Week 5 Mental health part 2 Flashcards
Amitriptyline
Elavil
Central Nervous System
Antidepressant
Tricyclic Antidepressant
Depression (Off label Neuropathic pain, insomnia)
Anticholinergic Side Effects, Sedation, Ortostatic Hypotension, Cardiovascular Risk
Meds with Anticholinergic Properties
CI: MAOI w/in 14 days, Acute post-MI; Precaution: BPH, glaucoma, urinary retention
• Patient Counseling
o Do not abruptly stop; talk to your health care provider before stopping
o Review risk of anticholinergic side effects with patients
o This may cause sedation (if not taking for insomnia)
o Minimize use of alcohol
Bupropion
Wellbutrin (Depression)
Zyban (Smoking Cessation)
PO (IR, SR, ER)
Central Nervous System
Antidepressant
Monocyclic Antidepressant
Depression, SAD (Seasonal Affective Disorder), Smoking Cessation
Weight loss (DO NOT USE IN PATIENTS WITH EATING DISORDERS), Xerostomia, Insomnia, Agitation/hostile behavior, Seizures
Alcohol, St. John’s Wort
CI: History of seizures, History of eating disorders (anorexia, bulimia)
• Warnings
o CONTRAINDICATIONS
Do not use in patients with a history of seizure (lowers seizure threshold)
Do not use in underweight patients or patients with a history of eating disorders
• Patient Counseling
o Take at the same time each day
o ER: Tablet will remain visible in the stool
o This medication may cause trouble with sleeping at night; if that happens, take your last dose no later than 3pm
Zyban®: Take second dose by 3PM (need at least 8 HOURS between doses)
• Clinical Pearls
o Less risk of sexual dysfunction than SSRIs
o Great option in a patient trying to LOSS weight (off-label indication for weight-loss)
o Great option for those struggling with sedation from other antidepressants
* START ELDERLY PATIENTS AT HALF THE USUAL DOSE
Donepezil
Aricept
Namzaric (combo with memantine)
PO (including ODT)
Central Nervous System
Neurodegenerative Agent
Cholinesterase Inhibitor
Alzheimer’s Dementia
Bradycardia, nausea, vomiting, diarrhea, insomnia
Cholinergic agents, Anticholinergic agents, Gingko bilboa
Altered cardiac conduction, GI disorders, Anorexia/weight loss, Urinary Tract Obstruction (i.e. BPH)
Oral solution should be administered using the dosing device with the oral syringe provided by the manufacturer; do not mix with any other liquid
Hydroxyzine
Atarax (hydroxyzine hydrochloride)
Vistaril (hydroxyzine pamoate)
Central Nervous System
Anti-anxiety
Rapid-acting Antihistamine
Anxiety, Pruritis, Sedation, Anti-emetic
Sedation/fatigue, dry mouth, other anticholinergic Ses
Acetylcholinesterase Inhibitors, CNS depressants, Anticholinergic medications
BPH, COPD, Asthma, Glaucoma
Pregnancy catergory: C
• Patient Counseling
o This medication can be used on an as-needed basis
o Tolerance usually develops fairly rapidly to sedation side effect
o Contraindicated in early pregnancy- CAUTION IN WOMEN OF CHILD BEARING POTENTIAL
o Avoid use with other medications with anticholinergic side effects
Memantine
Namenda Namzaric (combo with donepezil)
PO (including oral soluation and XR tablet)
Central Nervous System
Neurodegenerative Agent
NMDA (N-Methyl-D-Aspartate) Receptor Antagonist
Alzheimer’s Dementia
Constipation, cough, dizziness/syncope, vomiting Alkalinizing agents (e.g. carbonic anhydrase inhibitors, sodium bicarbonate)
Cardiovascular disease, Urine pH (reduced by alkaline urine), Seizure disorder
Oral solution should be administered using the dosing device with the oral syringe provided by the manufacturer; do not mix with any other liquid
Mirtazapine
Remeron
Central Nervous System
Antidepressant
Antidepressant, α2 Antagonist
Depression, OCD (Obsessive Compulsive Disorder), PTSD (Post Traumatic Stress Disorder)
WEIGHT GAIN, Increased cholesterol, Xerostomia, Constipation, Somnolence
Sedating medications, Serotonergic medications
Arrhythmias (QTc prolongation), Liver Function (LFT elevation)
• Patient Counseling
o Take at the same time each day
o ER: Tablet will remain visible in the stool
o This medication may cause trouble with sleeping at night; if that happens, take your last dose no later than 3pm
• Clinical Pearls
o Less risk of sexual dysfunction than SSRIs
o Great option in a patient trying to weight (off-label indication for weight-loss)
o Great option for those struggling with sedation from other antidepressants
Trazodone
Desyrel
PO (IR, ER)
Central Nervous System
Antidepressant
Antidepressant (histamine (H1) and α-1 receptors)
Depression (Off label insomnia)
Xerostomia, Dizziness, Sedation, Constipation, Feeling Nervous, PRIAPISM (rare)
Serotonergic medications, CNS depressants
Serotonin Syndrome, Bleeding Risk
• Patient Counseling
o Counsel male patients on slight incidence of prolonged or inappropriate erections and to report them immediately
o Immediate release dosage forms should be taken after a meal
o Extended release dosage forms should be taken on an empty stomach and SHOULD NOT be crushed or chewed
o Discuss the risk of sedation if not being used to treat insomnia
• Clinical Pearls
o Anticholinergic side effects may be seen at high doses
Varenicline
Chantix
Central Nervous System
Smoking Cessation Agent
Partial neuronal α4β2 nicotinic receptor agonist
Smoking Cessation
Insomnia, vivid dreams, nausea, headache, abnormal behavior, changes in mood/suicidal ideation
Bupropion, H2RAs, Quinolone antibiotics (i.e. levofloxacin), Trimethoprim
Precautions: Cardiovascular disease/events, kidney impairment, seizure history; Boxed Warning for neuropsychiatric events removed 12/2016 (should still monitor)
• Smoking Cessation Patient Counseling (Zyban® also)
o This medication should be started one week before the patient’s quit date
o Review the medication dosing schedule with the patient to ensure they understand the step-up dose process
o Report any changes in mood to healthcare provider IMMEDIATELY
o Take evening dose with dinner instead of at bedtime if the patient experiences insomnia
o Can take with food to decrease nausea
Which of the following medications is an antidepressant? A. Buspirone B. Bupropion C. Varenicline D. Hydroxyzine
B. Bupropion
Which of the following side effects should you counsel a patient about for amitriptyline (related to its anticholinergic profile)? A. Insomnia B. Diarrhea C. Urinary retention D. Stomach ulcer
C. Urinary retention
Does bupropion increase the risk of serotonin syndrome?
A. Yes
B. No
B. No – does not affect
serotonin, only
norepinephrine and
dopamine
TS is a 26 year old female seeking depression
management with a history of anorexia. Which antidepressant SHOULD NOT BE USED?
A. Bupropion—weight loss
B. Sertraline
C. Trazodone
D. Mirtazapine – weight gain
A. Bupropion—weightnloss
Which medication for dementia would be
preferred in a patient with low heart rate?
A. Aricept®
B. Namenda®
B. Namenda®
Which dementia medication may need be avoided in patients with body mass issues (i.e.underweight)?
A. Aricept®
B. Namenda®
A. Aricept®
Which smoking cessation medication is also indicated for use in depression?
A. Varenicline
B. Bupropion
B. Bupropion
