PANCE Medications Flashcards
What are the selective serotonin reuptake inhibitor’s?
Citalopram (celexa) Escitalopram (Lexapro) Paroxetine (Paxil) Fluoxetine (Prozac) Sertaline (Zoloft) Fluvoxamine (Zyvox)
What is the mechanism of action of SSRIs?
Selectively inhibit CNS uptake of serotonin; Will increase serotonin
What are the indications for SSRI’s?
First-line therapy for depression, anxiety disorder
Do SSRIs have a low or high toxicity in overdose?
Low toxicity in cases of OD
What are some common side effects of SSRIs?`
G.I. upset, sexual dysfunction, headache
What SSRI do you want to avoid in patients with a long QT syndrome?
Citalopram
What is your most serious side effect of SSRIs?
Serotonin syndrome especially with use of MAOIs
What are examples of SNRI’s
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
What is the MOA of SNRI’s?
Stops serotonin, norepinephrine and dopamine reuptake
What are the indications for SNRI’s?
Often use first line in patient with significant fatigue or pain syndrome with depression
Used second line when there is no response to SSRI’s
What are the common side effects of SNRI’s
Hyponatremia, hypertension, and dizziness
There is an increased risk of serotonin syndrome if the SNRI’s are used with what drug?
St. John’s Wort
What are the TCA’s?
Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil) Nortripyline (Pamelor)
What is the mechanism of action of TCA?
Stops reuptake of serotonin and norepinephrine
What are the indications of TCAs?
Depression, insomnia, diabetic neuropathic pain, incontinence, migraine
Why are TCAs used less often?
Because of their severe toxicity in overdose
What are some side effects of TCAs?
Anti-cholinergic effects, sedation, weight gain, prolonged QT
What are some signs of overdose with TCAs?
Sinus tachycardia, wide complex tachycardia, neuro symptoms
What is the mechanism of action of Bupropion?
Stops uptake of dopamine and norepinephrine
What are the indications for Bupropion
Depression
What symptoms are less likely to happen with Bupropion than with SSRI’s
G.I. distress and sexual dysfunction
What is a contraindication with Bupropion
Seizure d/o
What are some Nonselective MAOI’s?
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
What is the mechanism of action of MAOIs?
Blocks the breakdown of neurotransmitters by inhibiting monoamine oxidase
What are the indications for MAOIs?
Refractory depression. Maybe use with some types of affective and anxiety disorders
What are the side effects of MAOIs?
Hypertensive crisis (must avoid tyramine containing foods), insomnia, orthostasis, anxiety, weight gain, sexual dysfunction
What are some examples of tyramine containing food
Cheese, wine, beer, aged foods, smoked meat, chocolate, coffee, tea
What are the contraindications to MAOIs?
SSRI= May cause serotonin syndrome TCA= May cause delirium and HTN
What are some examples of selective MAOB’s?
Selegiline ( Eldepryl)
What is the benefit of using a selective MAOI instead of a nonselective MAOI?
With selective there is less chance of hypertension crisis induced by tyramine
How long should anti-depressants be continued for to determine efficacy?
Minimum 3 to 6 weeks
What are some examples of typical antipsychotic meds?
Haloperidol (Haldol) Droperidol Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Prochlorperazine (Compazine) Promethazine (Phenergan)
What is the MOA of typical antipsychotic?
Blocks CNS dopamine receptors
What are the indications for first generation antipsychotic meds?
Psychotic disorders such as schizophrenia or psychosis
Positive symptoms
Emesis
What are some side effects of typical first generation antipsychotic meds?
Extrapyramidal sx: rigidity, bradykinesia, tremor, restlessness
Neuroleptic Malignant syndrome
QT prolongation, cardiac arrhythmias, sedation, increased prolactin, weight gain
What are three types of extrapyramidial symptoms?
Dystonic reactions (Dyskinesia)
Tardive Dyskinesia
Parkinsonism
When does a dystonic reaction normally happen and how do you treat it?
Hours – days after initiation of typical antipsychotic
Treat with Dyphenhydramine IV (Benztropine)
What are symptoms of dystonic reaction?
Trismus, protrusions of tongue, facial grimacing, difficulty speaking
What is tardive dyskinesia?
Repented of involuntary movements mostly involving extremities and face: Lip smacking, teeth grinding, rolling of tongue
What is neuroleptic malignant syndrome?
Life-threatening this order due to D2 in addition in basal ganglia
What are the symptoms of neuroleptic malignant syndrome?
Extreme muscle rigidity, mental status change, tremor, autonomic instability (tachycardia, tachypnea, hyperthermia/fever)
When is Neuroleptic malignant syndrome most common to happen?
Within 90 Days of initiation or after a dose increase
What is the treatment for neuroleptic malignant syndrome?
Stop the offending agent
Treat hyperthermia was calling blankets and ice to axilla/groin and dantrolene
Dopamine agonist: Bromocriptine, Levodopa
What are some contra indications/cautions for Haldol?
Parkinson disease and anticoagulant use or severe cardiac disorders
Name some atypical or second generation antipsychotic medications?
Clozapine (Clozaril)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Loxapine (Loxatane)
Are extrapyramidal symptoms more common with typical or atypical antipsychotic agents?
First generation typical antipsychotics
What is the MOA of a typical antipsychotic medications?
Blocks CNS dopamine D4 receptors, serotonin
What are the indications for a typical antipsychotics?
First line for psychotic disorders
Clozapine useful in patients who have resistance to other psych meds
What are the side effects of atypical antipsychotics?
Extrapyramidal symptoms
Mild increase in prolactin levels, hyperglycemia, hyperlipidemia, weekend, and NMS
What are some contraindications/cautions with atypical antipsychotic medications?
Diabetes mellitus
Clozapine causes agranulocytosis (monitor CBC weekly)
Seizures
Myocarditis
QT prolongation
Diabetes and marked weight gain with Olanzapine
Name the Benzisoxazoles?
Risperidone (Risperdal)
Ziprasidone (Geodon)
What are the side effects of Benzisoxazoles
Increased prolactin, EPS, sedation, weight gain hypotension
Name the Quinolinones
Aripiprazole (Abilify)
What is the mechanism of action of lithium?
Increase norepinephrine and serotonin receptor sensitivity
What are the indications for lithium?
Bipolar disorder and acute mania
What are the side effects of lithium
Hypothyroidism, sodium depletion, increased urination and thirst (must drink 8-12 glasses H2O a day), diabetes insipidus, seizures, arrhythmias, hyperparathyroidism, weight gain, tremor
What do you need a monitor with lithium?
Narrow therapeutic index; monitor EEG changes
What is valproate?
Anticonvulsants may help suppress impulsive and aggressive behavior
