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77 Cards in this Set
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- Back
- 3rd side (hint)
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What is Imipramine? What is its brand name? |
Tofranil, a TCA
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What is Amitriptyline? What is its brand name?
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TCA, Elavil
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What is trimipramine? What is its brand name?
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Surmontil, a TCA
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What is nortriptyline? What is its brand name?
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TCA, Pamelor
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What is Clomipramine? What is its brand name?
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TCA, ANafranil
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What is Doxepin? What is its brand name?
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TCA, Sinequan
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TCA least likely to cause orthostatic hypotension
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Nortriptyline
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TCA least sedating, least anticholinergic side efects
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Desipramine
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TCA most serotonin specific, useful in treating OCD?
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Clomipramine
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SSRI for treating OCD
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Fluvoxamine
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Side effects of TCA
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Anti-HAM
Anti histamine--sedation Anti adrenergic--orthostatic hypotension Anti muscarinic (anticholinergic)--hot as a hare, mad as a hatter, dry as a bone, red as a beet, bloated as a toad... Weight gain Lethal in overdose Convulsions, coma, cardiotoxicity |
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Mechanism of TCAs
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Inhibit reuptake of NE and serotonin (increase availability in synapse)
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Hallmark of TCA toxicity on EKG, used as threshold to treatment
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Wide QRS (>100 msec)
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Mainstay of treatment of TCA overdose
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IV sodium bicarbonate
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Mechanism of MAOIs
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Prevent inactivation of biogenic amines: NE, serotonin, dopamine, tyramine
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Inhibition of MAO-A deactivates ___.
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serotonin, as well as dopamine and tyramine
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Inhibition of MAO-B increases ___.
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NE, Epi, as well as dopamine and tyramine
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Side effects of MAOIs
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Orthostatic hypotension
Drowsiness Common: Weight gain Sexual dysfxn Dry mouth Sleep dysfxn Severe: Serotonin syndrome w/ SSRIs Hypertensive crisis with tyramine rich foods or sympathomimetics |
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Symptoms of serotonin syndrome
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Lethargy
Restlessness Confusion Flushing Diaphoresis (sweating) Tremor Myoclonic jerks Progression to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death. |
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Tyramine rich foods
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red Chianti wine, cheese, chicken liver, fava beans, cured meats --> buildup of stored catecholamines (lead to hypertensive crisis with MAOIs)
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Sympathomimetics in common over the counter _____ medications.
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Cold medications
Can cause hypertensive crisis if taken with MAOIs |
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Mechanism of SSRIs
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Inhibit presynaptic serotonin pumps--> increased availability of serotonin in synaptic clefts.
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SSRI with longest half-life with active metabolites (do not need to taper)
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fluoxetine (prozac)
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What is sertraline? What is its brand name?
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SSRI
Zoloft |
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What is Paroxetine? What is its brand name?
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SSRI
Paxil |
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What is fluvoxamine? What is its brand name? What is it used for?
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SSRI
Luvox Only for treating OCD |
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Two drugs to treat OCD
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Clomipramine (Anafranil)--TCA
Fluvoxamine (Luvox)--SSRI |
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What is citalopram? What is its brand name and claim to fame?
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SSRI
Celexa Used in Europe for 12 yrs before approved by FDA Cheaper cousin of escitalopram (Lexapro) |
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What is escitalopram? What is its brand name and claim to fame?
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SSRI
Lexapro Levo enantiomer of citalopram (celexa), fewer side effects, similar efficacy, increased $$$ |
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Side effects of SSRIs
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Sexual dysfxn
GI disturbance Insonia Headache Anorexia Wt loss Serotonin syndrome with MAOIs (wait 2 wks before switching from SSRI to MAOI or vice versa) |
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Name of an SNRI and its use
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Venlafaxine (effexor)
Serotonin NE reuptake inh refractory depression and CAP |
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Use of MAOIs
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refractory depression
refractory panic disorder |
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SFX of venlafaxine
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This is an SNRI
It can increase BP (contra in pts with labile or untreated BP) Withdrawal with 1-3 missed doses (flulike sx, shock-like zaps) |
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Name of an NDRI and its use
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Buproprion is a NE dopamine reuptake inhibitor
NO sexual side effects Smoking cessation, adult ADHD, SAD |
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SFX buproprion
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seizures, psychosis
Contra in anxiety, anorexia, epilepsy, currently on MAOI |
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Name an SARI and its use
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Nefazodone and trazodone (serzone, desyrel)
Refractory major depression |
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Atypical antipsychotic with low incidence of EPS and TD
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Clozapine, Quetiapine
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Atypical that can cause cataracts
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Quetiapine
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Atypical that can cause QTc prolongation
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Ziprasidone
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Atypical antipsychotic approved for depression augmentation
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Aripiprazole
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Atypical with less incidence of metabolic syndrome and hyperprolactinemia
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Aripiprazole
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Active metabolite of risperdone that has no effect on liver
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invega
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Atypical that is the hardest to monitor
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Clozapine
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If no other antipsychotic works, this one will
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Clozapine
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Atypical effective for tardive dyskinesia
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Clozapine
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Antipsychotic that can cause liver toxicity
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Olanzapine
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Monitor LFTs
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Atypical that causes the most weight gain
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Olanzapine
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How to monitor Clozapine
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CBC, ANC q week x 6 months
q 2 weeks x 1 year q month after that |
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CBC and ANC levels needed for Clozapine
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CBC > 3500
ANC > 2000 |
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Atypical that acts more like typical antipsychotics at > 6 mg
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Risperdone (EPS, TD)
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What receptors do atypical antipsychotics work on?
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Not as potent on DA receptors as typicals, but does block DA.
Blocks serotonin 5HT2 |
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What does blocking serotonin 5HT2 receptors do?
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Sedation
Nausea Anticholinergic side effects |
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Atypical with a 1% incidence of agranulocytosis
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Clozapine
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Atypical with a 2-5% chance of seizures
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Clozapine
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Psych pt with fever and fast heart rate is sweaty and rigid. He has an obvious tremor. What labs do you draw?
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Check CPK and WBC. If pt has leukocytosis (increased WBC) and elevated CPK, it is neuroleptic malignant syndrome
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Treatment for neuroleptic malignant syndrome.
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Discontinue current medications
Supportive care (cooling, hydration) Sodium dantroline, bromocriptine, amantadine. |
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Uses of mood stabilizers (besides the obvious)
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Potentiation of antidepressants in MDD pts refractory to monoTX
Potentiation of antipscyhotics in pts c schizophrenia Enhancement of abstinence in tx of alcoholism Tx of aggression and impulsivity in dementia, MR, intox, personality d/o, etc. |
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What are the mood stabilizers?
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Lithium
Carbamazepine Valproic Acid |
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Side effects of lithium
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Tremor
Sedation Ataxia Thirst Metallic taste Polyuria Edema Weight gain GI problems Benign leukocytosis Thyroid eenlargement Hypothyroidism Nephrogenic DI Interstitial nephritis Ebstein's anomaly in babies |
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Side effects of carbamazepine
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Leukopenia
Hyponatremia Aplastic anemia Agranulocytosis Skin rash Drowsiness Ataxia Slured speech Neural tube dfx in babies |
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Uses of carbamazepine
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Mixed episodes and rapid-cycling bipolar d/o
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Uses of lithium
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Acute mania
Prophylaxis for manic and depressive episodes in bipolar |
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Onset of action of lithium and carbamazepine
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5 to 7 days
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What is the therapeutic range for lithium?
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0.7 to 1.2
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Toxic lithium levels
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> 1.5
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Lethal lithium levels
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> 2
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TCA for noctournal enuresis
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Imipramine
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TCA for ADHD and tics
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Imipramine
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2 TCAs for pain and insomnia
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Amitriptyline and nortriptyline
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How many grams of TCAs are fatal?
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2-3 g
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Treatment for TCA overdose
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IV sodium bicarbonate
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Can a patient who got neuroleptic malignant syndrome (NMS) on haldol take haldol again later?
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Yes. It is not an allergic reaction.
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What is tardive dyskinesia
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Writing movements (choreoathetoid) of mouth and tongue
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Who gets TD (tardive dyskinesia) the most?
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People who have used neuroleptics more than 6 months.
Older women. |
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How often does TD spontaneous remit?
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50% of the time. But if untreated it can be permanent
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Baseline tests before giving lithium?
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EKG
Pregnancy test TSH BUN, Cr Electrolytes ECG |
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How often do you check lithium levels?
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q month x 3 months
q 3 months after that |
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