Psychopharmacology Flashcards
Can MAOI and SSRI be given together
No
Need at least 2wks between
Can cause serotonin syndrome
Tricyclic antidepressants (TCAs)
Name
Amitriptyline
TCAs
Amitriptyline
(When to give)
At night (their sedative)
TCA
Amitriptyline
Uses
Migraine
Sleep (sedative)
Anxiety
Depression (mainly)
TCAs
Amitriptyline
Major AR
Cardiotoxic:
CI: cardiac condition (their lethal in overdose)
Cholinergic: drying, urine retention, blurry vision.
SSRI
Names
Citralopram (take at bed time)
Escitalopram
Sertraline
Fluvoxamine
Paroxetine
Fluoxetine (long half life)
SSRI are safe, effective and well tolerated?
Yes
Has a low SE profile bc it is selective
SSRI
Use
Depression (gold standard for it)
Anxiety
SSRI SE
GI (transcient SE. starts early and goes away)
*take meal 1st before taking
Sleepiness
Wt changes (gain)
Hyponatremia
Sexual dysfunction
SSRI
123 approach
1: SE
2: boost of energy (big worry (black box warning)
3: mood benefits help w/ anxiety
SSRI take how long to be fully effective
4-6wks
Slow acting
SSRI black box warning
Under age of 25
Super depressed w/ boost of energy causes them to go through with suicidal ideations
What meds should you avoid with SSRIs
MAOIs
TCAs
St johns wort
MDMA
(Migraine meds:-triptins)
All risk of serotonin syndrome
SRNIs
Names
Venlafaxine (bad d/c syndrome d/t short half-life)
Desvenlafaxine
Duloxetine
SRNI use
Depression (works on both serotonin and norepi)
Duloxetine (pain/anxiety/depression)
SRNI Se
Increased BP & HR
Less sexual dysfunction than SSRIs
Atypical antidepressants
Name
When to take
Bupropion
In AM (gives you energy)
Atypical antidepressants
Bupropion
Use
Adhd
Depression
Smoking cessation
Atypical antidepressants
Bupropion
CI
Hx of seizures
Eating disorder (lowers appetitie)
Alcohol withdrawal (causes seizures)
Atypical antidepressants
Bupropion
Can it be used with SSRI
Yes
monoamine oxidase inhibitors (MAOIs)
Names
Phenelzine
Selegiline
monoamine oxidase inhibitors (MAOIs)
Phenelzine
Selegiline
Complications
HTN crisis: d/t tyramine
Tyramine type foods
Aged cheese
Cured meats (charcuterie board)
Sauerkraut
Red wine
Benzodiazepines
Names
Lorazepam
Diazepam
Alprazolam (short half-life) addictive bc of this
Benzodiazepines:
Lorazepam
Diazepam
Alprazolam
Use
Sleep (sedating, slows reflexes)
Anxiety (fast acting)(panic)
Seizures
Which benzos have a long HL vs short
Long HL: Lorazepam and diazepam
Short HL: Alprazolam
Short half lifes causes a worry with addiction (med wears off quicker)
Buspirone
Use
Is it addictive?
Can use with what med
Use: anxiety
Is not addictive
Can use w/ SSRIs
Buspirone
How long to start working
Take how many times a day
4-6 wks to work (not for anxiety attacks)
BID or TID
Hydroxyzine
Use
Anxiety
Antidepressant (betablocker)
Propranolol
Propranolol
Use
How often to take
Monitor what
Use: performance anxiety
Take PRN
Monitor: HR, BP (get baseline)
Dopamine
Too much vs enough
Related to what center
Effects what
Too much: psychotic
Enough: happy
Related to reward center (addiction)
Effect on movement (EPS extrapyramidal syndrome)
First gen typical antipsychotics
Names
Route
Do what
Chloropromazine
Haloperidol
IM
PO (do before LAI to see tolerability)
LAI (long acting injectible)
Block dopamine
First gen typical antipsychotics (blocks dopamine)
Chlorpromazine
Haloperidol
SE
Sedative
Wt gain
Orthostatic HOTN
EPS (most common in 1st gen due to block of dopamine)
EPS 4 signs (could happen with any psychotic)
Mainly with 1st gen though
Acute dystonia: muscle tone issue (ex: cant turn neck)
Pseudo-parkinsonism: tremors, shuffled fait, masked face, arms dont swing
Akathisia: uncontrollable motor restlessness
(increase risk of suicide due to feeling miserable)
Tardive dyskinesia (TD): late onset bad movement
*cant be tx by meds its irreversible)
EPS meds to treat
Benztropine
Diphenhydromine
AIMS
Abnormal involuntary movement scale
Helps provider assess for EPS
Second gen atypical antipsychotic
Name
Lurasidone
Ziprasidone
Olanzapine
Quetiapine
ADDED:
Clozapine
Risperidone
Second gen atypical antipsychotics
Lurasidone
Ziprasidone
Olanzapine
Quetiapine
Which ones need to be taken with food
Big picture with these meds
When to give quetiapine
Lurasidone, ziprasidone need to be taken with food
Big picture: metabolic burden (wt gain)
quetiapine: give at bedtime (sedating)
Second gen atypical antipsychotics
Lurasidone
Ziprasidone
Olanzapine
Quetiapine
Education
Monitor
Education:
-healthy lifestyle
-dietician
Monitor:
-wt
-BMI
-waist circumference
Third gen atypical antipsychotics
Name
Aripiprazole
Third gen atypical antipsychotics
Aripiprazole
Less what than 2nd gen
High likely of what SE
How to tx that SE
Less metabolic strain than 2nd gen
Atkathesia (uncontrolled motor reslessness)
Can tx with EPS meds (benztropin, diphenhydramine)
Serotonin syndrome
Meds that can cause
S/s
MAOI
TCAs
St johns wort
MDMA
triptins
S/s:
Hyperreflexia
GI disturbances (diarrhea)
Dilated pupils
Neuroleptic malignant syndrome
What is it
Hallmark signs
Adverse effect of any antipsychotic
Hallmark:
-high temp (104)
-labile BP
-muscle rigidity (led pipe rigidity)
What can also work for Bipolar disorder
Antipsychotics
1st gen typical
2nd gen atypical
3rd gen
NEW 2nd gens
Clozapine
-best what
-is it 1st line and why or why not
-pharmacy needs what
-worries
Best antipsychotic
Not 1st line d/t risk of granulocytosis (low WBCs)
Pharmacy will need WBCs before releasing med
Worries:
Fever
Sore throat
NEW 2nd gen
Risperidon
Worry
Main thing (lab for it)
Metabolic syndrome is a worry (wt gain)
Main thing: prolactin
-leak from breast
Enlarged breast
Lab: prolactin
Bipolar meds (mood stabilizers)
Main one
Lithium
Lithium Carbonate
-therapeutic range (narrow or short)
-monitor what (what it can cause)
-What do we want consistent
-replace what if lost
Narrow
0.6-1.2=maintence range (pt stable)
1-1.5= more aggressive
Monitor fluids and Na
*dehydration increases lithium
*overhydration decreased lithium
Keep fluids constant and replace them if lost
Lithium use
Mood stabilizer
Protective against suicide
Lithium SE
Gi upset (nauseous)
Fine hand tremors
Polyuria
Polydipsia
Wt gain (d/t polydipsia)
Lithium toxicity
Se worsen
Vomiting/diarrhea
Coarse hand tremors
Can progress to:
sz
coma
death
ataxia
Speech slurred
Lithium:
minimize intake of what
Avoid
Caffeine
Diuretics
Nsaids
Lithium
Hard on what organs
Labs for this
Kidney
Thyroid
Labs:
BUN & Creatinine
TSH & T4
Lithium levels
Antiseizures/anticonvulsants can be used for what also
Mood stabilizing effect
Anti epileptic medications for bipolar disorder
Names
Valporic acid
Carbamazepine
Lamotrigine
Valporic acid
Used for what type of pts
Dose in blood
Elderly
50-125mg
Valporic acid
Hard on what organs (s/s)
Labs
Other S/s
Liver
Labs: LFT thru a CMP
Pancreas (pancreatitis)
Labs: amylase, lipase
S/s: pain in stomach, vomiting
Other s/s:
Wt gain
Teratogenic (birth control)
Thrombocytopenia (look out for bleeding)
Carbamazepine
Main SEs
Steven johnson syndrome
Slows neurons (tired)
Thrombocytopenia (watch out for bleeding)
Lamotrigine
Best what
SE
Most tolerated mood stabilizer
SE:
Benign rash(okay) or SJS
Lamotrigine
Look out for what
What to worry about with SJS (s/s of this)
Other S/S
Look out for a rash
Worried about SJS becoming systemic:
-fever
-uper trunk, neck, mouth
-notify provider of any rash
Other S/S:
HA
Tremors
Lamotrigine
Titration
25mg 2wks
50mg 2wks
For 5 weeks until reach 200mgs
*this decreases risk of rash
*takes 5 wks to get to therapeutic use/ slow)
When do you have to restart titration of Lamotrigine
If you miss 5 days of dose
Mirtazapine (tca)
-used for
-Se
-Give when
Depressive disorders
Se:
-cns depression (sleepiness)
-hungry (help you eat with elderly)
Give at night
Which meds to take in the morning
Bupropion
Which meds to take at bedtime (sedative)
Amitriptyline
Citralopram
Benzos
Quetiapine
Mirtazapine
Which meds to take with food
Lurasidone
Ziprasidone
Which meds to take after eating
SSRIs (due to GI disturbances)
which meds have a long half life
Fluoxetine
Lorazepam
Diazepam
Which meds have a short half life
Venlafaxine (d/c syndrome)
Alprazolam (addictive)
Antipsychotics can help what
Anticonvulsants can help what
Antipsychotics can help bipolar disorder
Anticonvulsants can help what mood stabilizing
Which med causes qt prolongation
Ziprasidone
