Behavioral Health Meds 2 Flashcards
Imipramine is useful for _____ and _____
Enuresis in children and panic disorder
What is the least sedating and least anticholinergic TCA?
Desipramine
Which TCA is the least likely to cause orthostatic hypotension?
Nortriptyline
Which TCA is best tolerated?
Nortriptyline
______ is good for smoking cessation
Bupropion
Bupropion causes less ___, ____ and ____ than SSRIs (AEs)
Sexual dysfunction, weight gain and GI effects
Bupropion MOA
Dopamine and norepinephrine reuptake inhibitor
What is Bupropion indicated for?
MDD and SAD
Bupoprion AKA
Wellbutrin
What is a serious neurological AE of bupropion?
Lowers seizure threshold
What are AEs of Wellbutrin? (7)
-Dry mouth
-Nausea
-Insomnia
-Agitation
-Weight loss
-HTN
-HA
Bupropion can increase risk of _____ at high doses
Psychosis
Avoid ___ _____ in Bupropion
abrupt withdrawl
When is Bupropion contraindicated?
-Increased seizure risk
-MAOI use in the last 2 weeks
What conditions would cause a state of increased seizure risk?
-Epilepsy
-Eating disorders (anorexia, bulemia)
-Discontinuing alcohol, benzos, barbiturates or antieptileptic)
What are the nonselective MAOIs?
Penelzine
Tranylcypromine
Isocarboxazid
What is the MOA of nonselective MAOIs?
Blocks breakdown of norepinephrine, serotonin (plus dopamine, epinephrine and tyramine) by inhibiting monoamine oxidase
What is the indication for nonselective MAOIs?
Refractory depression or refractory anxiety disorders
What is the most common AE of MAOIs?
Orthostatic hypotension
What are other AEs of MAOIs?
Insomnia
Anxiety
Weight gain
Sexual dysfunction
What is the crisis that can happen with MAOIs?
Hypertensive crisis following ingestion of foods high in tyramine (aged cheese, smoked/picked/cure meats/poultry/fish, red wine, draft beer and chocolates)
What is the drug-drug interaction concern with MAOIs?
Serotonin syndrome with SSRIs, SNRIs, St John’s Wort, MDMA, cocaine, Meperidine, Tramadol and Dextromethorphan
How long do you need to wait between switching between SSRIs and MAOIs?
2 weeks (5 for fluoxetine due to long half life)
MAOI + TCAs may cause…
delirium and hypertension
What are the serotonin receptor antagonists and agonists?
Trazodone and Nefazodone
What is the MOA of Trazodone?
Post synaptic inhibitor, reuptake inhibition and serotonin agonist. Plus Alpha-1 adrenergic receptor antagonist
What is trazodone indicated for
Antidepressant with anxiolytic and hypnotic effects (useful for insomnia)
Low dose trazodone may be used as a ___ ____
sleep aid
Unlike SSRIs, Trazodone does not affect _____
REM sleep or sexual side effects
What is the most common AE of Trazodone?
Sedation
What are other AEs of Trazodone?
-Dizzy
-Dry mouth
-Nausea
-Orthostatic hypotension
-HA
-Suicidality in children / young adults
-Cardiac arrhythmias
What is a rare but classic AE of Trazodone?
Priapism
What is the black box warning on Nefazodone?
Rare but serious fulmiant hepatitis
What is Serotonin Syndrome?
Life threatening syndrome caused by increased serotonergic activity in the CNS
When does Serotonin Syndrome most commonly occur?
Within 24 hours (especially six) of initiation of change in serotonergic drugs
What medications/substances that are not mental health drugs can contribute to Serotonin Syndrome?
-St. John’s Wort
-MDMA
-Cocaine
-Amphetamines
What categories of effects are seen in Serotonin Syndrome? (5)
-Cognitive
-Autonomic instability
-GI
-Neuromuscular hyperactivity
-Occular
What cognitive effects are seen in Serotonin Syndrome?
-AMS
-Agitation
-Confusion
-Hallucinations
-Hypomania
What autonomic instability effects are seen in Serotonin Syndrome?
-Hyperthermia
-Tachycardia
-Diaphoresis
-BP changes
What GI effects are seen in Serotonin Syndrome?
-Diarrhea
-N/V
-Increased bowel sounds
What neuromuscular effects are seen in Serotonin Syndrome?
-Spontaneous or inducible clonus
-Hypertonia (increased DTRs)
-Tremor
-Akathisia
What occular effects are seen in Serotonin Syndrome?
-Mydriasis
-Dry mucus membranes
-Flushed skin
How is Serotonin Syndrome diagnosed?
Clinical diagnosis with Hunter Criteria
How is mild Serotonin Syndrome managed?
- Prompt discontinuation of offending drugs
- Supportive care with O2, IV fluids and Benzos
Why are benzos used to treat Serotonin Syndrome?
-Reduce agitation, hyperthermia and correct mild increases in HR and BP
How is moderate Serotonin Syndrome treated?
Same as mild plus Cyproheptadine
What is Cyproheptadine?
Serotonin antagonist
Should antipyretics be used in hyperthermia of Serotonin Syndrome?
No
