • Pharmaceutical practices must consider these changes to frame treatment within the capacity for tolerability.
    • All drugs used in geriatric patients need special dosage adjustments and adequate accompanying measures to minimize potential risks.
    • Aging always determines an increase in morbidity and mortality, but this equilibrium may be disrupted by iatrogenic effects, drug therapeutic reactions that are not a consequence of the patient's therapy with an indication for the drug.
    • Elderly patients experience physiological changes that affect drug distribution and metabolism, including reduced nephron function, lower serum albumin, altered tissue hydration, and slower drug metabolism.
    • These changes influence drug distribution, with water-soluble drugs distributing differently in older patients.
    • Polypharmacy, using multiple medications, is a concern for the elderly, increasing the risk of drug interactions and metabolic effects.
    • Age-related gastric pH changes can affect drug absorption and metabolism in the elderly.
    • Elderly patients often present with higher variability in drug response due to age-related changes in pharmacokinetics and pharmacodynamics.
    • Current drug therapy guidelines are based on younger adults, making it challenging to determine the true impact of age-related changes on drug response.
    • Personalized dosing for elderly patients can reduce adverse drug reactions and hospitalizations.
    • Pharmacokinetic monitoring using physical health parameters and body composition measurements helps identify optimal therapeutic approaches for the elderly.
    • Age-related changes in drug metabolism are mainly caused by alterations in hepatic cytochrome P450 enzyme system activity, leading to decreased drug metabolism efficiency.

    Medication Adherence in Elderly Patients with Mental Illness

    • Poor adherence to medication is more common in elderly patients with mental health conditions, increasing the risk of hospitalization and caregiver burden.
    • Disease-related factors contribute significantly to poor adherence in elderly patients, especially those with cognitive impairment.
    • Stabilizing mental state improves medication adherence.
    • Common features of poor adherence include skipping doses and dosage irregularities.
    • Adverse drug effects can contribute to poor adherence.

    Treatment of Agitation in Elderly Patients with Dementia

    • Atypical antipsychotics have shown limited efficacy in treating behavioral symptoms, including agitation, in elderly patients with dementia and carry significant risks, such as death, cerebrovascular events, extrapyramidal motor symptoms, and metabolic effects.
    • Antipsychotic use in elderly patients with dementia has been linked to increased mortality and functional decline.

    Mental Health Conditions in Elderly Patients

    • Common mental health disorders in elderly patients include anxiety, depression, organic brain syndrome, late-onset psychosis, and schizophrenia.
    • These conditions can lead to polypharmacy, with medications such as anti-anxiety agents, sedatives, and antidepressants.
    • Depression is often underdiagnosed and inadequately treated in the elderly.
    • Anxiety disorders involve excessive autonomic activity, anxious avoidance, and anxious inhibitions.
    • Benzodiazepines are short-term anxiolytics, but they can be problematic for individuals with a history of substance abuse.
    • Selective serotonin reuptake inhibitors (SSRIs) are first-line treatment for anxiety disorders in the long term.
    • Combined use of psychotherapy and somatic treatments can be considered to inform treatment decisions.

    Assessment of Mental Disorders in Elderly Patients

    • Assessing adult patients should consider historical factors, present and past symptoms, atypical presentations, and potential misinterpretations to avoid delays in diagnosis and increased suffering.
    • Depressive symptoms interfering with daily functioning increase the risk of suicide.
    • Psychiatric symptoms can often be seen in individuals who consistently struggle with medical treatment adherence.
    • Thorough physical and psychiatric testing is often required to differentiate between mental and physical conditions.
    • Various assessment methods, tools, and scales are available for general or specific mental disorders.

    Treatment Options for Mental Disorders in Elderly Patients

    • Treatment options for mental disorders in the elderly include medications, non-medical treatments, and a team approach with case management or care coordination.
    • It's important to consider individual and cultural preferences regarding treatment, including potential biases against certain medications or alternative medicine practices.
    • Antidepressants are crucial in treating conditions like depression and anxiety disorders in the elderly.
    • Comorbidities and the use of other CNS-acting substances can make treatment with any medication challenging.
    • Antipsychotics are essential for managing symptoms in pathological conditions affecting mental health.

    Non-Pharmacological Interventions for Mental Disorders

    • Non-pharmacological interventions, like psychotherapy and behavioral therapies, can enhance patient autonomy and satisfaction with care.
    • These interventions are often underutilized, lacking widespread awareness and potentially harboring negative stereotypes.
    • Psychotherapy is an integral part of care for older adults with mental health issues, addressing adherence, illness insight, and drug-related concerns.
    • Individual and group therapy can help address adherence issues and manage addiction.
    • Music therapy assists non-verbal or less verbal patients.
    • Supportive psychotherapy and social contacts often show greater benefits than placebo groups.
    • Interpersonal psychotherapy proves equally or more beneficial than pharmacotherapy.
    • Behavioral therapies have been effective in treating depression and mania, but more research is needed.
    • Cognitive behavioral therapy has shown effectiveness compared to diverse treatment approaches.
    • Reminiscence therapy, similar to psychotherapy, leverages personal memories and internal resources to enhance life satisfaction.

    Medication Adherence and Management in Mental Illness

    • Medication adherence is crucial for the successful treatment of conditions requiring medication, especially in psychiatry, due to the risk of drug resistance, relapse, and even severe outcomes.
    • Noncompliance with treatment regimens can lead to negative consequences, including drug resistance, nonresponse, relapse, and even suicide or homicide.
    • A significant percentage of psychiatric patients are nonadherent or partially nonadherent to their prescribed treatment, particularly with chronic illnesses and pharmacologically sensitive conditions.
    • Factors contributing to nonadherence in psychiatric patients include dosage frequency. disease severity, associated cognitive and motivational deficits, and adverse drug effects.
    • Targeting obstacles to adherence, such as simplifying treatment regimens and aligning them with daily routines, can improve compliance in patients with schizophrenia.
    • Adherence to medication in elderly patients requires careful consideration of age-related changes and potential adverse effects.
    • The elderly may experience decreased responsiveness to certain medications such as beta-adrenergic drugs, requiring a balance between potential benefits and toxicity.
    • Opioid use in the elderly presents unique challenges due to their potential for toxicity.
    • A demographic shift to an older population highlights the need for increased awareness of optimal medication use in the elderly among medical professionals.

    Mental Illness and Substance Abuse

    • Individuals with mental illness may use substances to manage symptoms or cope with difficult life circumstances, negatively impacting treatment outcomes and increasing the risk of homelessness and incarceration.
    • It can be challenging to differentiate between substance cravings and symptoms of severe mental illness.
    • Lack of long-term resources can hinder the treatment of individuals with comorbid diagnoses of substance abuse and psychosis.
    • Mentally ill adults have the right to refuse medication.
    • Involuntary treatment may be employed when an individual's health or the health of others is at risk.
    • Mentally ill individuals in jails are vulnerable to adverse psychosocial events.
    • Legal procedures and administrative detentions apply to mentally ill elderly individuals.
    • Capacity, a legal concept, refers to a patient's ability to understand and make decisions concerning treatment.
    • Psychiatrists do not have the final determination of capacity.

    Future Directions in Pharmacotherapy for Mental Illness

    • Future research should focus on drug interactions of commonly prescribed drugs in primary care.
    • Collaboration between various disciplines, including psychiatry, geriatrics, neurology, internal medicine, and pharmaceutical therapy, is essential..
    • Public health involvement in studies on effectiveness and cost factors is crucial for better healthcare outcomes.
    • Development of clear treatment guidelines for mental disorders and related problems should be prioritized.
    • Research should focus on personalized treatments for the elderly and those with dementia.
    • Knowledge translation is essential to ensure non-expert health care workers understand scientific findings.

    Emerging Technologies in Psychiatry and Mental Health

    • Advancements in nanotechnology and biotechnology have led to the development of new CNS-active medications for various brain disorders, such as schizophrenia and autism.
    • Nanotechnology holds promise for creating novel neurodiagnostic and therapeutic agents.
    • Complex drug molecules can be incorporated into robust CNS agents for intravenous and intramuscular administration through freeze-drying techniques.
    • Neurobiology advancements have led to identification of disease targets and associated drugs, such as D2/5HT6 ligands for schizophrenia and cholinesterase-inhibiting agents for Alzheimer's disease.
    • The focus is on developing drugs that act rapidly on targets, minimize side effects, and are cost-effective.
    • Selective dopaminergic excitation may offer benefits in treating schizophrenia symptoms.

    Nanodrug Formulation

    • Benefits:
      • Can deliver effective medication doses with fewer side effects
      • Reduces metabolic and transport complications
      • Addresses issues of poor bioavailability, water and fat solubility, and permeability
    • Mechanism:
      • CNS-active nanodrug formulation allows for targeted delivery of medication to the brain
      • Reduced drug levels in peripheral areas minimize side effects

    Drug Therapy

    • Preferred Treatment:
      • Non-pharmacologic therapy is the preferred treatment for brain disorders
    • Pharmacological Interventions:
      • Used only in cases of imminent danger to the patient or others, or when non-pharmacological strategies fail
      • Drugs should be prescribed at the lowest effective doses only temporarily and with close monitoring

    Importance of Diagnosis

    • Subtypes:
      • Sensitive diagnosis of underlying dementia subtypes is essential for effective treatment planning
    • Behavioral Disturbances:
      • Identifying specific behavioral disturbances is crucial for tailoring non-pharmacological therapy

    Elderly and Mental Health

    • Higher Rates:
      • Elderly individuals experience higher rates of mental health disorders and increased reliance on long-term prescription drugs
    • Physiologic Changes:
      • These changes significantly impact pharmacotherapy

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    Test your knowledge on Cloral hydrate and melatonin in this quiz based on Pharmacology Chapter 5. You'll answer questions about usage, dosage recommendations, contraindications, and precautions for different patient groups. Challenge yourself to see how well you understand these medications!

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