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77 Cards in this Set

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What is Imipramine? What is its brand name?
Tofranil, a TCA
What is Amitriptyline? What is its brand name?
TCA, Elavil
What is trimipramine? What is its brand name?
Surmontil, a TCA
What is nortriptyline? What is its brand name?
TCA, Pamelor
What is Clomipramine? What is its brand name?
TCA, ANafranil
What is Doxepin? What is its brand name?
TCA, Sinequan
TCA least likely to cause orthostatic hypotension
Nortriptyline
TCA least sedating, least anticholinergic side efects
Desipramine
TCA most serotonin specific, useful in treating OCD?
Clomipramine
SSRI for treating OCD
Fluvoxamine
Side effects of TCA
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
Mechanism of TCAs
Inhibit reuptake of NE and serotonin (increase availability in synapse)
Hallmark of TCA toxicity on EKG, used as threshold to treatment
Wide QRS (>100 msec)
Mainstay of treatment of TCA overdose
IV sodium bicarbonate
Mechanism of MAOIs
Prevent inactivation of biogenic amines: NE, serotonin, dopamine, tyramine
Inhibition of MAO-A deactivates ___.
serotonin, as well as dopamine and tyramine
Inhibition of MAO-B increases ___.
NE, Epi, as well as dopamine and tyramine
Side effects of MAOIs
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
Symptoms of serotonin syndrome
Lethargy
Restlessness
Confusion
Flushing
Diaphoresis (sweating)
Tremor
Myoclonic jerks
Progression to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death.
Tyramine rich foods
red Chianti wine, cheese, chicken liver, fava beans, cured meats --> buildup of stored catecholamines (lead to hypertensive crisis with MAOIs)
Sympathomimetics in common over the counter _____ medications.
Cold medications

Can cause hypertensive crisis if taken with MAOIs
Mechanism of SSRIs
Inhibit presynaptic serotonin pumps--> increased availability of serotonin in synaptic clefts.
SSRI with longest half-life with active metabolites (do not need to taper)
fluoxetine (prozac)
What is sertraline? What is its brand name?
SSRI
Zoloft
What is Paroxetine? What is its brand name?
SSRI
Paxil
What is fluvoxamine? What is its brand name? What is it used for?
SSRI
Luvox
Only for treating OCD
Two drugs to treat OCD
Clomipramine (Anafranil)--TCA
Fluvoxamine (Luvox)--SSRI
What is citalopram? What is its brand name and claim to fame?
SSRI
Celexa
Used in Europe for 12 yrs before approved by FDA
Cheaper cousin of escitalopram (Lexapro)
What is escitalopram? What is its brand name and claim to fame?
SSRI
Lexapro
Levo enantiomer of citalopram (celexa), fewer side effects, similar efficacy, increased $$$
Side effects of SSRIs
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)
Name of an SNRI and its use
Venlafaxine (effexor)
Serotonin NE reuptake inh
refractory depression and CAP
Use of MAOIs
refractory depression
refractory panic disorder
SFX of venlafaxine
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)
Name of an NDRI and its use
Buproprion is a NE dopamine reuptake inhibitor
NO sexual side effects
Smoking cessation, adult ADHD, SAD
SFX buproprion
seizures, psychosis
Contra in anxiety, anorexia, epilepsy, currently on MAOI
Name an SARI and its use
Nefazodone and trazodone (serzone, desyrel)
Refractory major depression
Atypical antipsychotic with low incidence of EPS and TD
Clozapine, Quetiapine
Atypical that can cause cataracts
Quetiapine
Atypical that can cause QTc prolongation
Ziprasidone
Atypical antipsychotic approved for depression augmentation
Aripiprazole
Atypical with less incidence of metabolic syndrome and hyperprolactinemia
Aripiprazole
Active metabolite of risperdone that has no effect on liver
invega
Atypical that is the hardest to monitor
Clozapine
If no other antipsychotic works, this one will
Clozapine
Atypical effective for tardive dyskinesia
Clozapine
Antipsychotic that can cause liver toxicity
Olanzapine
Monitor LFTs
Atypical that causes the most weight gain
Olanzapine
How to monitor Clozapine
CBC, ANC q week x 6 months
q 2 weeks x 1 year
q month after that
CBC and ANC levels needed for Clozapine
CBC > 3500
ANC > 2000
Atypical that acts more like typical antipsychotics at > 6 mg
Risperdone (EPS, TD)
What receptors do atypical antipsychotics work on?
Not as potent on DA receptors as typicals, but does block DA.
Blocks serotonin 5HT2
What does blocking serotonin 5HT2 receptors do?
Sedation
Nausea
Anticholinergic side effects
Atypical with a 1% incidence of agranulocytosis
Clozapine
Atypical with a 2-5% chance of seizures
Clozapine
Psych pt with fever and fast heart rate is sweaty and rigid. He has an obvious tremor. What labs do you draw?
Check CPK and WBC. If pt has leukocytosis (increased WBC) and elevated CPK, it is neuroleptic malignant syndrome
Treatment for neuroleptic malignant syndrome.
Discontinue current medications
Supportive care (cooling, hydration)
Sodium dantroline, bromocriptine, amantadine.
Uses of mood stabilizers (besides the obvious)
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.
What are the mood stabilizers?
Lithium
Carbamazepine
Valproic Acid
Side effects of lithium
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
Side effects of carbamazepine
Leukopenia
Hyponatremia
Aplastic anemia
Agranulocytosis
Skin rash
Drowsiness
Ataxia
Slured speech
Neural tube dfx in babies
Uses of carbamazepine
Mixed episodes and rapid-cycling bipolar d/o
Uses of lithium
Acute mania
Prophylaxis for manic and depressive episodes in bipolar
Onset of action of lithium and carbamazepine
5 to 7 days
What is the therapeutic range for lithium?
0.7 to 1.2
Toxic lithium levels
> 1.5
Lethal lithium levels
> 2
TCA for noctournal enuresis
Imipramine
TCA for ADHD and tics
Imipramine
2 TCAs for pain and insomnia
Amitriptyline and nortriptyline
How many grams of TCAs are fatal?
2-3 g
Treatment for TCA overdose
IV sodium bicarbonate
Can a patient who got neuroleptic malignant syndrome (NMS) on haldol take haldol again later?
Yes. It is not an allergic reaction.
What is tardive dyskinesia
Writing movements (choreoathetoid) of mouth and tongue
Who gets TD (tardive dyskinesia) the most?
People who have used neuroleptics more than 6 months.
Older women.
How often does TD spontaneous remit?
50% of the time. But if untreated it can be permanent
Baseline tests before giving lithium?
EKG
Pregnancy test
TSH
BUN, Cr
Electrolytes
ECG
How often do you check lithium levels?
q month x 3 months
q 3 months after that