Medications Flashcards Preview

Psychiatry > Medications > Flashcards

Flashcards in Medications Deck (128):
1

SSRI drugs

Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine

2

SSRI general uses

OCD
Social Phobias
Gen. Anxiety D/o
PTSD
Bulemia
Panic d/o
also good for PMDD (pre-menstral depression)
recently approved for hot flashes (paroxetine)
Pre-mature Ejaculation

3

SSRI general side effects

"SSRI - sex, stomach, restless, insomnia"
main s/e = increased weight and dec. sex drive
GI, restlessness goes away in a few weeks

4

How to avoid GI/Restlessness s/e of SSRI

start w/ low dose and slowly titrate

5

TCA - (act like SNRI's, weak SSRI)
DRUG NAMES

Imipramine
Nortriptyline
Amitriptyline
Clomipramine
Desipramine
Doxepin --> Insomnia; x50 stronger vs Benadryl
Amoxapine
Trimiparmine
Protryptiline

6

TCA general uses

insomnia (Doxepin)
Irritable bowel disease
migraines
fibromyalgia

7

TCA general side effects

Anti-Ach side effects
- dry mouth
- urinary/bowel retention
- flushing
- inc QT --> inc risk of torsade
Will cause orthostasis

8

MAO-Inhibitors Drug Names

Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline - MAO-B (works mostly on DA)

9

MAO-Inhibitors side effects

watch for tyramine effect as tyramine mimics NE and will not be broken down if GI MAO's are blocked by these drugs
can get serotonin syndrome b/c they also block serotonin breakdown
wait 7 days after stopping venlaflaxine before starting MAO-inh

10

Bupropion Mech of axn and uses

DNRI
DOES NOT WORK FOR ANXIETY issues (PTSD, GAD, Phobias, etc)
ADHD
BPH
Smokers
mild/moderate obesity --> weight loss!!

11

Avoid Bupropion in....

BULEMIA

12

Burpropion Side effects

NO GI/Nausea/Sex side effects!!!!!!
can combine with lower dose SSRI to get benefits of both with less s/e

13

SSRI + 5HT2 block

Nefazodone
Trazodone
= block of 5HT2a --> priapism

14

SNRI + 5HT2 and 5HT 3 block

Mirtazapine (Remeron)
= blocks GI side-effects via the 5HT3
= still get the sex side effects

15

SNRI's Drug Names

***remember TCA"s behave like SNRI***
- Venlafaxine
- Desvenlafaxine
- Duloxetine
- Savella --> good for depression

16

SNRI side effects

same as SSRI + Added HTN

17

TYPICAL Anti-psychotics
Mech of Axn
Drug Names

***Dopamine ANT-agonist***
Haloperidol (Haldol)
Chlorpromazine
Fluphenazine
Loxapine
Pimozide
Molindone
Thioridazine
Mesoridazine
Perphenazine
Trifluoperazine
Thiothixene

18

ATYPICAL Anti-Psych
MOA
Drugs Names

***Dopamine and 5HT-2A ANT-agonist***
Clozapine - only one good for neg. sx; also for suicide
Olanzapine
Risperidone
Quetiapine
Ziprasidone
Apriprazole
Paliperidone
Iloperidone
Asenapine
Lurasidone

19

Drugs that work for bipolar depression

Quetipine and Lurasidone

20

Quetiapine works well for

Bipolar depression
Mania
can be used for monotherapy

21

ATYPICAL Anti-Psy uses

Clozapine - NEG sx of psychosis, suicide
Schizophrenia
Bipolar D/O
Tic D/O --> tourettes
Apriprazole can be used for depression if monotx fails
Risperidone and Apriprazole can be used for irritability

22

Mood Stabilizers Drug Names

Lithium Carbonate
Divalproex Sodium
Carbamezapine (Tegretol)
Gabapentin
Pregablin
Loamotrigine
Oxcarbazapine
Topiramate

23

Sedative Hypnotics and Anxiolytics
BZD Drug Names

- Lorazepam
- Flurazepam
- Triazolam
- Temazepam
- Diazepam
- Chlordiazepoxide
- Oxazepam
- Chlorazepate
- Alprazolam
- Clonazepam

24

Sedative Hypnotics and Anxiolytics
NON-BZD Drug Names

Buspirone
Hydroxyzine
Propranolol
Clonidine
Zolpidem
Zaleplon
Eszopiclone
Ramelteon
Doxepin

25

MOA (non-bzd sedatives/anxiolytics):
Buspirone
Hydroxyzine
Propranolol
Clonidine
Zolpidem
Zaleplon
Eszopiclone
Ramelteon
Doxepin

Buspirone - 5HT1 AGONIST
Hydroxyzine - Anti-H
Propranolol - beta-block
Clonidine - Alpha 2 - AGONIST
Zolpidem - BZD1 AGONIST
Zaleplon - " "
Eszopiclone- " "
Ramelteon - Melatonin receptor agonist
Doxepin - TCA/Anti-H (50x stronger than benadryl)

26

Stimulants
- can be used for depression but NOT as monoTx

Modafinil
Armodafinil
Methylphenidate (Ritalin, Concerta)
Amphetamine Salts (Adderall)
Dextroamphetamine
Lis-dexamptheamine
Methamphetamine

*****These 3 are FDA approved for ADHD but are NOT Stimulants:*****
Atomoxetine (SNRI)
Guanfacine (alpha 2 agonist)
Clonidine (alpha 2 agonist)

27

Addictive Medicine

Methadone --> Morphine (opioid)
Buprenorphine - opioid agonist
Naloxone - opioid antagonist
Acamprosate - NMDA antagonist
Naltrexone - Opioid antagonist
Varenicline - Nictonic Receptor antagonist
Bupropion - DNRI

28

EPS of antipsychotics

Dystonia - spasm of face,neck and tongue
Parkinsonianism - resting tremor, rigidity, bradykinesia
Akathisia - restless

29

Tx of EPS

Anti-Parkinsons Drugs
- benztropine, diphenhydramine)
BZD
Beat Blocker (FOR AKATHISIA)

30

Main Side Effect of 2nd Gen Anti-Psychotic

Metabolic Syndrome
-increase blood pressure
-increased insulin and excess waistline fat
- INCREASED risk of CV disease,

31

Weight neutral Anti=Psychotics

Apriprazole - only 2nd gen
First Gen antipsych

32

Short Term Tx of Tardive Dyskinesia

BZD
Beta-blocker
Cholinomimetics

33

Neuroleptic Malignant Syndrome

Look for leukocytosis, fever, rigidity, elevated CPK, metabolic acidosis,

34

Thioridazine side effect

TYPICAL anti-psychotic
causes IRREVERSIBLE retinal pigmentation

35

Chlorpromazine

Typical Anti-psychotic
causing corneal and lens deposits

36

Tx for Mood Disorder

FIRST LINE --> Lithium

If can't use Lithium (renal issues, pregnant, etc)
--> USE VALPROATE

37

Valproate side effects

Spina Bifida if pregnant
Pancreatitis
Low Platelets
Agranulocytosis

38

2nd line agents

Carbamazepine (also for Trigeminal neuralgia)
Lamotrigine

39

CNS stimulants - Indications/Contraindications
Methlyphenidate
Dexmethylphenidate
Dextroamphetamine
Amphetamine
Pemoline

Indications
-ADD
-Narcolepsy
Contraindications
- Co-admin w/ MAO-I
- Narrow angle glaucoma

40

CNS Stimulant SIDE EFFECTS - Adverse

Adverse
- Anxiety Insomnia
Anorexia
Tachycardia

41

CNS Stimulant SIDE EFFECTS - Severe

Drug Dependence
HTN
Cardiac Arr
CV Collapse (rare)

42

Novel CNS Stim - Modafinil
Indications

Narcolepsy
ADD
Primary and Secondary Hypersomnia

43

Modafinil Contraindications

Co-admin with MAO-I

44

Modafinil Side Effects - Adverse

HA
Nausea
Rhinitis
Anxiety
Insomnia

45

Atomoxetine (Strattera)
Indications/Contraindications

CNS Stimulant used for
- ADD
Contraindicated
- Co-admin with MAO-I
- Narrow Angle Glaucoma

46

Atomoxetine Adverse Effects

Dyspepsia
N/V
Anorexia
Dizziness
Insomnia
Sexual dysfxn

47

Atomoxetine Serious Effects

Suicidal ideation
Severe Liver Injury

48

MOA of Antipsychotics

Target the D2 pathway in MESOLIMBIC

D2 Block in other pathways causes side effects
- Block of Nigrostriatal --> EPS
- Block of tuberoinfundibular --> HyperPL
- Block of Mesocrotical --> Worsens negative sx and cognition

Typical Antipsych - also block Ach, Alpha adrenergic, and H1 receptors

49

High Potency Anti-Psychotics

Holperidol
Fluphenazine
Pimozide
Thiothixene
Trifluphenazine

50

Mid Potency Anti-Psychotics

Perphenazine
Molindone
Loxapine

51

Anti-Psychotic Side Effect profile BY potency

HIGH Potency -- worse EPS

LOW Potency -- more Anti-Ach, Anti-H1, and Anti-alpha adrenergic

MID Potency - more balanced profile

52

Low Potency Anti-Psychotics

Chlorpromazine
Mesoridazine
Thioridazine

53

Chlorpromazine

HIGHLY sedating
Significant hypotension and Anti-Ach
LOW EPS sideeffects!!

54

Thioridazine

Least EPS of all the Typicals
Significant QT prolongation
doses >800mg/day --> retinitis pigmentosa

55

Uses/Indications of TYPICAL Anti-psychotics

Psychotic Disorders
-Schizophrenia
-Shizoaffective d/o
-Brief Psychotic d/o
-Substance and Med - induced psychosis

Psychotic Symptoms in Mood D/o
- MDD w/ psychotic features
- Acute Manic, depressed,and mixed manic states of bipolar disorder

Tourette's
Huntington's

56

Adverse Effects of Typical Anti-Psychotics

EPS - Akathisia, Parkinsonian, Dystonia
- tx Akathisis w/ Anti-Act, Betablock or BZD
- tx Dystonia w/ Anti-Act (po or IM)
- tx Parkinsonian w/ Anti-Act, Dopaminergics, or Beta-blockers

Sedation
Weight Gain
Anti-Ach side-effects
Orthostatic HypoTN
Dec.Seizure threshold
Sexual Dysfxn
Dermatologic effects (dermatitis, and photosensitivity)

57

NMS sx

hyperpyrexia
ANS instability
Rigidity
Delerium

58

Atypical Anti-Psychotics

Block D2 and 5HT2A
- the 5HT2a is responsible for mitigating the D2 related EPS side effects and the D2 block in other pathways

also block Muscurinic-Ach, Alpha Adrenergic, and H1 to varying degress

MORE Metabolic side effects and LESS EPS
- hyperglycemia
- DM2
- Hyper-Lipidemias

59

Clozapine Indications/Contraindications

Indications
- Tx- refractory Schizo
- Schizo with concurrent Tard.Dyskinesia

Contraindications
- Granulocytopenia
- DM/hyperlipidemias

60

Clozapine Adverse Effects

Sedation
Anti-Ach + ECG changes
Orthostatic HypoTn
Hypersalivation
Weight Gain (substantial)
Seizures (high dose or fast titration)
Metabolic problems (DM and HLD)

Serious Effects include Agranulocytosis (requires frequent CBC checks)

61

Risperidone Indications/Contraindications

Acute Mania

62

Risperidone Adverse Effects

Orthostatic HypotTN
Reflex Tachy
Dizziness
Insomnia
Agitation
HyperPL
if >6mg/day --> EPS MAY develop
Metabolic Problems

63

Olanzapine Indications/Contraindications

Acute Mania
Bipolar Maintainence

Contraindications in DM and HLD pts

64

Olanzapine Adverse Effects
wide antagonism of 5HT2, D1, D2, D4, H1, Musc-Ach,

Anti_Ach + ECG Changes
Orthostatics and dizziness
Sedation
Weight Gain
hyperglycemia --> DM2 --> DKA
HLD

65

Ziprasidone Side Effects

Sedation
Weight Gain, to lesser extent than clozapine, olanzapine, and risperidone
Metabolic problems, including diabetes and hyperlipidemias, probably at a lower rate than olanzapine and clozapine
Possible increased risk for prolongation of QT interval

66

Apriprazole

Also good for Bipolar Maintainence

67

Apriprazole Side effects

Weigth Gian, but less than Clozapine, Olanzapine, and Risperidone
Metabolic problems

68

PPx for Recurrent Mania Or for Bipolar Maintanence

Olanzapine and Apriprazole

69

Imipramine uses

Panic
Enuresis

70

TCA secondary amines benefit over primary

fewer side effects
less sedating
safer in OD

Desipramine, Nortiptyline, Protriptyline

71

TCA contraindications

Cardiac conduction delays
Cardiac Arr

72

The TCA with the least amount of orthostasis

Nortriptyline

73

TCA with least amount of Anti-Ach

Desipramine

74

Doxepin uses

pain, insomnia, anxiety

75

Clomipramine indications

highly seritonergic
indicated for OCD

76

Amitriptyline uses

PAIN
headache,
insomnia

77

TCA general indications

MDD
Bipolar Depression
Dysthymia
Panic d/o
Gen Soc. Phobia
GAD
OCD (clomipramine)
Panic D/o (migrains/neuralgias)

78

TCA side effects

weight gain, Anti-Ach
Sedation
Orthostatic HYPOtn
sex dysfxn + anorgasmia in women
seizures
mania in bipolar patients

79

TCA - serous side effects
do regular blood monitoring

Cardiotoxicity --. slow the condunction --> EKG changes, ARR, and AV block

Neurotox --> tremor ataxia

Overdose --> agitation, delerium, coma, and death

80

Uses for MAO-I and contraindications

MDD
Atypical Depression
Panic d/o
Social Phobias
OCD

DO NOT GIVE w/
demerol
another SSRI
Sympathomimetic drugs
Tyramine

81

MAO-I side effects

Weight gain
sex dys fxn
insomnia
myoclonus. mm pains, and paresthesia
mania
orthostatic hypoTN

82

Fluoxetine (PROZAC)

longest half-;life
good for bulemia

83

Paroxetine

more sedating than fluoxetine and sertraline

84

Sertraline

less sedating than paroxetine

85

Fluvoxamine

indicated for OCD

86

SSRI Side effects by receptor

5HT3 - in GI sys --> N/V/D
5HT2C - CNS --> anxiety and mental agitation
5HT2A - CNS, spinal cord--> anxiety, mental agitation, akathisia, insomnia, myoclonus, and sex dysfxn

87

Serotonin Discontinuation Syndrome

HA, Dizziness, Irrtiability, and Fatigue on abrupt discontinuation

88

Venlafaxine Uses and Contraindications

SNRI - best efficacy for antidepresion
- MDD
- GAD
- Panic d/o
- Gen Soc. Phobia

DO NOT co-admin with MAO-I

89

SNRI side effects
(Venlafaxine, Duloxetine)

Tremor
Agitation
Tachy/HTN
N/V/D
Anxiety and Mental Agitation
Akathisia
Insomnias
Myoclonus
Sex Dysfxn
Seizures (rare)
Mania

Discontinuation syndrome is the same as SSRI

90

Duloxetine indications

DM Neuropathy
Nausea
Fibromyalgia
Pain for OA

91

Mirtazapine

good MDD but do NOT give with MAO-I

92

Mirtazapine side effects

Sedation
INC Appetite and Weigh Gain

Serious effects --> agranulocytosis and blood dyscrasias

93

Trazodone and Nefazodone uses

MDD and Dysthymia
do not give w/ MAO-I

94

Trazodone and Nefazodone side effects

Trazodone - priapism
Nefazodone - liver tox (black box)

since 5HT2A is blocked sex dys is avoided

95

Bupropion uses

MDD
Dysthymia
Bipolar Depression
ADHD
Smoking Cessation
BPH
Weight Loss

96

Bupropion Contraindications

Anorexia
Bulemia
Seizure d/o
co-admin with MAO-I

97

Bupropion side effects

Activation
Insomnia
Nausea
Tremor

Seizure at high dose

98

Short Acting BZD in order of decreasing potency

Alprazolam - very addictive
Lorazepam
Oxazepam
Temazepam (sleep aid)

99

Long Acting BZD in order of dec potency

Clonazepam
Diazepam (fast onset but active metabolite)
Chlordiazepoxide - etoh Detox

100

BZD indications and contraindications

GAD
Situation Anxiety Phobias
Panic d/o
epilepsy
muscle spasm
akathisia
etoh w/d
agitation
anxiety in other psych d/o

101

BZD overdose tx

Flumazenil <-- BZD antagonist

102

BUSpirone

5HT1A AGONIST
- good for GAD and adjunct in MDD
-takes at least 2 wks to kick in

103

BUSpirone side effects

Dizzy/HA/Fatigue/Gi distress

NO sedation or addictive potential like BZD

104

Hydroxyzine

good for situational anxiety (anti-H)

105

Hydroxyzine side effects

Sedation
Weight gain
Anti-Ach

106

Non=BZD drugs for Insomnia

Zolpidem
Zaleplon
Eszoplicone
Diphenhydramine
remelteon

107

Zolpidem vs Zaleplon vs Eszoplicone

Zaleplon is short acting
Eszoplicone - not supposed to have tolerance

108

Side effects of
Zolpidem
Zaleplon
Eszoplicone

Zolpidem - N/V/D/ Gi distress
Zaleplon - Dizzy, Dyspepsia
Eszoplicone - headaches

109

Diphenhydrramine

can counter oculogyric crisis
but also good for insomnia

110

Diphenhydramine side effects

Dizzy and Fatigue

111

Lithium Carbonate uses

Bipolar 1 (esp euphoric mania_
Bipolar 2
Bipolar Maintainence
Intermittent Explosive D/O
Adjunct to anti-depressant

112

Lithium CONTRAINDICATIONS

Pregant women --> ebsteins anomanly
renal fx/dx patients
-Caution w/ diuretics, ACE-Inh, NSAIDS <-- all can raise Li levels

113

Monitoring parameters with Lithium

periodic therapeutic blood monitoring
thyroid
kidney function testing.

114

Lithium Side effects

GI irritation
Polyuria polydipsia, nephrogenic DI
Tremor, subtle incoord,
Cognitive Blunting
Benign Leukocytosis
Weight Gain

115

Lithium SERIOUS effects

Li tox
- oliguira
- N/V/D
- oliguria
- ataxia
- coarse tremor
- inc DTR's
- obtundation
- seizure
- death
Thyrotox
Long-term nephrotox
Cardiac Arr + T-wave flattening

116

Carbazmazepine uses

Bipolar 1 (mixed mania and rapid cycling)
Bipolar 2
Epilepsy and Neuralgias
EtOH w/d

117

Carbamazepine contraindications

Pregnant women
--> cleft lip, palate,
-->neural tube defects
-->learning d/o

118

Carbamazepine side effects

N/V/D
Seadation
Lightheaded
Tremor
Coginitive blunting
Hyponatremia
Anti-Ach effects
Rash --> SJS
Weight Gain

119

Carbamazepine Serious effects

Blood dyscrasias (aplastic anemia, agranulocytosis and thrombocytopenia)
Hepatotox

OD --> coarse tremor, coma, death

120

Carbamazepine monitoring parameters

Therapeutic levels
CBC
LFT
metabolic fxn tests

121

Clozapine WBC monitoring

if Leukopenic at 3000-3500 (2x/week CBC and continue Clozapine)
If leukopenic at 2000-3000 stop Clozapine and check CBC daily. CAN restart if it resolves
if Agranulucytosis (uncomplicated or complicated) STOP --> Protective isolation
- CANNOT RESTART CLOZAPINE

122

Lithium Tox

>3mEq --> Dialysis

123

Drugs affective Carbamazepine

Theophyline and Cisplatin = DEC Carbamazepine

Carbamazepine will cause a drop in Warfarin and Hormonal contraceptives

Eryhtromycin will INC Carbamazepine levels

124

tx of hyperarousal in PTSD

clonidine or beta blocker

125

SSRI - Discont. Syndrome

flu-like (chills and aches)
Nausea
Vomiting
Dizzy
Sensory and sleep disturbance
usually occurss 1-3 days after last dose
since Sertraline and paroxetine are short half-life --> taper
since fluoxetine is long half life - can stop abruptly

126

associated lab findings in NMS

leukocytosis
elevated Transaminases
myoglobinuria

127

Li induced tremor

can use beta blocker, cessation of caffeine and dose reduction/slow release of lithium to tx

128

Tx of Rapid Syndrome in long term neurleptic usage

Anti-Ach