Psych meds Flashcards
What are the antidepressant categories?
SSRIs, SNRIs, MAOIs, TCAs, and atypical
How long does it take to start seeing some improvement of symptoms when patients are started on an antidepressant?
1-3 weeks
How long does it take for optimal results to peak when patients are started on an antidepressant?
12 weeks
When should we begin to titrate/reassess for need for titration when starting a patient on an antidepressant?
1 month
What are the 1st line antidepressants?
SSRIs, SNRIs, Buproprion, Mirtazapine
What is the black box warning that ALL antidepressants carry?
They may increase suicidal thoughts or actions, increased suicide risk
What patient population is at highest risk to the BBW for suicide risk?
Patients less then 25 y/o
What is the mechanism of action of the SSRIs?
They inhibit the reuptake of serotonin, thus allowing for more in the synaptic space
What are the adverse effects of the SSRIs?
nausea, headache, sexual dysfunction, CNS stimulation, weight gain, serotonin syndrome
What are the patient education points for SSRIs?
Avoid use with alcohol, avoid OTC medications that can cause CNS depression
What is the pregnancy category for SSRIs?
Category C
What are the therapeutic uses for SSRIs?
Depression, bipolar disorder, panic disorder, OCD, bulemia
What are the symptoms of serotonin syndrome?
shivering, sweating, tachycardia, mydriasis, AMS, delirium, tremors, hyperreflexia, HTN, hyperthermia
What are the two most common SSRIs?
Sertaline (Zoloft) and Fluoxetine (Paxil)
What is the mechanism of action of the SNRIs?
Inhibit the reuptake of norepinephrine and serotonin, leaving more in the synaptic spaces
What are the adverse effects of the SNRIs?
headache, somnelence, dizziness, insomnia, fatigue, dry mouth, orthostatic hypotension, can increase blood glucose levels, anorexia
What are the therapeutic uses for the SNRIs?
depression, generalized anxiety disorder, panic disorder, social anxiety
What are the common SNRIs?
Duloxetine (Cymbalta) and Venlafaxine (Effexor)
What medications should be avoided with use with the SNRIs?
Fluoroquinolones, MAOIs, OTC medications as they can have many interactions depending on the medication
What is the mechanism of action of the TCAs?
They act on many neurotransmitters to prevent reuptake
What are the adverse effects of the TCAs?
anticholinergic effects (dry mouth, weight gain, dizziness, ortho hypotension, etc), sedation, hypotension, diaphoresis, QT prolongation
What are the TCA’s most commonly used today?
Amitryptyline, Nortryptyline, Imipramine
Who are TCAs contraindicated in?
Patients with heart disease due to risk of QT prolongation
Why are TCAs falling out of favor?
The development of SSRIs and SNRIs
They are easy to overdose on (lethal dose is only 8 times the therapeutic dose)
How should TCAs be stopped?
Need a taper dose, don’t abruptly stop
What are the therapeutic uses for TCAs?
2nd line treatment normally
depression, bipolar disorder, neuropathy, insomnia, ADD/ADHD, panic disorder, OCD
What is the mechanism of action of the MAOIs?
Irreversibly inhibit MAO to prevent norepinephrine, serotonin, and dopamine reuptake
What are the adverse effects of the MAOIs?
HTN crisis (very large risk), orthostatic hypotension, insomnia, diarrhea
What foods must be avoided with MAOIs?
Tyramine high foods (smoked meats, aged cheese, pickled food, dried fruits, avocados)
What are the MAOIs medications?
Phenelzine (Nardil), Marplan, Parnate, Selegline (MAO-B only, dopamine)
What are the therapeutic uses of the MAOIs?
Last line
depression (normally atypical depression), panic disorders, Parkinsons (Selegline for dopamine)
What is the most commonly used atypical antidepressant?
Bupropion (Wellbutrin)
What is the mechanism of action of Bupropion?
It’s a stimulant, may block NE and/or dopamine receptors to promote more in the synapses
What are the adverse effects of Bupropion?
agitation, headache, constipation, weight loss (off label use), GI upset, tremor, insomnia, blurred vision, tachycardia
What are the therapeutic uses of Bupropion?
depression, smoking cessation, weight loss
What are the 1st line treatments for GAD?
SSRI, SNRI, Buspar
What is the 2nd line treatment for GAD?
Benzos
What is the 1st line treatment for panic disorders?
SSRIs
What is the 2nd line treatment for panic disorders?
Benzos, SNRIs, TCAs, MAOIs (last line)
What is the 1st line treatment for OCD?
SSRIs
What is the 2nd line treatment for OCD?
TCAs
What is the 1st line treatment for social anxiety?
SSRIs
What is the 2nd line treatment for social anxiety?
Benzos, propanolol (low dose)
What is the drug therapy for PTSD?
SSRI or SNRI
What is the mechanism of action of Buspar?
relieves anxiety by reducing triggers without working on the CNS
What are the adverse effects of Buspar?
dizziness, headache, nausea, nervousness, sedation, light-headedness, excitement
What is the mechanism of action of the benzos? (-lam or -pam)
potentiate the action of GABA to inhibit the excitatory ability of the neurons to reduce anxiety and resolve insomnia
What are the anxiety dose side effects of benzos?
insomnia, excitations, euphoria, heightened anxiety, rage
What are the insomnia dose side effects of benzos?
drowsiness, light-headedness, incoordination, amnesia, sleep-behaviors
What is the pregnancy category for benzos?
Category D, cannot give in pregnancy
What are the fast acting benzos?
Diazepam (Valium) and Temazapam (Restoril)
What are the intermediate acting benzos?
Xanax and Ativan
What are the long acting benzos?
Clonazepam and Oxazepam
What medications are used to treat ADD/ADHD?
CNS stimulants
What is the mechanism of action of the amphetamines?
promote the release of NE and dopamine to help promote wakefulness and alertness
What are adverse effects of the amphetamines?
euphoria, restlessness, insomnia (prescribe in AM if possible), weight less, tachycardia, HTN, dysrhythmias, paranoia, psychosis
What is a concern with the amphetamines?
They are highly abused, often used for illicit use, they chemically change the wiring of the brain, have high physical dependence
What are the amphetamine medications?
Vyvanse, Adderall
What is the medication trend leaning towards with prescribing for ADD/ADHD treatment?
Moving away from amphetamine use and towards methylphenidate (less addictive)
What is the mechanism of action of the methylphenidates?
Promotes NE and dopamine release and prevents reuptake
What are the adverse effects of methyphenidate?
insomnia, anorexia, weight loss, emotional lability
What the the methylphenidate medications?
Ritalin, focalin, Concerta
What are the risks of methylphenidate?
They also carry a high illicit drug use risk, they cause physical dependence
What is the scheduling class of amphetamines and mehtyphenidates?
Class 2 controlled substances
How can the abuse potential be combated/lowered?
ER tablets, prodrugs (Vyvanse), patches instead of pills
What is the medication that is a CNS stimulant, but not amphetamine based?
Strattera
What is the mechanism of action of Strattera?
Selectively inhibits NE reuptake to increase NE in the synapses
What are the adverse effects of Strattera?
GI upset, anorexia, weight loss, somnolence, growth delay in children, SI in children, mood swings, insomnia, sexual dysfunction, liver failure, HTN, syncope
What other non-stimulants are approved for ADD/ADHD treatment?
Guanfacine and Clonidine
What adverse effects do Guanfacine and Clonidine carry?
sedation, hypotension, fatigue
What is the mechanism of action of the antipsychotic medications?
They block the dopamine receptors to help stabilize mood
What is the adverse effects of the antipsychotics?
EPS symptoms (most common in typicals), anticholinergic effects