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33 Cards in this Set
- Front
- Back
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TCAs
Drug Names (7) and distinguishing characteristics |
- Imipramine (Tofranil)
- Amitryptyline (Elavil) - Trimipramine (Surmontil) - Nortryptyline (Pamelor): least likely to cause orthostatic hypotension - Desipramine (Norpramin): least sedating, least anticholinergic - Clomipramine (Anafranil): good for OCD - Doxepin (Sinequn) |
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TCAs
1. MOA 2. Side Effects (a-f) 3. Treatment of OD 4. Use |
1. Inhibit reuptake of NE and 5HT, increasing availability in synapse
2a. Antihistamine props (sedation) 2b. Antiadrenergic (orthostatic hypotension, tachycardia, arrhythmia) 2c. Antimuscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia) 2d. Weight gain 2e. LETHAL IN OD 2f. Complications (3 C's): convulsions, coma, cardiotox 3. IV sodium bicarbonate 4. Rarely 1st-line |
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MAOIs
Drug Names (3) |
- Phenelzine (Nardil)
- Tranylcypromine (Parnate) - Isocarboxazid (Marplan) |
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MAOIs
1. MAO 2. Side Effects (a-f) 3. Use |
1. Prevent inactivation of biogenic amines (NE, DA, 5-HT, tyramine). Irreversibly inhibits MAO-A (for 5-HT) and MAO-B (for NE/Epi)
2a. Orthostatic hypotension 2b. Drowsiness 2c. Weight gain 2d. Sexual dysfunction 2e. Dry mouth 2f. Sleep dysfunction 3. Rarely 1st-line, but good for refractory depression and refractory panic disorder |
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Serotonin Syndrome
1. When it happens 2a. Symptoms (minor) 2b. Symptoms (severe) 3. First step in treatment |
1. When SSRIs and MAOIs taken together
2a. Lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks 2b. May progress to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death 3. DISCONTINUE MEDICATION |
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Hypertensive Crisis
1. When it happens 2. Specific triggers |
1. Risk when MAOIs are taken with tyramine-rich foods (tyramine is an intermediate in conversion of tyrosine to NE) or sympathomimetics
2. Red wine, cheese, chicken liver, fava beans, cured meats, or OTC cold remedies (containing sympathomimetics) |
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SSRIs
1. MOA 2. Advantages over other antidepressants |
1. Inhibit presynaptic serotonin pumps --> increased availability in synaptic clefts
2. Low incidence of side effects, no food restrictions, much safer in OD |
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SSRIs
1. Drug Names (6) and distinguishing characteristics |
- Fluoxetine (Prozac): longest t1/2
- Sertraline (Zoloft): highest risk of GI side effects - Paroxetine (Paxil) - Fluvoxamine (Luvox): only approved for OCD - Citalopram (Celexa) - Escitalopram (Lexapro) |
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SSRIs
1. Side effects (6) |
1a. Sexual dysfunction
1b. GI disturbance 1c. Insomnia 1d. Headache 1e. Anorexia, weight loss 1f. Serotonin syndrome (when used with MAOIs) |
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SNRIs
1. Drug name 2. Use 3. Side effects (3) |
1. Venlafaxine (Effexor)
2. Good for refractory depression 3a. Similar to SSRIs 3b. Can increase BP 3c. Withdrawal syndrome (flulike sympts and electric-like shocks or zaps) |
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Bupropion (Wellbutrin)
1. MOA 2. Side effects (3) 3. Use |
1. Increases NE and DA by unknown mechanism
2a. Stimulant effects (tachycardia, insomnia) 2b. Headache 2c. Risk for seizure and psychosis at high doses 3. Smocking cessation, seasonal affective disorder, ADHD |
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Trazadone (Desyrel)
1. MOA 2. Side effects (6) 3. Use |
1. Inhibits 5-HT uptake
2a. Nausea 2b. Dizziness 2c. Orthostatic hypotension 2d. Cardiac arrhythmia 2e. SEDATION 2f. PRIAPISM 3. Refractory major depression, insomnia |
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Mirtazapine (Remeron)
1. MOA 2. Side effects (7) 3. Use |
1. a2 antagonist (increases release of NE and 5-HT)
2a. Sedation 2c. WEIGHT GAIN 2d. Dizziness 2e. Somnolence 2f. Tremor 2g. Agranulocytosis 3. Refractory major depression |
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Typical vs. Atypical Antipsychotics
What is the difference? Do they treat positive or negative psychotic symptoms? |
Traditional: classified by potency (low and high), block DA receptors
Atypical: block both DA and 5-HT receptors, but effect on DA is weaker --> fewer side effects BOTH treat POSITIVE PSYCHOTIC SYMPTOMS (hallucinations, delusions), use atypicals for negative symptoms |
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Low Potency Traditional Antipsychotics
1. Drug names (2) 2. Side effects (very general --> high vs. low incidence) |
1a. Chlorpromazine (Thorazine)
1b. Thioridazine (Mellaril) 2a. High incidence: anticholinergic and antihistaminic 2b. Low incidence: extrapyramidal side effects, neuroleptic malignant syndrome |
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High Potency Traditional Antipsychotics
1. Drug names 2. Side effects (very general --> high vs. low potency) |
1a. Haloperidol (Haldol)
1b. Fluphenazine (Prolixin) 1c. Trifluoperazine (Stelazine) 1d. Perphenazine (Trilafon) 1e. Pimozide (Orap) 2a. High incidence: extrapyramidal side effects, neuroleptic malignant syndrome 2b. Low incidence: anticholinergic and antihistaminic |
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Traditional Antipsychotics
Important Side Effects (9) |
1. Antidopaminergic effects - extrapyramidal symptoms
2. Anti-HAM (Histaminic, Adrenergic, Muscarinic) 3. WEIGHT GAIN 4. Elevated liver enz, jaundice 5. Optho problems - thioridazine: irreversible retinal pigmentation - chlorpromazine: deposits in lens and cornea 6. Dermatologic problems: rashes, photosensitivity, also blue-gray skin discoloration w/ chlorpromazine 7. Seizures: lower seizure threshold, more likely with low potency 8. Tardive dyskinesia 9. Neuroleptic malignant synd |
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Extrapyramidal Side Effects of Traditional Antipsychotics (4)
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1. Parkinsonism: masklike face, cogwheel rigidity, pill-rolling tremor
2. Akathisia: subjective anxiety adn restlessness, fidgetiness 3. Dystonia: sustained contraction of muscles of neck, tongue, eyes (painful) 4. Hyperprolactinemia Tx: decrease dose of drug and give antiparkinsonian (amantadine), anticholinergic (benztropine), or antihistaminic (benadryl) meds |
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Anti-HAM Side Effects of Traditional Antipsychotics
3 Categories |
1. Antihistaminic: sedation
2. Anti-alpha adrenergic: orthostatic hypotension, cardiac abnormalities, sexual dysfxn 3. Antimuscarinic-Anticholinergic: dry mouth, tachycardia, urinary retention, blurry vision, constipation |
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Tardive Dyskinesia
1. What is it? 2. Prognosis 3. Treatment |
1. Choreoathetoid (writhing) movements of mouth and tongue, may occur after 6 months of neuroleptic use, often in older women
2. 50% cases spontaneously remit, 50% are permanent 3. D/c medication, sometimes administer anxiolytics or cholinomimetics |
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Neuroleptic Malignant Syndrome
1. Susceptible group of patients 2. Mneumonic 3. Treatment |
1. Males early in treatment with neuroleptics - 20% mortality if untreated
2. F: fever A: autonomic instability (tachycardia, hypertension, diaphoresis) L: leukocytosis T: tremor E: elevated CPK R: rigidity 3. D/c meds, supportive (hydration/cooling), Dantrolene **Note: NOT an allergic rxn |
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Atypical Antipsychotics
1. Use 2. Drug-specific side effects (3) |
1. Treats positive AND negative sympts of schitzophrenia (1st line treatment)
2a. Clozapine: agranulocytosis, seizures 2b. Olanzapine: hyperlipidemia, glucose intolerance, weight gain, liver tox 2c. Quetiapine: cataracts |
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Mood Stabilizers (3)
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1. Lithium
2. Carbamazepine 3. Valproic acid |
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Lithium
1. MOA 2. Therapeutic window 3. Side effects: important ones (2), others (9) 4. Toxicity (4) |
1. Unknown: thought to alter neuronal Na+ transport
2. 0.7-1.2 (toxic > 1.5, Lethal > 2.0) 3a. Important: Hypothyroidism, nephrogenic DI 3b. Others: tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, GI problems 4. Altered mental status, coarse tremors, convulsions, death |
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Carbamazepine (Tegretol)
1. MOA 2. Important side effects (5) 3. Monitoring |
1. Blocks Na+ channels and inhibits action potentials
2. Leukopenia, hyponatremia, aplastic anemia, agranulocytosis, and teratogenic (neural tube defects) 3. CBC and LFTs |
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Valproic Acid (Depakene)
1. MOA 2. Important side effects (5) 3. Monitoring |
1. Increases Na+ channel inactivation, increase GABA concentration
2. Hepatotoxicity, thrombocytopenia neural tube defects in fetus, tremor, weight gain 3. CBC and LFTs |
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Benzodiazepines
1. MOA 2. Use 3. Side effects (3) 4. Toxicity (1) |
1. Facilitate GABA by increasing the FREQUENCY of Cl- channel opening
2. First-line anxiolytic 3. Drowsiness, impairment of intellectual function, reduced motor coordination 4. Respiratory depression, esp with alcohol use |
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Long Acting BDZs (3)
How long do they last? And what they are used for? |
**Last 1-3 days
1. Chlordiazepoxide (Librium): used in alcohol detox, presurg anxiety 2. Diazepam (Valium): rapid onset, used for anxiety and seizure control 3. Flurazepam (Dalmane): rapid onset, insomnia |
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Intermediate Acting BDZs (4)
How long do they last? And what they are used for? |
**Last for 10-20 Hours
1. Alprazolam (Xanax): panic attack 2. Clonazepam (Klonopin): panic attack, anxiety 3. Lorazepam (Ativan): panic attack, alcohol withdrawal 4. Temazepam (Restoril): insomnia |
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Short Acting BDZs (2)
How long do they last? And what they are used for? |
**Last for 3-8 Hours
1. Oxazepam (Serax) 2. Triazolam (Halcion): rapid onset, insomnia |
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Zolpidem (Ambien) / Zaleplon (Sonata)
1. MOA 2. Use 3. Withdrawal/dependence |
1. Binds BZD site on GABA receptor
2. Short-term treatment of insomnia 3. No withdrawal effects, little/no tolerance/dependence |
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Buspirone (BuSpar)
1. MOA 2. Use 3. Abuse potential |
1. Partial agonist at 5HT-1A receptor
2. Generalized anxiety disorder 3. Low potential for abuse/addiction, does NOT potentiate CNS depression of alcohol |
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Propranolol
1. MOA 2. Use |
1. Beta blocker
2. To treat autonomic effects of panic attacks/performance anxiety --> palpitations, sweating, tachycardia |
