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CMT > Psych Pharmacology > Flashcards

Psych Pharmacology Flashcards

1
Q

SSRI

Fluoxetine (Prozac)

A
  • Dose - 10mg - 60mg, weekly form 90mg
  • FDA indications- MDD (age 8+), OCD (age 7+), panic disorder, bulimia, PMDD
  • Monitoring-none
  • Side Effects- most likely to cause insomnia, anxiety, reduced appetite

Misc Info
* Has longest half live (active metabolite T1/2 is 2+ weeks) of any SSRI which can make it self-tapering (no discontinuation syndrome)
* stimulating med

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2
Q

SSRI

Paroxetine (Paxil)

A
  • Dose: 10mg - 40mg
  • Indications- MDD, OCD, panic disorder, social anxiety, GAD, PTSD, PMDD, menopausal hot flashes
  • Monitoring- none
  • Side Effects- weight gain, sexual side effects, sedation
  • Pregnancy category D, so avoid if possible in women of child-bearing age
  • Half life of less than 24 hours, bad rebounds symptoms if stopped abruptly
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3
Q

SSRI

Sertaline (Zoloft)

A
  • Dose: 50mg - 300mg
  • Indications- MDD, OCD (age 6+), panic disorder, PTSD, PMDD, social anxiety
  • Monitoring- none
  • Side Effects- n/v/d (called squirt-raline due to GI sx)
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4
Q

SSRIs

Citalopram (Celexa)

A
  • Dose: 10mg - 40mg
  • Indications- MDD
  • Monitoring- none
  • Side Effects- QTc prolongation (do not exceed 40mg/day)
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5
Q

SSRIs

Escitalopram (Lexapro)

A
  • Dose: 10mg - 20mg
  • Indications- MDD (age 12+), GAD
  • Monitoring- none
  • Side Effects- Considered the cleanest SSRI meaning it has the fewest SE
  • Enantiomer of citalopram (S enantiomer is the pure active form and R enantiomer has anticholinergic properties which causes more side effects)
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6
Q

SSRI

Fluvoxamine (Luvox)

A
  • Dose: 50mg - 300mg
  • Indications- OCD, MDD, panic disorder, GAD, PTSD
  • Monitoring- none
  • Side Effects: general SSRI side effects
  • Less commonly used, many drug-to-drug interactions
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7
Q

SNRI

A

Blocks serotonin and norepinephrine reuptake transports to increase both in synaptic cleft

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8
Q

SNRIs

Venlafaxine (Effexor)

A
  • Dose: 37.5mg - 225mg
  • Indications- MDD, social anxiety disorder, GAD, panic disorder
  • Monitoring- periodic BP
  • Side Effects- anorexia, dizziness, dry mouth, sweating, sexual side effects, nervousness, hypertension, hyponatremia (in volume depleted)
  • Has significant discontinuation syndrome even with the XR formulation, titrate off very slowly or consider using fluoxetine taper
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9
Q

SNRIs

Desvenlafaxine (Pristiq)

A
  • Dose: 50mg - 200mg
  • Indications- MDD (fibromyalgia off label)
  • Monitoring- periodic BP
  • Side Effects- hypertension, nausea, dizziness, insomnia, excessive sweating, sexual side effects
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10
Q

SNRIs

Duloxetine (Cymbalta)

A
  • Dose: 20mg - 120mg (typically BID)
  • Indications- MDD, GAD (ages 7+), diabetic peripheral neuropathic pain, fibromyalgia, chronic MSK pain
  • Monitoring- LFTs is suspect liver disease, periodic BP
  • Side Effects- liver disorders, nausea, dry mouth, insomnia, fatigue, HA, sexual side effects, urinary hesitation, urinary retention
  • Very useful in patients with comorbid pain syndromes or with stress urinary incontinence
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11
Q

SNRIs

Levomilnacipran (Fetzima)

A
  • Dose: 20mg - 120mg
  • Indications- MDD
  • Monitoring- periodic BP and pulse
  • Side Effects- nausea, vomiting, constipation, sweating, increased HR, urinary hesitation, urinary retention
  • second line due to elevated cost & high occurrence of side effects
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12
Q

NRDI

Bupropion (Wellbutrin)

A
  • Dose: comes in IR and XL version. 75mg - 450mg
  • Indications- MDD, seasonal affective disorder, smoking cessation (Zyban)
  • Side effects- seizure, agitation, insomnia (take in morning to reduce), HA, nausea, vomiting, tremor, tachycardia, NE effects make this med stimulating making it particularly useful in patients with fatigue and poor concentration associated with depression
  • Lack of sexual side effects and weight gain make it very useful in patients suffering these SE from other meds or are worried about this SE
  • Can reduce seizure threshold so don’t give in bulimic patients and be very careful in patients with alcohol use disorder and electrolyte disorders
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13
Q

Mirtazapine (Remeron)

A
  • MOA- serotonin antagonist and alpha-2 adrenergic antagonist
  • Dose: 7.5mg to 45mg
  • Indications- MDD
  • Monitoring- weight
  • Side Effects- somnolence, increased appetite, weight gain, agranulocytosis or severe neutropenia (rare)
  • Its tendency to cause stimulant appetite and sedation makes it a great choice for some patients (insomnia, cachexia, etc) but a terrible option for others (eating disorders, body dysphoric disorder)
  • If patient has too much sedation at starting dose, consider increasing dose as it has more noradrenergic activity relative to antihistaminergic activity at higher doses
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14
Q

Trazodone

A
  • MOA- serotonin reuptake inhibitor, alpha-1 adrenergic antagonist, serotonin receptor antagonist
  • Dose: 25mg to 300mg
  • Indications- MDD (insomnia, anxiety off label)
  • Monitoring- no routine monitoring
  • Side Effects- drowsiness, dry mouth, lightheadedness, orthostatic hypotension, priapism (TrazoBone)
  • Mostly used for insomnia due to its sedating qualities
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15
Q

Vilazodone (Viibryd)

A
  • MOA- serotonin reuptake inhibitor and serotonin partial agonist
  • Dose: 10mg to 40mg
  • Indications- MDD
  • Monitoring- no routine monitoring
  • Side Effects- diarrhea, nausea, vomiting, insomnia, hyponatremia
  • Must be taken with food
    Fewer Sexual side effects
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16
Q

Vortioxetine (Trintellix)

A
  • MOA- multimodal antidepressant: antagonist, partial agonist, and agonist of different serotonin receptors
  • Dose: 5-20mg
  • Indications- MDD
  • Monitoring- no routine monitoring
  • Side Effects- GI side effects, sexual side effects
  • Helps with cognitive functioning in depression
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17
Q

Brexpiprazole (Rexulti)

A
  • MOA- dopamine D2 and serotonin partial agonist and antagonist
  • Dose: 0.5mg to 4mg
  • Indications- schizophrenia, depression adjunct (never monotherapy for depression)
  • Monitoring- fasting glucose, lipids
  • Side Effects- weight gain, akathisia, somnolence, tardive dyskinesia, impulse control problems, pathologic gambling
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18
Q

Esketamine (Spravato)

A
  • MOA- NMDA receptor antagonist
  • Indications- treatment resistant major depression (in conjunction with an oral antidepressant)
  • Monitoring- must be monitored after dose for 2 hours (cannot be taken at home)
  • Side Effects- sedation, dissociation, elevated BP, cognitive impairment, hypertensive crisis
  • Recently approved for treatment resistant major depression, even more recently approved for use in emergency room for urgent depressive episode or suicidal ideation
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19
Q

TCAs

A
  • Meds: nortryptiline, amitryptiline
  • MOA- serotonin and NE reuptake inhibitor which causes its therapeutic effects, but it also blocks histamine and muscarinic receptors and effects Na and Ca channels which account for its side effects and toxicity
  • Indications- MDD
  • Monitoring- ECG if history of cardiac disease, requires plasma levels
  • Side Effects- sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision, arrhythmias, QT prolongation
  • monitor for overdose/toxicity
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20
Q

Cognitive Behavior Therapy

A
  • recognizing thoughts/triggers and challenging those thoughts
  • CBT monotherapy is just as effective as antidepressants monotherapy
  • for best results: combine CBT + meds!
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21
Q

Light Box Therapy

A
  • Indications- indicated for seasonal affective disorder and non-seasonal depression
  • Side effects- eye strain, HA, mania in bipolar patients (uncommon)

MOA
* Light boxes emit full spectrum light with the standard minimum intensity of 10,000 lux (similar to light experienced if standing outside for 30 minutes
* Decreases melatonin production (so don’t use before bedtime)

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22
Q

Electroconvulsive Therapy (ECT)

A
  • Indications- treatment resistant or severe depression (either unipolar or bipolar), catatonia
  • Side effects- acute confusion, memory loss, tension HA (30%), nausea, jaw pain
  • Induces a generalized seizure which has antidepressant/antipsychotic effects via unknown mechanism
  • Treatments given 3x/wk, response usually within 3-6 treatments, average number of treatments = 7-10 (inpatient treatment); High remission rate however relapse is common with out maintenance treatment
  • Most effective treatment for depression
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23
Q

Transcranial Magnetic Stimulation (TMS)

A
  • Indications- depression that has not responded to 1 prior antidepressant, OCD, migraine pain
  • Side effects- scalp discomfort, seizures (uncommon), hearing loss (uncommon

MOA
* Modulates activity in cortical regions
* In theory, left dorsolateral prefrontal cortex in underactive in depression
* Treatments are given 5x/wk with response usually beginning after 20 treatment

24
Q

Antipsychotics- Typicals

Chlorpromazine (Thorazine)

A
  • First antipsychotic developed, not commonly used
  • Dose: 60mg - 800mg PO
  • Indications- Psychosis, mania, nausea and vomiting, intractable hiccups
  • Monitoring- ECG if cardiac disease
  • Side Effects- sedation, orthostasis, tachycardia, drowsiness, dry mouth, constipation, blurred vision, prolactin elevation, skin pigmentation, ocular changes, jaundice, photosensitivity
25
Q

Antipsychotic- Typicals

Fluphenzine (Prolixin)

A
  • Dose: 3 - 45mg PO
  • Indications- psychosis, schizophrenia
  • Side Effects- EPS, headache, drowsiness, dry mouth
26
Q

Antipsychotics- Typicals

Haloperidol (Haldol)

A
  • Dose: 1-40mg PO
  • Indications- psychosis, Tourette’s disorder
  • Side Effects- EPS, headache, drowsiness, dry mouth, prolactin elevation
27
Q

Antipsychotics- Atypicals

Quetiapine (Seroquel)

A
  • Dose: 300 - 800mg
  • Indications- Schizophrenia (13+yo), bipolar manic/mixed (10+), bipolar depression, maintenance for bipolar, major depression (as adjunct)
  • Monitoring- fasting glucose, lipids
  • Side Effects- somnolence (!), hypotension, dry mouth, dizziness, constipation, weight gain, fatigue, orthostatic hypotension
28
Q

Antipsychotics- Atypicals

Ziprasidone (Geodon)

A
  • Dose: 120 - 160mg PO or IM
  • Indications- Schizophrenia, bipolar disorder (acute tx of mania/mixed episodes, Bipolar maintenance as adjunct, acute agitation in schizophrenia (IM only)
  • Monitoring- fasting glucose, lipids, ECG if cardiac disease
  • Side Effects- somnolence, dizziness, akathisia, rash, QT prolongation, DRESS

Misc Info
* Need to take with 500 cals
* Less weight gain than clozapine, olanzapine, quetiapine, and risperidone
* More QT prolongation than any other atypical antipsychotic

29
Q

Antipsychotics- Atypicals

Lurasidone (Latuda)

A
  • Dose: 40mg to 120mg
  • Indications- Schizophrenia (adults and adolescents 13-17), bipolar depression (as monotherapy and adjunct in adults and children 10-17)
  • Monitoring- fasting glucose, lipids
  • Side Effects- sedation, akathisia, nausea, parkinsonism, agitation, orthostatic hypotension, syncope

Misc Info
* Administer with at least 350 calories to increase absorption
* Appears relatively weight neutral

30
Q

Antipsychotics- Atypicals

Aripiprazole (Abilify)

A
  • Dose: 10 - 30mg
  • Indications- schizophrenia (13-17, adults), bipolar disorder (acute mania: adults and 13-17, maintenance: adults), major depression as adjunct (adults), irritability in autism (children 6-17), Tourette’s disorder (children 6-17)
  • Monitoring- fasting glucose, lipids
  • Side Effects- akathisia, anxiety, insomnia, sedation, tremors

Misc Info
* Minimal weight and metabolic side effects but risk of akathisia

31
Q

Antipsychotics- Atypicals

Olanzapine (Zyprexa)

A
  • Dose: 5 - 20mg
  • Indications- schizophrenia (13+), acute or mixed bipolar 1 manic episodes (13+), maintenance tx of bipolar, bipolar depression (as Symbyax, 13+), treatment resistant depression (as Symbyax), acute agitation in schizophrenia and bipolar mania (injectable form)
  • Monitoring- fasting glucose, lipids
  • Side Effects- somnolence, dry mouth, constipation, weight gain (10-30lb is common), increased appetite, EPS

Misc Info
* High prevalence of weight gain and metabolic side effects
* Symbyax is an expensive combination of olanzapine and fluoxetine (just write as separate generic medications)

32
Q

Antipsychotics- Atypicals

Paliperidone (Invega)

A
  • MOA- dopamine D2 and serotonin 5-HT2A receptor antagonist
  • Indications- Schizophrenia (13+), schizoaffective disorder
  • Monitoring- fasting glucose, lipids, prolactin if symptoms
  • Side Effects- akathisia, EPS, tremor, tachycardia, insomnia, somnolence, weight gain, orthostatic hypotension, headache, elevated prolactin

Misc Info
* ”Ghost pills” osmotic delivery system
* Not highly effective in acute mania
* Along with risperidone, causes the most EPS and hyperprolactinemia of all atypicals

33
Q

Antipsychotics- Atypicals

Risperidone (Risperdal)

A
  • Dose: 4 - 16mg
  • Indications- schizophrenia (13+), bipolar disorder (manic/mixed 10+), irritability in autism (children 5+)
  • Monitoring- fasting glucose, lipids, prolactin if symptoms
  • Side Effects- EPS, somnolence, anxiety, constipation, nausea, dyspepsia, dizziness, prolactin elevation, weight gain, orthostatic hypotension

Misc Info
* Along with paliperidone, causes most EPS and hyperprolactinemia of all atypicals

34
Q

Antipsychotics- Atypicals

Asenapine (Saphris)

A
  • Dose: 10 - 20mg
  • Indications- Schizophrenia, bipolar disorder (acute and maintenance of manic/mixed episodes in adults and kids 10-17)
  • Monitoring- fasting glucose, lipids
  • Side Effects- akathisia, oral hypoesthesia, somnolence, dizziness, EPS, weight gain

Misc Info
* Sublingual and patch formulation, good if swallowing pills is an issue

35
Q

Antipsychotics- Atypicals

Cariprazine (Vraylar)

A
  • Dose: 3 - 6mg
  • Indications- Schizophrenia, bipolar I depression, Major depressive disorder
  • Monitoring- fasting glucose, lipids
  • Side Effects- GI upset, dizziness, insomnia, increased appetite. Typically very well tolerated and effective
36
Q

Antipsychotics

Clozapine (Clozaril)

A
  • Dose: 300 - 600mg
  • Indications- treatment resistant schizophrenia, reduction in risk of suicide in schizophrenia and schizoaffective disorders
  • Monitoring- fasting glucose, lipids, baseline ANC (>1000) then weekly for 6 months, then biweekly for another 6-12 months, then monthly after 12 months
  • Side Effects- sedation (!), orthostatic hypotension, hypersalivation, weight gain, constipation, tachycardia, potentially life-threatening neutropenia (1-2%)

Misc Info
* Must be in risk evaluation and mitigation strategy program (REMS) in order to prescribe

37
Q

Bipolar Disorder

meds for bipolar maintenance

8

A
  • Quetiapine (Seroqual)- SGA
  • Ziprasidone (Geodon)- SGA
  • Risperidone (Riperdal Consta)- SGA LAI
  • Asenapine (Saphris)- SGA
  • Lamotrigine (Lamictal)- Anticonvulsant
  • Lithium- Mood Stabilizer
  • Olanzapine (Zyprexa)- SGA
  • Aripiprazole (Abilify)- SGA
38
Q

Bipolar Disorder

meds for bipolar depression

4

A
  • Quetiapine (Seroquel)- SGA
  • Olanzapine/Fluoxetine (Symbyax)- SSRI/SGA
  • Lurasidone (Latuda)- SGA
  • Cariprazine (Vraylar)- SGA
39
Q

Bipolar Disorder

Meds for Mania Management

10

A
  • Quetiapine (Seroquel)- SGA
  • Asenapine (Saphris)- SGA
  • Ziprasidone (Geodon)- SGA
  • Lithium- Mood Stabilizer
  • Divalproex (Depakote/Depakote ER)- anti-convulsant
  • Carbemazepine (Equetro)- anti-convulsant
  • Risperidone (Risperdal)- SGA
  • Aripiprazole (Abilify)- SGA
  • Olanzapine (Zyprexa)- SGA
  • Cariprazine (Vraylar)- SGA
40
Q

Mood Stabilizer

Lithium

A
  • MOA: not completely known but is thought alter the sodium transport across membranes of nerve and muscle cells.
  • Thought to modulate dopamine, glutamate and GABA.
  • Gold standard for bipolar disorder (indicated for mania and maintenance)
  • Can reduce risk of suicide completion (8x less)
  • VERY effective, 80% of patients respond well
  • can take 1-2 weeks to become effective (augment with valproate or atypical antipsychotics)
  • Contraindications: renal impairment, myasthenia gravis, 1st trimester/breastfeeding (teratogenic due to Ebsetin Anomaly)
  • Caution/Avoid: NSAIDs, ACE inhibitors, HCTZ; excess sweating, low Na diet, dehydration (all increase Li levels)
41
Q

Mood Stabilizers

Lithium Side Effects

9

A
  • nausea/diarrhea (take w/meals, split dosing, ER)
  • Tremor (propranolol)
  • polyuria/polydipsia (dose at bedtime)
  • Hypothyroidism (7-9%, 9x more likely in women, tx: levothyroxine)
  • nephrotoxicity (diabetes insipidus)
  • Weight gain
  • Memory problems
  • Edema
  • Rarely - EKG abnormalities
42
Q

Mood Stabilizers

Lithium Level

A
  • Level should be between 0.6 and 1.2 (aim for 1)
  • Starting dose: 300-600mg QHS, can be BID
  • Typical dose is 900 to 1200mg/day but can vary. Max: 2400mg/day

Lithium Toxicity
* Occurs when plasma levels raise above 1.2
* Nausea, cogwheeling tremor, vomiting, somnolence, confusion, muscle weakness
* Plasma levels over 3 = seizures, coma, and death

43
Q

Mood Stabilizers

Lithium Monitoring

A

When Beginning
* Check Li level, BUN/creatinine, electrolytes, TSH/T3/T4, EKG (over 50), Preg test
* Recheck 1 week + 1 month after initiation. Maintenance q 6-12 months

When Changing Doses
* Check Li level 1 week after changing doses - 12 hours after last Li dose
* Once level achieved, check q 3 months for 6 months
* Once stable, check q 6-12 months

Misc Monitoring Notes
* Monitor for metabolic effects (BMI, lipids, etc)
* Compliance/access to labs can be an issue

44
Q

Anti-Convulsant

Lamotrigine (Lamictal)

A
  • MOA: Sodium channel blocker, Anticonvulsant
  • Indications: bipolar maintenance
  • Starting dose: 25mg x 14 days. “Max”: 200mg; best if split BID (100mg BID), takes about 8 weeks to get to target dose
  • Side effects: dizziness, headaches, benign rash (7%) diplopia, blood dyscrasias, withdrawal seizures if abruptly d/c,
  • If miss 5+ doses in a row, must start back at 25mg q daily
  • Complication: Stevens Johnsons Syndrome (SJS) - 1 in 1000 patients, but can be lethal; Valproate can DOUBLE lamotrigine levels
  • Levels are lowered by oral contraceptives, so may need higher dose in women taking OCP. Levels can be higher during “placebo” week
45
Q

Anti-Convulsant

Valproic Acid/Valproate (Depakote)

A
  • Anticonvulsant indicated for bipolar mania (off label good for rapid cycling)
  • Dose: 250-500mg/day, rapidly titrate up to max of 4000mg/day
  • Monitoring: serum level 50-125 ug/mL (aim for 100); check 5 days after increase and q 6 months
  • Side effects: somnolence, nausea, fatigue, dizziness, hair loss, tremor, thrombocytopenia, hyperammonemia (confusion)
  • ER formulation absorbs 20% less valproate
  • Complications: Pancreatitis, Hepatic necrosis, EXTREMELY TERATOGENIC (NTD/spina-bifida and low IQ scores, decreases folate)
46
Q

Anti-Convulsants

Carbmazepine (Equetro)

A
  • MOA: sodium channel blocker (anticonvulsant)
  • Indications: acute mania, maintenance
  • Dose: 200mg BID with max of 800mg BID
  • Side Effects: dizziness, somnolence, nausea, headache; rare include agranulocytosis, aplastic anemia, hepatic failure, SIADH, SJS/TEN
  • Will decrease OCP effectiveness
  • NOT APPROVED FOR PSYCH (Tegretol)
47
Q

Anti-Convulsants

Oxycarbazepine (Trileptal)

A
  • “Gentle” carbamazepine
  • Off label use only for bipolar disorder, NOT first line
  • Dose: 300mg BID up to 2400mg/day
  • Side Effects: dizziness, somnolence, headache, ataxia, nausea and vomiting
  • Complications: SJS/TEN, angioedema, anaphylaxis
  • NOT FDA APPROVED FOR PSYCH USE; OFF LABEL USE ONLY
48
Q

Alcohol Use Disorder

Acamprosate (Campral)

A
  • MOA: Glutamate neurotransmission modulation at metabotropic-5 glutamate receptor sites
  • Dose: 666mg 3x daily
  • Monitoring: No labs required, but should be avoided in patients with severe renal impairment
  • Side Effects: diarrhea, nervousness, and fatigue
  • Can take with naltrexone and disulfiram and in pts who continue to drink
49
Q

Alcohol Use Disorder/Opioid Use Disorder

Naltrexone

A
  • MOA: mu opioid receptor blocker; naltrexone also modifies the HPA axis to suppress ethanol consumption (~25% in studies); opioid antagonist
  • Dose: 50mg PO QD or 380mg IM q4 wks
  • Monitoring: LFTs Q6 mo
  • Side Effects: nausea, HA, dizziness, fatigue, liver damage
  • Contraindicated: hepatic failure
  • must be free from opioids or will enter precipitated withdrawal
  • d/c 72 hrs before scheduled surgery if opioid use is anticipated (if IM d/c 30d prior)
50
Q

Alcohol Use Disorder

Disulfiram (Antabuse)

A
  • MOA: discourages drinking by causing an unpleasant physiologic reaction when alcohol is consumed; Inhibits aldehyde dehydrogenase and prevents the metabolism of alcohol’s primary metabolite, acetaldehyde
  • Dose: initially dosed at 500 mg/day for 1-2 weeks, followed by an avg maintenance dose of 250 mg/day with a range from 125-500 mg based on the severity of adverse effect
  • When EtOH is Consumed: causes sweating, headache, dyspnea, lowered blood pressure, flushing, sympathetic overactivity, palpitations, nausea, and vomiting
  • Side Effects; rash, drowsiness, HA, metallic taste, hepatitis
  • Contraindications: severe myocardial disease and/or coronary occlusion, psychosis, or known hypersensitivity to the medication or other thiuram derivatives. Also avoid in pregnancy and during breastfeeding
51
Q

Opioid Use Disorder

Methadone

A
  • Pure opioid agonist → greater OD risk than buprenorphine
  • Function: works to prevent cravings and withdrawal sx for 24+ hrs; reduces the euphoric effects of subsequent illicit opioid use by maintaining high levels of opioid tolerance
  • Best studied and longest used medication for treatment of opioid addiction
  • Methadone maintenance therapy is associated with overall lower mortality rates, including 70% lower than untreated heroin abusers
  • Methadone is first line for pregnant patients with OUD
  • Must be administered by certified center, typically dosed daily
52
Q

Opioid Use Disorder

Buprenorphine

A
  • Opioid partial agonist (Some pain relief, potential for diversion)
  • Oral form combined with naloxone to decrease diversion to injection (Suboxone/Bunavail/Zubsolv)
  • Long-acting injection available (Sublocade) and implant (Probuphine)
  • Patient should be experiencing withdrawal symptoms prior to starting (depends on half-life of drug)
  • Safe in pregnancy, but less research than methadone, so this is not first line
  • Patients are at higher risk of death if concurrently taking benzodiazepines, alcohol or using IV opiates in combination with Buprenorphine
  • Does not show up on standard drug screen
  • Contraindicated: severe hepatic impairment
53
Q

Opioid Use Disorder

Naloxone

A
  • MOA: Opioid antagonist that blocks effects of opioid analgesics and reverses the effects of overdose
  • No abuse potential
  • Can be administered in both healthcare settings and in community
  • Project DAWN (Deaths Avoided with Naloxone)
  • Demonstrated to decrease mortality, not cause opioid dose escalation and improve eventual entry into treatment
54
Q

ADHD

Amphetamies

A
  • Meds: adderal, vyvanse, mydayis, dexedrine, evekeo, dyanavel, adzenys
  • MOA: releases and blocks reuptake of norepinephrine and dopamine; can be too strong and lead to anxiety
  • Side Effects: HA, insomnia, anorexia, anxiety, irritability, HTN, aggression
  • Contraindications: glaucoma, tics, MAOI use, agitation, structural cardiac abnormalities, uncontrolled hypertension, +/- hyperthyroidism
    Potential abuse

ABUSE POTENTIAL

55
Q

ADHD

Stimulant- Methylphenidate

A
  • Meds: ritalin, focalin, daytrana, concerta, metadate, quilivant, cotempla, aptensio, jornay, azstarys
  • MOA: : blocks reuptake of norepinephrine and dopamine
  • Side Effects: HA, insomnia, anorexia, anxiety, irritability, HTN, aggression
  • Contraindications: glaucoma, tics, MAOI use, agitation, structural cardiac abnormalities, uncontrolled hypertension, +/- hyperthyroidism
    Potential abuse

ABUSE POTENTIAL

CMT (78 decks)

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