Lecture 1 - Intro to Psych Flashcards
Dopamine associated with which disorders
Parkinsonism
Schizophrenia
addictive disorders
Norepinephrine associated with which disorder
Depressive disorders
Serotonin associated with which disorders.
Depressive disorders
OCD
eating disorders
GABA associated with which disorders…
anxiety
Seizures & tremors
Insomnia
Glutamate associated with which disorders
Schizophrenia
seizures
migraines
box warning for all antidepressants?
inc risk of suicidality in children, adolescents and young adults < 24
risk just be balanced with clinical need
no inc risk > 24yrs old, reduction in risk > 65 yrs old
close monitoring for all pts on anti depressants for worsening or unusual behaviors
SSRI overview
1st line
3-8 wks for effect, longer in older ppl
starting dose 50% in > 65yrs old
CI = MAOI (in linezolid) w/I 14 days
Serotonin syndrome with additional serotonergic agents
CYP 450inhib
Fluoxetine Half life
4-6 days, mad long
Citalopram info…
has bunch of drug interactions, QTc prolongation
Escitalopram is like 2.0, better
how to enhance absorption with sertraline?
Food
Paroxetine claim to fame
weakly anticholinergic
dont use older adults, us at night
Fluvoxamine usually used for…
OCD
SSRI warnings, precautions, side effects
QTc prolongation, most w/ citalopram
most can induce mania
Neurologic, GI, Gentiourinary (sexual dysfunction), weight gain, Hyponatremia (possible SIADH), inc risk of bleeding
Venlafaxine OD info
more likely to cause death in overdose than an SSRI
Which SNRI should be avoided in ESRD?
Milnacipran (Savella)
Levomilnacipran ER Tab (Fetzima)
Which SNRI should be avoided in glaucoma?
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
SNRI warnings, precautions, Side effects
Inc Blood pressure and HR (except Duloxetine)
Sweating, Weight loss, GI
Levomilnacipran avoid statement
avoid in uncontrolled HTN, cardiovascular conditions, dose-dependent effects on urinary hesitancy
Discontinuation/Withdrawal syndrome of drugs
characterized by agitation, anxiety,chills, dizziness, headache, insomnia
consider with meds hat have short half life, higher doses and duration of treatment (> 5 weeks)
least risk = fluoxetine, vortioxetine
greatest = paroxetine, venlafaxine, fluvoxamine, vilazodone
counseling = avid stopping on own, med specific approach if D/c
Bupropion info
CI = bulimia nervosa, anorexia, seizure disorder
CI = MAOI w/I 14 day. withdrawal from alc/benzo/sedatives
Good for smoking cessation & people who have sexual dysfunction
Take AM due to mild stimulating effect
What does Bupropion inhibit?
2D6 = potent
Bupropion Side effects
Special concern: Lowers seizure threshold = inc risk those
Insomnia, anxiety, BP, nausea, can cause weight loss
Mirtazapine dosing info
are sedative at lower doses than at higher doses due to amount of alpha it blocks
TCA info
liver metabolism and lipophilic..problematic in OD
Lots of adverse effects and time for drugs to go away due to going in fat
TCA warnings, precautions, SE
Dangerous in OD, QTc prolongation, anticholinergic toxicity, seizures
bad, lots of SE/ interactions
MAOI overview
CI = HF, liver disease, pheochromocytoma
Avoid sympathomimetics
Dietary restriction of tyramine due to HTNsive crisis
CI with serotonergic med due to inc risk HTNsive crisis
MAOI warnings, precautions, SE
Dangerous in OD
careful transition from other antidepressants
Sexual side effects, HTNsive crisis, postural hypotension, weight gain
Clinical pearls Nefazodone (Serzone)
CI with liver dysfunction
Concerns for hepatoxdcity
Trazadone (Desyrel) clinical pearls
Hypotension, priapism, sedation, arrhythmias
Vilazodone (Viibryd) clinical pearls
Take w/ food to inc absorption (GI side effects)
dose rec w/ 3A4 inhib/inducers
Vortioxetine (Trintellix) clinical pearls
may improve cognitive impairment
Nausea most common side SE
Which Benzo used if hepatic impairment?
Lorazepam
Oxazepam
Temazepam
B/C Undergo Glucuronidation
Hydroxyzine precautions/SE
QTc prolongation
Rare derm reaction
Anticholinergic
CNS depression
Buspirone precautions/SE
Dizziness
HA
nervousness
drowsiness
insomnia
serotonin syndrome
Monitoring Req for Lithium
12hrs after last dose
acute mania = 0.8-1.2
Maintenance = 0.6-1
Renal excretion so dose adjustments req
Valproic Acid info
Highly protein bound
extensive liver metabolism
SE : thrombocytopenia, hepatic failure
Carbamazepine info
req monitoring, induces own metabolism
SE: rash (SJS/TEN), agranulocytosis, bunch of SE
Lamotrigine info
Rash/hypersensitivity reaction req stict dose initiation, titration and adherence due to life threatening rash
have to reiterate if pt is on and stops ( > 7 days)
2nd gen metabolic side effects
Highest Risk - > Lowest
Clozapine/Olanzapine
Risperidone/Paliperidone
Aripirazole. Lurasidone, Ziprasidone
2nd gen associated with QTc prolongation
Ziprasidone
2nd gen associated with EPS
risperidone
2nd gen associated with Agranulocytosis
Clozapine, special monitoring
2nd gen associated with anticholinergic effects
Clozapine, Olanzapine, Quetiapine
