Mental Health Flashcards
(21 cards)
ANTIDEPRESSANTS
TCAs
examples
ADRs
Cautions
Pregnancy
nonselective norepinephrine-serotonin reuptake inhibitors
amitriptyline, nortriptyline, imimpramine
diaphoresis, anticholinergic effects, orthostatic hypotension, sedation, drowsiness (act on histamine- drowsiness, weight gain)
Overdose can be fatal
Contraindicated: CV, glaucoma, prostatic hypertrophy, urinary incontinence, seizure disorders
C
TCAs continued
do not prescribe with
do not
baseline
maois
d/c abruptly, titrate both ways
EKG
assess suicidality
TCAs (older) nnsri
MAOIS (older)
SSRIs
SNRIS
Amitriptyline, nortriptyline, impiramine
Deoxepin, desipramine, clomipramine
Nardil, Marplan, Parnate
Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram
Venlafaxine, deluoxetine, milnacipran, desvenlafaxine
MAOIs
ADRs
pregnancy
metabolism
Nardil marplan parnate
tyramine (toxicity- htn) orthostatic hypotension, HA, insomnia, diarrhea
C
major liver, cyp
tyramine- restrict 14 days after dc or other drugs (SSRIs SNRIs)
Pros cons older agents antidepressants
Older:
pro- effective, more effective at psychotic/melancholic depression, MAOIS for atypical depression, experienced, strong lit, cost effective, known therapeutic window
cons- delay in onset, SE- nonselsective, dietary restrictions, toxic, lethal in overdose
SSRIs
Half life
Metabolism
Which for OCD
ADR
Pregnancy
elderly
slow absorption, half life 21-26 hours except fluoxetine 1-3 days
major first pass, liver metabolism
fluvoxamine
CNS, GI, sexual dysfunction
RENAL/HEPATIC impairment
B/C- avoid in 1st and last (sertraline used without adverse consequences)
elderly half dose recommended
SSRIs cont.
Never give more than
Initial SE
Celexa- think….
lexapro-
4 weeks
nausea, lightheaded sedation muscle restlessness sleep disturbance- minor and transient
celexa- qtc prolongation, >60 or concurrent use (cimetidine, omeprazole)
lexapro- active metabolite citalopram no QTC
SSRIs
prozac
other- luvox, paxil, zoloft
Serotonin syndrome
Withdrawal syndrome
prozac- weekly dose available
Serotonin syndrome- fatal (n/d, chills, sweating, hyperthermia, hypertension, jerking, agitation, confusion) - adequate titration (5 half lives per dose decrease), do not combine with serotonergic agents
Withdrawal- shorter half life drugs (paxil, zoloft, celexa, escialopram) can show withdrawal after one missed - nausea, dizziness, pareshesia (all require gradual tapering except prozac)
SNRIs
Nefazadone
Duloxetine- not approved for
Do not give these to
Interactions
Pregnancy
nefazadone- bb liver toxity, failure, not recommended
cymbalta not approved for children
do not give to glaucoma
quinolones (metabolized by liver)
C- effexor did not increase incidence
SNRI
ADRs
Used in
Watch
headache, somnolence, dizziness, insomnia, fatigue dry mouth, constipation, orto, increase bg, urinary retntion
major depression
Watch patients with liver disease, electrolyte imbalance in elderly
SNRIs continued
effexor
effexor- discontinuation symptoms if dosed miss
cymbalta- more potent, monitor liver
pristiq- active metabolite of effexor, renal dosing
Other antidepressants
Wellbutrin
Remeron
Trazadone
wellbutrin- Dop and Norep, can cause anxiety, psychosis and seizures, can improve sexual function
Remeron- weight gain good for elderly, NE serotonin
Trazadone- take with food, sleep
Pros cons newer agents
pro- effective, broad indications, high TI, improved compliance, tolerance, some once a day dosing
cons- expensive, sexual dysfunction, less efficacious for endogenous and psychotic depression, “poop” out problem except effexor, less drug monitoring
BENZODIAZEPINES GABA Short- Intermediate- Long-
contraindicated in
ADR
short- Clorazepate, Halazepam, Prazepam
intermediate- xanax, ativan, serax, librium
long- valium, klonopin
pregnancy, lactation, children < 6 , hepatic/renal disease, geriatric caution
ADR- CNS depression mainly- cardiac repsp depression excessive sedation
Non benzo gaba
Not used for
Up to ___ weeks for max effect
Contraindicated in
Preganncy
Buspar - seretonergic anxiolytics- take with food
Panic disorder
6 weeks
Renal, hepatic
B
ANTIPSYCHOTICS
warning
Typical-effective at ___ symptoms, ADRs
Examples
Contraindicated in
increased mortality in elderly patietns with dementia-related pscyhosis
Typical- phenothiazine and nonphenothiazine- effective at reducing positive symptoms
ADRs- EPS (antihistamines, antiparkinsons, anticholinergics given to counteract) NMS, sedation, reduction seizure threshold, sexual dysfunction
Ex: Haldol, fluphenazine (high potency) chlorpromazine and thiroidazine (low potency)
Contraindicated in: narrow angle glaucoma, bone marrow depression, severe liver CV disease
Atypical
Effects
Less
ADRs
Caution in
Pregnancy
block serotonin and inhibit release of dopamine
Positive and negative
Less risk EPS TD
Weight gain, seizures, hyperprolactinemia, dizziness, ortho, tachycardia, sleep distrubance, constipation
hepatic or renal
C
Atypicals continued
Clozapine- risk for
clozapine- fatal agranulocytosis- registration required- weekly or biweekly- monitor 4 weeks after dc
Bipolar
Lithium- pregnancy, children, interactions
Valproic acid- used for, pregnancy, highly?, ADRs, interactions
C, do not give to <12
Nsaids, diuretics (increase NA excretion increase lithium levels)
Valproic- for acute mania and prevention, D, highly protein bound, ADR- GI CNS alopecia, interactions- protein bound so displaced by carbamezapine and warfarin THERAPEUTIC MONITORING 50-100
MOOD STABILIZERS
Third line tx for
Examples
Pregnancy
ADRS
3rd line tx: bipolar
Ex: Lamictal, Gabapentin, Topamax
C
somnolence, dizziness, ataxia, fatigue
lamictal/topamax- SJ
BIPOLAR DISORDER
1st generation antisychotics
2nd generation
1st- before lithium were mainstay, manage agitation and psychosis in acute mania, many se, less expensive, category C
2nd- monotherapy or in combo with mood stabilizers, antidepressant and mood stabilizing (treat both poles)
