_MEDS: Depression, Schizophrenia, Bipolar, Anxiety Flashcards
Class/s of meds used for schizophrenia?
What symptoms do each class affect? (NT & S/S)
+ Typical antipsychotics – FGA - first generation - affects POSITIVE symptoms ONLY
+ Atypical, antipsychotics – SGA - second generation - affects POSITIVE & NEGATIVE symptoms
Typical antipsychotics used - names (art museum)
+ haloperidol (truck halo lights) – Haldol
+ chlorpromazine – Thorazine
+ fluphenazine (flip phone) – Prolixin
Typical antipsychotics side effects - name 6!!!
+ EPS symptoms
+ NMS
+ “Cholinergic side effects“ (COLA bottle) – urine, retention, dry mouth, tachycardia, constipation
+ orthostatic hypertension - dizzy standing
+ sedation (avoid alcohol/sedatives)
+ cardiac arrhythmias - torsades des points (deadly)
+ agranulocytosis
Atypical antipsychotics used - names (surprise party)
+ Clozapine - Clozaril
+ olanzapine - Zyprexa
+ aripiprazole - Abilify
+ risperidone - Risperdal
+ quetiapine - Seroquel
+ ziprasidone - Geodon
Side effects of atypical antipsychotics – SGAs
+ Anticholinergic effects!!!
+ photosensitivity
+ sedation/lethargy
+ TD, EPS, and MS (lower risk than FGAs)
+ metabolic syndrome: ⬆️ weight, ⬆️ cholesterol, ⬆️ triglycerides, ⬆️ blood sugar
What classes of symptoms do first generation and second generation antipsychotic effect?
What neurotransmitters to effect?
+1st GEN: positive symptoms, dopamine
+ second GEN: positive and negative symptoms, dopamine & serotonin
Medical intervention for NMS
+ stop medications - antipsychotic
+ Dopamine agonists
+ muscle relaxants – dantrolene or benzodiazepine
+ frequent vital signs, treat, fever, lab tests
- What type of crisis/delirium can be caused from antipsychotics?
- Interventions?
+ anti-cholinergic crisis
+ Discontinue medication
+ gastric lavage, charcoal
+ physostigmine
- What syndrome can be caused by antipsychotics?
- Intervention?
+ EPS
+ Benztropine (Cogentin)
What class is benztropine/Cogentin
+ anti-cholinergic / anti-parkinson
What is the drug of choice for bipolar disorder?
+ Lithium
Normal side effects for Lithium
+ Fine hand tremor
+ polyuria
+ mild thirst
+ mild nausea - take w/food
+ mild weight gain
+ sedation
+ acne
+ cognitive problems
+ hair loss
- Early signs lithium toxicity
- interventions
+ Increased nausea, vomiting, diarrhea, increased thirst and polyuria, SLURRED SPEECH, MUSCLE WEEKNESS
+ hold medication! Measure blood lithium levels – reevaluate dose
Advanced signs of lithium toxicity
+ Coarse hand tremor + mental confusion + muscle, hyper irritability + in coordination + EEG changes
+ ** HOLD MEDICATION**
+ Obtain blood level and reevaluate dose
+ treat more serious symptoms
Severe signs of lithium, toxicity and intervention
+ Ataxia
+ serious EEG changes, SEIZURES
+ blurred vision, tinnitus, blurred vision
+ Severe hypotension, coma, death
+ clonic movements, in coordination
+ large output of the dilute urine
+ STOPP MEDICATION facilitate excretion by gastric lavage, give emetic, treatment with urea, mannitol
Other medication’s that treat bipolar
+ Valproic acid/Depakote – – increases levels of GABA. Levels 50-100.
+ carbamazepine/Tegretol — decreases synaptic transmission in CNS by affecting sodium levels — for rapid cyclers
First line management of acute Mania – medication
+ Antipsychotics – olanzapine first, then the others
First line treatment for bipolar, while waiting for lithium to work
+ Olanzapine/fluoxetine combo for bipolar depression + qeutiapine monotherapy
+ Prevention of relapse of mania/depression – olanzapine and quetiapine mono therapies
First line medication‘s for depression
- How do they work?
+ SSRIs
+ blocks reuptake of serotonin
+ fewer side effects than TCAs – better compliance from patients
- Common side effects of SSRIs
- Serious side effects
+ Sexual dysfunction, weight gain, stomach issues, headaches, dizziness, some anticholinergic symptoms (urine retention, constipation, dry mouth)
+ Serotonin syndrome – hypertension, tachycardia, hyperpyrexia, agitation
What do SSRIs treat besides depression?
+ OCD
+ anxiety
+ eating disorders
Common SSRIs
+ Fluoxetine/Prozac
+ paroxetine/Paxil
+ sertraline/Zoloft
Second line of treatment for depression?
What NT do they affect?
+ SNDIs and SNRIs
+ duloxetine, venlaflaxine
+ Norepinephrine 
Medication for depression that’s rarely used anymore – highly anticholinergic
Side effects?
+ TCAs
Side effects are anticholinergic/adrenergic: tachycardia, postural, hypotension, drowsiness, dysrhythmias, cardiotoxic, heart blocks
+ CAN OD ON 1 mo SUPPLY
+ Amitriptyline, nortriptyline, imipramine, Clomid, Fermin
Effective treatment for depression, but complicated to manage
+ MAOIs - monoamine oxidase inhibitors
+ phenelzine
+ tranylcypromine /parnate
Frontline medication’s for anxiety disorder
+ SSRIs – fluoxetine, sertraline, paroxetine,
+ SNRIs – venlafaxine
Medication for severe anxiety attack. – PRN
Anxiolytics: Benzodiazepines
– lorazepam
– clonazepam
– alprazolam
Class of medication used to treat OCD - only one FDA approved
TCAs - clomipramine
+ more effective than SSRI/SNRI
