Pharm Flashcards
Tx for EPS (from 1st gen anti-psychotics)
Anti-parkinsonian agents (benztropine, diphenhydramine, etc), benzodiazepines, beta-blockers (esp. indicated for akathiasia)
Tx for anticholinergic symptoms (from low-potency trad antipsychotics and atypical antipsychotics)
as per symptom (eyedrops, stool softeners, etc)
Tx for tardive dyskinesia (from high-potency antipsychotics)
discontinue or reduce offending agent and consider using another atypical neuroleptic
- use benzodiazepines, beta-blockers, cholinomimetics in short-term
-
What is neuroleptic malignant syndrome?
Change in mental status, autonomic changes (high fever, elevated BP, tachy), “lead pipe” rigidity, sweating, elevated CPK, leukocytosis, metabolic acidosis
- prompt withdrawal of all antipsychotic medications
High potency vs. low-potency neuroleptic side effects
High potency = EPS
Low potency = anticholinergic s/es
What heart medication can exacerbate psychosis in predisposed pts?
beta-blockers and digoxin
side effect of thioridazine? (2)
- significant QT prolongation
- irreversible retinal pigmentation at high doses
What is serotonin syndrome?
autonomic instability, hyperthermia, seizures
- coma or death may result
- from using MAOIs with SSRIs
Which antidepressant is the most lethal in overdose?
TCAs
What should one be careful for when using MAOIs?
Hypertensive crisis (when used w/ sympathomimetics or ingestion of tyramine-rich foods) - ex. wine, beer, aged cheese, liver, smoked meats
Which patients are specifically unable to tolerate side effects of antidepressants?
elderly and pregnant women
What can be used to convert nonresponders (of anti-depressants) to responders ?
T3 (Liothyronine), T4 (Levothyroxine), lithium, L-tryptophan (serotonin precursor)
What are MAOIs useful for?
Tx of “atypical” depression or refractory depression
What are anticonvulsants useful for? (carbamazepine or valproic acid)
rapid cycling BP disorder and mixed episodes
- but associated w/ increased risk of suicide
Why are antidepressants discouraged as monotherapy for BP disorder?
b/c of concerns of activating mania or hypomania
- addition of antidepressants as adjunctive tx to mood stabilizers not shown to be effective
What should be given to pt w/ history of postpartum mania for subsequent pregnancies?
antidepressants and lithium as prophylaxis
- but these are relative contraindications to breast-feeding
What can be given for symptomatic treatment of delirium (psychomotor agitation) while etiologic causes are treated?
Low-dose haloperidol (antipsychotic)
Which drug should you avoid using in delirious pts?
Benzodiazepines (will exacerbate the delirium)
When can you give benzodiazepine in delirious pts?
If delirium is secondary to alcohol or benzo w/d
What can be given for treatment of REM sleep behavior disorder?
Clonazepam (Klonopin)
What SSRIs are preferred in long-term treatment of panic disorder?
Paroxetine and sertraline
What can be used for treatment of social anxiety disorder?
Paroxetine (Paxil) - SSRI
1st line therapy for OCD?
SSRIs; or TCAs (clomipramine)
What pharm therapies can be used for PTSD?
Antidepressants
Anticonvulsants (for flashbacks and nightmares)
What is 1st line pharm tx for GAD?
SNRI (venlafaxine)
Why should benzodiazepines (clonazepam, diazepam) be avoided in pts w/ PTSD?
b/c of high rate of substance abuse in these pts (and benzos have high risk of tolerance and dependence)
What atypical antidepressant is used often in elderly? and why? (2)
Mirtazapine = b/c it can increase appetite and is also sedating
What side effects of antidepressants are elderly most sensitive to?
anti-cholinergics
What side effects of sedative-hypnotic drugs are more likely in elderly? (4)
- memory impairment
- ataxia
- paradoxical excitement
- rebound insomnia
If sedative-hypnotics must be prescribed to elderly, what medication should be given? (2)
Hydroxyzine (Vistaril) or trazodone
- these are safer than the more sedating benzodiazepines
