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psychotropic agent
Epidemiology:
- most commonly prescribed drugs are
- sertraline (Zoloft)
- citalopram (Celexa)
- fluoxetine (Prozac)
- alprazolam (Xanax)
- zolpidem (Ambien) [2]
- 17% of adults filled at least one psychotropic drug prescription in 2013
- highest among whites, 21%, lowest among Asians, 5%
- women were more likely than men (21% vs 12%)
- use was more common among older adults, 25% of those age 60-85 years [2]
Pharmacology:
- crosses the blood-brain barrier
- acts primarily on the central nervous system
- results in alterations in perception, mood, consciousness, cognition, & behavior
Includes:
any drug that affects brain activity associated with mental processes & behavior
- alcoholic beverage
- stimulants
- coffee, tea, tobacco, coca, amphetamine, phenethylamine, cocoa, guarana, mate, ephedra, khat
- depressants
- sedative/hypnotic, narcotics
- antipsychotics, antidepressants, anxiolytics
- hallucinogens
- psilocybin, LSD, Salvia divinorum, nitrous oxide
- marijuana
- mood stabilizers, anticonvulsants, muscle relaxants, anticholinergics, antihistamines, NMDA receptor antagonist
Management:
- use psychotropic drugs must be accompanied by gradual dose reductions, & behavioral intervention, unless contraindicated, in an effort to discontinue
- gradual dose reductions may not be appropriate for specific, chronic, progressive or terminal conditions such as chronic depression, Parkinson's disease psychosis or recurrent seizures [3]
- PRN orders for psychotropic medications
- excluding antipsychotics: limited to 14 days, but may be extended
- must have documented rationale for extension in the medical record, including a specific duration [3]
- PRN orders for antiosychotics limited to 14 days without exception.
- patient must be evaluated first. [3]
Interactions
drug adverse effects of psychotropic agents
Specific
analeptic (CNS stimulant)
antidepressant
antipsychotic agent
appetite stimulant
atomoxetine (Strattera)
attention-deficit hyperactivity disorder (ADHD) medication
cannabinoid (spice, K2, AMB-FUBINACA)
hallucinogen; psychodysleptic
mood stabilizer
sedative/hypnotic (tranquilizer)
General
pharmaceutical agent
References
- Wikipedia: Psychoactive drug.
http://en.wikipedia.org/wiki/Psychoactive_drug
- Moore TJ, Mattison DR
Adult Utilization of Psychiatric Drugs and Differences by
Sex, Age, and Race.
JAMA Intern Med. Published online December 12, 2016
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2592697
- CMS Pharmacy Services
https://qsep.cms.gov/data/107/PharmacyServices.pdf