Psychologist's Neuropsychotropic Desk Reference

Louis Pagliaro, Anne Pagliaro

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781317838784
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

First published in 1999. This comprehensive neuropsychotropic drug reference is designed with prescribing psychologists and psychology students in mind. An accurate and authoritative reference, the Psychologists' Neuropsychotropic Drug Reference (PNDR) details drug monographs for over 80 different prescription neuropsychotropic drugs available for clinical prescription in North America. Each neuropsychotropic monograph is clearly and concisely written to reflect essential and important data that are commonly required by prescribing psychologists and psychology students. Thus, whenever possible and appropriate, each monograph includes: a phonetic pronunciation guide; up to five common trade or brand names; pharmacologic or therapeutic classification and subclassification; USDEA schedule designation for abuse potential; recommended dosages; and many other critical details. The form, style, and content of each monograph has been reviewed by members of an Editorial Advisory Committee of distinguished psychologists. With this quality assurance, this text is certain to become an asset to prescribing psychologists and psychology students as they strive to provide the maximum benefit of neuropsychotropic pharmacotherapy.

Neuropsychotropic Drug Monographs

ACETAZOLAMIDE

(a set a zole′ a mide)

TRADE NAME

Diamox®

CLASSIFICATION

Anticonvulsant (carbonic anhydrase inhibitor)

APPROVED INDICATIONS FOR NEUROPSYCHOLOGICAL DISORDERS

Adjunctive pharmacotherapy for the prophylactic management of:

• seizure disorders: absence (petit mal) seizures. Acetazolamide also is indicated for other various forms of seizure disorders.

USUAL DOSAGE AND ADMINISTRATION

Seizure Disorders: Absence (Petit Mal) Seizures

Adults: 8 to 30 mg/kg daily orally in three or four divided doses

MAXIMUM: 1 gram daily orally. Dosages exceeding 1 gram daily do not appear to provide any additional efficacy and are not recommended.

Women who are, or who may become, pregnant: FDA Pregnancy Category C. Safety and efficacy of acetazolamide pharmacotherapy for women who are pregnant have not been established. Avoid prescribing acetazolamide pharmacotherapy to women who are pregnant. If acetazolamide pharmacotherapy is required, advise patients of potential benefits and possible risk to themselves and the embryo, fetus, or neonate. Collaboration with the patient’s obstetrician is indicated.

Women who are breast-feeding: Safety and efficacy of acetazolamide pharmacotherapy for women who are breast-feeding and their neonates and infants have not been established. Acetazolamide is excreted in small amounts in breast milk. However, significant adverse reactions to acetazolamide are unlikely among breast-fed neonates and infants. Collaboration with the patient’s pediatrician is indicated.

Elderly adults: See “Adults.”

Children and adolescents younger than 18 years of age: See “Adults.”

Notes, Seizure Disorders: Absence (Petit Mal) Seizures

Acetazolamide is prescribed as adjunctive pharmacotherapy. Tolerance to its anticonvulsant action develops relatively quickly, and, thus, prevents its use for long-term, continuous pharmacotherapy. However, full efficacy is generally quickly restored after a temporary disruption of acetazolamide pharmacotherapy.

AVAILABLE DOSAGE FORMS, STORAGE, AND COMPATIBILITY

Capsules, oral extended-release: 500 mg

Injectable, intravenous: 500 mg/vial (sterile dry powder. See “Notes”)

Tablets, oral: 125, 250 mg

Notes

Acetazolamide oral tablets: Diamox® tablets contain povidone. Some patients may be hypersensitive to povidone.

Acetazolamide injectable: The acetazolamide injectable formulation is indicated for intravenous use only. The injectable formulation must be reconstituted prior to use with a minimum of 5 ml of sterile water for injection in order to produce an injectable solution containing no more than 100 mg of acetazolamide/ml. The injectable solution should be used within 24 hours after reconstitution because it contains no preservatives. Any unused injectable solution should be safely and appropriately discarded within 24 hours after reconstitution.

General instructions for patients: Instruct patients who are receiving acetazolamide to

• safely store acetazolamide oral capsules and tablets out of the reach of children in child-resistant containers at controlled room temperature (15° to 30°C; 59° to 86°F).

• obtain an available patient information sheet regarding acetazolamide pharmacotherapy from their pharmacist at the time that their prescription is dispensed. Encourage patients to clarify any questions that they may have regarding acetazolamide pharmacotherapy with their pharmacist or, if needed, to consult their prescribing psychologist.

PROPOSED MECHANISM OF ACTION

The exact mechanism of acetazolamide’s anticonvulsant action has not yet been fully determined. However, it appears to be associated with the following mechanisms: 1) the production of metabolic acidosis; 2) mediation through an adrenergic mechanism; and 3) carbonic anhydrase inhibition within the brain and resultant increased carbon dioxide tension. Acetazolamide also decreases the formation of cerebrospinal fluid. However, the relevance of this effect to acetazolamide’s anticonvulsant action has not been determined.

PHARMACOKINETICS/PHARMACODYNAMICS

Acetazolamide is well absorbed from the GI tract after oral ingestion. Peak blood concentrations are achieved within 1 to 3 hours. Acetazolamide is distributed throughout the body and crosses the placenta. It is excreted 100% in unchanged form in the urine. Additional data are not available.

RELATIVE CONTRAINDICATIONS

Adrenocortical insufficiency

Hyperchloremic acidosis

Hypersensitivity to acetazolamide, other carbonic anhydrase inhibitors, or sulfonamides (acetazolamide is a nonbacteriostatic sulfonamide derivative)

Hypokalemia (low serum potassium concentration)

Hyponatremia (low serum sodium concentration)

Kidney dysfunction, severe

Liver dysfunction, particularly cirrhosis

CAUTIONS AND COMMENTS

Prescribe acetazolamide pharmacotherapy cautiously to patients who

• have severe respiratory impairment (e.g., advanced pulmonary disease, chronic obstructive pulmonary disease [asthma, bronchitis, emphysema], pulmonary infection, pulmonary obstruction). Acetazolamide pharmacotherapy may precipitate or exacerbate respiratory acidosis among these patients.

• have diabetes mellitus. Acetazolamide pharmacotherapy may cause hyperglycemia and glycosuria. Thus, blood and urine glucose should be monitored closely among these patients.

• have gout. Acetazolamide pharmacotherapy decreases uric acid excretion and may, thus, aggravate gout.

Caution patients who are receiving acetazolamide pharmacotherapy against

• performing activities that require alertness, judgment, or physical coordination (e.g., driving an automobile, operating dangerous equipment, supervising children) until their response to acetazolamide pharmacotherapy is known. Acetazolamide may adversely affect these mental and physical functions.

CLINICALLY SIGNIFICANT DRUG INTERACTIONS

Concurrent acetazolamide pharmacotherapy and the following may result in clinically significant drug interactions:

Aspirin Pharmacotherapy

High dosage aspirin pharmacotherapy, such as is commonly used for the treatment of rheumatoid arthritis, may potentiate acetazolamide’s adverse drug reactions.

Diuretic Pharmacotherapy

Concurrent acetazolamide pharmacotherapy may augment by way of its own diuretic actions the effects of other drugs that have diuretic actions (e.g., furosemide [Lasix®], hydrochlorothiazide [hydroDIURIL®]).

Lithium Pharmacotherapy

Acetazolamide pharmacotherapy increases the renal excretion of lithium (Lithane®). Monitor lithium blood concentrations and individual patient response whenever concurrent acetazolamide pharmacotherapy is initiated, adjusted, or discontinued.

Pharmacotherapy With Drugs That Are Weak Acids or Weak Bases

Acetazolamide alkalinizes the urine. Thus, the renal excretion of drugs that are weak acids (e.g., phenobarbital [Luminal®], salicylates) is increased, while the renal excretion of drugs that are weak bases (e.g., amphetamines, procainamide [Pronestyl®], quinidine [Biquin®]) is decreased.

ADVERSE DRUG REACTIONS

Acetazolamide pharmacotherapy has been commonly associated with diarrhea, frequent urination (polyuria), hearing dysfunction (including ringing in the ears [tinnitus]), loss of appetite (anorexia), nausea, paresthesias (particularly a tingling sensation in the extremities), and vomiting. Acetazolamide pharmacotherapy also has been associated with the following ADRs, listed according to body system.

CNS: confusion, depression, drowsiness, fatigue, headache, and sedation

Cutaneous: rash and skin eruptions, including exfoliative dermatitis. These reactions are generally associated with hypersensi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Editorial Advisory Committee
• Preface
• Preface to The Pharmacologic Basis of Psychotherapeutics: An Introduction for Psychologists
• Foreword to The Pharmacologic Basis of Psychotherapeutics: An Introduction for Psychologists. “Prescription Privileges for Psychologists: An Historical Overview”
• Acknowledgment
• Neuropsychotropic Drug Monographs
• References
• Appendix A: Pharmacologic Classification and Listing of the Neuropsychotropic Drugs Included in This Text
• Appendix B: United States Drug Enforcement Agency Schedule Designations
• Appendix C: Food and Drug Administration Pregnancy Categories
• Appendix D: Abbreviations and Symbols
• Index
• About the Book