Antipsychotics and Antidepressants Flashcards
Antidepressants
a patient with major depressive disorder is most likely to develop antidepressant poop-out during maintenance treatment when she is taking which antidepressant?
sertraline
Antidepressants
this type of antidepressant is a selective inhibitors of norepinephrine (NE; greater reuptake of NE) & tends to have a better side effect profile (i.e., no sedative, anticholinergic, or hypotensive side effects)
secondary amines
Antidepressants
(SSRIs/TCAs) tend to have fewer side effects & are less cardiotoxic
SSRIs
Antidepressants
which antidepressant is least likely to have an adverse impact on sexual functioning?
bupropion (Wellbutrin)
First Generation Antipsychotics
this is a severe side effect of long-term use of first-gen antipsychotic?
tardive dyskinesia
Antipsychotics
this side effect primarily begins with involuntary movements of the tongue, face, and jaw
tardive dyskinesia
Antidepressants
taking both an SSRI and an MAOI together may cause this side effect, which is characterized by agitation, hyperthermia, & autonomic instability (e.g., sweating, increased body temp, rapid heart rate, high blood pressure)
serotonin syndrome
Antidepressants
this antidepressant (generic name) increases norepinephrine and dopamine levels, resulting in an energizing (stimulating) effect
buproprion (Wellbutrin)
1) tardive dyskinesia (e.g., involuntary, repetitive movements in the face, arms, legs)
2) parkinsonism (e.g., tremors, rigidity)
3) dystonia (e.g., involuntary muscle contractions, spasms, and abnormal postures)
4) akathisia (e.g., restlessness, inabiltiy to sit still)
Second Generation Antipsychotics
primary side effects of second-gen antipsychotics
metabolic (weight gain)
First Generation Antipsychotics
list the sxs of schizophrenia that are targeted by first-gen antipsychotics
only positive sxs
e.g., hallucinations & delusions
Second Generation Antipsychotics**
list the sxs of schizophrenia that are targeted by second-gen antipsychotics?
positive & negative sxs
Antipsychotics
list the main differences in treatment effects (i.e., neurological) between first-gen & second-gen antipsychotics
first-gen: block dopamine receptors
second-gen: block dopamine & serotonin receptors
First Generation Antipsychotics
list the 4 first-gen antipsychotics (generic names)
- chlorpromazine (Thorazine)
- haloperidol (Haldol)
- thioridazine (Mellaril)
- fluphenazine (Prolixin)
First Generation Antipsychotics
list 2 major side effects of first-gen antipsychotics
- extrapyramidal side effects (EPS)
-
neuroleptic malignant syndrome
(e.g., agranulocytosis
cardiotoxic)
First Generation Antipsychotics
list 5 symptoms indicative of anticholinergic side effects from first-gen antipsychotics
list the 2 meds most likely to cause these side effects (low potency)
- dry mouth
- blurred vision
- urinary retention
- constipation
- tachycardia
chlorpromazine & thioridazine
First Generation Antipsychotics
name the 2 high potency first-gen antipsychotics more likely to cause extrapyramidal side effects
haloperidol & fluphenazine
First Generation Antipsychotics
this extrapyramidal side effect is potentially life threatening, begins after long-term drug use, and is more common in women & older adults
tardive dyskinesia
First Generation Antipsychotics
list 2 symptoms of tardive dyskensia
- involuntary, rhythmic movements of the tongue, face, & jaw (may also affect the limbs & trunk)
First Generation Antipsychotics
describe the treatment for tardive dyskinesia
- irreversible
- taper off
- Rx benzo or second-gen antipsychotic
First Generation Antipsychotics
symptoms of neuroleptic malignant syndrome
autonomic dysfunction
- unstable blood pressure
- tachycardia
- excessive sweating
altered mental state
- confusion
- combativeness
First Generation Antipsychotics
describe the treatment for neuroleptic malignant syndrome
- stop at first sign
- hydrate & cool
Second Generation Antipsychotics
list the 5 second-gen antipsychotics (SGAs)
- clozapine (Clozaril)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- aripiprazole (Abilify)
Second Generation Antipsychotics
list the 2 primary disorders second-gen antipsychotics treat
schizophrenia
MDD
Antipsychotics
this second-gen antipsychotic is used for treatment-resistant schizophrenia
clozapine (Clozaril)
Second Generation Antipsychotics
second-gen antipsychotics alleviate positive symptoms of schizophrenia by blocking which neurotransmitter? And, alleviate negative & cognitive symptoms of schizophrenia by blocking which neurotransmitter?
- dopamine (D3 & D4)
- serotonin
Second Generation Antipsychotics
list the most common side effect of second-gen antipsychotics
metabolic syndrome
Second Generation Antipsychotics
list symptoms of metabolic syndrome
substantial weight gain
increased risk for diabetes & heart disease
- high blood pressure
- insulin resistance
- hyperglycemia
Second Generation Antipsychotics
this second-gen antipsychotic is most likely to cause neutropenia & agranulocytosis
clozapine (Clozril)
Second Generation Antipsychotics
this severe side effect, caused by second-gen antipsychotics, is potentially life-threatening and involves dangerously low levels of white blood cells, which are an essential part of the body’s immune system
neutropenia
(e.g., agranulocytosis)
Second Generation Antipsychotics
patients taking clozapine must have regular blood tests and, when neutrophil levels are too low, treatment may include…
- discontinuing the drug
- Rx antibiotic for infections
- Rx meds to improve body’s ability to produce neutrophils more quickly
Antidepressants
list 5 types of antidepressants
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin and norepinephrine reuptake inhibitors (SNRIs)
- norepinephrine dopamine reuptake inhibitors (NDRIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
Antidepressants
list 5 SSRIs (generic names)
1) sertraline (Zoloft)
2) citalopram (Celexa)
3) paroxetine (Paxil)
4) fluoxetine (Prozac, Sarafem)
5) fluvoxamine (Luvox)
Antidepressants
list the most frequently prescribed class of antidepressant, which is also generally considered first-line pharmacological treatment for MDD and PDD
SSRIs
Antidepressants
list common disorders treated with SSRIs
- MDD & PDD
- PMDD
- OCD
- GAD
- PTSD
- panic disorder
- bulimia nervosa
- premature ejaculation
Antidepressants
SSRIs are classified as serotonin agonists or indirect agonists, explain how these meds exert their therapeutic effects
- block resynaptic reuptake of serotonin >
- increase availability of serotonin in the synaptic cleft
Antidepressants
list 3 advantages of SSRIs
- fewer side effects
- safer in overdose/less cardiotoxic
- safer for older adults
Antidepressants
list 5 side effects of SSRIs
- mild anticholinergic effects
- GI disturbances
- insomnia
- anxiety
- sexual dysfunction
Antidepressants
abruptly stopping this class of medication can cause discontinuation syndrome, which is characterized by headaches, dizziness, mood lability, impaired concentration, sleep disturbances, & flu-like symptoms
SSRIs
Antidepressants
when SSRIs are combined with these meds, the likelihood of serotonin syndrome increases
- MAOIs
- lithium
- other serotonergic drugs
Antidepressants
this severe side effect of is potentially fatal & involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, & delirium
serotonin syndrome
Antidepressants
describe the treatment for serotonin syndrome
- immediate withdrawal of serotonergic drugs
- treat symptoms w/ appropriate medical interventions
Antidepressants
this side effect is caused by taking an SSRI (or MAOI), occurs when a person with depression loses a previous antidepressant treatment response, and is caused by a person staying on the same drug & dosage
tachyphylaxis
Antidepressants & Antipsychotics
common signs of tachyphylaxis
- apathy
- fatigue
- dulled cognitive functioning
- sleep disturbance
- sexual dysfunction
Antidepressants
describe treatment strategies for tachyphylaxis
- increasing dosage of current drug
- switching meds (e.g., a different SSRI, a SNRI [Venlafaxine], a TCA [Clomipramine])
- augmenting current SSRI w/ another med
- depression-focused therapy
Antidepressants
list 4 common meds used in the treatment of tachyphylaxis to augment current SSRI
- TCAs
- bupropion
- lithium
- atypical antipsychotic
Antidepressants
SSRIs have a delayed onset with initial therapeutic effects occurring at how many weeks, with full effects not being achieved until how long?
initial: 2 - 4 weeks
full: 6 - 8 weeks
Generic names for the 3 SNRIs
1) venlafaxine (Effexor
2) duloxetine (Cymbalta)
3) desvenlafaxine (Pristiq)
list 3 disorders treated by SNRIs
- MDD
- social anxiety disorder
- neuropathic pain & other pain disorders
Antidepressants
SNRIs may be more effective than SSRIs for what disorder?
severe depression
Antidepressants
this class of meds exerts its therapeutic effects by inhibiting the reuptake of serotonin and norephinephrine at synapses
SNRIs
Antidepressants
these 2 healthissues are caused by abruptly stopping SNRIs, especially if combined with other serotonergic drugs
- discontinuation syndrome
- serotonin syndrome
Antidepressants
SNRIs effects on norepinephrine may cause cause these 3 side effects associated to norepinephirne & are contraindicated for people with what pre-existing health issues
- same as SSRIs
- elevated blood pressure
- hypertension & heart problems
Antidepressants
list the generic name for 1 NDRI & list the disorders this med treats
- B (Wellbutrin, Zyban)
- MDD
- smoking cessation
Antidepressants
this class of meds exert their therapeutic effects by inhibiting the reuptake of norepinephrine and dopamine at synapses
NDRIs
inhibiting
Antidepressants
list 6 side effects of NDRIs
- skin rash
- decreased appetite and weight loss
- agitation
- insomnia
- dizziness
- seizures
Antidepressants
list 3 advantages of bupropion (Wellbutrin)
- causes few anticholinergic effects
- does not cause sexual dysfunction
- not cardiotoxic
Antidepressants
antidepressants that increase levels of norepinephrine and dopamine have what type of an effect?
This means they’re useful for patients who have low energy and low motivation but not for those who have what disorders?
- energizing
- insomnia & severe anxiety
Antidepressants
list the meds, which are categorized as tertiary or secondary amines based on their chemical structure.
TCAs
Antidepressants
list the 4 generic names for tertiary amines (TCAs)
1) amitriptyline (Elavil)
2) imipramine (Tofranil)
3) clomipramine (Anafranil)
4) doxepin (Sinequan)
Antidepressants
these meds exert their effects by inhibiting the reuptake of both serotonin and norepinephrine, with some having a stronger effect on serotonin
tertiary amines (TCAs)
Antidepressants
list the 3 generic names for secondary amines (TCAs)
1) nortriptyline (Pamelor)
2) desipramine (Norpramin)
Antidepressants
this type of TCA is more potent at inhibiting the reuptake of norepinephrine than serotonin
secondary amines
Antidepressants
list 4 disorders trerated with TCAs
- MDD
- panic disorder
- OCD
- neuropathic pain
Antidepressants
list the TCA primarily used to treat OCD
clomipramine (Anafranil)
Antidepressants
list the TCA primarily used to treat neuropathic pain
nortiptyline (Pamelor) & amitriptyline (Elavil)
Antidepressants
list 5 side effects of TCAs
CARDIOTOXIC
- cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension)
anticholinergic effects
sedation
weight gain
sexual dysfunction
Antidepressants
this type of TCA is less likely to cause sedation and anticholinergic effects.
secondary amines
Antidepressants
this type of antidepressant is most likely to induce a manic or hypomanic episode when used to treat bipolar disorder
TCAs
Antidepressants
this type of antidepressant must be prescribed with caution for people who have heart disease or are suicidal because they are cardiotoxic
TCAs
Antidepressants
list generic names for 3 MAOIs
1) phenelzine (Nardil)
2) isocarboxazid (Marplan)
3) tranylcypromine (Parnate)
Antidepressants
this type of antidepressant is most useful for treatment-resistant depression or atypical depression
MAOI
Antidepressants
list 3 symptoms of Antidepressants
reversed vegetative symptoms
- hypersomnia
- increased appetite
- reactive dyphoria
Antidepressants
this deactivates norepinephrine, serotonin, and dopamine, and this med increases the levels of these neurotransmitters by inhibiting the activity of this enzyme
the enzyme monoamine oxidase
Antidepressants
list 4 side effects of MAOIs
- anticholinergic effets
- orthostatic hypotension
- sedation
- sexual dysfunction
Antidepressants
combining this type of antidepressant with amphetamines, antihistamines or foods containing tyramine (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas can produce hypertensive crisis characterized by severe, throbbing headache, neck pain/stiffness, rapid heart rate, nausea & vomiting, sweating, sensitivity to light, and confusion & delirium
MAOIs