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Integrative Psychopharmacology > Psychopharmacology for the Naturopath > Flashcards

Psychopharmacology for the Naturopath Flashcards

1
Q

SSRI - Uses

A

FDA-approved

  • Major Depressive Disorder
  • Generalized Anxiety Disorder
  • Obsessive Compulsive Disorder
  • Panic Disorder
  • Social Anxiety
  • PMDD
  • PTSD

Non-FDA-approved
- Sexual compulsions/aggression

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2
Q

SSRIs

A
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)
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3
Q

SSRIs - MOA

A
  • Increase 5HT by inhibiting the function of SERT
  • Increased 5HT causes 5HT1a receptors to downregulate
  • Serotonergic neurons become uninhibited
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4
Q

SSRIs - side effects

A
  • Sexual dysfunction
  • Akathisia
  • CYP450 interactions
  • Hyperhydrosis
  • Insomnia or sedation
  • B12 depletion
  • Serotonin syndrome
  • Platelet dysfunction (if also taking NSAIDs)
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5
Q

SSRIs - CYP450 interactions

A

Least to Most

  • Escitalopram
  • Citalopram
  • Sertraline
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
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6
Q

SSRIs - efficacy for MDD

A

Best to Worst

  • Escitalopram
  • Citalopram
  • Sertraline/fluoxetine/paroxetine
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7
Q

SSRIs - withdrawal syndrome

A

Least to Most

  • Fluoxetine
  • Escitalopram
  • Citalopram
  • Sertraline
  • Paroxetine
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8
Q

SSRIs - activation

A

Least to Most

  • Sertraline
  • Escitalopram
  • Citalopram
  • Paroxetine
  • Fluoxetine
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9
Q

SSRIs - sedation

A

Least to Most

  • Fluoxetine/sertraline/escitalopram
  • Citalopram
  • Paroxetine
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10
Q

Fluoxetine - trade name

A
  • Prozac
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11
Q

Fluoxetine

A
  • 1st introduced SSRI
  • Longest half life
    > Fewest discontinuation problems, but also slowest onset of action
  • Activating
  • Can use it to taper other drugs down
  • Takes about 21 days to feel a difference
  • Only SSRI FDA-approved for kids/adolescents
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12
Q

Paroxetine - trade name

A
  • Paxil
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13
Q

Paroxetine

A
  • Significant teratogen (only SSRI that is)
  • Significant CYP interactions
  • Likely to cause activation or over-sedation
  • Do not use! Suggest patients switch if they’re on it
  • Main good use is to decrease sexual thoughts/aggressions
  • Causes a lot of side effects
  • Patients might feel so fatigued that they think there’s a medical problem as well
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14
Q

Sertraline - trade name

A
  • Zoloft
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15
Q

Sertraline

A
  • Largest dosing window (50mg - 200mg
    > Best for anxiety (use larger doses of SSRIs when treating anxiety)
  • Commonly causes insomnia and stomach issues (usually resolve within two weeks)
  • Go-to for anxiety!
  • Less activating than others
  • Might cause bruxism
  • Go-to for PTSD with both anxiety and MDD
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16
Q

Citalopram - trade name

A
  • Celexa
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17
Q

Citalopram

A
  • Often causes drowsiness
  • Significant QTc prolongation
    > If taking >30 mg, do regular EKGs
    > More significant with co-morbidities (Hep C, diabetes, etc.)
  • Causes fewer other side effects
  • Less sexual dysfunction than other SSRIs
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18
Q

Escitalopram - trade name and notes

A
  • Lexapro
  • Cleaner isomer of citalopram
  • Use 1/2 the dose of escitalopram (eg. 20mg of citalopram = 10mg of escitalopram)
  • Fewer side effects
  • Great efficacy
  • May cause bruxism
  • Go-to for depression!
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19
Q

Fluvoxamine - trade name

A
  • Luvox
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20
Q

Fluvoxamine

A
  • Rarely seen in US
    > Prescribed commonly in Europe
  • Only FDA approval is for OCD
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21
Q

Poop out syndrome

A
  • Patient has good response to SSRI for a while (can be years), but gradually it stops working
  • Can switch to a different SSRI and it will likely work
  • Can discontinue the original SSRI for 6 months and then it will work again after the break
    > Each subsequent use of the original SSRI will last for a shorter time before it poops out again
  • Happens pretty commonly
    > Especially when another life stressor occurs
  • Tachyphylaxis is technical name for when a drug causes a great response at first, but then stops working quickly
    > Poop out syndrome is only kinda-sorta the same since it’s a longer process
  • When true tachyphylaxis occurs with an SSRI, it’s a red flag for bipolar disorder (because they likely just need a mood stabilizer)
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22
Q

PTSD

A
  • Evidence for SSRIs in PTSD is pretty poor, though SSRIs can be helpful for PTSD patients
  • Significant evidence shows that SSRIs increase hippocampal volume in patients with PTSD by increasing BDNF
  • Rare to see a patient with PTSD without another mood disorder, especially depression
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23
Q

Contraindications to SSRIs

A
  • Past sensitivity to drug class
  • Concurrent significant NSAID use (platelet dysfunction)
  • History of long QTc syndrome
  • Concurrent use of other QTc prolonging diagnoses or agents
  • Concurrent tramadol use (for seizures)
  • Bipolar disorder
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24
Q

Contraindications for the ND

A
  • Hypericum
  • 5HTP
  • Yohimbe
  • L-tryptophan
  • Melatonin (may neutralize the intended enzymatic activity of the SSRI)
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25
Q

Depletions for the ND

A
  • Melatonin?
    > Some suggest supplementing with 1-3mg before bed
    > Luvox appears to actually increase melatonin
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26
Q

How to stop SSRIs

A
  • Very, very slowly
  • Can replace others with very low dose Prozac to help with titration (because of its long half life)
  • Can use other serotonergic support (5HTP, etc.)
  • Make sure to differentiate between relapse and withdrawal symptoms
    > Look for dizziness, sensitivity, suicidality
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27
Q

Buproprion - trade name

A
  • Wellbutrin
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28
Q

Buproprion - FDA approvals

A
  • MDD
  • ADHD
  • Smoking cessation
  • Commonly prescribed along with SSRIs
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29
Q

Buproprion - formulation types

A
  • Regular (dose TID 5 hours apart)
  • Sustained Release (SR) (dose BID 3-4 hours apart morning and noonish)
  • Extended Release (XL) (dose QD)
  • SR often for smoking cessation and ADHD
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30
Q

Buproprion - MOA

A
  • Inhibition of NE and dopamine reuptake
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31
Q

Buproprion - side effects

A
  • Anxiety
  • Sleep disturbance
  • Jaw tightening
  • Hypertension
  • Lowers the seizure threshold (esp Regular and SR - must take it as prescribed)
  • Can be very stimulating in the first few days, but then evens out
    > Decreased sleep and appetite
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32
Q

Buproprion - interactions

A
  • MAOIs
  • Tramadol
    > Also lowers the seizure threshold
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33
Q

Buproprion - contraindications

A
  • History of seizure disorder
  • History of eating disorders
    > Brings back ED behaviors, even if they’ve been gone for years
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34
Q

SNRIs

A

Selective Serotonin and Norepinephrine Reuptake Inhibitors

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Desvenlafaxine (Pristiq)
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35
Q

SNRIs - FDA approved for

A
  • MDD
  • Chronic Anxiety Disorder
  • Panic Disorder
  • Social Anxiety Disorder
  • Chronic musculoskeletal pain**
  • Fibromyalgia**

**Cymbalta only

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36
Q

SNRIs - MOA

A
  • Serotonin and NE reuptake inhibition
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37
Q

SNRIs - side effects

A

Same as SSRIs

  • Sexual dysfunction
  • Akathisia
  • CYP450 interactions (fewer than SSRIs)
  • Hyperhydrosis
  • Insomnia or sedation
  • B12 depletion
  • Serotonin syndrome
  • Platelet dysfunction (if also taking NSAIDs)
  • Hypertension
  • Elevated hepatic enzymes
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38
Q

SNRIs - interactions

A

Same as SSRIs

  • Hypericum
  • 5HTP
  • Yohimbe
  • L-tryptophan
  • Melatonin (may neutralize the intended enzymatic activity of the SSRI)
  • Past sensitivity to drug class
  • Concurrent significant NSAID use (platelet dysfunction)
  • History of long QTc syndrome
  • Concurrent use of other QTc prolonging diagnoses or agents
  • Concurrent tramadol use (for seizures)
  • Bipolar disorder
  • Caution with L-tyrosine
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39
Q

SNRIs - contraindications

A
  • Glaucoma
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40
Q

Venlafaxine - trade name

A
  • Effexor
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41
Q

Duloxetine - trade name

A
  • Cymbalta
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42
Q

Desvenlafaxine - trade name

A
  • Pristiq
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43
Q

Venlafaxine

A
  • Very bad withdrawal symptoms
    > Use Prozac to taper off
  • Similar to Paxil in that it doesn’t get used as often anymore
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44
Q

Duloxetine

A
  • Better for pain than for mood
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45
Q

Desvenlafaxine

A
  • Nicer version of Effexor
  • Useful for patients who haven’t had good responses to SSRIs, or patients who are drowsy/needing more energy
  • Becoming cheaper and more commonly prescribed
  • Commonly used for patients with a history of opiate addiction
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46
Q

Tricyclic antidepressants

A
  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil)
  • Doxepin (Sinequan)
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47
Q

TCAs - MOA

A
  • Block serotonin transporter (SERT) and NE transporter (NET)
    > Block reuptake for 5HT and NE
  • Increase concentrations in synaptic space
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48
Q

TCAs - side effects

A
  • Prolonged QTc
  • Antimuscarinic effects
    > Dry mouth
    > Urinary retention
    > Dry eyes
    > Constipation
  • Sexual dysfunction
  • Akasthisia (rarely)
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49
Q

TCAs - interactions

A

Same as SSRIs

  • Hypericum
  • 5HTP
  • Yohimbe
  • L-tryptophan
  • Melatonin (may neutralize the intended enzymatic activity of the SSRI)
  • Past sensitivity to drug class
  • Concurrent significant NSAID use (platelet dysfunction)
  • History of long QTc syndrome
  • Concurrent use of other QTc prolonging diagnoses or agents
  • Concurrent tramadol use (for seizures)
  • Bipolar disorder
  • SAMe (accelerates the onset of action of TCAs)
  • More CYP interactions than SSRIs
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50
Q

TCAs - contraindications

A
  • Suicidality (TCAs are lethal at low doses)
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51
Q

Clomipramine

A
  • Considered first line for OCD (then NAC, then Luvox)
    > Doesn’t treat depression/anxiety as well as Luvox
    > Has more side effects and CYP interactions than Luvox
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52
Q

Amitriptyline

A
  • Readily used in primary care for sleep, headaches, and neuropathic pain
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53
Q

Nortriptyline

A
  • Essentially the same as amitriptyline, but cleaner and more powerful
    > 50mg of amitriptyline = 25mg of nortriptyline
    > Fewer side effects than amitriptyline
  • Good for sleep
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54
Q

Doxepine

A
  • Good for insomnia
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55
Q

Anxiolytics

A
  • SSRIs
  • Benzos
  • Gabapentin
  • Buspar
  • Propranolol
  • Clonidine
  • Prazosin
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56
Q

SSRIs

A
  • Start lower (1/2 usual dose)
  • Go slower (wait at least 2 weeks between increasing dose)
  • Go higher (will likely need the max dose to treat anxiety)
  • Go-to is Zoloft
  • “Max dose” is a recommendation, and some providers go higher (they just haven’t been studied at higher than “max dose”)
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57
Q

Benzodiazepines

A
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Temazepam (Restoril)
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58
Q

Benzodiazepines - FDA approved for

A
  • Panic disorders
  • Anxiety disorders
  • Insomnia
  • Preoperative anxiety
  • Seizures
  • Muscle spasms (often used in sports medicine)
  • Alcohol withdrawal
  • Anything that needs the CNS suppressed…
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59
Q

Benzodiazepines - detox

A
  • Prioritize detoxing patients
  • Comfortable schedule for detox
    > Significant patient education (decreases REM, increases anxiety, increases depression)
    > Convert to Lorazepam, Valium, or Klonopin to taper (reference Ashton manual)
    > Consider adding Gabapentin (300mg TID)
    > 10-20% dose decrease every 2-4 weeks
    > Support with GABAnergic supplements
    ^ Passiflora
    ^ Skullcap
    ^ GABA
    ^ Valerian
    ^ Kava
    ^ Phenibut
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60
Q

Benzodiazepines - differences

A
  • Onset of action
  • Half life
  • Receptor sites
    > All bind to GABA A receptors with differences within subtypes
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61
Q

Benzodiazepines - side effects

A
  • Sedation
  • Anxiety
  • Depression
  • Dizziness
  • Ataxia
  • Forgetfulness, feeling “fuzzy”
  • “Being snowed”
  • Reduced REM sleep (sleep more, but not getting rest)
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62
Q

Benzodiazepines - depletions

A
  • Calcium

- Vitamin D

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63
Q

Benzodizepines - contraindications

A
  • DHEA (esp Klonopin)
  • CNS suppressing herbs (like Kava)
  • Hypericum (CYP interactions)
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64
Q

Alprazolam - trade name

A
  • Xanax
65
Q

Lorazepam - trade name

A
  • Ativan
66
Q

Clonazepam - trade name

A
  • Klonopin
67
Q

Diazepam - trade name

A
  • Valium
68
Q

Temazepam - trade name

A
  • Restoril
69
Q

Benzodiazepines - general notes

A
  • Just don’t use them if possible…
  • Research says there’s no long-term reason to use them for longer than 4 weeks
  • Good for patients who have bad akathisia from antipsychotics
  • If discontinue abruptly, can be deadly
  • Can develop tissue depletion and addictive behaviors
  • Increase risk of dementia and Alzheimer’s by 60-75%
  • Make EMDR less effective
  • Make it more likely for patients with an acute stress response to develop PTSD (if they’re already showing PTSD symptoms)
  • “Legacy” patients are ones who have been on a drug so long that it might actually be more beneficial to keep them on a low dose than to discontinue it totally
70
Q

Gabapentin - trade name

A
  • Neurontin
71
Q

Gabapentin - MOA

A
  • Neuronal calcium channel blocker
  • Decreases release of glutamate
  • Makes the experience of there being more GABA
72
Q

Gabapentin - general notes

A
  • Great patients who have liked CNS suppressants (benzos, opioids
  • Great for easing benzo/alcohol withdrawal symptoms
  • TID dosing
  • Has the possibility of being abused, but much safer than benzos and opiates
73
Q

Gabapentin - interactions

A
  • Naproxen
74
Q

Gabapentin - contraindications

A
  • Few to none

- Monitor patients with poor kidney function

75
Q

Gabapentin - Depletions

A
  • B6 (when lumped in with other anticonvulsant medications…)
76
Q

Buspirone - trade name

A
  • Buspar
77
Q

Buspirone - MOA

A
  • 5-HT1A receptor partial agonist

- Minimal D4 receptor agonist

78
Q

Buspirone - FDA approval

A
  • Anxiety disorders
79
Q

Buspirone - dosing

A
  • TID
80
Q

Buspirone - interactions

A
  • Serotonergic agents and supplements
  • MAOIs
  • Significant CYP interactions
81
Q

Buspirone - contraindications

A
  • Bipolar disorder
82
Q

Antihypertensives

A
  • Propranolol (Inderal)
  • Clonidine (Catapress)
  • Prazosin (Minipress)
83
Q

Antihypertensives - side effects

A
  • Hypotension
84
Q

Propranolol - trade name

A
  • Inderal
85
Q

Propranolol - MOA

A
  • Beta blocker
86
Q

Propranolol - uses

A
  • Social anxiety/public speaking
  • PTSD prevention (give in first 3 days)
  • Especially indicated for patients with somatic anxiety
87
Q

Propranolol - contraindications

A
  • Diabetes mellitus (masks the s/s of hypoglycemia)
  • Hypotension
  • COPD
88
Q

Propranolol - interactions

A
  • Beta agonists
  • Hypotensive agents
  • Hawthorne
89
Q

Propranolol - depletions

A
  • CoQ10
90
Q

Clonidine - trade name

A
  • Catapress
91
Q

Clonidine - MOA

A
  • Central alpha agonist
92
Q

Clonidine - uses

A
  • Generalized anxiety with rapid thoughts
93
Q

Clonidine - contraindications

A
  • Hypotension

- Diabetes mellitus

94
Q

Clonidine - interactions

A
  • Hypotensive agents
  • CNS depressants
  • Hawthorne
95
Q

Clonidine - depletions

A
  • CoQ10
  • B6
  • B1
  • Zinc
96
Q

Prazosin - trade name

A
  • Minipress
97
Q

Prazosin - MOA

A
  • Peripheral alpha blocker
98
Q

Prazosin - uses

A
  • PTSD (gold standard)
99
Q

Prazosin - contraindications

A
  • Hypotension
100
Q

Prazosin - interactions

A
  • Hypotensives

- Alpha agonists

101
Q

Prazosin - depletions

A
  • CoQ10

- Zinc

102
Q

Prazosin - general note

A
  • Slow upward titration
103
Q

Second Generation Antipsychotics (SGAs)

A
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Aripiprazole (Abilify)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Paliperidone (Invega)
  • Ziprasidone (Geodon)
  • Lurasidone (Latuda)
  • Asenapine (Saphris)
104
Q

SGA - FDA approval

A
  • Schizophrenia
  • Schizoaffective disorder
  • Acute mania
  • Bipolar disorder
  • Bipolar depression (Latuda, Seroquel, Abilify)
105
Q

SGA - MOA

A
  • Blocks D2 receptors in some regions of the brain
  • Blocks 5HT 2A receptors
    > Causes enhancement of dopamine release in certain brain regions
106
Q

SGA - side effects

A 
- Metabolic syndrome
     > Hyperglycemia
     > Hyperlipidemia
     > Weight gain (central)
- Akathisia
- Other extra-pyramidal symptoms
- QTC prolongation
- Sedation
107
Q

SGA - metabolic concerns

A

Least to Most

  • Lurasidone and ziprasidone
  • Aripiprazole
  • Asenapine
  • Risperidone
  • Quetiapine
  • Olanzapine
108
Q

SGA - side effects scale

A

Least to Most

  • Lurasidone and ziprasidone
  • Aripiprazole
  • Risperidone
  • Asenapine
  • Quetiapine
  • Olanzapine
109
Q

Aripiprazole - trade name

A
  • Abilify
110
Q

Aripiprazole - notes

A
  • “Third generation” antipsychotic
  • Partial agonist of D2 receptors
  • More serotonergic activity than other SGAs
  • More anti-depressant effects
  • Fewer metabolic and EPS SEs
  • Causes problematic akathisia
  • Causes gambling
  • One of the most commonly used
  • Often 1st line for bipolar
  • Often used for adjunctive depression therapy
111
Q

Olanzapine - trade name

A
  • Zyprexa
112
Q

Olanzapine - notes

A
  • Mania sledgehammer
    > Best for acute psychosis
  • Very sedating
  • Increases CRP with just one dose
  • Very popular
  • Can cause 10lbs of weight gain in one week
  • Can use it acutely and then transfer to a different SGA
113
Q

Quetiapine - trade name

A
  • Seroquel
114
Q

Quetiapine - notes

A
  • Very sedating
  • Used for sleep issues
  • Some anti-depressant effects
  • Significant SEs with prolonged use
  • Causes QTC prolongation
    > Second to Geodon
  • Causes the least amount of EPS SEs
115
Q

Risperidone - trade name

A
  • Risperdal
116
Q

Risperidone - notes

A
  • Cheapest, first covered by insurance
  • Medium sedation
  • Minimal anti-depressant effect
  • Causes prolactinemia
  • Causes breast enlargement
  • Becomes a 1st generation antipsychotic at 4mg
  • Go-to middle-of-the-road SGA when no significant needs stand out
  • In the middle for SEs and efficacy
117
Q

Clozapine - trade name

A
  • Clozaril
118
Q

Clozapine - notes

A
  • 1st SGA developed
  • Not used as often anymore
  • Most effective
  • Causes such bad SEs that patients must be on a national registry if they’re taking it
119
Q

Paliperidone - trade name

A
  • Invega
120
Q

Paliperidone - notes

A
  • There’s an injectable version that is well-tolerated
121
Q

Ziprasidone - trade name

A
  • Geodon
122
Q

Ziprasidone - notes

A
  • IM used for psychosis

- Worst for causing QTC prolongation

123
Q

Lurasidone - trade name

A
  • Latuda
124
Q

Lurasidone - notes

A
  • Also FDA-approved for bipolar

- Currently very expensive

125
Q

SGA - contraindications

A
  • DMII (okay with monitoring)

- QTC prolongation

126
Q

SGA - interactions

A
  • Dopaminergic medications
    > Ex. - Levadopa
  • Some CYP interactions
127
Q

Mood stabilizers - general notes

A
  • Prevent mania
  • Alleviate depression (SSRIs CI in bipolar)
  • Alter progression of the “disease”
  • Many are anti-seizure drugs
  • Some stabilize from above (tamp down mania) and some stabilize from below (lift up depression)
128
Q

Mood stabilizers

A
  • Lamictal (Lamotrigine)
  • Lithium
  • Depakote (Valproic acid (VPA) or Depakene)
  • Tegretol
  • Topomax
129
Q

Lamictal - trade name

A
  • Lamotrigine
130
Q

Lamictal - MOA

A
  • Anti-convulsant

- Blocks voltage-sensitive sodium channels

131
Q

Lamictal - notes

A
  • Best anti-depressant mood stabilizer
  • Slow titration schedule to reduce allergic response/chances of developing Stevens Johnsons Syndrome
  • Stabilizes from below
    > Probably helps with some mania/hypomania, but more depression-oriented
  • Can take up to 400-800mg/day
  • After 200mg, don’t get much more mood effects, but can really help with anxiety and irritability
132
Q

Lamictal - side effects

A
  • Benign rash
  • Deadly rash (SJS)
  • Sedation (rare)
  • Blurred vision (rare)
  • Stop taking immediately at first sign of a rash
133
Q

Lamictal - interactions

A 
- Depakote 
     > Increases lamictal concentrations and risk of rash
- Some oral contraceptives
     > Decrease lamictal concentrations
- Many CYP reactions
134
Q

Lamictal - contraindications and depletions

A
  • None known
135
Q

Lithium - MOA

A
  • “unknown and complex”

- Alters sodium transport across cell membranes

136
Q

Lithium - notes

A
  • Gold standard for bipolar 1
  • 3 forms: orotate, carbonate, and various “slow release” forms
  • Must monitor thyroid function, kidney function, and calcium at baseline and then at least yearly
    > Not true for orotate form
  • Stabilizes from above
  • Stops suicidal ideation within a day of a minimum dose
  • If dehydrated, lithium blood levels will increase (because it’s a salt)
137
Q

Lithium - dosing

A
  • 0.8-1.1 mmol/L is therapeutic range
  • 0.6-0.7 mmol/L is suboptimal, but okay for maintenance
  • Above 1.2 is toxic
  • 0.9 is best for mania prevention
  • 1.0+ has more SEs
  • Can stay lower for MDD and suicidal ideation
  • Must reach 0.5-0.6 for mania
138
Q

Lithium - side effects

A
  • Weight gain
  • Stomach upset (switch to the long-acting form)
  • Thyroid dysfunction
  • Kidney dysfunction
  • When reach toxicity: ataxia, delirium, tremor, nausea, vomiting (looks like serotonin syndrome)
139
Q

Lithium - interactions

A 
- Cox-2 inhibitors (like NSAIDs)
     > Increase lithium levels
- Diuretics
     > Increase lithium levels
- ACE inhibitors 
     > Increase lithium levels
140
Q

Lithium - contraindications

A
  • Kidney disease
  • Cardiovascular disease
  • Sodium depletion
141
Q

Lithium - possible positive additive effects

A
  • Folic acid
  • 5-HTP
  • Inositol (watch for re-emergence of mania)
142
Q

Lithium - depletions

A
  • Chromium
143
Q

Depakote - MOA

A
  • Blocks voltage-sensitive sodium channels by an unknown mechanism
  • Increases GABA by an unknown mechanism
  • Anti-convulsent
144
Q

Depakote - dosing

A
  • 0.6 - 1.0 ug/mL

- Requires regular plasma

145
Q

Depakote - notes

A
  • Generally stabilizes from above
  • Good for patients with a lot of anger
    > Otherwise choose other meds
146
Q

Depakote - interactions

A
  • Lamictal (VPA increases lamictal plasma levels)
  • Carbamazapime (VPA levels will be lowered)
  • Aspirin (will increase VPA levels)
  • Clonazepam (potential for rare seizures)
  • CYP interactions
147
Q

Depakote - contraindications

A 
- Poor liver health
     > Monitor enzymes closely
- Pancreatitis
- Very teratogenic
     > Monitor anyone who has the potential of becoming pregnant
148
Q

Depakote - depletions

A
  • Folic acid
  • Zinc
  • Selenium
  • Carnitine
  • Biotin
  • B12
  • B1
  • Copper
149
Q

Sleepers

A
  • Trazodone
  • Seroquel
  • Ambien
  • Temazepam
150
Q

Trazodone - MOA and class

A
  • SARI (5HT agonist/reuptake inhibitor)
151
Q

Trazodone - side effects

A
  • Hangover
  • Others more uncommon
    > N/V
    > Anticholinergic SEs
    > Syncope
    > EKG changes
  • Hangover usually doesn’t last too long, but is pretty common
152
Q

Trazodone - interactions

A
  • Many, but fairly mild

- Possibly serotonergic agents, but can be used with SSRIs

153
Q

Trazodone - notes

A
  • Go-to for falling asleep and staying asleep
  • Doesn’t interrupt REM
  • Aids in PTSD nightmare reduction
  • No tolerance, dependence, or withdrawal
  • Some people get activated if they don’t fall asleep within 30 minutes of taking it
  • Possibly suppresses melatonin
154
Q

Quetiapine - trade name

A
  • Seroquel
155
Q

Quetiapine - notes

A
  • Highly sedating atypical antipsychotic
  • Great for nightmares if prazosin or trazodone fail
  • Must do same monitoring as all SGAs
  • Causes SGA SEs
  • 25-100mg for sleep
    > Very histaminergic
  • 150-300mg for antidepressant/mood/anxiolytic
  • > 400mg for antipsychosis
156
Q

Zolpidem - trade name

A
  • Ambien
157
Q

Zolpidem - notes

A
  • Almost, but not quite a benzo
    > Good to just consider it one when considering prescribing it
  • Dependence and withdrawal
  • Does not allow REM
    > Harmful in PTSD
  • Different doses depending on biological sex
  • Decreases life expectancy
  • Patients report doing unsafe things while on it, or even the morning after
158
Q

Temazepam - trade name

A
  • Restoril
159
Q

Temazepam - notes

A
  • It’s a benzo
  • Causes fewer euphoric effects, but more sedative effects
  • Less anxiolytic than other benzos

Integrative Psychopharmacology (2 decks)

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