Psychopharm Nuggets Flashcards
Medications approved for OCD
fluvoxamine paroxetine sertraline fluoxeteine clomipraine (look for anticholinergic side effects and sedation)
TCA’s used for insomnia
Amitrityline
Doxepin
Common side effects associated with anticholinergics
dry mouth, constipation, tachycardia
Off label uses for wellbutrin other than the standard depression
ADHD, bipolar depression, and sexual dysfunction caused by SSRI
Target dose for wellbutrin for managing depression
300 mg total
Difference in how you dose wellbutrin when prescribing SR,IR,or ER
SR and IR need BID dosing (separate at least 6-8 hrs to decrease risk of seizures)- there is a higher risk for seizures with larger doses of wellbutrin in SR and IR versions
ER is once a day
Ways that seizure risk is increased with wellbutrin
SR/IR at high doses (>450)
Crushing and snorting it, chewing it, dividing it
Receptors that wellbutrin acts on
DA and NE reuptake inhibitors
Common side effects of wellbutrin
Agitation, insomnia, headache, nausea, vomiting, tremor, tachycardia, dry mouth, weight loss.
Ideal depressed patients that would benefit from wellbutrin
Those with poor concentration and fatigue and concerned about weight gain
Factors to base SSRI decision on
side effects, cost, and drug interactions
All of the SSRI’s are technically of the same efficacy
Which SSRI is associated with a prolonged QTc
Citalopram (studies noted that when given doses greater than 40 mg daily, QTc prolonged)
This is not seen with escitalopram
Which SSRI has the least drug interactions
Escitalopram, racemic version of citalopram
Which SSRI is most associated with anxiety, insomnia, and decreased appetite
fluoxeteine/prozac
What disorder is fluvoxamine often used for
OCD
Con’s with prescribing fluvoxamine
BID dosing and risk for drug interactions
What sexual dysfuntion is an SSRI helpful for
premature ejaculation
Which benzo is a good one to start with for anxiety if needed
clonazepam because of it’s long half life and has a gradual onset and offset
Time frame regimen for rx ssri + benzo
start patient on ssri and benzo, but then tell them the plan to stop the benzo in 2 weeks because they will no longer need it because the SSRI would have started to kick in by then
When is propranolol useful in anxiety
when the patient is experiencing somatic symptoms like heart pounding and shortness of breath and shaking/tremors
Why is prescribing benzos and opiates a no-no
increased risk of profound sedation, respiratory depression, coma, and death
Mechanism of propranolol
non-selective beta 1 and beta 2 antagonists
Dosage range for propranolol
10mg -40 mg BID
When would you want to use propranolol with lithium
if there is a lithium induced tremor
Metabolism of propranolol
CYP2D6
How long until you see some effect when starting an antidepressant
It is actually 1-2 weeks the patient should see some impovement (2-4 weeks is actually a myth according to maudsley)
When should you consider switching an antidepressant
if there is NO response at all by 3-4 weeks (if they experience some relief then don’t switch, they may get a full response in a few more weeks)
What side effects are associated with paxil
weight gain and sexual dysfunction
What SSRI is associated with diarrhea the most
zoloft
Cardiac side effects associated with TCA’s
prolonged QTc, tachycardia, hypotension
When is suicide risk the highest with antidepressants
when first starting the medication and when discontinuing it
(still good to place people on SSRI beccause treating depression is the best way to prevent suicide and SSRI’s is one of the best treatments for now that we have)
How long should a patient be on an antidepressant
6-9 months for single episodes
do SSRI’s treat the cause of depression
NO, they only help to relieve the symptoms
At what point should you assess to see if a patient is experiencing benefit from SSRI
2 weeks! switch to another agent
An indication to use IR buproprion
Pt’s with bariatric surgery, concerns about how it is absorbed
Alternative medication combo with fluoxeteine for treatment resistant depression
combine with olanzapine, typically is related to bipolar depression
Meds often used as adjucnt to SSRI when treatment resistant depressione
lithium, quetiapine (150-300 mg), abilify (2-10 mg), buproprion (up to 400 mg), or mirtazipine (can do combo of venlafaxine also, but in general with adding mirtazipine, there is a theoretical risk of serotonin syndrome)
What are the cons associated with ketamine treatment in resistant depression (Pro is rapid response)
has to be done in the hospital if IV and need multiple sessions
What dose of T3 is needed for adjunct in resistant depression
20-50 micrograms
Dose of omega 3 for depression adjunts
1-2 grams daily
Best treatment for depression with psychotic features
combination of SSRI + antipsychotic OR TCA (imipramine) alone
Also consider ECT, effective and thought to be protective against relapsing into it again
With ECT, meds that decrease the duration of the seizure (meds you want to hold)
Benzos, AED’s, barbituates.
Some recommend holding lithium because it increases the risk of confusion- actually increases length of seizure possibly
What population should TCA’s be avoided in
those with cardiac issues and elderly patients, Go for SSRI’s
Benefits of stimulants in depression
euphoria, wakefulness, and improved fatigue (although modafanil does not provide euphoria but don’t have to worry about dependence or tolerance like the other ones)
Not really recommended to use stimulants in depression though
When might using stimulants in depression be a good idea
for patients on hospice who are not expected to live for much longer
Which antidepressants have been studied the most and found to be the most tolerable and effective in post-stroke
zoloft, prozac, celexa, and nortriptyline
Nortriptyline is not associated with increased bleeding risk if stroke was hemorrhagic or the patient is on an anticoagulant
Celexa does not affect the enzymes related to anticoagulants as well
Risks associated with SSRI’s in elderly
- increased risk of bleeding (if on NSAIDS, warfarin, or steroids)
- more likely to develop hyponatremia from it
- hypotension
- falls
SSRI’s that are more likely to have drug-drug interactions
fluvoxamine, fluoxetine, and paroxetine because they are potent CYP inhibitors
SSRI’s that are least likely to have drug- drug interactions
sertraline, citalopram, escitalopram, and vortioxetine
Which SNRI/SSRI is the most toxic in the case of overdose
venlafaxine
Adverse effects seen in TCA’s
can lead to anticholinergic effects (urinary retention, dry mouth, blurry vision), seizures, cardiac arrythmias
what increases the risk of reccurence of depressive episodes?
Having multiple episodes, the more episodes you have the more likely you are to have another episode in comparison to someone who has only had 1 episode
When continuing antidepressant therapy and their symptoms have improved, should you adjust their dose?
No, keep it at the same treatment dose. There is no benefit in decreasing it
Discontinuation syndrome vs withdawal
discontinuation = symptoms that you experience when you stop a drug that is not a drug of dependence
withdrawal = symptoms associated with drugs of dependence
Types of symptoms experienced in discontiuation syndrome
GI, affective, neuro (parastheisas or increased dreaming)
Which psych meds increases the risk of discontinuation syndrome
ones with short half lifes (paxil and effexor)
Common symptoms assosicated with SSRI discontinuation syndrome
Flu like symptoms Shock like sensations dizziness worse with movement insomnia vivd dreaming irritability crying spells
(Paxil and venlafaxine)
Common discontinuation syndrome symptoms with TCA’s
Flu like
insomnia
excessibe dreaming
Common discontinuation syndrome symptoms with MAOI
agitation irritability ataxia vivid dreams slowed/pressured speech
The time frame you should take to discontinue an antidepressant
4 weeks (especially for one’s that have a shorter half life)
If discontinuation symptoms are bad, may do it slower or introduce one with a longer half life and taper
How long do you have to take an antidepressant to experience discontinuation syndrome
6 weeks
When is it appropriate to discontinue an antidepressant abruptly
severe adverese events, like cardiac arrythmias
Pharmacodynamic effects of TCA’s
- H1 blockers- sedating (be mindful of combining with other sedating meds/substance because it can lead to resp depression)
- Anticholinergic (mindful of combining with antihistamines or antipsychotics)
- a1 blockers (hypotension, espically if getting other a1 blockers)
- arrythmogenic (mindful of electrolyte disturbances or if they are on diuretics)
- lowers seizure threshold (if have epilepsy, may need higher dose of AED)
- some are serotenergic (look out for serotonin syndrome when combined with certain meds)
Which TCA’s are serotonergic
imipramine, comipramine, amitriptyline
Pharmacology risks associated with SSRI
- increased risk of bleeding 2/2 to inhibiting platelet aggregation (esp when patient takes NSAID and aspirin)
- increased risk of hyponatremia
- may cause osteopenia
- serotonin syndrome when combined with other serotonergic medications
Risk with MAOI’s
hypertensive crisis 2/2 to overload of monoamines because MAOI’s prevent the destruction of monoamines
antidepressants that are associated with arrythmias (either at normal doses or when OD)
TCA
Trazodone (some case reports)
MAOIs
citalopram
Antidepressants associated with prolonging QTc
citalopram, duloxeteine, trazodone, and TCA’s
Other than TCA’s the prolonged Qt is seen in overdose and from studies there aren’t many clinical correlates with it)
Safest antidepressant post MI
zoloft! (has the least cardaic effects and may help improve cardiovascular risk factors)
Mirtazipine is good as well, as well as fluoxeteine
Antidepressants associated with postural hypotension
TCA
Trazodone
MAOI’s
With benzos, which populations are more likely to get a paradoxical reaction
children/elderly and TBI patients
Max dose of buspar you can give in a day
60 mg total (typically want to split it up)
What receptor does buspar work on?
5ht1a, partial agonsit
What diagnosis is buspar most effective for
GAD (not panic or the other anxiety disorders)
Good alternative for those who cannot have benzos (but probably won’t give as robust a response)
May also help potentiate SSRI antidepressant effects
why does valium act so quickly?
has the highest lipid solubility of all the benzos and thus gets into the CNS the quickest- leading to the rush that people like to abuse
Target dose for prazosin
1-5 mg
Efficacy of prazosin on nightmares
Mixed, some studies have found that it is not more helpful than placebo but you might as well see if it helps with the PTSD nightmares
Dose of vitamin D for depression
1000 -5000 IU
Why do TCA’s induce arrythmias
because they inhibit sodium and calcium channels leading to prolonged PR, QRS, and QT
ECG is a better measure of toxicity than even levels
The cardiotoxicity of antidepressants, especially TCA’s is dependent on what
dose! The higher the dose, the more toxic
Which antidepressants are most associated with hyponatremia
SSRI and SNRI
TCA are medium risk
Risk factors for developing hyponatremia on an SSRI
older age***the most important one female surgery hx of hyponatremia use of other drugs associated with hyponatremia (diuretics, nsaids, antipsych, carbamazapine, laxatives) medical comorbidities low body weight
Time frame to monitor hyponatremia in pt’s on antidepressants
baseline then 3 month
Treatment of hyponatremia from SSRI (likely caused by SIADH)
- can try fluid restriction but if severe, discontinue it!
Conditions associated with hyponatremia
COPD, CHF, hypothyroidism, diabetes, TBI, CVA, HTN
Signs of hyponatremia
HA, nausea, vomiting, muscle cramps, restlessness, lethargy, confusion, and disorientation
At what sodium level is there a risk for seizures
<125! they need a specialist and admission to the hospital. Discontinue that shit!
What to do if someone’s sodium is low but above 125?
Will need daily monitoring until better (lol at this point, may need to be admitted to the hospital for all that lol)
Can you restart someone on an SSRI if they were hyponatremic?
Better to start them on an agent in a different class (nortriptyline, mirtazapine, MAOI, etc. or even ECT)
What anti-seizure med is commonly associated with hyponatremia
carbamazapine
How does vraylar/carpirazine work?
D2, D3, and 5HT1a receptor partial agonists
5ht2A antagonist
What was vraylar specifically created to address
Is similar to abilify with it’s partial agonisim of D2
Hopeful to address negative symptoms in schizo and bipolar (can still help with mania)
Side effects associated with vraylar
akathisia, EPS, weight gain
which antidepressant is associated with flase positive PCP
venlafaxine
Common side effects with effexor
anorexia, constipation, dry mouth, nausea, nervousness, sexual side effects, headaches
at what doses is effexor like an ssri vs snri
ssri @ 75 mg/day
snri @ 150-225 mg/day
affects all monoamines @ 225 mg
at what dose of effexor will you see some improvement with severely depressed patients
some may need 350 mg
why ppl choose effexor over other meds
may be slightly more effective than other ssri’s, but has a lot of side effects
at what doses do you see an increase in bp with effexor
225+
What effect do SSRI’s have on diabetes
Can actually help improve glycemic control modestly in DM II
Effect of TCAs on diabetes
TCA are associated with weight gain and hyperglycemia, so may want to avoid in those with diabetes
What antidepressants are the least associated with sexual dysfunction
Buproprion and mirtazipine
What sexual disorders can ssri’s be used for
premature ejaulation, can use clomipramine or an SSRI
At what doses is buproprion helpful for sexual dysfunction
higher doses, like 300 mg
The risks and benefits of drug holidays for sexual dysfunction
pt skips 1-2 doses prior to sex so that they don’t experience the sexual dysfunction, but increases their risk of discontinuation syndrome
SSRI’s that inhibit reuptake more potently and are more likely to be associated with bleeding
sertraline, paroxetine, fluoxetine, duloxetine, and clomipamine
mirtazipine and nortriptyline are the more common and less/non-potent reuptake inhibitors
Which medications should you be mindful of prescribing SSRI’s that places the patient at an increased risk of bleeding
aspirin, NSAIDS, anticoagulants like warfarin
What types of bleeds are patients on antidepressants at risk for
Upper GI bleeds and ICH
Can give a PPI to help
The other name for st johns worts
Hypericum perforatum
Side effects to warn patients about if they chose to take saint john’s worts
photosensitivity, may increase their risk of bleeding, can induce mania in a bipolar patient
Serotonin syndrome is possible when taken with other serotonergic medications
Mechanism of st john wort
unclear, may work on 5ht, MAOI, NE, etc.
Why not to prescribe st john for depression
We do not know enough about it or how it works, not a licensed medication
It is helpful for mild to moderate depression
What drugs does St John’s commonly interact with
*interaction happen because it is a potent inducer of CYP enzymes in intestines and liver and affects the plasma concentrations of the drugs
Warfarin, OCP, digoxin, indinavir, clozapine, statins, just to name a few (makes anticoagulant and birth control less effective)
Preferred SSRI for management of anxiety
Zoloft and Prozac
Prozac most effective
Zoloft the most well tolerated
What is the negative associated with BuSpar
It takes a long time to feel the effects, about six weeks
What does a propranolol is ideal for management of anxiety
40 to 120 mg per day divided throughout the day
What are the FDA first line drug options for treatment of anxiety
SSRI, SNRI, Lyrica
What tricyclics are recommended for treatment of anxiety
Imipramine and clomipramine
When is the ideal time to use benzodiazepines for management of anxiety
With severe and distressing anxiety, try to avoid using it due to dependence and potential withdrawal symptoms
First line treatment for panic disorder
SSRI or venlafaxine
What should you be cautious about when starting a medication in a patient with anxiety or panic disorder
There’s symptoms may get worse when you’re starting the medication therefore informed the patient and also start at a low-dose
Preferred SSRI for management of PTSD
Paxil, Zoloft, Prozac
Venlafaxine as well
When were an antipsychotic be helpful in PTSD
When they are having intrusive symptoms like flashbacks and nightmares, not helpful with avoidance and hyper arousal
Which antipsychotic has been studied the most and PTSD
Risperidone at low doses
What are the first line drugs used to treat OCD
Any SSRI or clomipramine, start with an SSRI due to there being less tolerance for clomipramine
What medication can you add to an SSRI while treating OCD but not getting a good response
Can I add an antipsychotic to the SSRI at a low to moderate dose. Most studies have looked at Abilify and Risperidone
My one patient is on Zyprexa and is doing well it’s a combination
What are the second line medication is used for OCD treatment
And AC or and anti-epileptic medication like Topamax or Lamictal
For benzos, which population of patients do you want to avoid Giving this medication to
Patients with substance use disorder
Other than propranolol for management of anxiety, what other beta blocker can you use
Atenolol, 25 to 100 mg a day
First line treatment for social phobia
Any SSRI or venlafaxine
Why is it so important to treat GAD
Prevents the development of major depression
Initial treatment for body dysmorphic disorder
CBT, can add an SSRI if not improving or is moderate to severe
First line treatment for social anxiety
CBT
What should you monitor and all patients treated with an SSRI
Akathisia, increase anxiety, increase and suicidal ideation
What anti-seizure medication is similar to benzodiazepine in terms of treatment for anxiety
Lyrica, has a comparable speed of onset of action to a benzo. Starting dose of 150 mg they can be increased to a maximum of 600 mg dust 2 to 3 times throughout the day
Why is it important to not stop Lyrica abruptly
Stopping Lyrica Abruptly may lead to seizures, taper it off
What is the longest amount of time you should use a benzo when treating anxiety disorder
2 to 4 weeks while waiting for the effect of an SSRI to kick in
What phase of sleep is inhibited with the use of benzos
REM sleep
Common side effects of benzodiazepines
Headaches, confusion, ataxia, dysarthria, blurred vision, gastrointestinal disturbances, jaundice, paradoxical excitement, it is sometimes linked with aggressive behavior
When is respiratory depression more likely with the use of benzos
When given IV, it is more rare with oral therapy
What is the benzodiazepine antagonist that can be used if someone uses too much benzos
Flumazenil
Has a shorter lifespan Valium, wash the patient for several hours after administering
Who is at risk for paradoxical reactions with benzo use
Young/old, cns damage, those with learning disabilities or impulse control issues
What are the Brand names for guanfacine
Intuniv, the long acting version and tenex, The immediate release version
What is guanfacine typically used for
Mono therapy for ADHD, not the most effective and it’s only approved for monotherapy and children, or as an adjunct to stimulant therapy therapy
Off label it is used for conduct disorder, Tourette’s and text, opioid withdrawal, migraine prophylaxis
What is the minimal and the maximal dose for Intuniv
1 mg to 4 mg
What is the mechanism of action for intuniv
Selective alpha-2 adrenergic agonist
What is the benefit of guanfacine over clonidine
Guanfacine times to be less sedating then clonidine
Common side effects associated with guanfacine
Dry mouth, somnolence, dizziness, constipation, fatigue, headache, hypotension, syncope, orthostasis
What is the patient at risk for if they abruptly stop guanfacine
They are at risk for a nervousness, anxiety, potential rebound hypertension. It is important to taper off this medication 1 mg per day
How long does it take to see the effects of guanfacine
About 2 to 4 weeks
Which version of guanfacine is used More frequently
Intuniv the extended release version
What is a good stimulant option for patients who abuse drugs
Atomoxeteine, start with this one.
If They struggle with depression and tobacco use then you can consider bupropion
If they struggle with insomnia then you can try clonidine or guanfacine (although more commonly used in children)
Why is methylphenidate preferred over Amphetamines
Amphetamines have more side effects and are more likely to be abused or diverted
For switching from amphetamine to amphetamine, what is the conversion
They are all equivalent, no extra conversion is needed
Vyvanse is the main amphetamine that works need to be doubled because it’s formation only has about 30% amphetamine
When changing from one methylphenidate to another what is the conversion
All her equipment except for Concerta and Focalin
Focalin is a dextro isomer of methylphenidate that is twice as potent, so you will need half a dose of Focalin
Concerta has 83% off Methylphenidate, so 18 mg of Concerta is equivalent to 15 mg of methylphenidate
What is the conversion from methylphenidate to amphetamine
Methylphenidate is half as potent as amphetamine
I 10 mg of Ridellan it’s like the equivalent of 5 mg of taxes are in
Do you need to cross taper when switching from one Stimulant to another
No, just have the patient take the last dose of the stimulus and start the new similar on the next day
It is helpful to start a new stimulant at a slightly lower dose
What are the major side effects associated with all stimulants
They can potentially call psychosis or aggression, this has to be related to dose
Can worsen Tourette’s or tics
Increases the risk of seizures because it lowers the seizure threshold, patients with seizures can be on this medication just need to monitor seizure disorders closely
Can inhibit Grove and children was long-term use
Associated with weight loss due to appetite suppression
Increased risk of cardiovascular events, try to avoid Amphetamines and Patients with cardiovascular disease
It is a controlled substance, schedule two needs to be a new prescription every month
What are the non-stimulant options for ADHD
Guanfacine, clonidine, modafinil, atomoxetein, wellbutrin
The different options for amphetamines
Dexedrine/dextroamphetamine
Desoxyn/methamphetamine
Eveko/amphetamine
Adderall / miser amphetamine salts
Adderall XR
Vyvanse/ lysdexamphetamine
Mydayis
The different options for methylphenidate
Focalin/dextromethylphenodate
Ritalin
Concerta
Contempla
Focalin XR
How does straterra work
It is a selective norepinephrine reuptake inhibitor
Metabolized by the liver, CYP2D6
What antidepressants do you want to avoid using with straterra or use with caution
Maois
Prozac, Paxil, and quinodine because they are cyp2d6 inhibitors and thus will increase the levels of strattera. Use with caution and slower titration
Side effects associated with Strattera
In children I can leave the headaches and stomach pain decreased appetite nausea vomiting. There is also a warning for suicidal ideation and children and teens
An adult that can lead to G.I. upset, dry mouth, decreased appetite, insomnia, erectile dysfunction, urinary hesitation
For a side effect includes severe hepatic injury demonstrated by elevated LFTs and jaundice, they can also experience elevated blood pressure and heart rate
In terms of ADHD symptoms, what is Strattera most helpful for
Improving attention it does not help significantly with hyperactivity
What laughs do you need to monitor the patient is on Strattera
Liver function test
How long does it take for the effects of Strattera to be seen
2 to 4 weeks
What is the generic name for Focalin
Dexmethylphenidate
What are common side effects seen with Focalin
Decreased appetite, insomnia, anxiety, G.I. upset, tics, Tachycardia, hypertension, dry mouth
What is the mechanism of Focalin
It inhibits the reuptake of Dopamine and norepinephrine
What is the strength of Oakland compared to methylphenidate
It is two times more potent, it is the D isomer of methylphenidate
What is unique about the Focalin XR capsules
They contain two types of beets, how far immediate release pizza and the other half are delayed release beats
Therefore these capsules cannot be split but the beads can be sprinkled on their food and they have to eat all the food
How can you decrease the risk of G.I. upset when taking Focalin
Take it with food
What is the generic name for Dexedrine
Dextroamphetamine
How is the potency if Dexedrine compared to amphetamine
It is the d isomer and is more potent but has less peripheral effects
What are the uses for Dexedrine
ADHD in children less than 3 and narcolepsy
Also can be used for obesity and treatment resistant depression
What are the indications for Vyvanse
ADHD and binge eating disorder
What is unique about Vyvanse
Is dextroamphetamine with a lysing attached to it that makes it an active until G.I. enzymes clear off the lysing and converted to the active dextroamphetamine. It’s made this way so drug abusers can’t get high by snorting or injecting it
What effect does food have on Vyvanse
Sometimes taking it with food can decrease the effect of it and delay the peak of the medication. If the patient is not feeling the effects fast enough tell them to take it on an empty stomach
What is the mechanism of action of Vyvanse
Is it a stimulant that will Hibbetts three uptake of dopamine in norepinephrine, it was metabolized by the liver not using CYP and signs
What are the common side effects with Vyvanse
Headache, insomnia, anorexia, G.I. upset, increased heart rate, anxiety, irritability or agitation
What a relationship is seeing between Vyvanse and blood pressure medication
Vyvanse can sometimes make blood pressure medication less effective
Which stimulant is the most addicting
Desoxyn, also known as methamphetamine
It is the same as the abuse streets drug meth just the pharmaceutical grade. It is generally not recommended
What are common side effects of Desoxyn
Anorexia, tachycardia, insomnia, restlessness, headache, constipation, dental complications like poor dental hygiene and cavities and tooth where, and there is an increased risk of abuse
What is the generic name for Ritalin
methylphenidate
What are common side effects of Ritalin
Insomnia, headache, abdominal pain, nausea vomiting, anorexia, affect lability
What are some benefits of Ridellan compared to amphetamines
Less side effects and lower abuse potential and patient reports feeling less wired
In general with stimulants, what over-the-counter medication is the best avoided when using it
Antacids
What are the extended release versions of methylphenidate
Concerta and Ritalin SR & LA
Typically the capsules are composed of beads that I am extra of immediate release an extended release
What is the generic of Adderall
It is mixed amphetamine salts
Composed of dextro and levo isomers of amphetamine, mostly dextro
What is the benefit of Adderall over the methylphenidate
I will provide more of a kick and tends to be more potent
Unique property of abilify
Partial agonist of D2 and 5HT1A
5HT2 receptor antagonist
Common side effects associated with abilify
akathisia, anxiety, insomnia, sedation
Rare: pathological gambling and impulse control issues (reversible with discontinuation)
Why is abilify helpful with hyperprolactinemia 2/2 to antipsychotic use
it’s partial D2 agonism helps counter the antagonism caused by other antipsychotics
What is the max dose of abilify for adults and children
30 mg/day
goal should be about 10 mg or when symptoms start to improve
What new antipsychotic acts very similarly to abilify
brexipiprazole/rexulit
D2 partial agonist and 5HT1A partial agonist and 5HT2 receptor antagonist
Used for schizophrenia and as an adjunct for depression
Very expensive, so might as well stick with abilify
Which antipsychotics are reported to be the most “efficacious”
clozapine and olanzapine, but both have a lot of side effects with the major concerns being metabolic syndrome/weight gain
Clozapine also has other crappy side effects and extenisive monitoring is required
Which stimulant is approved for children that are three years old and up
Adderall IR
They have to be six years and older for extended release
What do you SSR eyes specifically block in their mechanism of action
The SERT transporter
What role does 5HT1a have on neurons that releases serotonin
They are a type of autoreceptor that is responsible for decreasing the amount of serotonin that is released when there is serotonin present and binding to it
What happens to the amount of 5HT1A Receptors when a patient has started on an SSRI
The amount of these receptors is down regulated once they are started on an SSRI because the SSRI leads to an increase amount of serotonin that eventually leads to the amounts of those receptors decreasing.
This results in the neuron now being disinhibited enable to fire and release more serotonin which is what we want
Remember that this receptor is responsible originally for decreasing the amount of serotonin that’s released
What is the hypothesis for depression that involves BDNF
The hypothesis states that there are decreased levels of BDNF Impatience with depression and that when the patient was started on an antidepressant it can help increase his levels and help improve the Neuronalplasticity of these patients
Brain derived neurotrophic factor
Why is the location of serotonin 1a receptors important
The presynaptic receptors are responsible for inhibiting the releases serotonin whereas the receptors that are postsynaptic (in the hippocampus,amygdala, and the cortex) have different functions - My controlling mood cognition and memory
How does BuSpar work
It is a serotonin 1a partial agonist and also antagonist
What is the proposed mechanism as to why fluoxetine is so activating
It’s inhibition of 5htc receptor
What is one of the more activating ssri’s
Prozac
So be cautious when rx to patients with increased anxiety or insomnia
What ssri is approved for bulimia?
Prozac!
Max dose for wellbutrin so that we decrease the risk for seizures
450 mg, the target dose is 300 mg, but once you get to 450 mg + that is when the seizure risk increases 10 +
If using IR, no single dose should be above 150 mg
