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Thrp: Psyc Flashcards

1
Q

Fluoxetine

A

SSRI
inc t1/2

Worse Insomnia, sexual dis-fn, **anxiety/activation (avoid in PD/Anxiety tx), GI
d/c Sx start w/in1-3wks (longer t1/2)
SE: ++Seizures

Used in combo with Olanzapine in Bipolar but metabolic SE

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2
Q

Sertraline

A

SSRI: Starting Dose: 25-50mg (Geriatric=12.5mg) Dose range 50-200mg)
good anxiety 1st choice, *tx for PTSD

Worse Insomnia, Diarrhea, GI, anxiety/activation
SE: +sedation ++ Seizures

Breast feeding: Lowest infant SDC and fewest ADR
No dose adj for Renal Impairment

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3
Q

Paroxetine

A

SSRI
good anxiety 1st choice, *tx for PTSD

Worse Sedation, sexual dis-fn, anti-cholinergic effects, *WT gain, d/c-sx (must taper after 1 week)
SE: ++Sedation, ++Seizures ++AntiACH

1st trimester minimal cardiac defect risk
Breast feeding: Lowest infant SDC and fewest ADR

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4
Q

Fluvoxamine

A

SSRI

Worse Sedation
SE: ++Sedation, ++Seizures

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5
Q

Citalopram

A

SSRI: Starting dose=20mg (Geriatric 10mg) Dose range=20-60mg
Only SSRI good for HA

QRS/AT prolongation: Dose dependent: *NTE 40mg/day (20mg/day 60+yo or on omeprazole/cimetidine)
*Monitor: ECG, LFT (cleared by liver), K+,MG++)
SE: ++Sedation, ++Seizures **++Dose related Arrhythmias
Substrate for CYP2C19

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6
Q

Escitalopram

A

SSRI: (Dose 1/2 citalopram)
Only SSRI good for HA; good anxiety 1st choice

SE:

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7
Q

Vilazodone

A

Dual-acting 5-HT RUI/Partial 5HT1a AG (may help with sexual dys-fn SE)
NEW Rx

SE: GI (w/food), insomnia

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8
Q

Bupropion

A

Aminoketone: (Starting dose=75mg qd-bid):
2nd line agent Depression
Good in smoking cessation and parkinsons Dz, atypical depression, CV dz, alzheimer’s Dz (*NOT PD)
ADHD Tx: 1.5-3mg/kg max=6mg/kg/day divided BID

Less sexualy disfuntion: Add Rx late in day or switch to this if is a problem
SE: Nausea, dizzy, tremor, insomnia
++++Seizures- rare but not good for pts w/seizures
+AntiACh

DDI 2D6 inhibitor

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9
Q

Venlafaxine

A

SNRI: good 2nd line agent: QD-BID dosing

D/c-Sx in 7 days, worse d/c-sx (must taper after 1 week)
*tx for PTSD

*Dose dependent SE
Low dose: nausea/vomiting
High Dose: inc BP
SE: +AntiACh, + Sedation, ++Seizures, +Arrhythmais

Has mainly pharmacodynamic DDI

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10
Q

Desvenlafaxine

A

SNRI

*Dose dependent SE
Low dose: nausea/vomiting more than venlafaxine
High Dose: inc BP
SE: +AntiACh, + Sedation, ++Seizures, +Arrhythmais

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11
Q

Duloxetine

A

SNRI: BID dosing
Tx neuropathy: good or DM pts

N/D sedation,
SE: +Anti-ACh-mostly dry mouth
+ Orthostasis, and inc HR in supine/standing

Has mainly pharmacodynamic DDI
and 2D6 inhibitor

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12
Q

Trazodone

A

Triazolopyridines
Tx for sleep in PTSD

+++Orthostasis-alpha blocker
+++ Sedation-give at HS, ++Seizures, ++Arrhytmias
Priapism (prolonged errection_ rare but d/c and ER

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13
Q

Nefazodone

A

Triazolopyridines: 2nd liner

Less sexualy disfuntion: switch to this if is a problem

Liver toxicity - Monitor LFT bimonthly during 1st yr
++Sedation
SE: +AntiACH, ++Seizures, ++Orthostasis,

DDI: Potent 3A4 inhibitor

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14
Q

Amitriptyline

A

TCA

SE: ++++Sedation, ++++AntiACh, +++Orthostasis, ++++arrhythmias, +++Seizures

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15
Q

Doxepin

A

TCA

SE: ++++Sedation, +++AntiACh, ++Orthostasis, ++arrhythmias, +++Seizures

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16
Q

Clomipramine

A

TCA Lots of AE*
Used to Tx OCD AFTER 3 failed tires of SSRI

SE: ++++Sedation, ++++AntiACh, ++Orthostasis, ++++arrhythmias, ++++Seizures

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17
Q

Imipramine

A

TCA
Depression
ADHD (less effective) Dose 1mg/kg inc 0.5mg/kg max=3mg/kg divided BID

SE: +++Sedation, +++AntiACh, ++++Orthostasis, ++++arrhythmias, ++++Seizures

OD risk

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18
Q

Desipramine

A

TCA
Depression
ADHD (less effective) Dose 1mg/kg inc 0.5mg/kg max=3mg/kg divided BID

SE: +++Sedation, +++AntiACh, *+Orthostasis, +++arrhythmias, ++Seizures

good Pregnancy Rx Choice

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19
Q

Nortriptyline

A

TCA

SE: +++Sedation, +++AntiACh, +Orthostasis, +++arrhythmias, ++Seizures

Good Rx choice for pregnancy
Breast feeding: Lowest infant SDC and fewest ADR

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20
Q

Phenelzine

A

MAOI - never 1st line

SE: most orthostasis, sedation

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21
Q

Tranylcypromine

A

MAOI - never 1st line

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22
Q

Trasdermal Selegiline

A

MAOI - never 1st line

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23
Q

Lithium

A

Mood Stabilizer Bipolar (effective but less than VPA)
Other: Anti-depressant
Persistent aggression/hostility/mood lability Schizo Tx

Base line Tests: T’BEER P (initially and q12mo)

t1/2=~24hrs (steady-state = 1 wk) bridge with BDZ
DOSE= start 300mg BID-TID
(300mg = 0.2mEq/L)
GOAL = 0.6 - 1.2 mEq/L

*DO NOT d/c abruptly ->Sx occur more rapidly and more difficult to control

Early SE: Tremor, polyuria, lethargy/sedation
long term SE: Hypothyroidism, Fine hand tremor, wt gain, Teratogenic (ebstein anomaly) Breastfeeding (risk of hypothyroidism in baby et.c)
Narrow TI Rx: Neurotoxicicity, AND Serotonin syndrome with serotenergic Rx’s

SIGNS OF Toxicity= GO TO ER

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24
Q

Mirtazapine

A

TCA: 2nd liner: HS dosing
unique MOA: inhibits presynaptic alpa-2 receptors and pstsynaptic 5-HT
good adjunct for sleep

Add rx at HS to Tx sex-dis-fn
SE: +++Sedation- at lower doses
Wt gain (anti histaminic properties)
++AntiACh, ++Orthostasis, +arrhythmias

Has mainly pharmacodynamic DDI

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25
Q

CYP2D6 Substrates

A

Paroxetine, Sertraline, Desipramine, Nortriptyline, clozapine, Haloperidol (major), Thioridazine, Perphenazine, Propanolol, Metoprolol, Timolol, Tamoxifen, Atomoxetine

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26
Q

CYP3A3/4 Substrates

A

Statins, Alprazolam, Ethinyl estradiol, Cyclosporine, Buspirone, Quetiapine (major)

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27
Q

CYP1A2 Substrates

A

Caffeine, Clozapine (major)

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28
Q

CYP2C9 Substrates

A

Warfarin

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29
Q

CYP2C19 Substrates

A

Citalopram, Diazepam

30
Q

CYP2D6 Inhibitors

A

Paroxtine/Fluoxetine/Duloxetine/Bupropion

31
Q

CYP3A4 Inhibitors

A

Fluvoxamine/Nefazodone/TCAs, grapefruit juice

32
Q

CYP1A2 Inhibitors

A

Fluvoxamine, grapefruit juice

33
Q

CYP2C9 inhibitors

A

Fluoxetine/fluvoxamine

34
Q

CYP2C19 inhibitors

A

Fluoxetine/fluvoxamine, omeprazole, cimetidine

35
Q

CYP Inducers

A

St John’s Wort, phenobarbital/Phenytoin, carbamazepine,

36
Q

Alprazolam

A

BDZ- (0.5) t1/2=short-intermediate

Common PD Tx

37
Q

Clonazepam

A

BDZ (0.25) t1/2=Intermediate-long
Common PD Tx
Alternative to mood stabilizer in Bipolar Tx

38
Q

Diazepam

A

BDZ (5) t1/2= Long

39
Q

Lorazepam

A

BDZ (1) t1/2=short-intermediate
OK in hepatic Dz and elderly (met via conjugation)
Least-used; Parenteral dosing preferred

Alternative to mood stabilizer in Bipolar Tx
ACUTE Bipolar Mania IM Tx 1-3mg + AAP
Agitation/Excitement Schizo Tx: 1-4mg q1-2hr (often combine w/Haloperidol lactate)

40
Q

Oxazepam

A

BDZ (15) t1/2=Short

OK in hepatic Dz and elderly (met via conjugation)

41
Q

Temazpepam

A

BDZ for Sleep

OK in hepatic Dz and elderly (met via conjugation)

42
Q

Chlordiazepoxide

A

BDZ (10) t1/2=long

43
Q

Buspirone

A

Serotonin/Dopaminergic
Tx: GAD or as augmentation *Must Titrate
*NOT Tx for Panic Disorder

No Sedation,tolerance,dependence,toxicity w/OD
Takes 2 weeks for anti-anxiety, NO prn tx,
SE: GI, HA, abnormal Movements, weakness/dysphoria,paresthesias,Restlessness
Substrate 3A4

44
Q

Severe, Acute, agitated Manic Tx

A

IM 1 - 3mg lorazepam +

IM 10mg ziprasidone OR 9.75 mg aripiprazole

45
Q

Divalproex Sodium

A

(depakote) Highly effective Mood Stabilizer
1st line Tx Bipolar Disorder (often used in combo) w/ Sx improvement ~5d & Rapid Cyclers
Persistent aggression/hostility/mood lability Schizo Tx

Start: 250mg TID w/food and titrate up (MAX=60mg/kg/day)
Loading Dose: 20-30mg/kg/day in 3 doses Hospital setting only

ADR: Hepatotoxic( monitor LFT), Wt gain, Ataxia, dose-related thrombocytopenia (monitor platelets) teratogenic
Monitor: LFT, CBC with differential, SDC monthly, glucose, WT, hair

DDI: IS a 3A4 inhibitor & highly protein bound
*inc levels of Rx’s esp Laotrigine => SJS

46
Q

Lamotrigine

A

Anticonvulsant - Bipolar Tx: Less effective
1st line : RAPID CYCLERS

SE: SJS EPS with the DDI VPA that inc Lamotragene levels
Teratogenic: Cleft lip/palate in first trimester

47
Q

Carbamazepine

A

Anticonvulsant - Bipolar Tx NOT 1st line
Start:100-200mg BID WITH FOOD
Persistent aggression/hostility/mood lability Schizo Tx

Teratogenic, neurotoxic metabolite, CI in AV block

*DDI

48
Q

Chlorpromazine

A

Typical Antipsychotic Low Potency
(100) 30-1000mg

SE: High to Mod hypotensive, Hight sedative/Ach

49
Q

Perphenazine

A

Typical Antipsychotic Med Potency
(10) 12-64mg

SE: Low-mod sedative, Low ACh/Hypotensive

50
Q

Haloperidol

A

Typical Antipsychotic High Potency
(2) 1-15mg
Tx: Agitation/Excitement Schizo: 5mg q1/2-1hr until pt calm: combo w/lorazepam, NO combo with AAP

DDI: Fluoxetine/Paroxetine inhibit met -> EPS

SE: Low Sedative/ACh/Hypotensive

51
Q

Fluphenazine

A

Typical Antipsychotic high Potency
(2) 1-50mg

Low sedation/ACh/Hypotensive *VERY high EPS

52
Q

Loxapine

A

Typical Antipsychotic med Potency
(10-15) 10-250mg

SE: Low-Mod Sedation/Hypotensive low ACH

53
Q

Aripiprazole

A

Atypical Antipsychotic: w/ least metabolic SE
Tx Agitation/excitment Schizo: 5.25-9.75mg IM q2hr: NTE 30mg/day
Activating AAP=Insomnia SE

Least wt gain, least effect on lipids

54
Q

Asenapine

A

Atypical Antipsychotic

SL Tablet DO NOT SWALLOW: dec bioavailability; do not eat/drink 10min after

55
Q

Clozapine

A

Atypical Antipsychotic: Most effective on (+) (-) Sx and Tx *suicidality but 3rd line
Highest risk of decreasing seizure threshold
AGRANULOCYTOSIS: wkly monitoring
High Anti-ACh
High Metabolic Wt gain
Pregnancy Class B
Lowest TD
Orthostatic hypotension is a limiting factor in dose titration

DDI: Cigarette smoke inc metabolism

For Tx-Resistatnt schizo

56
Q

Iloperidone

A

Atypical Antipsychotic w/ least EPS

Not used in hepatic impairment (lack of data)
Dose related tachycardia
Lower Akathesia

57
Q

Lurasidone

A

Atypical Antipsychotic
Pregnancy Class B

**TAKE WITH FOOD for bioavailability AT LEAST 350kcal
Wt neutral

58
Q

Olanzapine

A

Atypical Antipsychotic:
Tx Agitation/Excitement Schizo: 2.5-10mg IM repeat in 2hrs after 1st dose and q4hrs after: NTE 30mg/day *DO NOT COMBO w/ BDZ (best if pt is very agitated/violent)

DDI: Cigarette smoke inc metabolism

Similar to clozapine but less seizure and agran
Risk of delirium and extreme sedation in first 3 hrs: Must monitor w/ q-injection for 3 hrs q-time

59
Q

Quetiapine

A

Atypical Antipsychotic w/ least EPS SE

XR formulation for QDay dosing

60
Q

Paliperidone

A

Atypical Antipsychotic w/ greatest EPS

Actie metabolite of risperidone

61
Q

Quetiapine

A

Atypical Antipsychotic

62
Q

Risperidone

A

Atypical Antipsychotic w/ greatest EPS

with 1st IM injection give PO for 3 weeks

63
Q

Ziprasidone

A

Atypical Antipsychotic w/ least metabolic SE
Tx: Agitation/Excitement Schizo (most common): 10-20mg IM, repeat 10mg q2hr or 20mg q4hr: NTE 40mg/day
Severe, Acute, agitated Manic Tx: IM 10mg ziprasidone

*take with food (for bioavailability)
CI in QT prolongation Hx
IM=Mesylate

64
Q

Clozaine

A

Atypical Antipsychotic

65
Q

Benztropine

A

Anticholingeric Tx AP SE:
Acute Dystonic rxn: 1-2mg IV and 1-2mg PO BID-TID for 4 weeks
Pseudoparkinsonism: 1-6mg/day
Tartive dyskinesia: Shortest possible time=risk factor for TD

66
Q

Propranolol

A

Tx’s Antipsychotic SE’s: Akathisia’s, Tremor (non parkinsonism) 20-30mg TID
Seratonin Syndrome (5HT depleter)
Performance Anxiety: 10-80mg (Need Test Dose)

67
Q

Haloperidol decanoate

A

Long-acting AP indictable Depot

68
Q

Haloperidol lactate

A

Long-acting AP indictable IM rel: used in aute agitation

69
Q

Fluphenazine decanoate

A

Long-acting AP indictable: time to steady state 4-8 weeks

70
Q

STIMULANTS

A

****NOTES****

71
Q

SSRI Tx Time Response

A 
Depression 6-8wk
Panic 3-5wk
Phobic 6-10wk
GAD 8-12wk
OCD 12 wk
PTSD 8-12wk

Therapeutics (10 decks)

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