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3. The principles of rational prescribing of psychotropics © SPMM Course 3. The principles of rational prescribing of psychotropics Watchful waiting: When treating conditions such as depression and anxiety, NICE recommends watchful waiting before pharmacologic...

4. Placebo effect © SPMM Course 4. Placebo effect  Placebo is any intervention deliberately used for non-specific psychological or psychophysiological treatment effect. Placebo effect, as defined in research trials, includes any difference in outcome between ...

5. Drug approval © SPMM Course 5. Drug approval Any drug must undergo the following steps before approval is granted by regulatory agencies such as FDA in the US and MHRA in the UK. Preclinical Animal Studies: The pathway a drug must undergo before approval a...

6. Medication adherence

Adherence measurement tools © SPMM Course 6. Medication adherence  Compliance is defined as the extent to which a person’s behaviour coincides with medical advice. o Implies sole patient’s responsibility o Criticized as paternalistic.  Adherence includes the...

Factors affecting adherence

Improving adherence © SPMM Course Factors affecting adherence  Patients with poor insight may still take medications – accepting label is less important than enhancing awareness of drug effects  Dose strength – the relationship between dose strength and adhe...

1. Principles of pharmacokinetics

A. Absorption

Oral administration © SPMM Course Principles of pharmacokinetics Pharmacokinetics refers to the time course and disposition of drugs in the body (what the body does to the drug). The pharmacokinetics for the same drug will differ to some extent on the basis o...

Intramuscular administration

Intravenous routes © SPMM Course Size of drug particle Solubility of the drug Properties of intestinal fluid (e.g. p H) Intramuscular administration With IM administration, absorption occurs over 10-30 minutes. It avoids most of the first pass metabolism. Th...

B. Permeation: © SPMM Course B. Permeation: Permeation of a drug is defined as the lipid membrane permeability of the drug molecule. After oral administration, a drug may be incompletely absorbed e.g. only 40% of a dose of chlorpromazine reaches the systemic c...

C. Distribution: © SPMM Course C. Distribution: Distribution of a drug refers to ‘where’ in the body it can be found. Drugs are not evenly distributed throughout the body. Some drugs are confined to the body fluids only, but others accumulate in particular tis...

Blood-brain barrier © SPMM Course (Chadwick et al., 2005). Protein binding interactions become relevant in a renal disease where proteinuria can occur. The principle plasma protein responsible for binding to acidic drugs is albumin while α1-acid glycoprotein i...

D. Bioavailability: © SPMM Course D. Bioavailability: Bioavailability refers to how much of an administered drug reaches its target. It is the extent to which the drug reaches the systemic circulation when taken by a patient orally or parenterally, compared wi...

E. Metabolism of drugs: © SPMM Course for lithium carbonate or Clozaril vs. zaponex for clozapine. E. Metabolism of drugs: Xenobiotics refer to the mechanism by which a foreign agent such as a drug molecule is metabolized and eliminated from our body. The meta...

F. Excretion: © SPMM Course F. Excretion: The major routes of drug excretion are via urine, faeces and bile. Psychotropic drugs are also excreted in sweat, sebum, tears, saliva and breast milk. Both active forms and inactive metabolites can be excreted. Ionize...