Psych Meds Flashcards
Acute anti-cholinergic syndrome (delirium) rom TCAs mosts occurs because?
High dose or combination of anticholinergics
promethazine (phenergan)
Homeopathic medicines- datura, brugmansia
Anti-epileptic drugs that cause craving and release in alcoholism?
topiramate (topamax)
Anti-epileptic drugs other intended effects?
Decrease impulsivity and aggressiveness
Adjunct to pain control
Decrease craving and relapse in alcoholism
topiramate (topamax)
Prevent migraine
Divalproex (Depakote),topiramate (topamax)
Many other possible effects being studied
Other anti-depressants rare but severe side effects: MAO inhibitors?
Potentially fatal interactions with food and other medications
Medications for Depression?
SSRI
SNRI
MAOI - monoamine oxidase inhibitor
TCAs
Atypical anti-psychotics
Anti-epileptic drugs to prevent migraines?
Divalproex (Depakote)
topiramate (topamax)
MAO Inhibitor examples?
Phenalzine (Nardil),
tranylcypromine (Parnate)
Antidepressants (and other meds) and suicide?
Overall medications appear to reduce suicide attempts and completed suicides
increased suicide risk in children
when 1st starting medications
This may also be true in adults
Medications for Psychosis: Atypical anti-psychotic Injectable long lasting atypical examples?
risperdal consta,
Invega Sustenna
Placebo (Nocebo) rare but severe side effects?
???
Medications for Bipolar Disorders?
Lithium
Anti-epileptic drugs
Atypical anti-psychotics
TCAs other intended effects?
Sleep
Pain relief
Anti-itching
Doxepin
Anti-anxiety
Placebo Other Intended Effects?
Eliminate “side effects
Medications interaction?
Other prescriptions or OTC meds
some foods
street drugs
Other anti-depressants rare but severe side effects: Bupropion (Wellbutrin)?
Seizures
this is not a good choice if they have hx of seizures
Anti-epileptic drugs rare but severe side effects: blood and liver problems?
Esp. carbamazepine (Tegretol)
Lithium main intended effects?
Anti-manic
Mood stabilizer
SSRI main intended effects?
Anti-depressant
Anti-anxiety
Anti-OCD
SSRIs examples?
fluoxetine (Prozac)
sertraline (Zoloft),
paroxetine (Paxil),
citalopram (Celexa),
escitalopram (Lexapro)
In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability
Atypical antipsychotic Other Intended Effects ?
Anti-depressant
Decrease agitation due to any cause
Anti-anxiety
Sleep
Practically anything anybody can think of
SSRI other intended effects?
Sleep
Activation / energy
Lithium common side effects?
Tremor
Diarrhea, nausea
Weight gain
Inability to concentrate urine
Increased urination
Increased need to drink water
Easy tendency to dehydration
Thyroid dysfunction
hypothyroidism
TCAs main intended effects?
Anti-depressant
How to Reduces Risks when Prescribed Drugs
Rationale for Using the Medication
Informed Consent
True informed consent not the fake kind
Follow Up
Is it working? Could it be working better? Make changes when needed
Other anti-depressants other intended effects?
Sleep
Weight gain
mirtazapine (Remeron)
SNRIs rare but severe side effects?
Serotonin syndrome
At very high doses or when used in combination with other meds effecting serotonin system
MDMA, (PMA), amphetamines, fentanyl, tramadol, cocaine, LSD
Anti-epileptic drugs examples?
Lamotragine (Lamictal),
divalproex (Depakote),
topiramate (Topamax),
carbamazepine (Tegretol),
oxcarbazapine (Trileptal)
Anti-epileptic drugs causing cognitive slowing an d brain fog?
Esp topirimate (Topamax)
TCAs rare but severe side effects?
Acute anti-cholinergic syndrome (delirium)
Heart rhythm effects including death
Death in overdose
SSRI rare but severe side effects?
Serotonin syndrome
Benzodiazepines other intended effects?
Decrease “agitation” in any condition
Treat alcohol withdrawal
Treat intoxication due to stimulants
Amnesia
Older anti-psychotics 1st generation common side effects?
Movement disorders
Extrapyramidal Symptoms (continuous spasms and muscle contractions, rigidity)
Tardive Dyskinesia (irregular, jerky movements)
Akathisia (motor restlessness),
Sexual side effects
Sedation
Weight gain
Medications for Psychosis: Older ( 1st Generation) examples?
chlorpromazine (Thorazine),
haloperidol (Haldol),
thioridazine (Melloril)
**B52 -
50 benadryl, 2 ativant, 5 haldol **
Serotonin syndrome combonitation drugs that cause it ?
fentanyl
tramadol
MDMA
(PMA)
amphetamines
cocaine
LSD
**both are narcotics, Fentanyl - elephant tranquilizer, short quick and easy to reverse **
Basic Pharmacology?
Medications receive FDA approval for specific indications but are also very commonly used for other indications (off label)
Any substance can have adverse effects if used in the wrong way at the wrong time
Even water can kill you
Any drug can cause an allergy and if severe it (and closely related drugs) should not be used
Many drugs can have idiosyncratic (unpredictable) liver, kidney, or other toxicity
Some side effects are relatively mild but so common that they are important
Some side effects are rare but so severe that they are important
Basic Pharmacology questions?
What is a “psych med”?
Why do or don’t medical providers prescribe psych meds?
Why do or don’t people take psych meds?
Harm reduction vs. harm production
Are psych meds part of harm reduction?
Can psych meds produce harm?
When is it a med and when is it a drug. Why is it a med when you prescribe it but a drug when the cops bust me for it? Biological component of bio-psycho-social-spiritual spectrum but we are biological beings.
Tricyclic Anti-Depressant examples?
Amitryptaline (Elavil),
Nortryptaline (Pamelor),
Desipramine (Norpramin),
Doxepin (Sinequan),
derm for itching
In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability
Placebo main intended effects?
Anti-depressant
Anti-anxiety
???
Other anti-depressants common side effects?
Sedation
Weight gain
Mirtazapine (Remeron)
Over-activation
Bupropion (Wellbutrin)
Medications for Psychosis: Atypical anti-psychotic 2nd generation examples?
olanzapine (Zyprexa),
quetiapine (Seroquel),
risperidone (Risperdal),
aripiprazole (Abilify),
ziprasadone (Geodon),
paliperidone (Invega),
clozapine (Clozaril)
Anti-epileptic drugs main intended effects?
Mood stabilizer
prevent seizures
Lithium other intended effects?
Anti-depressant
Lithium rare but severe side effects?
Toxic levels can be fatal
Can occur quickly in overdose or if at normal dose patient becomes dehydrated
Kidney failure
SNRIs examples?
venlafaxine (Effexor),
duloxetine (Cymbalta),
desvenlafaxine (Pristiq)
levomilnacipran (Fetzima)
milnacipran (Savella)
In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability
Atypical anti-psychotics common side effects?
Weight gain
Diabetes
Abnormal lipids (cholesterol, LDL, etc)
Sedation
Sexual side effects
Movement disorders
Akathisia, tremor, dystonic reactions, repetitive movements
Less common than older antipsychotics
Medications effects?
change how they act,
how long or short they act,
how toxic they are
Effective dose
Other anti-depressants main intended effects?
Anti-depressant
Anti-anxiety Not bupropion (Wellbutrin)
Older anti-psychotics 1st generation main intended effects?
Anti-psychotic
Anti-mania
Medications for Anxiety?
SSRis
Benzodiazepines
Other
Atypical antipsychotic main intended effect?
Anti-psychotic
Anti-mania
Mood stabilizer
Anti-epileptic drugs common side effects?
Cognitive slowing / brain fog Esp topirimate (Topamax)
GI effects
Abdominal pain, nausea and vomiting
Sedation
Weight gain
Weight loss
topiramate (Topamax)
dizziness
Medications can act _______________ in causing adverse effects including risk of overdose
synergistically
Serotonin syndrome occurs when?
At very high doses or when used in combination with other meds effecting serotonin system
Atypical anti-psychotics Rare but Severe Side Effects
?
Prolong QT interval causing fatal heart arrhythmias
when combined with other QT prolonginn medications (e.g. methadone, zofran)
Depersonalization / feeling like a zombie
Tardive dyskinesia
Neuroleptic malignant syndrome
Excess prolactin production
Increased risk of stroke and death in elderly
Benzodiazepines main intended effects?
Anti-anxiety
Anti-panic attack
Sleep
SNRIs common side effects?
Sexual side effects
Orgasm delay or anorgasmia
Low libido, ED
Stomach discomfort, jitteriness in 1st 1-2 weeks
Mild sedation
Dizziness, dry mouth
Difficulty urinating
Insomnia
Headache
Emotional Blunting
Other anti-depressants rare but severe side effects: Trazadone?
Priapism - erection that won’t go away
Basic Pharmacology cont..?
medication should be started at the lowest possible dose
gradually increased to the lowest effective dose
In some urgent situations higher doses must be used right away
Many adverse effects are dose dependent
Some medications require monitoring of blood levels for effective levels and to prevent toxic levels
when stopping a medication, slowly decreasing the dose
decreases the risk of discontinuation symptoms
In some cases of adverse reactions medications must be stopped immediately
Anti-epileptic drugs causing weight loss as side effect?
topiramate (Topamax)
Older anti-psychotics 1st generation rare but severe side effects?
Neuroleptic malignant syndrome
Irreversible tardive dyskinesia
Benzodiazepines Rare but Severe Side Effects?
Addiction especially in people with other addictive disorders
Fatal overdose when mixed with alcohol or other sedatives or opioids
Severe withdrawal including seizures and delirium
Falls and fractures esp. in elderly
Benzodiazepines examples?
Diazapam (Valium) - highest addictive potential ,
lorazapam (Ativan),
alprazolam (Xanax),
clonazapam (Klonapin) - long acting and can be dosed like twice daily
Medications for Anxiety: Other examples?
Buspirone (Buspar)
Atypical anti-psychotics, anti-psychotics (major tranquilizers)
Older anti-psychotics 1st generation other intended effects ?
Decrease any kind of agitation
SNRIs other intended effects?
Sleep
Activation / energy
`Placebo (Nocebo) common side effects?
Expected adverse effects are more likely to occur
Often interfere with effective treatment
SSRIs common side effects?
Sexual side effects
Orgasm delay or anorgasmia
Low libido, ED
Stomach discomfort, jitteriness in 1st 1-2 weeks
Mild sedation
Insomnia
Uncomfortable effects when abruptly stopped
Esp. paroxetine (Paxil)
Emotional Blunting
**receptors are also in the gut so we can have abd pain
you can also get jitteriness , constipation med that is serotonin based **
SNRIs main intended effects?
Anti-depressant
Anti-anxiety
Anti-OCD
Neuropathic pain
Fibromyalgia
Anti-epileptic drugs rare but severe side effects: severe skin rash?
Esp. lamotrigine (Lamictal)
Anti-epileptic drugs rare but severe side effects: confusion, ataxia, delirium?
Esp. at high doses or overdose
Other anti-depressants ?
MAO Inhibitor
Bupropion (Wellbutrin)
Mirtazapine (Remeron) - causes weight gain
Trazadone - for sleep ( side effect is pripraism)
In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability
TCAs common side effects?
Anti-cholinergic
Dry mouth, sedation, urinary retention,
Sedation
Benzodiazepines common side effects?
Sedation
Interferes with memory and learning
Unpleasant withdrawal when stopped abruptly
