Psychiatric Medications Flashcards
Anti-depressants
- Common mechanism of action
- Common time needed
Anti-depressants
- Common mechanism of action
- Common time needed
- Serotonin activity
- increase activity at post-synaptic receptor - 2-3 weeks
SSRIs
- Mechanism
SSRIs
- Mechanism
- Reduce pre-synaptic uptake
- Increased junction serotonin
- Down-regulation of post-synaptic receptors
SSRIs
- ADRs
- Short term
- Sensitive
- Uncommon
SSRIs
- ADRs
- Short term
- restlessness/agitation
- GI/Nausea
- Headache - Weight change
- Sexual dysfunction
- low libido
- failure to orgasm - Less common
- Bleeding (eg. PPI with aspirin)
- Suicidal ideation
(Young men, first few weeks)
SSRIs
- 4 commonest (dose)
- Choosing
SSRIs
- Commonest & Use
- Sertraline (50-200)
- Safe in heart disease - Citalopram (20-40)
- QTc prolongation
- Escitalopram (10-20) - Fluoxetine (20-60) (prozac)
- Serotonin syndrome when switching - Paroxetine (20-60)
- Discontinuation syndrome
SNRIs
- Mechanism
- Uses
SNRIs
- Mechanism
1. Reduce pre-synaptic uptake
2. Increased junction serotonin (and NA)
3. Down-regulation of post-synaptic receptors - Uses
1. Evidence for neuropathic pain
2. Similar to SSRIs
SSRIs vs SNRIs
- Effects
SSRIs vs SNRIs
- Effects
SNRI
1. Greater sedation
2. Greater Nausea
3. Greater Sexual dysfunction
SNRIs
- 2 examples (doses)
- ADRs
SNRIs
- 2 examples (doses)
- ADRs
- Duloxetine (60-120mg)
- Venlafaxine (75-375mg)
- More efficacious
- Higher dose tolerated
- Caution in heart disease (BP)
Mirtazepine
- Mechanism
- Activity and ADRs
Mirtazepine
- Mechanism
1. NaSSA - NA and Serotonin
2. 5HT-2 and 5HT-3 antagonist - Activity and ADRs
1. Strong H1 activity - sedation
- Weight gain
Tricyclic Antidepressants
- ADRs
Tricyclic Antidepressants
- ADRs
- Muscarinic
- Histaminic
- Overdose
- QTc prolongation
- Arrythmias
MAOIs
- Types
- Examples (reversible/irreversible)
- ADRs
MAOIs
- Types
1. MAOi - A - More serotonin
2. MAOi - B - More on dopamine
- Examples
1. Reversible - Moclobamide
- Tranylcypromine
- Irreversible
- Phenelzine
- Isocarboxazid
- ADRs
1. Serious interactions
- Tyramine reaction
- HTN crisis
- Avoid tyramine foods (cheese, pickled meats, wine) - 6 week washout period before new AD
Vortioxetine
- Effects
- ADRs
Vortioxetine
- Effects
1. Serotonergic
2. Antagonism and agonism - ADRs
1. Few side effects
2. Less nausea
3. Less cognitive symptoms
ADs
- Dose changing
ADs
- Dose changing
- Depression
- If no effect, switch, don’t increase - Anxiety
- If no effect, consider increasing - ADRs
- May improve in 2 weeks
- Consider switching if problem
Discontinuation syndrome
- Character
- Causes
Discontinuation syndrome
- Character
1. Shakes,
2. Agitation, insomnia
3. Headaches, N&V
4. Paresthesia, clonus - Causes
1. Short half lives
2. Paroxetine & Venlafaxine - Slow taper
- Consider Fluoxetine cover
Serotonin syndrome
- Cognitive
- Autonomic
- Somatic
- Treatment
Serotonin syndrome
- Cognitive
1. Headaches, agitation
2. Hypomania, confusion
3. Coma - Autonomic
1. Shivering, sweating
2. Hyperthermia, tachycardia
3. N&D - Somatic
1. Myoclonus, hyper-reflexia
2. Tremor - Treatment
0. Stop treatment
1. Fluids
2. Monitoring
3. Seizure Meds
Antipsychotics
- Effects
- Pathways
- Unwanted pathways
- ADRs
Antipsychotics
- Effects
1. D2 receptors - Pathways
1. Mesocortical
2. Mesolimbic - Unwanted pathways
1. Nigrostriatal
2. Tuberoinfundibular (HPA) - ADRs
1. Sedation
2. Extra-pyramidal
3. Weight gain
- Acurte dystonia
- Oculogyric crisis
Antipsychotics
- Typical vs Atypical
- ADRs, receptors
Antipsychotics
- Typical
1. Extrapyramidal
2. Muscarinic
3. Histaminic - Atypical
1. Serotenergic
Antipsychotics
- 5 Typicals
- 5 Atypicals
Antipsychotics
- 3 Typicals
- Haloperidol
- Chlorpromazine
- Flupenthixol
- 5 Atypicals
1. Clozapine
2. Olanzapine
3. Risperidone
4. Quetiapine
5. Aripiprazole - D2 partial agonist
- No QTC
Tardive dyskinesia
- Signs
Tardive dyskinesia
- Signs
- Involuntary mouth movements
- Chewing
- Tongue movements - Sometimes throat