Psychopharmacological Therapy & Dantrolene Flashcards
SSRI (fluoxetine, sertraline, paroxetine) SE
-HA
-N/D
-sex dysfx
-agitation
-insomnia
Taper d/c to avoid: dizziness, paresthesia, myalgias, irritability insomnia
SSRI (fluoxetine, sertraline, paroxetine) Interactions
-may inhibit CP450 enzymes
-serotonin syndrome
Tricyclic antidepressants MOA
block presynaptic uptake/reuptake of serotonin and/or NE
Tricyclic (trimipramine, nortriptyline, amitriptyline) antidepressants SE
-anticholinergic
-antiadrenergic (alpha blockade)
-antihistamine
-ortho HoTN
-tachycardia
-sedation
-weakness
-fatigue
-fine tremor
Structurally similar to phenothiazines and LA
Tricyclic antidepressants Interactions
-Interfere w/ sympathomimetics, inhaled anesthetics, anticholinergics, antihypertensives, opioids
-highly protein bound
MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline) SE
-ortho HoTN
-impotence
-weight gain
-paresthesias
-hepatitis (rare
MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline) interactions
-serotonin syndrome
-avoid tyramine (cheese, liver, fava beans, avocados, chianti wine)
MAOI overdose
-SNS stim
-tx w/ gastric lavage
-dantrolene for muscle rigidity
Prohibited drugs with MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline)
-cyclic antidepressants
-fluoxetine
-cold/allergy meds
-nasal decongestants
-indirect-acting sympathomimetics
-opioids (esp meperidine)
Anesthesia management w/ MAOI
-Ok to continue meds
-Avoid certian drugs: meperidine, indirect-acting sympathomimetics
Lithium MOA
inhibits 2nd messenger system = dampened signal transmission in hyperactive neurons
Lithium SE
-hypothyroid
T wave flat/inverted
-cardiac conduction
-acne
-psoriasis
-memory impairment
-hand tremor
-sedation
-polyuria
-polydipsia
Lithium interactions
-serotonin syndrome
-prolong NMBs
-↓MAC
-↓tubular response to ADH (↓ or ↑Na)
-impairs PTH release (↓Ca)
-thiazides ↑lithium reabsorption
-NSAIDs & ACEIs ↑lithium toxicity
Lithium and Na
-0% protein bound
-Reabsorbed in PCT (competes there w/ Na
-lithium lvls inverse of Na lvls (↓Na = ↑lithium)
Lithium therapeutic levels
0.8-1.2 mEq/L
>2 = AV block, HoTN, dysrhythmias, sz
Malignant Hyperthermia
Onset
Causes
Key features
Tx
Onset: within min
Causes: halogenated anes, succ
Key features: Hypercarbia, tachycardia, myoglobinuria, acidosis, muscle rigidity
Tx: dantrolene, support
Serotonin syndrome
Onset
Causes
Key features
Tx
Onset: up to 12 hr
Causes: SSRI, SNRI, MAOI, MDMA, + methylene blue or meperidine or fentanyl
Key features: Akathisia, mydriasis, tremor, altered mental status, clonus, muscle rigidity
Tx: cyproheptadine, supportive
Antipsychotic (Neuroleptic) Drugs
-Phenothiazines (promethazine, chlorpromazine)
-Thioxanthenes (thiothixene, chlorprothixine)
-Butyrophenones (droperidol, haloperidol)
Antipsychotic Drug Interactions
Opioids:
-exaggerated ventilatory depressant effects
- ↑ miotic & sedative effects
-potentiated analgesic effects
ETHO: effects enhanced
Interfere w/exogenously administration dopamine
