Midterm 1 Psych Meds; Antidepressants, Antipsychotics, Antiepileptics, Antianxiety Flashcards
What are the antipsychotic medications? (Conventional)
chlorpromazine
fluphenazine
haloperidol
What is the antidote for first generation antipsychotics?
benztropine
What could occur as a result of taking too much of an anticholinergic drug? Such as benztropine
Anti-cholinergic crisis consisting of the following s/s
Blurred vision
Dry mouth
Constipation
Urinary retention
What is the action of typical/conventional/first generation antipsychotics?
These drugs bind to D2 receptors resulting in a decrease in dopaminergic neuron transmission (Or simply decrease dopamine levels to simplify it)
What do first generation antipsychotics treat (symptoms of the disease) Give examples
Positive symptoms of schizophrenia such as;
Hallucinations
Delusions
Bizarre behavior
Formal thought disorder
Catatonia
What side effects could occur as a result of FGAs? Elaborate
EPS such as…
Acute Dystonia
Parkinsonism
Akathisia
NMS
Tardive Dyskinesia
Define Acute Dystonia
Occurring 1-5 days after taking a conventional antipsychotic
Includes uncontrolled muscle spasms mainly on tongue, neck, and face
Torticollis; twisted neck (stiff turned neck)
Ocular garlic crisis; Eyes gazed upward and outward
Oropharyngeal dysphasia; difficulty swallowing
Define Parkinsonism…
Occurring 1-4 weeks after taking a first generation antipsychotic
Consists of Parkinsonian features such as…
Generalized muscle rigidity
Bradykinesia/akinesia
Mask-like face
Tremors
Define Akathisia
Occurring 5-60 days after taking a typical antipsychotic
When the body is restless and the patient has an inability to stay still
Define NMS….
Occurring weeks to months after taking a typical antipsychotic
(Life Threatening Emergency)
Consists of the following symptoms; Increased AMS, lead pipe rigidity, hyperthermia, autonomic instability (increased HR, RR, increasing and decreasing BP)
Define tardive dyskinesia…
Occurring after months to years of taking conventional antipsychotics,
Involuntary painless movements of face and upper extremities (chorea), and formal thought disorder
Is potentially irreversible and is due to chronic antipsychotic use
Depot medications are…
The reason they are used is to…
Long acting injectable medications that can last up to months aimed to prevent a patient from relapsing from non adherence to a medication regime
What pathway keeps ACh and DA balanced
Nigrostriatal pathway
Why is Benztropine given with 1st gen antipsychotics
To balance out the ACh and DA levels. DA is decreased so you’d want to decrease ACh too
Pros & cons of 1st gen antipsychotics
Pros:
Fewer withdrawal symptoms
Cons:
Increase risk for tardive dyskinesia
More likely to cause EPS
How do atypical antipsychotics work
Blocks DA & 5-HT receptors. Decrease DA & increases 5-HT
What do atypicals tx, list a few examples
Negative & positive symptoms
Negative:
-apathy
-social withdrawal
-blunted/flat affect
-anhedonia (lack of joy)
-poverty and speech
Atypical drugs (6) & things to look out for
Clozapine: metabolic syndrome, decrease bone marrow (neutropenia)
Olanzapine: (M.S. taken @ HS)
Risperidone: OHTN & sedation= Fall risk
Quetiapine: helps w/ sleep
Ziprasidone: prolonged QTC interval….ECG needed
Aripriprazole: tx schiz, bipolar, and Major Depression
Pros and cons of atypical
Pros: less likely to cause EPS
Low tardive dyskinesia
Cons:
Higher risk of NMS
All cause M.S. (weight gain, increased Blood glucose, triglycerides, hyperlipidemia)
How do SSRIs work
Inhibit 5-HT protein transporter to prevent the reuptake of 5-HT
SSRI drugs
Fluoxetine
Escitalopram
Paroxetine
Sertraline
Side effects from SSRIs
Decreased libido
Agitation
Insomnia
Nausea
Serious:
Birth defects
Dizzy/blurred vision
Key points to note while taking SSRIs
Do not take while pregnant
Do not discontinue abruptly
Do not take 2 serotonergic drugs at the same time
Can cause neonatal withdrawals if mother takes while pregnant
Not recommended ages 18-24
Who shouldn’t take SSRIs and why
Mothers (birth defects)
People ages 18-24 (increase risk of suicide)
Bipolar 1 (increases mania)
How do TCAs work
Block NE and 5-HT protein transporters to prevent reuptake of NE & 5-HT and increase sensitivity of receptors
What do TCAs tx (3)
OCD/anxiety (?)
depression
Neuropathic pain
TCA side effects
*Anti-Cholinergic effects (block muscurinic receptors)
-dry mouth
-urinary retention
-blurred vision
-constipation
*increase dizziness & decrease BP= fall risk
*increase weight
*increase sedation
* Risk of TCA OD and leads to cardiotoxicity (caution w/ elderly pts, slower metab. So increase risk)
TCA drugs
Amitriptyline
Noritriptyline
Clomipramine
Imipramine
How do MOAIs work
Blocks monamine oxidase leading to increase in DA, NE, & 5-HT
Side effects of MAOIs
Weight gain
Fatigue
Sexual dysfunction
Hypotension
Muscle cramp
Urinary retention
Constipation
Serious side effect from MAOIs doses (9-12mg) & Tyramine diet
Hypertensive crisis
Sweating
N/V
Palpitations
Tachycardia
Confusion
What foods should you avoid while taking MAOIs list a few examples
Alcohol
Fermented fruit/veggies
Chocolate
Cheese
Dried/cured meats
Caffeine
Dry pickled & cured fish
Dried fruit/veggies
What are the MAOI drugs
Phenelzine
Tranylcypromine
things to know about MAOIs (2)
Don’t take with ANY other antidepressants
Wait 2 weeks after stopping MAOIs to move onto another antidepressant
What are the two mood stabilizer classes
Anti-Mania
Anti-epileptic
How do Anti-Mania meds work
Alters Na ion channels, also increases GABA and decrease DA & glutamate
What do anti-manias tx
Bipolar 1&2
Schiz
MDD (not very helpful)
Impulsivity disorder
Therapeutic vs non therapeutic range of lithium
0.6-1.2mEq/L
Non: 1.5<
Long term side effects of lithium
Hypothyroidism
Renal failure
What labs to check when on lithium
CBC
Cr
GFR
BUN
TSH
Atypical drug medications
clozapine
olanzapine
risperidone
quetiapine
ziprasidone
aripiprazole
