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56 Cards in this Set

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What are 3 main subdivisions of Psychopharmacotherapy?
1. Antidepressants
2. Antipsychotics
3. Anxiolytic/hypnotics
What do many of the psycho drugs affect?
Neurotransmitters
What are the 3 main NT classes?
1. Monoamines
2. Amino acids
3. Glutamic acid
What are the Monoamine NT's?
-Serotonin
-Histamine
-Acetylcholine
-Norepi
-Dopamine
What is the amino acid?
GABA
What are 3 subcategories of ANTIDEPRESSANTS?
1. Tricyclics/heterocyclics
2. SSRIs/SNRIs
3. MAOIs
How do the Tricyclic antidepressants work?
Increase NE and 5HT in the synapse by inhibiting their reuptake
Why aren't TCAs the first line txmt anymore?
They cause fatal cardiac arrythmias in overdose
What are 5 major side effects of ALL TCA's?
-Anticholinergic effects
-Sedation
-Weight gain
-Tachycardia/QT prolongation
-Orthostatic hypotension
What are 4 anticholinergic side effects?
Blurry vision
Dry mouth
Constipation
Urine retention
What are 4 of the major TCAs?
-Amitriptyline
-Nortriptyline
-Desipramine
-Imipramine
What is a side effect unique to Amoxapine?
May cause extrapyramidal syndrome
Which TCA is the least anticholinergic and is also nonsedating?
Desipramine
Avg half life of TCAs:
16 hrs
What class is the most commonly used of antidepressants today?
SSRIs
What are 2 major side effects of SSRIs?
-GI distress/diarrhea
-Sexual dysfunction
What sort of sex dysfunction do SSRIs cause in males vs females?
Males - delayed ejaculation
Females - anorgasmia
What are 3 additional side effects of SSRIs?
-Agitation/anxiety
-Headaches
-Insomnia
What is a potentially FATAL complication of using SSRIs? How is it avoided?
Serotonin syndrome - don't prescribe SSRIs along WITH an MAOI, and wait at least 5 wks after d/c the SSRI before starting on an MAOI.
What is Serotonin syndrome?
Similar to neuroleptic malignant syndrome - confusion, high temp, muscle twiches, loss of conscsnss
What are 6 of the main SSRIs?
For some people forks can eat
-Fluoxetine
-Sertraline
-Paroxetine
-Fluvoxamine
-Citalopram
-Escitalopram
Which SSRI has the longest half-life?
Fluoxetine; 1-3 days!
Which SSRI causes diarrhea more commonly than others?
Sertraline
Which SSRI is mildly anticholinergic?
Paroxetine
Which SSRI more commonly causes nausea/vomiting than others?
Fluvoxamine
Which SSRI possibly has fewer sexual side effects?
Citalopram
Which class of antidepressants are LEAST commonly used? Why?
MAOIs - because it requires a Tyramine-free diet in order to prevent hypertensive crisis!
What does a tyramine-free diet consist of?
No fermented bvgs, cheese, sausage
What are MAOIs more useful for treating?
Atypical depressive symptoms - overeating, oversleeping, irritability
What is the main MAOI to remember?
Phenelzine!
What should you NEVER do with an MAOI?
Coadminister with an SSRI
What are 5 MISCELLANEOUS antidepressent meds?
-Venlafaxine
-Nefazodone
-Trazodone
-Mirtazepine
-Bupropion
What is Venlafaxine? mechanism?
an SNRI - inhibits 5HT and NE reuptake
What are Nefazodone and Trazodone? Mechanism?
5HT2 receptor blocker AND serotonin reuptake inhibitors
Which mixed 5HT2 antagonist/SRI is associated with decreased sexual dysfunction?
Nefazodone
What is a side effect that is associated with Trazodone?
PRIAPISM - prolonged erection which can actually lead to impotence!
What is the mechanism of Mirtazapine?
NE/Serotonin antagonism
What are 2 side effects of Mirtazapine?
Weight gain
Sedation
What is the mechanism of Buproprion?
NE and Dopamine reuptake inhibitor
What are Antidepressant MOOD STABILIZERS used for treating?
MANIA
What are the 3 main Antidepressant MOOD STABILIZERS?
-Lithium
-Valproic acid
-Carbamazepine
What is Lithium's mechanism of action?
Inhibits Adenylate cyclase
What are 3 major side effects of Lithium?
-Tremor
-Hypothyroidism
-Diabetes insipidus
What can Lithium cause at toxic levels?
Seizures Coma and Death
What 5 tests should be done on patients on Lithium and how often?
-Serum level tests q5-7 days w/ each dose change, q6-12 mo when stable
-Renal function tests q6-12 mo
-Thyroid function tests q6-12 mo
-Pregnancy test, ECG
What can be given to reduce the tremor caused by lithium in some patients?
Propanolol
What is the theory of Valproic Acid's mechanism?
Opens chloride channels
What are 4 major side effects of Valproic acid?
-Thrombocytopenia
-Hair loss
-Pancreatitis
-Teratogenic - neural tube defects
So what 4 tests should be done for patients on Valproic acid?
-CBC
-Liver function
-Pancreatic enzymes
-b-hCG in childbearing women
What is the mechanism of Carbamazepine?
Inactivates Sodium channels so inhibits repetitive firing of AP's
What are 4 major side effects of Carbamazepine?
-Slurred speech
-Low WBC count (agranulocytosis)
-High liver function tests
-Craniofacial defects in newborns
So what are 4 tests you should run on patients on Carbamazepine?
-LFT's
-Pancreatic enzymes
-CBC
-b-hCG in childbearing women
Another important point to remember about Carbamazepine?
Potent inducer of the P450 system!
What are 2 less commonly used mood stabilizers for mania?
-Lamotrigine
-Gabapentin
What are 3 possible s/e's of Lamotrigine?
-Leukopenia
-Rash (steven johnson syndrome)
-Liver failure
How do you avoid the rash with Lamotrigine?
Slowly increase the dosing