class of meds Flashcards
First line tx for OCD
SSRIs like fluoxetine, fluvoxamine, sertraline, and escitalopram. Also sometimes clomipramine (TCA)
first line tx for ptsd
SSRIs like sertraline and paroxetine
first line tx for MDD
SSRIs line sertraline, escitalopram, fluoxetine, paroxetine
first line tx for bipolar
mood stabilizers like lithium or depakote, sometimes atypical antipsychotics (seroquel, zyprexa, risperdal)
first line tx for schizophrenia
atypical antipsychotics: preferred d/t favorable s/e profile compared to older antipsychotics.
-risperidone
-aripiprazole
-quetiapine
-olanzapine
-lurasidone
first line tx for GAD
SSRIs like lexapro and zoloft, sometimes SNRIs like venlafaxine and duloxetine
TCAs
effective for certain mood and pain disorders but come w/ significant s/es and risks. use judiciously w/ careful monitoring and consideration of patient-specific factors
TCA MOA
inhibit reuptake of NorE and serotonin, increasing their levels in the brain to help improve mood
common TCAs
amitriptyline, nortriiptyline, imipramine, doxepin
TCA indications
MDD, anxiety d/os, chronic pain conditions (neuropathic pain, fibromyalgia), insomnia (d/t sedative effects)
TCA s/es
sedation, drowsiness, wt gain, dry mouth, constipation, blurred vision, urinary retention, orthostatic hypotension
TCAs and heart
cardiac s/e includ arrhythmias, esp in OD situations. Use w/ caution in pts w/ cardiac issues.
TCA discontinuation
abrupt discontinuation of TCAs can lead to withdrawal s/s. Taper gradually & under supervision
TCA drug interactions
interact w/ various meds including SSRIs and SNRIs, MAOIs, certain antihypertensives. ABSOLUTELY avoid combining w/ MAOIs
TCA + MAOI
= serotonin syndrome or hypertensive crisis
serotonin syndrome
s/s = agitation, restlessness, confusion, rapid HR, high BP, dilated pupils, muscle rigidity, sweating, severe cases may lead to seizures, hyperthermia, or even death
benzodiazepines: general properties
sedative and anxiolytic effects, rx’d for anxiety, insomnia, muscle spasms, seizure disorders
benzodiazepines: food interactions
some, like xanax, can have altered absorption when taken w/ high fat meals, which may increase peak plasma concentrations and prolong effects
benzodiazepines: localized action
exert effects primarily on amygdala, contributing to anxiolytic and sedative effects
benzodiazepines: MOA
Gaba receptor modulation: benzos enhance effect of GABA at GABA-A receptor
-binding at specific receptor site increases frequency of chloride channel opening when gaba is present, leading to greater inhibition of neuronal activity. Results in increased neuronal hyperpolarization, producing calming effects, reducing anxiety, inducing sedation
benzodiazepines: indications
short-term mgmt of anxiety d/os, panic, insomnia, muscle spasms
benzodiazepines: duration of use
recommended short term, no more 2-4wks d/t risk of tolerance, dependence, & withdrawal s/s
1st gen antipsychotics MOA
BLOCK dopamine D2 receptors in brain, believed to help alleviate positive s/s of schizophrenia
1st gen antipsychotics S/Es
higher risk of EPS, NMS, sedation, anticholinergic effects (dry mouth & constipation) and hormonal changes (increased prolactin levels)
1st gen antipsychotics clinical uses
mainly for schizophrenia and acute psychotic episodes
1st gen antipsychotics examples
haloperidol, chlorpromazine (thorazine), fluphenazine (prolixin)
2nd gen antipsychotics MOA
also blocks d2 receptors but to a lesser extent and additionally affect serotonin receptors (esp 5-HT2A). This dual action helps address both pos and neg s/s of schizophrenia and is thought to reduce risk of EPS
2nd gen antipsychotics S/Es
Lower risk of EPS but may still cause some movement disorders. Higher risk of metabolic S/Es like wt gain, diabetes, dislipidemia. May have more favorable effect on neg s/s and cognitive function compared to FGAs.
2nd gen antipsychotics clinical uses
used for treating schizophrenia, bipolar disorder, and as adjucts for MDD
2nd gen antipsychotics examples
olanzapine, risperidone, quetiapine, aripiprazole
How does a pine differ from a done
pine meds have higher risk of metabolic s/es, whereas dones have greater risk of EPS, particularly at higher doses
“pine” antipsychotics
olanzapine, quetiapine. Have higher affinity for serotonin (5-HT2A) receptors compared to dopamine receptors, often assoc w/ greater wt gain risk. effective in treating pos and neg schiz s/s. can be used in mood disorders
“done” antipsychotics
risperidone, lurasidone. Have more balanced effect on dopamine and serotonin receptors, which may contribute to lower risk of s/e. risperidone has higher risk of EPS d/t stronger D2 receptor blockade. Effective in tx both pos and neg s/s but different s/e profile than “pine”
prazosin: dosing guidelines
1mg at bedtime, may be increased by 1-2mg every few based based on bp response. for HTN, effective range 2-20mg in divided doses. in PTSD related nightmares, 2-6mg at bedtime
Prazosin S/E
orthostatic hypotension, drowsiness, sedation, headache, nausea, palpitations, nasal congestion
prazosin indications
HTN, PTSD, BPH
Clozapine monitoring during tx
WBC and ANC monitoring
wks 1-6: monitor weekly
wks 7-12: monitor q2wks
after 12wks: if stable, monitor q4wks
