Psychiatric medications Flashcards
HAM side effects
- anitHistamine-sedation, weight gain;
- antiAdrenergic-hypotension
- antiMuscarinic-dry mouth, blurred vision, urinary retention
Which drugs show HAM side effects
TCAs and Low potency antipsychotics
Serotonin Syndrome
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.
EPS-extrapyramidal side effects
Parkonsinism, Akathisia, Dystonia
Hypertensive Crisis
Caused by buildup of stored catecholamines. MAOIs plus foods with tyrramine (red wine, cheese, chicken liver and cured meats, fava beans.) or plus sympathetomimetics
Hyperprolactinemia
Caused by dopamine blockade of tuberoinfundibular tract. Caused by high-potency traditional anti-psychotics
Tardive Dyskinesia
Choreathetoid muscle movements, usually of mouth and tongue.
Parkinsomism
Mask facies, cogwheel rigidity, resting tremor and
Akathisia
Restlessness and agitation
Dystonia
sustainded contraction of muscles of neck, tongue, eyes and diaphragm
NMS-neuroleptic Malignant Syndrome
Fever, tachycardia, hypertension, tremor, elevated creatine phosphokinase(CPK), ‘lead pipe’ rigidity
CYP450 Inducers
Decrease Drug Levels: Smoking, Carbamazepine, Barbiturates, St. Johns wort,
CYP450 Inhibitors
Drug levels increase: SSRIs: Fluvoxamine, Fluoxetine, Paroxitine, Duloxetine, Sertraline
Antidepressant withdrawal phenomenon
Dizziness, headaches, nausea, insomnia, malaise
Fluoxetine
Prozac Longest half life-no need to taper Safe in pregnancy and children More common sleep changes and anxiety Can elevate levels of neuroleptics
Sertraline
Zoloft
Highest risk for GI disturbance
Very few drug interactions
More common sleep changes
Paroxitine
Paxil
Highly protein bound-several drug interactions
More anticholinergic effects: sedation, constipation, weight gain
Short half-life withdrawal phenomena
Fluvoxamine
Luvox
Approved only for OCD
Nausea and vomiting more common
Lots of drug interactions
Citalopram
Celexa
Fewest drug-drug interactions
Possibly fewer sexual side effects
Escitalopram
Lexapro
Similar but more expensive than Celexa
SSRI side effects
Sexual dysfunction, GI disturbance, Insomnia, Headache, Anorexia-weight loss, Restlessness, Seizures(0.2%), ‘Increases suicidal thinking.’ Serotonin syndrome
Can increase levels of warfarin
Venlafaxine
Effexor (SNRI) Uses-GAD, Depression, ADHD. Low drug interaction profile Can increase BP Desvenlafaxine(Pristiq)-expensive metabolite
Duloxetine
Cymbalta (SNRI)
Depression and Neuropathic Pain, Fybromyalgia
More Dry mouth and constipation 2/2 norepi effects
Buproprion
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
Trazodone and Nefazodone
Desyrel and Serzone
Refractory major depression, MDD+anxiety, insomnia
No sexual side effects, do not effect REM sleep
Trazodone side effects
Nausea, dizziness, orthostatic hyptension, cardiac arrhythmias, sedation and priapism
Liver Failure-rare but serious
Mirtazapine
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
TCA-Tertiary amines
TCA which are highly anticholinergic, more sedating, and greater lethality in OD.
Amitriptyline, Imipramine, Clomipramine, Doxepin
TCA-Secondary amines
less anticholinergic, less sedating: Nortriptyline, Desipramine
Amitriptyline
Elavil-chronic pain, Migraines and insomnia
Imipramine
Tofranil-
Has IM form
Useful in enuresis and panic disorder
Clomipramine
Anafranil
Most serotonin specific
Useful in OCD
Doxepin
Sinequan
Useful in treating chronic pain
Emerging use as sleep aid in low doses
Nortriptyline
Pamelor, Aventyl
Least likely to cause orthostatic hypotension
Useful therapeutic blood levels
Useful in treating chronic pain
Desipramine
Norpramin
More activating; least sedating
Least anticholinergic
Tetracyclic Antidepressants
Amoxapine, Maprotiline
Amoxapine
Asendin
Metabolite of antipsychotic loxapine
May cause EPS with side effects similar to antipsychotics
Maprotiline
Ludiomil
Higher rates of seizure, arrhythmia, and fatality on OD
Major Complications of TCAs
Cardiotoxicity, Coma, Convulsions
Side effects of TCAs
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
TCA OD
Agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures and coma
MAOIs
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
MAOI Examples and Uses
Phenelzine(Nardil)
Tranylcypromine(Parnate)
Isocarboxazide(Marplan)
Uses for refractory depression and refractory panic/anxiety disorder
MAOI side effects
Serotonin syndrome, Hypertensive Crisis, Orthostatic hypotension(most common), Drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction, People with B6 deficiency can have parathesias
AntiDep for OCD
SSRIs in high doses and TCAs clomipramine
AntiDep for Panic Disorder treatment
SSRI, TCA(imipramine), MAOI
AntiDep for eating disorder
SSRI in high dose, TCAs and MAOIs
AntiDep for dysthymia
SSRI
AntiDep for Social Phobia
SSRI, TCAs and MAOIs
AntiDep for GAD
SSRIs, SNRIs(venlafaxine), TCAs
AntiDep for PTSD
SSRIs
AntiDep for Irritible bowel syndrome
SSRIs, TCAs
AntiDep for Enuresis
TCAs-imipramine
AntiDep for Neuropathic Pain
TCAs-amitriptyline and nortriptyline, duloxetine
AntiDep for chronic pain
SSRIs, TCAs
AntiDep for fibromyalgia
SSRIs
AntiDep for Migraine Headaches
TCAs (amytriptyline), SSRIs
AntiDep for Smoking Cessation
Buproprion
AntiDep for Premenstrual Dysphoric Disorder
SSRIs
AntiDep for Depressive phase of manic depression
SSRIs
AntiDep for Insomnia
Mirtazipine, TCAs (amytriptyline)
AntiDep for Depression in Elderly
Mirtazipine-helps with sleep and appetite
Treatment for TCA OD
IV sodium bicarb
Atypical Depression treated better by MAOIs
Hypersomnia, increases appetite and increases sensitivity to social rejection.
Serotonin Syndrome-First Steps of Treatment
d/c meds. try Ca channel blockers(nifedipine), If carefully monitored try chorpromazine or phentolamine.
Lamotrigine Drug Interactions
- Oral contraceptives lower Lamotrigine levels
- Lamotrigine lowers contraceptive levels
- Valproic acid increases Lamotrigine levels
ECG changes with Lithium
- T-wave depression or inversion
- First degree AV block and sinus node dysfunction
- ECG changes prevalence is 30%
Lithium and HCTZ interaction
HCTZ increase lithium levels
Other diuretics which can increase Li levels: ethacrynic acid, spironolactone, triamterine
NSAID (except aspirin and suldinac
Abx: metronidazole and tetracycline
Anti-psychotics available as long acting injectibles
- Haloperidol
- fluphenazine
- Risperidone
- Paliperidone
Low-Potency Typical Anti-Psychotics
-Chlorpromazine
-Thioridazine
Higher incidence of anti-cholinergic and anti-histaminergic and lower EPS and NMS.
Mid-Potency Typical Antipsychotics
- Loxapine
- Thiothixene
- Trifluoperazine
- Perphenazine
High-Potency Typical Antipsychotics
-Haloperidol
-Fluphenazine
-Pimozide
Less anti-cholinergic but more EPS and Tardive Dyskinesia. Less sedation and orthostatic hypotension
Chlorpromazine
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
Thioridazine
Mellaril
Associated with retinitis pigmentosa
Loxapine
Loxitane
Mid-Potency Typical Antipsychotics
Higher risk of seizure
Metabolite is an antidepressant
Thiothixene
Navane
Mid-Potency Typical Antipsychotics
Can cause ocular pigment changes
Trifluoperazine
Stelazine
Mid-Potency Typical Antipsychotics
Can reduce anxiety
Perphenazine
Trilafon
Mid-Potency Typical Antipsychotics
Haloperidol
Haldol
High-Potency Typical Antipsychotics
Decanoate form available
Fluphenazine
Prolixin
High-Potency Typical Antipsychotics
Decanoate form available
Pimozide
Orap
High-Potency Typical Antipsychotics
Associated with heart block, v-tach and other cardiac affects
Treatment of NMS
- Discontinue current meds
- Administer hydration and cooling
- Dantrolene, bromocriptine and amantadine are infrequently used
Clozapine
Clozaril
More efficacious-used in resistant psychosis
2% chance of Agranulocytosis and 5% seizures
More anticholinergic side effects
Can cause tachycardia and hypersalivation
Risperdone
Risperdal
Can increase prolactin
Some orthostatic hypertension and reflex tachycardia
Long acting inject-able form called Consta
Quietapine
Seroquel
Sedation and orthostatic hypotension
Olanzapine
Zyprexa
Common side effect is weight gain
Ziprasidone
Geodon
Less likely to cause weight gain
Aripiprazole
Abilify
Unique mechanism of partial D2 agonism
Can be more activating (akathisia) and less sedating
Less potential for weight gain
Paliperidone
Invega(Metabolite of risperidone)
Long acting injectable form
New Atypical Antipsychotic
Asenapine
Saphris
New Atypical Antipsychotic
Iloperidone
Fanept
New Atypical Antipsychotic
Lithium
- 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
Lithium side-effects
Nephrogenic DI GI disturbance Weight gain Sedation Thyroid enlargement, hypothyroidism ECG changes Benign leukocytosis Tricuspid Malformation(Ebstein's Anomaly
Carbamazepine
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
Carbamazepine side effects
GI and CNS (drowsiness, ataxia, sedation and confusion
Hypertensive crisis can be caused by meperidine and which class of psychotropic medications?
MAOIS
