Psych Pharm Flashcards
What are the high potency neuroleptics?
haloperidol, fluphenazine, loxapine, thiothixene, trifluoperazine
What are the low potency neuroleptics?
thioridazine, chlorpromazine
What are the atypical antipsychotics?
olanzipine, quetiapine, risperidone, clozapine, ariprazole
Which antipsychotic is most closely associated with an increased risk of diabetes?
olanzipine
What is the most serious side effect of clozapine?
agranulocytosis
What are the clinical features of neuroleptic malignant syndrome?
- delirium and mental status changes
- autonomic instability (tachycardia)
- muscle rigidity
- hyperthermia
- rhabdomyolysis and myoglobinuria
What is the first line pharmacotherapy for neuroleptic malignant syndrome?
Dantrolene
others: bromocriptine, amantadine
What mood stabilizers are used in the treatment of bipolar disorder?
Lithium
Atypical antipsychotics (respiridine, aripiprazole, olanzipine)
Antiseizure - valproic acid, carbamazepine, lamotrigine
What are the potential side effects of lithium?
Neuro Sx - tremor (esp postural) - dizziness and sedation Endo Sx - nephrogenic diabetes insipidus - hypothyroidism, goiter Arrhythmia Sx - sick sinus syndrome - heart block Teratogenic - Ebstein anomaly
What is Ebstein anomaly?
Caused by lithium; atrialization of the right ventricle
- tricuspid leaflets displaced inferiorly
- RV hypoplasia
- Tricuspid regurgitation or stenosis
- +/- patent foramen vale with R->L shunt
Selective Serotonin Reuptake Inhibitors (SSRIs) (names)
Fluxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram
SSRIs MOA, Use, AE
MOA - inhibit serotonin reuptake
Use - depression, GAD, panic disorder, OCD, buleimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder
AE - sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) (names)
Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran
SNRIs MOA, Use, AE
MOA - inhibit serotonin and norepinephrine reuptake
Use - depression, GAD, diabetic neuropathy
Venlafaxine - indicated for social anxiety disorder, panic disorder, PTSD, OCD
Duloxetine - indicated for fibromyalgia & milnacipran is ONLY used for fibromyalgia
AE - increase BP d/t increased NE; can cause serotonin syndrome
TCAs (names)
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
TCAs MOA, Use, AE
MOA - inhibit NE and serotonin reuptake
Use - major depression, OCD (clomipramine), migraine prophylaxis, nocturnal enuresis (imipramine)
AE - TriC’s - antiCholinergic, Cardiac toxicity (arrhythmias), CNS toxicity (convulsions, coma)
MAOIs names
tranylcypromine, phenelzine, isocarboxazid, selegiline, rasagiline
MAOIs MOA, Use, AE
MOA - inhibit MAO, therefore increasing NE and DA
Use - atypical depression anxiety; Selegiline and Rasagiline are used for Parkinson Dz
AE - HTN crisis especially with ingestion of tyramine (aged cheese and wine); C/I with SSRIs, TCAs, St. John’s wort, meperidine, etc to prevent serotonin syndrome
Atypical antidepressants (names)
bupropion, mirtazapine, trazodone, vilazodone, vortioxetine
Which antidepressant has the side effect of priapism?
trazodone and nefazodone (serotonin modulators)
which antidepressant lowers the seizure threshold?
bupropion
Which antidepressant causes appetite stimulation likely to result in weight gain?
mirtazapine
Which antidepressant can be used for smoking cessation?
bupropion
Which antidepressant can be used for bedwetting in children?
imipramine
What are the symptoms of TCA overdose?
TriC’s: antiCholinergic excess, CNS toxicity, Cardiac arrhythmias
What is the mechanism of action of bupropion?
inhibits reuptake of NE and dopamine; no sexual side effects
