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Psychiatry Psychopharm > Individual Drugs > Flashcards

Individual Drugs Flashcards

1
Q

Haloperidol

A

Haldol

Typical antipsychotic - high potency

Worse EPS, tardive dyskinesia, NMS

Less cholinergic/histaminergic/adrenergic side effects

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2
Q

Fluphenazine

A

Prolixin

Typical antipsychotic - high potency

Worse EPS, tardive dyskinesia, NMS

Less cholinergic/histaminergic/adrenergic side effects

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3
Q

Pimozide

A

Orap

Typical antipsychotic - high potency

Only used for Tourettes!

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4
Q

Thiothixine

A

Navane

Typical antipsychotic - high potency

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5
Q

Trifluoperazine

A

Stelazine

Typical antipsychotic - high potency

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6
Q

Perphenazine

A

Trilafon

Typical antipsychotic - mid potency

Balanced side effect profile Most sedating of the mid potency

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7
Q

Loxapine

A

Loxitane

Typical antipsychotic - mid potency

Balanced side effect profile

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8
Q

Molindone

A

Moban

Typical antipsychotic - mid potency

Balanced side effect profile

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9
Q

Chlorpromazine

A

Thorazine

Typical antipsychotic - low potency

Most sedating, most orthostatic hypotension, most anticholinergic

Least EPS

Decreases seizure threshold

Most QT prolongation of typicals

Risk for retinitis pigmentosa at high doses

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10
Q

Mesoridazine

A

Serentil

Typical antipsychotic - low potency

Not on the market

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11
Q

Thioridazine

A

Mellaril

Typical antipsychotic - low potency

Not on the market

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12
Q

Clozapine

Class

Indications

Minor side effects

Serious side effects

Contraindications

A

Clozaril

Atypical antipsychotic

  • Good for
    • Treatment refractory
    • Tardive dyskinesia
  • Decreases suicide and aggression
  • Minor side effects
    • Orthostatic hypotension is most common
    • Significant anti-cholinergic
    • Sedation
    • Hypersalivation = treat with glycopyrrolate
    • Myoclonus
  • Serious side effects
    • Metabolic syndrome
    • Agranulocytosis
    • Seizures
    • Myocarditis, dilated cardiomyopathy
  • Contraindicateds
    • With anticholinergics (benztropine) for risk of acute megacolon and intestinal perforation
    • Diabetes/hyperlipidemia
    • Granulocytopenia
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13
Q

Risperidone

Typical side effects

Atypical side effects

A

Risperdal

Atypical antipsychotic

High potency = popular

Typical side effects = EPS ( when > 6 mg/day), hyperprolactinemia, sexual dysfunction, most likely to cause tardive

Atypical side effects = metabolic syndrome, insomnia, agitation

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14
Q

Olanzapine

Side effect

Contraindication

A

Zyprexa

Atypical antipsychotic

Longest compliance per CATIE trial

Worst weight gain!

Contraindicated in diabetes/hyperlipidemia

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15
Q

Quetiapine

Indications

SIde effects

A

Seroquel

Atypical antipsychotic

Indications

  • Sleep aid at low doses
  • Adjunct for unipolar depression
  • Parkinson’s disease

Side effects

  • Causes weight gain
  • Causes QT prolongation
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16
Q

Ziprasidone

A

Geodon

Atypical antipsychotic

Causes metabolic syndrome but not as much as clozapine, olanzapine, and risperidone

QT prolongation that is dose dependant

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17
Q

Aripiprazole

A

Abilify

Atypical antipsychotic

WEIGHT NEUTRAL YAY - partial agnoist at 5-HT1A

Causes some sedation

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18
Q

Paliperidone

A

Invega

Atypical antipsychotic

Metabolite of risperidone - possibly less EPS

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19
Q

Iloperidone

A

Fanapt

Atypical antipsychotic

Increased risk of QT prolongation

Possibly less weight gain

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20
Q

Asenapine

A

Saphris

Atypical antipsychotic

Novel mechanism of action

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21
Q

Lurasidone

A

Latuda

Atypical antipsychotic

Good for bipolar depression!

Possibly less weight gain

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22
Q

Phenelzine

A

Nardil

MAOI

Used for atypical depression

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23
Q

Tranylcypromine

A

Parnate

MAOI

Atypical depression, BPD, refractory panic disorder

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24
Q

Isocarboxazid

A

Marplan

MAOI

Used for MDD

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25
Q

Selegeline

A

Emsam

MAOI

Transdermal form used for MDD

In low doses, is selective MAOB inhibitor which can be used as adjunct to levodopa/carbidopa (sinemet) for Parkinson’s

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26
Q

Amitriptyline

A

Elavil

TCA - tertiary amine

Good for MDD, neuropathic pain, headache, insomnia

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27
Q

Clomipramine

A

Anafranil

TCA - tertiary amine

Most specific for serotonin

Used for OCD, depression, panic

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28
Q

Doxepin

A

Sinequan

TCA - tertiary amine

Depression, anxiety, neuropathic pain, insomnia, PTSD

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29
Q

Trimipramine

A

Surmontil

TCA - tertiary amine

Depression

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30
Q

Imipramine

A

Tofranil

TCA - tertiary amine

PTSD, depression, panic

In children - enuresis, ADHD

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31
Q

Desipramine

A

Norpramin

TCA - secondary amine

Depressive disorder in adults and kids

Least sedating

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32
Q

Nortriptyline

A

Pamelor

TCA - secondary amine

ADHD, depression, anxiety, enuresis in kids, neuropathic pain

Adjunct for smoking cessation

Least orthostatic hypotension

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33
Q

Protriptyline

A

Vivactil

TCA - secondary amine

Depression

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34
Q

Fluoxetine

A

Prozac/Sarafem

SSRI

Longest half-life

Safest SSRI in pregnancy!

Can also be used for Bulimia and premature ejaculation

Side effects = activating - worsens anxiety, prominent sexual side effects

Can cause persistent pulmonary hypertension in fetus/baby

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35
Q

Paroxetine

A

Paxil SSRI

Shortest half-life

Worst withdrawal syndrome!

Can be used for social anxiety disorder, GAD, OCD, PTSD

More sedating

Worst anticholinergic side effects = GI

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36
Q

Sertraline

A

Zoloft SSRI

Safest SSRI in breastfeeding

Less sedating = can be used in elderly

Metabolized by liver, safe for kidneys

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37
Q

Fluvoxamine

A

Luvox SSRI

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38
Q

Citalopram

A

Celexa SSRI

39
Q

Escitalopram

A

Lexapro SSRI

Can be used in GAD and MDD

40
Q

Venlafexine

A

Effexor SNRI

Superior to all new antidepressants

Short half-life = withdrawal

Good for GAD, social anxiety, panic

Side effects = Worsens BPH

41
Q

Duloxetine

A

Cymbalta SNRI

Expensive

Can be used for trigeminal neuralgia/fibromyalgia

Severe nausea

42
Q

Desvenlafexine

A

Pristiq SNRI

43
Q

Mirtazepine

A

Remeron

NaSSA - Noradrenergic and Specific Serotonergic antidepressant

  • alpha 2 antagonist
  • alpha 1 agonist

Good for terminally ill - induces appetite/weight gain, sedating for sleep

Contraindication = MAOI (Serotonin syndrome)

Really bad for weight gain

Serious side effect = agranulocytosis, other blood dyscrasias (need to check levels weekly)

44
Q

Trazodone

A

Desyrel SARI - Serotonin antagonist and reuptake inhibitor

Very sedating at high doses

Also nausea, dizziness, mania

Can cause priapism! and vivid nightmares

Prevents sexual dysfunction - post-synaptic 5-HT antagonism

45
Q

Nefazodone

A

Serzone SARI

Liver toxicity is black box warning

sedating, nausea, dizziness, mania

46
Q

Bupropion

A

Wellbutrin, Zyban

NDRI - noradrenergic and dopaminergic reuptake inhibitor

No sexual side effects! No metabolic side effects!

Lowers seizure threshold (contraindicated in epilepsy, eating disorders, alcoholism)***

also used for smoking cessation and ADHD

Minor side effects - activation, insomnia, nausea, tremor

47
Q

Vilazodone

A

Viibryd SSRI/SPA

Less sexual dysfunction and weight gain compared to regular SSRIs

Same side effects as SSRIs

48
Q

Lithium

A

Eskalith/Lithobid Mood stabilizer - mania/maintenance, intermittent explosive disorder, adjunct for depressive disorders, patient on clozapine with dropping WBC

*Cleared by kidneys

Low therapeutic levels - requires monitoring q2-3 month, then q6 mo Therapeutic range of 0.8-1.2 mo

Contraindications - pregnancy for ebsteins anomaly, renal disease

Causes benign leukocytosis, GI, tremor, weight gain

Li toxicity - N/V/D, oliguria, ataxia, coarse tremor, coma, seizures, death -treatment = kayexalate or dialysis

Can cause thyrotoxicity - monitor TSH/T4

Can cause nephrotoxicity

Can cause cardiac arrhythmias, T wave flattening

49
Q

What drugs increase Li levels

A

Thiazide diuretics

Ace I

Spironolactone

triamterene

Most NSAIDs

50
Q

What drugs do not affect Li levels

A

ASA, sulindac

51
Q

What drugs decrease Li levels

A

Mannitol

Acetazolamide

Caffeine, theophylline

52
Q

Valproic acid

A

Depakote/depakene Anticonvulsant

Enhances GABA, decreases glu

Metabolized by liver

Inhibits metabolism of lamotrigine = increases level

Contraindicated in pregnancy - NTD, cardiac defects, facial defects, skeletal defects

Contraindicated in women of child-bearing age - causes PCOS

Minor side efects - N/V/D, sedation, tremor, weight gain, alopecia

Serious side effects - thrombocytopenia, hemorrhagic pancreatitis, hepatotoxicity, PCOS

Overdose - coarse tremor, lethargy, coma, death

Needs monitoring

53
Q

Carbamazepine

A

Tegretol Anticonvulsant

Enhances GABA

1st line for trigeminal neuralgia

Contraindicated in pregnancy - craniofacial abnormalities, NTD, learning disorders, hypospadias

Can cause SIADH - hyponatremia

Minor side effects - N/V?D, sedation, anti-cholinergic, weight gain

Serious side effects - blood dyscrasias (aplastic anemia, agranulocytosis, thrombocytopenia)

Causes SJS!

Hepatotoxic

Overdose - coarse tremor, coma, death Needs monitoring

54
Q

Oxcarbazepine

A

Trileptal Anticonvulsant

Enhances GABA

Fewer side effects than carbamazepine

No blood monitoring needed

Can also cause hyponatremia via SIADH

55
Q

Lamotrigine

A

Lamictal Anticonvulsant

Inhibits glutamate

Induces metabolism of valproic acid = lowers levels

Maintenance in pregnancy!

Most efficacious for bipolar depression

Can cause SJS!

Minor side effects - N/V/D, sedation, lightheadedness, tremor

56
Q

What is a common side effect of all anticonvulsants

A

N/V/D Sedation, lightheadedness, tremor weight gain (except for gabapentin and topiramate)

57
Q

Gabapentin

A

Neurontin Anticonvulsant

GABAergic

Trigeminal neuralgia

adjunct for mania

Contraindicated in renal disease

58
Q

Topiramate

A

Topamax Anticonvulsant

Adjunct for mania

Used for epilepsy, migraines, neuralgia

“Dopamax” - sedation, lightheaded, cognitive dulling

Nephrolithiasis - CaPO4 stones

Anorexia and weight LOSS!

59
Q

Alprazolam

A

Xanax Benzo

Short half-life

Fast/intermediate onset, equivalent dose 0.25-0.5

Gets rid of symptoms the fastest with panic attacks

60
Q

Lorazepam

A

Ativan Benzo

Short half-life

Can be used in liver disease

Equivalent dose - 1 mg

Gets rid of panic attack symptoms quickly

61
Q

Oxazepam

A

Serax Benzo

Short half-life

Can be used in liver disease

62
Q

Temazepam

A

Resteril

Benzo

Short half-life

Can be used in liver disease

63
Q

Clonazepam

A

Klonopin Benzo

Longer half-life Slow onset Equivalent dose - 0.5 mg

Least addictive but slow to relieve symptoms

64
Q

Diazepam

A

Valium Benzo

Longer half-life

Fast onset

Active metabolite

Used in ETOH withdrawal

65
Q

Chlordiazepoxide

A

Librium Benzo

Longer half-life

Intermediate onset

Equivalent dose 10 mg

Used in ETOH withdrawal

66
Q

Buspirone

A

Buspar

Non-benzo anxiolytic

5-HT1a agonist = positive effects of SSRIs

Takes at least 2 weeks

Good for anxiety and history of substance abuse

Side effects - dizziness, headaches, fatigue, GI distress

Absent side effects - sedation, addiction!

67
Q

Hydroxyzine

A

Atarax, Vistaril

Non-benzo anxiolytic

Anti-H1

Used for situational anxiety

Side effects = sedation, anti-cholinergic, weight gain

68
Q

Propranolol

A

Inderal Non-benzo anxiolytic

Used for performance anxiety

Contraindicated in asthma!

Side effects - dizziness, fatigue, bradycardia, hypotension

69
Q

Zolpidem

A

Ambien Non-benzo hypnotic

Gabaergic

Temporary* use for insomnia - efficacy decreases after 2 weeks

Contraindicated in substance abuse history

Side effects - dizziness, GI distress, strange dreams, progressive tolerance/dependence

70
Q

Zaleplon

A

Sonata Non-benzo hypnotic

Gabaergic

Short-acting, can use in middle of night

Used for terminal* insomnia - waking up early in the morning and needing to function the next day

Side effects - dizziness, dyspepsia, progressive tolerance/dependence, habit-forming because short half-life

71
Q

Eszopiclone

A

Lunesta Non-benzo hypnotic

Gabaergic

No tolerance! Used for chronic insomnia

Side effects - headaches, withdrawal

72
Q

Diphenhydramine

A

Benadryl Non-benzo hypnotic

Anti-histaminergic

Contraindicated in elderly or medically ill

Side effects - sedation, weight gain, anti-cholinergic, delirium

73
Q

Ramelteon

A

Rozarem Non-benzo hypnotic

Melatonin agonist

Used for insomnia and circadian rhythm disturbances (jet lag)

Side effects - dizziness, fatigue

74
Q

Methylphenidate

A

Ritalin CNS stimulant

75
Q

Methylphenidate extended release

A

Concerta/Metadate CD/Metadate ER CNS stimulant

76
Q

Dexmethylphenidate

A

Focalin CNS stimulant

77
Q

Dextroamphetamine

A

Dexadrine CNS stimulant

78
Q

Amphetamine/dextroamphetamine

A

Adderall CNS stimulant

79
Q

Pemoline

A

Cylert CNS stimulant

80
Q

Modafinil

A

Provigil Novel CNS stimulant

Unknown mechanism of action, not adrenergic agonist

Used for ADD/ADHD, narcolepsy, hypersomnia

Minor side effects - headache, nausea, rhinitis, anxiety, insomnia

81
Q

Atomoxetine

A

Straterra Novel CNS stimulant

Unclear mechanism, possible selective inhibition of NE reuptake

Used for ADD/ADHD

*Contraindicated with MAOIs, narrow angle glaucoma

Minor side effects - GI, dizziness, insomnia, sexual dysfunction

Serious side effects - *Suicidal ideation, severe liver injury

82
Q

Nicotine replacement therapy

A

NRT Gum, lozenges, nasal spray, inhaler, long-acting patch

83
Q

Buproprion

A

Wellbutrin NDRI antidepressant

84
Q

Varenicline

A

Chantix

Nicotinic acetylcholinergic receptor partial agonist

Side effect - psychosis

85
Q

Nortriptyline

A

Pamelor Adjunct for smoking cessation

86
Q

Clonidine

A

Alpha 2 adrenergic agonist - sympatholytics

Decreases noradrenergic release

Decreases SNS activation

87
Q

Disulfuram

A

Antabuse

Inhibits aldehyde dehydrogenase causes buildup of acetylaldehyde

Used for alcohol abuse

88
Q

Acamprosate

A

Campral

Glutamate antagonist GABA agonist

Diminishes cravings

NO liver toxicity

89
Q

Naltrexone

A

Mu agonist

Diminishes cravings for ETOH and opioids

Liver toxicity

90
Q

Depot naltrexone

A

Vivitrol opioid antagonist for poor compliance

Liver toxicity

91
Q

Methadone

A

Mu agonist = long acting

Side effects - sweating, constipation, urinary retention, orgasm dysfunction

Prolongs QTc

92
Q

Buprenorphine

A

Mu partial agonist

NO QTC prolongation!

Will precipitate withdrawal if patient still has opioids in system

93
Q

Suboxone

A

Buprenorphine and Naloxone

Naloxone prevents abuse if patients try to inject Naloxone does not really get absorbed through PO version which is safe

Psychiatry Psychopharm (6 decks)

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