Exam 2: Module 3 - Psychotropic Medications Flashcards
Serotonin Syndrome symptoms
o tremors
o fever
o altered mental state (AMS)
o hypertension
Selective Serotonin Reuptake Inhibitors (SSRI) Drugs
o Sertraline
o Fluoxetine
o Escitalopram
o Citalopram
o Paroxetine
first line for depression and anxiety
SSRI
when should a patient take SSRI medications due to the SE/AE of insomnia?
morning/A.M.
SSRI
MOA, indication, SE/AE, BBW
MOA: inhibits/block the reuptake of serotonin elevating patients serotonin levels
indications: depression and anxiety
SE/AE: insomnia and sexual dysfunction
BBW: risk for suicdie
Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) drugs
o Dulaxotine
o Venlafaxine
SNRI
MOA, indication, SE/AE, BBW
MOA: inhibit/block reuptake of serotonin and norepinephrine
indications: anxiety, depression, MIGRAINE PREVENTION, FIBROMYALGIA
SE/AE: sexual dysfunction, insomnia, HTN, ORTHOSTATIC HYPOTENSION, HEPATOTOXICITY
BBW: risk for suicide
Tricyclic Antidepressants (TCA) drugs
o Amitriptyline
o Imipramine
o Nortriptyline
o Doxepin
TCA
MOA, indication, SE/AE, BBW
MOA: inhibit/block reuptake of serotonin and norepinephrine (same as SNRI)
indication: depression
off label use: fibromyalgia, IBS, migraines, anxiety and withdrawal syndrome
SE/AE: anticholinergic effects, ECG changes, CNS depression, orthostatic hypotension, sedation, weight gain
BBW: risk for suicide
o NOT FIRST LINE TREATMENT FOR DEPRESSION
o DOXEPIN IS USED FOR BOTH DEPRESSION AND INSOMNIA
Monoamine Oxidase Inhibitors (MAOI) drugs
o Phenelzine
MAOI
MOA, indication, BBW, SE/AE
MOA: MAO is responsible for getting rid of norepinephrine, dopamine, epinephrine and serotonin in the body so MAOI blocks this action which increases the neurotransmitter levels in the body
indication: depression
off label: anxiety
SE/AE: orthostatic hypotension, hypertension when interacting with tyramine, insomnia, anticholinergic effects
o DO NOT CONSUME FOODS CONTAINING TYRAMINE
O NOT FIRST LINE TX FOR DEPRESSION
Bupropion
MOA, indication, SE/AE, BBW
MOA: unknown - inhibits/blocks uptake of norepinephrine and dopamine
indications: depression and smoking cessation
off label : ADHD, bipolar d/o
SE/AE: risk for seizures (highest with high doses or rapid titration) and insomnia
BBW: risk for suicide and neuropsychiatric events
drug used for smoking cessation
Zyban
- bupropion drug
Benzodiazepines drugs
o Lorazepam
o Diazepam
o Alprazolam
Benzos
MOA, indications, SE/A, BBW
MOA: GABA agonist, GABA being an inhibitory neurotransmitter so Benzos slows down cerebral functions
indications: seizure disorder, insomnia, anxiety, sedation, muscle relaxant, ETOH withdrawal
SE/AE: muscle weakness, hypotension, sedation, respiratory depression
BBW: do not mix with CNS depressants - can cause respiratory depression and addiction and dependency
o CONTROLLED SUBSTANCE (SCHEDULE IV)
o FIRST LINE FOR CESSATION OF ACUTE GENERALIZED SEIZURE
o DO NOT TAKE WITH ETOH OR OTHER CNS DEPRESSANTS
reversal agent for benzodiazepine OD
Flumazenil
another drug used for anxiety that can help test anxiety and other situational anxiety that presents with physical manifestations such as tachycardia, palpitations, and hypertension.
- slows down cardiovascular system
Propranolol
Mood Stabilizer Drug
o Lithium
Mood Stabilizer (Lithium)
MOA, Indication, SE/AE, BBW
MOA: unknown - alters ion transport (sodium levels)
indication: bipolar disorder
off label: depression
SE/AE: adverse cardiac, renal, CNS effects, nephrogenic diabetes insipidus (DI), polyuria
BBW: narrow therapeutic index
Lab Values: therapeutic response 0.4 - 1.2 mEq/L (narrow therapeutic index), toxic above 1.5 mEq/L
o MONITOR LITHIUM LEVELS - REQUIRES REGULAR LAB MONITORING
o ENCOURAGE PATIENTS TO INCREASE FLUID INTAKE DUE TO INTERFERING WITH ADH AND SE OF POLYURIA - COULD BECOME THIRSTY AND DEHYDRATED
Valproate Drug
o Valproic Acid
Valproate (Valproic Acid)
MOA, indications, BBW
MOA: prolong sodium channel inactivation and is also a GABA agonist
indications: seizure disorder, migraines, bipolar disorder
BBW:
o Hepatoxicity (monitor AST/ALT, skin discoloration - like jaundice)
o Highly teratogenic - least preferred for females of childbearing age
o pancreatitis
Lamotrigine
MOA, indications, BBW
MOA: prolong sodium channel inactivation, blocks specific calcium channels, blocks glutamate (in the brain)
indications: seizure disorder and bipolar disorder
BBW: SJS/TEN (stevens-johnson’s syndrome and toxic epidermal necrolysis) - fatal skin diseases
what is a fourth option for bipolar disorder
antipsychotics
CNS Stimulants Drugs
o Methylphenidate*
o Amphetamine
o Dextroamphetamine
CNS Stimulants
MOA, indications, BBW, SE/AE
MOA: CNS stimulants. these drugs cause RELEASE of norepinephrine and dopamine
indications: ADHD and narcolepsy
SE/AE: weight loss and insomnia
BBW: linked to abuse and dependency due to SE/AE of weight loss and insomnia
o CONTROLLED SUBSTANCE (SCHEDULE II)
o FIRST LINE TREATMENT FOR ADHD
Benzodiazepine Receptor Agonist (BZRA) drugs
o Zolpidem*
o Eszopiclone
BZRA
MOA, indication, BBW
MOA: same as benzodiazepines - GABA agonist which means it slows own cerebral functions
indications: insomnia
BBW: risk of abuse and dependency
o SHOULD NOT BE USED FOR LONG-TERM MANAGEMENT
o CONTROLLED SUBSTANCE (SCHEDULE IV)
Melatonin Receptor Agonist drug
o Ramelteon
Melatonin Receptor Agonist (Ramelteon)
MOA, indication
MOA: activates melatonin receptors which control circadian rhythm and sleep-wakefulness
indication: insomnia
o NOT A CONTROLLED SUBSTANCE
o RELATIVELY SAFE FOR LONG TERM USE
o 8-10x STRONGER THAN OTC MELATONIN
First Generation Antipsychotics Drugs
(phenothiazine and non-phenothiazine)
o Chlorpromazine (phenothiazine)
o Fluphenazine (phenothiazine)
o Haloperidol (non-phenothiazine)
First Generation Antipsychotics
MOA, indication, SE/AE, BBW
MOA: blocks dopamine 2 receptors
indication: schizophrenia
off label: bipolar and nausea
SE/AE: drowsiness, anticholinergic effects, sexual dysfunction, orthostatic hypotension
o associated with EPS and NMS (more with pheno than non-pheno drugs)
BBW: not to be used for dementia related psychosis
o ANTIPSYCHOTICS HAVE A HIGH INCIDENCE OF MEDICATION NONCOMPLIANCE
What is EPS?
Extrapyramidal Symptoms
o acute dystonia (involuntary muscle contractions)
o parkinsonism (tremors/ridgity)
o akathisia (restlessness)
o tardive dyskinesia (involuntary, repetitive, purposeless movements)
what is used to treat EPS?
o Benztropine
What is NMS?
Neuroleptic Malignant Syndrome
rare but potentially fatal reaction that presents with:
o rigidity
o high fever
what is used to treat NMS?
o Dantrolene
Second Generation Antipsychotics Drugs
(Atypical Antipsychotics)
o Aripiprazole
o Lurasidone
o Olanzapine
o Quetiapine
o Risperidone
o Ziprasidone
Second Generation Antipsychotics
MOA, indications, SE/AE, BBW
MOA: blocking dopamine 2 AND serotonin receptors
indications: bipolar disorder (possible 1st line option), depression, and schizophrenia
off label: delusional disorder and OCD
SE/AE: metabolic effects (weight gain, DM, dyslipidemia), EPS, and orthostatic hypotension
o less likely to have EPS than first generation
BBW: not to be used for dementia related psychosis
o ANTIPSYCHOTICS HAVE A HIGH INCIDENCE OF MEDICATION NONCOMPLIANCE
What 1st and 2nd gen antipsychotics is used for acute psychosis?
o Haloperidol (1st gen)
o Ziprasidone (2nd gen)
