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Psychiatry > Medication Fast Facts > Flashcards

Medication Fast Facts Flashcards

1
Q

Fluoxetine (Prozac)

A

Longest half-life with active metabolites –> no need to taper
Need to wait 5-6 weeks before starting MAOIs
Common SE: Insomnia, anxiety, sexual dysfunction
CYP inhibitor –> can increase antipsychotic levels
ONLY SSRI approved for pediatric depression

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2
Q

Sertraline (Zoloft)

A

Higher risk of GI disturbances
Common SE: Insomnia, anxiety, sexual dysfunction
Very few drug interactions

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3
Q

Paroxetine (Paxil)

A

Several drug interactions, including CYP inhibition
Common SE: Anticholinergic side effects (eg sedation, weight gain) and sexual dysfunction
Withdrawal phenomenon from short half life

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4
Q

Fluvoxamine (Luvox)

A

ONLY approved for OCD
Common SE: N/V
Multiple drug interaction due to CYP inhibition

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5
Q

Citalopram (Celexa)

A

FEWEST drug-drug interactions

Dose dependent QTc prolongation

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6
Q

Escitalopram (Lexapro)

A

Similar efficacy as citalopram, maybe fewer SE?

Dose dependent QTc prolongation

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7
Q

Venlafaxine (Effexor)

A

Depression, anxiety disorders (eg GAD), neuropathic pain

SE similar to SSRIs but can increase BP in higher doses –> DO NOT USE in those with untreated/labile BP

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8
Q

Duloxetine (Cymbalta)

A

Depression, neuropathic pain, fibromyalgia
SE similar to SSRIs but more dry mouth constipation from NE effects
Hepatotoxicity more likely in pt with liver dz/EtOH use
CYP inhibition

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9
Q

Buproprion (Wellbutrin)

A

NET and DAT inhibitor
Lack sexual side effects compared to SSRIs and less likely to cause weight gain.
Effective for smoking cessation.
SE: increased anxiety (mild stimulant effects), increased seizure and psychosis risk at high doses
CONTRAINDICATED in those with seizure, active ED, or on MAOI

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10
Q

Trazodone (Desyrel)

A

Antagonizes 5-HT/alpha 1/H1 histamine receptors, inhibits 5-HT reuptake
Useful for MDD, MDD with anxiety, insomnia (from sedative effects)
SE: N/V, orthostatic hypotension, arrhythmias, sedation, priapism

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11
Q

Nefazodone (Serzone)

A

Related to Trazodone

Black Box Warning for RARE BUT SERIOUS liver failure–rarely used

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12
Q

Mirtazapine (Remeron)

A

Alpha 2 antagonist, but also 5-HT and H1 receptor antagonists
Used for MDD, esp. for those with significant weight loss and/or insomnia (think elderly)
SE: sedation, weight gain, RARE agranulocytosis

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13
Q

Heterocyclic antidepressants

A

Include tricyclic and tetracyclic antidepressants
TCAs inhibit NE and 5-HT reuptake –> increase synaptic monoamine availability
Long half-lives so dosed once daily
TCA OD treated with sodium bicarbonate (QRS > 100ms)

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14
Q

Tertiary amine TCAs

A 
Amitriptyline
Imipramine
Clomipramine
Doxepin
Highly anticholinergic and antihistaminergic --> more sedating/antiadrenergic (block alpha 1) with greater lethality in OD
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15
Q

Secondary amines

A

Nortriptyline
Dispramine
Metabolite of tertiary amines and less anticholinergic/antihistaminic/antiadrenergic

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16
Q

Amitriptyline (Elavil)

A

Tertiary amine
Chronic pain
Migraines
Insomnia

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17
Q

Imipramine (Tofranil)

A

Tertiary amine
Enuresis (wetting self)
Panic disorder

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18
Q

Clomipramine (Anafranil)

A

Tertiary amine

Most serotonin-specific –> USEFUL FOR OCD

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19
Q

Doxepin (Sinequan)

A

Tertiary amine
Chronic pain
Emerging use as sleeping aid in low doses

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20
Q

Nortriptyline (Pamelor, Aventyl)

A

Secondary amine
Least likely to cause orthostatic hypotension
Chronic pain

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21
Q

Amoxapine (Asendin)

A

Metabolite of FGA loxapine –> may cause EPS and similar SE profile

22
Q

MAO inhibitors

A

Prevents inactivation of biogenic amines: NE, 5-HT, dopamine, tyramine via irreversible inhibition of MAO-A and MAO-B

MAO-A –> NE and 5-HT
MAO-B –> dopamine, tyramine

Used for refractory depression and more effective than TCAs in depression with atypical features

23
Q

MAOI side effects: serotonin syndrome

A

2 week window between SSRI and MAOI, 5-6 weeks for fluoxetine

Lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks –> hyperthermia, hypertonicity, rhabdomyolysis, renal failure, coma, death

D/c med –> benzos and supportive care, can use 5-HT antagonist cyproheptadine

24
Q

MAOI side effects: hypertensive crisis

A

MAOIs taken with tyramine-rich foods or sympathomimetics

HTN, sweating, N/V, photophobia, autonomic instability, arrhythmias, neck stiffness. MOST DANGEROUS THING IS STROKE

Can use nitroprusside or phentolamine, alpha 1 and 2 antagonist

25
Q

Low-potency vs. high-potency FGAs

A

Low-potency with higher incidence of antiadrenergic, anticholinergic, and antihistaminic side effects –> more lethality in OD due to QTc prolongation (TdP) with potential for heart block and Vtach; more likely to lower seizure threshold

High-potency with higher incidence of EPS, TD, NMS, hyperprolactinemia due to stronger affinity for dopamine receptors

26
Q

Chlorpromazine (Thorazine)

A 
Low-potency FGA
Orthostatic hypotension
Blue-gray skin discoloration
Photosensitivity
Can be used to treat N/V and intractable hiccups
27
Q

Thioridazine (Mellaril)

A

Low-potency FGA

Retinitis pigmentosa

28
Q

Loxapine (Loxitane)

A

Mid-potency FGA
Higher risk of seizures
Metabolite is amoxapine, a tetracyclic antidepressant

29
Q

Thiothixene (Navane)

A

Mid-potency FGA

Can cause ocular pigment changes

30
Q

Pimozide (Orap)

A

High-potency FGA a/w QTc prolongation and Vtach

31
Q

Antipsychotics more likely to cause hyperprolactinemia?

A

FGAs and risperdone + paliperidone (risperidone metabolite)

32
Q

Tardive dyskinesia

A

Thought to be secondary to D2 receptor upregulation and super-sensitivity

May occur in those who have used neuroleptics > 6 months

Clozapine less likely to cause TD

33
Q

Clozapine

A

SGA that is less likelyt o cause TD
Only antipsychotic shown to be efficacious for treatment refractory schizophrenia AND DECREASE SUICIDE RISK
Side effects: sialorrhea, myocarditis, agranulocytosis (stop if ANC < 1500), seizures

34
Q

Risperidone (Risperdal)

A

SGA
Hyperprolactinemia
Orthostatic hypotension and reflex tachycardia
Long acting IM form Consta

35
Q

Quetiapine (Seroquel)

A

SGA
Much less likely to cause EPS
Common SE: sedation, orthostatic hypotension

36
Q

Olanzapine (Zyprexa)

A

SGA

Common SE: sedation, weight gain

37
Q

Ziprasidone (Geodon)

A

SGA
Less likely to cause significant weight gain
A/w QTc prolongation
MUST be taken w/ food

38
Q

Aripriprazole (Abilify)

A

SGA
Unique mechanism of D2 agonism –> can be more activating to cause akathisia
Less sedating and less potential for weight gain

2 A’s in AripriprAzole = AkAsthisia from d2 agonism

39
Q

Lurasidone (Latuda)

A

Newer SGA that is used in BIPOLAR DEPRESSION

Must be taken with food

40
Q

Only mood stabilizer to decrease suicidality?

A

Lithium

Also drug of choice for acute mania and ppx for manic and depressive episodes in bipolar and schizoaffective

41
Q

Monitoring for lithium toxicity

A

Prior to initiation: ECG, BMP, TFTs, CBC, pregnancy test
Monitor creatinine, TFTs, and lithium levels:
-Therapeutic: 0.6-1.2
-Toxic >1.5
-Potentially lethal: >2.0 –> dialysis

Note that lithium can case benign leukocytosis
Be careful about prescirbing NSAIDs, ACE-I, ASA, tetracyclines, and MTZ

42
Q

Carbamazepine

A

Useful in treating mania with mixed features and rapid-cycling bipolar; less effective for depressed phase

CYP inducer

Common SE: GI, CNS (drowsiness, ataxia, confusion)
Be careful of SJS, agranulocytosis, transaminitis, NTDs

43
Q

Valproic acid (Depakote)

A

Useful in treating acute mania, mania with mixed features, and rapid-cycling
Check drug levels after 4-5 days (therapeutic range 50-150)

44
Q

Lamotrigine (Lamictal)

A

Efficacy for bipolar DEPRESSION, LITTLE EFFICACY for acute mania or mania ppx
Most serious SE is SJS, which can manifest in first 2-8 weeks. Minimize by starting at low doses and titrate up.
Valproate will increase lamotrigine levels, lamotrigine will decrease valproate levels.

45
Q

Indication or long-term antidepressant maintenance therapy?

A

=> 2 major depressive episodes
Chronic depressive episodes lasting > years
Active comorbid psychiatric disorder, history of childhood trauma, and early age onset (<20) at risk of recurrence

46
Q

Naltrexone

A
  • One of the first line meds for EtOH use d/o
  • Opioid receptor blocker –> can precipitate withdrawal in those with physical opioid dependence
  • Decreases craving and “high “ associated with EtOH
47
Q

Acamprosate (Campral)

A
  • One of the first line meds for EtOH use d/o
  • Modulates glutamate transmission
  • Start post-detox for relapse prevention
  • CAN BE used in LIVER disease but CONTRAINDICATED in severe renal disease
48
Q

Disulfiram (Antabuse)

A
  • Second line for EtOH use d/o
  • Blocks aldehyde DH in liver –> aversive rxn to EtOH –> best used in highly motivated patients
  • CONTRAINDICATED in severe cardiac disease, pregnancy, psychosis
  • MONITOR LIVER function
49
Q

Topiramate

A
  • Second line for EtOH use d/o
  • Potentiates GABA and inhibits glutamate
  • Reduces cravings –> used for binge-eating!
50
Q

Which class of drugs have a black box warning regarding increased risk of death in patients with dementia?

A

Antipsychotics!

51
Q

Benzos not metabolized by liver (safe to use in chronic alcoholics/liver dz)?

A

There are a LOT of them:
Lorazepam
Oxazepam
Temazepam

52
Q

Clonazepam

A

Long-acting benzo (half life >20hr) useful in treatment of anxiety, as well as for refractory sleepwalking or sleep terrors

Psychiatry (3 decks)

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