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Psych meds Flashcards

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1
Q

What are the antidepressant categories?

A

SSRIs, SNRIs, MAOIs, TCAs, and atypical

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2
Q

How long does it take to start seeing some improvement of symptoms when patients are started on an antidepressant?

A

1-3 weeks

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3
Q

How long does it take for optimal results to peak when patients are started on an antidepressant?

A

12 weeks

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4
Q

When should we begin to titrate/reassess for need for titration when starting a patient on an antidepressant?

A

1 month

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5
Q

What are the 1st line antidepressants?

A

SSRIs, SNRIs, Buproprion, Mirtazapine

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6
Q

What is the black box warning that ALL antidepressants carry?

A

They may increase suicidal thoughts or actions, increased suicide risk

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7
Q

What patient population is at highest risk to the BBW for suicide risk?

A

Patients less then 25 y/o

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8
Q

What is the mechanism of action of the SSRIs?

A

They inhibit the reuptake of serotonin, thus allowing for more in the synaptic space

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9
Q

What are the adverse effects of the SSRIs?

A

nausea, headache, sexual dysfunction, CNS stimulation, weight gain, serotonin syndrome

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10
Q

What are the patient education points for SSRIs?

A

Avoid use with alcohol, avoid OTC medications that can cause CNS depression

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11
Q

What is the pregnancy category for SSRIs?

A

Category C

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12
Q

What are the therapeutic uses for SSRIs?

A

Depression, bipolar disorder, panic disorder, OCD, bulemia

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13
Q

What are the symptoms of serotonin syndrome?

A

shivering, sweating, tachycardia, mydriasis, AMS, delirium, tremors, hyperreflexia, HTN, hyperthermia

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14
Q

What are the two most common SSRIs?

A

Sertaline (Zoloft) and Fluoxetine (Paxil)

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15
Q

What is the mechanism of action of the SNRIs?

A

Inhibit the reuptake of norepinephrine and serotonin, leaving more in the synaptic spaces

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16
Q

What are the adverse effects of the SNRIs?

A

headache, somnelence, dizziness, insomnia, fatigue, dry mouth, orthostatic hypotension, can increase blood glucose levels, anorexia

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17
Q

What are the therapeutic uses for the SNRIs?

A

depression, generalized anxiety disorder, panic disorder, social anxiety

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18
Q

What are the common SNRIs?

A

Duloxetine (Cymbalta) and Venlafaxine (Effexor)

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19
Q

What medications should be avoided with use with the SNRIs?

A

Fluoroquinolones, MAOIs, OTC medications as they can have many interactions depending on the medication

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20
Q

What is the mechanism of action of the TCAs?

A

They act on many neurotransmitters to prevent reuptake

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21
Q

What are the adverse effects of the TCAs?

A

anticholinergic effects (dry mouth, weight gain, dizziness, ortho hypotension, etc), sedation, hypotension, diaphoresis, QT prolongation

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22
Q

What are the TCA’s most commonly used today?

A

Amitryptyline, Nortryptyline, Imipramine

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23
Q

Who are TCAs contraindicated in?

A

Patients with heart disease due to risk of QT prolongation

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24
Q

Why are TCAs falling out of favor?

A

The development of SSRIs and SNRIs

They are easy to overdose on (lethal dose is only 8 times the therapeutic dose)

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25
How should TCAs be stopped?
Need a taper dose, don't abruptly stop
26
What are the therapeutic uses for TCAs?
2nd line treatment normally | depression, bipolar disorder, neuropathy, insomnia, ADD/ADHD, panic disorder, OCD
27
What is the mechanism of action of the MAOIs?
Irreversibly inhibit MAO to prevent norepinephrine, serotonin, and dopamine reuptake
28
What are the adverse effects of the MAOIs?
HTN crisis (very large risk), orthostatic hypotension, insomnia, diarrhea
29
What foods must be avoided with MAOIs?
Tyramine high foods (smoked meats, aged cheese, pickled food, dried fruits, avocados)
30
What are the MAOIs medications?
Phenelzine (Nardil), Marplan, Parnate, Selegline (MAO-B only, dopamine)
31
What are the therapeutic uses of the MAOIs?
Last line | depression (normally atypical depression), panic disorders, Parkinsons (Selegline for dopamine)
32
What is the most commonly used atypical antidepressant?
Bupropion (Wellbutrin)
33
What is the mechanism of action of Bupropion?
It's a stimulant, may block NE and/or dopamine receptors to promote more in the synapses
34
What are the adverse effects of Bupropion?
agitation, headache, constipation, weight loss (off label use), GI upset, tremor, insomnia, blurred vision, tachycardia
35
What are the therapeutic uses of Bupropion?
depression, smoking cessation, weight loss
36
What are the 1st line treatments for GAD?
SSRI, SNRI, Buspar
37
What is the 2nd line treatment for GAD?
Benzos
38
What is the 1st line treatment for panic disorders?
SSRIs
39
What is the 2nd line treatment for panic disorders?
Benzos, SNRIs, TCAs, MAOIs (last line)
40
What is the 1st line treatment for OCD?
SSRIs
41
What is the 2nd line treatment for OCD?
TCAs
42
What is the 1st line treatment for social anxiety?
SSRIs
43
What is the 2nd line treatment for social anxiety?
Benzos, propanolol (low dose)
44
What is the drug therapy for PTSD?
SSRI or SNRI
45
What is the mechanism of action of Buspar?
relieves anxiety by reducing triggers without working on the CNS
46
What are the adverse effects of Buspar?
dizziness, headache, nausea, nervousness, sedation, light-headedness, excitement
47
What is the mechanism of action of the benzos? (-lam or -pam)
potentiate the action of GABA to inhibit the excitatory ability of the neurons to reduce anxiety and resolve insomnia
48
What are the anxiety dose side effects of benzos?
insomnia, excitations, euphoria, heightened anxiety, rage
49
What are the insomnia dose side effects of benzos?
drowsiness, light-headedness, incoordination, amnesia, sleep-behaviors
50
What is the pregnancy category for benzos?
Category D, cannot give in pregnancy
51
What are the fast acting benzos?
Diazepam (Valium) and Temazapam (Restoril)
52
What are the intermediate acting benzos?
Xanax and Ativan
53
What are the long acting benzos?
Clonazepam and Oxazepam
54
What medications are used to treat ADD/ADHD?
CNS stimulants
55
What is the mechanism of action of the amphetamines?
promote the release of NE and dopamine to help promote wakefulness and alertness
56
What are adverse effects of the amphetamines?
euphoria, restlessness, insomnia (prescribe in AM if possible), weight less, tachycardia, HTN, dysrhythmias, paranoia, psychosis
57
What is a concern with the amphetamines?
They are highly abused, often used for illicit use, they chemically change the wiring of the brain, have high physical dependence
58
What are the amphetamine medications?
Vyvanse, Adderall
59
What is the medication trend leaning towards with prescribing for ADD/ADHD treatment?
Moving away from amphetamine use and towards methylphenidate (less addictive)
60
What is the mechanism of action of the methylphenidates?
Promotes NE and dopamine release and prevents reuptake
61
What are the adverse effects of methyphenidate?
insomnia, anorexia, weight loss, emotional lability
62
What the the methylphenidate medications?
Ritalin, focalin, Concerta
63
What are the risks of methylphenidate?
They also carry a high illicit drug use risk, they cause physical dependence
64
What is the scheduling class of amphetamines and mehtyphenidates?
Class 2 controlled substances
65
How can the abuse potential be combated/lowered?
ER tablets, prodrugs (Vyvanse), patches instead of pills
66
What is the medication that is a CNS stimulant, but not amphetamine based?
Strattera
67
What is the mechanism of action of Strattera?
Selectively inhibits NE reuptake to increase NE in the synapses
68
What are the adverse effects of Strattera?
GI upset, anorexia, weight loss, somnolence, growth delay in children, SI in children, mood swings, insomnia, sexual dysfunction, liver failure, HTN, syncope
69
What other non-stimulants are approved for ADD/ADHD treatment?
Guanfacine and Clonidine
70
What adverse effects do Guanfacine and Clonidine carry?
sedation, hypotension, fatigue
71
What is the mechanism of action of the antipsychotic medications?
They block the dopamine receptors to help stabilize mood
72
What is the adverse effects of the antipsychotics?
EPS symptoms (most common in typicals), anticholinergic effects

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