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2022 Adv Pharm Faculty Landing Page > Psychotropics > Flashcards

Psychotropics Flashcards

1
Q

Neurotransmitters impacted by antidepressants

A
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2
Q

Symptoms of neurotransmitter deficiency

A
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3
Q

Which drug classes effect which neurotransmitters?

A
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4
Q

Nonselective norepinephrine-serotonin reuptake inhibitors(aka Tricyclic Antidepressants) mechanism of action

A

Block the reuptake of serotonin and norepinephrine at the presynaptic neuron

šBlock histamine and acetylcholine receptors (causes side effects)

šBlock alpha adrenergic and Na+ channels

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5
Q

TCA examples and indications

A

Amitriptyline, Imipramine, Desipramine, Nortriptyline

Indications: depression, OCD, chronic pain, Enuresis (imipramine)

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6
Q

TCA off label uses

A

Panic disorder, bulemia, phantom leg pain, PMS, migraine prophylaxis

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7
Q

TCA side effects

A

Anticholinergic effects (Beers criteria, use caution in older adults)

Sexual dysfunction

Weight gain

Drowsiness (take before bed)

Contraindicated with CV disease d/t arrhythmias (consider baseline EKG)

***Risk for fatal overdose with supply greater than 2 weeks***

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8
Q

Selective serotonin reuptake inhibitor mechanism of action

Examples

A

Inhibits serotonin reuptake in the presynaptic cell

No impact on histaminic, or cholinergic receptors or Na+ pumps (less side effects)

Fluoxetine (Prozac), Citalopram (Celexa), Escitaopram (Lexapro), Sertraline (Zoloft)

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9
Q

SSRI side effects

A

Transiet (typically resolve within several weeks): nausea, light headedness, headache, sedation, sleep distrubance, increased sweating, agitation

Sexual side effect: decreased libido, difficulty acheiving organism. These are typically dose dependent

Weight changes (Paxil has more)

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10
Q

Considerations for prescribing SSRIs

A

Serotonin syndrome: MAOIs, caution with triptans, St. John’s Wort

Recommended to take for at least 6-9 months if effective

Increased risk for suicide in first 3 weeks

Withdrawl syndrome: nausea, dizziness, paresthesias, sleep disturbance, headache

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11
Q

Symptoms of serotonin syndrome

A

šNausea, diarrhea, chills, sweating, HTN, tremor, agitation, disorientation, seizures

Can be fatal

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12
Q

Serotonin–norepinephrine reuptake inhibitor mechanism of action

Examples

A

Block the reuptake of serotonin and norepinephrine at the presynaptic cell

Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)

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13
Q

SNRI inidcations and monitoring

A

šVenlafaxine works well for persons with depression and anxiety, phobias, PTSD

šDuloxetine is also FDA approved for neuropathic pain and overactive bladder

Monitor BP: can cause HTN

LFTs with duloxetine

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14
Q
A
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15
Q

SNRI side effects

A

Headache, nausea, dizziness, insomnia, dry mouth, constipation, sexual dysfunction

Need to be weaned slowly as they can cause significant withdrawl symptoms. Typically tapered over several months

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16
Q

Norepinephrine and dopamine reuptake inhibitors mechanism of action

Example

A

Blocks reuptake of dopamine and norepinephrine at the presynaptic cell

Bupropion

17
Q

NDRI side effects

A

Insomnia, jitteriness, weight loss, irritability, headache, dry mouth

May cause exacerbation of anxiety

Lowers seizure threshold ***contraindicated with any hx of seizure***

18
Q

NDRI positve side effects

A

Can increase energy levels (good for patients with hypersomnia)

Appetite suppressant

Fewer sexual side effects

19
Q

Trazadone

A

Subclass of SSRI

Doses used for depression are very sedating

Most commonly used for sleep

Side effects: headache, dizziness, hypotension

20
Q

MAOIs

A

Rarely used due to extensive drug interactions

Avoid foods with tyramine (aged meats and cheeses)

šPhenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam), isocarboxazid (Marplan)

21
Q

FDA warnings for antidepressants

A
22
Q

Drugs that cause depression

A

šBeta blockers

šCorticosteroids (mania and euphoria common with short term use)

šFluoroquinolones

šInterferon

šAnticonvulsants (CNS depression)

šOpioids

šHormonal BC

šPPI (inhibits absorption of B-12)

šAnti-depressants (increased suicidal ideation)

23
Q

Antidepressants used for anxiety

A
24
Q

Benzodiazepine mechanism of action and indications

A

Acts as a CNS depressant

Enhances GABA which is an inhibitor of neuronal activity

šIndications include: Insomnia, šInduce relaxation and loss of memory of medical procedures or surgery, šReduce anxiety (anxiolytic), šPanic disorders, šTreat or prevent seizures, šAlcohol withdrawal treatment, šMuscle relaxant

25
Q

Half life considerations of benzodiazepines

A

Shorter half life drugs have more addictive properties

Consider using longer acting formulations to reduce risk for misuse

26
Q

Benzodiazepine adverse effects

A

ššDepression, emotional anaesthesia, aggression, increased suicide risk in elderly

Use caution in elderly: šconfusion, memory impairment, over sedation (most common S/E) & falls (40% increase risk for hip fracture)

Physical dependence common (risk for dependence increases with hx of substance use disorder)

šIncreased accident risk

šTolerance & rebound insomnia

šAlcohol & CNS depressants potentiate adverse effects

**Black box warning with opioids**

27
Q

Benzodiazepine withdrawl

A

šAcute withdrawal: insomnia, irritability, GI distress, tremors, agitation, muscle spasms, seizures

šTaper if daily use for > 30 days

šConsider switching to loger acting formulation for tapering to reduce withdrawal symptoms

28
Q

Typical antipyschotics mechanism of action and examples

A

Block dopamine (D2) receptors causing reduction in špositive symptoms (mesolimbic pathway)

Not as effective at treating negative symptoms

šChlorpromazine, šAcetaphenazine, šFluphenazine, šHaloperidol, šTrifluoperazine, šTriflupromazine

29
Q

Typical antipsychotics adverse effects

A

šToo much D2 blockade leads to EPS (nigrostriatal pathway)

šmotor abnormalities (parkinsonism), tardive dyskinesia or hyperkinetic movement disorder, sedation, anticholinergic effects

Hyperprolactinemia

30
Q

Atypical antipsychotics mechanism of action and examples

A

šEffect on multiple dopamine pathways as well as serotonin pathways reducing negative and positive symptoms

šAripiprazole (Abilify), šClozapine (Clozaril), šRisperidone (Risperdal), šOlanzapine (Zyprexa), šQuetiapine (Seroquel), šZiprasidone (Geodon)

31
Q

Atypical antisychotic adverse effects

A

šSIGNIFICANT incidence of metabolic syndrome, weight gain, diabetes

Less EPS than typical antipsychotics

32
Q

Antipsychotics black box warning (typicals and atypicals)

A

1) Increased Mortality in Elderly Patients With Dementia-Related Psychosis
2) Suicidal behavior when combined with antidepressants

33
Q

Stimulant examples and indications

A

šMethylphenidate (Ritalin, Concerta) š

Dexmethylphenidate (Focalin)

Amphetamines [šDextroamphetamine (Dexedrine), šDextroamphetamine-amphetamine (Adderall), šLisdexamfetamine (Vyvanse)]

Indications: ADD/ADHD, šNarcolepsy, Fatigue, depression (palliative care setting)

Schedule II controlled substance, need to check PDMP

34
Q

Stimulant adverse effects

A

šAnorexia, weight loss

šSleep disturbance

šJitteriness

šEmotional lability

šIncreased pulse and BP

2022 Adv Pharm Faculty Landing Page (22 decks)

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