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Flashcards in just the meds Deck (55):
1

antipsychotic agents aka

dopaminergic antagonists
(block D2 dopamine receptors in brain)

2

antipsychotic black box warning

increased mortality in elderly patients with dementia-related psychosis

3

antidepressant black box warning

?

4

levodopa: definition + 1 interaction

oral form of dopamine used to treat parkinsonism
+ antagonized by antipsychotics!!

5

chlorpromazine (thorazine)

typical antipsychotic
- phenothiazine
- low potency

- target sx: antiemetic, hiccup relief
- more anticholinergic SE
- sedation, hypotension common

6

haloperidol (haldol)

typical antipsychotic
- nonphenothiazine (butyrophenone)
- high potency

- target sx: agitation, aggression
- unlikely anticholinergic SE
- more EPSE

7

alt: prolixin, stelazine, navane

typical antipsychotic, high potency

OTHER

8

alt: mellaril (thioridazine)

typical antipsychotic, low potency

OTHER

9

butyrophenone

type of nonphenothiazine, high potency typical antipsychotic

- haloperidol (haldol)

10

benztropin (cogentin)

epse treatment!
antiparkinsonian; anticholinergic

moa: anticholinergic - block central cholinergic receptors

11

trihexyphenidyl (artane)

epse treatment!
antiparkinsonian; anticholinergic

moa: anticholinergic - block central cholinergic receptors

12

diphenhydramine (benadryl)

epse treatment!
antihistamine

moa: suppression of central cholinergic activity; prolongs action of dopamine by inhibiting reuptake and storage

13

clozapine (clozaril)

atypical antipsychotic

moa: strong blockade of D1, weaker D2
also blocks 5HT, NE, histamine, ACh

common se: sedation, drowsiness, hypersalivation, tachycardia, dizziness, constipation

adverse: agranulocytosis 1-2%
generalized seizures 3%

14

risperidone (risperdol)

atypical antipsychotic

moa: binds to multiple receptors
- D2 (weak)
- 5HT (strong)
- histamine
- alpha-adrenergic
does NOT block cholinergic receptors

side effects (generally infrequent, mild): fatigue, somnolence, dizziness, agitation

> see especially in non-psych settings <

15

olanzepine (zyprexa)

moa:
- positive effects: dopamine, 5HT
- negative effects: NE, histamine

side effects (mild)
somnolence 26%
hypotension
anticholinergic effects
** longterm use: weight gain **

16

seroquel (quetiapine fumarate)

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

common SEs: sedation, hypotension, dizziness, weight gain

OTHER

17

geodon (ziprasidone)

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

historically associated with cardiac side effects

OTHER

18

saphris (asenapine)

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

sublingual

OTHER

19

fanapt (iloperidone)

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

approved for schizophrenia only

OTHER

20

latuda (lurasidone)

atypical antipsychotic - effective in treatment of mood disorders with psychotic symptoms

primarily have D2, 5HT2 actions

OTHER

21

antidepressant black box warning for youth

increased risk of suicidal thinking/suicidality in children, adolescents with major depressive and other psych disorders

applies to ANY antidepressant; ALSO seizure/epilepsy meds

risk vs clinical need
close observation
advise family, caregivers

22

fluoxetine (prozac)

SSRI - first one to be made!

23

zofran, reglan + SSRI = ?

serotonin syndrome. zofran and reglan already increase serotonin alone.

24

atropine

anticholinergic!
?
?

25

nifedipine (procardia)

antihypertensive, Calcium channel blocker
used for hypertensive crisis due to MAOI interaction

26

venlafaxine (effexor)

atypical antidepressant: SNRI (serotonin-norepinephrine reuptake inhibitor)

does not block cholinergic, histamine, alpha1-adrenergic
- very selective, no peripheral side effects

use: bipolar disorder (if more depressive)

side effects (common): headache, anorexia, insomnia
- increased 5HT = more excitatory!
- increased NE = excitatory (in this case)

adverse effects (less common): serotonin syndrome, neuroleptic malignant syndrome, hypertension, bleeding, increased serum lipids, activation of mania

27

bupropion (wellbutrin)

atypical antidepressant: norepinephrine-dopamine reuptake inhibitor

moa: inhibits nicotinic receptors
- does NOT block 5HT!!

smoking cessation (Zyban)

side effects: weight loss, dizziness, dry mouth (NE effects!)
nausea, headache, insomnia, tremor, agitation (direct stimulation effects!)

increased risk for seizures!

28

trazodone (desyrel)

atypical antidepressant: heterocyclic

moa: SSRI and 5HT2 antagonist

use: adjunct
- sedation for insomnia, potentiates SSRI
- dose for depression alone too high

side effects: sedation, hypotension, nausea, vomiting, priapism
- sedative due to histamine activation
- similar to TCA (increase in 5HT and NE levels = added sedative effects)
- priapism due to alpha-adrenergic blocking

29

NaSSA (norepinephrine and serotonergic specific antidepressant) also known as...

TeCA (tetracyclic antidepressant)

30

TeCA (tetracyclic antidepressant) also known as...

NaSSA (norepinephrine and serotonergic specific antidepressant)

31

mirtazepine (remeron)

atypical antidepressant: NaSSA/TeCa -- norepinephrine and serotonergic specific antidepressant; also tetracyclic antidepressant

moa: moa: blocks alpha-2 adrenergic receptors (those inhibit release of NE & 5HT)

elimination half-life: 20 to 40 hours

side effects: somnolence (> 50%), increased appetite, cholesterol, dizziness, weight gain (significant: 50-60lbs/year)
-- give at bedtime
-- increase dose = somnolence decreases

dosing: 15mg QHS, max 30mg

quick dissolve - first antidepressant with this route
- great for compliance (can't hide in cheek, spit out)
-- esp. dementia patients with depressive features

32

zyban

atypical antidepressant: norepinephrine-dopamine reuptake inhibitor -- bupropion!

EXCEPT USED FOR SMOKING CESSATION

33

divalproex (depakote)

along with lithium, gold standard treatment for bipolar disorder (great for mania)

34

lithium

mood stabilizer

moa: interchangeable with Na, modulates synaptic transmissions
-- stabilizes neuron electrical activity

- influences excitatory second messenger systems
- decreases neuronal activity
- depends on renal function: RAPID RENAL EXCRETION

toxicity: involves kidneys

35

lithium: plasma levels (3)

0.8 - 1.4 mEq/L initial treatment (during acute phase)
0.4 - 1.0 mEq/L maintenance (during stable phase)
> 1.5 mEq/L toxic

36

carbamazepine (tegretol)

antiseizure medication: MUST CHECK SERUM LEVELS

37

valproic acid (depakote)

antiseizure medication: MUST CHECK SERUM LEVELS

38

valproic acid vs divalproex

divalproex is a derivative of valproic acid

39

lamotrigine (lamictal)

mood stabilizer, antiepilepsy; ok to use adjunct with antiseizure meds

40

topiramate (topamax)

anticonsulsant; ok to use adjunct with antiseizure meds

41

phenytoin (dilantin)*

moa: suppresses action potential of hyperactive neurons by delayed recovery of select Na channels

administration notes:
-small dosing changes can result in considerable changes in therapeutic levels
- rapid IV administration can result in cardiac collapse

ae: gingival hyperplasia!

therapeutic dosage range: 10-20 mcg/ml NARROW!

42

valproic acid (depakote)*

first choice for seizure treatment, unofficially first choice for bipolar

moa:
- suppresses Na channels
- suppresses Ca influx
- augments GABA

adverse effects: can be hepatotoxic

dosage range: 50-150mcg/ml

43

alprazolam (xanax)

benzodiazepine: anxiolytic

44

lorazepam (ativan)

benzodiazepine: anxiolytic

45

clonazepam (klonopin)

benzodiazepine: anxiolytic

46

diazepam (valium)

benzodiazepine: anxiolytic

47

flumazenil (romazicon)

benzodiazepine antagonist

uses:
- to reverse sedation post-anesthesia
- overdose

may result in generalized seizures with convulsions

side effects: dizziness, agitation, mood lability, confusion, n, v, ha, blurred vision

48

benzodiazepines class

sedative-hypnotic: anxiety

49

barbituates class

sedative-hypnotic: anxiety

50

benzodiazepine-like drugs class

sedative-hypnotic: insomnia!

51

zolpidem (ambien)

benzodiazepine-like: insomnia

52

zaleplon (sonata)

benzodiazepine-like: insomnia

53

eszopiclone (lunesta)

benzodiazepine-like: insomnia

54

ramelteon (rozerem)

class: melatonin agonist

use: insomnia

moa: activates specific receptor subtypes of melatonin

adverse effects: drowsiness, dizziness, fatigue
- neuroendocrine effects secondary to high prolactin and low testosterone

interactions: fluvoxamine (luvox) !!!!!
increases levels 50-60x. VERY DANGEROUS

55

buspirone (buspar)

NOT SEDATIVE-HYPNOTIC!

class: spiro compound
moa: not clearly established
- high affinity to 5HT receptors
- low affinity to dopamine receptors
- DOES NOT BIND to GABA or benzo sites

administration: better absorbed when taken with food
- lag time to peak effectiveness (3-6 weeks)

adverse effects
dizziness, headache
nausea
nervousness, excitement

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