Anxiety/Depression/Biopolar Disorder - Brand/Generic Flashcards Preview

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Flashcards in Anxiety/Depression/Biopolar Disorder - Brand/Generic Deck (67):
1

Librium

- Indication

CHLORdiazepoxide

- Indication: anxiety and EtOH w/d

2

Klonopin
Clonapam

- Indication

CLONazepam

- Indication: panic disorder

3

Valium

- Indication

Diazepam

- Indication: anxiety/acute etoh w/d, anti-convulsive

4

Dalmane

- Indication

FLURazepam

- Indication: only approved for insomnia

5

Ativan

- Indication

Lorazepam

- Indication: anxiety, alleviate N/V, panic attacks

6

RESToril

- Indication

TEMazepam

- Indication: insomnia

7

Prosom

- Indication

ESTazolam

- Indication: insomnia

8

Xanax, Xanax XR, Niravan

- Indication:

Alprazolam

- Indication: anxiety

9

Serax

- Indication

OXazepam

- Anxiety, EtOH w/d

10

Halcion

- Indication

Triazolam

- Anxiety

11

BuSpar
Vanspar

- Dose
- SEs

Buspirone

- Dose: Start 15mg/d. Max 60mg/day
- Non sedative anxiolytic agent. Take up to 4 wks to work
- SEs: Dizziness, drowsiness, HA

12

SSRI Pt counseling
- Delay onset of effect
- Avoid





SSRI MOA






SSRI and Bleeding
- Cause
- Which agents has the least

SSRI SEs









SSRI DDI

SSRI Pt counseling
- Delay onset of effect
1st wk: Improved sleep/appetite
4th wk: increase energy = suicide
6-8 wk: improved mood
- Avoid:
EtOH, valerian, St. John's wort, SAMe, Kava kava

SSRI MOA
- MOA Inhibits reuptake of 5-HT at all 5HT receptors, acting as a serotonin agonist
5HT1 = depression
5HT2 = sexual dysfunction
5HT3 = GI SEs

SSRI and Bleeding
- SSRIs reduce platelet => incr bleeding risk
- Least agent: fluvoxamine and citalopram

SSRI SEs
- Activating or sedating
Fluoxetine = highly activating
Fluvoxamine = highly sedating
- GI effects
- Sexual dysfunction
- HA
- HypoNa
- Anticholinergic effects

SSRI DDI
- Fluvoxamine: strong 1A2 Inhibitor
- Fluoxetine and paroxetine: strong 2D6

13

Celexa

- Indication
- Dose
- DDI

Citalopram
- SSRI
- Indication: MDD
- Dose: 10-60mg/da QD. High dose = QT and torsades . Max 40mg/d. Age > 60, max 20mg
- DDI: Avoid going over 20mg when combined w/ 2C19 inhibitors omeprazole, cimetidine, PO OC

14

Lexapro

- Indication
- Dose

Escitalopram

- SSRI
- Indication: MDD and generalized anxiety (GA)
- Dose: 10-20mg PO QD

15

Prozac

- Indication
- Dose
- MOAIs

Fluoxetin

- SSRI
- Prozac MDD, OCD, Bulimia nervosa
- Prozac ER = MDD: 90mg PO QW
- Dose: 10-80mg PO QD AM
- MOAIs: d'c 14d prior to start fluoxetin. To start MOAI, d/c fluoxetin 5wk prior to start MOAI due to long t1/2

16

Luvox

- Indication
- Dose

FLUVOXamine

- SSRI

- Indication: OCD
- Dose: 50-300mg/d QHS

17

Paroxetine

- Indication
- Frequency

Paxil
- SSRI

- Indication: MDD, OCD, Panic disorder, social anxiety disorder, PTSD
- Frequency QAM

18

Zolof

- Indication
- Dose

Sertraline

- SSRI
- Indication: MDD, OCD, PTSD, Panic disorder
- Dose: 50-200mg PO QD
- Food increase BA

19

Vilazodone

- Indication
- Administration

Viibryd

- Indication: MDD in adults
- Dose: Start 10mg QD with FOODs x 7d, then 20mg with FOOD x 7d. Then MD 40mg QD with FOODs

20

Effexor

- MOA
- Indication
- Frequency
- Warning pt
- SEs

Venlafaxine

- MOA: SNRI
- Indication: MDD, GAD (XR only)
- Dose frequency: BID/TID. ER take QD.
- Warning pt: ghost tablet in stool
- SEs: Activating/sedating, GI, sexual dysfunction
*HTN*, HA

21

Pristiq






-------
Khedezla

Desvenlafaxine

- Major active metabolite of effexor XR => take QD
- MOA: SNRI
- Dose: 50-400mg/QD. CrCl

22

Cymbalta

- MOA
- Indication
- Dose
- Momitor:

Duloxetine

- MOA: SNRI
- Indication: depression, GAD, diabetic peripheral neuropathy, fibromyalgia, management of chronic musculoskeletal pain
- Dose: Initial 30. Usually 60. Max 120mg QD
- Monitor: BP

23

Savella

- MOA
- Indication
- Dose
- SEs
- Allergy


-----
Fetzima
- MOA
- Indication
- Dose
- SEs

MILnacipran

- MOA: SNRI
- Indication: fibromyalgia
- Dose: Start 12.5mg to 50mg BID
- SEs: HA, SZ, HypoNa, Inc LFTs, GI (constipation),
*Inc BP & Pulse*
- Allergy: contains FDC Yellow No.5 (tartrazine)

------
LevoMILnacipran
- MOA: SNRI
- Indication: MDD
- Dose: 40-120mg QD
- SEs: same

24

Wellbutrin

- MOA
- Indication
- Max dose
- Counseling ~ dose
- SE
- Caution

Bupropion

- MOA: Dopamine and NE agonist
- Indication: MDD, nicotine w/d
- Max dose: ~400mg/d
- Counseling ~ dose: take 2nd dose before 5PM
- SEs: activation, GI, SZ
- Caution: bulimia, alcoholics, Sz

25

Desyrel IR

- Indication
- SEs

TraZOdone

- Indication: sleep disorder (IR)
- Dose: 50mg QHS
- SEs: GI, sexual dysfunction, anticholinergic effects, orthostatic hypoTN, **priapism

26

Serzone

- MOA
- Indication
- SEs

NEFazodone

- MOA: Blocks serotonin reuptake (less potent than SSRI) and alpha adrenergic blocker
- Indication: MDD
- SEs: similar to Trazodone. No Priapism

27

REMeron

- MOA
- Dose
- SEs

MIRtazapine

- MOA: Inc NE and serotonin in brain, alpha antagonist, serotonin receptor antagonist
- Dose: Initial 15mg QHS. Max 40mg. Also come in disintegrating tab
- SEs: somnolence, appettite incr, weight gain, increase TC and TG. Anticholinergic SEs

28

AmiTIPtyline

- MOA for all TCA
- Indications
- Dose
- SEs

Elavil

- TCA: Tertiary amines
- MOA: Block reuptake of NEs and serotonin.
Also stimulated alpha adrenergic (orthostatic hypoTN), histaminergic (weight gain and sedation), anticholindertic
- Indications: all TCAs are use for MDD except clomipramine are indicated for MDD
- Dose: range 50 - 300 mg/day
- SEs: sedation, anticholinegic, orthostatic hypoTN, tachycardia, arrhythmia

29

Anafranil

- Indication
- Class

CLOMipramine

- TCA: Tertiary amines
- Indication: OCD & MDD

30

Sinequan

- Indication
- Class

DOXepin

- TCA: Tertiary amines
- Indication: MDD and anxiety

31

Tofranil

- Indication

IMipramine

- TCA: Tertiary amines
- Indication: MDD, night time bed-wetting episodes

32

Surmontil

- Class

TIMipramine

- TCA: Tertiary amines

33

Asendin

- Indication

aMOxapine

- Depression

34

Norpramine

- Indications:
- Class

DesiPRAMINE

- TCA: Secondary amines
- Other indication: ADHD

35

Ludiomil

- Class

MAProtiline

- TCA: Secondary amines

36

Pamelor

- Class

Nortriptylin

- TCA: Secondary amines

37

Vivactil

- Class

PROtriptyline

- TCA: Secondary amines

38

Marplan

- MOA
- Indication
- SEs
- DDIs
- Tyramine containing foods:

IsocarBOXazid

- MAOIs: inhibits MAO enzyme causing a decrease in the breakdown of dopamine, serotonin, and NE in the synapse
- Indication for all MOAI: MDD
- SEs: MAOI's
Map = weight gain
A = anticholinergic
O = orthostatic hypotension, hypoTN
I = insomnia
s - sexual dysfunction

DDI
- Dextromethorphan: hyperpyrexia & death
- Meperidine: sz, fever, death
- Sympathomimetics: amphetamines, ephedrine, etc
- TCA's and SSRI's: hyperthermia, hyperTN, muscle rigiditiy, delirium, coma
- Tyramine (tryptophan) release NE => hypertensive crisis (signs = HTN, HA, flushing, palpitation, anxiety, N/V, stiff neck, photophobia)

**Containing foods: smoked aged or pickled meat/fish, aged cheeses, yeast, fava beans, beer, avocado, red wine, caffeine, chocolate, soy sauce, yogurt.

39

Nardil

PheNELzine

- MOAIs

40

Parnate

TRANylcypromine

- MOAIs

41

Emsam

- MOAIs
- Indication
- Forms
- Direction

SeLEGiline

- MOAIs Type B
- Indication: MDD
- Forms: patches in 6, 9, 12 mg/24H
- Direction: apply to dry intact skin QD.

42

Abilify

- Indication
- Dose

Aripiprazole

- Indication: antipsychotic for MDD, bipolar, scz
- Dose: start 2-5mg/d up to 15mg/d (lower dose than use for schizophrenia)

43

SymBYAX

- Indication
- Dose
- Direction to take
- SEs

Olanzapine/fluoxetine

- Indication: fast response for depression with bipolar or schizophrenia, treatment resistant depression
- Dose: 3/25mg, 6/25mg, 6/50mg, 12/25mg, 12/50mg QHS
- Take QHS due to Olazapine
- SEs: EPSE, tardive dyskinesia, obesity, dyslipidemia, diabetes
- Monitor: weight, BP, Glucose, lipid

44

Depakote

- Indication
- SEs

Divalproex Na

- Indication: Biopolar disorder
- SEs: hepatitis, pancreatitis

45

Lamictal

- Indication
- SEs

Lamotrigine

- Biopolar disorder
- SEs: severe hypersensitivity reaction

46

Topamax

Topiramate

- Biopolar disorder

47

Equetro

- Indication
- Dose
- SEs

Carbamazepine

- Biopolar disorder
- Dose: 100, 200, 300mg
- SEs: aplastic anemia, agranulocytosis (CBC)

48

Zyprexa

- Indication
- Dose

Olanzapine

- Biopolar disorder
- Dose: start 10mg IM for acute mania

49

Resperdal

RISPERidone

- Biopolar disorder

50

Geodone

ZIPrasidone

- Biopolar disorder

51

Abilify

Aripiprazole

- Biopolar disorder

52

Eskalith

- Indication
- MOA
- OSA
- Dose
- Therapeutic level
- Dose adjustment
- SEs

Lithium

- Indication: tx of manic/depressive (bipolar) and depressive disorders.
- MOA: Positive charged element
- OSA: Effects usually begin in 1 week and full effect is seen by 2-3 weeks.
- Dose: 900-1800mg/d (15-20mg/kg) with FOODs to avoid N
Li carbonates (Eskalith and Lithobid) and Li citrate (syrup) = more GI)
- Therapeutic level: 0.6 to 1.2mmol/L (MD); 0.8-1.5 (acute level)
- Dose adjustment in:
* Elderly and renal: decrease dose
* Pregnancy: increase dose
- SEs: LITH APM
L = Leukocytosis
I - Nephrogenic diabetic insipidus, GI = N/V/D
T = final intentional tremor
H = hypothyroidism => bradycardia
A = Acne and alopecia
P = polyuria and polydipsia
M = Map = weight gain

53

Li toxicity management

- D/C Li
- Resp and CV support
- Restore fluid and electrolyte balance
- Benzodiazepine prn agitation and/or sz
- Phenytoin prn sz
- There is no antidote. Care is supportive

54

Drugs increase Li

Drugs decrease Li

Li with SSRIs

Drugs inc Li
- Thiazides, ACEI
- NSAIDs: reduce kidney's ability to eliminate Li and lead to elevated levels of Li in blood
- Na restriction, dehydration, renal fxn

Decrease Li
- Pregnancy
- Increase NaCl
- Drugs caused urine to alkaline

Li with SSRIs
- Serotonin syndrome

55

Li Monitoring

- BUN and SCr
- Urine specific gravity
- CBC
- Electrolyte: hypoNa and hypoK
- TSH
- EKG
- Glucose

56

Flumazenil

- Indication

Antidote for Benzodiazepam

57

Brintellix

- Class
- Indication
- Dose
- CI

Vortioxetine

- Class: SNRI, 5HT1 agonist, 5HT3 antagonist
- Indication: MDD
- Dose: 10-20mg QD
- CI: do not use w/ linezolid

58

Sarafem

- Indication
- MOAIs

Fluoxetine

- Indication: Premenstrual dysphoric disorder
=> start 14d before expected menses onset through first full day of menses.
- MOAIs: d'c 14d prior to start fluoxetin. To start MOAI, d/c fluoxetin 5wk prior to start MOAI due to long t1/2

59

Aventyl

- Class

Nortriptylin

- TCA: Secondary amines

60

Aplenzin ER

Bupropion

61

Zyban

- Indication

Bupropion

- Nicotine w/d

62

Buproban

Bupropion

63

Wellbutrin XL

- Indication

Bupropoin

- To prevent SAD. Start Wellbutrin XL in fall; taper off in spring)

64

Oleptro XR

- Indication

Trazodone

- I: depression

65

Stavzor

Valproic acid DR

66

Lithobid

Lithium

67

Clinoril

- Class:

Sulindac

- Class: NSAID that doesn't increase Li level