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Psychiatry > Psychiatric medications > Flashcards

Psychiatric medications Flashcards

1
Q

HAM side effects

A
  • anitHistamine-sedation, weight gain;
  • antiAdrenergic-hypotension
  • antiMuscarinic-dry mouth, blurred vision, urinary retention
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2
Q

Which drugs show HAM side effects

A

TCAs and Low potency antipsychotics

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3
Q

Serotonin Syndrome

A

Confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure and death. Wait 2 weeks before switching from SSRI to MAOI; 5-6 with fluoxitine.

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4
Q

EPS-extrapyramidal side effects

A

Parkonsinism, Akathisia, Dystonia

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5
Q

Hypertensive Crisis

A

Caused by buildup of stored catecholamines. MAOIs plus foods with tyrramine (red wine, cheese, chicken liver and cured meats, fava beans.) or plus sympathetomimetics

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6
Q

Hyperprolactinemia

A

Caused by dopamine blockade of tuberoinfundibular tract. Caused by high-potency traditional anti-psychotics

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7
Q

Tardive Dyskinesia

A

Choreathetoid muscle movements, usually of mouth and tongue.

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8
Q

Parkinsomism

A

Mask facies, cogwheel rigidity, resting tremor and

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9
Q

Akathisia

A

Restlessness and agitation

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10
Q

Dystonia

A

sustainded contraction of muscles of neck, tongue, eyes and diaphragm

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11
Q

NMS-neuroleptic Malignant Syndrome

A

Fever, tachycardia, hypertension, tremor, elevated creatine phosphokinase(CPK), ‘lead pipe’ rigidity

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12
Q

CYP450 Inducers

A

Decrease Drug Levels: Smoking, Carbamazepine, Barbiturates, St. Johns wort,

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13
Q

CYP450 Inhibitors

A

Drug levels increase: SSRIs: Fluvoxamine, Fluoxetine, Paroxitine, Duloxetine, Sertraline

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14
Q

Antidepressant withdrawal phenomenon

A

Dizziness, headaches, nausea, insomnia, malaise

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15
Q

Fluoxetine

A 
Prozac
Longest half life-no need to taper
Safe in pregnancy and children
More common sleep changes and anxiety
Can elevate levels of neuroleptics
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16
Q

Sertraline

A

Zoloft
Highest risk for GI disturbance
Very few drug interactions
More common sleep changes

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17
Q

Paroxitine

A

Paxil
Highly protein bound-several drug interactions
More anticholinergic effects: sedation, constipation, weight gain
Short half-life withdrawal phenomena

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18
Q

Fluvoxamine

A

Luvox
Approved only for OCD
Nausea and vomiting more common
Lots of drug interactions

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19
Q

Citalopram

A

Celexa
Fewest drug-drug interactions
Possibly fewer sexual side effects

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20
Q

Escitalopram

A

Lexapro

Similar but more expensive than Celexa

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21
Q

SSRI side effects

A

Sexual dysfunction, GI disturbance, Insomnia, Headache, Anorexia-weight loss, Restlessness, Seizures(0.2%), ‘Increases suicidal thinking.’ Serotonin syndrome
Can increase levels of warfarin

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22
Q

Venlafaxine

A 
Effexor (SNRI)
Uses-GAD, Depression, ADHD.
Low drug interaction profile
Can increase BP
Desvenlafaxine(Pristiq)-expensive metabolite
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23
Q

Duloxetine

A

Cymbalta (SNRI)
Depression and Neuropathic Pain, Fybromyalgia
More Dry mouth and constipation 2/2 norepi effects

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24
Q

Buproprion

A

Wellbutrin (NDRI)
Lack of sexual side effects compared to SSRIs
May help in ADHD
Can increase risk of seizures and psychosis in high doses. Increases anxiety in some.
Contraidicated in patients with seizure or actibe eating disorders and those on MAOIs

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25
Q

Trazodone and Nefazodone

A

Desyrel and Serzone
Refractory major depression, MDD+anxiety, insomnia
No sexual side effects, do not effect REM sleep

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26
Q

Trazodone side effects

A

Nausea, dizziness, orthostatic hyptension, cardiac arrhythmias, sedation and priapism
Liver Failure-rare but serious

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27
Q

Mirtazapine

A

Remerone
alpha 2 andtagonist
Refractory Major depression, especially in patients who need to gain weight.
Side Effects: sedation, weight gain, dizziness, somnolence, tremor, dry mouth, constipation and rare agranulocytosis

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28
Q

TCA-Tertiary amines

A

TCA which are highly anticholinergic, more sedating, and greater lethality in OD.
Amitriptyline, Imipramine, Clomipramine, Doxepin

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29
Q

TCA-Secondary amines

A

less anticholinergic, less sedating: Nortriptyline, Desipramine

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30
Q

Amitriptyline

A

Elavil-chronic pain, Migraines and insomnia

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31
Q

Imipramine

A

Tofranil-
Has IM form
Useful in enuresis and panic disorder

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32
Q

Clomipramine

A

Anafranil
Most serotonin specific
Useful in OCD

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33
Q

Doxepin

A

Sinequan
Useful in treating chronic pain
Emerging use as sleep aid in low doses

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34
Q

Nortriptyline

A

Pamelor, Aventyl
Least likely to cause orthostatic hypotension
Useful therapeutic blood levels
Useful in treating chronic pain

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35
Q

Desipramine

A

Norpramin
More activating; least sedating
Least anticholinergic

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36
Q

Tetracyclic Antidepressants

A

Amoxapine, Maprotiline

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37
Q

Amoxapine

A

Asendin
Metabolite of antipsychotic loxapine
May cause EPS with side effects similar to antipsychotics

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38
Q

Maprotiline

A

Ludiomil

Higher rates of seizure, arrhythmia, and fatality on OD

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39
Q

Major Complications of TCAs

A

Cardiotoxicity, Coma, Convulsions

40
Q

Side effects of TCAs

A

Sedation(H1), Orthostatic Hypotension(alpha1), dizziness, reflex tachycardia, arrhythmias and ECG changes(widened QRS, QT and PR), M receptors-dry mouth, constipation, urinary retention, blurred vision, tachycardia, exacerbation of narrow angle glaucoma
Weight gain, OD, Seizures,
Serotonergic effects: Erectile/ejaculatory dysfunction in males and anorgasmia in females

41
Q

TCA OD

A

Agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures and coma

42
Q

MAOIs

A

Prevent inactivation of biogenic amines: norepinephrine, serotonin, dopamine and tyramine.
MAO-A prefers to deactivate serotonin
MAO-B prefers to deactivate Nor and epinephrine
both act on dopamine and tyramine

43
Q

MAOI Examples and Uses

A

Phenelzine(Nardil)
Tranylcypromine(Parnate)
Isocarboxazide(Marplan)
Uses for refractory depression and refractory panic/anxiety disorder

44
Q

MAOI side effects

A

Serotonin syndrome, Hypertensive Crisis, Orthostatic hypotension(most common), Drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction, People with B6 deficiency can have parathesias

45
Q

AntiDep for OCD

A

SSRIs in high doses and TCAs clomipramine

46
Q

AntiDep for Panic Disorder treatment

A

SSRI, TCA(imipramine), MAOI

47
Q

AntiDep for eating disorder

A

SSRI in high dose, TCAs and MAOIs

48
Q

AntiDep for dysthymia

A

SSRI

49
Q

AntiDep for Social Phobia

A

SSRI, TCAs and MAOIs

50
Q

AntiDep for GAD

A

SSRIs, SNRIs(venlafaxine), TCAs

51
Q

AntiDep for PTSD

A

SSRIs

52
Q

AntiDep for Irritible bowel syndrome

A

SSRIs, TCAs

53
Q

AntiDep for Enuresis

A

TCAs-imipramine

54
Q

AntiDep for Neuropathic Pain

A

TCAs-amitriptyline and nortriptyline, duloxetine

55
Q

AntiDep for chronic pain

A

SSRIs, TCAs

56
Q

AntiDep for fibromyalgia

A

SSRIs

57
Q

AntiDep for Migraine Headaches

A

TCAs (amytriptyline), SSRIs

58
Q

AntiDep for Smoking Cessation

A

Buproprion

59
Q

AntiDep for Premenstrual Dysphoric Disorder

A

SSRIs

60
Q

AntiDep for Depressive phase of manic depression

A

SSRIs

61
Q

AntiDep for Insomnia

A

Mirtazipine, TCAs (amytriptyline)

62
Q

AntiDep for Depression in Elderly

A

Mirtazipine-helps with sleep and appetite

63
Q

Treatment for TCA OD

A

IV sodium bicarb

64
Q

Atypical Depression treated better by MAOIs

A

Hypersomnia, increases appetite and increases sensitivity to social rejection.

65
Q

Serotonin Syndrome-First Steps of Treatment

A

d/c meds. try Ca channel blockers(nifedipine), If carefully monitored try chorpromazine or phentolamine.

66
Q

Lamotrigine Drug Interactions

A
  • Oral contraceptives lower Lamotrigine levels
  • Lamotrigine lowers contraceptive levels
  • Valproic acid increases Lamotrigine levels
67
Q

ECG changes with Lithium

A
  • T-wave depression or inversion
  • First degree AV block and sinus node dysfunction
  • ECG changes prevalence is 30%
68
Q

Lithium and HCTZ interaction

A

HCTZ increase lithium levels
Other diuretics which can increase Li levels: ethacrynic acid, spironolactone, triamterine
NSAID (except aspirin and suldinac
Abx: metronidazole and tetracycline

69
Q

Anti-psychotics available as long acting injectibles

A
  • Haloperidol
  • fluphenazine
  • Risperidone
  • Paliperidone
70
Q

Low-Potency Typical Anti-Psychotics

A

-Chlorpromazine
-Thioridazine
Higher incidence of anti-cholinergic and anti-histaminergic and lower EPS and NMS.

71
Q

Mid-Potency Typical Antipsychotics

A
  • Loxapine
  • Thiothixene
  • Trifluoperazine
  • Perphenazine
72
Q

High-Potency Typical Antipsychotics

A

-Haloperidol
-Fluphenazine
-Pimozide
Less anti-cholinergic but more EPS and Tardive Dyskinesia. Less sedation and orthostatic hypotension

73
Q

Chlorpromazine

A 
Thorazine
Commonly causes orthostatic hypotension
Can cause a bluish skin discoloration
Can lead to photosensitivity
Can treat nausea and vomiting, as well as intractable hiccups
74
Q

Thioridazine

A

Mellaril

Associated with retinitis pigmentosa

75
Q

Loxapine

A

Loxitane
Mid-Potency Typical Antipsychotics
Higher risk of seizure
Metabolite is an antidepressant

76
Q

Thiothixene

A

Navane
Mid-Potency Typical Antipsychotics
Can cause ocular pigment changes

77
Q

Trifluoperazine

A

Stelazine
Mid-Potency Typical Antipsychotics
Can reduce anxiety

78
Q

Perphenazine

A

Trilafon

Mid-Potency Typical Antipsychotics

79
Q

Haloperidol

A

Haldol
High-Potency Typical Antipsychotics
Decanoate form available

80
Q

Fluphenazine

A

Prolixin
High-Potency Typical Antipsychotics
Decanoate form available

81
Q

Pimozide

A

Orap
High-Potency Typical Antipsychotics
Associated with heart block, v-tach and other cardiac affects

82
Q

Treatment of NMS

A
  • Discontinue current meds
  • Administer hydration and cooling
  • Dantrolene, bromocriptine and amantadine are infrequently used
83
Q

Clozapine

A

Clozaril
More efficacious-used in resistant psychosis
2% chance of Agranulocytosis and 5% seizures
More anticholinergic side effects
Can cause tachycardia and hypersalivation

84
Q

Risperdone

A

Risperdal
Can increase prolactin
Some orthostatic hypertension and reflex tachycardia
Long acting inject-able form called Consta

85
Q

Quietapine

A

Seroquel

Sedation and orthostatic hypotension

86
Q

Olanzapine

A

Zyprexa

Common side effect is weight gain

87
Q

Ziprasidone

A

Geodon

Less likely to cause weight gain

88
Q

Aripiprazole

A

Abilify
Unique mechanism of partial D2 agonism
Can be more activating (akathisia) and less sedating
Less potential for weight gain

89
Q

Paliperidone

A

Invega(Metabolite of risperidone)
Long acting injectable form
New Atypical Antipsychotic

90
Q

Asenapine

A

Saphris

New Atypical Antipsychotic

91
Q

Iloperidone

A

Fanept

New Atypical Antipsychotic

92
Q

Lithium

A
  • Uses: Bipolar, schizoaffective, cyclothymia and MDD.
  • Metabolized by kidneys so decreased doses for higher creatinine levels
  • ECG, electrolytes, TSH, CBC and BhCG before starting
  • therapeutic range is 0.6-1.2
93
Q

Lithium side-effects

A 
Nephrogenic DI
GI disturbance
Weight gain
Sedation
Thyroid enlargement, hypothyroidism
ECG changes
Benign leukocytosis
Tricuspid Malformation(Ebstein's Anomaly
94
Q

Carbamazepine

A

Tegretol

  • Useful for mixed episodes and rapid-cycling bipolar disorder, and less for depressed phase
  • trigeminal neuralgia
  • blocks sodium channels and inhibits APs
  • CBC and LFTs needed before initiation
95
Q

Carbamazepine side effects

A

GI and CNS (drowsiness, ataxia, sedation and confusion

96
Q

Hypertensive crisis can be caused by meperidine and which class of psychotropic medications?

A

MAOIS

Psychiatry (2 decks)

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