Psychiatric Medications

Question 1

Common SSRI side effects

Answer 1

Low incidence of SE overall. Most common is sexual dysfunction (GI upset, headache less common).

Question 2

Fluoxetine (advantages and disadvantages)

Answer 2

Prozac
Relatively activating, extremely long half-life so good for patients with variable compliance. No need to taper.

Dirtiest of SSRIs, has the most side effects, sexual dysfunction common. Activating properties can worsen anxiety.

Question 3

Paroxetine (advantages and disadvantages)

Answer 3

Paxil
Relatively sedating, used in anxiety disorders.

Short half-life. Can’t miss doses otherwise discontinuation syndrome can occur.

Question 4

Sertraline

Answer 4

Zoloft
Few drug-drug interactions, can be used in medically ill, elderly, anxiety disorders.

Can cause GI upset, especially when starting. Relatively short half-life so can cause discontinuation syndrome

Question 5

Citalopram

Answer 5

Celexa
Few drug-drug interactions, very low incidence of side effects.

Dose limited to 40 in adults, 20mg in geri patients due to possible QTc prolongation

Question 6

Escitalopram

Answer 6

Lexapro

Good drug, doesn’t prolong QTc

Question 7

Fluvoxamine

Answer 7

Luvox (NOT USED IN DEPRESSION)
Used in OCD and social anxiety disorder.

BID dosing, very short half-life.

Question 8

SNRI common side effects

Answer 8

Sexual side effects, GI upset, slightly more activating

Question 9

Venlafaxine

Answer 9

Effexor
Helps with depression and chronic pain

Contraindicated in patients with poorly controlled HTN, very short half-life and can cause withdrawal.

Question 10

Duloxetine

Answer 10

Cymbalta
Helps with depression and chronic pain.

Very short half-life. Can cause nausea.

Question 11

Buproprion

Answer 11

Wellbutrin
Inhibits NE and DA reuptake
No sexual side effects
Activating, helpful in smoking cessation

Can worsen anxiety, lowers seizure threshold: contraindicated in epileptics and eating disorders

Question 12

Mirtazapine

Answer 12

Remeron
A2 antagonism with 5HT antagonism.

Causes appetite stimulation and sedation at low doses.

Can lead to weight gain.

Question 13

MAOIs Side effects

Answer 13

Common: GI distress, orthostatic hypotensions, sleep disturbance, dry mouth, headache.

Dangerous: Serotonin syndrome (flushing, diaphoresis, myoclonus, cardiovascular collapse), and hypertensive crisis

Question 14

Phenelzine

Answer 14

Nardil. MAOI

Question 15

Tranylcypromine

Answer 15

Parnate, has amphetamine-like properties. MAOI

Question 16

Isocarboxazid

Answer 16

Marplan. MAOI

Question 17

Selegiline

Answer 17

used in PD, transdermal form available. MAOI

Question 18

Tricyclic Antidepressants side effects

Answer 18

Anti HAM 
(sedation, orthostatic hypotension, tachycardia, arrhythmias, dry mouth, constipation, urinary retension, blurred vision)

Dangerous: Lethal in overdose, can lengthen QT causing torsades

Question 19

How to treat TCA overdose

Answer 19

Sodium bicarb and magnesion.

Can cause torsades.

Question 20

Nortriptyline

Answer 20

Pamelor

Least likely to cause orthostatic hypotension.

Question 21

Desipramine

Answer 21

Norpramin

Least sedating, least likely to cause anticholinergic side effects too

Question 22

Clomipramine

Answer 22

Anafranil
Used to treat OCD.

Most specific for 5HT

Question 23

How do TCAs work? What are they used to treat?

Answer 23

By inhibiting reuptake of 5HT and NE.

Treat depression, OCD, headaches (imipramine).

Question 24

Valproate

Answer 24

Depakote. Used as a mood stabilizer. Can cause sedation, weight gain, alopecia, pancreatitis, hepatotoxicity, thrombocytopenia.

Can cause nystagmus.