PyschPharm Flashcards
1
Q
A
2
Q
of identifiable neurotransmitters
A
21
3
Q
2nd generation typical anti-psychotic
SE
A
2nd generation typical anti-psychotic
SE
-
droperidol is a vasoconstrictor,
- decrease CBF but not CMRO2
- Decrease in systemic in BP from alpha blockade - minimal
-
Antidysrthymic!
- protects against epinephrine induced dysrthymia
- large doses decrease conduction along accessory pathways
- Prolonged QT interval
-
R/F Torsade’s de Pont.
- must have EKG before
- must be monitored 2-3 hours after
4
Q
Acute dystonia associated with anti-psychotics responds well to
A
diphenhydramine, 25-50 mg IV.
Also helps EPS
5
Q
current antidepressants primarily act on either
A
NE or serotonin by affecting metabolism, reuptake, or selective receptor antagonism
exception: ketamine
- is an NMDA receptor antagonist. MOA for anti-depression unclear
6
Q
all sodium channel blockers are
A
usually more associated with stevens-johnson syndrome
7
Q
All TCAs have
A
All TCAs have
active metabolites.
8
Q
Alprazolam can depress
A
cortisol secretion
9
Q
Amantadine (“Symmetrel”)
class:
MOA:
uses:
A
Amantadine (“Symmetrel”)
class:
anti-viral
MOA:
unknown
enhances dopamine release and delay re-uptake
uses:
symptomatic improvement of parkinsonian symptoms
10
Q
amine hypothesis:
A
Depression is a functional decrease in amine (NE, serotonin, dopamine) transmissio.
Incidental disocvery r/t use of reserpine (depletes vesciles of NE)
11
Q
Anesthesia notes on MAO-Is
A
Anesthesia notes on MAO-Is
Minimize possility of a sympathetic nervous stimulation or drug induced hypotension - get a nice hydrated patient to sleep.
Avoid need for sympathomimetic in anyway.
May need higher MAC
12
Q
Anesthesia with pts on Lithium
A
Anesthesia with pts on Lithium
-
Pre-Op labs:
- ECG, Mag, Na+
-
Anesthetic Requirements may be decreased
- titrate very slowly, esp CNS depressants
- Additive effects with sedation / cognitive slowing
-
Actions of NMB may be prolonged
- use agent that can be reversed with sugammadex
- must have PNS
13
Q
Anti-Cholinergics for Parkinson’s
SE
A
Anti-Cholinergics for Parkinson’s
- Trihexyphenidyl (Artane)
- Benzotripine (Cogentin)
SE
- hallucinations
- confusion
- urinary rention
14
Q
Anti-Depressant Discontinuation Syndrome
A
Anti-Depressant Discontinuation Syndrome
- Dizziness
- myalgias
- Parathesias
- Irratbility
- Insomnia
- Visual Distburances
- Tremors
- Lethargy
- N/V/D
15
Q
Anti-Epileptics:
CYP450 inhibitors
A
Anti-Epileptics:
CYP450 inhibitors
Valproate
16
Q
Anti-Epileptics
CYP450 inducers:
A
Anti-Epileptics
CYP450 inducers:
phenytoin
phenobarbital
carbamezapine
17
Q
Atypical Anti-Psychotic
MOA:
Agent:
A
Atypical Anti-Psychotic
MOA:
Multi-receptor antagonists
- Less potent dopamine blocker than typical agents
- Potent serotonin receptor antagonist
- Also blocks alpha, histamine, cholinergic
- like TCA and typical anti-psychotics
Prototype drug: Clozapine (“Clozaril”)
18
Q
Atypical Anti-Psychotics prematurely age
A
the CV system.
“can be at risk for MI or stroke”
19
Q
Atypical Anti-Psychotic
SE:
A
Atypical Anti-Psychotic
SE:
- Weight Gain
- DM II
- Dyslipidemia
- Myocarditis/pericarditis
- tonic-clonic seizures 3%
-
Alpha Antagonism
- Orthostatic Hypotension
-
Histamine Antagnosim
- Sedation
-
Cholinergic Antagonism
- Anticholinergic SE
20
Q
Atypical Anti-Pyschotics are used to treat:
A
Bipolar
Schizophrenia, esp with suicide risk
21
Q
Buspirone (“Buspar”)
Class:
MOA:
Uses:
E1/2T:
A
Buspirone (“Buspar”)
Class:
not a BZD
MOA:
partial agonist at serotonin receptor
Uses:
used for tx of generalized anxiety disorder, but not panic disorder
E1/2T:
2- 11 hours
“No direct effect on GABA so no cross reactivity with benzos, barbs, ETOH…”
22
Q
Carbamezepine (“Tegretol”)
MOA:
SE:
A
Carbamezepine (“Tegretol”)
MOA:
blocks sodium channels
SE:
minimal cognitive impiarment; mild CNS effects can occur
Rash: mild to steven-johnson’s syndrome
Hematological Effects: Aplastic Anemia, thrombocytopenia, anemia, leukopenia
SIADH -> hyponatremia
23
Q
Carbemezapine (“Tegretol”)
interactions
A
Carbemezapine (“Tegretol”)
interactions
CYP450 inducer!!
Accelerates metabolism of: warfarin, oral contraceptives, other anti-seizures, NDNMB, phenytoin, phenobarb.
Grapefruit juice
increases levels of drug
24
Q
Cardiac Concerns/Testing with droperidol
A
Droperidol has a black box warning for QT prolongation, r/f torsade’s de pont, ventricular fibrillation.
- Must have EKG before.
- Must be monitored prior to admin and continued 2-3 hours after.
- Caution with pts at risk for developing QT syndrome
- Avoid giving with other drugs that prolong QT (erythromycin, amiodarone, quindine, TCAs)
25
**_Cholinesterase Inhibitors for AD:_**
Agents:
SE:
**_Cholinesterase Inhibitors for AD:_**
Donazepil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
SE:
Nausea
diarrhea
head ache
***bronchoconstriction***
26
Clozapine ("Clozaril") specific SE
agranulocytosis
Fatal infections (1:5000)
contra-indicated with WBC \<3500
27
Clozaril is contraindicated with
WBC \<3,500
**fatal infections** with clozaril = 1:5000
28
**Direct Dopamine Agonists:**
**Direct Dopamine Agonists:**
1. _pramipexole "mirapex"_
2. bromocriptine
3. pergolide
4. ropinirole (requip)
29
eldepryl
selegiline \* selective for MAO-I B
30
**_Entacapone_**
class:
MOA:
Uses:
SE:
**_Entacapone_**
## Footnote
_class:_
COMT-inhibitor
_MOA:_
prevents breakdown of dopamine and other catecholamines.
End result: increase the amount of dopamine available to CNS
_Uses:_
**Prolongs half life of dopamine 50-75%**, used with sinemet to prolong half-life of dopamine
_SE:_
Similar to sinemet
orange urine
**hallucinations**
31
Fosphenytoin ("Cerebryx" is a
prodrug of phenytoin (Dilantin)
32
**Fosphenytoin ("Cerebryx")**
MOA:
Dose:
**Fosphenytoin ("Cerebryx")**
_MOA:_
blocks Na+ channel
_Dose:_
10-20mg/kg IV dose
33
**Lamotrigine ("Lamictal")**
MOA:
SE:
**Lamotrigine ("Lamictal")**
## Footnote
_MOA:_
blocks Na+ channel,
_SE:_
major concern: steven-johnson's sndrome
CNS: sedation, visual disturbances, HA, N/V, depression
34
**Levetiracetam ("Keppra")**
MOA:
SE:
**Levetiracetam ("Keppra")**
## Footnote
_MOA:_
Unknown.
Not known to affect GABA
May have affects on voltage gated ion channels
_SE:_
**Adverse effects are much less significant** cmopared to other anti-epileptics
35
**Levodopa/Carbidopa ("Sinemet")**
interactions
**Levodopa/Carbidopa ("Sinemet")**
interactions
_Butyrophenones, Phenothiazines:_
* antagonist effects - dopamine antagonists)
_Metoclopramide_
* also a dopamine antagonist
_Droperidol\*_
* especially can cause skeletal muscle rigidity and pulmonary edema d/t sudden antaognism of dopamine
_MAO-I_
* Interferes with inactivation of catecholamines inculding dopamine , can be beneficial
_Anti-Cholinergics:_
* act synergistically with levodopa to improve tremor.
36
**Levodopa/Carbidopa ("Sinmet")**
MOA:
SE:
**Levodopa/Carbidopa ("Sinmet")**
_MOA:_
Is a dopamine precursor and decarboxylase inhibitor. Increase dopamine in brain.
_SE:_
1. N/V -\> dopamine at CRTZ
2. Transient flushing of skin, ST, PACs, PVCs, orthostatic hypotension r/t higher plasma dopamine levels
3. Abnormal involuntary morvements devleop in 50% of pts after 1-4 onths
4. Psychiatric disturbances
5. Increase liver enzymes
6. transient increase in bUN
7. **_urinary metabolites can cause false positive for ketoacidosis_**
37
**Lithium Interactions:**
**Lithium Interactions:**
## Footnote
**_Diuretics:_**
*Increase* lithium levels and r/f lithium toxicity r/t lowering of sodium
**_NSAIDs:_**
*Increase* lithium levels by **~60%**
**_ACE-inhibitors:_**
*Increase* lithium levels
**_Anticholinergics:_**
urinary retention!
**Painfu**l with high volume of urine.
**_Amiloride:_**
(potassium sparing diuretic)
*decreases urine volume* !
38
Lithium is contraindicated in patients with
SA node dsyfunction:
Sick-sinus syndrome
39
Lithium range for acute mania:
1 - 1.2 mEq/L for acute mania
very narrow
40
Low dose typical anti-psychotics can be used anti-emetics because
they block dopamine at chemo trigger zone
[dopamine antagonism]
41
MAO-Inhibitor A
increases
serotonin,
epinephrine,
norepinephrine
42
MAO-Inhibitor B increases
phenylethylamine
## Footnote
**dopamine**
43
**MAO-I:**
SE:
**MAO-I:**
SE:
**Orthostatic hypotension**
**Weight Gain**
anticholinergic effects
Impotance/Anorgasmy :(
Sedation **_OR_** mild stimulant effects
MAO-A enzyme is present in liver, GI tract, kidneys, lungs -\> metabolizes dietary tyramine.
44
**MAO-I**
MOA:
**MAO-I**
## Footnote
MOA:
MAO-Is form a stable irreversible complex monoamine oxidase, increasing the availability of these neurotransmitters in the CNS and peripheral autonomic nervous system.
45
**MAO-I**
C/I
**MAO-I**
C/I
* **Dietary tyramine** + MAO-I = massive release of endogenous catecholamines/serotonin -\> HTN crisis or sertonnin syndrome, r/f CVA
* **SSRIs, TCAs** - r/f sertonin syndrome
* **Meperidine** - r/f serotonin syndrome
* **Ephedrine** - can be fatal
* Decrease dose of **phenylephrine** to 1/3
* **Cold/Allergy drugs** may have some sympathomimetics
* **Nasal Decongestants**
46
marplan
isocarboxazid
47
**Mild Lithium Toxicity**
\>1.2 mEq/L
* **Sedation,**
* nausea,
* **skeletal muscle weakness,**
* **wide QRS,**
* **AV heart block,**
* hypotension,
* dysrthymia,
* **seizure**
48
**Mirtazapine ("Remeron")**
SE
**Mirtazapine ("Remeron")**
SE
**"more pronounced effect on co-morbid anxiety" - decreases anxiety**
Sedation \> 50%
Constipation
**Increased Appetite**
Weight Gain
Increased Cholesterol
**Less sexual SE, less GI effects**
49
**Mirtazapine ("Remeron")**
## Footnote
_Class:_
_MOA:_
_Notable Uses:_
**Mirtazapine ("Remeron")**
## Footnote
_Class:_
atypical anti-depressant
_MOA:_
Unique: presynaptic a2 - antagonist, blocks negative feedback mechanism and increases release of NE serotonin. Is also a serotonin antagonist?
_Notable Uses:_
In addition to normal anti-depressant reasons, specifically can be used in CA patient to help with insomnia and appetite.
50
**Mirtazpine ("Remeron")**
C/I
**Mirtazpine ("Remeron")**
C/I
With MAO-Is -\> r/f serotonin syndrome
Caution with CNS depressants r/t sedation
51
Mood Stabilizer:
**Lithium**
MOA:
Uses:
Mood Stabilizer:
**Lithium**
_MOA:_
* Unknown!
* Theories:
* Alterated glutamine signaling, serotonin receptor blockade.
* Lithium is a positively charged inorganic ion.
_Uses:_
* Tx for bipolar, gold standard!
* Especially good for manic phase.
52
**_Mood Stabilizer: Lithium_**
SE:
**_Mood Stabilizer: Lithium_**
SE:
* **Polydipsia/Polyuria - 3L/urine per day**
* **Impaired renal concentrating ability**
* ECG: T wave changes
* clinically irrelevant and reversible
* Heart Block (rare)
* C/i in pts with SA node dysfunction
* Hypothyroidism
* more common in females
* New onset Psoriasis
* Fine tremor
* Sedation
* Memory Disturbances
* **Cognitive Slowing**
53
Nardil
phenelzine
54
**_Neurolepetic Malignant Syndrome_**
**_Neurolepetic Malignant Syndrome_**
* develops over 24 - 72 hours
* more common in young men
* hyperthermia
* hypertonicity of skeletal muscles
* myoglobinuria
* instability of autonomic NS
* fluctuating lOC
* 4%mortality with early intervention
* 30% mortality with delayed intervention r/t respiratory failure, CV collapse, dysrthymias
Tx is supportive and inlcuds **dantrolene** and dopamine agonists.
55
**Memantine ("Namdena")**
Class
MOA:
Uses:
SE:
**Memantine ("Namdena")**
## Footnote
Class:
NMDA antagonist
MOA:
blocking the leacky NMDA channels that allow excess calcium into neurons.
Chronic glutamate release depolarzies NMDA.
Uses:
Alzheimer's, very modest benefits.
SE:
Dizziness
HA
fatigue
sedationn
**_Hypertension_**
Rash
Diarrhea
Weight gain
urinary frequnecy
**_anemia_**
56
Notable SE of citalopram
QT prolongation
57
parnate
tranylcypromine
58
**Phenobarbital**
MOA:
SE:
**Phenobarbital**
_MOA:_
Modulation of post-synaptic ations of GABA and glutamate.
Prolong duration of cholride channel opening, limiting spread of seizure
_SE_
cognitive and behavior side effects limit usefulness
**Adults:** sedation
**Children;** paradoxical excitation
**Elderly:** confusion
**_Induces CYP450_**
59
**Phenytoin ("Dilantin")**
Administration:
**Phenytoin ("Dilantin")**
Administration:
**infusion no faster than** 50mcg/min in adults.
1-3 mg/kg/min in peds or 50 mcg/min, whichevr is slower! To avoid hypotension and dysrthymias.
60
**Phenytoin ("Dilantin")**
interactions
**Phenytoin ("Dilantin")**
interactions
**Phenytoin is a CYP450 inducer**
increases metabolism of other anti-epiletptics, OC, warfarin, corticosteroids, NDNMB
**Topiramate:**
can increase levels of phenytoin
61
**Phenytoin ("Dilantin")**
MOA:
**Phenytoin ("Dilantin")**
MOA:
Regulates ***Na+ and Ca++*** ion transport across the neuronal membrane to decrease excitability.
62
**Phenytoin ("Dilantin")**
Pk
**Phenytoin ("Dilantin")**
Pk
Atypical Pharmokinetics:
Non-linear pharmacokinetics; metabolism is saturable.
1st order kinetics until higher dose than 0 order kinetics.
63
**Phenytoin**
SE:
**Phenytoin**
SE:
_Dose Related:_
ataxia, nystagmus, diplopia, vertigo, peripheral neuropathy, drowsiness, cognitive impairment
_NON-Dose Related:_
Steven-Johnson's syndrome, **gingival hyerplasia, _hepatotoxicity_**, purple glove syndrome
64
Pramipexole ("mirapex")
class:
MOA:
Uses:
SE:
Pramipexole ("mirapex")
_class:_
direct dopamine agonst
_MOA:_
selectively binds to D2, D3
**delayed onset! 2-3 weeks**
_Uses:_
*Used as **1st line monotherapy** then combined with levodopa as diseas progresses*
_SE:_
* N/V
* postural hypotension
* hallucinations
* vivid dreams
* sleepiness
* dyskinesias (less than with levodopa)
* **_Impulse high risk behaviors_**
65
**_Sertonin Syndrome_**
**_Sertonin Syndrome_**
* MAO-I + any other drug that increases serotonin can cause SS
* meperidine
* SSRI
* SNRI
* tyramine containing foods
Symptoms:
Hyperthermia
Diaphoresis
muscle rigidity
rapid flucations in VS/mental status
confusion
agitation
hallucinations
Excitatory Response (Type I):
agitation, skeletal muscle rigidty, hyperprexia
Depressive Response (Type II)
Hypotension, respiratory depression, coma
***Serotonin Syndrome is rare but fatal***
66
**Significant Lithium Toxicity**
**Significant Lithium Toxicity**
\>2.5 mEq/L
more significant symptoms!
**_Life threatening dysrthymias._**
**_Medical Emergency!_**
**Sedation,**
**nausea,**
**skeletal muscle weakness,**
wide QRS,
AV heart block,
hypotension,
dysrthymia,
**seizure**
67
**SNRI**
SE
**SNRI**
SE
**GI distress**
**sexual dysfunction**
**diastolic blood pressure increases 5-7%**
**Pupil dilation** (caution in glaucoma)
insomnia
withdrawl syndroms if stopped abruptly
neonatal withdrawl syndrome
68
Sodium depletion can cause
increase plasma concentratino of lithium by 50%
69
_SSRIs + pregnancy_
_SSRIs + pregnancy_
Most are category C:
Late pregnancy use = small risk to fetus. But infant withdrawl symptoms and pumlonary HTN can happen.
When you increase serotonin in really high concentratoins it can promote pulmonary HTN.
70
SSRIs inhibit
CYP450-**2D6**
will increase levels of warfarin, TCAs, and lithium
71
**SSRI**
interactions
**SSRI**
interactions
**MAO-I:** r/f serotonin syndrome, absolute contraindications.
**Drugs that impair coagulation/platelets**
**SSRIs inhibit CYP450-2D6** (potentiate warfarin, TCA, lithium)
SRRI + **wellbutrin** = increase r/f seizure
**St John's Wart, TCAs** = increase serotonin
72
**SSRI**
SE
**SSRI**
SE
**Sexual dysfunction**
**Suppretion of plt aggregation**
**Orthostatic Hypotension**
**Hyponatremia (esp c diuretics)**
**Withdrawl if stopped abruptly**
CNS excitation (agitation, insomnia)
GI distress
Sleepiness, light headedness
Bruxism
Rash
Short term weight loss/long term weight gain
Prolonged QT (citalopram)
r/f serotonin syndrome
Black box warning - r/f suicide, esp in first few months
73
**Tardive Dyskinesia with Typical Anti-Psychotics:**
is usually not reversible, diagnosed 6 months after chronic use.
74
_TCA also acts on receptors_
TCA receptor activated:
1. Alpha Adrenergic Antagonism
2. Histamine Antagonist
3. Cholinergic Antagonism
75
**_TCA_**
side effects
**_TCA_**
side effects
**1. Alpha-Adrenergic Antagonism**
* hypotension, orthostatic hypotension, can lead to mild tachycardia r/t blocking of alpha2
**2. Histamine Antagonism:**
* sedation, weakness, fatigue
**3. Cholinergic Antagonism**
* tachycardia
* dry mouth
* urinary retention
* constipation
* ileus
* slow gastric emptying
**4. Cardiac Conduction Abnormalities:**
* QT prolongation, arrthymias via vagal and bundle-of-his conduction (inhibition). -\> promotes tachycardia.
**5. Lowers seizure threshhold**
* only for pts who have seizure d/o
**6. Hypomania**
**7. Must be weaned to prevent withdrawl symptoms**
76
**_TCA_**
overdoses;
**_TCA_**
overdoses;
are often fatal.
So they are only given 1 week supply at a time.
77
TCAs are prone to drug interactions because
1. they are metabolized by CYP450
2. and bc they have affects at so many receptors (cholinergic, hisatmine, alpha)
78
_TCAs are structurally simliar to_
_TCAs are structurally simliar to_
**Dopamine Antagonists** (typical anti-psychotics)
* phenothiazines
* thioxanthenes
* butyrphenones
* haloperidol
* droperidol
79
TCAs are used for neuropathic pain:
1. at low doses
2. because they resemble LA
3. potentiate enodgenous opioids
4. inhibit overactive inflammatory response system
80
**_TCAs_**
uses
**_TCAs_**
uses
depression
bipolar (depssive episodes)
chronic pain syndrome - low doses
81
**_TCAs_**
C/I
**_TCAs_**
C/I
**_MAO-Is_**: strict contraindication
**_Direct & Indirect Acting Sympathomimetic:_** use extreme caution
***_Avoid_*** Ephedrine
***_Avoid_*** anti-cholinergic drugs
***_Avoid_*** droperidol, erythromycin -\> _prolong QT_
**_Caution with_**
* sedating drugs, etoh, barbs, anti-histamines, opioids, inhaled agents, IV induction agents
* liver diseae, renal diease -\>active metabolites
82
_TCAs_
## Footnote
**PB:**
_TCAs_
**PB: high!**
Acidosis may increase unbound drug leading to more SE and dysrthymias, important because drug has a ***narrow therapuetic window.***
83
To prevent QT prolongation, avoid anti-pyschotics concurrent use with
TCA
erythromycins
quinidine
amiodarone
84
**Topiramate ("Topomax")**
interactions:
**Topiramate ("Topomax")**
interactions:
1. when given with _valproate:_ can lead to _ammonia_ accumulation, CNS toxicity
2. **Can increase levels of phenytoin,**
3. **Can increase levels of cabramezapine**
85
**Topiramate ("Topomax")**
MOA:
SE:
**Topiramate ("Topomax")**
## Footnote
_MOA:_
Blocks Na+ channels
Enhances gaba
Blocks Ca++ channels
Glutamate Antagonist
Produces GABA release
NMDA antagonist
_SE:_
Drowsiness, impaired cognition
ataxia
weight loss
**Psychomotor slowing**
**renal stones**
**metabolic acidosis**
**glaucoma**
86
**_Tricyclic Anti-Depressants:_**
MOAs:
**_Tricyclic Anti-Depressants:_**
MOAs:
Blocks reuptake of serotonin and/or NE
**tertiary amines:**
* *inhibit sertonin and NE reuptak*e
* Amitryptilline (Elavil)
* Imipramine (Tofranil)
* Clomipramine (anafranil)
**secondary amines:**
* *inhibit NE reuptake*
* desipramine (norpramin)
* nortriptyline (pamelor)
87
Tx for Lithium Toxicity
1. Hemodiaysis
2. Osmotic Diuresis with NaBicarb
88
**_Typical Anti-Psychotics_**
SE
**_Typical Anti-Psychotics_**
SE
**Histamine Antagonism**
* sedation
**Cholinergic Antagonism:**
* dry mouth, constipation, urinary retention
**Alpha Adrenergic Antagonism**
* hypotension, orthostatic hypotension
**Parkinsonianism**
* bradykinesia,
* tremor,
* rigidity,
* akinesia
**Dyskinesia**
spasms of muscle groups
**_Acute Dystonia:_**
*Acute skeletal muscle rigidity and cramping of muscles of eyes, tongue, face, larynx, r/f laryngospasm, neck, back - can be so severe that jaw discloates, acute respiratory distress from laryngeal dyskinesea*
**Tardive Dyskinesia**
Not reversible, usually diagnosed after 6 months of chronic use
**Severe dysrthymias and _QT prolongation_**
direct cardiac depression
***droperidol has blackbock warning***
**Decreased BP**
**Agranulocytosis**
**Sedation**
d/t histamine antagonism, tolerance to sedation with chronic therapy
**Seizure threshhold is reduced**
89
Typical Anti-Psychotics are similar to
TCAs
they both act as:
1. histamine antagonists
2. cholinergic antagonists
3. alpha adrenergic antagonist
**in addition to their MOA/effect**
90
**Typical Anti-Pyschotics:**
_Agents:_
_MOA:_
_Generations:_
**Typical Anti-Pyschotics:**
## Footnote
_Agents:_
Phenonthiazines (1st)
Thioxanthenes (1st)
Butyrophenones (2nd)
_MOA:_
Dopamine antagonists at D2 receptors in the basal ganglia and limbic portions of the forebrain.
_Generations:_
First generation
Second generation = more potent, so less side effects
91
**Valproate ("Depakote")**
+ CYP450
**Valproate ("Depakote")**
not metabolized by CYP450 but does induce CYP450
92
**Valproate ("Depakote")**
MOA:
SE:
C/I"
**Valproate ("Depakote")**
## Footnote
_MOA:_
Blocks Na+ channels
Blocks T-Type VGCC
Promotes synthesis of GABA
_SE:_
N/V
weight gain
alopecia
thrombocytopenia
fatal hepatotoxicity (1:40,000)
fatal pancreatitis
_C/I:_
pregnancy
93
**Valproate ("Depakote")**
SE:
**_Valproate ("Depakote")_**
SE:
N/V
weight gain
alopecia
thrombocytopenia
fatal hepatotoxicity
* 1:40,000 = adults
* 1:500 = pediatrics less than 2y/o
**CYP450 inhibitor**
94
**Vaproate ("Depakote")**
+ topiramate
**Vaproate ("Depakote")**
+ topiramate
high levels of **_ammonia_** can accumulate and cause **_CNS toxicity_**
95
**Wellbutrin**
Class:
MOA:
Uses:
**Wellbutrin**
_Class:_
atypical anti-depressant
_MOA:_
primarily an inhibitor of dopamine and NE reuptake
Uses:
* prevent seasonal affective disorder
* smoking cessation aid
* pt's not tolerating other SSRIs
* **Hypoactive sexual desire disorder**
Off label:
* neuropathic pain
* ADHD
96
**Wellbutrin**
C/I
**Wellbutrin**
_C/I_
Dopamine and NE reuptake inhibitors.
**MAO-Is**
Avoid:
drugs that inhibit cyp450-CYP2D6 ( SSRIs )
increase seizure risk
97
_Wellbutrin_
SE
_Wellbutrin_
SE
* **Nervousness**
* HA
* **insomnia**
* N/V/constipation
* Dry Mouth
* **Tremor**
* Weight Loss
* **Small risk of psychotic symptoms r/t dopamine**
* **Increased r/f seizures (0.4%)**
