What is the generic name for the following SSRIs: - celexa - Lexapro - paxil - Prozac - Zoloft

- celexa:citalopram - Lexapro: excitalopram - paxil: paroxetine - Prozac: fluoxetine - Zoloft: sertraline

Duloxetine (Cymbalta): - use - two considerations

- good for depression + neuropathic/fibromyalgia pain - hepatotoxic with alcohol use - pricey

Pharmacology Flashcards by Leah Stalnaker

What are the “HAM” side effects?

What drugs are associated with these ADRs?

-anti-“H”istamine (sedation, weight gain)
-anti-“A”drenergic (hypotension)
-anti-“M”uscarinic (dried out)
TCAs, low potency antipsychotics

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Symptoms of serotonin syndrome?

Classic cause?

confusion
flushing, diaphoresis
tremor, jerks
rhabdo –> renal failure –> death

SSRIs + MAOi combination

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Classic drug related cause of HTN crisis

-MAOis + tyramine rich foods or sympathomimetics

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First line treatment for extrapyramidal symptoms assc with antipsychotics

benztropine (Cogentin)

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Hyperprolactinemia is assc with what drug class?

-typical antipsychotics + risperdone

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Neuroleptic malignant syndrome: symptoms

CPK^^
lead pipe rigidity
hypertension
fever

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Important psych meds that are cyp INHIBITORS:

Many SSRIs:
-fluvoxamine 
-fluoxetine (Prozac)
-paroxetine (paxil)
-sertraline 
Also 1 SNRI: 
-duloxetine

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Three major categories of antidepressants

SSRIs/SNRIs
TCAs
MAOis

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Time needed for antidepressant to take effect

3-6 weeks

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Which SSRI has weekly dosing option?

Fluoxetine (Prozac); longest half life of antidepressants

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OTC drug that may increase serotonin levels

dextromethorphan

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Common side effects of SSRIs

N/V
sexual side effects
insomnia/ anxiety

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Sertraline (Zoloft): most notable ADR

highest incidence of GI disturbance

(s) ertraline upsets the (s)tomach

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Paroxetine (Paxil): three considerations

protein bound –> drug interactions
shortest half life (withdraw)
anticholinergic effects

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Fluvoxamine (Luvox): current FDA approved use

OCD only

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Citalopram (Celexa): two considerations

-least drug interactions
-but known for QTc prolongation
(dose capped at 40mg due to cardiac risks, most patients need 80mg! Makes drug nearly useless. Consider Lexapro instead. It is the “s isomer” of citalopram…. Dr. Melvin likes this fact.)

**Note: 4mg selexa= 1 mg Lexapro

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What is the generic name for the following SSRIs:

celexa
Lexapro
paxil
Prozac
Zoloft

celexa:citalopram
Lexapro: excitalopram
paxil: paroxetine
Prozac: fluoxetine
Zoloft: sertraline

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Venlafaxine (Effexor):

MOA
Most notable side effect

SNRI

- can raise BP, don’t give to patients with untreated hypertension, can also cause orthostatic hypoTN

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How does desvenlafaxine compare to venlafaxine?

Pristiq

active metabolite
pricey
no known benefit over duloxetine (Effexor)

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Duloxetine (Cymbalta):

use
two considerations

good for depression + neuropathic/fibromyalgia pain
hepatotoxic with alcohol use
pricey

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Bupropion (Wellbutrin):

-advantages (3)

few sexual side effects
might help with ADHD
might help with smoking cessation

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Major contraindication to Wellbutrin:

**You will be asked this by multiple people in both neuro and psych!! KNOW THIS.

INCREASES SEIZURE RISK. AND ITS REAL/ TRUE. DO NOT GIVE THIS TO EPILEPTIC PATIENT!!!!!!

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Trazadone/ nefazadone:

-use

-major depression, but mostly insomnia

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What limits trazadones use?

orthostatic hypotension at higher doses
possible priapism
usually have to combine low dose trazadone with SSRI to treat insomnia + depression.

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Nefazadone black box warning:

-liver failure, so rarely used.

Remeron/Mirtazapine: | MOA

a2 antagonist --> causes ^^5HT and NE

Why are TCAs rarely first line?

- higher incidence of side effects - dosing requires titration - LETHAL IN OD!!!! (THIS IS REAL!!!, WE SAW THIS HAPPEN WITH AMITRIPTYLINE!)

Special use for: imipramine clomipramine amitriptyline

- imipramine: enuresis - clomipramine: OCD - amitryptiline: migraines

Doxepine: MOA Uses

- TCA | - chronic pain, sleep aid

What neurotransmitters are increased at synapse by TCAs?

NE, 5HT

What are "secondary amines" and why are they useful?

- metabolites of tertiary amines (TCAs) | - less HAM ADRs

List two secondary amines

- desipramine | - nortriptyline

How many TCAs are needed to cause lethality?

-1 week supply!!!! OR LESS IF PATIENT IS TAKING OTHER SEDATING MEDS!!!!

3 major complications of TCAs

- convulsions - cardiotox - coma

What antidepressants are preferably in atypical (hypersomnia, hyperphagia, mood reactivity) depression?

MAOis (except not really in real life because its too hard for patients to avoid tyramine)

What is the MOA of MAOis?

-^^ ALL monoamines, least selective, blocks MAO-A and B | NE, 5HT, DOPA, tyramine

List three MAOis

phenelzine tranylcypromine isocarboxazid

Three drugs indicated for insomnia

trazadone TCAs mirtazapine

How do antipsychotics effect the elderly?

treat behavioral symptoms but ^ risk all cause mortality

MOA for typical vs atypical antipsychotics

- typical: block D2C receptors | - atypical: block D2 and 2A receptors

What side effects are present in LOW POTENCY TYPICAL antipsychotics? What are two low potency antipsychotics?

HAM ADRs More lethality in OD due to QT prolongation - chlorpromazine - thioridazine

Chlorpromazine: weird ADR weird use

blue grey skin discoloration | N/V, hiccups

Thiroidazine: weird ADR

retinitis pigmentosa

Loxapine: | two considerations

- increases seizure risk | - metabolite = antidepressant (luvox, fluvoxetine)

Thiothixene weird ADR

ocular pigment changes

List four high potency antipsychotics

- Haldol - fluphenazine - pimozide - trifluphenazine Thugs pressed homicidal fairies

Which of the high potency antipsychotics is assc with QTc prolongation + v tach?

pimozide

List six atypical antipsychotics

- aripiprazole - risperdone - clozapine - olanzapine - quetiapine - ziprasidone Aardvarks Really Can Offer Quilts (to) Zebras!

Lurasidone/Latuda: What is it? Use?

- used for bipolar depression | - new antipsychotics, expensive

How are acute manic episodes treated? | How is bipolar maintained?

- acute mania: atypical + mood stabilizer | - maintenance: monotherapy with atypicals

Black box warning clozapine

agranulocytosis

Special use for clozapine?

-psychosis in Lewey Body demenentia because **LESS DOPA BLOCKADE**

What are the mood stablizers?

- lithium | - AEDs (valproate, lamotrigine, carbamazepine)

For what conditions is lithium DOC?

- acute mania - px for episodes in bipolar/ schizoaffective d/o - cyclothymic disorder

When prescribing lithium, what levels must be monitored?

- creatinine **(renal fxn may decrease, beware also giving NSAIDs) - thyroid function - lithium levels

What is the major drawback of lithium?

narrow therapeutic index | also NDI/ nephro/thyro toxic

What psych drugs require getting "levels'

- lithium - valproate - carbamazepine - clozapine

How does lithium effect CBC?

leukocytosis, may be helpful if fiven with clozapine which= agranulocytosis

Carbamazepine: MOA labs needed to start treatment

- blocks sodium channels | - CBC, LFTs

Notable side effects of carbamazepine:

-hyponatremia** (which is in itself a seizure risk. If patient is refractory to carbamazepine check Na before stopping.) -agranulocytosis

For what is carbamazepine used in psychiatry?

-mania + mixed features or rapid cycling BP

Carbamazepine metabolic consideration

autoinduction of metabolism= requires increasing dosages

Valproate MOA

blocks Na channels and increases GABA

Labs that must be done when using valproate

CBC LFTs Drug levels

Lamotrigine: use in psychiatry | Most serious side effect

bipolar depression | stevens johnsons syndrome

What drug increases the level of lamotrigine?

- increased by valproate | - decreases valproate

Oxcarbazepine (trileptal): - What should be monitored? - What preferable over carbamazepine if possible?

- sodium - less rash, less hepatox (more effective for mood disorders, less for seizures)

Most limiting side effect of topiramate? | Use in psych?

- cognitive slowing (also kidney stones, acidosis, weight loss) - impulse control disorders

Antidote for BDZ withdraw

Flumazenil

List 1 short 1 med 2 long acting benzos

short: lorazepam med: diazepam long: clonazepam, chlordiapoxide something another

What is the most effective treatment for major depressive disorder +/- psychotic symptoms?

ECT

Atypicals clearly have a better side effect profile than typical psychotics. So why do we give typicals?

-typicals can be given IM (depot) once a month and are needed in poorly compliant patients (also some patients were started on typicals decades ago before atypicals existed)

Rules for dosing SSRIs

- try for 6 weeks - treat for 6 months - 3 weeks wash out - max the dose

Who shouldn't get bupropion?

- bulimics | - epileptics

Valproate ADRs

- NTDs - pancreatitis - low platelets - agranulocytosis

Order of drug choices for mood stabilizers

1) lithium 2) valproate 3) carbamazepine/lamotrigine

Order of choices for antipsychotics

1) atypicals 2) typicals 3) clozapine

Contrast specificity and potency of atypical and typical antipsychotics

- atypicals: poor potency, good specificity | - typicals: good potency, poor specificity

ADRs assc with carbamazepine

- AV block | - cleft palate

Weird ADR assc with lamotrigine

blurred vision

What's in "B52"?

Haldol lorazepam diphenhydramine