psychopharm2 Flashcards
midpotency typical antipsychotics examples
Loxapine, thiothixene, trifluoperazine, perphenazine
loxapine
loxitane; higher risk of seizure; metabolite is an antidepressant
thiothixene
Navane; can cause ocular pigment changes
trifluoperazine
stelazine; can reduce anxiety
perphenazine
trilafon; mid potency typical antipsych
high potency typical antipsychotics
lower dose needed to achieve the effect; cause less sedation, orthostatic hypotension, and anticholinergic effects; greater risk for EPS and tardive dyskinesia
examples of high potency typical antipsychotics
heloperidol, fluphenazine (prolixin); pimozide (orap)
haloperidol
haldol; decanoate form availabe (long acting injectable)
fluphenazine
prolixin; decanoate form available
pimozide
orap; assoc with heart block, v tach and other cardiac effects
components of the mesolimbi pway
assoc with pos sx of schizophrenia; nuc accumbens, fornix, the amygdala, and the hippocampus
neg symptoms for schizophrenia
dopamine in the mesocortical pway; think cortex involved in personality so neg sx of schizo
EPS symptoms localized wheere
nigrostriatum; think parkinsons is involved in this
tuberoinfundibbular
prolactin
what are the EPS side effects associated with typical antipsychotics
parkinsonism, akathisia, dystonia (torticollis, contraction of the tongue, eyes)
what does hyperprolactinemia cause?
decreaed libido, galactorrhea, gynecomastia, impotence, amenorrhea, osteoporosis
what are the main categories of side effects of the typical antipsychotics?
Anti-dopaminergic, Anti-HAM, TD, and less commonly neuroleptic malignant syndrome; opthalmologic problems; derm problems; seizures
epi of TD
most often occurs in older women
epi of neuroleptic malig syndrome
young males early in treatment with both atypical and typical antipsychotics
characteristics of neuroleptic malignant syndrome
FALTERED; fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigidity, excessive sweating, and delirium
treatment of neuroleptic malig syndrome
discontinue offending med and administrate supportive care
optho problems seen with typical antipyschotics
irreversible retinal pigmentation with high doses of thioridazine, deposits in lens and cornea with chlorpromazine
derm problems seen with typical antipsychotics
rashes and photosensitivity (blue-gray skin discoloration with chlorpromazine)
seizures and antipsychotics
low potency anti-psychotics are more likely to cause seizures than high potency
how are atypical antipsychotics different from typical in terms of mecahnism of action?
atypical blocks both dopamine and seratonin; they are more effective in treating the negative sx of schizophrenia
side effects for atypicals
less likely to cause EPS, TD, or neuroleptic malig syndrome;
examples of atypical antipsychotics
clozapine (clozaril), risperidone (resperidal), quetiapine (seroquel), olanzipine (zyprexa), ziprasidone (geodon), aripiprazole (abilify), paliperidone (invega), asenapine (saphris), iloperidone (fanapt)
clozapine
clozaril, less likely to cause TD, assoc with tachycardia and hypersalivation, more anticholinergic SE, myocarditis can develop, risk of agranulocytosis and seizures
the only antipsychotic shown to decr the risk of suicide
clozapine
when to stop clozapine
if absolute neutrophil count drops below 1500
risperidone
can cause increased prolactin, some orthostatic hypotension and reflex tachycardia, has long acting injectable form called Consta
quetiapine
seroquel; common side effects incl seadation and orthostatic hypotension
olanzipine
zyprexa; common side effect is weight gain
ziprasidone
geodon; less likely to cause weight gain
aripiprazole
abilify; unique mecahnism of partial D2 agonism; can be more activating (akathisia) and less sedating; less potential for weight gain
newer expensive atypical antipsychotics
paliperidone, asenapine, iloperidone
side effects of atypical antipsychotics
metabolic syndrome, some anti-HAM side effects, weight gain, hyperlipidemia, hyperglycemia, liver function, QTc prolongation
what are mood stabilizers used for?
acute mania and to help prevent relapses of manic episodes in bipolar disorder and schizoaffective disorder
less commonly, mood stabilizers like lithium can be used for
potentiation of antidepressants, potentiation of antipsychotics, enhancement of abstinence in tx of alcoholism, tx of aggression and impulsivity
what are the mood stabilizers
lithium and anticonvulsants like valproic acid, lamotrigine, and carbamazepine
lithium
drug of choice for acute mania and as a prophylaxis for both manic and depressive episodes n bipolar and schizoaffective disorders; can also be used in cyclothymia and unipolar depression
how is lithium metabolized and what consequences does this have?
metabolized by the kidney, so you must adjust dose and monitor levels if patient has renal dysfunction
prior to initiating lithium, patients must have what?
ECG, basic chemistries, thyroid function test, a CBC, and a pregnancy test
onset of action for lithium
5-7 days
checking blood levels in patients on lithium
unlike SSRIs, blood levels of lithium correlate with clinical efficacy and should be checked after 5 days and then every 2-3 days until therapeautic
major downsides to lithium
side effects and narrow therapeutic range
side effects of lithium
toxic levels cause AMS, tremors, convulsions, and death; other side effects incl tremor, nephrogenic DI, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis, Ebstein’s anomaly
lithium can cause ebstein’s anomaly. What is that?
cardiac defect in abbies born to mothers taking lithium
carbamazepine
tegretol; esp useful in treating mixed episodes and rapid-cycling bipolar disorder, and less effective for the depressed phase
carbamazepine also used in the treatment of what
trigeminal neuralgia
how does carbamazepine work
blocks sodium channels and inhibits action potential
onset of action of carbamazepine
5-7 day
side effects of carbamazepine
most common are GI and CNS (drowsiness, ataxia, sedation, confusion); possible skin rash (SJS), leukopenia, hyponatremia, aplastic anemia, thrombocytopenia, and agranulocytosis
other SE of carbamazepine
elev of liver enzymes, causing hepatitis; teratogenic effecs in pregnancy
drug interactions and carbamazepine
induces cyp 450; induces its own metabolism, requiring increasing dosages
carbamazepine toxicity
confusion, stupor, motor, restlessness, ataxia, tremor, nystagmus, twitching and vomitting
valproic acid
depakote and depakene; useful in treating mixed episodes of bipolar disorder as well as rapid cycling
valproic acid levels
usually checked after 3-5 days
lamotrigine
lamictal: an anticonvulsant; effective for bipolar depression but not for acute mania or prevention of mania
lamotrigine mech of action
works on sodium channels that modulate glutamate and aspartate
most common side effects of lamotrigine
dizziness, sedation, etc; but most serious side effect is Stevens-johnson syndrome
how is SJS with lamotrigine minimized
start with low doses and increase them slowly
valproate will increase lamotrigine levels and lamotrigine with decrease valproate levels
right
oxcarbazepine
trileptal; as effective in mood disorders as carbamazepine, but better tolerated and less risk of rash and hepatotoxicity
gabapentin
neurontin; often used adjunctively to help with anxiety and sleep; little efficacy in bipolar
pregabalin
lyrica; used in general anxiety disroder and fibromyalgia; little efficacy in bipolar
tiagabine
gabitril; may be helpful with anxiety
topiramate
topamax; helpful with impulse control disorder and anxiety; beneficial side effect is weightloss; can cause hypochloremic, non-anion gap met acidosis and kidney stones
most limiting side effect of topiramate
cognitive slowing
anxiolytics/hypnotics include which drugs
benzos, barbiturates, and buspirone
benzos
potentiate the effects of GABA; relatively safer in overdose than barbiturates
long acting benzos
half life greater than 20 hours; diazepam (valium), clonazepam (klonopin)
intermediate acting benzos
half life 6-20 hours; alprazolam (xanax), lorazepam (ativan), oxazepam (serax), temazepam (restoril)
short acting benzos
less than 6 hours; triazolam (halcion), midazolam (Versed)
diazepam
valium; used during detox from alc or sedative-hypnotic-anxiolytics and for seizures
clonazepam
Klonopin; treatment of anxiety, incl panic attacks; avoid with renal dysfunction; longer half life allows for once daily dosing
alprazolam
xanax; tx of anxiety, incl panic attacks; short onset, so high abuse potential
lorazepam
ativan; tx of panic attacks, alc and sedative hypnotic anxiolytic detox; not metabolized by the liver
oxazepam
serax; alcohol ad sedative-hypnotic-anxiolytic detox; not metabolized by the liver
benzos notmetabolized by the lier
LOT; lorazepam, oxazepam, temazepam
temazepam
restoril;decreasingly used for tx of insomnia due to dependence; not metabolized by the liver
triazolam
halcion; short-acting benzo; treatment of insomnia
midazolam
versed; short acting benzos; primarily used in med and surgical settings
side effects of benzos
drowsiness, impairment of intellectual function; anterograde amnesia
toxicity of benzos
resp depression, esp when combined with alcohol
examples of non-benzo hypnotics
zolpidem (ambien); dephenhydramine (benadryl); chloral hydrate (noctec, somnote); ramelteon (rozerem)
zolpidem
ambien, just like zaleplon (sonata), and eszopiclone (Lunesta); selective bindng to benzo receptor 1, which is responsible for sedation
diphenhydramine
benadryl; antihistamine; side effects are sedation, dry mouth, constip, urinary retention, and blurry vision
chloral hydrate
Noctec, Somnotec; not commonly prescribed due to tolerance and dependence; lethal in overdose, causing hepatic and liver failure
Ramelteon (Rozerem)
non benzo hypnotic; Selective melatonin MT1 and MT2 agonist; no tolderance or dependence
examples of non-benzo anxiolytics
buspirone (BuSpar); hydroxyzine (Atarax); Barbiturates; propranolol
buspirone
buSpar; partial agonist of the 5HT-1A receptor; has slow onset than benzos (takes 1-2 weeks for effect); not that effective, so often used in combo with another agent like SSRI for treatment of anxiety
in what population is buspirone good and why?
good in alcoholics because it does not potentiate the CNS depression of alcohol; also has a low potential for abuse/addiction
Hydroxyzine
atarax; antihistamine; quick acting short term med
barbiturates
eg. Butalbitol, phenobarbitol, amobarbitol, pentobarbitol; rarely used now because lethality of overdose and side effect profile
propranolol
beta blocker; useful for treating the autonomic side effects of panic attacks; can also be used to treat akathisia (side effect of typical antipsychotics)
examples of psychostimulants
dextroamphetamine and amphetamines; methylphenidate; atomoxetine; modafinil
dextroamphetamine and amphetamines
dexedrine, adderall
methylphenidate
ritalin, Concerta; watch for leukopenia, anemia, incr LFTs
atomoxetine (strattera)
presynaptic norepi transport inhib; less appetite suppression and insomnia
modafinil
Provigil; used in narcolepsy
acetylcholinesterase inhib
donepezil (Aricept); galantamine (Reminyl); Rivastigmine (Excelen); Tacrine (Cognex); Memantine (Namenda)
acetylcholinesterase inhib patch
less side effects; rivastigmine (Excelon)
