Psych Drugs - Exam 3 Flashcards
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRIs
Mech: Block reuptake of serotonin
Concentration of serotonin in synapse increases !
Use: Tx of major depression Approved for BPD, panic disorder, OCD
SE: -Sexual dysfunction, Weight gain
-Serotonin syndrome = agitation, confusion, anxiety, hallucinations.
-Withdrawal S&S w/ sudden cessation
Notes: -Increased risk of serotonin syndrome when given
w/ MAOIs
-Increased risk of bleeding when given w/ warfarin
Inhibits CYP450!
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
SNRIs
Mech: Block reuptake of serotonin AND NE
Concentration of both increase in synapse
Use: Tx of major depression, anxiety, nerve pain!
SE: Similar to SSRIs but not tolerated as well!
Some changes to vital signs because of NE
Amitriptyline (Elavil)
Tricyclic Antidepressants (TCAs)
Mech: Block reuptake of NE ALONE or NE and Serotonin (depends on drug)
ALSO block muscarinic & histamine receptors
Use: Major depression, BPD, Pain management for fibromyalgia, shingles
SE: TCA = Toxic Cardiac Arrhythmias ! 8x dose = lethal cardiac arrhythmias!
“CIRCUS”
- “Can’t pee, can’t…”
- Increased sweating
- RISK OF SUICIDE!
- Cardiac Arrhythmias!
- Unstable BP / ortho hypoT
- Sedation (blockade of H receptors)
Notes: If given w/ MAOIs =
excessive adrenergic stimulation
Severe hyperT
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Monoamine Oxidase Inhibitors (MAOIs)
Mech: MAO is inhibited, monoamines are NOT metabolized
Neurotransmitters won’t be broken down, stay in synapse
Continues until new MAO is manufactured, can take 2 weeks
Use: Used for depression More dangerous than SSRI or TCA due to dietary restrictions!
SE: Hypertensive Crisis! MAOIs blocks breakdown of NE and Tyramine!
Tyramine Stim release of NE. Flood of NE = vasoconstriction
-CNS stimulation, anxiety, insomnia, agitation
-Ortho hypoT
Notes: Teach pt to eat avoid foods high in Tyramine! Like fermented or smoked meats, sausages, most cheeses, avos, beers
Bupropion
(Wellbutrin)
Atypical antidepressants
Mech: Stimulant effect similar to amphetamines
Use: Used for MDD, Seasonal affective disorder Increases sexual desire!
SE: Agitation, Headache, Dry mouth, Constipation
Seizures RARE
Notes: Metabolized by CYP450
Mirtazapine
(Remeron)
Atypical antidepressant
Mech: Blockade of Alpha2 Receptors -> unopposed NE release!
Enhances effect of serotonin by blocking some receptors but not others
Blocks histamine receptors
Use: Promotes sedation, weight gain from decreased activity level
SE: Somnolence (from histamine blockade)
Increased appetite and weight gain
Notes: Careful when combining with other antidepressants that can ↑ levels of norepinephrine or serotonin
Lithium
(Lithobid)
Mood stabilizer
Mech: Unknown! Ion distribution in neurons?
Use: Drug of choice for mania!
Reduces euphoria & hyperactivity!
Reduces suicide risk d/t decreased energy
SE: LOW LEVELS:
Nausea, vomiting, diarrhea
HIGH LEVELS:
EKG changes, seizures, coma, death!
Notes: Narrow range! Initial episode = 0.8-1.4mEq/L
Maintenance = 0.4-1mEq/L
MUST BE KEPT BELOW 1.5 or TOXIC!
Valproate
(Depakote)
Mech: Neuroprotective , stabilizes neuron
Blocks Na influx – stops impulse
Blocks Ca influx – blocks release of neurotransmitter
Potentiates GABA
Use: Anti seizure drug approved for use in bipolar !
More $$ than lithium but better tolerated!
SE: Nausea, vomiting, diarrhea
Thrombocytopenia & liver fl RARE
Highly teratogenic! DO NOT use in pregnancy!
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Conventional (1st Gen) Antipsychotics “Neuroleptics”
Mech: Blocks receptors for dopamine, Ach, NE, and histamine in CNS! Prevents over Stim, particularly of dopamine receptors
Use: Used for Schizophrenia
SE: EPS = movement disorders or Tardive dyskinesia
Dystonia – spams of muscles in face, neck, tongue, back (torticollis commonly seen first)
Pseudoparkisonism (shuffling gait, cogwheel rigidity, tremor)
Neuroleptic malignant syndrome! Rare! D/t sudden drop in dopamine levels = rigidity, fever, sweating, fluctuation in BP and CV rhythm Tx w/ Dantrolene!
-Anticholinergic effects!
Thorazine only can cause hypotension & sedation
Clozapine (Clozaril)
Risperiodone (Risperdal)
Olanzapine (Zyprexa)
Atypical antipsychotics (2nd Gen)
Mech: Block receptors, especially dopamine & serotonin
Lower affinity for dopamine receptor = less EPS, less risk of tardive dyskinesia
Use: Schizophrenia
SE: Agranulocytosis (decreases WBCs report sore throat, fever!)
-Sig weight gain!
-New onset DM
-Dyslipidemia
-much lower chance of EPS
Notes: Contraindicated w/ other bone marrow suppressing drugs!
