Psych Flashcards
(19 cards)
SSRI: Paroxetine
-takes up to 4 weeks due to long half-life
-taper off over a few weeks
-treats GAD, anxiety, depression, OCD, panic, trauma
-complications: HA, low libido, insomnia, weight gain, suicidal thoughts, serotonin syndrome
Herbs and supp
St John’s Wort: depression
Kava: insomnia and anxiety
Lavender: anxiety, insomnia, depression
Melatonin: insomnia
Chamomile: anxiety
SSRI: Fluoxetine
-1st line for depression
-1-2 weeks to see effects, 4-6 wks for full
-taper to avoid withdrawal
-sexual dysfunction can be intolerable=report
-neuroleptic malignant syndrome
-serotonin syndrome
SNRI: Venlafaxine
-use: MDD, GAD, social anxiety, panic, pain
-complications: nausea, weight loss, HA, insomnia, anxiety, HTN, neuroleptic malignant syndrome, suicide, serotonin syndrome, dizziness, sexual dysfunction
-taper to avoid withdrawal
Atypical: Bupropion
-MOA: inhibits NE and dopamine
-use: depression, MDD, seasonal affective
-alternative to SSRI and SNRI due to favorable side effects
-aids in smoking cessation and ADHD
-complications: HA, dry mouth, GI distress, constipation, tachycardia, HTN, restlessness, insomnia, seizures, weight loss, n/v
Atypical: Mirtazapine
-serotonin and NE disinhibitory (increase amount)
-sooner effects and less sexual dysfunction unlike SSRI
-sleepy, weight gain, elevated cholesterol may be a concern
Atypical: Trazadone
-moderate selective blockade of serotonin
-causes sedation=take at night
-usually used with another antidepressant
-priapism (long erection), serotonin syndrome, suicide
-no grapefruit juice
TCA: Amitriptyline
-MOA: block reuptake of NE and serotonin
-10-14 days before seeing effects, max=4-8 wks
-use: depression, bipolar depression, others like anxiety
-complications: ortho hypotension, dry mouth, photophobia, urinary retention, constipation, tachycardia
-minimize anticholinergic effects by chewing gum, hard candy, sip water, wear sunglasses, high fiber foods, exercise, increase fluids
-take at night (sedates)
-toxicity: cholinergic blockade and cardiac toxicity (VS, EKG, monitor, report)
-excessive sweating may occur
-OD can be lethal, narrow therapeutic range
MAOI: Phenelzine (Nardil)
-taken with tyramine foods=hypertensive crisis
-takes 2-4 wks
-interacts with everything, last resort med
-use; bulimia, depression, panic, GAD, OCD, PTSD
-complications: CNS stimulation, ortho hypotension, hypertensive crisis
Lithium: mood stablizer
MOA: produces neuro chemical changes in the brain (serotonin receptor blocker) to increase neuro growth
-bipolar med
-Complications: GI distress, fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiters, brady-dysrhythmia, hypotension, electrolyte imbalances
narrow therapeutic range=higher risk for toxicity
-early: 1.5-2: GI and confusion, withhold med to treat
-advanced: 2-2.5: Extreme polyuria, tinnitus, involuntary movement, severe hypotension, whole bowel irrigation to treat
-late: >2.5: Oliguria, seizures, rapid progression coma to death; hemodialysis to treat
Chlorpromazine (Thorazine): antipsychotic 1st gen
-controls positive manifestations (hallucinations, delusions)
-MOA: blocks dopamine, Ach, NE, histamine in brain and peripheral
-use: acute/chronic psych disorders, schizophrenia spectrum disorder, agitation, bipolar, prevent n/v
-EPS: acute dystonia, parkinsonism, akathisia, tardive dyskinesia
-neuroleptic malignant syndrome
-anticholinergic effects, neuroendocrine (like gynecomastia), seizures, sexual dysfunction, liver impairment
-Don’t give to older patients with dementia or Parkinson’s, caution with liver/renal disorder or glaucoma
Risperdal: antipsychotic 2nd gen
-MOA: similar to first gen, more serotonin blocking
Uses: Schizophrenia, psychotic episodes, bipolar, impulse control
-relief of positive and negative symptoms
-fewer to no EPS due to less dopamine blocking, fewer anticholinergic effects
-Watch for galactorrhea (males too!), gynecomastia (males too!), amenorrhea
Methylphenidate, Dexmethylphenidate, Dextroamphetamine: CNS stimulant
MOA: raise dopamine and NE levels
-Uses: ADHD, narcolepsy, obesity
-Complications: CNS stimulation, decreased appetite, weight loss, growth suppression, cardiovascular effects, psychotic manifestations, tolerance and withdrawal, toxicity
-Administration: Instruct on safety and storage of medications, Schedule II drug, ADHD is managed with meds and therapy, high potential for abuse
Bupropion (Wellbutrin), Atomoxetine (Strattera): NE reuptake inhibitors
-MOA: blocks reuptake NE at the synapse (not a stimulant)
-Bupropion: 2nd line drug for ADHD, blocks reuptake of dopamine and NE
-use: ADHD and depression
-Complications: appetite suppression, weight loss, growth suppression, GI effects, SI, hepatotoxicity, seizures
Guanfacine: Alpha2 adrenergic agonists
MOA: Not well understood, activates presynaptic alpha 2 adrenergic receptors within the brain
-use: ADHD, tic disorders, conduct, ODD
-Complications: Sedation, drowsiness, fatigue, hypotension, bradycardia, weight gain
-admin: taper off, sudden stop can cause rebound HTN
Succinylcholine: neuromuscular blockers
-depolarizing
-Bind to cholinergic receptors on the motor end-plate and remain bound preventing the end-plate from repolarizing
-short duration, quick to work (good for short procedures)
-Used as adjuncts to general anesthesia to promote muscle relaxation
Vecuronium: neuromuscular blockers
-non-depolarizing
-blocks Ach=muscle relaxation (paralysis)
-Don’t cross blood brain barrier so complete paralysis is achieved without loss of consciousness or decreased pain sensation
-works longer
-antidote: Neostigmine
-Used as adjuncts to general anesthesia to promote muscle relaxation
Baclofen: muscle relaxants/antispasmodics
-centrally acting
-enhances GABA depressing spasticity of muscles
-Uses: Cerebral Palsy, spinal cord injury, multiple sclerosis
-Complications: Nausea, constipation, urinary retention, seizures
Dantrolene: muscle relaxants/antspasmodics
-peripherally acting
-Works directly on spastic muscle contraction by preventing release of calcium in skeletal muscles
-Uses: Cerebral Palsy, spinal cord injury, multiple sclerosis, malignant hyperthermia
-Complications: Hepatic toxicity and muscle weakness
