Psych Flashcards
SSRI’s (drugs)
PPLZ “C”
Paxil (paroxetine) - most sedating and causes ED, wt gain. Shortest half life. Good for OCD and off label PMDD
Prozac (fluoxetine): causes jitters and has longest half life. Best for non- compliant pts. wt neutral. Good for bulemia.
Lexapro (escitalopram) - good for elderly - low S/E profile
Zoloft (sertraline) - high safety profile; good for elderly
-Celexa (citalopram): few drug interactions
SSRI class,
adv effects, and warnings, special considerations
Thought to work by increasing levels of serotonin in the brain
Adv effects: anxiety, insomnia, sexual S/E, serotonin syndrome, anorexia
Black box warning: suicidal ideation, especially in those <24 years (assess for suicidal thinking after 2 weeks of therapy) and do not d/c abruptly. Avoid SSRI’s within 14 days of MAOIs (serotonin syndrome). Bipolar Patients may cause mania
May prolong QT interval
Elderly: citalopram (Celexa) and escalopram (Lexapro) have fewer drug interactions.
Avoid SSRI’s with anorexia or thin elderly d/t loss of appetite
Takes 4-12 weeks for effect
Do not stop abruptly- withdrawal symptoms may occur
Increased risk of bleeding if taken with blood thinners
Paxil= ED
Atypical Antipsychotics drugs, adv effects and warning
Warnings: monitor er q 3 months
Drugs: zyprexa (olanzapine),
Risperdal (Risperidone), Seroquel (quetiapine)
Adv effects: obesity, DM2, hyperlipdemia, metabolic syndrome, hypothyroidism
Anticonvulsants
Lamptrigine (lamictal), carbamazepine (tegretol), valproate (depakote)
SNRI’s
vanalfexine (Effexor)
Desvenlafaxine (pristiq) duloxetine (CYmbalta)
SNRI’s are used for depression and neuropathic pain.
S/E: nausea, anticholinergic effects, excessive sweating
Adv effects: can worsen acute narrow angle glaucoma so warning to avoid with those who have glaucoma
Typical Antipsychotics
Haloperidol (haldol)
Adv effects: increase lipids/triglycerides and malignant neuroleptic syndrome
Warning: monitor glucose and lipids
Black box warning: elderly = death
TCA’s
Not 1st line depression meds
Good for postherpetic neuralgia, stress urinary incontinance, chronic pain
Imipramine (Tofranil)
Amitriptyline (elavil)
Nortryptaline (pamelor)
Doxepin (sinaquan)
Adv events: sedation, anticholinergic effects, category X pregnancy
Warning: “SADCUB”
Sedating, Anorexia, Dry mouth, Confusion, Constipation, Urinary retention, BPH
Do not combine SSRI’s with MAOI’s d/t increase in serotonin syndrome
Avoid with or who have hx of suicide (can hoard and OD)
Lithium
Adv events: diarrhea, dry mouth, metallic taste
Warning: check blood levels
Atypical antidepressants
Bupropion (Wellbutrin)
Zyban for smoking cessation
Adv events: seizures
Warning: be careful can cause seizures! contraindicated in patients with anorexia, bulimia (bc they are low of electrolytes and may lead to a seizure), hx of seizures
MAOIs
Phenelzine (Nardil)
tranylcypromine (Pernate)
S/E: anticholinergic effects
special consideration: do not combine MAOI’s, SSRI, TCA - wait 2 weeks before switching groups
Warning MAOI’s are rarely used
d/t serious food/drug interactions with tyramine
Benzodiazepines
1st line tx: anxiety, panic disorder, insomnia
Drugs (-Pam’s and -Lam’s)
-diazepam (Valium) for severe ETOH withdrawals
-midazolam (versed)
-alprazolam (Xanax)
-lorazepam (Valium)
-clonazepam (klonopin)
Special consideration: avoid long acting in elderly - Valium, Librium, Restoril, Klonipin
Warning: don’t d/c abruptly as it may cause seizures
Other
Bupropion (zyban) used for smoking cessation- ok if used in conjunction with patches and gums;
Bupropion (Wellbutrin) used in conjunction for ED caused by SSRI’s
Duloxetine (Cymbalta) used for depression and neuropathic pain
Acute Serotonin Syndrome
High risk when combining 2 drugs that both block serotonin (SSRI’s, MAOI’s, TCA’s, triptans, tryptophan. ***WHY we wait 2 weeks if switching drugs
Malignant Neuroleptic Syndrome
Cause rare, life threatening rxn from typical (1st generation and atypical (2nd generation) antipsychotics
Following initiation of a new therapy or recent increase in dose. These drugs affect the dopinergic system of the brain.
S/S: acute high fever, muscular rigidity, mental status changes, tachyonea, elevated HR fluctuation inBO, urinary incontinence
Depression in Pregnancy
Don’t give:
Give:
NO PAROXETINE (Paxil) in pregnancy
Give Fluoxetine (Prozac) or Sertraline (Zoloft) in pregnancy
Depression in Elderly
Start with
Avoid:
Start with SSRI’s at a low dose
Avoid TCA’s
Baker Act means
Provide mental health emergency services
Depression screening
1st line meds
Risk with St John’s Wort
How long does it take for meds to work?
PHQ-2 if + do PHQ9
First line:SSRI and SNRI
Seratonin syndrome
4-6 weeks, if no symptom relief check for other causes
What SSRI is notorious for additional wt gain?
Paxil
What SSRI is bad for pts with anxiety because it can make them feel “jittery”
Prozac
The SNRI, Effexor, cans cause issues with …
HTN
Do a good cardiac evaluation exam and EKG before prescribing what class of antidepressant meds?
TCA’s (like Amitriptyline) can cause heart block, ventricular arrhythmias and sudden death
SSRI’s helpful with PTSD
Paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa)
Start lowest dose
What SSRI is most likely to cause ED?
Paroxetine (Paxil)
Wellbutrin increases the chance of a
Seizure
Which med for depression should be avoided in patients with uncontrolled HTN?
Venalfaxine (Effexor)
Effexor effects BP!!!!
