Psych medications Flashcards
Haloperidol MOA
- produce strong blockade of dopamine in CNS
- block receptors to varying degree (dopamine, each, histamine, norepinephrine)
Haloperidol Use
schizophrenia
Haloperidol class
first generation antipsychotic (EGA), high potency
Haloperidol adverse effects
EPS - extrapyramidal symptoms
- acute dystonia (tongue/neck spasm)
- pseudo parkinsonism (TRAP)
- akathisia (pacing, restlessness)
- tardive dyskinesia (TD)
Neuroleptic Malignant Syndrome
- life threatening emergency
- high grade fever, dysrhythmias, mm rigidity, BP fluctuations
- change in level of consciousness
General
- orthostatic hypotension
- anticholinergic effects
Tardive dyskinesia
twisting or worm-like movement of tongue or lip-smacking
Haloperidol Implications
- high potency cause more early EPS but fewer of above symptoms
- neuroleptic malignant syndrome: give dantrolene, ASA, tylenol, cooling blankets, stop meds
- schizophrenia patients often non-compliant and require interdisciplinary team
- anticholinergic agents + benzodiazepines commonly used to reverse/reduce symptoms of acute dystonia (diphenhydramine)
Olanzapine Class
2nd generation antipsychotic, atypical
Olanzapine MOA
moderate blockade of dopamine receptors, strong blockade of serotonin receptors
Olanzapine adverse effects
General: sedation, orthostatic hypotension, anticholinergic effects
Metabolic effects: weight gain, diabetes, dyslipidemia
Olanzapine implications
- report weight gain >30lbs, chest pain, dyspnea, tachycardia
Olanzapine facts
- serotonin > dopamine = less incidence of EPS and TD
Sertraline class
SSRI
Sertraline MOA
inhibits serotonin reuptake
Sertraline use
depression, bipolar, OCD, panic disorder, bulimia nervosa
Sertraline adverse effects
General: sexual dysfunction, weight gain, sleepiness, hyponatremia
Serotonin syndrome
- caused by increasing serotoninergic transmission in CNS
- usually begins 2-72 hrs after treatment onset
- altered mental status, incoordination, myoconus, hyperreflexia, excessive sweating, tremor, fever
Withdrawal syndrome: dizzy, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria
Neonatal affect from use in pregnancy
- Neonatal abstinence syndrome: irritability, abnormal crying, tremor, respiratory distress, seizures
- persistent pulmonary hypertension of the newborn
Sertraline implications
- therapeutic effects seen in 10-20 days
- wean off slowly
- take with food
- monitor for hyponatremia
- report serotonin syndrome
- MAOIs increase risk of serotonin syndrome
Duloxetine class
SNRI
Duloxetine MOA
inhibits serotonin and norepinephrine uptake
Duloxetine use
depression
Duloxetine adverse effects
dry mouth, constipation, blurry vision, nausea, insomnia, somnolence, fatigue, diaphoresis, headache, anorexia
Duloxetine implications
- risk of SS with MAOI use
- wean
- 2-4 weeks for therapeutic effects
Amitriptyline class
tricyclic antidepressant
Amitriptyline MOA
blocks reuptake of norepinephrine and serotonin
Amitriptyline use
depression, bipolar, fibromyalgia, neuropathic pain
Amitriptyline adverse effects
orthostatic hypotension, anticholinergic effects, sedation, seizures, cardiac toxicity, hypomania, confusion in elderly, suicide risk
Amitriptyline implications
- 1-3 weeks for results
- take at bedtime
- black box warning
- need ECG prior to starting drug
Selegiline Class
MAOI
Selegiline MOA
block MAO-A in brain, increasing norepinephrine and serotonin
Selegiline Use
depression, bulimia nervosa, agoraphobia, ADHD, OCD
Selegiline adverse effects
CNS stimulation, orthostatic hypotension, hypertensive crisis (most dangerous, from eating tyramine)
Selegiline implications
- not first choice because danger
- therapeutic effects 1-3 weeks
- avoid foods containing tyramine (beer, wine, yeast extracts, cheese, fermented sausages, aged fish/meat, avocados, figs, bananas)
- caution with caffeine and chocolate
