PSYCHOTROPIC MEDS Flashcards
antipsychotics: target symptoms
positive symptoms; agitation, hallucinations, delusions, combativeness/belligerent behavior, sleep disturbance, tension, paranoid behavior/disorganized thinking
antipsychotics: symptoms less likely to respond
negative symptoms; impaired judgement, lack of insight, depression and withdrawal, poor motivation
antipsychotics: side effects
sedation, postural hypotension, weight gain, photosensitivity, sexual dysfunction, breast swelling, anticholinergic (dry mouth, blurred vision, urinary hesitation, constipation), tardive dyskinesia, acute dystonic reactions (involuntary muscle spasms or tightening of face), neuroleptic malignant syndrome (medical emergency, fever, muscle rigidity, mental status changes)
antipsychotics: tardive dyskinesia side effect treat
limit antipsychotic exposure, use vitamin E for prevention
antipsychotics: extrapyramidal symptoms (parkinsonian movements) treat
Artane, Cogentin, benadryl
antipsychotics: common atypical; clozapine
clozaril
different action
side effects–high saliva production, sedation, nausea, hypotension, dizziness, weight gain, risk of seizures; no tardive dyskinesia
need for weekly blood monitoring
antipsychotics: common atypical; resperidone
riserdal
injectable
side effects; sedation, some headache, dry mouth, constipation, blurred vision, palpitations, no tardive dyskinesia
question of relief for positive and negativesymptoms
antipsychotics: newer meds
apriprazole--abilify ziprasidone--geodon quetiapine--seroquel olanzapine--zyprexa asenapine-saphris paliperidone palmitate--invega sustenna paliperidone-invega illoperidone--fanapt
tricyclic antidepressants: side effects
autonomic, anticholinergic (dry mouth, blurred vision, constipation, urinary probs, sweating/heat sensitivity), pustural hypotension, tachycardia, change in EKG arhythmias
tricyclic antidepressants: contraindicated for
people with heart disease, lethal in high doses so not good for suicidal pts
tricyclic antidepressants: therapeutic effects in
2-3 weeks
monoamine oxidase inhibitors (MAOIs): most effective for
atypical and nonendogenous depression
monoamine oxidase inhibitors (MAOIs): side effects
hypertension with high dose or when tricyclic/stimulant also taken
monoamine oxidase inhibitors (MAOIs): adverse drug reactions
stimulants, appetite suppressants, cold remedies, cocaine derivatives, anything that raises blood pressure
monoamine oxidase inhibitors (MAOIs): dietary restrictions
food with high levels of tyramine; avoid beer/ale, wine, cheese, smoke/pickled fish, beef/chicken liver, summer sausage, italian beans, yeast vitamin supplements
second generation antidepressants: benefits
reduced, different side/averse effects
second generation antidepressants: SSRIs therapeutic efficacy similar to
TCAs (tricyclic acids)
second generation antidepressants: SSRIs side effects are dose related
weight loss, nausea, diarrhea, nervousness (fluoxetine/prozac), insomnia, sexual dysfunction with long term use, less toxic to heart and safer in overdose than TCAs
second generation antidepressants: SNRIS side effects dose related
dry mouth, loss of appetite, nausea, diarrhea, constipation, nervousness, insomnia, elevated blood pressure and sexual problems
less toxic and safer in overdose
mood stabilizers: lithium
narrow therapeutic index; need blood levels/kidney/thyroid checked regularly
mood stabilizers: lithium side effects
thyroid can enlarge and underactive (treat with thyroid replacement meds)
renal kidney impact, need to drink more water for dehydration
gastrointestinal (anorexia, cramps, nausea, vomiting)
CNS (mental dullness, decreased memory and concentration, headache, hand tremors, fatigue and lethargy, weight gain)
mood stabilizers: lithium; don’t take
during first trimester of pregnancy
mood stabilizers: sometimes combined
with antidepressant or antipsychotic
mood stabilizers: therapeutic effect
2+ weeks to build dosage to therapeutic level, need LI does multiple times a day
mood stabilizers: response rate
70-90% with typical bipolar respond, most effective at preventing mania not depression
mood stabilizers: anticonvulsants to stabilize mood; carbamazepine
tegretol
avoid during pregnancy, may depress bone marrow function (blood count monitoring)
patient needs to report signs of infection or bleeding ASAP
mood stabilizers: anticonvulsants to stabilize mood; valproic acid
depakote
more effective for rapid cycling and mixed bipolar
avoid during pregnancy
anxiety medications: panic disorder with or without agoraphobia
TCAs, MAOIs, SSRIs, alprazolam/xanax
anxiety medications: OCD
TCAs (clomipramine/Afafranil), MAOIs, SSRIs (fluvoxamine/Luvox, sertraline/Zoloft)
anxiety medications: specific phobias and social phobia
beta blockers (propanolol) to treat somatic symptoms of stage fright paxil for social phobia
anxiety medications: GAD, benzos; side effects
impaired muscle coordination, impairment of short term memory
anxiety medications: GAD, benzos; can also be used for detox of
alcohol or other depressants to prevent seizures
anxiety medications: GAD, benzos; safer and more effective than
barbiturates
anxiety medications: GAD, benzos; treatment issues
chronic use vs PRN, relapse vs withdrawal after meds discontinued, abuse liability, hard to discontinue, over use; drug most often used in overdose
anxiety medications: GAD, barbiturates
high abuse potential/safety problem, hard to separate anxiolytic and sedative doses, dangerout when used with alcohol
anxiety medications: GAD, barbiturates formerly used
methaqualone (quaaludes), hydroxyzine (atarax, vistaril), meprobamate (Milltown)
anxiety medications: GAD; antipsychotics
no more effective than benzos, more side effects, combo with anxiolytic in psychotic patient with high anxiety
anxiety medications: GAD, can use buspirone/buspar but
takes 2-6 weeks to relieve symptoms and not as good a PRN option
meds for sleep (hypnotics): benzos have less probabilty to tolerance
to hypnotic effects than with barbiturates
hyperactivity in kids: psychostimulants are standard: side effects
insomnia, decreased appetite, stomachace, headaches, jitteriness
hyperactivity in kids: meds; methylphenidate
ritalin and concerta
hyperactivity in kids: meds; amphetamine
adderall
hyperactivity in kids: meds; pemoline
cylert
hyperactivity in kids: meds; lisdezamfetamine
vyvanse
hyperactivity in kids: meds; other options; aripiprazole, ziprasidone, guanfacine, cloridine
ability, geodon, intuniv, kaprav
autism spectrum; not approved by FDA but use
SSRIs, TCAs, psychoactive antipsychotics, stimulants, antianxiety meds
Thorazine/chlorpromazine Stelazine/trifluoperazine Mellaril/thioridazine Prolixin/fluohenazine (prolixin D injectable) Navene/thiothixene Haldol/haloperidol
Typical antipsychotics
Clozapine/clozaril
Reperidone/risperdal (available as injectable)
Apriprazole/abilify Ziprasidone/geodon Quetiapine/seroqeul Olanzapine/zyprexa Asenapine/saphris Paliperidone palmitate/inveva sustenna Paliperidone/invega Illoperidone/fanapt
Atypical antipsychotics
Imipramine/tofranil Amitriptyline/elavil Nortriptyline/aventyl, pamelor, norpress Desipramine/norpramin, pertofrane Doxepin/adapin, deptran, sinequan
Tricyclic antidepressants
Phenelzine/Nardill
Tranylcypromine/parnate
Isocarboxazid/marplan
MAOIs (Minoan is oxidase inhibitors) antidepressant
Amoxapine/asendin Trazadone/desyrel Maprotiline/ludiomil Bupropin/Wellbutrin Venlaxafine/Effexor Nafazadone/serzone
Second generation antidepressants
Fluoxetine/Prozac
Sertraline/Zoloft
Paroxetine/Paxil
Vilazodone/vilbryd
SSRIs
Duloxetine/cymbalta
Desvenlafaxine/pristiq
SNRIs
Lithium
Mood stabilizer
Carbamazepine/tegretol Valproic acid/depakote Gabapentin/neurontin Lamotrigine/lamictal Toprimate/topomax
Anticonvulsants to stabilize mood
Panic disorder with or without agoraphobia
TCAs, SSRIs, MAOIs, Xanax/alprazolam
OCD
TCA
MAOI
SSRI (Luvox/fluvoxamine, sertraline/Zoloft)
Beta blockers (propranolol) Paxil
Somatic symptoms of stage fright
Social phobia
Diazepam/Valium
Chlordiazepam/Librium
Lorazepam/Ativan
Clorazepate/tranxene
Benzos
Amobarbital
Secobarbital
Penobarbital
Barbiturates
Benzos
Flurazepam/dalmare
Triazolam/halcion
Temazepam/restoril
Barbiturates-chloral hydrate
Trazadone/desyrel
Eszopicione/lunesta
Zolpidem/ambien
Zaleplon/sonata
Ramelteon/rozerem
Sleep aids/hypnotics
Donepezil/aricept
Mamantine/name day
Dementia meds
