Unit 8: OVERVIEW (Depression, Anxiety, Psychosis, Bipolar, etc.) Flashcards
Drug Classes used to treat Depression
SSRIs (Selective Serotonin Reuptake Inhibitors)
TCAs (Trycyclic Antidepressants)
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
SARIs (5-HT2 Antagonists)
Tetracyclic and Unicyclic Antidepressants
MAOIs
Advantages to SSRIs
very affordable (many on $4 list)
MOA of SSRIs
increase serotonin by blocking reuptake
SSRIs interact with MAOIs and can cause what major issue?
SEROTONIN SYNDROME
Important dosing note for SSRIs
DO NOT STOP abruptly; taper minimum of 2 weeks
What happens if SSRIs are abruptly stopped?
withdrawal syndrome
Side effects can happen with SSRIs; what do you need to tell patients?
hang in there; many side effects tend to go away
Name 7 SSRIs
fluoxetine (Prozac) paroxetine sertraline (Zoloft) citalopram (Celexa) escitalopram (Lexapro) fluvoxamine vilazodone
How do the SNRIs work to treat depression?
block reuptake of serotonin & norepinephrine
Name 4 SNRIs used to treat depression
venlafaxine
desvenlafaxine
duloxetine
milnacipran
How do the TCAs work to treat depression?
block reuptake of biogenic amines, including serotonin and norepinephrine
Name 5 tertiary amine TCAs used to treat depression
amitriptyline clomipramine doxepin imipramine trimipramine
Name 3 secondary amine TCAs used to treat depression
despiramine
nortriptyline
protriptyline
What antidepressant class can be fatal in overdoses, and why?
TCAs
due to arrhythmias or seizures
What happens with many TCAs and other drugs?
many drug-drug interactions increase the TCA concentration
Name the 1st, 2nd and 3rd line classes used to treat depression
- SSRIs
- SNRIs
- TCAs
Name 2 SARIs used to treat depression
trazodone (Desyrel)
nefazodone
How do the SARIs (5-HT2 Antagonists) work?
block of serotonin @ 5-HT2A receptors –>
antianxiety
antipsychotic
antidepressant
Name 2 tetracyclic and unicyclic antidepressants
bupropion
mirtazapine
Name 4 MAOIs used to treat depression
isocarboxazid
phenelzine
tranylcypromine
selegiline
MAOIs can interact with what drugs to cause a hypertensive crisis?
antidepressants
carbamazepine
levodopa
MAOIs can interact with what drugs to cause serotonin syndrome?
dextromethorphan
antidepressants
Why can MAOIs be fatal?
slow elimination
interaction with SSRI or tyramine-containing foods can cause a fatal hypertensive crisis
What does tyramine do?
releases norepinephrine which increases BP and can cause arrhythmias
What drug classes are used to treat insomnia and acute anxiety?
barbitruates benzodiazepines benzodiazepine antagonists hypnotics 5-HT Receptor Antagonists
Define tolerance
reduced effect with repeated use of a drug; need higher doses for same effect
Define cross-tolerance
person tolerant to 1 drug also tolerant to drugs in the same class
Define dependance
s/sx of withdrawal when drug levels fall
For what are barbiturates used?
anesthesia
insomnia
seizure disorders
What barbiturate works within minutes and is used for anesthesia?
thiopental
What barbiturates have a duration of action for hours?
pentobarbital
secobarbital
amobarbital
What barbiturate has a duration of action for days?
phenobarbital
Which benzodiazepines are more difficult to discontinue?
shorter-acting agents
Name 2 short-acting benzodiazepines
midazolam
triazolam
Name 2 intermediate-acting benzodiazepines
alprazolam (Xanax)
lorazepam (Ativan)
Name 2 long-acting benzodiazepines
clonazepam (Klonipin)
diazepam (Valium)
Name a 5-HT Receptor Antagonist used to treat anxiety
buspirone (Buspar)
Name 3 hypnotics
zolpidem (Ambien)
zalepon
ezopiclone (Lunesta)
What is the risk of using hypnotics in elderly patients?
delirium
Name a benzodiazepine antagonist used for benzodiazepine overdose
flumazenil
Of what should you be aware if you give flumazenil for a benzodiazepine overdose?
withdrawal symptoms in patients who are dependent on benzodiazepines
Goal of Schizophrenia treatment
most drugs bind to dopamine receptors
want to keep dopamine available in the synapse so patients feel more euphoric/up
Classes used to treat Schizophrenia
antipsychotic drugs
antischizophrenics
tranquilizers
Typical antipsychotics can cause what irreversible side effect?
tardive dyskinesia
Name some 1st generation typical antipsychotics
chlorpromazine fluphenazine haloperidol perphenazine thoridazine thiothixene trifluoperazine
Name some 2nd generation atypical antipsychotics
ariprazole (Abilify) clozapine (Clozaril) olanzapine (Zyprexa) quetiapine (Seroquel) risperidone (Risperdal) ziprasidone (Geodon)
What atypical antispsychotic has a huge risk fo agranulocytosis and requires
WEEKLY BLOODWORK and
patients to be on a registry?
clozapine (Clozaril)
Serious side effects of typical antipsychotics
QT prolongation
neuroepileptic malignant syndrome
extrapyramidal effects
Which antipsychotics can cause QT prolongation?
ziprasidone (Geodon)
quetiapine (Seroquel)
Which antipsychotics increase the risk of stroke?
risperidone
olanzapine
What do you need to remember for all antipsychotics?
1 year to life
can cause withdrawal because they work on neurotransmitters –> taper on/off
