Psychopharmacology Flashcards
antipsychotics are generally…
dopamine antagonists (lower Da)
antipsychotic suffixes
“azine”
“apine”
“idone”
side effects of antipsychotics
TD, EPS (1st gen), metabolic effects (2nd gen)
when initially starting meds: sedation/drowsiness, dizziness, anticholinergic effects
antipsychotics: dependence? OD?
no sig concerns
antipsychotic withdrawal
not bad - some GI distress, insomnia, nightmare, headache if suddenly stopped
Thorazine (chlorpromazine)
1st gen/typical antipsychotic
Prolixin (fluphenazine)
1st gen/typical antipsychotic
Haldol (haloperidol)
1st gen/typical antipsychotic
Trilafon (perphanazine)
1st gen/typical antipsychotic
Clozaril (clozapine)
2nd gen/atypical antipsychotic
Risperdal (risperidone)
2nd gen/atypical antipsychotic
Zyprexa (olanzapine)
2nd gen/atypical antipsychotic
Invega (paliperidone)
2nd gen/atypical antipsychotic
Seroquel (quetiapine)
2nd gen/atypical antipsychotic
Geodon (ziprasidone)
2nd gen/atypical antipsychotic
Abilify (ariprazole)
2nd gen/atypical antipsychotic
Prozac (fluoxetine)
SSRI
Paxil (paroxetine)
SSRI
Zoloft (sertraline)
SSRI
Lexapro (escitalopram)
SSRI
Effexor (venlafaxine)
SNRI antidepressant
MAOIs
antidepressants
Wellbutrin (buproprion)
antidepressant; dopamine agonist (unusual)
Strattera (amoxetine)
SNRI used for ADHD (unusual)
black box warning for SI in youth
Anafranil (clomipramine)
tricyclic antidepressant (TCA)
Tofranil (imipramine)
tricyclic antidepressant (TCA)
Elavil (amitryptyline)
tricyclic antidepressant (TCA)
Sinequan (doxepin)
tricyclic antidepressant (TCA)
antidepressant suffixes
“tine”
“line”
“mine”
antidepressants are generally…
serotonin and norepinephrine agonists (increase 5-HT and NE)
exception: Wellbutrin is a Da agonist
dangers of antidepressants…
-OD w/ TCAs or MAOIs can be fatal (esp. w/ alcohol)
-MAOIs dangerous w/ certain foods/meds
-TCAs contraindicated for pts w/ heart conditions, high BP, seizures
no sig. concerns re: dependence or withdrawal
types of antidepressants
SSRIs/SNRIs
MAOIs
tricyclics (TCAs)
all equally effective but SSRIs best tolerated and have minimal lethality
antidepressants can also help with…
-bipolar
-anxiety, OCD, PTSD
-chronic pain
-eating disorders
-childhood sleep disorders
benzodiazepines are…
-GABA agonists (increase GABA) –> leads to reduced anxiety and seizures, increased muscle relaxation and sedation
-anxiolytics and/or sedatives/hypnotics/sleep agents
TCA side effects
-severe anticholinergic effects (dry mouth, blurred vision, constipation, urinary hesitation, confusion)
-sedation
-orthostatic hypotension
-weight gain
-nausea
-sexual dysfx
-greater risk of heart disease– contraindicated for pts w/ heart conditions, high BP, or seizures
agranulocytosis
sudden drop in white blood cell count associated w/ use of Clozaril (clozapine; 2nd gen antipsychotic), increased risk of serious infection
Desyrel (trazodone)
an unusual antidepressant
MAOI side effects
-orthostatis hypotension
-weight gain
-edema
-sexual dysfx.
-insomnia
-possible tyramine-induced hypertensive crisis
side effects of benzos
mainly DROWSINESS and DIZZINESS
also: mild cognitive impairment (incl. memory), nightmares, headache, impaired coordination, upset stomach
dangers of benzos…
-high risk for dependence
-withdrawal can be fatal
-cross-tolerance w/ alcohol
-dangerous in combination w/ alcohol or other depressants
-in older adults: increased risk of falls, MVAs, cog imp.
-when used for sedation/sleep and discontinued, can cause rebound insomnia and/or REM rebound w/ vivid, disturbing dreams
benzo suffixes
“pam” and “lam”
Buspar (buspirone)
non-BZ anxiolytic; takes 2-4 wks to work; low potential for abuse; does NOT cause sedation, cog imp, or withdrawal
Inderal (propranalol)
beta-blocker (usually used for high BP, heart stuff) that can also be used as an anxiolytic (esp. for social anxiety disorder)
beta-blockers (what is it, side effects)
usually used for high BP, heart stuff but can also be used as an anxiolytic (esp. for social anxiety)
Side Effects:
sexual dysfx
fatigue
dizziness
SoB
angina (chest pain, reduced blood flow to heart)
cold hands/feet
sleep issues
Xanax (alprazolam)
benzo - anxiolytic
Klonopin (clonazepam)
benzo - anxiolytic
Valium (diazepam)
benzo - anxiolytic
Ativan (lorazepam)
benzo - anxiolytic
Restoril (temazepam)
benzo - sedative/hypnotic
Halcion (triazolam)
benzo - sedative/hypnotic
Ambien (zolpidem)
non-BZ sedative
(also Lunesta, Sonata)
withdrawal from benzos
can be fatal; must be tapered, monitored
Stage 1: tremors, sweating, agitated, anxious
Stage 2: hallucinations, panic
Stage 3: grand mal seizures
benzo uses
Anxiolytic use:
-panic disorder
-GAD
-possibly: other anxiety and anxiety-adjacent dxs, acute mania, akathisia, alcohol withdrawal
-should only be used for short periods!
Sedative use:
-short-term sleep problems, e.g., acute stress or jetlag
mood stablizers
1) lithium
2) anticonvulsants - originally for tx seizures, used when lithium doesn’t work or is contraindicated
mechanism of action unknown
lithium side effects
hand tremor
GI distress
weight gain
sedation
hair loss
polyuria
polydipsia
lithium toxicity (potentially fatal!) - mimics the flu, abdominal pain, diarrhea, vomit, tremor, ataxia (can occur on stable dose or due to OD)
anticonvulsant side effects
drowsiness
dizziness
headache
nausea, vomit, diarrhea
increase risk of SI/SBx
(used as mood stablizers)
dangers of mood stabilizers
lithium contraindications: pregnancy, thyroid disease, heart disease
-no concern for dependence or withdrawal
-biggest concern w/ lithium is nonadherence
Eskalith
mood stabilizer (lithium carbonate)
Lithobid
mood stabilizer (lithium citrate)
Tegretol (carbamazepine)
anticonvulsant mood stabilizer
Neurontin (gabapentin)
anticonvulsant mood stabilizer
Depakote (divalproex)
anticonvulsant mood stabilizer
Depakene (valproic acid)
anticonvulsant mood stabilizer
Lamictal (lamotrigine)
anticonvulsant mood stabilizer
Trileptal (oxcarbazepine)
anticonvulsant mood stabilizer
Ritalin/Concerta (methylphenidate)
stimulant
Adderall (amphetamine)
stimulant
Dexedrine (dextroamphetamine)
stimulant
stimulants are generally…
dopamine and NE (catecholamine) agonists (increase them)
used to tx ADHD, response within first 2 days
catecholamines
Da and NE
lithium used for…
-bipolar - may be combined w/ atypical antipsychotic (for mania) and/or antidepressant; takes 1-3 wks to tx mania, 6-8 wks for depression
also:
-schizoaffective dx
-schizophrenia (in combo w/ antipsychotics)
-depression
-impulse control disorders
-rarely: cyclothymia, BPD
lithium used for…
-bipolar - may be combined w/ atypical antipsychotic (for mania) and/or antidepressant; takes 1-3 wks to tx mania, 6-8 wks for depression
also:
-schizoaffective dx
-schizophrenia (in combo w/ antipsychotics)
-depression
-impulse control disorders
-rarely: cyclothymia, BPD
anticonvulsants used for…
-bipolar - when lithium doesn’t work or is contraindicated
-depression
-impulse control disorders
-neurological chronic pain
stimulants sometimes used for…
-tx-resistant depression
-tx-resistant obesity
-narcolepsy
-chronic, medically debilitating dxs (e.g., AIDS, cancer)
side effects of stimulants
decreased appetite
insomnia
headaches
GI distress/nausea
anxiety, irritability, dysphoria
(temporary) growth suppression in kids
increased HR, BP
dangers of stimulants (dependence, OD)
potential for abuse, dependence, and withdrawal
OD is rarely lethal
stimulant withdrawal
increased appetite
weight gain
increased sleep
low energy
tardive dyskinesia
abnormal movements of lips, tongue, jaw (possibly trunk, arms); side effect of tx w/ antipsychotics (esp. 1st gen but also 2nd gen)
-starts after a year+ of tx
-seen in 20-40% of pts treated w/ 1st gen.
-reversible in ~50% of pts; no tx for it
extrapyramidal sxs (EPS)
movement-related side effects of 1st gen antipsychotics
-dystonia (muscle spasms)
-parkinsonism (mask-like face, shuffling gait, drool, tremor, rigidity, bradykinesia)
-akathisia (restlessness)
akathisia
-restlessness
-side effect of antipsychotics, antidepressants
bradykinesia
slowness of movement or speed
hallmark sx of parkinson’s
