CONTRAINDICATIONS AND DRUG SURVEILLANCE IN PSYCHOPHARMACOLOGY An important aspect of primary healthcare in
metabolism pathways of these drugs. Both the S- and R-warfarin enantiomers are metabolized by the cytochrome P450 enzymes. Carbamazepine and phenobarbital are potent inducers of the cytochrome 450 enzymes. By inducing the action of these enzymes, these psychotropic drugs alert the pharmacodynamics of warfarin in action, which may result in therapeutic failure. Concomitant administration of antidepressants with anticoagulants has also been linked to therapeutic failure in many patients. Some psychotropic medications, including fluoxetine, fluvoxamine, topiramate, and oxcarbazepine, also interact with the metabolism of clopidogrel and decrease its effectiveness (Auschra et al., 2022). lorazepam, clonazepam, and flurazepam. In the same vein, it appears the protease inhibitors also increase the effects of some psychotropic drugs, including risperidone, haloperidol, fluphenazine, clozapine, aripiprazole, and chlorpromazine. antidepressants directly stimulates insulin secretion, lowering blood glucose levels and increasing the risk of hypoglycemia in psychiatric patients also managed with antidiabetics. Although the mechanism for this interaction is still largely under investigation, it has been described in different cases of MOAI coadministration with insulins, acarbose, miglitol, metformin, nateglinide, repaglinide, canagliflozin, chlorpropamide, glimepiride, glipizide, and tolbutamide. olanzapine, chlorpromazine, thioridazine; antidiarrheals such as diphenoxylate and atropine; and antiemetics such as prochlorperazine and promethazine. The concomitant administration of these medications with digoxin, disopyramide, furosemide, dantrolene, orphenadrine, flavoxate, and oxybutynin increases the risk of anticholinergic-induced toxicity in the patients (Ambwani et al., 2021).
psychopharmacology is the evaluation of drug interactions and contraindications. This is particularly important for medications with a narrow therapeutic index and those with pharmacokinetics that depend heavily on the extent of drug distribution in the body. The most important drugs interactions in psychopharmacology include the following. Interactions with Anticoagulants Warfarin, an anticoagulant, interacts considerably with psychotropic drugs, altering the levels of distribution and the therapeutic index in many cases. Concomitant administration of warfarin and clopidogrel results in pharmacological interactions. These interactions are largely facilitated by the Interactions with Antiretrovirals Protease inhibitors, widely prescribed antiretrovirals, are strong inhibitors of the cytochrome 3A4 inhibitors. Concomitant administration of these medications with psychotropic drugs may alter therapy outcomes. This generally holds true for diazepam, Interactions with Antidiabetics Interactions with antidiabetics are particularly important in the geriatric population. Carbamazepine acts as an inducer of the CYP450 3A4 enzyme, which is generally responsible for the metabolism of many diabetic medications. This interaction explains why the therapeutic effects of linagliptin and repaglinide may be reduced in geriatric patients managed with carbamazepine. Another frequent drug interaction in this class is linked to monoamine oxidase inhibitors. This class of Interactions with Anticholinergic Medications Increased anticholinergic effects can actively induce toxicity with a range of symptoms, including confusion, hypertension, flushing, pyrexia, and tachycardia. Some psychotropic drugs commonly prescribed in psychopharmacology have moderate anticholinergic effects. These include antihistamines such as chlorpheniramine, cyproheptadine, diphenhydramine, and hydroxyzine; some antidepressants such as TCAs and paroxetine; some antipsychotics such as clozapine, Interactions with Immunosuppressants Commonly prescribed immunosuppressants are metabolized by the cytochrome P450 enzyme system. Tacrolimus, ciclosporins, and sirolimus are exclusively metabolized by the CYP 450 3A4 enzyme. Carbamazepine and phenobarbital, as potent inducers of CYP450 3A4 (Fuhr et al., 2021), reduce the levels of immunosuppressants and increase the possibilities of therapeutic
failure. On the other hand, antipsychotics that inhibit the actions of CYP450 3A4 such as fluvoxamine and fluoxetine may increase the levels of immunosuppressants. This interaction makes it important to monitor the levels of the immunosuppressant drug in patients who take these medications and a psychotropic drug.
PSYCHOTHERAPY IN PSYCHOPHARMACOLOGY
Modern psychopharmacology does not relegate psycho- behavioral clinical interventions to “medication-only” practices. Instead, the current era of psychopharmacology combines the valuable insights of psychotherapy with psychotropic medications to achieve optimal clinical care. Any selected psychotherapy option should comprehensively focus on the core psychotherapy techniques such as motivation, empathy, openness, collaboration, warmth, positive regard, sincerity, providing corrective experience, catharsis, establishing goals, establishing a time-limited relationship, and establishing that patient effort is needed to succeed. The American Psychological Association (APA) has a widely recommended approach for designing a psychotherapy plan for patients in this regard. This approach is broadly divided into five categories: Cognitive therapy, psychoanalysis and psychodynamic principles, behavior therapy, humanistic therapy, and integrative or holistic therapy. Cognitive therapy is a collection of interventions with the basic premise that mental health disorders are psychosocial distress maintained by cognitive factors. In psychopharmacology, the
overall goal is the initiation of cognitive-behavioral therapy (CBT) to achieve symptomatic improvement, improving cognitive functions, and inducing remission of the psycho- behavioral condition. Although CBT emphasizes cognitive factors, emotional and physiological inputs also play important roles. Combining these components can help patients change their thinking process. The psychoanalysis and psychodynamic principle are focused on modifying problematic behaviors, thoughts, and feelings by leveraging unconscious meaning and motivations. In behavior therapy, the approach is on designing models that help the patients develop normal behaviors. Classical conditioning or associated learning as demonstrated by Ivan Pavlov is widely employed in this approach. Humanistic therapy emphasizes a patient’s capacity to make rational decisions and develop their potential to the maximum. The integrative or holistic approach simply blends elements from the others and designs a therapy plan that suits the patient’s working diagnosis.
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Book Code: PYFL4024
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