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Psychiatry > Medications > Flashcards

Medications Flashcards

1
Q

SSRI drugs

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine
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2
Q

SSRI general uses

A 
OCD
Social Phobias
Gen. Anxiety D/o
PTSD
Bulemia
Panic d/o
also good for PMDD  (pre-menstral depression)
recently approved for hot flashes (paroxetine)
Pre-mature Ejaculation
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3
Q

SSRI general side effects

A

“SSRI - sex, stomach, restless, insomnia”
main s/e = increased weight and dec. sex drive
GI, restlessness goes away in a few weeks

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4
Q

How to avoid GI/Restlessness s/e of SSRI

A

start w/ low dose and slowly titrate

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5
Q

TCA - (act like SNRI’s, weak SSRI)

DRUG NAMES

A 
Imipramine
Nortriptyline
Amitriptyline
Clomipramine
Desipramine
Doxepin --> Insomnia; x50 stronger vs Benadryl
Amoxapine
Trimiparmine
Protryptiline
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6
Q

TCA general uses

A

insomnia (Doxepin)
Irritable bowel disease
migraines
fibromyalgia

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7
Q

TCA general side effects

A 
Anti-Ach side effects 
 - dry mouth
 - urinary/bowel retention
 - flushing
 - inc QT --> inc risk of torsade
Will cause orthostasis
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8
Q

MAO-Inhibitors Drug Names

A

Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline - MAO-B (works mostly on DA)

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9
Q

MAO-Inhibitors side effects

A

watch for tyramine effect as tyramine mimics NE and will not be broken down if GI MAO’s are blocked by these drugs
can get serotonin syndrome b/c they also block serotonin breakdown
wait 7 days after stopping venlaflaxine before starting MAO-inh

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10
Q

Bupropion Mech of axn and uses

A 
DNRI
DOES NOT WORK FOR ANXIETY issues (PTSD, GAD, Phobias, etc)
ADHD
BPH
Smokers
mild/moderate obesity --> weight loss!!
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11
Q

Avoid Bupropion in….

A

BULEMIA

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12
Q

Burpropion Side effects

A

NO GI/Nausea/Sex side effects!!!!!!

can combine with lower dose SSRI to get benefits of both with less s/e

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13
Q

SSRI + 5HT2 block

A

Nefazodone
Trazodone
= block of 5HT2a –> priapism

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14
Q

SNRI + 5HT2 and 5HT 3 block

A

Mirtazapine (Remeron)
= blocks GI side-effects via the 5HT3
= still get the sex side effects

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15
Q

SNRI’s Drug Names

A
  • remember TCA”s behave like SNRI*
  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine
  • Savella –> good for depression
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16
Q

SNRI side effects

A

same as SSRI + Added HTN

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17
Q

TYPICAL Anti-psychotics
Mech of Axn
Drug Names

A 
***Dopamine ANT-agonist***
Haloperidol (Haldol)
Chlorpromazine
Fluphenazine
Loxapine
Pimozide
Molindone
Thioridazine
Mesoridazine
Perphenazine
Trifluoperazine
Thiothixene
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18
Q

ATYPICAL Anti-Psych
MOA
Drugs Names

A 
***Dopamine and 5HT-2A ANT-agonist***
Clozapine - only one good for neg. sx; also for suicide
Olanzapine
Risperidone
Quetiapine
Ziprasidone
Apriprazole
Paliperidone
Iloperidone
Asenapine
Lurasidone
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19
Q

Drugs that work for bipolar depression

A

Quetipine and Lurasidone

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20
Q

Quetiapine works well for

A

Bipolar depression
Mania
can be used for monotherapy

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21
Q

ATYPICAL Anti-Psy uses

A

Clozapine - NEG sx of psychosis, suicide
Schizophrenia
Bipolar D/O
Tic D/O –> tourettes
Apriprazole can be used for depression if monotx fails
Risperidone and Apriprazole can be used for irritability

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22
Q

Mood Stabilizers Drug Names

A 
Lithium Carbonate
Divalproex Sodium
Carbamezapine (Tegretol)
Gabapentin
Pregablin
Loamotrigine
Oxcarbazapine
Topiramate
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23
Q

Sedative Hypnotics and Anxiolytics

BZD Drug Names

A
  • Lorazepam
  • Flurazepam
  • Triazolam
  • Temazepam
  • Diazepam
  • Chlordiazepoxide
  • Oxazepam
  • Chlorazepate
  • Alprazolam
  • Clonazepam
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24
Q

Sedative Hypnotics and Anxiolytics

NON-BZD Drug Names

A 
Buspirone
Hydroxyzine
Propranolol
Clonidine
Zolpidem
Zaleplon
Eszopiclone
Ramelteon
Doxepin
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25
Q 
MOA (non-bzd sedatives/anxiolytics):
Buspirone
Hydroxyzine
Propranolol
Clonidine
Zolpidem
Zaleplon
Eszopiclone
Ramelteon
Doxepin
A 
Buspirone - 5HT1 AGONIST
Hydroxyzine - Anti-H
Propranolol - beta-block
Clonidine - Alpha 2 - AGONIST
Zolpidem - BZD1 AGONIST
Zaleplon - " "
Eszopiclone- " "
Ramelteon - Melatonin receptor agonist
Doxepin - TCA/Anti-H  (50x stronger than benadryl)
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26
Q

Stimulants

- can be used for depression but NOT as monoTx

A 
Modafinil
Armodafinil
Methylphenidate (Ritalin, Concerta)
Amphetamine Salts (Adderall)
Dextroamphetamine
Lis-dexamptheamine
Methamphetamine

These 3 are FDA approved for ADHD but are NOT Stimulants:
Atomoxetine (SNRI)
Guanfacine (alpha 2 agonist)
Clonidine (alpha 2 agonist)

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27
Q

Addictive Medicine

A 
Methadone --> Morphine (opioid)
Buprenorphine - opioid agonist
Naloxone - opioid antagonist
Acamprosate - NMDA antagonist
Naltrexone - Opioid antagonist
Varenicline - Nictonic Receptor antagonist
Bupropion - DNRI
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28
Q

EPS of antipsychotics

A

Dystonia - spasm of face,neck and tongue
Parkinsonianism - resting tremor, rigidity, bradykinesia
Akathisia - restless

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29
Q

Tx of EPS

A

Anti-Parkinsons Drugs
- benztropine, diphenhydramine)
BZD
Beat Blocker (FOR AKATHISIA)

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30
Q

Main Side Effect of 2nd Gen Anti-Psychotic

A

Metabolic Syndrome

  • increase blood pressure
  • increased insulin and excess waistline fat
  • INCREASED risk of CV disease,
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31
Q

Weight neutral Anti=Psychotics

A

Apriprazole - only 2nd gen

First Gen antipsych

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32
Q

Short Term Tx of Tardive Dyskinesia

A

BZD
Beta-blocker
Cholinomimetics

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33
Q

Neuroleptic Malignant Syndrome

A

Look for leukocytosis, fever, rigidity, elevated CPK, metabolic acidosis,

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34
Q

Thioridazine side effect

A

TYPICAL anti-psychotic

causes IRREVERSIBLE retinal pigmentation

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35
Q

Chlorpromazine

A

Typical Anti-psychotic

causing corneal and lens deposits

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36
Q

Tx for Mood Disorder

A

FIRST LINE –> Lithium

If can’t use Lithium (renal issues, pregnant, etc)
–> USE VALPROATE

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37
Q

Valproate side effects

A

Spina Bifida if pregnant
Pancreatitis
Low Platelets
Agranulocytosis

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38
Q

2nd line agents

A

Carbamazepine (also for Trigeminal neuralgia)

Lamotrigine

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39
Q 
CNS stimulants - Indications/Contraindications
Methlyphenidate
Dexmethylphenidate
Dextroamphetamine
Amphetamine
Pemoline
A 
Indications
-ADD
-Narcolepsy
Contraindications
- Co-admin w/ MAO-I
- Narrow angle glaucoma
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40
Q

CNS Stimulant SIDE EFFECTS - Adverse

A

Adverse
- Anxiety Insomnia
Anorexia
Tachycardia

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41
Q

CNS Stimulant SIDE EFFECTS - Severe

A

Drug Dependence
HTN
Cardiac Arr
CV Collapse (rare)

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42
Q

Novel CNS Stim - Modafinil

Indications

A

Narcolepsy
ADD
Primary and Secondary Hypersomnia

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43
Q

Modafinil Contraindications

A

Co-admin with MAO-I

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44
Q

Modafinil Side Effects - Adverse

A 
HA
Nausea
Rhinitis
Anxiety
Insomnia
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45
Q

Atomoxetine (Strattera)

Indications/Contraindications

A 
CNS Stimulant used for 
- ADD
Contraindicated
- Co-admin with MAO-I
- Narrow Angle Glaucoma
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46
Q

Atomoxetine Adverse Effects

A 
Dyspepsia
N/V
Anorexia
Dizziness
Insomnia
Sexual dysfxn
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47
Q

Atomoxetine Serious Effects

A

Suicidal ideation

Severe Liver Injury

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48
Q

MOA of Antipsychotics

A

Target the D2 pathway in MESOLIMBIC

D2 Block in other pathways causes side effects

  • Block of Nigrostriatal –> EPS
  • Block of tuberoinfundibular –> HyperPL
  • Block of Mesocrotical –> Worsens negative sx and cognition

Typical Antipsych - also block Ach, Alpha adrenergic, and H1 receptors

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49
Q

High Potency Anti-Psychotics

A 
Holperidol
Fluphenazine
Pimozide
Thiothixene
Trifluphenazine
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50
Q

Mid Potency Anti-Psychotics

A

Perphenazine
Molindone
Loxapine

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51
Q

Anti-Psychotic Side Effect profile BY potency

A

HIGH Potency – worse EPS

LOW Potency – more Anti-Ach, Anti-H1, and Anti-alpha adrenergic

MID Potency - more balanced profile

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52
Q

Low Potency Anti-Psychotics

A

Chlorpromazine
Mesoridazine
Thioridazine

53
Q

Chlorpromazine

A

HIGHLY sedating
Significant hypotension and Anti-Ach
LOW EPS sideeffects!!

54
Q

Thioridazine

A

Least EPS of all the Typicals
Significant QT prolongation
doses >800mg/day –> retinitis pigmentosa

55
Q

Uses/Indications of TYPICAL Anti-psychotics

A

Psychotic Disorders

  • Schizophrenia
  • Shizoaffective d/o
  • Brief Psychotic d/o
  • Substance and Med - induced psychosis

Psychotic Symptoms in Mood D/o

  • MDD w/ psychotic features
  • Acute Manic, depressed,and mixed manic states of bipolar disorder

Tourette’s
Huntington’s

56
Q

Adverse Effects of Typical Anti-Psychotics

A

EPS - Akathisia, Parkinsonian, Dystonia

  • tx Akathisis w/ Anti-Act, Betablock or BZD
  • tx Dystonia w/ Anti-Act (po or IM)
  • tx Parkinsonian w/ Anti-Act, Dopaminergics, or Beta-blockers
Sedation
Weight Gain
Anti-Ach side-effects
Orthostatic HypoTN
Dec.Seizure threshold
Sexual Dysfxn
Dermatologic effects (dermatitis, and photosensitivity)
57
Q

NMS sx

A

hyperpyrexia
ANS instability
Rigidity
Delerium

58
Q

Atypical Anti-Psychotics

A

Block D2 and 5HT2A
- the 5HT2a is responsible for mitigating the D2 related EPS side effects and the D2 block in other pathways

also block Muscurinic-Ach, Alpha Adrenergic, and H1 to varying degress

MORE Metabolic side effects and LESS EPS

  • hyperglycemia
  • DM2
  • Hyper-Lipidemias
59
Q

Clozapine Indications/Contraindications

A

Indications

  • Tx- refractory Schizo
  • Schizo with concurrent Tard.Dyskinesia

Contraindications

  • Granulocytopenia
  • DM/hyperlipidemias
60
Q

Clozapine Adverse Effects

A 
Sedation
Anti-Ach + ECG changes
Orthostatic HypoTn
Hypersalivation
Weight Gain (substantial)
Seizures (high dose or fast titration)
Metabolic problems (DM and HLD)

Serious Effects include Agranulocytosis (requires frequent CBC checks)

61
Q

Risperidone Indications/Contraindications

A

Acute Mania

62
Q

Risperidone Adverse Effects

A 
Orthostatic  HypotTN
Reflex Tachy
Dizziness
Insomnia
Agitation
HyperPL
if >6mg/day --> EPS MAY develop
Metabolic Problems
63
Q

Olanzapine Indications/Contraindications

A

Acute Mania
Bipolar Maintainence

Contraindications in DM and HLD pts

64
Q

Olanzapine Adverse Effects

wide antagonism of 5HT2, D1, D2, D4, H1, Musc-Ach,

A 
Anti_Ach + ECG Changes
Orthostatics and dizziness
Sedation
Weight Gain
hyperglycemia --> DM2 --> DKA
HLD
65
Q

Ziprasidone Side Effects

A

Sedation
Weight Gain, to lesser extent than clozapine, olanzapine, and risperidone
Metabolic problems, including diabetes and hyperlipidemias, probably at a lower rate than olanzapine and clozapine
Possible increased risk for prolongation of QT interval

66
Q

Apriprazole

A

Also good for Bipolar Maintainence

67
Q

Apriprazole Side effects

A

Weigth Gian, but less than Clozapine, Olanzapine, and Risperidone
Metabolic problems

68
Q

PPx for Recurrent Mania Or for Bipolar Maintanence

A

Olanzapine and Apriprazole

69
Q

Imipramine uses

A

Panic

Enuresis

70
Q

TCA secondary amines benefit over primary

A

fewer side effects
less sedating
safer in OD

Desipramine, Nortiptyline, Protriptyline

71
Q

TCA contraindications

A

Cardiac conduction delays

Cardiac Arr

72
Q

The TCA with the least amount of orthostasis

A

Nortriptyline

73
Q

TCA with least amount of Anti-Ach

A

Desipramine

74
Q

Doxepin uses

A

pain, insomnia, anxiety

75
Q

Clomipramine indications

A

highly seritonergic

indicated for OCD

76
Q

Amitriptyline uses

A

PAIN
headache,
insomnia

77
Q

TCA general indications

A 
MDD
Bipolar Depression
Dysthymia
Panic d/o
Gen Soc. Phobia
GAD
OCD (clomipramine)
Panic D/o (migrains/neuralgias)
78
Q

TCA side effects

A 
weight gain, Anti-Ach
Sedation
Orthostatic HYPOtn
sex dysfxn + anorgasmia in women
seizures
mania in bipolar patients
79
Q

TCA - serous side effects

do regular blood monitoring

A

Cardiotoxicity –. slow the condunction –> EKG changes, ARR, and AV block

Neurotox –> tremor ataxia

Overdose –> agitation, delerium, coma, and death

80
Q

Uses for MAO-I and contraindications

A 
MDD
Atypical Depression
Panic d/o
Social Phobias
OCD
DO NOT GIVE w/ 
demerol
another SSRI
Sympathomimetic drugs
Tyramine
81
Q

MAO-I side effects

A 
Weight gain
sex dys fxn
insomnia
myoclonus. mm pains, and paresthesia
mania
orthostatic hypoTN
82
Q

Fluoxetine (PROZAC)

A

longest half-;life

good for bulemia

83
Q

Paroxetine

A

more sedating than fluoxetine and sertraline

84
Q

Sertraline

A

less sedating than paroxetine

85
Q

Fluvoxamine

A

indicated for OCD

86
Q

SSRI Side effects by receptor

A

5HT3 - in GI sys –> N/V/D
5HT2C - CNS –> anxiety and mental agitation
5HT2A - CNS, spinal cord–> anxiety, mental agitation, akathisia, insomnia, myoclonus, and sex dysfxn

87
Q

Serotonin Discontinuation Syndrome

A

HA, Dizziness, Irrtiability, and Fatigue on abrupt discontinuation

88
Q

Venlafaxine Uses and Contraindications

A

SNRI - best efficacy for antidepresion

  • MDD
  • GAD
  • Panic d/o
  • Gen Soc. Phobia

DO NOT co-admin with MAO-I

89
Q

SNRI side effects

Venlafaxine, Duloxetine

A 
Tremor
Agitation
Tachy/HTN
N/V/D
Anxiety and Mental Agitation
Akathisia
Insomnias
Myoclonus
Sex Dysfxn
Seizures (rare)
Mania

Discontinuation syndrome is the same as SSRI

90
Q

Duloxetine indications

A

DM Neuropathy
Nausea
Fibromyalgia
Pain for OA

91
Q

Mirtazapine

A

good MDD but do NOT give with MAO-I

92
Q

Mirtazapine side effects

A

Sedation
INC Appetite and Weigh Gain

Serious effects –> agranulocytosis and blood dyscrasias

93
Q

Trazodone and Nefazodone uses

A

MDD and Dysthymia

do not give w/ MAO-I

94
Q

Trazodone and Nefazodone side effects

A

Trazodone - priapism
Nefazodone - liver tox (black box)

since 5HT2A is blocked sex dys is avoided

95
Q

Bupropion uses

A 
MDD
Dysthymia
Bipolar Depression
ADHD
Smoking Cessation
BPH
Weight Loss
96
Q

Bupropion Contraindications

A

Anorexia
Bulemia
Seizure d/o
co-admin with MAO-I

97
Q

Bupropion side effects

A

Activation
Insomnia
Nausea
Tremor

Seizure at high dose

98
Q

Short Acting BZD in order of decreasing potency

A

Alprazolam - very addictive
Lorazepam
Oxazepam
Temazepam (sleep aid)

99
Q

Long Acting BZD in order of dec potency

A

Clonazepam
Diazepam (fast onset but active metabolite)
Chlordiazepoxide - etoh Detox

100
Q

BZD indications and contraindications

A 
GAD
Situation Anxiety Phobias
Panic d/o
epilepsy
muscle spasm
akathisia
etoh w/d
agitation
anxiety in other psych d/o
101
Q

BZD overdose tx

A

Flumazenil <– BZD antagonist

102
Q

BUSpirone

A

5HT1A AGONIST

  • good for GAD and adjunct in MDD
  • takes at least 2 wks to kick in
103
Q

BUSpirone side effects

A

Dizzy/HA/Fatigue/Gi distress

NO sedation or addictive potential like BZD

104
Q

Hydroxyzine

A

good for situational anxiety (anti-H)

105
Q

Hydroxyzine side effects

A

Sedation
Weight gain
Anti-Ach

106
Q

Non=BZD drugs for Insomnia

A 
Zolpidem
Zaleplon
Eszoplicone
Diphenhydramine
remelteon
107
Q

Zolpidem vs Zaleplon vs Eszoplicone

A

Zaleplon is short acting

Eszoplicone - not supposed to have tolerance

108
Q

Side effects of
Zolpidem
Zaleplon
Eszoplicone

A

Zolpidem - N/V/D/ Gi distress
Zaleplon - Dizzy, Dyspepsia
Eszoplicone - headaches

109
Q

Diphenhydrramine

A

can counter oculogyric crisis

but also good for insomnia

110
Q

Diphenhydramine side effects

A

Dizzy and Fatigue

111
Q

Lithium Carbonate uses

A 
Bipolar 1 (esp euphoric mania_
Bipolar 2
Bipolar Maintainence
Intermittent Explosive D/O
Adjunct to anti-depressant
112
Q

Lithium CONTRAINDICATIONS

A

Pregant women –> ebsteins anomanly
renal fx/dx patients
-Caution w/ diuretics, ACE-Inh, NSAIDS <– all can raise Li levels

113
Q

Monitoring parameters with Lithium

A

periodic therapeutic blood monitoring
thyroid
kidney function testing.

114
Q

Lithium Side effects

A 
GI irritation
Polyuria polydipsia, nephrogenic DI
Tremor, subtle incoord,
Cognitive Blunting
Benign Leukocytosis
Weight Gain
115
Q

Lithium SERIOUS effects

A 
Li tox
- oliguira
- N/V/D
- oliguria
- ataxia
- coarse tremor
- inc DTR's
- obtundation
- seizure
- death
Thyrotox
Long-term nephrotox
Cardiac Arr + T-wave flattening
116
Q

Carbazmazepine uses

A

Bipolar 1 (mixed mania and rapid cycling)
Bipolar 2
Epilepsy and Neuralgias
EtOH w/d

117
Q

Carbamazepine contraindications

A

Pregnant women

  • -> cleft lip, palate,
  • ->neural tube defects
  • ->learning d/o
118
Q

Carbamazepine side effects

A 
N/V/D
Seadation
Lightheaded
Tremor
Coginitive blunting
Hyponatremia
Anti-Ach effects
Rash --> SJS
Weight Gain
119
Q

Carbamazepine Serious effects

A 
Blood dyscrasias (aplastic anemia, agranulocytosis and thrombocytopenia)
Hepatotox

OD –> coarse tremor, coma, death

120
Q

Carbamazepine monitoring parameters

A

Therapeutic levels
CBC
LFT
metabolic fxn tests

121
Q

Clozapine WBC monitoring

A

if Leukopenic at 3000-3500 (2x/week CBC and continue Clozapine)
If leukopenic at 2000-3000 stop Clozapine and check CBC daily. CAN restart if it resolves
if Agranulucytosis (uncomplicated or complicated) STOP –> Protective isolation
- CANNOT RESTART CLOZAPINE

122
Q

Lithium Tox

A

> 3mEq –> Dialysis

123
Q

Drugs affective Carbamazepine

A

Theophyline and Cisplatin = DEC Carbamazepine

Carbamazepine will cause a drop in Warfarin and Hormonal contraceptives

Eryhtromycin will INC Carbamazepine levels

124
Q

tx of hyperarousal in PTSD

A

clonidine or beta blocker

125
Q

SSRI - Discont. Syndrome

A 
flu-like (chills and aches)
Nausea
Vomiting
Dizzy
Sensory and sleep disturbance
usually occurss 1-3 days after last dose
since Sertraline and paroxetine are short half-life --> taper
since fluoxetine is long half life -  can stop abruptly
126
Q

associated lab findings in NMS

A

leukocytosis
elevated Transaminases
myoglobinuria

127
Q

Li induced tremor

A

can use beta blocker, cessation of caffeine and dose reduction/slow release of lithium to tx

128
Q

Tx of Rapid Syndrome in long term neurleptic usage

A

Anti-Ach

Psychiatry (13 decks)

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