MEDICATION IN-DEPTH Flashcards
Lithium (MOA, Indications, Effects, CI, Drug Interactions, etc.)
→ MOA: may lateral neural sodium transports and influence reuptake of serotonin or norepi
→ Indications: Bipolar DO, Manic Episode, Schizoaffective DO
→ Effects: DECREASES SUICIDE RISK!!!!!
HYPER-parathyroid, -calcemia, -magnesium
HYPO-natremia, -thyroidism
Nephrogenic Diabetes Insipidus
Increased thirst, Tremor, Weight Gain, Leukocytosis, Arrhythmias, V/D
→ NARROW THERAPEUTIC INDEX:
Before prescribing: EKG, CBC, TSH, Preg
Plasma Levels Checked every 4-8 weeks
(0.8-1.2 = Normal), (TOXIC > 1.5)
If CrCl <30 = AVOID
→ CONTRAINDICATIONS:
PREGNANCY: EBSTEIN ANOMALY (heart problem at birth - incorrect tricuspid valve)
→ Drug Interactions:
Lithium levels in the blood can be increased by dehydration, thiazides, TCAs, NSAIDS = can raise to toxic level
Carbamazepine
→ Class: Anticonvulsants
–> MOA: Blocks Na Channels
→ BBW: SJS/TEN, TERATOGENIC (Neural Tube)
Lamotrigine
→ Class: Antiepileptic
→ MOA: Inhibits glutamate/Na Channels
→ INEFFECTIVE FOR ACUTE MANIA**
→ BBW: SJS/TEN/HLA B1502, aplastic anemia, agranulocytosis
Valproate
–> Class: Anticonvulsants
→ MOA: Blocks Na Channels = Increases GABA
→ BBW: NEURAL TUBE DEFECTS (fetal toxicity), HEPATOTOXICITY , Pancreatitis
→ Contraindications: Hepatic Dysfunction
LIST 6 SSRIs
→ FLUOXETINE / Prozac
→ PAROXETINE / Paxil
→ CITALOPRAM / Celexa
→ ESCITALOPRAM / Lexapro
→ SERTRALINE / Zoloft
→ FLUVOXAMINE / Luvox
Which SSRI causes QT prolongation?
Citalopram (avoid with long QT syndrome)
Which SSRI causes anticholinergic SE (dry mouth, dizziness, wt gain)
Paroxetine
Only antidepressant approved for the treatment of Bulimia
Fluoxetine (Longer half life = can switch to MAOI (5 weeks)
When is max dose reached with SSRIs?
4-6 weeks
First line tx for Depression + Neuropathic Pain
Duloxetine (SNRI)
This drug is good for patients who fear sexual dysfunction, weight gain, or want to tey to quit smoking:
Bupropion (Wellbutrin)
Antidepressant (TCA) with the least sexual side effects (but does cause weight gain)
Mirtazapine / Remeron
Name SNRIs (5)
→ Venlafaxine / Effexor
→ Duloxetine / Cymbalta
→ Desvenlafaxine, Levomilnacipran, Milnacipran
SSRIS: MOA, INDICATIONS, SE, BBW
~SSRIs:
→ FLUOXETINE / Prozac
→ PAROXETINE / Paxil
→ CITALOPRAM / Celexa
→ ESCITALOPRAM / Lexapro
→ SERTRALINE / Zoloft
→ FLUVOXAMINE / Luvox
MOA:
Inhibits serotonin reuptakes (keeps the serotonin in the synapse longer) by blocking the serotonin (5HT1A) transporter
Treats:
FIRST LINE IN: Depression, PTSD, OCD, Panic DO, PDD, and Anxiety DO
Side Effects:
GI symptoms, sleep impairments, sexual dysfunction, weight changes
QT Prolongation with CITALOPRAM
Anticholinergic SE with PAROXETINE
Serotonin Syndrome
BBW:
Increases risk of SUICIDE up to the age 25
Fluoxetine = only antidepressant to treat Bulimia (Longer half life = can switch to MAOI (5 weeks)
REACH MAX DOSE ~ 4-6 weeks!!!
SNRIS: MOA, INDICATIONS, SE, BBW
~SNRIs:
→ Venlafaxine / Effexor
→ Duloxetine / Cymbalta
→ Desvenlafaxine, Levomilnacipran, Milnacipran
MOA:
→ Blocks norepinephrine and serotonin, keeping them both in the synapse longer
** DULOXETINE = 1st line especially with patients with significant FATIGUE or NEUROPATHY PAIN (neuropathic pain, diabetic neuropathic pain, fibromyalgia) **
SE:
→ Norepinephrine effects: sweating, dizziness, dry mouth, constipation
→ anticholinergic effects
** AVOID VENLAFAXINE in patients with HTN bc it causes HTN **
CI:
→ With MAOIs
→ Renal/Hepatic (Kidney/Liver)
→ Seizures
→ Caution with HTN
→ Increased risk of Serotonin Syndrome with use of St. John Wart
BURPROPION/WELLBUTRIN
MOA:
→ NDRI: Norepinephrine-Dopamine Reuptake
Inhibitor - Dopaminergic/Noradrenergic
→ Increase dopamine concentration in the nucleus accumbens
*** NICOTINE ANTAGONIST: Helps stop smoking
Indications:
→ MDD & Seasonal Affective DO
*** LESS GI SYMPTOMS, WT GAIN, and SEXUAL DYSFUNCTION
S/E:
→ LOWER SEIZURES THRESHOLD
→ Worsens suicide ideations
→ CNS s/e: anxiety, insomnia, agitation
→ Can increase psychosis in high doses
C/I:
→ EPILEPSY or INCREASED RISK OF SEIZURE (eating d/o, bulimia, anorexia)
Tricyclic Antidepressants (TCAs):
TERTIARY AMINES:
→ AMITRIPTYLINE (Migraines, Neuropathic/Chronic Pain)
→ CLOMIPRAMINE (approved for OCD)
→ IMIPRAMINE (Nocturnal Enuresis)
→ DOXEPIN (Migraines)
→ AMOXAPINE
SECONDARY AMINES
→ DESIPRAMINE (least sedative/anticholinergic)
→ NORTRIPTYLINE (least likely to cause orthostatic HTN)
MOA:
→ Inhibits reuptake of both Serotonin (5-HT) & Norepinephrine (more in the synapse)
Indications:
→ Depression, Insomnia, Neuropathies, Pain Disorders
*** USED LESS OFTEN = ADVERSE EFFECT/SEVERE TOXICITY WITH OVERDOSE
** CLOMIPRAMINE = approved for OCD (serotonin specific) >= 10
** IMIPRAMINE = nocturnal enuresis
** AMITRIPTYLINE = Neuropathic/Chronic Pain
** AMITRIPTYLINE or DOXEPIN = migraine prophylactic
S/E:
** PROLONGED QT INTERVAL (indication of OD)
** Lower seizure threshold
*** Increased suicide in pt <25
→ Anticholinergic Effects: dry mouth,
constipation, urinary retention, tachycardia, orthostatic hypertension
Amitriptyline and Doxepin = most anticholinergic
→ Antihistamine (H1) Effects = sedation and drowsiness, increased appetite, weight gain, confusion
→ Orthostatic hypotension, dizziness
→ Serotonergic Effects: Sexual Dysfunction
C/I:
→ Use of MAOI, recent MI, Seizure history
Which 2 treatments for Bipolar cause neural tube defects?
Valproate and Carbamazepine
Which antidepressant/SNRI cannot be used in HTN?
** AVOID VENLAFAXINE in patients with HTN bc it causes HTN **
TRICYCLIC ANTIDEPRESSANTS (TCAs) (7)
TERTIARY AMINES:
→ AMITRIPTYLINE
→ CLOMIPRAMINE
→ IMIPRAMINE
→ DOXEPIN
→ AMOXAPINE
SECONDARY AMINES
→ DESIPRAMINE
→ NORTRIPTYLINE
Which TCA is approved for OCD?
Clomipramine
TCA OVERDOSE:
→ 3 C’S: CARDIOTOXICITY (Wide Complex Tachycardia), CONVULSIONS (Seizures), COMA (respiratory depression)
→ TX:
Sodium Bicarbonate
Clozapine causes?
Agranulocytosis
Last line treatment for treatment resistance psychosis?
Clozapine
