Psychotherapeutics Flashcards
Chlorpromazine
ANTIPSYCHOTIC (FGA)
Action:
-dopamine antagonist (blocks receptors in limbic system)
-antischizophrenic
-neuroletpic (break down nerves, calm down)
-major tranquilizer (sedation)
-controls hallucinations, agitation, hyperactivity, delusions, paranoia (positive effects)
-low potency
P. Kinetics:
-oral, im (take with food and full glass of liquid)
-depot preparations (haloperidol decanoate) can be given if patient is refusing
-given in divided doses, then one dose at night
-metabolized in liver and excreted in urine and feces (CARE in hepatic and renal disease; elderly)
-excretion is slow; onset = 4-6 weeks
-withdraw slowly
ADRs:
movement is blocked in extrapyramidal motor system = EPSE
1. acute dystonia: eyeballs roll back, jerking of head, neck, tongue, difficulty breathing (give anticholinergic)
2. pseudo-parkinsonism: bradykinesia, tremor, mask like/stiff face, fixed arms, short/shuffling steps, stooped posture, rigidity
3. akathisia: compulsive/ restless movement, jiggly/tapping legs/feet, rocking back and forth, up and down out of chair
4. tardive dyskinesia: excessive tongue movement, worm-like, popping and clicking of mouth
Other ADRs:
-neuroleptic malignant syndrome (sudden fever = convulsions, seizures, coma)
-anticholinergic SE such as dry mouth, blurred vision, constipation, urinary retention
-orthostatic hypotension
-sedation
-dermatology (UV sensitivity)
-agranulocytosis (WBC- more susceptible to infection)
-endocrine imbalance (menstrual irregularities, excessive prolactin and swelling of breasts, weight gain, seizures, sexual dysfunction, arrhythmias)
Implications:
-do NOT use for dementia (can result in dementia related psychosis)
-also an anti emetic effect
-watch that patient takes drug
Haloperidol
ANTIPSYCHOTIC (FGA)
Action:
-dopamine antagonist (blocks receptors in limbic system)
-antischizophrenic
-neuroletpic (break down nerves, calm down)
-major tranquilizer (sedation)
-controls hallucinations, agitation, hyperactivity, delusions, paranoia (positive effects)
-high potency
P. Kinetics:
-oral, im (take with food and full glass of liquid)
-depot preparations (haloperidol decanoate) can be given if patient is refusing
-given in divided doses, then one dose at night
metabolized in liver and excreted in urine and feces (CARE in hepatic and renal disease; elderly)
-excretion is slow; onset = 4-6 weeks
-withdraw slowly
ADRs:
movement is blocked in extrapyramidal motor system = EPSE
1. acute dystonia: eyeballs roll back, jerking of head, neck, tongue, difficulty breathing (give anticholinergic)
2. pseudo-parkinsonism: bradykinesia, tremor, mask like/stiff face, fixed arms, short/shuffling steps, stooped posture, rigicity
3. akathisia: compulsive/ restless movement, jiggly/tapping legs/feet, rocking back and forth, up and down out of chair
4. tardive dyskinesia: excessive tongue movement, worm-like, popping and clicking of mouth
Other ADRs:
-neuroleptic malignant syndrome (sudden fever = convulsions, seizures, coma)
-anticholinergic SE such as dry mouth, blurred vision, constipation, urinary retention
-orthostatic hypotension
-sedation
-dermatology (UV sensitivity)
-agranulocytosis (WBC- more susceptible to infection)
-endocrine imbalance (menstrual irregularities, excessive prolactin and swelling of breasts, weight gain, seizures, sexual dysfunction, arrhythmias)
Implications:
-do NOT use for dementia (can result in dementia related psychosis)
-also an anti emetic effect
-watch that patient takes drug
Clozapine
ANTIPSYCHOTIC (SGA)
Action:
-dopamine and serotonin receptor blocker
-more effective than Aripiprazole
-equally as effective as FGAs
-less likely to cause EPSE (including TD)
ADRs:
-anticholinergic SE such as dry mouth, blurred vision, constipation, urinary retention
-sedation
-agranulocytosis (pts on Clozapine are more at risk)
metabolic effects
-weight gain
-hyperglycemia
-diabetes
-dyslipidemia
Aripiprazole
ANTIPSYCHOTIC (SGA)
Action:
-dopamine and serotonin receptor blocker
-equally as effective as FGAs
-less likely to cause EPSE (including TD)
-adjunct therapy in depression
ADRs:
-anticholinergic SE such as dry mouth, blurred vision, constipation, urinary retention
-sedation
-agranulocytosis (pts on Clozapine are more at risk)
metabolic effects
-weight gain
-hyperglycemia
-diabetes
-dyslipidemia
Fluoxetine
ANTIDEPRESSANT, SEDATIVE, ANXIOLYTIC
Action:
-selective serotonin re-uptake inhibitor (SSRI)
-blocks neuronal re-uptake of serotonin = increased concentration of serotonin in cleft
-compensates for serotonin deficiency
-DOC
P. Kinetics:
-oral, id
-liver and kidney disease; elderly
-effects usually seen after 1-4 weeks
ADRs:
-GI: NVD (take w/ food), dry mouth
-CNS: nervousness, insomnia (take in morning), headache
-sexual dysfunction (take drug holidays)
-sweating
-weight gain
-serotonergic syndrome, vvv rare (too much serotonin = convulsions)
Amitriptyline
ANTIDEPRESSANT
Action:
-tricyclic antidepressant (TCA)
-block neuronal re-uptake of monoamines (NE AND serotonin)
-increased concentration of NE and serotonin in cleft = compensation
-less specific than SSRIs, meaning more ADRs
Uses:
-depression
-anxiety disorders (OCD, eating disorders)
-pain syndromes (trigeminal neuralgia)
P. Kinetics:
-oral
-liver and kidney disease; elderly
-effects seen after 3 weeks, settles in after 5-6 weeks
ADRs:
-sedation (take at night, care w/ other CNS depressants)
-orthostatic hypotension
-anticholingeric effects (dry mouth, blurred vision, constipation)
-cardiac toxicity (dysrhythmias; rare)
-very narrow TI - care! (too much = death from heart block)
CI:
-MI
-dysrhthymias
-overdose
Phenelzine
ANTIDEPRESSANT
Action:
-monoamineoxidase inhibitor (MAOI)
-blocks MAO degradation of NE and serotonin = increase in NTs
Uses:
-use when depression is unresponsive to other treatments
-atypical depression (oversleeping, over eating)
-anxiety disorders
P. Kinetics:
-oral (take in morning)
-liver and kidney disease; elderly
-onset after 2-3 weeks, effect persists after 2 weeks after stopping treatment
ADRs:
-orthostatic hypotension
-cardiac toxicity (heart may stop)
-anticholinergic effects (dry mouth, blurred vision, constipation)
-narrow TI- care!
-drug interaction (serotonin syndrome, hypertensive crisis)
-food interaction (tyramine causes risk for hypertensive crisis)
-avoid aged cheese, avocados, Chianti wine, pickled and smoked meats, soy sauce, tap beer
Lithium carbonate
ANTI-MANIA
Action:
-MOA is unclear
-mood stabilizer
-DOC for mania
-also used in bipolar
-monitor sleep patterns
P. Kinetics:
-oral (take w/ food)
-excreted in kidneys, not metabolized (can cause renal damage)
ADRs:
-GI: NVD (take w/ food)
-polydipsia (increased thirst) and polyuria (increased urination)
-fine tremor in hands
-lethargy and slurred speech
Toxicity:
-narrow TI
-normal levels 0.6-1.2
-requires constant blood monitoring
-higher levels can lead to convulsions and death
-too high = drink fluids to dilute, no antidote
-avoid low sodium levels
-CI = thiazide diuretics (diuretics eliminate sodium)
Carbamazepine
ANTI-MANIA & ANTIEPILEPTIC
Action:
-additive drug
-blocks sodium channels = decreased excitation
-“fast cyclers” helps to top up since lithium works slowly
Uses:
-tonic-clonic and partial seizures
ADRs: (less than phenytoin)
-CNS- minimal effects on cognitive function
-visual disturbances and ataxia -> tolerance
-bone marrow suppression
-birth defects
-allergic rash
-SJS (measles like rash)
-hepatotoxicity and pancreatitis (liver and pancreas tests)
Diazepam (Benzodiazepine)
FOR ANXIETY, INSOMNIA, & ANTIEPILEPTIC
Action:
-short term anxiety
-anticonvulsant
-anesthetics
-muscle relaxant
-potentiate inhibitory neurotransmitter GABA (Cl is let in, too neg. = wont fire)
P. Kinetics:
-oral
-iv, rectal (emergency, > 30 mins)
ADRs:
CNS depression
-decreased mental alertness
-drowsiness
-morning sedation
-headache
-do not drink, drive, or operate machinery
-care with other CNS depressants (opioids, FGAs, alcohol)
-orthostatic hypotension
-respiratory depression
-NVD
-allergic reactions (rash, itching)
-blurred vision
-paradoxical reactions (excitement, rage, heightened anxiety)
Implications:
-care: tolerance and dependence
1. tolerance: increase dose to achieve same effect
2. dependence: physical (withdrawal syndrome; cold turkey), psychological (nervous, agitated, panic, sleep trouble/insomnia)
-limit number of prescriptions and doses
-do not increase dosage
-only give for shortest effective period (temporary)
-dosage is individualized (lowest dose possible)
-minimize withdrawal by tapering off and warn patient
CI:
-respiratory depression (asthma, COPD)
-hypersensitivity
-pregnancy, lactation
-drug interactions (morphine, alcohol)
Lorazepam (Benzodiazepine)
FOR ANXIETY, INSOMNIA, & ANTIEPILEPTIC
Action:
-sedation, stronger than Diazepam
-anticonvulsant
-anesthetics
-muscle relaxant
-potentiate inhibitory neurotransmitter GABA (Cl is let in, too neg. = wont fire)
P. Kinetics:
-oral
-iv, rectal (emergency, > 30 mins)
-longer acting
ADRs:
CNS depression
-decreased mental alertness
-drowsiness
-morning sedation
-headache
-paradoxical reactions (excitement, rage, heightened anxiety)
-do not drink, drive, or operate machinery
-care with other CNS depressants (opioids, FGAs, alcohol)
-orthostatic hypotension
-respiratory depression
-NVD
-allergic reactions (rash, itching)
-blurred vision
Implications:
-care: tolerance and dependence
1. tolerance: increase dose to achieve same effect
2. dependence: physical (withdrawal syndrome; cold turkey), psychological (nervous, agitated, panic, sleep trouble/insomnia)
-limit number of prescriptions and doses
-do not increase dosage
-only give for shortest effective period (temporary)
-dosage is individualized (lowest dose possible)
-minimize withdrawal by tapering off and warn patient
CI:
-respiratory depression (asthma, COPD)
-hypersensitivity
-pregnancy, lactation
-drug interactions (morphine, alcohol)
Flumazenil
OVERDOSE ANTIDOTE
Action:
-blocks benzodiazepine receptor
-reverses sedative effects
ADRs: excitation
-dizziness
-agitation
-confusion
-NV
-seizures
Zolpidem & Zaleplon
FOR SHORT-TERM MANAGEMENT OF INSOMNIA
Action:
-improve sleep patterns and decrease latency
-act on GABA receptor (different from BDZ)
Methylphenidate
FOR ADD/ADHD
Action:
-CNS stimulant (improves attention and focus in the prefrontal cortex)
-increased NE and dopamine
-block NE reuptake = activity of frontal cortex is increased
Uses:
-improve attention and focus in prefrontal cortex
-hyperactivity
-impulsivity
P. Kinetics:
-short, immediate
-long duration
-long acting, take 1 dose in morning (avoid 4 hrs before bed)
-oral, transdermal (polymer coating; do not crush or chew)
ADRs:
-CNS overstimulation (restlessness, insomnia, minimize caffeine)
-weight loss, stops hunger (measure h/w before therapy
-CV adverse effects (HTN, palpitations, dysrhythmias, tachycardia)
-risk of dependence and abuse
Amphetamine
FOR ADD/ ADHD
Action:
-CNS stimulant (improves attention and focus in the prefrontal cortex)
-increased NE and dopamine
-block NE reuptake = activity of frontal cortex is increased
Uses:
-improve attention and focus in prefrontal cortex
-hyperactivity
-impulsivity
P. Kinetics:
-short, immediate
-long duration
-oral, transdermal (polymer coating; do not crush or chew)
ADRs:
-CNS overstimulation (restlessness, insomnia, minimize caffeine)
-weight loss, stops hunger (measure h/w before therapy)
-dose after breakfast, avoid 4hrs before bedtime
-CV adverse effects (HTN, palpitations, dysrhythmias, tachycardia)
-risk of dependence and abuse
