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Psychiatric medications Flashcards

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1
Q

HAM side effects

A
  • anitHistamine-sedation, weight gain;
  • antiAdrenergic-hypotension
  • antiMuscarinic-dry mouth, blurred vision, urinary retention
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2
Q

Which drugs show HAM side effects

A

TCAs and Low potency antipsychotics

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3
Q

Serotonin Syndrome

A

Confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure and death. Wait 2 weeks before switching from SSRI to MAOI; 5-6 with fluoxitine.

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4
Q

EPS-extrapyramidal side effects

A

Parkonsinism, Akathisia, Dystonia

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5
Q

Hypertensive Crisis

A

Caused by buildup of stored catecholamines. MAOIs plus foods with tyrramine (red wine, cheese, chicken liver and cured meats, fava beans.) or plus sympathetomimetics

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6
Q

Hyperprolactinemia

A

Caused by dopamine blockade of tuberoinfundibular tract. Caused by high-potency traditional anti-psychotics

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7
Q

Tardive Dyskinesia

A

Choreathetoid muscle movements, usually of mouth and tongue.

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8
Q

Parkinsomism

A

Mask facies, cogwheel rigidity, resting tremor and

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9
Q

Akathisia

A

Restlessness and agitation

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10
Q

Dystonia

A

sustainded contraction of muscles of neck, tongue, eyes and diaphragm

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11
Q

NMS-neuroleptic Malignant Syndrome

A

Fever, tachycardia, hypertension, tremor, elevated creatine phosphokinase(CPK), ‘lead pipe’ rigidity

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12
Q

CYP450 Inducers

A

Decrease Drug Levels: Smoking, Carbamazepine, Barbiturates, St. Johns wort,

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13
Q

CYP450 Inhibitors

A

Drug levels increase: SSRIs: Fluvoxamine, Fluoxetine, Paroxitine, Duloxetine, Sertraline

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14
Q

Antidepressant withdrawal phenomenon

A

Dizziness, headaches, nausea, insomnia, malaise

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15
Q

Fluoxetine

A 
Prozac
Longest half life-no need to taper
Safe in pregnancy and children
More common sleep changes and anxiety
Can elevate levels of neuroleptics
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16
Q

Sertraline

A

Zoloft
Highest risk for GI disturbance
Very few drug interactions
More common sleep changes

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17
Q

Paroxitine

A

Paxil
Highly protein bound-several drug interactions
More anticholinergic effects: sedation, constipation, weight gain
Short half-life withdrawal phenomena

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18
Q

Fluvoxamine

A

Luvox
Approved only for OCD
Nausea and vomiting more common
Lots of drug interactions

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19
Q

Citalopram

A

Celexa
Fewest drug-drug interactions
Possibly fewer sexual side effects

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20
Q

Escitalopram

A

Lexapro

Similar but more expensive than Celexa

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21
Q

SSRI side effects

A

Sexual dysfunction, GI disturbance, Insomnia, Headache, Anorexia-weight loss, Restlessness, Seizures(0.2%), ‘Increases suicidal thinking.’ Serotonin syndrome
Can increase levels of warfarin

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22
Q

Venlafaxine

A 
Effexor (SNRI)
Uses-GAD, Depression, ADHD.
Low drug interaction profile
Can increase BP
Desvenlafaxine(Pristiq)-expensive metabolite
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23
Q

Duloxetine

A

Cymbalta (SNRI)
Depression and Neuropathic Pain, Fybromyalgia
More Dry mouth and constipation 2/2 norepi effects

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24
Q

Buproprion

A

Wellbutrin (NDRI)
Lack of sexual side effects compared to SSRIs
May help in ADHD
Can increase risk of seizures and psychosis in high doses. Increases anxiety in some.
Contraidicated in patients with seizure or actibe eating disorders and those on MAOIs

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25
Trazodone and Nefazodone
Desyrel and Serzone Refractory major depression, MDD+anxiety, insomnia No sexual side effects, do not effect REM sleep
26
Trazodone side effects
Nausea, dizziness, orthostatic hyptension, cardiac arrhythmias, sedation and priapism Liver Failure-rare but serious
27
Mirtazapine
Remerone alpha 2 andtagonist Refractory Major depression, especially in patients who need to gain weight. Side Effects: sedation, weight gain, dizziness, somnolence, tremor, dry mouth, constipation and rare agranulocytosis
28
TCA-Tertiary amines
TCA which are highly anticholinergic, more sedating, and greater lethality in OD. Amitriptyline, Imipramine, Clomipramine, Doxepin
29
TCA-Secondary amines
less anticholinergic, less sedating: Nortriptyline, Desipramine
30
Amitriptyline
Elavil-chronic pain, Migraines and insomnia
31
Imipramine
Tofranil- Has IM form Useful in enuresis and panic disorder
32
Clomipramine
Anafranil Most serotonin specific Useful in OCD
33
Doxepin
Sinequan Useful in treating chronic pain Emerging use as sleep aid in low doses
34
Nortriptyline
Pamelor, Aventyl Least likely to cause orthostatic hypotension Useful therapeutic blood levels Useful in treating chronic pain
35
Desipramine
Norpramin More activating; least sedating Least anticholinergic
36
Tetracyclic Antidepressants
Amoxapine, Maprotiline
37
Amoxapine
Asendin Metabolite of antipsychotic loxapine May cause EPS with side effects similar to antipsychotics
38
Maprotiline
Ludiomil | Higher rates of seizure, arrhythmia, and fatality on OD
39
Major Complications of TCAs
Cardiotoxicity, Coma, Convulsions
40
Side effects of TCAs
Sedation(H1), Orthostatic Hypotension(alpha1), dizziness, reflex tachycardia, arrhythmias and ECG changes(widened QRS, QT and PR), M receptors-dry mouth, constipation, urinary retention, blurred vision, tachycardia, exacerbation of narrow angle glaucoma Weight gain, OD, Seizures, Serotonergic effects: Erectile/ejaculatory dysfunction in males and anorgasmia in females
41
TCA OD
Agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures and coma
42
MAOIs
Prevent inactivation of biogenic amines: norepinephrine, serotonin, dopamine and tyramine. MAO-A prefers to deactivate serotonin MAO-B prefers to deactivate Nor and epinephrine both act on dopamine and tyramine
43
MAOI Examples and Uses
Phenelzine(Nardil) Tranylcypromine(Parnate) Isocarboxazide(Marplan) Uses for refractory depression and refractory panic/anxiety disorder
44
MAOI side effects
Serotonin syndrome, Hypertensive Crisis, Orthostatic hypotension(most common), Drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction, People with B6 deficiency can have parathesias
45
AntiDep for OCD
SSRIs in high doses and TCAs clomipramine
46
AntiDep for Panic Disorder treatment
SSRI, TCA(imipramine), MAOI
47
AntiDep for eating disorder
SSRI in high dose, TCAs and MAOIs
48
AntiDep for dysthymia
SSRI
49
AntiDep for Social Phobia
SSRI, TCAs and MAOIs
50
AntiDep for GAD
SSRIs, SNRIs(venlafaxine), TCAs
51
AntiDep for PTSD
SSRIs
52
AntiDep for Irritible bowel syndrome
SSRIs, TCAs
53
AntiDep for Enuresis
TCAs-imipramine
54
AntiDep for Neuropathic Pain
TCAs-amitriptyline and nortriptyline, duloxetine
55
AntiDep for chronic pain
SSRIs, TCAs
56
AntiDep for fibromyalgia
SSRIs
57
AntiDep for Migraine Headaches
TCAs (amytriptyline), SSRIs
58
AntiDep for Smoking Cessation
Buproprion
59
AntiDep for Premenstrual Dysphoric Disorder
SSRIs
60
AntiDep for Depressive phase of manic depression
SSRIs
61
AntiDep for Insomnia
Mirtazipine, TCAs (amytriptyline)
62
AntiDep for Depression in Elderly
Mirtazipine-helps with sleep and appetite
63
Treatment for TCA OD
IV sodium bicarb
64
Atypical Depression treated better by MAOIs
Hypersomnia, increases appetite and increases sensitivity to social rejection.
65
Serotonin Syndrome-First Steps of Treatment
d/c meds. try Ca channel blockers(nifedipine), If carefully monitored try chorpromazine or phentolamine.
66
Lamotrigine Drug Interactions
- Oral contraceptives lower Lamotrigine levels - Lamotrigine lowers contraceptive levels - Valproic acid increases Lamotrigine levels
67
ECG changes with Lithium
- T-wave depression or inversion - First degree AV block and sinus node dysfunction - ECG changes prevalence is 30%
68
Lithium and HCTZ interaction
HCTZ increase lithium levels Other diuretics which can increase Li levels: ethacrynic acid, spironolactone, triamterine NSAID (except aspirin and suldinac Abx: metronidazole and tetracycline
69
Anti-psychotics available as long acting injectibles
- Haloperidol - fluphenazine - Risperidone - Paliperidone
70
Low-Potency Typical Anti-Psychotics
-Chlorpromazine -Thioridazine Higher incidence of anti-cholinergic and anti-histaminergic and lower EPS and NMS.
71
Mid-Potency Typical Antipsychotics
- Loxapine - Thiothixene - Trifluoperazine - Perphenazine
72
High-Potency Typical Antipsychotics
-Haloperidol -Fluphenazine -Pimozide Less anti-cholinergic but more EPS and Tardive Dyskinesia. Less sedation and orthostatic hypotension
73
Chlorpromazine
``` Thorazine Commonly causes orthostatic hypotension Can cause a bluish skin discoloration Can lead to photosensitivity Can treat nausea and vomiting, as well as intractable hiccups ```
74
Thioridazine
Mellaril | Associated with retinitis pigmentosa
75
Loxapine
Loxitane Mid-Potency Typical Antipsychotics Higher risk of seizure Metabolite is an antidepressant
76
Thiothixene
Navane Mid-Potency Typical Antipsychotics Can cause ocular pigment changes
77
Trifluoperazine
Stelazine Mid-Potency Typical Antipsychotics Can reduce anxiety
78
Perphenazine
Trilafon | Mid-Potency Typical Antipsychotics
79
Haloperidol
Haldol High-Potency Typical Antipsychotics Decanoate form available
80
Fluphenazine
Prolixin High-Potency Typical Antipsychotics Decanoate form available
81
Pimozide
Orap High-Potency Typical Antipsychotics Associated with heart block, v-tach and other cardiac affects
82
Treatment of NMS
- Discontinue current meds - Administer hydration and cooling - Dantrolene, bromocriptine and amantadine are infrequently used
83
Clozapine
Clozaril More efficacious-used in resistant psychosis 2% chance of Agranulocytosis and 5% seizures More anticholinergic side effects Can cause tachycardia and hypersalivation
84
Risperdone
Risperdal Can increase prolactin Some orthostatic hypertension and reflex tachycardia Long acting inject-able form called Consta
85
Quietapine
Seroquel | Sedation and orthostatic hypotension
86
Olanzapine
Zyprexa | Common side effect is weight gain
87
Ziprasidone
Geodon | Less likely to cause weight gain
88
Aripiprazole
Abilify Unique mechanism of partial D2 agonism Can be more activating (akathisia) and less sedating Less potential for weight gain
89
Paliperidone
Invega(Metabolite of risperidone) Long acting injectable form New Atypical Antipsychotic
90
Asenapine
Saphris | New Atypical Antipsychotic
91
Iloperidone
Fanept | New Atypical Antipsychotic
92
Lithium
- Uses: Bipolar, schizoaffective, cyclothymia and MDD. - Metabolized by kidneys so decreased doses for higher creatinine levels - ECG, electrolytes, TSH, CBC and BhCG before starting - therapeutic range is 0.6-1.2
93
Lithium side-effects
``` Nephrogenic DI GI disturbance Weight gain Sedation Thyroid enlargement, hypothyroidism ECG changes Benign leukocytosis Tricuspid Malformation(Ebstein's Anomaly ```
94
Carbamazepine
Tegretol - Useful for mixed episodes and rapid-cycling bipolar disorder, and less for depressed phase - trigeminal neuralgia - blocks sodium channels and inhibits APs - CBC and LFTs needed before initiation
95
Carbamazepine side effects
GI and CNS (drowsiness, ataxia, sedation and confusion
96
Hypertensive crisis can be caused by meperidine and which class of psychotropic medications?
MAOIS

Psychiatry (2 decks)

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