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Thrp: Psyc Flashcards

1
Q

Fluoxetine

A

SSRI
inc t1/2

Worse Insomnia, sexual dis-fn, **anxiety/activation (avoid in PD/Anxiety tx), GI
d/c Sx start w/in1-3wks (longer t1/2)
SE: ++Seizures

Used in combo with Olanzapine in Bipolar but metabolic SE

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2
Q

Sertraline

A

SSRI: Starting Dose: 25-50mg (Geriatric=12.5mg) Dose range 50-200mg)
good anxiety 1st choice, *tx for PTSD

Worse Insomnia, Diarrhea, GI, anxiety/activation
SE: +sedation ++ Seizures

Breast feeding: Lowest infant SDC and fewest ADR
No dose adj for Renal Impairment

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3
Q

Paroxetine

A

SSRI
good anxiety 1st choice, *tx for PTSD

Worse Sedation, sexual dis-fn, anti-cholinergic effects, *WT gain, d/c-sx (must taper after 1 week)
SE: ++Sedation, ++Seizures ++AntiACH

1st trimester minimal cardiac defect risk
Breast feeding: Lowest infant SDC and fewest ADR

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4
Q

Fluvoxamine

A

SSRI

Worse Sedation
SE: ++Sedation, ++Seizures

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5
Q

Citalopram

A

SSRI: Starting dose=20mg (Geriatric 10mg) Dose range=20-60mg
Only SSRI good for HA

QRS/AT prolongation: Dose dependent: *NTE 40mg/day (20mg/day 60+yo or on omeprazole/cimetidine)
*Monitor: ECG, LFT (cleared by liver), K+,MG++)
SE: ++Sedation, ++Seizures **++Dose related Arrhythmias
Substrate for CYP2C19

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6
Q

Escitalopram

A

SSRI: (Dose 1/2 citalopram)
Only SSRI good for HA; good anxiety 1st choice

SE:

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7
Q

Vilazodone

A

Dual-acting 5-HT RUI/Partial 5HT1a AG (may help with sexual dys-fn SE)
NEW Rx

SE: GI (w/food), insomnia

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8
Q

Bupropion

A

Aminoketone: (Starting dose=75mg qd-bid):
2nd line agent Depression
Good in smoking cessation and parkinsons Dz, atypical depression, CV dz, alzheimer’s Dz (*NOT PD)
ADHD Tx: 1.5-3mg/kg max=6mg/kg/day divided BID

Less sexualy disfuntion: Add Rx late in day or switch to this if is a problem
SE: Nausea, dizzy, tremor, insomnia
++++Seizures- rare but not good for pts w/seizures
+AntiACh

DDI 2D6 inhibitor

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9
Q

Venlafaxine

A

SNRI: good 2nd line agent: QD-BID dosing

D/c-Sx in 7 days, worse d/c-sx (must taper after 1 week)
*tx for PTSD

*Dose dependent SE
Low dose: nausea/vomiting
High Dose: inc BP
SE: +AntiACh, + Sedation, ++Seizures, +Arrhythmais

Has mainly pharmacodynamic DDI

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10
Q

Desvenlafaxine

A

SNRI

*Dose dependent SE
Low dose: nausea/vomiting more than venlafaxine
High Dose: inc BP
SE: +AntiACh, + Sedation, ++Seizures, +Arrhythmais

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11
Q

Duloxetine

A

SNRI: BID dosing
Tx neuropathy: good or DM pts

N/D sedation,
SE: +Anti-ACh-mostly dry mouth
+ Orthostasis, and inc HR in supine/standing

Has mainly pharmacodynamic DDI
and 2D6 inhibitor

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12
Q

Trazodone

A

Triazolopyridines
Tx for sleep in PTSD

+++Orthostasis-alpha blocker
+++ Sedation-give at HS, ++Seizures, ++Arrhytmias
Priapism (prolonged errection_ rare but d/c and ER

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13
Q

Nefazodone

A

Triazolopyridines: 2nd liner

Less sexualy disfuntion: switch to this if is a problem

Liver toxicity - Monitor LFT bimonthly during 1st yr
++Sedation
SE: +AntiACH, ++Seizures, ++Orthostasis,

DDI: Potent 3A4 inhibitor

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14
Q

Amitriptyline

A

TCA

SE: ++++Sedation, ++++AntiACh, +++Orthostasis, ++++arrhythmias, +++Seizures

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15
Q

Doxepin

A

TCA

SE: ++++Sedation, +++AntiACh, ++Orthostasis, ++arrhythmias, +++Seizures

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16
Q

Clomipramine

A

TCA Lots of AE*
Used to Tx OCD AFTER 3 failed tires of SSRI

SE: ++++Sedation, ++++AntiACh, ++Orthostasis, ++++arrhythmias, ++++Seizures

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17
Q

Imipramine

A

TCA
Depression
ADHD (less effective) Dose 1mg/kg inc 0.5mg/kg max=3mg/kg divided BID

SE: +++Sedation, +++AntiACh, ++++Orthostasis, ++++arrhythmias, ++++Seizures

OD risk

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18
Q

Desipramine

A

TCA
Depression
ADHD (less effective) Dose 1mg/kg inc 0.5mg/kg max=3mg/kg divided BID

SE: +++Sedation, +++AntiACh, *+Orthostasis, +++arrhythmias, ++Seizures

good Pregnancy Rx Choice

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19
Q

Nortriptyline

A

TCA

SE: +++Sedation, +++AntiACh, +Orthostasis, +++arrhythmias, ++Seizures

Good Rx choice for pregnancy
Breast feeding: Lowest infant SDC and fewest ADR

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20
Q

Phenelzine

A

MAOI - never 1st line

SE: most orthostasis, sedation

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21
Q

Tranylcypromine

A

MAOI - never 1st line

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22
Q

Trasdermal Selegiline

A

MAOI - never 1st line

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23
Q

Lithium

A

Mood Stabilizer Bipolar (effective but less than VPA)
Other: Anti-depressant
Persistent aggression/hostility/mood lability Schizo Tx

Base line Tests: T’BEER P (initially and q12mo)

t1/2=~24hrs (steady-state = 1 wk) bridge with BDZ
DOSE= start 300mg BID-TID
(300mg = 0.2mEq/L)
GOAL = 0.6 - 1.2 mEq/L

*DO NOT d/c abruptly ->Sx occur more rapidly and more difficult to control

Early SE: Tremor, polyuria, lethargy/sedation
long term SE: Hypothyroidism, Fine hand tremor, wt gain, Teratogenic (ebstein anomaly) Breastfeeding (risk of hypothyroidism in baby et.c)
Narrow TI Rx: Neurotoxicicity, AND Serotonin syndrome with serotenergic Rx’s

SIGNS OF Toxicity= GO TO ER

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24
Q

Mirtazapine

A

TCA: 2nd liner: HS dosing
unique MOA: inhibits presynaptic alpa-2 receptors and pstsynaptic 5-HT
good adjunct for sleep

Add rx at HS to Tx sex-dis-fn
SE: +++Sedation- at lower doses
Wt gain (anti histaminic properties)
++AntiACh, ++Orthostasis, +arrhythmias

Has mainly pharmacodynamic DDI

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25
CYP2D6 Substrates
Paroxetine, Sertraline, Desipramine, Nortriptyline, clozapine, Haloperidol (major), Thioridazine, Perphenazine, Propanolol, Metoprolol, Timolol, Tamoxifen, Atomoxetine
26
CYP3A3/4 Substrates
Statins, Alprazolam, Ethinyl estradiol, Cyclosporine, Buspirone, Quetiapine (major)
27
CYP1A2 Substrates
Caffeine, Clozapine (major)
28
CYP2C9 Substrates
Warfarin
29
CYP2C19 Substrates
Citalopram, Diazepam
30
CYP2D6 Inhibitors
Paroxtine/Fluoxetine/Duloxetine/Bupropion
31
CYP3A4 Inhibitors
Fluvoxamine/Nefazodone/TCAs, grapefruit juice
32
CYP1A2 Inhibitors
Fluvoxamine, grapefruit juice
33
CYP2C9 inhibitors
Fluoxetine/fluvoxamine
34
CYP2C19 inhibitors
Fluoxetine/fluvoxamine, omeprazole, cimetidine
35
CYP Inducers
St John's Wort, phenobarbital/Phenytoin, carbamazepine,
36
Alprazolam
BDZ- (0.5) t1/2=short-intermediate | Common PD Tx
37
Clonazepam
BDZ (0.25) t1/2=Intermediate-long Common PD Tx Alternative to mood stabilizer in Bipolar Tx
38
Diazepam
BDZ (5) t1/2= Long
39
Lorazepam
BDZ (1) t1/2=short-intermediate OK in hepatic Dz and elderly (met via conjugation) Least-used; Parenteral dosing preferred Alternative to mood stabilizer in Bipolar Tx ACUTE Bipolar Mania IM Tx 1-3mg + AAP Agitation/Excitement Schizo Tx: 1-4mg q1-2hr (often combine w/Haloperidol lactate)
40
Oxazepam
BDZ (15) t1/2=Short | OK in hepatic Dz and elderly (met via conjugation)
41
Temazpepam
BDZ for Sleep | OK in hepatic Dz and elderly (met via conjugation)
42
Chlordiazepoxide
BDZ (10) t1/2=long
43
Buspirone
Serotonin/Dopaminergic Tx: GAD or as augmentation *Must Titrate *NOT Tx for Panic Disorder No Sedation,tolerance,dependence,toxicity w/OD Takes 2 weeks for anti-anxiety, NO prn tx, SE: GI, HA, abnormal Movements, weakness/dysphoria,paresthesias,Restlessness Substrate 3A4
44
Severe, Acute, agitated Manic Tx
IM 1 - 3mg lorazepam + | IM 10mg ziprasidone OR 9.75 mg aripiprazole
45
Divalproex Sodium
(depakote) Highly effective Mood Stabilizer 1st line Tx Bipolar Disorder (often used in combo) w/ Sx improvement ~5d & Rapid Cyclers Persistent aggression/hostility/mood lability Schizo Tx Start: 250mg TID w/food and titrate up (MAX=60mg/kg/day) Loading Dose: 20-30mg/kg/day in 3 doses Hospital setting only ADR: Hepatotoxic( monitor LFT), Wt gain, Ataxia, dose-related thrombocytopenia (monitor platelets) teratogenic Monitor: LFT, CBC with differential, SDC monthly, glucose, WT, hair DDI: IS a 3A4 inhibitor & highly protein bound *inc levels of Rx's esp Laotrigine => SJS
46
Lamotrigine
Anticonvulsant - Bipolar Tx: Less effective 1st line : RAPID CYCLERS SE: SJS EPS with the DDI VPA that inc Lamotragene levels Teratogenic: Cleft lip/palate in first trimester
47
Carbamazepine
Anticonvulsant - Bipolar Tx NOT 1st line Start:100-200mg BID WITH FOOD Persistent aggression/hostility/mood lability Schizo Tx Teratogenic, neurotoxic metabolite, CI in AV block *DDI
48
Chlorpromazine
Typical Antipsychotic Low Potency (100) 30-1000mg SE: High to Mod hypotensive, Hight sedative/Ach
49
Perphenazine
Typical Antipsychotic Med Potency (10) 12-64mg SE: Low-mod sedative, Low ACh/Hypotensive
50
Haloperidol
Typical Antipsychotic High Potency (2) 1-15mg Tx: Agitation/Excitement Schizo: 5mg q1/2-1hr until pt calm: combo w/lorazepam, NO combo with AAP DDI: Fluoxetine/Paroxetine inhibit met -> EPS SE: Low Sedative/ACh/Hypotensive
51
Fluphenazine
Typical Antipsychotic high Potency (2) 1-50mg Low sedation/ACh/Hypotensive *VERY high EPS
52
Loxapine
Typical Antipsychotic med Potency (10-15) 10-250mg SE: Low-Mod Sedation/Hypotensive low ACH
53
Aripiprazole
Atypical Antipsychotic: w/ least metabolic SE Tx Agitation/excitment Schizo: 5.25-9.75mg IM q2hr: NTE 30mg/day Activating AAP=Insomnia SE Least wt gain, least effect on lipids
54
Asenapine
Atypical Antipsychotic SL Tablet DO NOT SWALLOW: dec bioavailability; do not eat/drink 10min after
55
Clozapine
Atypical Antipsychotic: Most effective on (+) (-) Sx and Tx *suicidality but 3rd line Highest risk of decreasing seizure threshold AGRANULOCYTOSIS: wkly monitoring High Anti-ACh High Metabolic Wt gain Pregnancy Class B Lowest TD Orthostatic hypotension is a limiting factor in dose titration DDI: Cigarette smoke inc metabolism For Tx-Resistatnt schizo
56
Iloperidone
Atypical Antipsychotic w/ least EPS Not used in hepatic impairment (lack of data) Dose related tachycardia Lower Akathesia
57
Lurasidone
Atypical Antipsychotic Pregnancy Class B **TAKE WITH FOOD for bioavailability AT LEAST 350kcal Wt neutral
58
Olanzapine
Atypical Antipsychotic: Tx Agitation/Excitement Schizo: 2.5-10mg IM repeat in 2hrs after 1st dose and q4hrs after: NTE 30mg/day *DO NOT COMBO w/ BDZ (best if pt is very agitated/violent) DDI: Cigarette smoke inc metabolism Similar to clozapine but less seizure and agran Risk of delirium and extreme sedation in first 3 hrs: Must monitor w/ q-injection for 3 hrs q-time
59
Quetiapine
Atypical Antipsychotic w/ least EPS SE XR formulation for QDay dosing
60
Paliperidone
Atypical Antipsychotic w/ greatest EPS | Actie metabolite of risperidone
61
Quetiapine
Atypical Antipsychotic
62
Risperidone
Atypical Antipsychotic w/ greatest EPS with 1st IM injection give PO for 3 weeks
63
Ziprasidone
Atypical Antipsychotic w/ least metabolic SE Tx: Agitation/Excitement Schizo (most common): 10-20mg IM, repeat 10mg q2hr or 20mg q4hr: NTE 40mg/day Severe, Acute, agitated Manic Tx: IM 10mg ziprasidone *take with food (for bioavailability) CI in QT prolongation Hx IM=Mesylate
64
Clozaine
Atypical Antipsychotic
65
Benztropine
Anticholingeric Tx AP SE: Acute Dystonic rxn: 1-2mg IV and 1-2mg PO BID-TID for 4 weeks Pseudoparkinsonism: 1-6mg/day Tartive dyskinesia: Shortest possible time=risk factor for TD
66
Propranolol
Tx's Antipsychotic SE's: Akathisia's, Tremor (non parkinsonism) 20-30mg TID Seratonin Syndrome (5HT depleter) Performance Anxiety: 10-80mg (Need Test Dose)
67
Haloperidol decanoate
Long-acting AP indictable Depot
68
Haloperidol lactate
Long-acting AP indictable IM rel: used in aute agitation
69
Fluphenazine decanoate
Long-acting AP indictable: time to steady state 4-8 weeks
70
STIMULANTS
*******************NOTES*****************
71
SSRI Tx Time Response
``` Depression 6-8wk Panic 3-5wk Phobic 6-10wk GAD 8-12wk OCD 12 wk PTSD 8-12wk ```

Therapeutics (10 decks)

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