Flashcards in FIrst Aid: Psychopharmacology Deck (163)
What antidepressant class is used to treat enuresis?
What antidepressant class is used to treat Autism?
What antidepressant class is used to treat premenstrual dysphoric d/o?
What is the treatment for the depressive phase of manic depression?
What is the treatment for insomnia?
What antidepressant class is used to treat neuropathic pain?
What antidepressant class is used to treat dysthymia?
What is the MOA of TCAs?
-Inhibit reuptake of NE and 5-HT
Why are TCAs not first-line agents?
higher incidence of side effects, require greater monitoring of dosing and are lethal in overdose
What is the hallmark of TCA toxicity?
widened QRS (>100 msec)
List examples of TCAs
Which TCA is least likely to cause orthostatic hypotension?
Which TCA is least sedating (least anticholinergic side effects)?
Which TCA is the most serotonin specific?
What is clomipramine specifically used to treat?
How do you treat a TCA overdose?
IV sodium bicarbonate
What are the major TCA side effects?
-antiAdrenergic (orthostatic hypotnesion, tachycardia, arrhythmia)
-antiMuscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia)
-lethal in overdose
What dosage of TCA's is lethal in OD?
1 week supply
What are the 3 C's of TCAs?
What is the MOA of MAOIs?
prevent the inactivation of biogenic amines such as NE, 5-HT, dopamine, and tyraminMOA-e (increase amount of these transmitters available in synapses)
MAO-A preferentially deactivates what neurotransmitter?
MOA-B preferentially deactivates what neurotransmitter?
MOAIs are very effective for what conditions?
-Refractory panic disorder
List some examples of MAOIs.
What are the common side effects of MAOIs?
What happens when SSRIs and MAOIs are taken together?
serotonin syndrome (lethargy, restlessness, confusion, flushing, diaphoresis, tremor and myoclonic jerks)
What does serotonin syndrome progress into?
What is the first step when suspecting serotonin syndrome?
How long must you wait before you switch from an SSRI to MAOIs?
at least 2 weeks
When would you get a hypertensive crisis when on MAOIs?
if you take it with tyramine-rich food or sympathomimetics
What type of foods have tyramine?
Why do you get a hypertensive crisis when you take an MAOI with foods with tyramine?
causes a build-up of stored catecholamines
What is the MOA of SSRIs?
Inhibit presynaptic serotonin pumps, leading to increased availability of serotonin in synaptic clefts
Why are SSRIs the most commonly prescribed antidepressants?
-Low incidence of side effects
-No food restrictions
-Much safer in overdose
List the SSRIs.
-Citalopram (and escitalopram)
Which SSRI has the longest half-life (so no need to taper)?
Which SSRI has the highest risk of GI disturbances?
Which SSRI is most serotonin specific and most activating?
Which SSRI is currently only approved for use in OCD?
Which SSRI is the levo enantiomer of citalopram?
escitalopram (much more expensive and fewer side effects)
What neurotransmitters do the SSRIs not act on?
What are the common side effects of SSRIs?
-Anorexia, weight loss
-Serotonin syndrome when used with MAOIs
Atypical antidepressants include which classes of drugs?
SARIs (5-HT antagonist)
What is the example of an SNRI?
What is a side effect of venlafaxine?
can increase BP
What happens if you miss 1-3 doses?
potential withdrawal (flu-like symptoms and electric-like shocks or zaps)
What is the example of NDRIs?
What are the major uses for buproprion?
-Seasonal affective disorder
What is the most significant advantage of buproprion?
Lack of sexual side effects
At high doses, what could buproprion do?
it's dopaminergic effect can exacerbate psychosis
What are some side effects of buproprion?
increased risk of seizures
What patients should not take buproprion?
-Pts with significant anxiety
-Contraindicated in patients with seizure or active eating disorder
List the examples of SARIs.
What are the uses of SARIs?
-Refractory major depression
-Major depression with anxiety
-Insomnia (secondary to its sedative effects)
What are the side effects of SARIs?
List an example of a NASA?
What is mirtazapine used for?
Refractory major depression (especially in patients who need to gain weight)
What are the side effects of mirtazapine?
What is the dose of mirtazapine with the maximal sedative effect?
15 mg of less
What happens to the sedative effect of mirtazapine at higher doses?
increases NE uptake and is less sedating
What is the MOA of traditional (typical) anipsychotics?
block dopamine receptors
What is the MOA of atypical antipsychotics?
block both dopamine and serotonin receptors
Why do atypical antipsychotics have fewer side effects than typical?
their effect on dopamine is weaker
List the 2 low potency traditional antipsychotics.
What does "low potency" mean as far as antipsychotics go?
lower affinity for dopamine receptors (so higher doses are required)--DOES NOT MEAN LOWER LEVEL OF EFFICACY
True or false: low potency typical antipsychotics have higher incidence of anticholinergic and antihistaminic side effects
True or false: low potency typical antipsychotics have higher incidence of EPS and NMS than high potency typical antipsychotics
FALSE- high potency do!
List the 5 major high potency typical antipsychotics.
What does "high potency" mean as far as antipsychotics go?
greater affinity for dopamine receptors and a relatively low dose is needed to achieve effect
Which high potency typical antipsychotics are available in long-acting forms (decanoate)?
haloperidol and fluphenazine
How often must you give IM injections of haloperidol decanoate?
every 4-5 weeks
How often must you give IM injections of fluphenazine decanoate?
every 2-3 weeks
Dopamine naturally inhibits what chemicals?
List the 4 antidopaminergic effects.
What word is used to describe the EPS of masklike face, cogwheel rigidity and pill rolling tremor?
What word is used to describe the EPS of subjective anxiety and restlessness and objective fidgetiness?
What word is used to describe the EPS of sustained contraction of muscles of neck, tongue, eyes (painful)?
What does hyperprolactinemia cause?
How do you treat EPS?
Reducing dose of antipsychotic +treatment with antiparkinsonian, anticholinergic, or antihistaminic medications (ex. amantadine, benadryl, or benzotropine)
What is another name for benzotropine?
What are some anti-HAM side effects of antipsychotics?
-Anti-Alpha Adrenergic- orthostatic hypotension, cardiac abnormalities, sexual dysfunction
-Anti-Muscarinic- dry mouth, tachycardia, urinary retention, blurry vision, constipation
What is another general side effect of antipsychotics?
What hepatic side effects are associated with antipsychotics?
Elevated liver enzymes
What opthalmologic problems are associated with antipsychotics?
-Irreversible retinal pigmentation with high doses of thioridazine
-Deposits in lens and cornea with chlorpromazine
What dermatologic problems are associated with antipsychotics?
-Blue-gray skin discoloration (chlorpromazine)
What type of antipsychotics are more likely to cause seizures?
low-potency (lower seizure threshold)
What is the word for choreoathetoid (writhing) movements of mouth and tongue that occur in pt's with long-term neuroleptic use?
What causes tardive dyskinesia?
Increase in number of dopamine receptors (causing lower levels of Ach)
How long do you take neuroleptics before you get tardive dyskinesia?
> 6 months (usually in older women)
What is the prognosis for tardive dyskinesia?
50% of cases spontaneously remit
Untreated cases may be permanent
Who gets neuroleptic malignant syndrome?
males early in treatment
What is the prognosis for NMS?
20% mortality rate if untreated
What often precedes NMS?
What are the s/s of NMS?
Fever (most common)
Autonomic instability (tachycardia, labile hypertension, diaphoresis)
Rigidity (lead pipe rigidity almost universal)
How do you treat NMS?
-Discontinue current medications
-Administer supportive medical care (hydration, cooling, etc.)
-Sodium dantrolene, bromocriptine, amantadine
Is NMS an allergic reaction?
Can you ever restart a specific neuroleptic after it causes NMS?
What is the MOA of atypical antipsychotics?
Block both dopamine and serotonin receptors
Why are atypical antipsychotics sometimes preferred over typical?
less side effects (rarely cause EPS, tardive dyskinesia, or NMS)
List some examples of atypical antipsychotics.
What atypical is FDA approved as an adjunct for depression?
Which atypicals are FDA approved for the treatment of mania?
Which atypical is only used in severe refractory cases?
Which is the only generic atypical?
Which atypical requires weekly blood draws to check WBCs due to 1% risk for agranulocytosis?
True or false: atypical antipsychotics do not have anti-HAM side effects?
false! they do have some
Other than agranulocytosis, what is the major side effect of clozapine?
2-5% incidence of seizures
What must be monitored in patients on olanzapine?
LFTs (can cause liver toxicity
What is another common problem with olanzapine?
Weight gain, hyperlipidemia, glucose intolerance
Which atypical requires slit lamp eye exams every 6 months?
Which typical antipsychotic performs as well as the atypicals?
What is another term for mood stabilizers?
What are mood stabilizers used for?
-preventing relapses of manic episodes
How might mood stabilizers be good in an agitated demented or mentally retarded individual?
can be used to treat aggression and impulsivity
Mood stabilizers are used to potentiate what 2 classes of drugs?
-Antidepressants (in refractory MDD)
-Antipsychotics (in treatment of schizophrenia)
What is the use for mood stabilizers in treating alcoholism?
enhancement of abstinence
List the mood stabilizers.
What is the proposed MOA for lithium?
alters neuronal sodium transport
What is the mechanism of excretion for lithium?
secreted by kidney
How long does it take lithium to work (onset of action)?
What is the major drawback of lithium?
VERY narrow therapeutic index (.7-1.2)
Toxic above 1.5
Lethal above 2
What factors affect lithium levels?
-Salt deprivation (increase)
-Impairedrenal function (increase)
What are some unique side effects of lithium?
What does a patient look like who has lithium toxciity?
What should be monitored regularly in a patient on lithium?
-Blood levels of lithium
-Kidney function (GFR)
What drugs are used to treat mixed episodes and rapid-cycling bipolar disorder?
valproic acid (depakene)
What can carbamazepine also be used to treat?
What is the MOA of carbamazepine?
blocks sodium channels and inhibits action potentials
What is the onset of actionf or carbamazepine?
What are some unique side effects of carbamazepine?
What must be taken before starting a patient on carbamazepine or valproic acid and regularly after starting?
What is the teratogenic effect of taking carbamazepine or valproic acid during pregnancy?
neural tube defects
What is the proposed MOA of valproic acid?
increases CNS levels of GABA
What are some unique side effects of valproic acid?
What are the most widely used class of psychotropic medications?
What is an advantage of benzos over barbiturates?
Benzos are safer at high doses (but can be lethal if mixed with alcohol)
What is the MOA of benzos?
Potentiating effects of GABA (increase frequency of Cl- channel opening)
List examples of long acting (1-3 days) benzos.
What is chlordiazepoxide used to treat?
What is diazepam used to treat?
What is flurazepam used to treat?
List the rapid onset benzos.
List some intermediate acting (10-20 hours) benzos.
What is a common use for alprazolam, clonazepam and lorazepam?
What is another common use for orazepam?
What is temazepam used for?
List the short acting (3-8 hr) benzos.
What is triazolam used for?
List some SE of benzos.
Impaired intellectual function
Reduced motor coordination
What occurs with benzo toxicity?
respiratory depression in overdose (expecially if combined with ETOH)
What are zolpidem (ambien) and zaleplon used for?
short term treatment of insomnia
What is the MOA of zolpidem and zaleplon?
Selectively bind to benzodiazepine binding site on GABA receptor
What is an advantage of using zolpidem or zaleplon for insmonia?
-No withdrawal effects
-Minimal rebound insomnia
-Litter or no tolerance/dependence with long term use
What is the difference between zaleplon and zolpidem?
Zaleplon is a newer insomnia drug with a shorter half life than zolpidem
Are zaleplon and zolpidem benzos?
What is buspirone used for?
Alternative to Benzos or venlafaxine for treating GAD
What is the onset of action for busprione?
What is the MOA of buspirone?
partial agonist at 5-HT-1a receptor
Can you use buspirone in alcoholics?
YES- does not potentiate CNS depression of alcohol
What is the use of propranolol in psych patients?
treats autonomic effects of panic attacks, performance anxiety and can be used to treat akathisia (side effect of typical antipsychotics)
Which psychotropic drugs have anti-HAM side effects?
Low potency antipsychotics
What psychotropic drugs cause serotonin syndrome?
SSRIs + MAOIs