Psych meds Flashcards by Kate Pi

Fluoxetine

SSRI, anti-depressant, long half life

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Sertraline

SSRI

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Paroxetine

SSRI, more drug interactions: anti-cholinergic, more wt gain, short half life, usually mroe sedating

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Fluvoxamine

SSRI: used for OCD. has more drug interactions, shrot half life

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Citalopram

SSRI

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Escitalopram

SSRI

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SSRI’s

Indicated for Depression, Anxiety, Bulimia (fluoxetine), Premenstrual Dysphoric Disorder, off label for pre mature ejactulation, paraphilias, PDD/Autism

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SSRI side effects

Sexual Dysfunction, GI and jittery syndrome= main
Sometimes emotional blunting, hyponatremia (SIDAH), Weight Gain
Serotonin Syndrome
SSRI w/drawl: flu like sx

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Serotonin Syndrome

hyperreflexia, myoclonus, hyperthermia

watch with multiple serotenergic medications

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Venlafaxine

(effexor); SNRI; need to monitor BP, higher risk of w/drawl

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Duloxetine

(Cymbalta); cautin in liver diesease or alcoholics

FDA approved for diabetic neuropathy, chronic MSK pain, fibromyalgia

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SSRI and agonist for 5HT-1A:

similar to SSRI with buspirone- indicated for MDD

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Bupropion

NE, DA reuptake inhibition
MDD, smoking cessation, ADHD, no sexual side effects
Seizure risk, avoid in eating disorder, can make some more anxious (Dr Whitters saying: ‘energy, concentration and motivation’)
can get headache, tachycardia, insomnia

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Mirtazapine

alpha 2 and 5HT2 antagonist–actions on serotonin and NE

use for depresssion (off label-sleep, appetite, stimulation, anxiety), low dose sedation, wt gain, dry mouth

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Trazadone

blocks 5HT2 and alpha 1 receptors

primarily for sleep, risk of priapism, next-sleepiness and dry mouth, postural hypotension

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Buspirone

5HT1A and D2 actions– anxiety and depression augmentation

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TCA

inhibit NE and 5HT reuptake, inexpensive
can be lethal in overdose (arrhythmias!!, QTc)
some used in neuropathic pain, sleep, migraines, previously ADHD, nocturnal enuresis

Tertirary Amine

class of TCA; have active metabolites
imipramine, amytripyine, doxepin, clomipromine (OCD)
anticholinergic side effects: dry mouth, constipation, confustion,
orthostatic hypotension: anti-adrenergic
antihistaminic--sedation and wt gain assoc

Secondary amines

TCA class; more NE
Nortriptyline–(amytriptyline metabolite)
Desipramine–metabolite of imipramine
usually better tolerated

MAOIs

prevent NE, DA and 5HT breakdown
Phenelxine, Selegiline
Can have tyramine rxn–hypertensive crisis
serotenergic syndrome

Typical (1st gen) Psychotics

(haloperidol + ‘azines’
block DA, increase cAMP
use for schizophrenia, acute mania, psychosis, tourettes
highly lipid soluble

Atypical Psychotics

Dual mechanism: block DA receptors and block some serotonin receptors which may impart additional therapeutic benefits and reduce some ADR risk
–use in schizophrenia, bipolar, OCD, anxiety, depression, mania, tourette

Adverse reactions to first generation psychotics

Extra pyramidal: Dystonic reaction andakathesia–more quickly (hours to days); tremor, parkinsonism, tardive dyskinesia (more long term),
Hyperprolactinemia
Neuroleptic Malignant Syndrome
side effects from blocking muscarinic receptors

Clozapine:

atypical antipsychotic, probably most effective but also most side effects: agranulocytosis (weekly CBC!), seizure, anticholinergic,

Atypical psychotic side effects

hyperphagia--causing wt gain, insulin resistance

Olanzapine

atypical antipsychotic: more anticholinergic, higher metabolic effects--more weight gain

Quetiapine

atypical antipsychotic: sedating, (not an indication!)

Risperidone

atypical antipsychotic: higher DA blockade--may increase prolactin causing lactation and gynecomastia

Ziprasidone

atypical antipsychotic: prolong QTc. relatively wt neutral, must take with food otherwise v. little absorbed

Aripipazole

also D2 partial agonist, relatively wt neutral

Paliperidone

(Invega) atypical antipsychotic, newer, metabolite of risperidone

Some newer agents

Asenapine, Lurasidone, Iloperidone

Lithium

indicated for bipolar mania, maintenance and depression also indicated for MDD augmentation need to check labs: TSH, Cr, BUN, Hcg prior in females, blood level .8-1.2, steady state 4 days

Lithium adverse reactions

Hypothyroidism, Kidney (diabetes insipidus, intersititial renal fibrosis), problem with pregnancy, also tremor

Valproic Acid (depakote)

bipolar mania, labs: LFTs, CBC, Hcg in female, want blood level >50 steady state 4-5 days Adverse effects: transaminitis, hepatotoxicity

Carbamazapine

indicated for mania, labs: LFTs, CBC, Na, blood leve 8-12 adverse reactions: Hyponatremia

Lamotrigine

bipolar depression, approved for maintenance but not mania | adverse: rash, Steven Johnson's

High potency 1st gen antipsychotics

Trifluoperazine, fluphenazine, haloperidol | High potency have more EPS, less histamine and anticholinergic side effects

Low potency 1st gen anti psychotics

Chlorpromazine, Thioridazine | low potency have less EPS, more histminic/anticholinergic

Neuroleptic malignant syndrome

rigidity, myoglobinuria, autonomic instability, hyperpyrexia, encephalopathy treat with dantrolene, D2 agonists