Test 2 Flashcards
Alzheimer’s Med Categories
Cholinesterase inhibitors, NMDA receptor antagonist, Combination
Cholinesterase inhibitors
Donepezil
Rivastigmine
Galantamine
NMDA receptor antagonist
Memantine
Combination Alzheimer Med
Donepezil + Memantine
Cholinesterase Inhibitor MoA
• Selectively inhibit cholinesterase [enzyme that hydrolyzes (inactivates) Ach] in the CNS
Cholinesterase Inhibitor effect
May slow deterioration of cognitive function
– Preserves memory, learning, attention (does NOT affect the underlying degenerative process
Cholinesterase Inhibitors Adverse Effects - ALL
Diarrhea, Nausea and vomiting
Bradycardia, dizziness, syncope
Urinary incontinenced
Hypersalivation, sweating
Rivastigmine AE
Hepatotoxicity
Donepezil AE
Insomnia
Galantamine AE
Weight gain
Cholinesterase Inhibitors drug ineractions
anticholinergic drugs
drugs that induce 3A4
Memantine MOA
NMDA receptor antagonist
Memantine Indications
Indicated for moderate to severe disease
– Can be used alone or in combination with cholinesterase inhibitors
Memantine AE
– Headache, confusion, dizziness, hallucinations
– Hypertension
Memantine can be combined with
donepezil (combo drug is called Namzaric®)
Alzheimer’s combination agents
Namzaric (Donezepil & Memantime)
Parkinson’s drug classes
Dopaminergic COMT Inhibitors MAO-B inhibitors Dopamine Receptor Agonists Acetyl Choline Receptor Agonists
Parinkson’s Psychosis Drg
Pimavanserin
Dopaminergic agents
Levodopa
COMT Inhibitor agents
Tolcapone
Entalcapone
MAO-B Inhibitors
Selegiline
Rasagaline
Safinamide
Dopamine Receptor Agonists
Pramiprexole
Ropinirole
Acetylcholine Receptor Agonists
Benztropine
Trihexyphenidyl
Epilepsy Drug Classes
Sodium Channel Blockers GABA Agents Glutamate Agents T-Type Calcium Channel Blockers Miscellaneous
Sodium Channel Blockers
Phenytoin
Carbamazepine
Zonisamide
Lamotigrine
GABA Agents
Phenobarbital
Valproic Acid
Glutamate Agents
Topiramate
Perampanel
Levetiracetam
T-type Calcium Channel Inhibitors
Ethosuximide
Miscellaneous Epilepsy Drugs
Cannabidiol and Benzos
Depression Meds
TCAs MAOIs SSRIs SNRIs Miscellaneous
TCAs
Amitriptyline
Doxepin
Nortriplyine
MAOIs
Selegiline
SSRIs
Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro)
SNRIs
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Milanacipran (Saveila)
Misc Depression Drugs
Bupropion (Wellbutrin)
Mirtazapine
Antipsychotic Drugs
D2 Receptor Agonists (Typical)
Serotonin-Dopamine Agonists (Atypical)
Newer 2nd gen antipsychotics
D2 Receptor Agonists (typical antipsychotics)
Haloperidol (Haldol)
Serotonin-Dopamine Agonists (atypical)
Clozapine Olnazapine Quetiapine Aripiprazole (Abilify) [Aristada IM] Risperidone
Newer 2nd gen antipsychotics
Brexpiprazole
Cariprazine
Bipolar Meds
Lithium
Anti-Psychotics
Post Partum Meds
Brexanolone
Treatment Resistant Depression Med
Esketamine
Levodopa MoA
increases conc of dopamine in the brain
biosyntetic precursor of dopamine
Levodopa AE
Nausea and vomiting
Orthostatic hypotension, sedation
Depression, delirium, paranoia, delusions, hallucinations
Motor fluctuations
Levodopa metabolism
Metabolised by COMT
Less than 1% reaches brain (why we combine with meds)
Levodopa combined with
Carbidopa & COMT inhibitor
Levodopa + Carbidopa
Sinemet, Sinemet CR, & Parcopat (oral disintegrating); Rytary new control release
Carbidopa MoA
Decarboxylase inhibitor
Inhibits conversion of levodopa to dopamine in peripheral tissues
Increases amount of levodopa that enters the brain
Carbidopa metabolism
Wearing off phenomenon (2-5 years efficacy)
Titrate to minimum 75 mg daily
COMT Inhibitor MoA
Inhibits peripheral metabolism of levodopa through inhibition of COMT
COMT AE
Hepatotoxicity (tolcapone) Orthostatic hypotension Diarrhea Hallucinations Brown-orange urine discoloration (entacapone)
COMT combined with levo/carbidopa
Entacapone
Entacapone + Levodopa + Carbidopa
Stalevo
MAO-B Inhibitors MoA
MAO-B breaks down dopamine so these drugs irreversibly inhibit this action
MAO-B Inhibitor AE
Increase levodopa toxicity (dyskenesia, psych symptoms)
Nausea, dizziness, orth htn, hallucination, insomnia, serotonin syndrome if combined with other serotenergic agents
MAO-B inhibitor interactions
foods/drinks high in tyramine (e.g. aged cheese, smoked meat, red wines, others)
DA receptor agonist MoA
directly activates dopamine receptor in brain and elsewhere
DA receptor agonist advantage over levodopa
– Direct action on receptor – less free radicals released – Less motor fluctuations and dyskinesias
– Longer half-life = longer action
disadvantages of DA receptor agonists
– Difficult to use in elderly due to increased CNS effects – May cause or exacerbate dyskinesias
DA receptor agonist AE
– Nausea, anorexia, vomiting (reduced if taken with food)
– Postural hypotension
– Sedation and hallucinations, confusion, vivid dreams
– Impaired impulse control, sleep attacks
– Behavioral (Impulse) side effects (gambling, shopping) • Less common (<10%)
Ach receptor antagonist therapuetic effects
Helps reduce tremor more than other manifestations
Favorable effects on rigidity and bradykinesia
Acetylcholine Receptor Antagonists MoA
– Competes with Ach at muscarinic receptors
– Block dopamine reuptake–prolonging dopamine effect
Ach receptor antagonist AE
– Sedation, depression, confusion
– Dry mouth, blurred vision, constipation, urinary retention
– Patients often find them difficult to tolerate
PD Psychosis drug
Pimavanserin
Primavenserin MoA
Selectively blocks 5-HT2a and 2c receptors
Primavenserin AE
Worsening hallucinations, QTc prolongation, death
BBW: Increased mortality in elderly patients with dementia- related psychosis (all antipsychotics)
How do Antiepileptic Drugs Work?
– Limit repetitive firing of neurons
– Enhance GABA-mediated synaptic inhibition
– Attenuate Glutamate-mediated excitatory responses
Key Sodium Channel Blockers
Phenytoin
Carbamazepine
Zonisamide
Lamotrigine
Phenytoin use
• Focal and generalized seizures
• No activity against absence
seizures
Pheyntoin routes
PO and IV
Phenytoin max infusion rate
50 mg/min
Phenytoin pharmacokinetics
- high protein binding
- metabolized by liver
- dose dependent: enzyme system may become saturated and small dose increase may result in large increase in levels
Target Phenytoin concentration
– Total concentration: 10 - 20 micrograms/mL
– Free concentration: 1 - 2 micrograms/mL
Phenytoin Concentration dependent side effects
– > 20 micrograms/mL = Nystagmus
– > 30 micrograms/mL = ataxia, seizures reported
– > 40 micrograms/mL = lethargy, coma
Adjust total phenytoin level if:
– Low albumin (albumin <3.2 mg/dL)
What causes low albumin
Renal disease, malnutrition, cancer, liver failure
Adverse Effects of Phenytoin
- Nystagmus – can develop tolerance
- Diplopia/ataxia – indication to check level (may be dosed too high)
- Phenytoin anticonvulsant hypersensitivity syndrome (AHS): rash, increased LFTs, and fever
- Gingival hyperplasia (A) - ~ 20% of chronic use
- Hirsutism (B) – can be dose related
- Gingival hyperplasia (A) - ~ 20% of chronic use
- Hirsutism (B) – can be dose related
- Purple glove syndrome (C) - extravasation of phenytoin (do not use)
- Hypotension
Phenytoin Drug Interactions
Other high protein bound drugs (valproic acid)
Phenytoin metabolism
metabolized by liver, dose dependent, high protein binding; INDUCER
Carbamazepine indications
Focal and tonic clonic
Carbamazepine PK
highly protein bound requires TDM (goal 6-10 mcg/mL)
Carbamazepine metabolism
– Extensively hepatic metabolism to active metabolite
– Substrate and Inducer of CYP 3A4 and others
– AUTOINDUCTION: Up-regulates
Carbamazepine AE
– CNS: blurred vision, unsteadiness, headache, sedation (30%)
– Nausea/GI upset (take with food)
– Black box warnings: dermatologic reactions, blood dyscrasias (AHS)
– Hyponatremia (SIADH) –more common in elderly
Carbamazepine drug interactions
– Induces metabolism of many drugs
• Example: oral contraceptives
– Displacement interactions (high protein binding)
Anticonvulsant Hypersensitivity Syndrome (AHS)
Rare, life-threatening immunologic adverse drug reaction
Associated with several anticonvulsants
– Phenytoin, carbamazepine, lamotrigine, others
Variable onset: 2-12 weeks after exposure
Cross-reactivity between agents can occur
Zonisamide indications
Focal, generalized, and unknown seizures
Zonisamide metabolism
Oral formulation only
Requires dose increases if given with CYP 3A4 inducers
Approximately 85% excreted by kidneys unchanged
Zonisamide AE
– Somnolence, ataxia, anorexia, nervousness, fatigue
– Renal stones (rare 1%)
– Suicidal ideations
– Metabolic acidosis (rare-renal dx, severe diarrhea) – Monitor bicarbonate levels before and periodic after start
Zonisamide contraindications
– Sulfa allergy (skin reaction)
– CrCl < 50 mL/min
Lamotrigine indications
Focal, generalized, and unknown seizures
Lamotrigine metabolism
liver
Lamotrigine AE
– Dizziness, blurred vision, headaches
– Skin reactions - AHS( black box warning;d/c at firs tsign)
Lamotrigine drug interactions
- oral contraceptives (can be reduced)
- Fosphenytoin/phenytoin can decrease lam levels
- Valproate can increase lam levels
Phenobarbital routes
po, IV
Phenobarbital indications
Generalized and focal seizures (not absence), status epilepticus (and refractory cases)
Phenobarbital MoA
Synaptic inhibition through increasing GABA
Which two IV drugs cause hypotension
Phenobarbital & Phenytoin
Phenobarbital metabolism
inducer and longer 1/2 life (2-6 days)
Phenobarbital AE
– Hypotension/respiratory depression (IV) – Sedation (may develop tolerance) – Nystagmus and ataxia (toxicity) – Irritability – Hyperactivity (more so in children) – Confusion (more so in elderly)
Seizure meds that require TDM
Phenobarbital, Carbamazepine, phenytoin, valproate, Keppra (w/seizures), ethosuximide
Phenobarbital TDM
Goal 10-40 ug/mL)
Valproate route
po, IV
Valproate indications
Generalized and focal (including absence)
Valproate MoA
stimulates enzyme that converts glutamate to GABA
inhibits GABA degradation
Valproate metabolism
Highly protein bound
Hepatically metabolized
Inhibitor (many drug interactions)
Valproate TDM
50 - 100 micrograms/ml, up to 140 for status epilepticus
Valproate AE
Black box warnings: pancreatitis (rare), hepatotoxicity, teratogenicity (neural tube
defects)
CNS: headache, dizziness, somnolence, sedation, tremor
Valproate drug interactions
– Displacement reactions (e.g.phenytoin)
– CYP-mediated (inhibit smetabolism of phenytoin, phenobarbital, carbamazepine) – Increases lamotrigine levels (serious skin reactions)
-slowly titrate doses
Topiramate indications
Generalized and focal seizures (including absence and LGS)
Topiramate MoA
Antagonizes AMPA subunit of glutamate
– Also inhibits Na channels, K efflux (hyperpolarization), enhances GABA
Topiramate metabolism
Inducer/inhibitor
Excreted in urine – decrease dose for CLcr<70
does should be slowly titrated!!
Other uses of topiramate
migraines and weight loss
Topiramate AE
– Somnolence, dizziness, difficulty with memory and concentration, aggressive
behavior
– Weight loss, oligohydrosis (decreased ability to sweat)
– Nephrolithiasis (counsel need for fluid intake)
– Metabolic acidosis (renal disease)
Perampanel indications
Generalized and focal seizures
Perampanel MoA
AMPA glutamate receptor antagonist
Perampanel AE
– Black Boxed Warning: neuropsychiatric disorders (aggression, anger, hostility, irritability)
– Weight gain, nausea, dizziness, headache
– CNS (dizziness, gait disturbances, sedation)
Which seizure meds are controlled substances?
perampanel and phenobarbital
Perampanel PK
- Highly protein bound
- Major 3A4 substrate
- Use not recommended with CrCL < 30
Levetiracetam (Keppra) indications
Generalized and focal seizures
Levetiracetam (Keppra) MoA
Binds to a synaptic vesicle protein (SV2A) – responsible
for reducing presynaptic glutamate release
Levetiracetam (Keppra) PK
- Low protein binding (< 10%)
* Primarily excreted in urine – adjust for renal impairment
Levetiracetam (Keppra) TDM
ONLY if having seizures on medication – can help verify if patient is compliant with medications
Ethosuximide indications
Absence seizures
Ethosuximide MoA
(T-type) Calcium Channel Inhibitor
Ehtosuximide PK
- Very low protein binding
* Metabolized by the liver
Ehtosuximide AE
– Nausea and vomiting (divide dose), anorexia, weight loss, abdominal cramps
– Psychosis, mania, sleep terrors, aggressiveness – CNS depression
– Parkinsonian movements (dose related)
– Blood dyscrasias
Ehtosuximide TDM
Goal 40-100 mcg/mL
Cannabidiol MOA
Not entirely known, enhances cannabinoid receptors, enhances natural endocannabinoids
Cannabidiol AE
diarrhea, vomiting, somnolence, LFT abnormalities
Cannabidoil metabolism
Metabolized by 3a4 and 2C19 (think drug interactions)
Benzo MoA
Enhances activity of GABA
Benzo AE
depressed mental status, respiratory
depression, hypotension
Benzo hosptial recommendations
– Lorazepam (Ativan); IV
– Diazepam (Valium); IV and rectal
– Midazolam (Versed); IM (intranasal or buccal if IM not available)
• Can also be given IV
Avoid these epilepsy meds in pregnancy
phenytoin, carbamazepine, valproate, phenobarbital, topiramate
Safest epilepsy meds in pregnancy
Levetiracetam and lamotrigine
Depression meds effects 1-2 weeks
Improve sleep and reduced anxiety
Depression meds effects 1-3 weeks
improved self care, concentration, energy level and activity level up
Depression meds effects 2-4 weeks
improved mood, reduced suicidal ideation
TCA MoA
Nonselective inhibition of NE and serotonin reuptake
TCA AE
Orthostatic htn, sedation, dry mouth, constipation, cardiotoxicity–arrythmias, QTc prolongation, sexual dysfunction, weight gain, hepatotoxicity, seizure,
TCA tertiary amines
Amitriptyline
Doxepin
TCA secondary amines
Nortriplyine
Secondary amines description
lack active metabolism and have linear kinetics (wider therapeutic window)
TCA metabolism
Long half-lives; high concetrationsin CNS and cardiac tissue
TCA withdrawal
– GI complaints, dizziness, insomnia, restlessness
– Hyper-salivation, diarrhea, headache, vivid dreams
– Gradual dose reductions of per week helps reduce symptoms
TCA drug interactions
MAOI
SSRIs
Alcohol, other CNS depressants
MAOI MoA
– Irreversible inhibition of monoamine oxidase (1 to 2 weeks to restore)
– Responsible for metabolism of NE, 5-HT and dopamine within the neuronal synapse
• MAO-A – non-selective (NE, 5HT)
• MAO-B – selective for dopamine
Selegline dose for depression vs. PD
dosed higher for depression
MAOIs AE
– Postural hypotension
– Hypertensive crisis (food interaction)
– Sleep disturbances, weight gain
MAOIs drug interactions
– TCAs – SSRIs – Sympathomimetic agents (e.g. cocaine) – Linezolid (antibiotic) – MAO inhibition may persist for up to 10-14 days following discontinuation
SSRI MoA
Blocks serotonin transporter
Reuptake of 5HT into presynaptic neuron = increased circulating 5HT
for post synaptic uptake
Which SSRI has the longest half life and what is it?
Fluoxetine (prozac) – 5 days (5 week washout)
Which SSRI has the highest percentage of weight gain?
Paroxetine (paxil)
SSRI AE
• CNS
– Fluoxetine – activating (insomnia, anxiety, agitation) – Paroxetine – sedating
• Gastrointestinal
– Nausea, vomiting, diarrhea (highest with sertraline)
• Hematologic (monitor)
– rise risk of bleeding, esp. with aspirin, NSAIDs, anticoagulants
• Sexual dysfunction
– SSRIs have the highest percentage incidence
• Weight gain
– Paroxetine > all others
Cardio–QT prolongation
Hyponatremia
SSRI Withdrawal Syndrome
– GI complaints, flu-like symptoms, anxiety, insomnia
– Most notable with paroxetine
Which SSRIs have QT prolongation?
Citalopram (celexa) and escitalopram (lexapro)
SSRI drug interaction
MAOIs, TCAs, Linezolid
Waiting period after SSRI before MAOI
5 weeks
Waiting period after MAOI before SSRI
2 weeks
With SSRIs have fewest drug interactions?
citalopram (celexa) and escitalopram (lexapro), and sertraline (zoloft)
Depression med used for smoking cessation
Buproprion (Wellbutrin)
Bupropion (Wellbutrin) AE
– Lowers seizure threshold
• Associated with high doses and abrupt withdrawal – Activating (tremor, insomnia)
– NO sexual dysfunction/weight gain
Mirtazapine AE
– Sedation–often given at bedtime (histamine blockade)
– Weight gain (higher than other options-increased appetite)
– Low incidence of sexual dysfunction
SNRIs MoA
Bind to serotonin (SERT) and norepinephrine (NET) transporters
– Prevent reuptake of both 5HT and NE (selective for NE)
SNRIs AE
– Hypertension (NE)
– Sexual dysfunction
– Insomnia (take in the morning) – Nausea
First line add-ons for depression
Burpoprion and Mirtazapine
Other add-ons for depression
– Atypical-antipsychotics
– SNRI / TCA (low doses)
– Buspirone (indicated for general anxiety disorder)
Depression meds that target anxiety or insomnia
Trazodone, buspirone or mirtazipine
Dpression rate in pregnant women
14-23%
Best depression med for pregnancy
sertraline
Depression meds associated w/ birth defects
Paroxetine (Paxil) /Fluoxetine (prozac)
Schizophrenia positive symptoms
– Delusions – Hallucinations – Disorganized speech – Unusual behavior – Hostility – Excitement – Grandiosity
Schizophrenia negative symptoms
– Blunted affect – Lack of motivation and pleasure – Emotional withdrawal – Uncooperativeness – Social withdrawal – Poverty of speech
Antipsychotic Drugs MoA
– Dopamine (D2) receptor blockers inhibit the release of DA and thereby alleviate the positive symptoms of schizophrenia
– Serotonin (5-HT2) receptor blockers increase the release of DA and thereby alleviate the negative symptoms of schizophrenia
Typical Antipsychotic agent
Haloperidol (Haldol)
Typical Antipsychotics MoA
D2 receptors antagonists (Also block muscarinic, histamine and alpha-1 receptors)
Haldol route
tablet, injection, solution, depot
Typcial antipyschotics AE
anticholinergic side effects, orthostatic hypotension, QTc prolongation, extrapyramidal side effects, hyperprolactinemia
Haldol AE levels
Very low sedating, anticholinergic and hypotensive
Very high EPS
Advantages of atypical antipsychotics
Less sedation, movement disorders and tardive dyskinesia
Disadvantages of atypical antipsychotics
More weight gain and metabolic disturbances
IM version of abilify
aristada
beneftis of abilify
less EPS and weight gain
Abilify indications beyond schizophrenia
MDD and BPD
Dosing for aristada
IM avail every 4-6 weeks
Transitioning to aristada
must continue PO treatment of abilify for the first 3 weeks
Abilify AE
Prolongation of QT
Anticholinergic effects – dry mouth, urinary retention, constipation
Weight gain
Impaired glucose tolerance
Sexual dysfunction
hematologic (clozapine–agranulocystosis)
Which atypical antipsychotic can cause agranulocytosis
Clozapine
Atypical antipsychotics that cause weight gain the most
clozapine and olanzapine
Atypical antipsychotics that cause most sedation
clozapine and quetiapine
Atypical antipsychotics that cause most QTc prolongation
Ziprasidone
Atypical antipsychotic that doesn’t cause QTc prolongation
Abilify
Atypical antipsychotic that has the highest EPS
Risperidone
Antipsychotic that treats schizo and MDD
Brexipiprazole
Antipsychotic that treas schizo and BD
Cariprazine
Med that newer gen antipsychotic has similar AE profile
Abilify
Lithium metabolism
Narrow range b/w therapeutic and toxic levels
Frequent need for blood levels
Lithium warnings/contraindications
– Renal insufficiency
– Dehydration
– Sodium depletion
[decreased clearance – increased risk of toxicity]
Lithium drug interactions
NSAIDs
– ACEI and ARBs
– Diuretics
[increased conc – increased risk of toxicity]
Lithium AE
tremor, even when therapeutic
NVD
Cog impairment, fatigue
Seizures and death at v. high conc
Brexanolone MoA
Modulates GABAa
Brexanolone dosing
one time 60 hour infusion
Brexanolone indications
post-partum depression for those with no response to SSRIs at 6-8 weeks
Brexanolone AE
sedation/loss of consciousness (pulse ox needed)
Esketamine indications
used in combination with oral
antidepressant for treatment-resistant depression
Esketamine dosing
intranasal twice weekly in office
Esketamine AE
Extreme HTN, cog impairment, unsafe in pregnancy
Antiepileptic to avoid with sulfa allergy
Zonisamide
Which cholinesterase inhibitor would you give if a patient cannot tolerate PO meds?
Rivastigmine – transdermal patch
Which drug class do you have to be careful prescribing patients who are on cholinesterase inhibitors?
Anticholinergics
Pharmacologic tx of Parkinson’s aims to increase _______ and decrease________ .
Dopamine, acetylcholine
Dopamine from ________ normally regulates _____ in ___________
substantia nigra, Ach, corpus striatum
Levodopa must be given as a combined therapy with______ which is given at____mg daily dose minimum.
Carbidopa, 75
A patient with Parkinson’s disease comes in concerned about their urine that is looking brown-orange. Which medications do you suspect this patient is taking? Is this a concerning adverse effect?
Entancapone prescribed with levodopa/carbidopa
A pt is prescribed Selegiline. What diet changes must you educate the patient on and why?
MUST avoid foods that contain Tyramine
(aged cheese, red wine, smoked meat, soy beans, etc)
Tyramine is a compound that regulates BP that can cause vasoconstriction and MAO breaks down NE
MAO inhibited with increased Tyramine → increased BP → HTN crisis → hemorrhagic stroke
Which of the following helps reduce tremor more than other manifestations?
Pramipexole
Rasagiline
Primavanserin
Benztropine
Benztropine
Ach Receptor Antagonist
You have a 83 year old patient with dementia-related psychosis. Which medication would you be concerned about if you saw it prescribed to this patient? Pimavanserin Carbidopa Tolcapone Selegiline
Pimavanserin, b/c of BBW
Name the drugs that have a risk for causing AHS?
Phenytoin, carbamazepine, lamotrigine
What increases the risk for AHS?
HLA-B 1502 allele - southwest asian descent
Which drug class is used for status epilepticus?
Benzos
Name a drug that is highly protein bound
Phenytoin, perampanel, valproate, carbamazepine
What else causes high risk for drug interactions with phenytoin?
– induced of 3A4, metabolized by 2C9 and 2C19 – the more pathways it impacts, the more drug interactions!
Which oral antiepileptic is partially metabolized via autoinduction?
Carbamazepine
Education points for Carbamazepine
Give with food, watch for rash, careful with intense exercise, birth control change? Or at least use condoms
Antiepileptics to use during pregnancy
Keppra and lamictal
A 63 year old male with PMH of controlled epilepsy on one drug, uncontrolled DMT2, and controlled HTN on one drug. Allergies: PCN and sulfa drugs.
Recently CrCl = 55 so his drug dose is decreased.
Which drug is he on?
Topiramate
Antiepileptics that are excreted by the kidney
Zonisamide & topiramate
What are the advantages and disadvantages of atypical antipsychotics?
Advantages: less sedation, fewer movement disorders and TD
Disadvantages: metabolic disturbances
What to watch for with atypical antipsychotics
weight gain, glucose levels/A1C, lipids
Which antipsychotic medication are you likely to give an elderly, overweight patient with a history of cardiac dysrhythmias?
Aripiprazole (Abilify)
34 year old male with PMH depression and BMI 30 presents to clinic. Has been taking Escitalopram 20mg daily for 2 years, but recently his symptoms have increased. He reports lack of energy and inability to get out of bed in the morning or join social activities. What drug does the nurse anticipate will be added to his regimen?
Wellbutrin
Why give wellbutrin to overweight patient with no energy?
activating! and no weight gain
A patient taking Amitriptyline tells you after taking the medication for 2 weeks he doesn’t think it is working and just stopped taking the medication abruptly. What would you tell this patient and what effects (if any) would you expect to see?
Onset usually takes at least 4-6 weeks for full effect
Withdrawal syndrome
GI complaints, dizziness, insomnia, restlessness, hypersalivation, diarrhea, HA, vivid dreams
Pt started on Fluoxetine and comes in complaining of low energy and drive. Which drug would you consider switching the patient to? Paroxetine Venlafaxine Buproprion Mirtazipine
venlafaxine
Which of the following medication combinations would not have adverse drug interactions? Fluoxetine, Selegiline Fluoxetine, Bupropion Linezolid, Sertraline Amitriptyline, Paroxetine
Fluoxetine, Bupropion
SSRIs have significant interactions with MAOIs, TCAs, Linezolid (has MAO inhibition)
Antibiotic that has MAO inhibition
linezolid
_________ receptor blockers alleviate the positive symptoms of schizophrenia, and_______ receptor blockers alleviate the negative symptoms of schizophrenia.
D2 receptor blockers inhibit the release of DA and alleviate the positive symptoms of schizophrenia
5-HT2 receptor blockers increase the release of DA and alleviate the negative symptoms of schizophrenia
List anticholinergic effects:
Dry mouth, urinary retention, constipation
What are 3 contraindications for Lithium?
Renal insufficiency
Dehydration
Sodium depletion
