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
