Antipsychotics Flashcards
Anti-depressants: After therapeutic dose is achieved, how long does it take for symptoms to improve?
3-6 wks
When do u switch for another med/increase dose in antidepressant?
2 months
Which drug causes QT lengthening?
TCA
Tertiary TCA examples?
amitriptyline, Imipramine, doxepin, clomipramine
Secondary TCA examples?
Desipramine, notrtriptyline
Effective med for depression?
MAOI
MAOI S/E?
Sedation, weight gain
dry mouth, Postural HT
Sexual dys, sleep disturbance
what med if taken with tyramine rich food cause HTN crisis?
MAOI
How long do u wait before switching from SSRI to MAOI?
2 EXCEPT fluoxetine 5 wks
Serotonin syndrome symptoms include
- Abdominalpain • Diarrhea
- Sweats • Tachycardia
- HTN
- Myoclonus
- Irritability • Delirium
Severe S/E in serotonin syndrome?
Hyperpyrexia, cardiovascular shock and death.
SSRI is treatment for
depression and anxiety
SSRI S/E
GI upset, sexual dys
insomnia+sedation=fatigue
discontinuation syndrome caused by?
SSRI, SNRI
discontinuation syndrome cause
agitation, nausea, disequilibrium and dysphoria
Fluoxetine + and - ?
\+ low incidence of discontinuation syndrome - active metabolite may build up Significant P450 interactions
Antidepressant: Bad choice in pts already on a number of meds
Fluoxetine
QT interval prolongation in Citalopram dose above
40 mg/day
Antidepressant (SSRI) with fast response?
Escitalopram
Venlafaxine not given to pts w/
HTN
Venlafaxine s/e
Sexual s/e
QT prolongation
nausea
Discontinuation syndrome
effective for physical symptoms of depression?
Duloxetine
What antidepressant inc cholesterol and triglyceride?
Mirtazapine
what drug is sedating at low doses and activating at high doses?
Mirtazapine, 30mg is cutpoint
hyperlipidemia pt, what antidepressant is avoided?
Mirtazapine
Bupropion is good for?
depression and smoking cessation
Which med decreases suicide rate?
Lithium
prophylaxis for mania/depressive ep?
lithium
Factors predicting positive response to lithium
- classic mania
- mania followed by depression
- Prior long-term response or family member with good response
Affective in mania only (depression no)
valporic acid
Factors predicting a positive response to valporic acid?
-rapid cycling patients
- comorbid substance issues
– mixed patients
– Patients with comorbid anxiety disorders
___ is better tolerated than lithium
valporic acid
First line agent for acute mania and mania prophylaxis
Carbamazepine
used for neuropathic/chronic pain
Lamotrigine
before Lamotrigine is started check?
Liver function test
when to use antipsychotics?
Schizophrenia Psychotic depression Bipolar delirium dementia
Typical antipsychotics (high pot)?
Haloperidol, Pimozide
which drug have higher extrapyramidal S/E?
Typical antipsychotics: HIGH potency
Typical antipsychotics: low potency s/e?
Higher risk for Cardiotoxic and Anticholinergic adverse effects
Typical antipsychotics (low pot)?
Chlorpromazine and Thioridazine.
which atypical antipsychotic drug act like typical in high doses?
Risperidone at 6 mg
which antipsychotic drug is used with patients who have hyperactivity?
Risperidone
Olanzapine s/e?
Weight gain
hypertriglyceridemia
hypercholesterolemia
hyperglycemia
Extrapyramidal side effects include
Acute dystonia, Parkinson syndrome, Akathisia
Anxiolytics indications
– Panic disorder
– Generalized Anxiety disorder
– Substance-related disorders and their withdrawal
– Insomnias
Buspirone +/-
+
no sedation
-
2 wks for results
Buspirone will not work on the anxiety if
patient used to take BZD
How long is BZD given for
3-5 days
Benzodiazapine s/e?
Dependence
Tolerance
Cognitive deficits
Disinhibition
drug to treat insomnia? (BZD)
triazolam
drug to treat anxiety? (BZD)
Lorazepam
Oxazepam
Diazepam
