Medications Flashcards
Thorazine (chlorpromazine)
first generation antipsychotic
- low potency more likely to cause anticholinergic effects
Prolixin (fluphenazine)
first generation antipsychotic
- high potency more likely to cause extrapyramidal effects
Haldol (haloperidol)
first generation antipsychotic
- high potency (more likely to cause extrapyramidal)
Trifalon (perphanazine)
first generation antipsychotic
Clorazil (clozapine)
second generation antipsychotic
- best of SGAs
- only one approved for treatment resistant schizophrenia and only one shown to decrease suicide in schizophrenia
Risperdal (resperidone)
second generation antipsychotic
Zyprexa (olanzapine)
second generation antipsychotic
Seroquel (quetiapine)
second generation antipsychotic
Abilify (ariprazole)
second generation antipsychotic
- only one that doesn’t work by blocking dopamine in D3 & D4 receptors. Instead it is a partial agonist at the d2 receptor
Prozac (fluoxetine)
SSRI
(antidepressant)
- has the LONGEST half life of any SSRI
Zoloft (sertraline)
SSRI
(antidepressant)
Paxil (paroextine)
SSRI
(antidepressant)
- sexual dysfunction (premature ejaculation)
Effexor (venlafaxine)
SNRI
(antidepressant)
Celexa (citalopram)
SSRI
(antidepressant)
Elavil (amitryptyline)
TCA
(antidepressant)
Tertiary amine
Anafranil (clomipramine)
TCA
(antidepressant)
Tertiary amine
Tofranil (imipramine)
TCA
(antidepressant)
Tertiary amine
- used for bed wetting in kids
Sinequen (doxepin)
TCA
(antidepressant)
Tertiary amine
- helps with insomnia. Picture dashshund sleeping.
Wellbutrin (bupropion)
NDRI
(antidepressant, ADHD too)
- pros: doesn’t cause sexual dysfunction**, not cardiotoxic & few anticholinergic effects. Less likely to cause mania (despite energizing effect when compared to SSRI/TCAs)
- not good for those with insomnia/very anxious bc of energizing effect OR people with history of seizures/bulimia/anorexia bc it will increase seizure threshold and cause weight loss.
- also good for smoking cessation (tobacco use disorder)
- might be good for cocaine use disorder abstinence
Desyrel (trazadone)
other
(antidepressant)
Xanax (alprazolam)
anxiolytics
(benzodiazepine)
Klonopin (clonazepam)
anxiolytics
(benzodiazepine)
Valium (diazepam)
anxiolytics
(benzodiazepine)
Ativan (lorazepam)
anxiolytics
(benzodiazepine)
Restoril (temazepam)
sedative/hypnotic
(non-benzodiazepine)
Ambien (zolpidem)
sedative/hypnotic
(non-benzodiazepine)
Buspar (buspirone)
non-benzo anxiolytics
Prescribe if you want to avoid addictive quality in benzo, if there’s worry of withdrawal, fear of gaining weight and also worry about client abusing. It’s also not sedating.
Ambien (zolpidem)
non-benzo sedative/hypnotic
- linked to anterograde amnesia especially for people that sleep walk or do things in their sleep
Eskalith (lithium carbonate)
lithium
(mood stabilizer)
1st line for acute mania and classic BP (euphoric mania without rapid cycling)
Lithobid (lithium citrate)
lithium
(mood stabilizer)
1st line for acute mania and classic BP (euphoric mania without rapid cycling)
Tegretol (carbamazepine)
anticonvulsant
(mood stabilizer)
*can cause agranulocytosis or aplastic anemia
Neurontin (gabapentin)
anticonvulsant
(mood stabilizer)
- can cause ataxia or seizures if abruptly discontinued
Depakene (valproic acid)
anticonvulsant
(mood stabilizer)
Ritalin (methylphenidate)
stimulant
Adderall (amphetamine)
stimulant
Concerta (methylphenidate)
stimulant
Dexedrine (dextroamphetamine)
stimulant
Straterra (atomoextine)
SNRI
(antidepressant sometimes prescribed for the treatment of ADHD)
Most common non stimulant prescribed
Works by inhibiting reuptake of norepinephrine
Good for core ADHD symptoms + combordities= tic, sleep, anxiety or depression disorder
Luvox (fluvoxamine)
SSRI
(antidepressant)
Cymbalta (duloxetine)
SNRI
(antidepressant)
Nardil (phenylzine)
MAOI
(antidepressant)
Marplan (tranycypromine)
MAOI
(antidepressant)
Inderal (propanolol)
Beta-Blocker
Antabuse (disulfram)
addiction-related for substance use d
Works by: causing nausea, vomiting + other negative side effects when taken with alcohol
Revia (naltrexone)
addiction-related - substance use
Works by reducing pleasurable effects and craving for alcohol
Side effect for clozapine, valproic acid and carbamazepine
Agranulocytosis
Thioridazine (mellaril)
1st Gen antipsychotic
- low potency (more likely to cause anticholinergic effects)
Desvenlafaxine (pristiq)
SNRI
Escitalopram
SSRI
SSRI actions
Agonists / indirect agonists
Nortriptyline (Pamelor)
TCA
Secondary amine
Desipramine (norpramin)
TCA
secondary
Also used as a non stimulant - ADHD.
PTSD meds
Conditional support for these
SSRIs: paroxetine, fluoxetine, sertraline
SNRI: venlafaxine
Medications for anorexia
Antipsychotic 2nd Gen (atypical)= olanzapine (for initial weight gain)
SSRI= fluoxetine (for weigh maintenance)
** note that research is MIXED on this.
Drugs for Alzheimer’s
Mamentine (NMDA receptor agonist/reg’s glutamate activity) good for moderate/severe
Donepezil (only one for severe), rivastigmine and galantamine (cholinesterase inhibitors work by delaying the breakdown of Ach). All good for mild-moderate, except donepezil
*tacrine is also a cholinesterase inhibitor: but due to its potential for liver damage it’s no longer prescribed.
First line meds for depression
SSRI & SNRIs both first line
Medication most useful for reducing daytime sleepiness, improving night time sleep and reducing cataplexy?
Sodium Oxybate
Placebos vs ADs: impact on PFC
placebos: INCREASED activity in PFC
ADs: DECREASED activity in PFC
1st line Meds for cocaine addiction?
Studies have not yet ID’d meds for this disorder
But there is some evidence that bupropion, topiramate and several psychostimulants (modafinil, dextroamphetamine, mixed amphetamine salts) may be effective for increasing abstinence
When are anticonvulsant drugs (valproic acid, carbamazepine) most effective when it comes to treating bipolar disorder?
Best for treatment of atypical BD: mixed mood states, rapid cycling, lack of full recovery between episodes, onset of 10-15 yrs
St Worts
Same efficacy/treatment response as SSRI for mild/moderate depression.
Has a lower rate of adverse events
Benzo uses, side effects, tapering and special considerations (what not to combine it with)
Uses: insomnia, anxiety, seizures and alcohol withdrawal
Side effects: drowsiness/sedation, weakness, unsteadiness, impaired memory/concentration, anticholinergic effects and sexual dysfunction. ** in OA**: disorientation + confusion.
Special considerations: can cause paradoxical effect & chronic use —> dependence/withdrawal.
Tapering: Gradual tapering. Optimal tapering depends on: dose, drug half life and how long patient has taken benzo for (i.e. in OA longer taper is required for benzos with shorter half life= alprozalam, lorazepam)
Can’t be combined with: alcohol= lethal (2 depressants together) or high BP meds (central agonist, alpha blockers)= will seriously drop BP which is BAD.
Thiopental (Pentothal)
Barbiturate
Amobarbital (Amytal)
Barbiturate
Known as truth serum
Secobarbital (Seconal) is
Barbiturate
Barbiturate: uses, side effects and special considerations (taper and what not to combine it with)
Uses: anxiety, seizures and insomnia
Side effects: drowsiness, dizziness, confusion, ataxia, cognitive impairment + paradoxical excitement (same as benzo).
Special consideration: like benzo chronic use leads to dependence and withdrawal. SUDDEN Withdrawal = seizures, delirium and DEATH**. Should be tapered gradually bc of this. CANT mix with alcohol= Lethal
What is a BIG advantage to azapirones (Buspar aka buspirone) that benzos and barbiturates don’t offer?
Don’t cause sedation, dependance or tolerance
Opium, morphine, heroin, codeine
Natural opioids
Méthadone, oxycodone, hydrocodone & fentanyl
Semisynthetic opioids
Side effects to narcotic opioids, withdrawal signs & special fact about drug overdose
Side effects: dry mouth, nausea, pupil constriction, postural hypotension, drowsiness, dizziness, constipation, and respiratory depression
Withdrawal: flu symptoms (runny nose, watery eyes, nause, muscle aches, fever, yawning), insomnia, abdominal cramps, vomit, diarrhea, rapid heartbeat and high BP
Fact: drug overdose from opioids is leading cause of accidental deaths in USA
Beta blocker side effects and special considerations regarding discontinuation
Side effects: hypotension, reduced sex drive, insomnia, nausea/vomiting, dry eyes, dizziness and depression(fatigue/malaise), bradycardia (slow heart rate)
Extremely rare: coldness in extremities
Abrupt discontinuation—> rebound hypertension, tremors, headaches, confusion and cardiac arrthmias
Mood stabilizer side effects and which is best for what kind of bipolar disorder
Lithium: nausea, vomiting, diarrhea, metallic taste, increased thirst, weight gain, hand tremor, fatigue, and impaired memory/concentration. Blood should be checked to avoid lithium toxicity= seizures, coma, death
Best for: acute mania (1st line), classic BP (without rapid cycling)
Anticonvulsant: nausea, dizziness, sleepiness, lethargy, ataxia, tremor, visual disturbances and impaired concentration. Blood should be checked to avoid agranulocytosis (carbamazepine and valproic acid) and aplastic mania (only for carbamazepine)
Best for: acute mania and BP with mixed episodes
Pemoline (Cylert) & amphetamine-dextroamphetamine (Adderall)
Stimulants
Clonidine (Kapvay)
Non stimulant - ADHD
TCA desipramine, NDRI bupropion (Wellbutrin), guanfacine (Inutiv), clonidine (Kapvay) and atomoxetine (Straterra) are all what?
Non stimulant ADHD drugs
Guanfanicine (Inutiv)
Non stimulant
Acamprosate (Campral)
Addiction related - substance use
Works by reducing cravings for alcohol
Topiramate (topamax)
Addiction related - substance use
Antiseizure not approved by FDA used off label for alcohol use disorder. Reduces craving and pleasurable effects
Nicotine replacement therapy (NRT) bupropion and varenicline
Addiction related - tobacco use disorder
NRT- based on assumption that low level of nicotine prevents withdrawal when a person stops smoking.
Bupropion - prevents relapse from smoking cessation by reducing nicotine craving and withdrawal
Varenicline - reduces craving and also reduced rewarding effects of smoking
Cannabis & dronabinal oral solution (Syndros)
THC
Work by: stimulating release of dopamine in VTA (ventral striatum; nucleus accumbens; Mesolimbic system)
Good for: anorexia, AIDS patient weight loss and nausea in cancer patients
Drug half life (special considerations for OAs)
How long it takes for the drug to reach 50% in blood levels.
Short half-life: short interval between doses (can take more frequently) think Advil
Longer half life: longer intervals between doses (skip one day, I.e. accutane)
OAs: shorter half life drugs take longer to dispel/reduce in blood vs younger populations due to changes in metabolism. So, key is to start low and go slow with new medication (low dose, and gradually increase slowly). I.e. benzos take 72 hrs to dispel from system.
Other drugs that have a longer half life for OAs: ADs, antipsychotics, anxiolytics
Cross tolerance
When tolerance to one drug produces tolerance to another drug in same class
Ex. Tolerance to alcohol (CNS depressant) produces tolerance in benzos and barbiturates (also CNS depressants)
Therapeutic index (animal studies vs human studies; low vs high LD50)
Animal studies
Lethal dose (LD) 50 / effective dose (ED) 50
Human studies
Toxic dose (TD) 50 / effective dose (ED) 50
Lethal dose 50= lethal dose in 50% of sample
Toxic dose 50= toxic dose in 50% of sample
Effective dose 50= effective dose in 50% sample
- Low LD50 = more LETHAL (TI= 1.0 or LESS; narrow window) vs High LD50 = safer (TI= 1.0 or MORE; wide window)
Reuptake inhibitor
Chemical that stops a neurotransmitter from being reabsorbed or recipes into body = agonist response
Increased amount
Reuptake is important for what
REDUCING or Regulating the amount of neurotransmitters we have, we don’t want too much or too little we need the right amount so reuptake helps the body with reabsorbing the neurotransmitters so we don’t accumulate more than we need. So we have less.
Reuptake is NOT the inhibitor part
Agonist vs antagonist
Agonist: increase effects of neurotransmitters
- types: partial agonist (mimic neurotransmitter but not as much) and inverse agonist (produce opposite effect)
Antagonist: BLOCKS action of neurotransmitter at receptor site or other areas. Opposes an action from happening.
Differences between 1st & 2nd generation antipsychotics
2nd Gen less likely to cause tardive dyskinesia and extrapyramidal effects AND treat both positive and negative symptoms in schizophrenia. Also cause agranulocytosis
Worry with barbiturate amobarbital and secobarbital
Highly addictive can die from overdose drowsiness confusion and paradoxical effect (similar to benzos)
Lithium is best of all medications to reduce what
Suicide
