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Pharmacology > Neuro: Antidepressants/Antipsychotics > Flashcards

Neuro: Antidepressants/Antipsychotics Flashcards

1
Q

which drug class is the last tx option for antidep

A

MAOIs

monoamine oxidase inhibitors

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2
Q 
Citalopram 
Escitalopram 
Fluoxetine 
Fluvoxamine 
Paroxetine 
Sertraline
A

SSRIs

*first line for antidep

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3
Q

SSRIs

  • MOA
  • onset of action?
  • kinetics
  • SE
A

inhibit serotonin reuptake—incr concentrations of serotonin in synaptic cleft

onset–takes 2-12 weeks

Food does not affect absorption (except Sertraline)

SE:

  • N/V/D
  • HA
  • Sleep disturbances
  • Changes in wt
  • Sexual dysfunction
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4
Q

Which SSRI has increased absorption when taken with food

A

Sertraline

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5
Q

why has SSRIs first line tx compared to MAOI or TCAs

A

relatively safe in ODs

less severe SEs

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6
Q

Which SSRI is the only effective tx for bulimia?

A

Fluoxetine

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7
Q

Which SSRIs are more sedating and which are more activating

A

Sedating–Paroxetine and Fluvoxamine

Activating–Fluoxetine and sertraline

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8
Q

Black box warning for SSRIs

A

increased risk of suicidal thoughts in peds*****

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9
Q

Which SSRi are approved for tx of childhood depression?

A

Fluoxetine and Escitalopram

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10
Q

Which SSRI is approved for childhood OCD?

A

Fluoxetine, sertraline and Fluvoxamine

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11
Q

Which SSRi can cause QT prolongation in OD?

A

Citalopram

*think C for Cardio

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12
Q

OD for SSRI s/s

A
  • QT prolongation in Citalporam
  • seizures–bc all SSRIs lower seizure threshold
  • **Serotonin Syndrome
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13
Q

hyperthermia, muscle rigidity, sweating, myoclonus, changes in mental status and vital signs

A

S/S serotonin syndrome

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14
Q

How to stop SSRIs

A

TAPER OFF MED SLOWLY

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15
Q

What happens if you aprubtly stop taking SSRI

A 
Discontinuation sydrome: 
HA
malaise 
flu like symps 
agiation and irritability 
nervousness 
sleep changes
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16
Q

Which SSRI has lowest risk of causing discontinuation syndrome

A

Fluoxetine

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17
Q

Desvenlafaxine
Duloxetine
Venlafaxine

A

SNRIs

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18
Q

MOA for SNRIs

A

inhibit reuptake of BOTH serotonin and norepi

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19
Q

Low doses of Venlafaxine MOA

High does of Venlafaxine MOA

A

Low doses: JUST inhibt serotonin reuptake

High: inhib norepi and serotonin

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20
Q

Which antidepressant meds can also help aliviate pain

A

SNRIs
TCAs
**bc uptake of both serotonin and norepi

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21
Q

SE of:

  • Venlafaxine
  • Duloxetine
A

Venlafaxine and Duloxetine: constipation, nausea, HA, sleep disturbances, sexual dysfunction, dizziness,

Duloxetine: also has SE of:

  • dry mouth
  • sweating
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22
Q

high doses of SNRI can cause

A

tachycardia, HTN

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23
Q

PT with liver dysfunction should avoid which SNRI

A

Duloxetine

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24
Q

Duloxetine should/should not be given with antipsychotics

A

SHOULD NOT because of the metabolic pathway— it will increase concentrations of antipsychotics

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25
Q

SSRI and SNRI SE differences

A

SSRI–DIARRHEA

SNRI—CONSTIPATION

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26
Q

do SNRIs precipitate discontinuation syndrome if abruptly stopped?

A

yes

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27
Q

can you give a PT with liver dysfunction SNRI?

A

NO–bc they are heavily liver metabolized

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28
Q

Buproprion
Mirtazapine
Trazadone

A

Atypical antidepressants

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29
Q

Buproprion

  • MOA
  • SE
  • Contras
A
  • weak dopamine and norepi reuptake inhibitor
  • dry mouth, sweating, nervousness, TREMOR, DOSE DEP INCR RISK FOR SEIZURES

CONTRA in PTs:

  • bulimic
  • seizure disorders
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30
Q

which antidepressnt can be used for smoking cessation??

A

Buproprion—Zyban

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31
Q

Which atypical antidep drug increases risk of sezirues and contra in PTs with seizures

A

Buproprion

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32
Q

MOA Mirtazapine

A

Enhances serotonin and norepi

acts as antagonist at central presynpatic apha2 receptors

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33
Q

SE od Mirtazapine

A

Sedation (because has antihist. properties)
-incr appetite
-wt gain
NOOOO sexual dysfunction or antimuscarinic se

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34
Q

Trazadone MOA

A

weak inhibs of serotonin reuptake

antagonist at histmaine receptor (5-HT2)

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35
Q

SE of trazadone

A

sedation–bc of antihistamine acitivty
orthostasis and dizziness
priapism (prolonged erection)

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36
Q

off use label of trazadone?

A

insomnia bc has strong sedative properties

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37
Q

Imipramine
Amitriptylin
Doxepin

A

TCAs

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38
Q

MOA TCA

A

inhibit norepi and serotonin

*also block serotogenic, alpha adrenergic, histaminic, and muscarinic receptors

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39
Q

SE of TCA

A
  1. blockade of muscarinic rec: blurred vision, xerstomia, urinary retention, sinus tach, constipation, acute angle closure glaucoma
  2. Blockade of alpha-adren recep: orthostatic hypotension, dizziness, reflex tachy
  3. block histamine: sedation
  4. Wt gain, sexual dysfunction (less than SSRI)

**LT ARRHYTHMIAS ON OD****

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40
Q

TCA OD?

*antidote?

A

LT arrythmias

bicarb

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41
Q

Which drug to use for bed wetting?

A

Imipramine (TCA)

42
Q

which antidep is good in prevention of migraine and tx of chronic pain syndrome (neuropathic pain)

A

Amitriptyline

43
Q

Which TCA in low doses is good for insomnia?

A

Doxepin

44
Q

Therapeutix index for TCAs?

A

NARROW

45
Q

what to do if prescibing TCA to sucidal PT?

A

LOW LOW Doses and monitored closely—as an OD can be easily deadly

46
Q

Which medical conditions can TCAs exacerbate

A

BPH
epilepsy
preexisting arrythmias

47
Q

Avoid TCAs in which PTS

A
  • glaucoma

- elderly —-bc of orthostat hypot

48
Q

Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

A

MAOIs

49
Q

what is monoamine oxidase

A

enzyme in nerves + gut + liver +other tissues

“safety valve” to inactivate any excess NTs that leak out of synaptic cleft

50
Q

MAOI MOA

A

irreversible or reversibly inactivate MAO—letting NTs escape b/d—>NTs accumulate within neuron (all neurons in MANY tissues. not just brain) and then go into synapse space

51
Q

NTs that MAOI affect

A

Serotonin
norepi
dopamine

52
Q

SE for MAOI

A 
*prevention of tyramine b/d---->accumulates-->HTN crisis 
other SE: 
-drowsiness 
-orthostat hypot 
-blurred vision 
-dry mouth 
-constipation
53
Q

what do ppl on MAOI need to avoid

A

food with tyramine–aged or fermented cheese, all aged/smoked/pickled or cured meats/poultry/fish and RED wine, chocolates, draft beer

54
Q

MAOI have high…

A

drug-drug interactions

drug-food interactions

55
Q

IND for MAOI

A

depressed PT who are unresponsive or intolerant of other antidepresants
***last line

56
Q

how long should PT wait when stopping MAOI and starting new antidep?

-what is the exception and with what drug

A

2 weeks

Fluoxetine===SIX weeks

57
Q

what drugs are used to tx mania and BiPo

A

Carbamazepine
Lamotrigine
Valproic acid
Lithium

58
Q

MOA for lithium

A

unknown– chemical properties are similar to sodium

59
Q

Therapetuic index for lithium

A

very low

can be toxic

60
Q

SE for lithium

A 
HA 
dry mouth 
polydipsia--incr thirst 
polyuria 
polyphagia 
GI distress
fine hand tremor 
dizziness
fatigue 
derm rxns 
sedation
61
Q

S/S of high plasma levels of Lithium

A 
ataxia 
slurred speech 
coarse tremors 
confusion 
convulsions
62
Q

Decr ____ can lead to lithium toxicity

A

sodium

**hyponatremia can lead to toxicity

63
Q

which gland is affected by lithium and should be monitored

A

Thyroid gland

64
Q

Does mitrazipine cause sexual dyfsunction?

A

NO!

65
Q

Which SNRI is good for pain + depression

A

Duloxetine

66
Q

which drug iss most likely to decr thyroid function

A

Lithium

67
Q

is Lithium good to give to PTs with hepatic impairment?

A

YES!

68
Q

positive s/s of Schizo

A

Positive: hallucinations and delusions

69
Q

Negative s/s of schizo

A

BLunted affect
apathy
impaired attn
cognitive impairment

70
Q

Chlorpromazine

Thioridazine

A

first generation antipsychotics–LOW POTENCY

71
Q 
Fluphenazine
Haloperiodl 
Loxapine
Molindone
Perphenazine
Pimozide
Prochlorperazine
Thiothixene 
Trifluoperazine
A

first gen antipsychotics—HIGH POTENCY

72
Q

Another name for first gen antipsychotics

A

conventional

73
Q

High risk of ______ with first gen antipsychotics

A

Extrapyramidal symptoms—movement disorder

74
Q

MOA for first gen antipsych

A

Dopamine antagonists–block D2 receps in brain and periphery

75
Q

Main s/e with first gen antipsychotic drugs?

A

EPS–extrapyramindal sympstoms

76
Q

main s/e with seond gen antipsychotics?

A

Metabolic issues–incrs risk of DM, hypercholesteremia and WT gain

77
Q

haldol bings less potently or more potetly to D2 receptors

A

More potently

78
Q

Chlorpromazine binds more tightly or less potently to D2 receptors

A

less potently

79
Q 
Aripirazole 
Asenapine
Rexpiprazole
Cariprazine
Clozapine
Illoperidone
Lurasidone
Olanzapine 
Pimvanserin 
Quetiapine
Rispierdone 
Ziprasidone
A

Second gen antipsychotics

80
Q

another name for second gen antipsychoics

A

atypical

81
Q

MOA for second gen antipysh

A

block serotonin and dopamine

82
Q

What is used for first line schizophrenia and psychosis

A

SECOND gen

83
Q

Refractory PTs for schizo… what do we use?

A

Clozapine

84
Q

What needs monitoring when PT is on clozapine and WHY?

A

WBC because it can cause agranulocytosis

85
Q

which receptors do antipsychotic drugs block?

A

main ones: dopamine (just first gen) and/or serotonin (second gen does both)

ALSO BLOCKS

  • cholinergic
  • Adrenergic
  • Histaminergic
86
Q

negative s/s of schizo are more responsive to which generation

A

second generation

87
Q

what is thought to cause EPS?

A

blockade of dopamine receptors from first gen drugs

*parkinson like s/s **

88
Q

Antipsychotic drugs potentiate nausea or help with it?

A

help! they have antiemetic effecets
via D2 rec blockade
**haldol **

89
Q

Thioridazine and Chlorpromazine

A

1st gen low potency

90
Q

Clozapine and olanzapine

A

sec gen/ atypical

91
Q

Clozapine and olanzapine
Thioridazine and Chlorpromazine

Prod what kind of s/e?

A

Anticholinergic

  • dry mouth (EXCEPT FOR CLOZAPINE.. it INCRS saliv)
  • blurry vision
  • AMS
  • inhibition of GI
  • constipation and urinary retention
92
Q

Anticholinergic effects seen with some antipsychotics may assint in reducing——–

A

EPS

93
Q

Which drug is used to treat intractable hiccups

A

Chlorpromazine **

94
Q

Tx of Tourette disorder??

A

Pimozide (fiirst line)

95
Q

what is given to help control EPS

A

Benztropine–anticholineric

96
Q

What part of EPS can be irreversible

A

tardive dyskinesia

97
Q

Muscle rigidty, fever, AMS, stupor, unstable BP, Myoglobinemia + hx of taking antipsychotics

A

Neuroleptic malignant syndrome

LT***

98
Q

TX for Neuroleptic Malignant syndrome

A

discontinue antipsychotic

supportive tx

99
Q

Which antipsychotic can cause prolong qt

A

Thioridazine has highest risk

100
Q

how to remember the SSRIs

Effective 
For 
Sadness
Panic 
Compulsions
A 
Escitalopram 
Fluoxetine, Fluvoxamine 
Sertraline 
Paroxetine 
Citalipram

Pharmacology (28 decks)

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