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Flashcards in Pharmacotherapy Deck (63):
1

TCA

inhibit reuptake of NE, 5-HT.
Lethal in overdose, widens QRS (>100ms).
side effects:
1. antihistaminic: sedation
2. antiadrenergic: orthostatic hypotension, tachycardia, arrhythmia
3. antimuscarinic: dry mouth, constipation, urinary retention, blurred vision, tachycardia
4. weight gain
complications: convulsions, coma, cardiotoxicity.

2

Imipramine

aka Tofranil
TCA
side effects: dry mouth, sedation, urinary retention, weight gain, constipation

3

Amitriptyline

aka Elavil
TCA
side effects: dry mouth, sedation, urinary retention, weight gain, constipation

4

Trimipramine

aka Surmontil
TCA
side effects: dry mouth, sedation, urinary retention, weight gain, constipation

5

Nortriptyline

aka Pamelor
TCA
least likely for orthostatic hypotension
side effects: dry mouth, urinary retention, weight gain, constipation

6

Desipramine

aka Norpramin
TCA
least sedating, least anticholinergic side effects
side effects: dry mouth, urinary retention, weight gain, constipation

7

Clomipramine

aka Anafranil
TCA
most serotonin specific
used for OCD
side effects: dry mouth, sedation, urinary retention, weight gain, constipation, seizures

8

Doxepin

aka Sinequan
TCA
side effects: dry mouth, sedation, urinary retention, weight gain, constipation

9

MAOI

irreversibly inhibits MAO-A and MAO-B, increasing amounts of NE, DA, tyramine, 5-HT.
use: refractory depression, refractory panic disorder.
side effects: orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction, serotonin syndrome, hypertensive crisis.

10

Phenelzine

aka Nardil
MAOI
lupus-like syndrome
side effects: weight gain, slowed bowels, shifts in sleep timing, insomnia, hypersomnia, sexual dysfunction, orthostatic hypotension, daytime sleepiness

11

Tranylcypromine

aka Parnate
MAOI
side effects: overstimulation, insomnia, starting HTN then orthostatic hypotension, activating.

12

Isocarboxazid

aka Marplan
MAOI
lupus-like syndrome
side effects: weight gain, slowed bowels, shifts in sleep timing, insomnia, hypersomnia, sexual dysfunction, orthostatic hypotension, daytime sleepiness

13

SSRI

inhibit presynaptic 5-HT pumps, causes increased 5-HT.
use: anxiety disorers, OCD, premenstrual dysphoric disorder.
side effects: sexual dysfunction, GI disturbance, insomnia, headache, anorexia, weight loss, serotonin syndrome (with MAOI)

14

Fluoxetine

aka Prozac
SSRI
longest t1/2.
don't need to taper.
side effects: HA, N, akathisia, weight loss then gain, diarrhea, insomnia, rash, sweating, sexual dysfunction

15

Sertraline

aka Zoloft
SSRI
highest risk GI disturbances
side effects: N, HA, akathisia, diarrhea, sexual dysfunction, sweating

16

Paroxetine

aka Paxil
SSRI
most 5-HT specific
most activating
side effects: sedation, N, HA, akathisia, diarrhea, sexual dysfunction, sweating, withdrawal syndrome, CYP2D6 inhibitor (also metabolizes codeine)

17

Fluvoxamine

aka Luvox
SSRI
use: OCD
side effects: N, insomnia, somnolence, nervousness, sexual dysfunction, sweating, inhibit CYP450 (many drug interactions)

18

Citalopram

aka Celexa
SSRI
side effects: nausea, insomnia, somnolence, sexual dysfunction, sweating

19

Escitalopram

aka Lexapro
SSRI
similar to Citalopram but fewer side effects, more expensive.

20

Venlafaxine

aka Effexor
SNRI
use: refractory depression, CAP.
low drug interaction potential.
can increase BP.
do not use in pts with untreated or labile BP.
side effects: sexual dysfunction, GI disturbances, headaches, insomnia, anorexia, weight loss, serotonin syndrome, HTN

21

Buproprion

aka Wellbutrin
NRI, DRI2
use: smoking cessation, seasonal affective disorder, adult ADHD.
lacks sexual side effects
can exacerbate psychosis.
increased risk of seizures and psychosis at high doses.
don't use in pt with seizure or eating disorders or if on MAOI. Not for those with severe anxiety.
side effects: GI disturbances, insomnia, headache, anorexia, weight loss, seizures, HTN

22

Nefazodone

aka Serzone
SRI, 5-HT2A inhibitor
use: refractory major depression, major depression with anxiety, insomnia.
side effects: nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation, hepatotoxicity

23

Trazodone

aka Desyrel
5-HT2A inhibitor
use: refractory major depression, major depression with anxiety, insomnia.
side effects: nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation, priapism.

24

Mirtazapine

aka Remeron
inhibits alpha5HT receptors
use: refractory major depression.
for those who need to gain weight.
side effects: sedation, weight gain, dizziness, somnolence, tremor, agranulocytosis.
max sedative effect at 15mg.

25

Low Potency Antipsychotics

need higher dose.
more anticholinergic and antihistaminic side effects.

26

Chlorpromazine

aka Thorazine
Low potency typical antipsychotic
deposits in lens and cornea
sedating, orthostatic hypotension, cholestatic jaundice, seizures

27

Thioridazine

aka Mellaril
low potency typical antipsychotic.
irreversible retinal pigmentation (retinitis pigmentosa), prolonged QT, retrograde ejaculation

28

High Potency Antipsychotic

need lower dose.
higher incidence of EPSE and NMS

29

Traditional Antipsychotic Side Effects

1. Anti-DA.
EPSE: parkinsonism, akathisia, dystonia.
hyperprolactinemia
2. anti-HAM
antihistaminic: sedation
anti-alpha adrenergic: orthostatic hypotension, cardiac abnormalities, sexual dysfunction.
anti-muscarinic: dry mouth, tachycardia, urinary retention, blurry vision, constipation.
3. weight gain
4. elevated LFTs, jaundice
5. eye problems
6. rashes, photosensitivity
7. seizures
8. tardive dyskinesia
9. NMS

30

Fluphenazine

aka Prolixin
typical antipsychotic
side effects: EPS

31

Trifluoperazine

aka Stelazine
typical antipsychotic
side effects: some EPS

32

Pimozide

aka Orap
typical antipsychotic
side effects: EPS, prolonged QT

33

Thiothixene

aka Navane
typical antipsychotic
side effects: mild

34

Loxapine

aka Loxitane
typical antipsychotic

35

Molindone

aka Moban
typical antipsychotic

36

Aripiprazole

aka Abilify
atypical antipsychotic

37

Clozapine

aka Clozaril
atypical antispychotic
side effects: sedating, orthostatic hypotension, anticholinergic SE, prodiabetic, agranulocytosis, seizures

38

Olanzapine

aka Zyprexa
atypical antipsychotic
side effects: prodiabetic

39

Palperidone

aka Invega
atypical antipsychotic

40

Quetiapine

aka Seroquel
atypical antipsychotic

41

Risperidone

aka Risperdal
atypical antipsychotic

42

Ziprasidone

aka Geodon
atypical antipsychotic
side effects: prolonged QT

43

Duloxetine

aka Cymbalta
SNRI
side effects: N*, sexual dysfunction, HTN
renally excreted.

44

Selegiline

aka Emsam
MAOI
side effects: may irritate skin as patch, need dietary restrictions

45

Lithium

mood stabilizer
use: bipolar, aggression, suicidality, refractory depression
renally excreted, must test renal function.
serum level between 0.7-1.2
side effects: N, diarrhea, tremor, acne, polyuria, induced diabetes insipidus,
toxicity: ataxia, myoclonus, mental confusion, N/V, diarrhea, delirium, coma, death

46

Divalproex

anticonvulsant
use: refractory mania, rapid cycling bipolar, severe mood instability, intermittent explosive disorder
side effects: hepatotoxicity, bone marrow toxicity (bad platelet function), N, weight gain, incoordination, confusion

47

Carbamazepine

anticonvulsant
use: refractory mania, rapid cycling bipolar, severe mood instability, intermittent explosive disorder
need blood level monitoring
side effects: hepatotoxicity, bone marrow toxicity, agranulocytosis, dry mouth, constipation
toxicity: ataxia, diplopia

48

Lamotrigine

anticonvulsant
use: bipolar depression
side effect: skin rash, HA, N, dizziness, ataxia, somnolence, diplopia, blurred vision, Steven-Johnson syndrome

49

Alprazolam

aka Xanax
fast benzo
side effects: sedation, incoordination, confusion, dependence

50

Chlordiazepoxide

aka Librium
intermediate benzo
side effects: sedation, incoordination, confusion, dependence

51

Clonazepam

aka Klonopin
fast benzo
side effects: sedation, incoordination, confusion, dependence

52

Clorazepate

aka Tranxene
intermediate benzo
side effects: sedation, incoordination, confusion, dependence

53

Lorazepam

aka Ativan
fast benzo
side effects: sedation, incoordination, confusion, addiction

54

Diazepam

benzo
side effects: sedation, incoordination, confusion, dependence

55

Estazolam

aka ProSom
fast benzo
side effects: sedation, incoordination, confusion, dependence

56

Flurazepam

aka Dalmane
fast benzo
side effects: dizziness, daytime drowsiness, ataxia, HA, heartburn

57

Quazepam

aka Doral
fast benzo
side effects: daytime drowsiness, HA, fatigue, dizziness
long half life

58

Temazepam

aka Restoril
slow benzo
side effects: daytime drowsiness, HA, fatigue, dizziness

59

Triazolam

aka Halcion
fast benzo
side effects: daytime drowsiness, HA, fatigue, dizziness, anterograde amnesia

60

Buspirone

aka BuSpar
5-HT1A partial agonist
non-addictive
side effects: dizziness, HA, N

61

Eszopiclone

aka Lunesta
side effects: dysgeusia, HA, daytime drowsiness, dry mouth, dizziness, heartburn

62

Zolpidem

aka Ambien
BZ1 receptor binding
side effects: drowsiness, dizziness, diarrhea, anterograde amnesia

63

Buprenorphine

mu-receptor partial agonist
causes opiate withdrawal