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Mental Health Medications > PANCE Medications > Flashcards

PANCE Medications Flashcards

1
Q

What are the selective serotonin reuptake inhibitor’s?

A 
Citalopram (celexa) 
Escitalopram (Lexapro) 
Paroxetine (Paxil) 
Fluoxetine (Prozac) 
Sertaline (Zoloft) 
Fluvoxamine (Zyvox)
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2
Q

What is the mechanism of action of SSRIs?

A

Selectively inhibit CNS uptake of serotonin; Will increase serotonin

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3
Q

What are the indications for SSRI’s?

A

First-line therapy for depression, anxiety disorder

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4
Q

Do SSRIs have a low or high toxicity in overdose?

A

Low toxicity in cases of OD

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5
Q

What are some common side effects of SSRIs?`

A

G.I. upset, sexual dysfunction, headache

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6
Q

What SSRI do you want to avoid in patients with a long QT syndrome?

A

Citalopram

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7
Q

What is your most serious side effect of SSRIs?

A

Serotonin syndrome especially with use of MAOIs

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8
Q

What are examples of SNRI’s

A

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

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9
Q

What is the MOA of SNRI’s?

A

Stops serotonin, norepinephrine and dopamine reuptake

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10
Q

What are the indications for SNRI’s?

A

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

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11
Q

What are the common side effects of SNRI’s

A

Hyponatremia, hypertension, and dizziness

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12
Q

There is an increased risk of serotonin syndrome if the SNRI’s are used with what drug?

A

St. John’s Wort

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13
Q

What are the TCA’s?

A 
Amitriptyline (Elavil) 
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortripyline (Pamelor)
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14
Q

What is the mechanism of action of TCA?

A

Stops reuptake of serotonin and norepinephrine

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15
Q

What are the indications of TCAs?

A

Depression, insomnia, diabetic neuropathic pain, incontinence, migraine

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16
Q

Why are TCAs used less often?

A

Because of their severe toxicity in overdose

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17
Q

What are some side effects of TCAs?

A

Anti-cholinergic effects, sedation, weight gain, prolonged QT

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18
Q

What are some signs of overdose with TCAs?

A

Sinus tachycardia, wide complex tachycardia, neuro symptoms

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19
Q

What is the mechanism of action of Bupropion?

A

Stops uptake of dopamine and norepinephrine

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20
Q

What are the indications for Bupropion

A

Depression

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21
Q

What symptoms are less likely to happen with Bupropion than with SSRI’s

A

G.I. distress and sexual dysfunction

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22
Q

What is a contraindication with Bupropion

A

Seizure d/o

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23
Q

What are some Nonselective MAOI’s?

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)

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24
Q

What is the mechanism of action of MAOIs?

A

Blocks the breakdown of neurotransmitters by inhibiting monoamine oxidase

25
Q

What are the indications for MAOIs?

A

Refractory depression. Maybe use with some types of affective and anxiety disorders

26
Q

What are the side effects of MAOIs?

A

Hypertensive crisis (must avoid tyramine containing foods), insomnia, orthostasis, anxiety, weight gain, sexual dysfunction

27
Q

What are some examples of tyramine containing food

A

Cheese, wine, beer, aged foods, smoked meat, chocolate, coffee, tea

28
Q

What are the contraindications to MAOIs?

A 
SSRI= May cause serotonin syndrome
TCA= May cause delirium and HTN
29
Q

What are some examples of selective MAOB’s?

A

Selegiline ( Eldepryl)

30
Q

What is the benefit of using a selective MAOI instead of a nonselective MAOI?

A

With selective there is less chance of hypertension crisis induced by tyramine

31
Q

How long should anti-depressants be continued for to determine efficacy?

A

Minimum 3 to 6 weeks

32
Q

What are some examples of typical antipsychotic meds?

A 
Haloperidol (Haldol) 
Droperidol
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin) 
Prochlorperazine (Compazine)
Promethazine (Phenergan)
33
Q

What is the MOA of typical antipsychotic?

A

Blocks CNS dopamine receptors

34
Q

What are the indications for first generation antipsychotic meds?

A

Psychotic disorders such as schizophrenia or psychosis
Positive symptoms
Emesis

35
Q

What are some side effects of typical first generation antipsychotic meds?

A

Extrapyramidal sx: rigidity, bradykinesia, tremor, restlessness
Neuroleptic Malignant syndrome
QT prolongation, cardiac arrhythmias, sedation, increased prolactin, weight gain

36
Q

What are three types of extrapyramidial symptoms?

A

Dystonic reactions (Dyskinesia)
Tardive Dyskinesia
Parkinsonism

37
Q

When does a dystonic reaction normally happen and how do you treat it?

A

Hours – days after initiation of typical antipsychotic

Treat with Dyphenhydramine IV (Benztropine)

38
Q

What are symptoms of dystonic reaction?

A

Trismus, protrusions of tongue, facial grimacing, difficulty speaking

39
Q

What is tardive dyskinesia?

A

Repented of involuntary movements mostly involving extremities and face: Lip smacking, teeth grinding, rolling of tongue

40
Q

What is neuroleptic malignant syndrome?

A

Life-threatening this order due to D2 in addition in basal ganglia

41
Q

What are the symptoms of neuroleptic malignant syndrome?

A

Extreme muscle rigidity, mental status change, tremor, autonomic instability (tachycardia, tachypnea, hyperthermia/fever)

42
Q

When is Neuroleptic malignant syndrome most common to happen?

A

Within 90 Days of initiation or after a dose increase

43
Q

What is the treatment for neuroleptic malignant syndrome?

A

Stop the offending agent
Treat hyperthermia was calling blankets and ice to axilla/groin and dantrolene
Dopamine agonist: Bromocriptine, Levodopa

44
Q

What are some contra indications/cautions for Haldol?

A

Parkinson disease and anticoagulant use or severe cardiac disorders

45
Q

Name some atypical or second generation antipsychotic medications?

A

Clozapine (Clozaril)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Loxapine (Loxatane)

46
Q

Are extrapyramidal symptoms more common with typical or atypical antipsychotic agents?

A

First generation typical antipsychotics

47
Q

What is the MOA of a typical antipsychotic medications?

A

Blocks CNS dopamine D4 receptors, serotonin

48
Q

What are the indications for a typical antipsychotics?

A

First line for psychotic disorders

Clozapine useful in patients who have resistance to other psych meds

49
Q

What are the side effects of atypical antipsychotics?

A

Extrapyramidal symptoms

Mild increase in prolactin levels, hyperglycemia, hyperlipidemia, weekend, and NMS

50
Q

What are some contraindications/cautions with atypical antipsychotic medications?

A

Diabetes mellitus
Clozapine causes agranulocytosis (monitor CBC weekly)
Seizures
Myocarditis
QT prolongation
Diabetes and marked weight gain with Olanzapine

51
Q

Name the Benzisoxazoles?

A

Risperidone (Risperdal)

Ziprasidone (Geodon)

52
Q

What are the side effects of Benzisoxazoles

A

Increased prolactin, EPS, sedation, weight gain hypotension

53
Q

Name the Quinolinones

A

Aripiprazole (Abilify)

54
Q

What is the mechanism of action of lithium?

A

Increase norepinephrine and serotonin receptor sensitivity

55
Q

What are the indications for lithium?

A

Bipolar disorder and acute mania

56
Q

What are the side effects of lithium

A

Hypothyroidism, sodium depletion, increased urination and thirst (must drink 8-12 glasses H2O a day), diabetes insipidus, seizures, arrhythmias, hyperparathyroidism, weight gain, tremor

57
Q

What do you need a monitor with lithium?

A

Narrow therapeutic index; monitor EEG changes

58
Q

What is valproate?

A

Anticonvulsants may help suppress impulsive and aggressive behavior

Mental Health Medications (4 decks)

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