Psychiatry Flashcards
Opioids
Intoxication: euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction, seizures
Treatment: naloxone, naltrexone
Withdrawal: sweating, dilated pupils, lacrimation, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea
Treatment: long term suppport, mehodone, buprenoprhine
Benzodiazepines
Intoxification: greater safety margin. Ataxia, minor respiratory depression.
Treatment: supportive care, consider flumazenil
Withdrawal: sleep disturbance, depression, rebound anxiety, seizure, tachycardia palpitations, psychosis
Caffeine
Intoxication: Restlessness, increased diuresis, muscle twitching
Withdrawal: lack of concentration, headache
Nicotine
Intoxication: Restlessness
Withdrawal: irritability, anxiety, craving, increased appetite, dysphoria
CYP 450 inducer
Treatment: nicotine patch, gum, or lozenges
Buproprion/varenicline
Venlafaxine
SNRI
MOA: inhibit 5-HT and NE reuptake
Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN
Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea, increased intraocular pressure
Withdrawal effects: flu, electric shocks
Methadone
MOA: LONG ACTING oral opiate, mu receptor agonist
Used for heroin detoxification to suppress withdrawal symptoms
Fluphenazine
MOA: block dopamine receptors (increase cAMP)
High potency
Can be given in bi-monthly injection
Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS
Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures
galactorrhea
Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)
Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements
Alcohol
Intoxication: emotional liability, slurred speech, ataxia, coma, blackouts,
Serum y-glutamyltransfersase-sensitive indicator of alcohol use
Lab AST value is 2x ALT value
Chronic: Down regulates GABA receptors, up regulates NMDA receptors
Withdrawal:
Mild-symptoms similar to other depressants
Severe alcohol withdrawal can cause autonomic hyperactivity (increased temp and RR, insomnia) and Delirum tremens
Seziures, tachycardia, palpitatons
First manifestation is the shakes (tremors)
Treatment for Delirum tremens: benzodiazepines
Marijuana (cannabinoid)
MOA: Active ingredient in THC which stimulates canniboid receptors CB1 and CB2
Intoxication: euphoria, paranoid delusions, perception of slowed time, slowed reflexes, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injection, rapid heart rate, hallucinatons, short term memory loss
Prescription: dronabinol uses as antiemetic in chemo and appetite stimulant in AIDS
Withdrawal: irritability, depression, insomnia, nausea, anorexia
Symptoms peak in 48 hours
detectable in urine for 4-10 days but up to 30
stored in lipophilic tissues
Naloxone + buprenorphine
MOA: partial agonist
Long acting with fewer withdrawal symptoms than methadone
Naloxone not active if taken orally
Quetiapine
Atypical antipsychotic
MOA: Dopamine and sertonin antagonist
Clinical: schizophrenia positive and negative symptoms
MDD, PTSD
Toxicity: Least likely extrapyramidal, less anticholinergic side effects than traditional antipsychotics
increase glucose, lipids, weight gain, orthostasis, esophageal dysmotility,
SEDATING, CATARACTS, PARKINSON’s
PCP (phencyclidine)
MOA: antagnozies NMDA receptors
Intoxication: belligerence, impulsivness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, ataxia, psychosis, delirium, seizures
Death due to trauma
Treatment: benzodiazpeines, rapid-acting antipsychotic
Withdrawal: depression, anxiety, irritability, restlessness, anergia (lack of energy), distrubances of thought and sleep
Naltrexone
Long acting opioid antagnosist used for relapse prevention once detoxified
Haloperidol
MOA: block dopamine receptors (increase cAMP)
High potency
Clinical: Schizophrenia positive symptoms, psychosis, acute mania, acute psychosis, Tourette syndrome AND HUNTINGTONS
Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures
galactorrhea
Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)
Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements
Thioridazine
MOA: block dopamine receptors (increase cAMP)
Low potency
Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS
Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures
galactorrhea
Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)
Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements
RETINAL DEPOSITS
Mirtazapine
Atypical antidepressant
MOA: alpha2 antagonist (increases release of NE and 5HT) and potent 5HT2 and 5HT3 receptor antagonist
Toxicity: sedation (insomnia patients), increased appetite, weight gain (elderly, cancer or anorexic patients), dry mouth, agranulocytosis
Use in elderly
NO sexual and little GI side effects!
Olanzapine
Atypical antipsychotic
MOA: Dopmain and sertonin antagonist
Clinical: Schizophrenia positive and negative symptoms
Bipolar disorder,
Toxicity: Fewer EPS and anticholinergic side effects than traditional antipsychotics
Orthostasis, esophageal dysmotility
Weight gain-increased lipids and LFTS
Fluoxetine (Prozac)
MOA:Serotonin reuptake inhibitors
Take 4-8 weeks to have an effect use BDZs temporarily
Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose
CYP450 inhibitor
Longest half life-no need to taper
Safe in pregnancy and with children
Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim
Toxicity: Fewer side effects than TCAs
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, weight loss, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Can cause weight loss
Watch with cough supprsesant for serotonin syndrome
Aripiprazole
Atypical antipsychotic
MOA: dopamine and serotonin antagonist, partial dopamine agonist
Clinical: schizophrenia positive and negative symptoms
Bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome
Toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotcs
incresaed glucose, lipids, weight, orthostatsis, esophageal dysmotility
SEIZURES, MANIA, AKATHESIA
Serotonin syndrome
Occurs with any drug that increases serotonin
Linezolid, TCAs, MAO inhibitors, SNRIs, triptans, tramadol, SSRIs
Symptoms: hyperthermia confusion, myoclonus, cardiovascular collapse, tachycardia, flushing, diarrhea, seizures, diaphoresis, rhabdomyolysis, renal failure, and death
Treatment: cyproheptadine (5HT Receptor antagonist) and stop medications
Modafinil
Non amphetamine stimulant
1st line for narcolepsy
CYP-450 inducer
Amphetamines
Intoxication: euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia,fever, diaphroresis, choreiform movements, tooth decay
Severe: cardiac arrest, seizure
Withdrawal: anhedonia (can’t experience pleasure from activities), increased appetite, hypersomnolence, existential crisis (question life)
Buspirone
MOA: stimulates 5-HT receptors
Clinical: generalized anxiety disorder
Does not cause sedation, addiction or tolerance
Does not interact with alcohol-useful in abuse patients
Takes 1-2 weeks to take effect
Lithium
MOA: not established
Clinical: mood stabilizer for bipolar disorder, blocks relapse and acute manic events, SIADH, Alcohol dependency, aggression
Toxicity: tremor, sedation, edema, heart block, ataxia, delirium, hypothyroidism, polyuria, n/v, slurred speech, hyperreflexia, metal taste, weight gain, seizures
CAN CAUSE NEPHRONGENIC DIABETES INSIPIDUS
Ebstein anomaly and malformation of great vessels
Thiazide diuretics, ACE inhibitors and NSAIDS increase lithium levels
MNOP: movement (tremor), nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy probs
Methylphenidate, dextroampheatmine, metamphetamine, phentermine
MOA: increase catecholamines at the synaptic cleft, especially NE and dopamine
Treat: ADHD, narcolepsy, appetite control
Buproprion
Atypical antidperessant
MOA: increase NE and dopamine by inhibiting presynpatic uptake
Clinical: atypical depression and smoking cessation, migraines, depression in bipolar, adult ADHD
Toxicity: stimulant effects (tacchycardia, insomnia), headache, nausea
DON’T USE IN PATIENTS WITH EATING DISORDERS, EPILEPSY, OR ALCOHOL ABUSE DUE TO INCREASE RISK OF SEIZURES and psychosis or on MAOI
No sexual side effects!!!
Trazodone
MOA: blocks 5Ht2 and alpha1 adrenergic receptors
Clinical: primarily insomnia, high doses needed for antidepressant
Toxicity: sedation, nausea, priapism (constant boner), postural hypotension, hepatotoxicity, dizziness, orthostatsis, cardiac arrhythmias
Ziprasidone
Atypical antipsychotic-
MOA: Dopamine and serotonin antagonist
Clinical: Schizophrenia positive and negative symptoms,
Bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome
Toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotics
May prolong QT interval should obtain ECGs
Less metabolic side effects
Akathisia
reslessnes and agiation
Treatment: B-Blocker
Cocaine
MOA: Blocks reuptake of monoamines
Intoxication: impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death (coronary artery vasospasm), stroke, intracranial hemorrhage, seizures, sympathetic stimulation-tachycardia
Treatment: benzodiazepines
Withdrawal: hypersomonlence, malaise, severe psychological craving, depression/suicidality, increased appetite, psychomotor retardation, MI (increased demand and decreased perfusion)
Resperidone
Atypical antipsychotic
MOA: Dopamine and Serotonin antagonists
Fast acting
Clinical: Schizophrenia positive and negative symptoms
Bipolar disorder OCD, anxiety disorder, depression, mania, Tourette syndrome/tics
toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotics (however most likely atypical antipsychotic to cause EPS)
Increases prolactin leading to lactation and gynecomastia
Decreases GnRH, LH and FSH causing irregular menstruation and fertility issues
Varenicline
MOA: reinforces effects of nicotine that lead to dependene through partial agonistic acitivity on a4B2 nicotinic acetylcholin recpetor in CNS
Decreases symptoms of withdrawal and attenuating rewards
Clozapine
Atypical antipsychotics
MOA: Dopamine and serotonin antagonist
Acts on D4 receptors
Clinical: schizophrenia positive and negative symptoms (treatment resistant Schizo)
Toxicity: NO EPS and anticholinergic side effects than traditional antipsychotics (least likely atypical antipsychotic to cause EPS)
weight gain
AGRANULOCYTOSIS-requires weekly WBC monitoring
Seizures
MYOCARDITIS
LSD (Lysergic Acid Diethylamide)
Intoxication: perceptual distortion (visual auditory), visual hallucinations, depersonalization, anxiety, paranoia, psychosis, possible flashback
Phenelzine
MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off
Clinical: atypical depression, anxiety, hypochondriasis
Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine
Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome
Barbituates
intoxication: Low safety margin, marked respiratory depression
CYP450 Inducers
Treatment: symptom management-assist respiration, increase BP
Withdrawal: delirium, life threatening cardiovascular collapse
Electro convulsive therapy
Produced painless seizure in anesthetized patient
Treatment for major depressive disorder refractory to other treatments or pregnant women with depression
Or when immediate response is necessary (suicide)
Depression with psychotic features and Catatonia are also indications
AE: disorientation, temporary headache, and partial anterograde/retrograde amnesia fully resolving in 6 months
Psychoanalysis
Goal is to resolve unconscious conflicts by bringing repressed experiences and feelings into awareness
Insight oriented
Patients: under the age of 40, not psychotic, intelligent, in stable relationships and function daily
Useful in: Cluster C, Anxiety Disorders, OCD, Problems coping with life events, anorexia nervosa, sexual disorders, dysthymic disorder
Focus: unconscious conflicts cause symptoms, explore positive relationships, break down defense mechanisms , talk about problems
Behavioral Therapy
Helping patients change behaviors that contribute to their symptoms
Extinguishes maladaptive behaviors by replacing htem with healthy alternatives
Classical and operant conditioning
flooding: phobic disorders
Systemic desensitization: phobic disorders
Aversion therapy: paraphilias, substance abuse
Token economy: showering, shaving
Biofeedback: migraines, agoraphobia, fecal incontinence, tension headache, asthma, hypertension, chronic pain
Fluvoxamine (Luvox)
MOA:Serotonin reuptake inhibitors
CYP450 inhibitor
Lots of drug interactions
Clinical: ONLY OCD
Toxicity:
Nausea and vomiting more common
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Watch with cough supprsesant for sserotonin syndrome
Cognitive Behavioral Therapy
Combines cognitive therapy and behavior therapy
patient learns how behaviors is influenced by thoughts
used in: depression, anxiety, and substance abuse
Hyperprolactinemia
Seen with high potency traditional anti-psychotics (haloperidol and trifluoperazine) and risperidone
Hypertensive Crisis
Caused by builldup of stored catecholamines (NE)
MAOIs + foods with tyramine (red wine, cheese, chicken liver, cured meats) or plus sympathomimetics
Treat with: Phentolamine
Dystonia
Sustained contraction of muscles of neck, tongue, eyes, diaphragm
within days
High potency traditional antipsychotics (haloperidol and trifluoperazine)
Treat with: benedryl/cogentin
Group Therapy
Patients with similar problem or pathology meet together with a therapist for group sessions
Treat: substance abuse, adjustment disorder, eating disorder and personality disorders
Advantages: patients get immediate feedback and support from peers and may gain insight
Universilization: patient is not alone in their suffering
Group cohesion: group working towards same goal
Parkinsonism
Masklike face, cogwheel rigidiity, pill rolling tremor
Occur with high potency traditonal antipsychotics (haloperidiol and trifluoperazine)
Happens within months
Treat with benztropine
Cognitive Therapy
Corrects faulty assumptions and negative feelings that exacerbate psychiatric symptoms
Treats: depression and anxiety
paranoid personality disorder, OCD, somatoform disorder, and eating disorders
Tardive Dyskinesia
Choreoatetoid muscle movements usually of mouth and tongue
Occur after years of antipsychotic use particularly high potency traditional antipsychotics (haloperidol, trifluoperazine)
Can be irreversible
Treat with benztropine
Neuroleptic maligant syndrome
Fever, tachycardia, hypertension, tremor, elevated CPK, lead pipe rigidity, leukocytosis,
Can be caused by all antipsychotics after short or long time (increased risk with high potency traditional antipsychotics-haloperidol and trifluoperazine)
Treatment: stop drug, benedryl, dantrolene/bromocriptine/amantadine
Amitriptyline
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
also for pain
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Sertraline (Zoloft)
MOA:Serotonin reuptake inhibitors
Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose
CYP450 inhibitor
Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim
Toxicity: Fewer side effects than TCAs
highest risk of GI distress (N/V/D), sedation
sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, weight loss, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Watch with cough supprsesant for sserotonin syndrome
Withdrawal phenomenom of antidpressants
dizziness, headaches, nausea, insomnia and malaise
May need to be tapered
Paroxetine (Paxil)
MOA:Serotonin reuptake inhibitors-stimulant
Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose
CYP450 inhibitor
Short half life can lead to withdrawal phenomena
Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim
Toxicity: Fewer side effects than TCAs
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety,
More anticholinergic SE: sedation, constipation, weight gain, headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Worse for sexual sdie efects and weight gain
Late night sedation
Several Drug interactions
Watch with cough supprsesant for sserotonin syndrome
Dialectical Behavior Thearpy
Diminishes self destructive behaviors and hospitalizations
Incorporates cognitive and supportive techniques, improve emotion and regulation, distress tolerance, mindful awareness
Treats: Borderline personality disorder, self injury
Citalopram (Celexa)
MOA:Serotonin reuptake inhibitors
Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose
Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim
Toxicity: Fewer side effects than TCAs
LEAST Sexual side effects
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Can increase QTc interveal
FEWEST Drug interactions
Watch with cough supprsesant for sserotonin syndrome
Desvenlafaxine
SNRI
MOA: inhibit 5-HT and NE reuptake
Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN
Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea
Duloxetine
SNRI
MOA: inhibit 5-HT and NE reuptake
Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN
Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea, hepatatoxicity, bleeding
Milnacipran
SNRI
MOA: inhibit 5-HT and NE reuptake
Clinical: Only fibromyalgia
Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea
Nefazodone
MOA: blocks 5Ht2 and alpha1 adrenergic receptors
Clinical: primarily insomnia, high doses needed for antidepressant
Toxicity: sedation, nausea, postural hypotension, hepatotoxicity, dizziness, orthostatsis
Liver failure-black box warning
Levomilnacipran
SNRI
MOA: inhibit 5-HT and NE reuptake
Clinical: depression with pain
Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea
Clomipramine
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
OCD-clomipramine
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QRS prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Escitalopram (Lexapro)
MOA:Serotonin reuptake inhibitors
Much like citalopram but more expensive!
Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose
Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim
Toxicity: Fewer side effects than TCAs
LEAST Sexual side effects
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects
Fewest Drug interactions
Watch with cough supprsesant for sserotonin syndrome
Imipramine
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
also enuresis and pain
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Nortriptyline
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
Also for enuresis
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Doxepin
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Trimipramine
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Isocarboxazid
MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off
Clinical: atypical depression, anxiety, hypochondriasis
Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine
Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome
Tranylcypromine
MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off
Clinical: atypical depression, anxiety, hypochondriasis
Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine
Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome
Clonazepam
MOA: increases GABA by increasing frequency of Cl- channel opening
Intermediate acting
Uses: seizures, insomnia, GAD, Alcohol withdrawal
PANIC ATTACKS
Lethal with alcohol
Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Clonidine
a2 agonists
Used for opioid detoxification, tourrettes/tics
Propanolol
Used for panic attacks, social phobia, akathesia
Helps with sweating and tachycardia
Donepezil
Cholinesterase inhibitor
slows progression of Alzheimers
Zolpidem
For sleep
Not a BDZ
But binds to same receptor
No addiction and no withdrawal
Alprazolam
MOA: increases GABA by increasing frequency of Cl- channel opening
Short acting
Uses: seizures, insomnia, GAD, Alcohol withdrawal
PANIC ATTACKS
Lethal with alcohol
Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Interpersonal Therapy
For: relationship conflicts, life role transitions, grief
Focus current relationships and conflicts
memantine
NMDA antagonist
Used in alzheimers
Perphenazine
MOA: block dopamine receptors (increase cAMP)
Low potency
Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS
Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures
galactorrhea
Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)
Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements
Chlropromazine
MOA: block dopamine receptors (increase cAMP)
Low potency
Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS
Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures
BLUE SKIN, CORNEAL DEPOSITS
galactorrhea
Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)
Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements
Lorazepam
MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep
Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY
Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal
Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration
Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Supportive therapy
For: lower functioning patient, psychotic, cognitively impaired, acute life crisis
Focus: reinforce coping skills, build up adaptive defense mechanisms
Carbamazepine
blocks Na-voltage gated channels, increases GABA
used for bipolar rapid cycling, mixed episodes
Side effects: increased LFTs, teratogenic, hyponatremia, aplastic anemia
Lamotrigine
No acute use, used for mood stabilization
Side effects: rash, cytopenias, multi-organ hypersensivity
Oxazepam
MOA: increases GABA by increasing frequency of Cl- channel opening
Short acting
Uses: seizures, insomnia, GAD, Alcohol withdrawal
Lethal with alcohol
Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Triazolam
MOA: increases GABA by increasing frequency of Cl- channel opening
Short acting
Uses: seizures, GAD, Alcohol withdrawal
INSOMNIA
Lethal with alcohol
Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Chlrodiazepam
MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep
Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY
Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal
Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration
Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Valproic Acid
Increases GABA
Used: bipolar disorder, alcohol dependenc, psychosis, agression, rapid cycling bipolar
Side effects: teratogenic, hepatotoxic, thrombocytopenia, nausea, sedation, alopecia, pancreatitis
Diazepam
MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep
Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal
Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration
Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Tacrine
Cholinesterase inhibitor
Slows progression of Alzheimers
Zaleplon
For sleep
Not a BDZ
But binds to same receptor
No addiction and no withdrawal
Motivational therapy
Used in substance abuse
Address ambivalence to change, non judgmental, enhance motivation to change
Temazepam
MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep
Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY
Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal
Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration
Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
Despramine
MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine
Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
LEAST SIDE EFFECTS, LEAST SEDATING
Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias
Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)
CAUTION in BPH
Biofeedback therapy
For: prominent physical symptoms that accompany psych symptoms
Focus: improve awareness and control over physiological reactions
Lower stress levels
Integrate mind and body
Flurazepam
MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep
Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal
Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration
Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)
