Psych pharm Flashcards
Most psychotropic medications - how are they soluble?
lipid-soluble and metabolized by cytochrome P450 liver enzymes
if you’re a slow metabolizer, more likely to get
seratonin syndrome or Parkinsonism. or if too fast, meds won’t be as effective - need higher doses.
Most antipsychotics block which receptors?
postsynaptic dopamine (D2) receptors. (Atypicals also antagonize 5HT2 - this is serotonin) which reduces the amount of dopamine.
dont need to memorize - Effects on the ***mesolimbic area (limbic hallucinations)
decrease psychotic symptoms, especially hallucinations and delusions
dont need to memorize Effects on basal ganglia- too much (gang up on the ESPs)
produce EPS due to the many different transmitters and synapses utilized in this area
dont need to memorize - Effects on the hypothalamus - think milk
lead to increased pituitary production of prolactin with endocrine side effects (e.g. gynecomastia and galactorrhea (breast milk in ppl who should not be lactating)
Blockade of acetylcholine at muscarinic receptors results in
anticholinergic side effects - careful w/ elderly pts.
Antagonism of norepinephrine at alpha-1 receptors results in (nora is slow w/ ejaculation)
orthostatic hypotension and ejaculatory dysfunction
Blockade of H1 receptors for histamine results in (sneezing weight)
sedation and weight gain
Abrupt withdrawal of antipsychotics may cause (a syndrome)
discontinuation syndrome - Therefore, antipsychotics should be tapered slowly, esp. after long-term use. - main reason is ppl can relapse
Cross-tolerance can occur with
antipsychotics
Typicals - less effective for what?
Effective at treating positive symptoms (e.g. hallucinations and delusions), but less effective at treating negative symptoms (e.g. avolition, alogia, apathy, social withdrawal)
typicals - High potency neuroleptics (and examples) - (high potency, high EPS) (hi pro hal)
High potency neuroleptics (e.g. Haldol and Prolixin) have higher risk of EPS, but less anti-cholinergic side effects.
typicals - Low potency neuroleptics (antipsychotics) (low potency, low BP)
have less risk of EPS, but higher risk for orthostatic hypotension, sedation and anticholinergic side effects (urinary retention)
typicals - Depot injections: ex. and how long do they last? (hal is a pro at injections)
Haldol and Prolixin can both be given as IM Decanoates (deep muscle time released) that last q3-4 to weeks.
deconoates - problem
No antidote for decanoates if someone has a bad reaction - ie. NMS or dystonia. it’s usually give PO to see if pt can tolerate it before a shot. Extremely useful for very disorganized and noncompliant clients. Don’t confuse Depot injections with short-acting IM solutions!
atypicals - good or bad at selecting dopamine receptors?
Greater selectivity for dopamine receptor subtypes and/or block 5HT receptor sites.
atypicals - better at treating what
Believed to be more effective than typicals at treating negative symptoms, with less risk of EPS (but CATIE study has cast doubt on this belief!)
atypical - Clozaril (clozapine)
Clozaril (clozapine): very effective, but a “last-resort” drug b/c of the 1-3% chance of agranulocytosis (destruction of WBC). Pts must comply with life-long, frequent blood draws (WBC/ANC).
atypical - Olanzapine - side effect
(Ola is severely heavy)
Zyprexa (olanzapine): also works well, but associated with severe weight gain (average = 28 pounds in first-year), DM, lipid abnormalities.
atypical - Risperdal (risperidone) - side effect
(risper is unsteady and heavy)
Risperdal (risperidone): (most like typical antipsychotics) fewer anticholinergic side effects (considered safer in the elderly), but some orthostatic hypotension and weight gain.
atypical - Seroquel - what abnormal lab?
Seroquel (quetiapine): most common side effects include orthostatic hypotension and sedation (often given off label for anxiety, agitation and insomnia). Can also cause some weight gain and lipid abnormalities.
Ziprasidone - typical or atypical)
atypical
atypical - Abilify - MOA (pip is able to stabilize dopamine)
Abilify (aripiprazole): technically a “Third generation antipsychotic (TGA); dopamine stabilizer; efficacy less clear
Newer SGAs (second generation psychotics): (larisa in 2nd)
Larisadone and Asenapine
Newer TGAs (third generation antipsychotics): (Brex’s car is 3rd generation, but new)
brexpiprazole and Cariprazine
Atypical Decanoates: (a typical deacon taking Zs with Susan Vega)
Zyprexa Relprevv, Invega Sustenna
how to select which med
Conditions that contraindicate a certain med
Past response to a med in patient or relative
Predicted adherence
Present clinical status: PO or IM needed?
Genetic testing (CYP450 (liver) SNPs)
pregnancy
how to select which med
Vital signs, especially BP
MSE (one sign is fever)
Labs, especially CBC, LFTs, baseline glucose
EKG in elderly or PRN (esp with geodon) range of motion - some can cause dystonic symptoms - to assess - hold out arm and bend elbow, if it’s not smooth- it’s cogwheel rigidity - can be a sign of parkinsonism.
ROM
Polypharmacy - which meds metabolized by P450?
Polypharmacy - the possible complications are infinite. 80% of drug-drug interactions are not tested. All psychotropics except lithium are metabolized by cytochrome P450 (a class of 30+ hepatic isoenzymes) and many drugs can inhibit this.
Geriatric patients are more likely to develop which side effects?
confusion, agitation, restlessness, delirium, lethargy and orthostatic hypotension.
Plasma levels - indicated in the following circumstances (think the main drugs…and allergic)
most common are depakote and lithium
Possible nonadherence
Partial or poor response or adverse reaction
Monitoring side effects, especially in elderly
Determining drug-drug interactions
monotherapy is best - meaning 1 antipsychotic or just one drug.
Extrapyramidal symptoms (EPS) - what about dopamine?
Extrapyramidal symptoms (EPS) - caused by blockade of D2 receptors in the extrapyramidal motor system. Be careful to assess properly before giving any meds to treat EPS. Improper administration can cause or exacerbate anticholinergic crisis (which can look like delirium or worsening psychosis).
Parkinsonism - characteristics (a form of EPS) (Fox is slow and heavy) and pain?
Fatigue
Lack of interest
Slowness
Heaviness
Lack of ambition
Vague body discomforts
Dystonias
muscle spasms of the face, head, neck and back
dystonia - Oculogyric crisis
eyes rolled upward (treatment usually given IM)
dystonia - Torticollis –(stoned tortoise)
Torticollis – twistindg of cervical muscles w/ unnatural head position
dystonia - Retrocollis (retro stoned)
Retrocollis – head drawn directly backwards
dystonia - Glossospasm (glossy-eyed stoner) –
Glossospasm – stiff or thick tongue (most common) ppl will talk funny with this one
dystonia Usually occurs during what time frame?
first three months of treatment, but can happen anytime
risk factors for dystonia (young man is stoned)
Risk factors include: high-potency FGAs (first generation antipsychotics), high doses, IM injections, young males
treatment for dystonia/glossospasm? (Art has a stoned BAC)
Treatment is IM***(because this is emergent) Benadryl, Cogentin or Artane
Akathisia (Akilia can’t stop moving)
Akathisia - motor restlessness accompanied by the subjective sense of restlessness, nervousness and in patients.
Tardive dyskinesia (TD) - (what body parts) (tardy tongue)
Tardive dyskinesia (TD) - involuntary tonic muscular spasms typically involving the tongue, fingers, toes, neck, trunk or pelvis
TD - when does it occur?
Usually occurs after long-term treatment (months to years)
Often irreversible (50%)
Risk is up to 5-10% with typicals, 1% with atypicals.
TD - how to treat?
Historically, treatment is to switch antipsychotics while slowly tapering original antipsychotic.
Neuroleptic malignant syndrome (NMS) - caused by what neurotransmitters? (and one more)
caused by dopamine deficiency in nigrostriatum (controls movement) and hypothalamus (regulates BP and temp).
NMS - Seen in patients on which meds? (Fox takes a holiday from names)
antipsychotics and in Parkinson’s patients on a “drug holiday.”
NMS - risk factors (name the young males who get IM)
Risk factors include: use of FGAs, esp. high potency e.g. (Haldol, Prolixin), rapid titration, IM meds, young males
NMS - emergency? and what diseases does it cause? (name the rhab)
NMS is a medical emergency. Mortality rate =10% (complications include renal failure, rhabdomyolysis and DVTs)
NMS - s/sx (Akila is MAD as F at NMS)
**must know this - muscular rigidity, akinesia, dysphagia, fever
NMS - treatment
Hold all antipsychotics
Antipyretics, cooling blankets
Antidepressants - how long to start working?
Antidepressants – all have delayed onset (can take four to six weeks for full effects)
Tricyclics (TCAs) - works best for which patients?
Oldest group of antidepressants (first discovered in the 1950s), therefore well studied and inexpensive
May work best for clients with severe major depression
Monoamine oxidase inhibitors (MAOIs) EX -
(phen is trans w/ mono)
e.g. Tranylcypromine, Phenelzine
Many drug interactions (many drugs are metabolized by MAO. For example, patients must be off MAOIs at least two weeks before beginning other antidepressants)
Requires intensive teaching on the tyramine-reduced diet (e.g. avoid Chianti wine, smoked meats, aged cheeses, Fava beans, MSG, etc.)
Selective serotonin reuptake inhibitors (SSRIs) - ex (just the 3 main ones)
e.g. fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)
SSRIs
Newest and most widely used antidepressants (first-line agent)
Less side effects than TCAs and MAOIs
Side effects include HA, nausea, insomnia, initial anxiety/agitation and sexual side effects
Monitor closely for serotonin syndrome (slow metabolizers are at risk) and withdrawal syndrome
Many off-label uses (e.g. premature ejaculation)
Buproprion (Wellbutrin) - worst side effect if you take too much
acts on norepinephrine and dopamine (NDRI), rather than serotonin. Useful for clients who experience sexual side effects with SSRIs. Also used for smoking cessation (Zyban). Side effects include insomnia, seizures (only if you exceed the max dose), sweating. really not that helpful.
Mirtazapine (Remeron) - MOA- (Mirt makes me happy) and used for what?
is a norepinephrine and serotonin specific antidepressant (NaSSA).
Venlafaxine - what type of drug? (venla is a snail)
an SNRI.
Dysvenlafaxine (Pristiq), Levomolnacipran (Fetzima) and Duloxetine (Cymbalta) are (and esp good for what?)
the newest SNRIs. Cymbalta may also be effective for chronic pain. esp good for severe depression.
Desyrel - MOA (desrell makes me happy) and what else can it cause? and what is it used for? (desrell no issues there)
predominantly serotonergic. Used more for insomnia 2/2 side effect of pronounced sedation. Can cause priapism.
Esketamine (Spravato) - esp good for what?
is an NMDA receptor antagonist and a dissociative agent. Used especially for TRD (treatment resistant depression) and SI. Ketamine is also given off label for other conditions.
Brexanolone (Zulresso) (brex just had a baby)
is a neuroactive steroid given IV for postpartum depression.
panic disorder - how long?
Panic disorder - recurrent panic attacks followed by a month or more of persistent concern about having another panic attack — needs to be treated urgently
Generalized anxiety disorder - how long?
excessive, for 6 months, but no panic attacks.
what important assessment for anxiety?
Important to assess if anxiety is chronic (a.k.a. trait anxiety) vs situational or reactive anxiety (e.g., following a severe loss or stressor).
treatment for anxiety - benzos
Benzodiazepines are best for short-term, situational anxiety and initially for panic disorder. Provide immediate relief, but high potential for addiction/withdrawal requires careful screening. Less abuse potential with longer acting BZDs (e.g. Klonopin). Always assess respirations and level of sedation!
treatment for anxiety - SSRIs
SSRIs, especially Prozac, Lexapro and Zoloft and Paxil, are first-line agents for long-term maintenance and for chronic anxiety. SNRIs like Effexor and Cymbalta are also used frequently.
social anxiety - use propranolol
treatment for anxiety - Buspirone (Buspar) - how long to work? and who don’t they work for? (bupe doesn’t work for us)
Buspirone (Buspar) is a non-benzodiazepine and not addictive. However, it takes a few weeks to work and is often ineffective, particularly in patients who have a history of PSA. only about 30% effective.
general considerations w/ anxiety
Always teach non pharmacological relaxation techniques as well (e.g., deep breathing, progressive relaxation, guided imagery)
Monitor for side effects carefully, especially in the elderly (e.g. paradoxical agitation)
Screen for history of SUD prior to giving BZDs. Monitor for s/sx of abuse and/or withdrawal.
during a panic attack - use someone’s name, short statements “breathe with me”
drug detox
Etoh: BZDs (Ativan - used for elderly, safer for liver - 2nd choice), Librium (long half life, best choice), Serax, Valium)
Opiates: Clonidine (inpatient), Methadone, Buprenorphine
Disulfiram (Antabuse) –
Disulfiram (Antabuse) – produces extreme reaction (e.g. flushing, severe HA, sweating, increased BP, pulse) if patient drinks
Naltrexone (Revia)
Naltrexone (Revia) blocks the euphoric effects of opioids
Aside from BAD, mania can be induced by (3 things)
drugs, neurologic conditions and metabolic disorders.
Benzodiazepines or atypical antipsychotics (e.g. Zyprexa, Risperdal) can be used as an
adjunct until mood stabilizers take effect.
Antidepressants & mania?
precipitate (trigger) mania
lithium - do we understand the MOA?
Very efficacious, especially for mania/BAD Type I, but mechanism of action is still poorly understood (alters electrical conductivity)
lithium is made of what?
salt, so dehydration can cause lithium toxicity
how long for lithium to work?
Therapeutic effect takes two to four weeks.
Lithium levels can be affected by:
Medical illnesses, especially ones with GI effects
Surgery
Crash dieting
Very hot climate (diaphoresis/dehydration)
Advanced age
lithium is metabolized more in kidneys than the liver
Strenuous exercise
who doesn’t respond to lithium? (lithium doesn’t mix)
20 to 40% of patients do not respond to Li, especially BAD clients with more pronounced depressive symptoms or mixed episodes
lithium - how often for blood draws?
Initial blood draws are done one to two times a week, then monthly. Dosage and administration and lab draws should be standardized (i.e., done at the same time of day each time).
lithium - Mild to moderate toxicity number
Mild to moderate toxicity – 1.5 to 2.0 mEq/L
lithium -Severe toxicity - (number)
Severe toxicity - > 2.0 mEq/L
lithium is hard on what organs?
THYROID AND KIDNEYS**
what blood tests for lithium? (4)
Serum creatinine (renal function)
TSH/T4 (can cause hypothyroidism)
Electrolytes (especially calcium and potassium)
EKG - can be cardiac effects from lithium
common side effects of lithium (what you learned for the other test) - what about GI?
Diarrhea - very common
Fine hand tremor
Nausea
Polyuria and polydipsia
Muscle weakness, lethargy - usually transient except with toxicity. Lithium can affect cardiac conductivity.
common side effects of lithium (kurt by door)
Elevated WBCs
Hypothyroidism with goiter
Weight gain and acne
Alopecia and/or psoriasis
lithium toxicity - s/sx (slurring on lithium)
Course tremors
Ataxia (walking into things)
Confusion
Slurred speech
Lethargy/sedation
Cardiovascular collapse, seizures, coma, death
Vomiting
treatment for lithium toxicity
dialysis
Valproic acid (Depakote) - with food or without? (val needs a snack)
give it with a snack or milk
depakote - MOA (depak loves gluten)
Mechanism of action: increase GABA (calming neurotransmitter), decrease glutamate (excitatory neurotransmitter) and probably membrane stabilizing effect
depakote - esp. effective for who? (dep is mixed)
Especially effective for BAD - depressed type, rapid cycling, mixed episode
depakote side effects
GI distress, sedation and weight gain are common.
what labs for depakote? (dep has liver problems)
Monitor LFTs (can be hepatotoxic)*****
Carbamazepine - MOA (carbs and gluten make me calm)
Similar mechanism of action to Depakote - increase gaba and decrease glutamate
Carbamazepine good for who? (rapid ppl love carbs)
Works well with rapid cycling patients, but has many drug interactions (e.g. decreases serum levels of Warfarin, Haldol and OCPs).
Carbamazepine side effects (carbs give me double vision and make me dizzy)
Common side effects include dizziness, diplopia, ataxia and sedation
Carbamazepine - what labs to monitor (watch your liver and platelets on carbs)
Monitor LFTs and platelets
Lamotrigine (Lamictal) - MOA (sodium and milk)
Mechanism of action: inhibits voltage sensitive sodium channels and stabilizes neuronal membranes
Lamotrigine - good for who? (milk is good for bad II)
Especially effective and usually used for BAD II and depressed episodes. Shows promise as an adjunct tx for depression.
lamictal - how to administer? (slow milk for jason)
Titrate very slowly and monitor for rash and allergic reaction!** (Risk for Stevens-Johnson syndrome or toxic epidermal necrolysis = 0.1% - often fatal)
Topiramate (Topamax) - does it cause weight gain?
Not very effective as monotherapy, but often used as an adjunct with other mood stabilizers (esp. to counteract weight gain)
topamax - off label (top of the PTSD to ya)
Off label uses include PTSD, anxiety, migraine prophylaxis, bulimia
topamax - side effects (you know this - migraine)
Most common side effect is cognitive dysfunction (about 1/3 of ppl have it) can be disabling. helps with cravings in general
Gabapentin (Neurontin)
Not a first-line treatment for BAD, but can be used as an adjunct treatment. Also used for major depression, anxiety and neuropathic pain.
Many atypical antipsychotics are also now FDA approved for treatment of (psycho can treat mania)
acute mania and/or BAD maintenance: Zyprexa, Risperdal, Geodon, Seroquel, Saphris, Latuda
dementia - Cholinesterase inhibitors - how do they work?
slow down deterioration of cognitive functioning by increasing acetylcholine production, but benefits decline as more cholinergic neurons are lost (most dementia is irreversible).
Donezepil - what type of drug
Cholinesterase inhibitor
Donezepil (Aricept). - when to give it?
Only mildly helpful, but it’s the most commonly used med for dementia. Give in AM due to nightmares.
NMDA (glutamate) receptor antagonist EXAMPLE: (decreases glutamate) (MDMA is a meme)
Namenda (memantine)
memantine - MOA (think - you know this)
may temporarily slow deterioration of dementia by reducing excitotoxicity (glutamate).
Cylert treats what?
ADHD
Atomoxetine (Strattera) - MOA - (atoms are not as effective)
this is not a stimulant, usually not as effective.
ADHD meds - do they work well?
Highly efficacious (75 to 90% of ADHD pts respond to medication)
ADHD meds - side effects
Monitor for side effects such as headache, nervousness, dizziness, emotional lability, anorexia, insomnia (may need to decrease dose). appetite and sleep are the biggest deal.
Electroconvulsive therapy (ECT) - esp good for which patients? (shock into consciousness)
clients with catatonia, psychosis and/or vegetative symptoms
Electroconvulsive therapy (ECT) - pre operative care
Empty bladder, remove jewelry
NPO after midnight
IV usually started in OR
Prepare patient and family for common side effects: confusion, short-term memory loss and headache
signed consent.
Electroconvulsive therapy (ECT) - post operative care
Analgesics, usually NSAIDs, for HA
Reorient client PRN
Allow client to eat (saved breakfast/lunch) and sleep.
Reassure client and family that memory loss is usually temporary.
antipsychotics - withdrawal - discontinuation syndrome symptoms (zap the withdrawals)
sleep disturbances, dizziness, tremors, “brain zaps (when ppl change positions), anxiety and muscular discomfort.
Low potency neuroleptics - ex (thor and mel are low, but they’re psycho)
thorazine and mellaril
clozapine - pros and cons (claus is 2nd generation) - and what about the heart?
Very low risk for EPS, but high risk for weight gain and DM, and myocarditis
olanzapine trade name
Zyprexa
Slightly higher risk for EPS, TD and hyperprolactinemia than other atypicals. (respiradol gives me ESP)
respiradol
lactation
respiradol
quetiapine trade name
seroquel
ziprasidone - trade name
geodone
Ziprasidone - not good for who? (Zip not good for ppl w/ broken hearts)
Not good for cardiac patients as it can cause prolongation of QT wave interval.
Ziprasidone - with food, or not?
(Zipping around you need a lot of food)
Absorption is doubled when taken with food. Eat a full meal before taking it, breakfast and dinner.
aripiprazole - weight gain? (pip doesn’t gain much weight)
not much weight gain, 10 lbs a year.
aripiprazole - trade name
(Pip is able)
abilify
aripiprazole - weight? and higher risk for? (pip is able stay stable akila)
more “weight neutral”, somewhat activating w/ possibly higher risk for akathisia.
lurasidone (L)
Latuda
Saphris (saphire ascends)
asenapine
Rexulti (rex is brex)
brexpiprazole
Vraylar (vrm car)
cariprazine
atypical decanoates (a typical deacon is able to wrisper)
Risperdal Consta, Abilify Maintena
how is akisthesia treated? (treat akila’s public speaking)
In contrast to agitation, akathisia is relieved by reducing dose of antipsychotic. Often treated with Propranolol (monitor BP!)
early signs of TD
Earliest signs include: rapid blinking, vermiform tongue. Also: grimacing, lip smacking, choreoathetoid movements of the extremities and trunk (jerky full body)
parkinsonism - muscles?
Muscular rigidity (e.g. cogwheeling, lead pipe - arm stays in a position)
Alterations of posture (stuck in a position)
parkinsonism - tremors? (Fox rolls the pills)
Tremor (especially resting hand tremor) (pill rolling)
Mask-like faces
Shuffling gait
parkinsonism - salivation? (Fox drools)
Hypersalivation (most common), drooling, difficulty swallowing
parkinsonism and dystonia - treatment (Fox is BACS to the same 3)
Tx = PO Cogentin, Artane, Benadryl or Symmetrel. Also, consider reducing the dose of antipsychotic and/or changing med. Do not treat EPS prophylactically!
TD - meds (Ted was treated in Austin w/ val)
Ingrezza (valbenazine) and deutetrabenazine (Austedo) are now FDA approved for tx of tardive dyskinesia (can cause QT prolongation)
NMS - s/sx (Akila is MAD as F at NMS with a heart rate and pee)
must know this - tachycardia, labile hypertension, incontinence
NMS - labs (3 things) - (name the blood, liver, and kidneys)
must know this - and altered labs (high WBC, LFTs, CPK- creatinine, r/t muscle necrosis), severe muscle rigidity
NMS - treatment - fluids?
Restore fluid/electrolyte balance
Monitor for renal failure
NMS - what meds treat it (think about what causes NMS)
Anticholinergics are not useful and may exacerbate signs and symptoms
Dopamine agonists (increase dopamine) are sometimes helpful
Ativan may be helpful in early stages for rigidity
TCAs - examples (Amine works for the TSA)
e.g. Clomipamine, Amitriptyline, Desipramine, Imiprimine (ends in amine it’s usually a TCA)
TCA - mechanism of action (TCA confiscates epi and sera)
block both norepinephrine and serotonin reuptake
Many side effects: endocrine, anticholinergic, orthostatic, cardiac and sexual
High suicide potential (frequently lethal in overdose)
MAOIs - risk for what? (high salt, high BP)
Risk for hypertensive crisis (double vision, headache)
Generally used as a last resort medication or for atypical depression (increased appetite, etc)
SSRIs (Sirrr Luvs celexa)
fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro)
Prozac - generic name (pro flu)
fluoxetine
Zoloft - generic name
sertraline
Paxil - generic name
paroxetine
Luvox - generic name
fluvoxamine
Celexa
citalopram
SSRIs - withdrawals - which drugs are the worst and best?
worst for zoloft and paxil (shortest half life). prozac has a long halflife, so lesser withdrawals.
Remeron - generic name
Mirtazapine
mirtzapine - side effect? (mirt is slow and heavy)
Causes fewer sexual side effects. 2/2 side effects of sedation and weight gain. makes ppl hungry and tired.
remeron good for which clients? (cameron’s mom)
Good for elderly clients with vegetative symptoms
Effexor - generic name
Venlafaxine
effexor - risk for what (the effects are high BP)
Risk for increased DBP (diastolic bp) at high doses. High remission rate, especially for severe, refractory depression.
effexor - effects on high and low doses
acts more serotonin at low dose, and norepinephrine at a high dose.
Pristiq - generic name (prissy is dysen)
Dysvenlafaxine
Fetzima - generic
Levomolnacipran
Cymbalta - generic name
Duloxetine
Trazodone - generic name
Desyrel
Spravato - generic name
Esketamine
Zulresso - generic name (brex is a zulu)
Brexanolone
benzos increase what? MOA
increase gaba
what to watch for w/ anxiety in kids and elderly?
in elderly or kids - be careful w/ benzos. they can develop paradoxical affects, ie. increased anxiety
lithium and pregnancy
Pregnancy (crosses placental barrier) cannot take during pregnancy - it’s a teratogen
Namenda - generic name (name that meme)
memantine
memantine - does it work well?
Slightly improves mood, well-being and functioning (doesn’t help as much with cognition).
namenda - works best when?
Most effective when combined with a cholinesterase inhibitor for additive effects.
namenda - approved for what types of dementia?
Approved for moderate to severe dementia.
Cylert - generic name
Pemoline
Strattera - generic name
Atomoxetine
Ritalin - generic name
methylphenidate
Concerta
OROS methylphenidate
Strattera treats what? (Struttin w/ ADHD)
ADHD
Clonidine and guanfacine treats what?
ADHD
dextroamphetamine (Dexedrine, Adderall) treats what?
ADHD
Concerta treats what?
ADHD
Clonidine and guanfacine - MOA - and works better for who? (clonidine changes my behavior)
Clonidine and guanfacine are alpha agonists (used for BP) better for behavioral.
Strattera - generic name (atoms in the stratosphere)
Atomoxetine
strattera - MOA (epinephrine in the stratosphere)
is a norepinephrine reuptake inhibitor.
atomoxitine works better for who? (atoms are inattentive)
works better for inattentive type.
ADHD meds - with food?
eat a large breakfast and then take meds.
ECT - what meds are given before? (atop ECT)
IM Atropine (to reduce secretions and prevent bradycardia) is sometimes given with a muscle paralyzing agent and a sedative, such as Ativan.
clozaril - what to ask patients every day?
bowel impaction (ask pt every day if they’ve had a BM)
Geodon (ziprasidone) - how can it be administered?
Geodon (ziprasidone): first atypical to be available for short-acting IM injection. also available PO.
NMS - s/sx (MAD and sweaty and confused)
diaphoresis, confusion, disorientation
respiradol - typical or atypical?
atypical
Antabuse - generic name (difuse the antibuse)
Disulfiram
tegratol - drug class (tigers don’t convulse)
anticonvulsant
galantamine - what type of drug
(galantly against cholenestarase)
cholenesterase inhibitor
rivastigmine - what type of drug (riveted by alzheimers)
cholenesterase inhibitor
2nd generation antipsychotics - ex
clozapine (clozaril)
olanzapine (zyprexa)
risperidone (Risperdal)
quetiapine( Seroquel)
ziprasidone(Geodon)
aripiprazole (abilify)
the most weight gain
clozapine
olanzapine - side effects (ola is large)
weight gain, DM, abnormal lipids
ESP turns into
blockade of D2 receptors
leads to anticholinergic crisis-> delirium, worsening psychosis
types of ESP
Parkinsonism
dystonia
akathisia
TD( tarditive diskinesia)
NMS (neuroleptic mallignant syndrome)
how to get off antipsychotics
taper slowly
can build a tolerence to
antipsychotics
the MOST weight gain
clozapine - last resort drug
clozaril - generic name
clozapine
clozapine - drug class
antipsychotic
olanzapine - drug class
antipsychotic
respiradone - drug class
antipsychotic
quetiapine - drug class
antipsychotic
cylert treats what?
ADHD
proloxin - generic name (pro has the flu)
Fluphenazine
respiradone - ok for elderly or not?
ok
