Psychopharm Flashcards
Which of the following antidepressants has minimal norepinephrine selectivity?
- citalopram and escitalopram most selective serotonin and very little inhibition of NE and dopamine
NE activitity of SSRIs (highest to lowest): Paroxetine (somewhat significant) Fluoxetine (somewhat significant) Sertraline FluvoxamineCitalopram (very minimal) Escitalopram
Which TCA has most norepinephrine sensitivity?
- Desimipramine
2. Nortryptilline
Serotonin Syndrome?
Lab abnormalities: metabolic acidosis, rhabdomylosis, elevated serum AAT, creatiine, DIC*
hypERthermia, agitation, tremor, akithesia, deep tendon hypERreflexia, spontaenous CLONUS, DILATED PUPILS
Drugs associated with serotonin syndrome?
SSRI
Trazodone, Nefazodone, Clomipramine, Buspirone, Venlafaxine
MAOi - phenelzine, moclobemide, clorgiline,
Anticonvulsants - valproate
Analgesics - meperidine, fentanyl, pentazocine
Antiemetics - ondansetron, graniesteron, metclopramide
Antibiotics - linezolid
Lithium
MAOI side effects
OWEIS O- Orthostasis W - Weight gain E - edema/peripheral I - Insomnia S - sexual dysfunction
Pharmacokinetics w/aging
no change to conjucation and glucornidation
decreased hydroxylation and demethylation
decreased oxidation/decreased reduction
What don’t you use with clozapine?
Carbamezapine - increases agranulocytosis - BM suppression
Clozapine toxcitiy?
hypotension NOT hypERtension
Clonidine- pharm actions?
works on presynaptic - 2 adrenergic receptors- agonist
opp of heroin withdrawal
dry mouth, constipation, dizziness, hypotension
CYP1A2
- Fluvoxamine
- Fluoxetine
Minimal
- Bupropion
- Mirtazapine
- Paroxetine
- Sertraline
- Venlafaxine
CYP2D6
- Bupropion, Fluoxetine, Paroxetine
Mod - Citalopram, Escitalopram, Sertraline
Low - Fluvoxamine Mirtazapine Nefazodone Venlafaxine
CYP3A4/CYT p450
High:
Fluvoxamine
Nefazodone
Tricyclics
Fluoxetine
Sertraline
Low: citralopram escitalopram mirtazapine paroxetine venlafaxine
Largest risk for TD ?
elderly female
SSRI - side effects
platelet aggregation
What is least histaminergenic/ach?
desimpramine
Most common side effect of Trazodone?
Headache
2A & C reuptake inhibitor
NMS
Hyperthermia Mental status change CK elevation Blood pressure elevation Diaphoresis Urinary incontience
Lamotrogine - MOA
blockade of voltage gated Na channels
modulates release of glutumate and aspartate
Buspirone - MOA
affinity 5HT1A moderate affinity D2 no effect on GABA in GAD. Buspirone does not cause weight gain, sexual dysfunction, discontinuation symptoms, or significant sleep disturbance. It does not produce sedation or cognitive and psychomotor impairment. The most common adverse effects of buspirone are headache, nausea, dizziness, and (rarely) insomnia.
Tetrabenzine
Depression
VMAT
Carbamezapine
rash mild hematopoetic suppression sedation H- Headache A - Ataxia R - Rash D - Dizziness S - Sexual Dysfunction A - Anemia/Agranulocytosis N - Nausea D - Diplopia
Lithium induced tremor - tx
Propanolol
Anticholinergic toxcitiy
BLIND AS A BAT, MAD AS A HATTER blurred vision - mydriasis fever dry mouth tachycardia urinary retention ileus hypotension
Worst SSRI - sexual dysfunction
paroxetine
stimulation of 5Ht2
worse because it impairs NOS
Desimipramine
no SRI activity
all NRI*
MOA - Mirtazapine
alpha-2 antagonist, 5HT2A/C antagonist, H1 antagonist
Psychostimulants - key interactions
Psychostimulants may increase the level of phenytoin, carbamazepine, and phenobarbital.
At the same time, these antiepileptics may lower the psychostimulant level as they act as universal enzyme inducers.
Psychostimulants increase the level of MAO inhibitor and TCAs. Possible increase in SSRI level.
Psychostimulants may increase the effect of warfarin.
Valproic acid – increased concentrations of valproic acid: consider monitoring serum valproic acid concentrations.
Heart rate-lowering drugs: concomitant use not recommended.
Contraindications to psychostimulants
Treatment with MAO inhibitors and for up to 14 days
Pre-existing severe gastrointestinal narrowing after discontinuation
Advanced arteriosclerosis
Glaucoma
Known hypersensitivity or allergy to the products
Untreated hyperthyroidism
Moderate to severe hypertension
