Psych Drugs Flashcards
fluoxetine
SSRI - used for depression in pregnant women and children/adolescents
sertraline
SSRI - used for depression
paroxetine
SSRI - used for depression
fluvoxamine
SSRI - used for OCD
citalopram
SSRI - used for depression
escitalopram
SSRI - used for depression and GAD
venlafaxine
SNRI - used for depression, GAD, neuropathic pain
duloxetine
SNRI - used for depression, neuropathic pain, fibromyalgia
buproprion
NE/DA reuptake inh - used for depression and smoking cessation, will not cause sexual side effects so good for younger patients
trazodone
used in MDD, insomnia - no sexual side effects
mirtazapine
a2 antagonist - useful in MDD especially those with weight loss and insomnia
amitriptyline
tertiary amine (TCA) - chronic pain, migraines, insomnia
TCAs prevent reuptake of NE and serotonin.
imipramine
tertiary amine (TCA) - enuresis, panic disorder
TCAs prevent reuptake of NE and serotonin.
clomipramine
tertiary amine (TCA) - OCD
TCAs prevent reuptake of NE and serotonin.
doxepin
tertiary amine (TCA) - chronic pain, insomnia
TCAs prevent reuptake of NE and serotonin.
nortriptyline
secondary amine (TCA) - chronic pain
TCAs prevent reuptake of NE and serotonin.
desipramine
secondary amine (TCA)
TCAs prevent reuptake of NE and serotonin.
common SSRI SEs
- GI upset
- insomnia
- HA
- anorexia –> weight loss
- sexual dysfunction
- akathisia-like restlessness
- serotonin syndrome - fever, diaphoresis, tachycardia, hypertension, delirium, hyperreflexia
common SNRI SEs
- same as SSRI
- due to NE, hypertension, dry mouth, constipation
trazodone SEs
orthostatic hypotension, arrhythmias, priapism
mirtazapine SEs
sedation, weight gain
common TCA SEs
- anticholinergic - dry mouth, constipation, urinary retention, blurred vision, tachycardia
- antihistaminergic - sedation, weight gain
- antiadrenergic - orthostatic hypotension, reflex tachycardia, arrhythmias
- serotonergic - sexual SEs like SSRIs
phenelzine
MAO-I - refractory depression and anxiety
prevent inactivation of catecholamines (NE, DA, 5-HT, tyramine)
tranylcypromine
MAO-I - refractory depression and anxiety
prevent inactivation of catecholamines (NE, DA, 5-HT, tyramine)
isocarboxazid
MAO-I - refractory depression and anxiety
prevent inactivation of catecholamines (NE, DA, 5-HT, tyramine)
common MAO-I SEs
- 5-HT syndrome when taken with SSRI (wait at least 2 wks before switching from SSRI –> MAO-I)
- hypertensive crisis when tyramine rich foods or sympathomimetics are on board
- orthostatic hypotension
- sedation, sleep dysfunction
- weight gain
- sexual dysfunction
- supplement B6 to prevent peripheral neuropathy
mechanism of typical antipsychotics
D2 antagonists
mechanism of atypical antipsychotics
D2 and 5-HT-2A antagonists
chlorpromazine
- low potency typical antipsychotic
- higher incidence of antiadrenergic, anticholinergic, and antihistaminic side effects
- lower incidence of EPS and NMS
- blue-grey skin discoloration
haloperidol
- high potency typical antipsychotic
- lower incidence of antiadrenergic, anticholinergic, and antihistaminic side effects
- higher incidence of EPS and NMS
common SEs of typical antipsychotics
- mesocortical - makes negative symptoms worse, de-motivation
- nigrostriatal - EPS (akathisia, dystonia, parkinsonism)
- tubuloinfundibular - hyperprolactinemia
- antihistaminic - sedation, weight gain
- antiadrenergic - orthostatic hypotension, cardiac arrythmias
- anticholinergic - dry mouth, tachycardia, urinary retention, blurry vision, constipation
- TD - often permanent choreoathetoid mvmts of tongue and mouth as a result of > 6 mos of use
- NMS - fever, autonomic instability, leukocytosis, tremor, elevated CK, rigidity, delirium, diaphoresis
- hepatotoxicity
- seizure threshold is lower
- QTc prolongation
buproprion SEs
- increased anxiety (avoid in eating disorders)
- lower seizure threshold (avoid in epilepsy)
common SEs atypical antipsychotics
- metabolic syndrome - follow weight, waist circumference, FLP, BG
- QTc prolongation
- hepatotoxicity
atypical antipsychotics include (in decreasing order of metabolic risk):
- clozapine - treatment refractory schizophrenia, very low risk of agranulocytosis, only antipsychotic that helps to decrase risk of suicide
- olanzapine
- quetiapine
- paliperidone
- ziprasidone
- aripiprazole
Li+
mood stabilizer used to treat acute mania, prevent relapse of manic episodes/depressive episodes in bipolar d/o, and decrease suicidality
Prior to prescribing Li+, pt should have what tests? Because of what SEs?
- EKG - arrythmias
- BMP - nephrogenic DI and renal toxicity
- TFT - hypothyroidism
- CBC - leukocytosis
- pregnancy test - Ebstein’s anomaly in fetus
Check blood level of Li+ after ____ days.
5
carbamazepine
anticonvulsant used to treat mania with mixed features and rapid cycling bipolar d/o
mechanism of carbamazepine
Na+ channel antagonist
What labs to order and common SEs of carbamazepine?
- CBC, LFTs, pregnancy test
- GI upset, CNS sedation, SJS
- leukopenia, aplastic anemia, thrombocytopenia, agranulocytosis
- hyponatremia
- hepatitis
- neural tube defects in fetus
Carbamazepine ____ it’s own metabolism.
auto-induces
valproic acid
mood stabilizer used to treat acute mania, mania with mixed features, and rapid cycling bipolar d/o
mechanism of valproic acid
Na+ channel antagonist, potentiates GABA activity
Check valproic acid levels after ____ days.
4-5
Labs to order and common SEs of valproic acid
- LFTs - hepatotoxicity
- CBC - thrombocytopenia
- pregnancy test - neural tube defects
lamotrigine
mood stabilizer used ONLY for depressive episodes of bipolar d/o
mechanism of lamotrigine
works on Na+ channels that modulate glutamate and aspartate
concerning SE of lamotrigine
SJS
oxcarbazepine
mood stabilizer that functions like carbamazepine and is better tolerated (only has risk of hyponatremia)
gabapentin, pregabalin
helps with GAD, sleep, neuropathic pain, fibromyalgia
topiramate
mood stabilizer that helps with impulse control disorders
common SEs of topiramate
- weight loss
- met acid
- kidney stones
- cognitive slowing
Which benzos are not metabolized by the liver?
lorazepam, oxazepam, temazepam
diazepam
long acting benzo used for alcohol withdrawal, benzo/barb withdrawal, seizures
clonazepam
long acting benzo used for anxiety, panic attacks
alprazolam
int acting benzo used for anxiety, panic attacks
lorazepam
int benzo used to treat panic attacks, alcohol/benzo/barb withdrawal
oxazepam
int benzo used to treat alcohol/benzo/barb withdrawal
temazepam
int benzo used to treat alcohol/benzo/barb withdrawal
triazolam
short acting benzo used for insomnia
midazolam
short acting benzo
zolpidem/zaleplon/eszopiclone
- bind to omega-1 receptor on GABA-A receptor to cause sedation
- used for short-term treatment of insomnia
diphenhydramine
antihistamine with anticholinergic effects
ramelteon
melatonin agonist used for insomnia
buspirone
- partial 5-HT-1A agonist used for augmentation of GAD
- especially useful in alcoholics who cannot take benzos
hydroxyzine
short acting antihistamine and anticholinergic effects used for anxiety
In psychiatry, B blockers are used for:
- panic attacks
- performance anxiety
- akathisia
D-amphetamine
stimulant used for ADHD - watch BP, weight loss, insomnia, tic exacerbation, decreased seizure threshold
methylphenidate
stimulant used for ADHD - watch BP, weight loss, insomnia, tic exacerbation, decreased seizure threshold
atomoxetine
stimulant (inhibits NE, DA reuptake) used in ADHD
modafinil
stimulant used in narcolepsy
donepezil
AChesterase inh used in dementia
galantamine
AChesterase inh used in dementia
rivastigmine
AChesterase inh used in dementia
memantine
NMDA glutamate antagonist used in dementia to be used WITH AChesterase inh
ECT should be used for:
- refractory depression (esp with psychotic features)
- catatonia
- acute mania
light therapy is used to treat:
MDD with seasonal pattern
