Psych Flashcards
DSM-5 (depression): M SIG E CAPS
Mood
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal ideation
drugs that can cause or worsen depression
ADHD meds: atomoxetine (strattera)
indomethacin
NNRTIs: Efavirenz (in Atripla) and Rilpivirine (in Complera, Odefsey)
BB (especially propranolol)
OCs and anabolic steroids
antidepressants, benzos, steroids, interferons, chantix, alcohol
natural products
st johns wort, SAMe, valerian rool or 5-HTP
SSRIs
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
-do not use with MAOi or linezolid
-citalopram/escitalopram risk of QT prolongation do not use more than 20 mg/day (citalopram) and 10 mg/day (escitalopram) in elderly
-risk of SIADH/hyponatremia, bleeding
-most activating: fluoxetine
-most sedating: paroxetine
-zoloft preferred in patients with cardiac risk
SNRIs
Venlafaxine (Effexor XR)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)
-do not use with MAOis
-same as SSRIs with risks
-increased HR and dilated pupils, dry mouth, excessive sweating and constipation, increased BP
TCAs: Tertiary amines
amitriptylline (Elavil) and doxepin
TCAs: secondary amines
nortriptyline (Pamelor)
TCAs safety
-do not use with MAOis, linezolid, or methylene blue
-QT prolongation with OD, can cause fatal arrhythmias
-orthostasis
-anticholinergic side effects: dry mouth, blurred vision, urinary retention, constipation; tertiary amines have increased anticholinergic effects
dopamine and NR reuptake inhibitor
Bupropion (Wellbutrin SR, Xl)
-Zyban for smoking cessation
-do not exceed 450 mg/day due to seizure risk
-do not use in those with seizure disorder, hx of anorexia/bulimia, MAOi/linezolid/methylene blue
-dry mouth, tremors/seziures, weight loss
MAOi’s
Isocarboxazid (Marplan), Phenzine (Nardill), Tranylcypromine (Parnate)
-DDI and DFI (tyramine rich foods) - can be fatal
-hypertensive crisis or serotonin syndrome
avoiding serotonin syndrome
-2 week wash out period is required between MAOis and SSRIs, SNRIs, TCAs, and bupropion
-5 week wash out period is required when changing from fluoxetine to MAOi due to fluoxetines half life
tetracyclic antidepressant
mirtazapine (Remeron)
-helps with sleep and appetite stimualtio
Trazodone
used for sleep
-risk of priaprism
depression in preganacy
-do not use paroxetine
-mild-moderate psychotherapy is first line
-severe depression: citalopram, escitalopram, fluoxetine, sertraline first line
most sedating antidepressants
paroxetine, mirtazapine, trazodone
most activating antidepressants
fluoxetine and buproprion
adjunct therapies for treatment-resistant depression
aripiprazole (abilify) and Quetiapine (Seroquel)
-boxed warning for elderly patients with dementia-related psychosis
-olanzapine/fluoxetine do not use and do not use with MAOis, linezolid, or methylene blue
-aripirazole: anxiety, insomnia, akathisia
-olanzapine: sedation, weight gain, increase lipids and glucose
-quetiapine: sedation, orthostasis, weight gain, lipids, glucose
medications/recreational drugs that can cause psychotic symptoms
anticholinergics, dextromethorphan, dopamine or dopamine agonists, interferons, stimulants, systemic steroids, bath salts, cannabis, cocaine, LSD, methamphetamine, PCP
1st gen antipsychotics
low potency: chlorpromazine, thioridazine
high potency: haloperidol (haldol)
-dementia related psychosis
-QT prolongations, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, NMS
2nd gen antipsychotics
Abilify, clozapine, latuda, zyprexa, invega, Seroquel, risperdal, geodon
Aripiprazole (Abilify)
oral, injection
-akathisia, activing
Clozapine (Clozaril)
-3rd line agent due to side effects
-neutropenia/agranulocytosis
-myocarditis and cardiomyopathy
-seziures
-REMS
-ANC must be > 1500
Lurasidone (latuda)
somnolence, EPS, nausea
-risk of metabolic syndrome
Paliperidone (Invega)
increased prolactin
-EPS
-metabolic syndrome
Quetiapine (Seroquel)
somnolence, metabolic syndrome,
-low EPS risk often used for psychosis in Parkinsons disease
Risperidone (Risperdal)
increased prolactin
-EPS
-metabolic syndrome
Ziprasidone (Geodon)
QT prolongation; do not use with QT risk
NMS
stop antipsychotic, IV fluids, dantrolene
diagnosis of BPD
exhibits > 3 symptoms (if mood is only irritable, exhibits > 4 symptoms)
acute tx of BPD
-manic episode: valproate, lithium, or an antipsychotic
-depressive episode: antipsychotic - lithium, valproate or lamotrigine can be added
tx of BPD in preganancy
lamotrigine is the safest option
Lithium (Lithobid)
-trough: 0.6-1.2 mEq/L
-GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydypsia, weight gain, hypothyroidism
-> 1.5 toxicity - > 2.5 coma, seizures
-renally cleared
5 mL of lithium citrate syrup
= 8 mEq of lithium ion
-8 mEq of lithium ion = 300 mg of lithium carbonate tabs/caps
tx of adhd
first line: stimulants (methylphenidate, lisdexamfetamine, adderall)
second line: non-stimulants (atomoxetine)
add on medication: guanfacine ER (Intuniv) or Clonidine ER (Kapvay)
Methylphenidate
IR tab: Ritalin
ER tab: concerta (OROS - ghost tab)
ER capsule: Ritalin LA
transderm: Daytrana
Amphetamine/dextroamphetamine
IR: Adderall
ER: Adderall XR
Lisdexamfetamine
-Vyvanse
-low abuse potential - prodrug
Selective Norepi reuptake inhibitor
Atomoxetine (Strattera)
-risk of suicidal ideation
-decrease appetite, insomnia, somnolence, dry mouth, hypertension, tachycardia
alpha 2 adrenergic receptor agonists
clonidine (Kapavay) clonidine IR (catapres)
Guafacine (Intuniv)
-rebound hypotension > titrate off
drugs that cause anxiety
albuterol, antipsychotics, bupropion, caffiene, decongestants, illicit drugs, levothyroxine, steroids, stimulant, theophylline
Buspirone
used for anxiety
drugs that worsen insomnia
acetylcholinesterase inhibitors, alcohol, antiretrovirals, Abilify, Strattera, bupropion, caffeine, decongestants, diuretics, fluoxetine, steroids, stimulants, varenicline
Help falling asleep
eszopiclone, zolpidem, ramelteon, zaleplon
Help staying asleep
eszopiclone, zolpidem, doxepin, suvorexant
Help falling and staying asleep
eszopiclone, zolpidem
eszopiclone
lunesta
RLS
-gabapentin, pramipexole (Mirapex) and ropinirole (requip)
