Pharmacology Flashcards
classes of antidepressants
TCA
MAOI
SSRI
Atypical antidepressants (SNRI, NDRI, SARI, NASA)
TCA
Imipramine Amitriptyline Trimipramine Nortriptyline Desipramine Clomipramine Doxepin
Common side effects of TCA
Anti HAM
Anti-Histamine: sedation.
Anti-Adrenergic: Orthostatic hypotension, tachycardia, arrhythmias.
Anti-Muscarinic: Dry mouth, constipation, urinary retention, blurred vision, tachycardia.
Weight gain.
Lethal overdose
Major complications of TCA
Convulsions, coma, cardiotoxicity, avoid in pts with preexisting conduction abnormalities.
Mechanism of action MAOI
Prevent inactivation of biogenic amines, such NE, 5HT, Dopa, Tyramine.
MAO-A vs MAO-B
MAO-A: preferentially deactivates serotonin.
MAO-B: preferentially MAO-B preferentially deactivates NE/Epi
Common side effects of MAOI
Orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction.
Serotonin syndrome
SSRI and MAOI taken together. Presents first as lethargy, restlessness, confussion, flushin, diaphoreiesis. May progress to hyperthermia, hypertonicity, rhado, convulsions and renal failure.
Hypertensive crisis
MAOI with tyramine rich foods or sympathomimetics. Cause a build up of stored catecholamines.
SSRI
Fluoxetine Setraline Paroxetine Fluvoxamine Citalopram Escitalopram
Side effects of SSRI
Sexual dysfunction, GI disturbances, insomnia, HA, anorexia.
Atypical antidepressants
SNRI Venlafaxine:
NDRIs Bupropion
SARIs: Nefazodone/Trazodone
NASA: Mirtazapine
Treatment of choice for refractory major depression and needs to gain weight
Mirtazapine
Smoke cessation
Bupropion, be careful it can
Low potency antipsychotics
Chlorpromazine
Thioridazine
High potency antipsychotics
Haloperidol Fluphenazine Trifluoperaizne Perphenazine Pimozide.
Side effect difference between low and high potency antipsychotics
Low potency have higher Anti HAM effects
High potency have more EPS
Types of antidopaminergic s/e of traditional antipsychotics
Parkinsonism: mask like facies, cogwheel rigidity, pill rolling tremor
Akathisia: subjective anxiety, restlessness, fidgetiness.
Dystonia: sustained contraction of muscles of neck, tongue, and eyes.
Hyperprolactinemia: leads to decreased libido, galactorrhea, gynecomastia.
Treatment of EPS (parkinsonism, akathisia, dystonia)
Amatandine, Benadryl, Benztropine.
NMS “FALTER”
Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CPK, Rigidity.
Treatment NMS
Dantrolene, Bromocriptine, amantadine, and bromoctiptine
Antipsychotics approved for treatment of mania
Quetiapine and Ziprasidone
Mood stabilizers
Lithium
Carbamazepine
Valproic acid
Side effects of Li
Hypothyroidism and Nephrogenic Diabetes Insipidus.
Toxic levels of Li
AMS, coarse tremors, convulsions.
Indications for Carbamezapine
Mixed episodes
Rapid-cycling bipolar disorder
Trigeminal neuralgia
Side effects of Carbamezapine
Leukopinia, hyponatremia, aplastic anemia, and agranulocytosis.
Indications for Valproic acid
mixed manic episodes and rapid cycling bipolar disorder
Side effects of Valproic acid
Hepatotoxic, thrombocytopnea, weight gain and sedation
Long acting (1-3 days) benzos
Chlordiazepoxide (Librium): EtOH detox, presurgery anxiety
Diazepam (Valium): rapid onset, tx anxiety and seizure control
Flurazepam (Dlamane): rapid onset, treats insomnia
Intermediate acting (10-20 hours) benzos
Alprazolam (Xanax): treats panic attacks
Clonazepam (Klonopin): treats panic attacks, anxiety
Temazepam (Restoril) treats insomnia
