Psych Flashcards
Imipramine (Tofranil)
Nonselective norepinephrine-serotonin reuptake inhibitors (NNSRIs)
AKA Tricyclics
Amitriptyline (Elavil)
Nonselective norepinephrine-serotonin reuptake inhibitors (NNSRIs)
AKA Tricyclics
Nortriptyline (Pamelor)
Nonselective norepinephrine-serotonin reuptake inhibitors (NNSRIs)
AKA Tricyclics
Phelenzine (Nardil)
MAOI
Isocarboxazid (Marplan)
MAOI
Tranylcypromine (Parnate)
MAOI
Fluoxetine (Prozac)
SSRI
Paroxetine (Paxil)
SSRI
Cat D
Sertraline (Zoloft)
SSRI
citalopram (Celexa)
SSRI
escitralopram (Lexapro)
SSRI
Venlafaxine (Effexor)
SNRI
Duloxetine, (Cymbalta),
SNRI
Desvenlafaxine (Pristig)
SNRI
Mirtazapine (Remeron)
Atypical antidepressant
Norepi- and Serotonin-Specific Agonist
ADR: sedation
Nefazodone (Serzone)
Atypical antidepressant
Serotonin Agonist Reuptake Inhibitor
BBW: hepatotoxicity
Trazodone (Oleptro)
Atypical antidepressant
Serotonin Agonist Reuptake Inhibitor
TCA Drug Interactions
Anticholinergics, Clonidine (hypotension)
TCA Drug Interactions
Anticholinergics, Clonidine (hypotension)
MAOIs
Inhibit monoamine oxidase, the enzyme that terminates the actions of neurotransmitters such as dopamine, NE, epinephrine, and serotonin.
Used for atypical/ treatment-resistant depression.
Once take the drug, it’s in the body for 2 weeks. When stopping or starting other antidepressants in between, need to wait 5 weeks with TCAs or fluoxetine (Prozac)
ADRs of MAOIs
Insomnia/agitation, anticholinergic activity (dry mouth, blurred vision, urinary retention, constipation), dizziness, HA, orthostatic hypotension
Drug interaction reaction: hypertensive crisis when used with other antidepressants or sympathomimetic drugs, or with foods containing tyramine or supplements containing caffeine, tyrosine, phenylanine
MAOI Drug Interactions
Hypertensive crisis when used with other antidepressants or sympathomimetic drugs, or with foods containing tyramine or supplements containing caffeine, tyrosine, phenylanine
SSRIs
Uses: Depression, OCD (> 6 yo), Premenstrual Dysphoric Disorder, bulimia, PTSD, generalized anxiety disorder, social phobia, (not approved for Bipolar disorder)
ADRs of SSRIs
CNS excitation (insomnia, headache) N/D Sexual dysfunction, decreased libido May impair platelet aggregation Serotonin syndrome
Serotonin syndrome
Combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity.
Serotonin Withdrawal/ Discontinuation Syndrome
Dizziness, headaches, nausea, sensory disturbances, tremor, anxiety, dysphoria, shock-like sensations, flu-like s/s
SSRI Warnings
Careful in bipolar – can induce rapid cycling & mania
Serotonergic drugs
Careful with NSAIDS, ASA, anticoagulants and antiplatelet drugs
Avoid EtOH
Serotonin syndrome
Combination of mental status changes (agitation, euphoria, hypomania, hallucination, confusion, insomnia), neuromuscular hyperactivity (clonus, ataxia, tremor, hyperreflexia, incoordination, seizures), and autonomic hyperactivity (tachycardia, arrhythmia, HTN, diaphoresis, mydriasis, tachypnea).
SSRI Warnings
Careful in bipolar – can induce rapid cycling & mania
Serotonergic drugs
Careful with NSAIDS, ASA, anticoagulants and antiplatelet drugs
Avoid EtOH
SNRIs
Uses: Major depressive disorder, general anxiety disorder, neuropathy pain, fibromyalgia, (not approved for bipolar disorder)
NOT FDA approved for use in children
ADRs of SNRIs
HTN
Orthostatic hypotension
Impaired platelet aggregation
Steven-Johnson syndrome and other rashes
Warnings of SNRIs
Narrow-angle glaucoma, chronic liver disease, uncontrolled HTN
May cause hepatotoxicity; increase serum transamine levels (20X greater than normal)
Serotonin Withdrawal/Discontinuation Syndrome
Careful in bipolar – can induce rapid cycling & mania
Warnings of SNRIs
Narrow-angle glaucoma, chronic liver disease, uncontrolled HTN
May cause hepatotoxicity; increase serum transamine levels (20X greater than normal)
Serotonin Withdrawal/Discontinuation Syndrome
Careful in bipolar – can induce rapid cycling & mania
Bupropion (Wellbutrin)
Atypical Antidepressant: Norepi-Dopamine Reuptake Inhibitor
Acts as stimulant and suppresses appetite
Antidepressant effect begin in 1–3 weeks
Not for anxiety
Does not affect serotonergic, cholinergic, or histaminergic transmission; works w/ dopamine
Does not cause weight gain
Increases sexual desire and pleasure
ADRs of Bupropion (Wellbutrin)
Headaches Weight loss Dry Mouth, Nausea Agitation, Insomnia (not for anxiety!) Seizures
Contraindications of Bupropion (Wellbutrin)
Seizure disorders
Abuse potential with XL or SR forms; inhaling crushed tablets or injecting dissolved tablets has been reported
MAOIs can increase the risk of bupropion toxicity
chlorpromazine (Thorazine)
Typical antipsychotic
Phenothiazine
haloperidol (Haldol)
Typical antipsychotic
NON-phenothiazines
Aripiprazole (Abilify)
Atypical antipsychotic
Clozapine (Clozaril)
Atypical antipsychotic
Blocks dopamine (low affinity – lower EPS) Blocks serotonin
Use: Schizophrenia
ADRs:
Fatal agranulocytosis – monitor WBCs before and post
Olanzapine (Zyprexa)
Atypical antipsychotic
ADRs: little/no risk of agranulocytosis (can cause leukopenia) but higher metabolic effects (DM)
Approved to treat psychotic BPD
Olanzapine-fluoxetine (Symbyax)
Atypical antipsychotic
Paliperidone (Invega)
Atypical antipsychotic
Quetiapine (Seroquel)
Atypical antipsychotic
Risperidone (Risperdal)
Atypical antipsychotic
Ziprasidone (Geodon)
Atypical antipsychotic
Antipsychotics
Uses: Schizophrenia, delusional disorders, bipolar disorders, depressive psychoses, drug-induced psychoses
Should NOT be used to treat dementia in the older adult!
Increase dopamine levels in the brain; tranquilizing effect in psychotic patients
ADRs of First-generation antipsychotics
Cause serious movement disorders; extrapyramidal symptoms (EPS)
ADRs of Second-generation antipsychotics or atypical antipsychotics
Fewer EPS; higher risk of metabolic effects (wt gain, new onset DM, dyslipidemia)
Extrapyramidal Effects
Acute dystonia: muscle spasm of face (eyes), neck or back
Parkinsonism: pill rolling and shuffling
Akathisia: pacing and squirming
Tardive dyskinesia (late onset): involuntary tongue rolling, lip smacking; can be permanent!
Neuroleptic malignant syndrome (NMS)
Rare
Risk of death without treatment
Sweating, rigidity, sudden high fever, autonomic instability, seizures
Treat with dantrolene (Dantrium)
Antipsychotic BBW
Can cause hepatotoxicity
S/S: abdominal pain, jaundiced sclera, dark urine, or clay color stools
Benzodiazepines
For anxiety and insomnia
MOA: GABA (see slide later)
Pregnancy Cat D & X
Hepatic/renal impairment (toxicity)
lorazepam (Ativan)
Benzodiazepines
Uses: anxiety
flurazepam (Dalmane)
Benzodiazepines
Uses: insomnia
temazepam (Restoril)
Benzodiazepines
Uses: insomnia
triazolam (Halcion)
Benzodiazepines
Uses: insomnia
ADRs of Benzodiazepines
CNS depression (excessive sedation, dizziness, etc), anterograde amnesia, EPS Paradoxical effects: insomnia, excitation, euphoria, anxiety & rage
flumazenil (Romazicon)
Antidote to Benzo overdose/ toxicity
Buspirone (Buspar)
Serotonergic Anxiolytic
Use: first-line for mild to moderate anxiety
Advantages: Non-CNS depressant, No abuse potential, No withdrawal s/s, Pregn Cat B
ADRs: usually resolve
Warnings/Contraindications: NOT used with panic attacks
Drug Interactions: MAOIs and SSRIs: Serotonin syndrome
Zolpidem (Ambien)
Sedative/Hypnotics: Non-benzodiazapines
Zaleplon (Sonata)
Sedative/Hypnotics: Non-benzodiazapines
Eszopiclone (Lunesta)
Sedative/Hypnotics: Non-benzodiazapines
Sedative/Hypnotics: Non-benzodiazapines
Binds to GABA-receptor
Because of it’s selectiveness, does not have any activity as an anticonvulsant, anxiolytic, or muscle relaxant
Uses: Reduce sleep latency and awakenings, can prolong sleep duration
Sleep medication should not be used >3 weeks
Adverse effects:
Daytime drowsiness (if taken < 6 hrs from awakening), amnesia
Sleep driving & sleep-related complex behaviors (cooking, etc)
Depression and suicidal ideation
Caution in women & older adults (may need lower doses), hepatic impairment
Pharmacokinetics: Schedule IV drugs – can cause withdrawal so taper
Drug Interactions: Avoid CNS depressants incl ETOH
Pt teaching: Take immediately before bedtime and get at least 6 hours of sleep
ADRs of Sedative/Hypnotics: Non-benzodiazapines
Daytime drowsiness (if taken < 6 hrs from awakening), amnesia
Sleep driving, sleep-related complex behaviors (cooking, etc)
Depression and suicidal ideation
Caution in women & older adults (may need lower doses), hepatic impairment
Lithium (Lithonate, Lithotabs)
“Mood stabilizers”
DOC for manic bipolar episodes & long-term prophylaxis & preventing suicide
Narrow therapeutic range, must monitor drug levels
Lithium drug interactions
Lithium levels increase when sodium levels decrease (or vice versa).
Loss of Na+: Kidneys retain Li to compensate = Li toxicity
Caution with thiazide or loop diuretics, severe salt-restricted diet, dehydration, N/V, hot weather
Risk of toxicity increases when taking NSAIDS & Cox-2 inhibitors
ADRs of Lithium
Anorexia Fine tremors Dry mouth, increased thirst or urination Goiter and hypothyroidism Edema
Toxic Effects of Lithium
Diarrhea, vomiting
Course tremors
Drowsiness, muscle weakness, ataxia, confusion, lethargy, slurred speech, hyperreflexia
Seizures (late)
Teratogenesis – Preg Cat D; discourage use in lactation
Valproic acid/divalproex sodium (Valproate/Depakote)
Better for manic phases than Lithium
Works faster than lithium, less adverse effects
Lithium better at lowering suicide & preventing relapses
Carbamazepine
Better for manic phases than Lithium
Protects against recurrence of mania and depression
Stimulants
Amphetamine, methylphenidate, dextroamphetamine
Uses: ADHD, Chronic illness-related fatigue, Narcolepsy, Weight loss in obese patients
ADRs: Insomnia, undesired weight loss, tachycardia, palpitations, arrhythmias, restlessness, irritability, euphoria, headache, HTN
Warnings:
Highly abused substanceStimulants may affect growth
Don’t stop abruptly (fatigue, depression)
