psych drugs Flashcards
Trazodone
Old Sleep aid - sedating antidepressant antidepressant: prodrug that's converted to 5HT2 antagonist Adverse: - sedation - GI - orthostatic hypotension
Sinequan
Most sedating, antidepressant sleep-aid
mirtazapine
sedating antidepressant (sleep aid) antidepressant: 5HT2 antagonist that affects both the alpha2 and NE auto receptor, ehancing release of NE and 5HT AND it acts as 5HT2 antagonist
Adverse:
- sedating
- increased appeptite and weight gain
amitriptyline Hcl
sedating antidepressant (sedative hynotic for insomnia)
doxepin
Sedating antidepressant, sedative hypnotic for insomnia
Benzodiazepines
Sedative hypnotics “BzRAs”
GABA-agonist, bind receptor sites on GABA receptor complex, facilitate GABA action on Cl channel to hyperpolarize neurons. Multiple CNS effects include sedation, amnesia, anxiolysis, myorelaxation, ataxia
Long Half Lives
3 Nonbenzodiazepine hypnotics
- Ambien (Zolpidem tartrate)
- Lunesta (Eszopiclone)
- Sonata (Zaleplon)
Ambien
Zolpidem tartrate
nonbenzodiazepine hynotic
Lunesta
eszopiclone
nonbenzodiazepine hypnotic
Sonata
Zaleplon
nonbenzodiazepine hypnotic
Nitrous Oxide
Inhaled general anesthetic
low potency, quick on and quick off, good safety margian, adds to amnesia and analgesia
Isoflurane
Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction
Sevoflurane
Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction
Desflurane
Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction
Propofol
Intravenous general anesthetic
- rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
- liver metabolism is rapid, later
- good for long term sedation
- “Milk of Amnesia,” used for INDUCTION and MAINTENANCE as well as SEDATION
- risk of bacterial contamination
GABA Agonist, non-analgesic, amnestic, anitemetic
Etomidate
Intravenous general anesthetic
- rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
- liver metabolism is rapid, later
- the longer used, longer to wear off
- INDUCTION and SHORT SEDATION
- non-analgesic, potential endocrine effects
Ketamine
Intravenous general anesthetic
- rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
- liver metabolism is rapid, later
- the longer used, longer to wear off
Dexmedetomidine
Intravenous general anesthetic
Effects of General Anesthesia (5)
- Unconsciousness
- Amnesia
- Analgesia
- Attenuation of autonomic reflexes
- Skeletal Muscle Relaxation
Malignant Hyperthermia
Hypermetabolic syndrome in genetically susceptible patients after exposure to halogenated inhalationals and succinylcholine
- decrease in reuptake of Ca from sarcoplasmic reticulum
uncontrollable muscle contraction
-hyperthermia due to muscle contraction
- hypercabnia (increased CO2)
- Dantroline antidote (inhibits Ca from sarcoplasmic R)
Properties of SSRIs
- Inhibit 5-HT reuptake SELECTIVELY as compared to NE reuptake
- Relatively selective for 5HT transporter, thus side effects limited to effects on 5HT - mediated response
Properties of SNRI’s
Inhibit reuptake transporters for BOTH NE and 5HT
–> elevation of both NE and 5HT at synapse
Properties of TCA’s
Inhibit reuptake transporters for both NE and 5HT (like SNRI’s)
- tend to interact with other receptors, therefore a broad range of side effects
Action of MAOIs
Inhibit monoamine oxidase, preventing NT breakdown
Type A MAO metabolizes NE, 5HT, tyramine
Tybe B MAO is more selective for metabolising DA
- Pts taking MAOI’s must be careful with tyramine intake, which at high levels can reverse reuptake inhibitors, causing uncontroled catecholamine release, potential hypertensive crisis
SSRI adverse effects
Effects associated with enhanced 5HT:
- HA
- GI (nausea, diarrhea)
- weight gain
- sexual dysfunciton + decreased libido
- increased risk of bleeding
- insomnia/hypersomnia
- hyponatremia in elderly
- teratogenic potential with SSRI PAROXETINE
SNRI adverse effects
SSRI effects (enhanced 5HT) plus NA affects:
((HA, GI, WG, sexual dysfunction/decreased libido, inc bleeding, sleeping, hyponatremia in elderly))
+
INCREASED BP, INCREASED HR
CNS ACTIVATION (Insomnia, anxiety, agitation)
TCA adverse effects
SNRI effects + effects from interaction with other receptors:
5HT(HA, GI, WG, SX, inc bleeding, Sleeping, hyponatremia in elderly)
+ NE (Inc BP, HR, CNS activation)
+ OTHERS: anticholinergic effects, orthostatic hypotension and sedation
5HT antagonist adverse effects
Trazedone: sedation, GI, orthostatic hypotension
Mirtazapine: significant sedation, inc in appetite and WG (good for elderly)
MAOI adverse effects
Orthostatic hypotension
WG
Sexual disturbances
- interactions with tyramine containing foods can precipitate HTN crisis
- serotonin syndrome can result in combo w SSRI, SNRI
Drug combos that can cause Serotonin syndrome
SSRI + MAOI
SNRI + MAO
SSRI/SNRI + linezolid (has MAOI activity)
SSRI/SNRI + serotonergic drug: dextromethorphan, sumatriptan, tramadol, St. John’s Wort
Methylphenidate compounds
Ritalin, Concerta, Metadate, Focalin
Dextroamphetamine compounds
Dexedrine, DextroStat