Psych Flashcards
(47 cards)
DSM-5 (depression): M SIG E CAPS
Mood
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal ideation
drugs that can cause or worsen depression
ADHD meds: atomoxetine (strattera)
indomethacin
NNRTIs: Efavirenz (in Atripla) and Rilpivirine (in Complera, Odefsey)
BB (especially propranolol)
OCs and anabolic steroids
antidepressants, benzos, steroids, interferons, chantix, alcohol
natural products
st johns wort, SAMe, valerian rool or 5-HTP
SSRIs
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
-do not use with MAOi or linezolid
-citalopram/escitalopram risk of QT prolongation do not use more than 20 mg/day (citalopram) and 10 mg/day (escitalopram) in elderly
-risk of SIADH/hyponatremia, bleeding
-most activating: fluoxetine
-most sedating: paroxetine
-zoloft preferred in patients with cardiac risk
SNRIs
Venlafaxine (Effexor XR)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)
-do not use with MAOis
-same as SSRIs with risks
-increased HR and dilated pupils, dry mouth, excessive sweating and constipation, increased BP
TCAs: Tertiary amines
amitriptylline (Elavil) and doxepin
TCAs: secondary amines
nortriptyline (Pamelor)
TCAs safety
-do not use with MAOis, linezolid, or methylene blue
-QT prolongation with OD, can cause fatal arrhythmias
-orthostasis
-anticholinergic side effects: dry mouth, blurred vision, urinary retention, constipation; tertiary amines have increased anticholinergic effects
dopamine and NR reuptake inhibitor
Bupropion (Wellbutrin SR, Xl)
-Zyban for smoking cessation
-do not exceed 450 mg/day due to seizure risk
-do not use in those with seizure disorder, hx of anorexia/bulimia, MAOi/linezolid/methylene blue
-dry mouth, tremors/seziures, weight loss
MAOi’s
Isocarboxazid (Marplan), Phenzine (Nardill), Tranylcypromine (Parnate)
-DDI and DFI (tyramine rich foods) - can be fatal
-hypertensive crisis or serotonin syndrome
avoiding serotonin syndrome
-2 week wash out period is required between MAOis and SSRIs, SNRIs, TCAs, and bupropion
-5 week wash out period is required when changing from fluoxetine to MAOi due to fluoxetines half life
tetracyclic antidepressant
mirtazapine (Remeron)
-helps with sleep and appetite stimualtio
Trazodone
used for sleep
-risk of priaprism
depression in preganacy
-do not use paroxetine
-mild-moderate psychotherapy is first line
-severe depression: citalopram, escitalopram, fluoxetine, sertraline first line
most sedating antidepressants
paroxetine, mirtazapine, trazodone
most activating antidepressants
fluoxetine and buproprion
adjunct therapies for treatment-resistant depression
aripiprazole (abilify) and Quetiapine (Seroquel)
-boxed warning for elderly patients with dementia-related psychosis
-olanzapine/fluoxetine do not use and do not use with MAOis, linezolid, or methylene blue
-aripirazole: anxiety, insomnia, akathisia
-olanzapine: sedation, weight gain, increase lipids and glucose
-quetiapine: sedation, orthostasis, weight gain, lipids, glucose
medications/recreational drugs that can cause psychotic symptoms
anticholinergics, dextromethorphan, dopamine or dopamine agonists, interferons, stimulants, systemic steroids, bath salts, cannabis, cocaine, LSD, methamphetamine, PCP
1st gen antipsychotics
low potency: chlorpromazine, thioridazine
high potency: haloperidol (haldol)
-dementia related psychosis
-QT prolongations, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, NMS
2nd gen antipsychotics
Abilify, clozapine, latuda, zyprexa, invega, Seroquel, risperdal, geodon
Aripiprazole (Abilify)
oral, injection
-akathisia, activing
Clozapine (Clozaril)
-3rd line agent due to side effects
-neutropenia/agranulocytosis
-myocarditis and cardiomyopathy
-seziures
-REMS
-ANC must be > 1500
Lurasidone (latuda)
somnolence, EPS, nausea
-risk of metabolic syndrome
Paliperidone (Invega)
increased prolactin
-EPS
-metabolic syndrome
