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PANCE Medications Flashcards

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1
Q

What are the selective serotonin reuptake inhibitor’s?

A 
Citalopram (celexa) 
Escitalopram (Lexapro) 
Paroxetine (Paxil) 
Fluoxetine (Prozac) 
Sertaline (Zoloft) 
Fluvoxamine (Zyvox)
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2
Q

What is the mechanism of action of SSRIs?

A

Selectively inhibit CNS uptake of serotonin; Will increase serotonin

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3
Q

What are the indications for SSRI’s?

A

First-line therapy for depression, anxiety disorder

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4
Q

Do SSRIs have a low or high toxicity in overdose?

A

Low toxicity in cases of OD

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5
Q

What are some common side effects of SSRIs?`

A

G.I. upset, sexual dysfunction, headache

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6
Q

What SSRI do you want to avoid in patients with a long QT syndrome?

A

Citalopram

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7
Q

What is your most serious side effect of SSRIs?

A

Serotonin syndrome especially with use of MAOIs

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8
Q

What are examples of SNRI’s

A

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

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9
Q

What is the MOA of SNRI’s?

A

Stops serotonin, norepinephrine and dopamine reuptake

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10
Q

What are the indications for SNRI’s?

A

Often use first line in patient with significant fatigue or pain syndrome with depression

Used second line when there is no response to SSRI’s

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11
Q

What are the common side effects of SNRI’s

A

Hyponatremia, hypertension, and dizziness

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12
Q

There is an increased risk of serotonin syndrome if the SNRI’s are used with what drug?

A

St. John’s Wort

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13
Q

What are the TCA’s?

A 
Amitriptyline (Elavil) 
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortripyline (Pamelor)
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14
Q

What is the mechanism of action of TCA?

A

Stops reuptake of serotonin and norepinephrine

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15
Q

What are the indications of TCAs?

A

Depression, insomnia, diabetic neuropathic pain, incontinence, migraine

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16
Q

Why are TCAs used less often?

A

Because of their severe toxicity in overdose

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17
Q

What are some side effects of TCAs?

A

Anti-cholinergic effects, sedation, weight gain, prolonged QT

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18
Q

What are some signs of overdose with TCAs?

A

Sinus tachycardia, wide complex tachycardia, neuro symptoms

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19
Q

What is the mechanism of action of Bupropion?

A

Stops uptake of dopamine and norepinephrine

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20
Q

What are the indications for Bupropion

A

Depression

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21
Q

What symptoms are less likely to happen with Bupropion than with SSRI’s

A

G.I. distress and sexual dysfunction

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22
Q

What is a contraindication with Bupropion

A

Seizure d/o

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23
Q

What are some Nonselective MAOI’s?

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)

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24
Q

What is the mechanism of action of MAOIs?

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A

Blocks the breakdown of neurotransmitters by inhibiting monoamine oxidase

25
What are the indications for MAOIs?
Refractory depression. Maybe use with some types of affective and anxiety disorders
26
What are the side effects of MAOIs?
Hypertensive crisis (must avoid tyramine containing foods), insomnia, orthostasis, anxiety, weight gain, sexual dysfunction
27
What are some examples of tyramine containing food
Cheese, wine, beer, aged foods, smoked meat, chocolate, coffee, tea
28
What are the contraindications to MAOIs?
``` SSRI= May cause serotonin syndrome TCA= May cause delirium and HTN ```
29
What are some examples of selective MAOB's?
Selegiline ( Eldepryl)
30
What is the benefit of using a selective MAOI instead of a nonselective MAOI?
With selective there is less chance of hypertension crisis induced by tyramine
31
How long should anti-depressants be continued for to determine efficacy?
Minimum 3 to 6 weeks
32
What are some examples of typical antipsychotic meds?
``` Haloperidol (Haldol) Droperidol Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Prochlorperazine (Compazine) Promethazine (Phenergan) ```
33
What is the MOA of typical antipsychotic?
Blocks CNS dopamine receptors
34
What are the indications for first generation antipsychotic meds?
Psychotic disorders such as schizophrenia or psychosis Positive symptoms Emesis
35
What are some side effects of typical first generation antipsychotic meds?
Extrapyramidal sx: rigidity, bradykinesia, tremor, restlessness Neuroleptic Malignant syndrome QT prolongation, cardiac arrhythmias, sedation, increased prolactin, weight gain
36
What are three types of extrapyramidial symptoms?
Dystonic reactions (Dyskinesia) Tardive Dyskinesia Parkinsonism
37
When does a dystonic reaction normally happen and how do you treat it?
Hours – days after initiation of typical antipsychotic | Treat with Dyphenhydramine IV (Benztropine)
38
What are symptoms of dystonic reaction?
Trismus, protrusions of tongue, facial grimacing, difficulty speaking
39
What is tardive dyskinesia?
Repented of involuntary movements mostly involving extremities and face: Lip smacking, teeth grinding, rolling of tongue
40
What is neuroleptic malignant syndrome?
Life-threatening this order due to D2 in addition in basal ganglia
41
What are the symptoms of neuroleptic malignant syndrome?
Extreme muscle rigidity, mental status change, tremor, autonomic instability (tachycardia, tachypnea, hyperthermia/fever)
42
When is Neuroleptic malignant syndrome most common to happen?
Within 90 Days of initiation or after a dose increase
43
What is the treatment for neuroleptic malignant syndrome?
Stop the offending agent Treat hyperthermia was calling blankets and ice to axilla/groin and dantrolene Dopamine agonist: Bromocriptine, Levodopa
44
What are some contra indications/cautions for Haldol?
Parkinson disease and anticoagulant use or severe cardiac disorders
45
Name some atypical or second generation antipsychotic medications?
Clozapine (Clozaril) Quetiapine (Seroquel) Olanzapine (Zyprexa) Loxapine (Loxatane)
46
Are extrapyramidal symptoms more common with typical or atypical antipsychotic agents?
First generation typical antipsychotics
47
What is the MOA of a typical antipsychotic medications?
Blocks CNS dopamine D4 receptors, serotonin
48
What are the indications for a typical antipsychotics?
First line for psychotic disorders | Clozapine useful in patients who have resistance to other psych meds
49
What are the side effects of atypical antipsychotics?
Extrapyramidal symptoms | Mild increase in prolactin levels, hyperglycemia, hyperlipidemia, weekend, and NMS
50
What are some contraindications/cautions with atypical antipsychotic medications?
Diabetes mellitus Clozapine causes agranulocytosis (monitor CBC weekly) Seizures Myocarditis QT prolongation Diabetes and marked weight gain with Olanzapine
51
Name the Benzisoxazoles?
Risperidone (Risperdal) | Ziprasidone (Geodon)
52
What are the side effects of Benzisoxazoles
Increased prolactin, EPS, sedation, weight gain hypotension
53
Name the Quinolinones
Aripiprazole (Abilify)
54
What is the mechanism of action of lithium?
Increase norepinephrine and serotonin receptor sensitivity
55
What are the indications for lithium?
Bipolar disorder and acute mania
56
What are the side effects of lithium
Hypothyroidism, sodium depletion, increased urination and thirst (must drink 8-12 glasses H2O a day), diabetes insipidus, seizures, arrhythmias, hyperparathyroidism, weight gain, tremor
57
What do you need a monitor with lithium?
Narrow therapeutic index; monitor EEG changes
58
What is valproate?
Anticonvulsants may help suppress impulsive and aggressive behavior

Mental Health Medications (4 decks)

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