Psychopharmacology PDF

11/16/23, 11:21 AM Realizeit for Student Psychopharmacology Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in inpatients with anorexia n...

11/16/23, 11:21 AM Realizeit for Student Psychopharmacology Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in inpatients with anorexia nervosa. Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored (Davis & Attia, 2017); however, close monitoring is needed because weight loss can be a side effect. CLINICAL VIGNETTE: Anorexia Nervosa Maggie, 15 years old, is 5 ft 7 in tall and weighs 92 lb. Though it is August, she is wearing sweatpants and three layers of shirts. Her hair is dry, britt makeup. Maggie’s family physician has referred her to the eating disorders unit because she has lost 20 lb in the past 4 months and her menstrual and weak, but has trouble sleeping. Maggie is an avid ballet student and believes she still needs to lose more weight to achieve the figure she want concern to Maggie’s parents about her appearance and fatigue. Maggie’s family reports that she has gone from being an A and B student to barely passing in school. She spends much of her time isolated in her r hours, even in the middle of the night. Maggie seldom goes out with friends, and they have stopped calling her. The nurse interviews Maggie but ga to discuss her eating. Maggie does say she is too fat and has no interest in gaining weight. She does not understand why her parents are forcing he want to do is fatten you up and keep you ugly.” Psychopharmacology Since the 1980s, many studies have been conducted to evaluate the effectiveness of medications, primarily antidepressants, to treat bulimia. Drugs, such as desipramine (Norpramin), imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), phenelzine (Nardil), and fluoxetine (Prozac), were prescribed in the same dosages used to treat depression. In all the studies, the antidepressants were more effective than were the placebos in reducing binge eating. They also improved mood and reduced preoccupation with shape and weight; however, most of the positive results were short term. It may be that the primary contribution of medications is treating the comorbid disorders frequently seen with bulimia. Effects of Selected Medications on Weight Antidepressants Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem) and related drugs, may promote weight loss with short-term use. However, with long-term use, they reportedly may cause as much weight gain as tricyclic antidepressants (TCAs) such as amitriptyline. TCAs have long been associated with excessive appetite and weight gain. Mirtazapine (Remeron) and phenelzine (Nardil) are also associated with weight gain. The effects of bupropion (Wellbutrin and Zyban) on weight are unclear from clinical trials. Gain was reported when bupropion was used as a smoking deterrent, but both gain and loss occurred when it was used as an antidepressant. However, anorexia and weight loss occurred at a higher percentage rate than did increased appetite and weight gain. Antidiabetic Drugs Although little attention is paid to the topic in most literature about diabetic drugs, weight gain apparently occurs with insulin, sulfonylureas, and the glitazones (but not with metformin, acarbose, or miglitol). Almost all patients with type 2 diabetes eventually require insulin; those who are failing on oral agents generally gain a large amount of body fat when switched to insulin therapy. Although the mechanism of weight gain is unknown, it may be related to the chronic hyperinsulinism induced by long-acting insulins and the sulfonylureas (which increase insulin secretion). Less weight is gained when oral drugs are given during the day and an intermediate- or long-acting insulin is injected at bedtime. This strategy is thought to cause less daytime hyperinsulinemia than the more traditional insulin strategies. For near-normal-weight patients with diabetes who require drug therapy, a sulfonylurea may be given. However, for obese patients, metformin is usually the initial drug of choice because it does not promote weight gain. Metformin may also be used to treat obese diabetic children, aged 10 to 16 years, who require drug therapy. Antiepileptic Drugs Weight gain commonly occurs with the use of antiepileptic drugs (AEDs). This has been observed for many years with older drugs (e.g., phenytoin, valproic acid, carbamazepine) and with newer AEDs (e.g., gabapentin, lamotrigine, tiagabine). Mechanisms by which the drugs promote weight gain are unclear but may involve stimulation of appetite and/or a slowed metabolic rate. Consequences of weight gain may https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/2 11/16/23, 11:21 AM Realizeit for Student include increased risks of diabetes mellitus, hypertension, and other physical health problems as well as psychological distress over appearance, especially in children and adolescents. Antihistamines Histamine1 (H1) antagonists (e.g., diphenhydramine, loratadine) reportedly increase appetite and cause weight gain. Antihypertensive Agents The main antihypertensive drugs reported to cause weight gain are the beta-adrenergic blockers. The drugs can cause fatigue and decrease exercise tolerance and metabolic rate, all of which may contribute to weight gain. Other mechanisms may also be involved. As a result, some clinicians question the use of beta-adrenergic blockers in overweight or obese patients with uncomplicated hypertension. Alpha-blockers may also cause weight gain, but apparently at a low incidence. Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are not reported to promote weight gain. Antipsychotic Agents Weight gain is often reported and extensively documented with antipsychotic drugs. Although the exact mechanism is unknown, weight gain has been associated with antihistaminic effects, anticholinergic effects, and blockade of serotonin receptors. In addition, dietary factors and activity levels may also play significant roles. Clozapine and olanzapine reportedly cause significant weight gain in 40% or more of patients. Compared with clozapine and olanzapine, risperidone causes less weight gain, and quetiapine and ziprasidone cause the least weight gain. Weight gain may lead to noncompliance with drug therapy. In addition to weight gain, clozapine and olanzapine adversely affect glucose regulation and can aggravate preexisting diabetes or cause new-onset diabetes. The extent to which these effects are related to weight gain is unknown. For patients who are obese, diabetic, or at risk of developing diabetes, an antipsychotic drug that causes less weight gain would seem the better choice. Cholesterol-Lowering Agents Weight gain has been reported with the statin group of drugs; mechanisms and extent are unknown. Corticosteroids Systemic corticosteroids may cause increased appetite, weight gain, central obesity, and retention of sodium and fluid. Inhaled and intranasal corticosteroids have little effect on weight. Gastrointestinal Drugs Increased appetite and weight gain have been reported with the proton pump inhibitors such as omeprazole and others. The mechanisms and extent are unknown. Hormonal Contraceptives The weight gain associated with using hormonal contraceptives may be related more to retention of fluid and sodium than to increased body fat. Mood-Stabilizing Agent Weight gain has been reported with long-term use of lithium, with approximately 20% of patients gaining 10 kg (22 lb) or more. This increased weight is attributed to fluid retention, consumption of high-calorie beverages as a result of increased thirst, or a decreased metabolic rate. Weight gain is a common reason for noncompliance with lithium therapy, and weight gain may be more common in women with lithium-induced hypothyroidism and in those who are already overweight. Example https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/2