psychopharmacology Flashcards
1
Q
SSRIs
A
- Fluoxetine (prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), Citalopram (Celexa), Escitalopram (Lexapro)
- sexual SE – tx by augmenting with buproprion, changing to non-SSRI, or add sildenafil for men
- serotonin syndrome with triptans
- can increase levels of warfarin
2
Q
Venlafaxine (Effexor)
A
- SNRI
- can increase BP
3
Q
Duloxetine (Cymbalta)
A
- SNRI
- use in people with depression and neuropathic pain
4
Q
Buproprion (Wellbutrin)
A
- NE-DA reuptake inhibitors
- lack of sexual SE as compared to most other antidepressants
- increased risk of seizures – CI in PTs with seizure or eating disorders or those on an MAOI
5
Q
Trazadone and Nefazodone
A
- tx depression with insomnia or anxiety
- SE: sedation, priapism
- Nefazadone carries black box warning for liver failure
6
Q
Mirtazapine
A
- alpha-2 adrenergic antagonist
- refractory major depression and PTs who need to gain weight
- helps with sleep and appetite
7
Q
TCAs
A
- Amitriptyline, Imipramine, Clomipramine, Doxepin, Nortriptyline, Desipramine
- HAM SE:
- anti-Histamine– sedation, weight gaing
- anti-Adrenergic – hypotension, arrhythmias
- antiMuscarinic – dry mouth, blurred vision, urinary retention
- 3 C’s: cardiotoxicity, convulsions, coma
- treat OD with sodium bicarb
8
Q
MAOIs
A
- Phenelzine, Tranylcypromine, Isocarboxazid
- use for refractory + “atypical” depression
- MAO-A preferentially deactivates 5HT and MAO-B deactivates NE/Epi
- both act on DA and tyramine
- SE: serotonin syndrome with SSRIs, hypertensive crisis when taken with tyramine-rich foods
9
Q
Low potency, typical antipsychotics
A
- Chlorpromazine – bluish skin discolorationand, photosensitivity, corneal and lens deposits
- Thioridazine– associated with retinitis pigmentosa (retinal pigmentation)
- higher incidence of anticholinergic and antihistamine SE than high-potency for typicals and greater risk of seizure
10
Q
High-potency typical antipsychotics
A
- Haloperidol
- Trifluoperazine
- Fluphenazine
- greater risk of EPS effects (Parkinsonism, akathisia, dystonia) and tardive dyskinesia
11
Q
Clozapine and Risperidone
A
- atypical antipsychotics
- block both DA and 5HT receptors
- more effective treating negative symptoms than traditional
- Clozapine (Clorazaril) - never 1st line –> but more efficacious (tx resistant_
- SE: hypersalivation, agranulocytosis, seizures
- Risperidone (Risperdal)
- SE: more mvmt disorders, hyperprolactinemia
- long-acting injectable form available
- can also tx mania
12
Q
Quetiapine + Olanzapine
A
- atypical antipsychotics (block both DA and 5HT receptors)
- treats negative sxs better than typicals
- Quietiapine (Seroquel) – sedation, less mvmt disorders
- can also treat mania
- Olanzapine (Zyprexa)– weight gain
- can also treat mania
13
Q
Ziprasadone + Aripiprazole
A
- atypical antipsychotic
- Zipras (Geodon): less likely to cause weight gain; prolong QT
- can also treat mania
- Arip (Abilify): unique mechanism of partial D2 agonism
- more activating (akithesia)
- can also treat mania
14
Q
Lithium
A
- mood stabilizer
- drug of choice in acute mania, bipolar and schizaffective disorder
- check ECG, TSH, CBC and bHCG prior to use
- check blood levels
- narrow therapeutic range
- metabolized by kidney – careful in renal dysfunction
- toxicity: tremors, altered mental status, convulsions, death
- SE: fine tremor, nephrogenic DI, weight gain, thyroid dysfunction, acne
- teratogenic: Ebstein’s anomaly
15
Q
Carbamazepine
A
- anticonvulsant: Tegretol
- tx mixed episodes and rapid cycling bipolar, trigeminal neuralgia
- blocks Na channels –/ APs
- monitor CBC, LFTs
- SE: agranulocytosis, GI and CNS (drowsiness, ataxia, confsion), possible SJS, teratogenic
- induction of p450
