Drugs

Question 1

what does valporate treat?

Answer 1

reats acute mania
- available as divalproex (Depakote) and valproic acid
- helpful preventing future manic episodes
- has a black box warning
- important to monitor liver function
- Low platelets (thrombocytopenia) platelet counts and coagulation should be monitored
- Pancreatitis, and fatal hemorrhagic cases, have been reported
- lowest beneficial dosages should be used bc of severe side effects
- Do not use in pregnancy due to teratogenicity (ability to cause defects in a developing fetus)
Common side effects:
- nausea
- weakness
- somnolence (drowsiness or strong desire to fall asleep)
- indigestion
- diarrhea
- dizziness
- vomiting

Question 2

Carbamazepine

Answer 2

• acute mania and mixed states
• Inducer of cytochrome P450 3A4, of which many psychotropics are substrates → causes the rapid metabolism of these other drugs, making them less effective
• black box warning for serious dermatologic reactions → epidermal necrolysis or → Stevens-Johnson syndrome.
• Asian ancestry have a 10 times greater risk for toxic epidermal necrolysis prior genetic test should be done
• Complete blood counts should also be drawn prior to beginning treatment and periodically thereafter since carbamazepine is known to cause leukopenia and aplastic anemia.

Question 3

Second-generation antipsychotics
~Know the drugs listed in this category & potential serious side
effects

sedative properties
mood-stabilizing properties

Answer 3

• olanzapine (Zyprexa)
• risperidone (Risperdal)
• quetiapine (Seroquel)
• ziprasidone (Geodon)
• aripiprazole (Abilify)
• asenapine (Saphris)
• cariprazine (Vraylar)

Question 4

Fluoxetine, Paroxetine, Sertraline

Answer 4

Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 5

First line of treatment for major depression

Answer 5

Fluoxetine, Paroxetine, Sertraline

Selective Serotonin Reuptake Inhibitors (SSRIs)
Risk of lethal overdose minimized with SSRIs

Side effects: Agitation, insomnia, headache, nausea and vomiting, sexual dysfunction, and hyponatremia

Question 6

Efficacy similar to other antidepressants, but strict dietary (tyramine) restrictions and potential drug interactions make this drug class less desirable
Side Effects:
Insomnia, nausea, agitation, and confusion; hypertensive crisis

Answer 6

Phenelzine, Isocarboxazid
Monoamine Oxidase Inhibitors (MAOIs)

Question 7

use in generalized anxiety disorder

Side Effects
Nausea, dry mouth, insomnia, somnolence, constipation, reduced appetite, fatigue, sweating, blurred vision

Answer 7

Duloxetine
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Question 8

Venlafaxine
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Answer 8

Hypertension, nausea, insomnia, dry mouth, sedation, sweating, agitation, headache, sexual dysfunction

Effexor is a popular next-step strategy after trying SSRIs

Question 9

Therapeutic effects similar to SSRIs, but side effects are more prominent
May work better in melancholic depression and in people with comorbid medical conditions
Some therapeutic serum levels may be monitored

Side effects
Dry mouth, constipation, urinary retention, blurred vision, hypotension, cardiac toxicity, sedation

Answer 9

Amitriptyline, Nortriptyline, Doxepin

Tricyclic Antidepressants (TCAs)

Question 10

Tricyclic Antidepressants (TCAs):
a. Know the ANTICHOLINDERGIC SIDE EFFECTS under the Common adverse reactions paragraph

Answer 10

side effects include dry mouth, blurred vision, tachycardia, constipation, urinary retention, and esophageal reflux.

Question 11

Know the benefits of TCA administration

Answer 11

First, most TCAs have sedative effects and thereby aid sleep. Second, the minor side effects occur while the individual is sleeping, which increases compliance with drug therapy

TCA overdose carries a risk of death from cardiac conduction abnormalities: