Neuro: Antidepressants/Antipsychotics Flashcards
1
Q
which drug class is the last tx option for antidep
A
MAOIs
monoamine oxidase inhibitors
2
Q
Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
A
SSRIs
*first line for antidep
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
4
Q
Which SSRI has increased absorption when taken with food
A
Sertraline
5
Q
why has SSRIs first line tx compared to MAOI or TCAs
A
relatively safe in ODs
less severe SEs
6
Q
Which SSRI is the only effective tx for bulimia?
A
Fluoxetine
7
Q
Which SSRIs are more sedating and which are more activating
A
Sedating–Paroxetine and Fluvoxamine
Activating–Fluoxetine and sertraline
8
Q
Black box warning for SSRIs
A
increased risk of suicidal thoughts in peds*****
9
Q
Which SSRi are approved for tx of childhood depression?
A
Fluoxetine and Escitalopram
10
Q
Which SSRI is approved for childhood OCD?
A
Fluoxetine, sertraline and Fluvoxamine
11
Q
Which SSRi can cause QT prolongation in OD?
A
Citalopram
*think C for Cardio
12
Q
OD for SSRI s/s
A
- QT prolongation in Citalporam
- seizures–bc all SSRIs lower seizure threshold
- **Serotonin Syndrome
13
Q
hyperthermia, muscle rigidity, sweating, myoclonus, changes in mental status and vital signs
A
S/S serotonin syndrome
14
Q
How to stop SSRIs
A
TAPER OFF MED SLOWLY
15
Q
What happens if you aprubtly stop taking SSRI
A
Discontinuation sydrome: HA malaise flu like symps agiation and irritability nervousness sleep changes
16
Q
Which SSRI has lowest risk of causing discontinuation syndrome
A
Fluoxetine
17
Q
Desvenlafaxine
Duloxetine
Venlafaxine
A
SNRIs
18
Q
MOA for SNRIs
A
inhibit reuptake of BOTH serotonin and norepi
19
Q
Low doses of Venlafaxine MOA
High does of Venlafaxine MOA
A
Low doses: JUST inhibt serotonin reuptake
High: inhib norepi and serotonin
20
Q
Which antidepressant meds can also help aliviate pain
A
SNRIs
TCAs
**bc uptake of both serotonin and norepi
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
22
Q
high doses of SNRI can cause
A
tachycardia, HTN
23
Q
PT with liver dysfunction should avoid which SNRI
A
Duloxetine
24
Q
Duloxetine should/should not be given with antipsychotics
A
SHOULD NOT because of the metabolic pathway— it will increase concentrations of antipsychotics
25
SSRI and SNRI SE differences
SSRI--DIARRHEA
| SNRI---CONSTIPATION
26
do SNRIs precipitate discontinuation syndrome if abruptly stopped?
yes
27
can you give a PT with liver dysfunction SNRI?
NO--bc they are heavily liver metabolized
28
Buproprion
Mirtazapine
Trazadone
Atypical antidepressants
29
Buproprion
- MOA
- SE
- Contras
- weak dopamine and norepi reuptake inhibitor
- dry mouth, sweating, nervousness, TREMOR, DOSE DEP INCR RISK FOR SEIZURES
CONTRA in PTs:
- bulimic
- seizure disorders
30
which antidepressnt can be used for smoking cessation??
Buproprion---Zyban
31
Which atypical antidep drug increases risk of sezirues and contra in PTs with seizures
Buproprion
32
MOA Mirtazapine
Enhances serotonin and norepi
| acts as antagonist at central presynpatic apha2 receptors
33
SE od Mirtazapine
Sedation (because has antihist. properties)
-incr appetite
-wt gain
NOOOO sexual dysfunction or antimuscarinic se
34
Trazadone MOA
weak inhibs of serotonin reuptake
| antagonist at histmaine receptor (5-HT2)
35
SE of trazadone
sedation--bc of antihistamine acitivty
orthostasis and dizziness
priapism (prolonged erection)
36
off use label of trazadone?
insomnia bc has strong sedative properties
37
Imipramine
Amitriptylin
Doxepin
TCAs
38
MOA TCA
inhibit norepi and serotonin
| *also block serotogenic, alpha adrenergic, histaminic, and muscarinic receptors
39
SE of TCA
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********
40
TCA OD?
| *antidote?
LT arrythmias
bicarb
41
Which drug to use for bed wetting?
Imipramine (TCA)
42
which antidep is good in prevention of migraine and tx of chronic pain syndrome (neuropathic pain)
Amitriptyline
43
Which TCA in low doses is good for insomnia?
Doxepin
44
Therapeutix index for TCAs?
NARROW
45
what to do if prescibing TCA to sucidal PT?
LOW LOW Doses and monitored closely---as an OD can be easily deadly
46
Which medical conditions can TCAs exacerbate
BPH
epilepsy
preexisting arrythmias
47
Avoid TCAs in which PTS
- glaucoma
| - elderly ----bc of orthostat hypot
48
Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine
MAOIs
49
what is monoamine oxidase
enzyme in nerves + gut + liver +other tissues
| "safety valve" to inactivate any excess NTs that leak out of synaptic cleft
50
MAOI MOA
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
NTs that MAOI affect
Serotonin
norepi
dopamine
52
SE for MAOI
```
*prevention of tyramine b/d---->accumulates-->HTN crisis
other SE:
-drowsiness
-orthostat hypot
-blurred vision
-dry mouth
-constipation
```
53
what do ppl on MAOI need to avoid
food with tyramine--aged or fermented cheese, all aged/smoked/pickled or cured meats/poultry/fish and RED wine, chocolates, draft beer
54
MAOI have high...
drug-drug interactions
| drug-food interactions
55
IND for MAOI
depressed PT who are unresponsive or intolerant of other antidepresants
***last line
56
how long should PT wait when stopping MAOI and starting new antidep?
-what is the exception and with what drug
2 weeks
Fluoxetine===SIX weeks
57
what drugs are used to tx mania and BiPo
Carbamazepine
Lamotrigine
Valproic acid
Lithium
58
MOA for lithium
unknown-- chemical properties are similar to sodium
59
Therapetuic index for lithium
very low
| can be toxic
60
SE for lithium
```
HA
dry mouth
polydipsia--incr thirst
polyuria
polyphagia
GI distress
fine hand tremor
dizziness
fatigue
derm rxns
sedation
```
61
S/S of high plasma levels of Lithium
```
ataxia
slurred speech
coarse tremors
confusion
convulsions
```
62
Decr ____ can lead to lithium toxicity
sodium
| **hyponatremia can lead to toxicity
63
which gland is affected by lithium and should be monitored
Thyroid gland
64
Does mitrazipine cause sexual dyfsunction?
NO!
65
Which SNRI is good for pain + depression
Duloxetine
66
which drug iss most likely to decr thyroid function
Lithium
67
is Lithium good to give to PTs with hepatic impairment?
YES!
68
positive s/s of Schizo
Positive: hallucinations and delusions
69
Negative s/s of schizo
BLunted affect
apathy
impaired attn
cognitive impairment
70
Chlorpromazine
| Thioridazine
first generation antipsychotics--LOW POTENCY
71
```
Fluphenazine
Haloperiodl
Loxapine
Molindone
Perphenazine
Pimozide
Prochlorperazine
Thiothixene
Trifluoperazine
```
first gen antipsychotics---HIGH POTENCY
72
Another name for first gen antipsychotics
conventional
73
High risk of ______ with first gen antipsychotics
Extrapyramidal symptoms---movement disorder
74
MOA for first gen antipsych
Dopamine antagonists--block D2 receps in brain and periphery
75
Main s/e with first gen antipsychotic drugs?
EPS--extrapyramindal sympstoms
76
main s/e with seond gen antipsychotics?
Metabolic issues--incrs risk of DM, hypercholesteremia and WT gain
77
haldol bings less potently or more potetly to D2 receptors
More potently
78
Chlorpromazine binds more tightly or less potently to D2 receptors
less potently
79
```
Aripirazole
Asenapine
Rexpiprazole
Cariprazine
Clozapine
Illoperidone
Lurasidone
Olanzapine
Pimvanserin
Quetiapine
Rispierdone
Ziprasidone
```
Second gen antipsychotics
80
another name for second gen antipsychoics
atypical
81
MOA for second gen antipysh
block serotonin and dopamine
82
What is used for first line schizophrenia and psychosis
SECOND gen
83
Refractory PTs for schizo... what do we use?
Clozapine
84
What needs monitoring when PT is on clozapine and WHY?
WBC because it can cause agranulocytosis
85
which receptors do antipsychotic drugs block?
main ones: dopamine (just first gen) and/or serotonin (second gen does both)
ALSO BLOCKS
- cholinergic
- Adrenergic
- Histaminergic
86
negative s/s of schizo are more responsive to which generation
second generation
87
what is thought to cause EPS?
blockade of dopamine receptors from first gen drugs
| *parkinson like s/s **
88
Antipsychotic drugs potentiate nausea or help with it?
help! they have antiemetic effecets
via D2 rec blockade
**haldol **
89
Thioridazine and Chlorpromazine
1st gen low potency
90
Clozapine and olanzapine
sec gen/ atypical
91
Clozapine and olanzapine
Thioridazine and Chlorpromazine
Prod what kind of s/e?
Anticholinergic
* dry mouth (EXCEPT FOR CLOZAPINE.. it INCRS saliv)
* blurry vision
* AMS
* inhibition of GI
* constipation and urinary retention
92
Anticholinergic effects seen with some antipsychotics may assint in reducing--------
EPS
93
Which drug is used to treat intractable hiccups
Chlorpromazine **
94
Tx of Tourette disorder??
Pimozide (fiirst line)
95
what is given to help control EPS
Benztropine--anticholineric
96
What part of EPS can be irreversible
tardive dyskinesia
97
Muscle rigidty, fever, AMS, stupor, unstable BP, Myoglobinemia + hx of taking antipsychotics
Neuroleptic malignant syndrome
| LT*******
98
TX for Neuroleptic Malignant syndrome
discontinue antipsychotic
| *supportive tx*
99
Which antipsychotic can cause prolong qt
Thioridazine has highest risk
100
how to remember the SSRIs
```
Effective
For
Sadness
Panic
Compulsions
```
```
Escitalopram
Fluoxetine, Fluvoxamine
Sertraline
Paroxetine
Citalipram
```
