Pharm Exam 3 Drugs For Anxiety, Depression, And Psychosis

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Antidepressant Classes

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**SSRI
SNRIS
NDRI
**Tricyclic antidepressants
Monoamine Oxidase Inhibitors

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SSRI

Back 2

First line therapy

used for depression, panic, OCD, PTSD, bulimia nervosa, social phobia.

side effects: low risk in overdose, drowsiness or agitation, headaches, sexual dysfunction esp decreased libido and ability to orgasm (reason most people stop taking this drug), GI distress, Hyponatremia, Anticholenergic SEs (cant pee cant poop, cant spit)

Front 3

Types of SSRI

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Vilazodone (Viibyrd)
Citalopra (Celexa)
Escitalopran (Laprexo)
Fluvaxamine (Paxil)=pregos aviod
Sertraline (Zoloft)
Fluoxetine (Prozac)=may cause unusual excitement , restlessness, irritability, and trouble sleeping in younger kids.

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SSRI

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-takes about 3-4 weeks to work
-avoid alcohol and may have increased suicide -ideations
-Risk for serotonin syndrome
-vital signs skyrocket, tremors, shaky, hyperactive reflexes, diarrhea, n and v, confusion.

WAIT 2 WEEKS TO TAKE MORE SERITONIN AFTER STOPPING

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SNRI
(serotonin and norepinephorine reuptake inhibitors)

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Duloxetine (Cymbalta)
Venalfaxine (Effexor XR)=may slow growth and weight gain in kids
Desvenlafaxine (Pristiq)

Effexor and Cymbalta may causes brain shocks if stopped abruptly

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NDRI
(norepinephorine/dopamine reuptake inhibitor)

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Buropion (Wellbutrin)
this drug can also help with smoking cessation.

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SNRIs AND NDRIs

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give in the morning these tend to affect sleep

side effects are hypotension, nausea, insomnia, sweating, agitations, headache, sexual dysfunction but not as bad a SSRI
SEIZURES= WELBUTRINE has an increased risk for seizures and is never given to a person with a history of seizures head injury or eating disorder.

Front 8

TCAs

end in (il)

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These are a second line therapy antidepressants

Amitriptyline (Elavile)
Clomipramine (Anafranil)=only one effective in OCD
Desipramine (Norpramin)
Imipramine (Tofanil)
Nortriptyline (Aventyl)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

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TCAs
end in il

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side effects:
high risk in overdose, VERY CARDIOTOXIC, orthostatic hypotension, antichlolenergic effects (cant pee, poop, spit), sedation** give to patient at night, dizziness,

-don't not drink with alcohol because drug decreased hr. already so pt is at increased fall risk.
-don't give in someone with cardiac abnormalities.

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MAOIs

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this is a third line drug type

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Edepryl, Emsam)
Tranylcypromine (Parnate)

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MAOIs

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SIDE EFFECTS:
insomnia
nausea, gi distress, agitation, confusion ***increased risk for hypertensive crisis.
a lot of drug interactions
avoid tyramine containing foods
GO TO ER IF YOU HAVE SEVERE HEADACHE
monitor bp closely during the 1st six weeks of treatment
-maintain food and drug restriction for 14 days after stopping the meds.

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Bipolar Drugs

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Lithium
Several types of anticonvulsants
Atypical antipsychotics
Benzodiazepines
Calcium channel blockers

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Lithium

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first line treatment for acute mania and for long term prevention
-it is a naturally occurring salt and has a role in treating may conditions
therapeutic range 0.5-1.2mEq/L
-when taking this drug take dose at the same time everyday and drink enough and eat enough salt.
-take measure to prevent dehydration.

levels greater than 2.5 can cause convulsions, oliguria, and death.

Front 14

Lithium

Back 14

Side effects:
weight gain
electrocardiogram changes
fine hand tremors, fatigue, headache, mental dullness, lethargy
-acne and maculopapular rash
-thyroid dysfunction
DM diet or insulin therapy
gastric irritation, anorexia, cramps, nausea, vomiting, diarrhea, polyuria, polydipsia, edema.

Front 15

Lithium levels between 1.5-2.0

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side effects of toxic levels of this drug:
coarse hand tremors,
persistent GI upset
confusion,
muscle irritability
incoordination
sedation

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Lithium levels 2.0-2.5

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Toxic levels of this drug cause:
ataxia,
confusion
polyuria (dilute urine)
blurred vision
stupor
severe hypotension
coma

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Anitconvulsants.

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another type of drug that treats bipolar disorder and are mood stabilizers

Divalproex/ Valproic acid
Lamotrigine (Lamitcal)
Carbamazepine (Tegretol)

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Divalproex/ Valproic acid

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most commonly used to treat bipolar in the US
-not recommended for pt. during pregnancy because at risk for neural tube defect, spina bifida, teratogenicity category D, or in those with hepatic disease, blood dyscrasis, organic brain disease, renal function impairment.

over dose can be lethal; need lab work every 3-6months.

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Lamotrigine (Lamictal)

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great for bipolar and impulsive disorders

appears to decrease glutamate release, modulate reuptake or serotonin, generally block reuptake of monoamines, including dopamine,

side effects can cause Steven Johnson's syndrome (rash)

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Carbamazepine (tegretol)

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used for treating bipolar disorder

watch WBC count, lethal in overdose, not recommended for pregos.

peak effects are within 10 days of administrations can be used alone or in combination with other drugs.

Side effects: drowsiness, dizziness, ataxia, double vision, blurred vision, nausea, and fatigue.

Front 21

Benzodiazepine
(can also be used for static epillepticus)

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these are antianxiety drugs and can be addictive
-considered second-line agents after antidepressants in longterm therapy of teating anxiety disorders

Alprozolam (Xanax)
chlordiazepoxide (Librium)
clonazepam (Klonopin)
clorazepate (tranxene)
diazepam (Valium)
halazepam (Paxipam)
lorazepam (Ativan)
oxazepam (Serax)

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BZ Sedative Hypnotics

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another type of anti-anxiety drugs other than benzodiazepines

Estazolam (ProSom)
flurazepam (Dalmane)
temazepam (Restoril)
triazolam (Halcion)
Quazepam (Doral)

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Benzodiapines

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side effects are common, dos related, usually short term and harmless;

drowsiness, sedation, ataxia, dizziness
feelings of detachment, irritability, or hostililty
anterograde amnesia=forgetfulness
cognitive effects with long term use
tolerance, dependency, rebound insomnia/anxiety

children can become hyper
whean off because patient could have withdrawal symptoms.

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Ramazicone

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this med is to reverse a BZ overdose.

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nonbenzodiazepines (antianxiety drugs)

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buspirone (BuSpar)
propranolol (Inderal)
clonidine (catapress)
pregabalin (Lyrica)

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Nonbenzodiazepines (sedative-hypnotic agents)

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Zolpidem (Ambien)
zaleplon (sonata)
eszopicolone (Lunesta)
ramelteon (Rozerem)

-these may cause you to do crazy things at night and not remember
-may cause daytime drowsiness, dizziness and gi upset.

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Propanolol and Clonidine

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block peripheral of central nonadrenergic (norepinephrine) activity, anxiety (tremor, palpitations, tachycardia, sweating.)

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Propanolol

Back 28

test performance anxiety in some social phobia and panic disorders to decrease hr.

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Buspirone (BuSpar)

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does not exhibit muscle-relaxtant or anticonvulsant activity, interaction with CNS depressants, sedative-hypnotic properties.
-not effective to manage drug or alcohol withdrawal or panic disorder
-generally takes several weeks for antianxiety effects
not a 1 time of day med.

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Trazodone (Desyrel)

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preferred antidepressant for insomnia
mainly used as a sleep aid.
offers sedation with few cholengeric effects

side effects: orthostatic hypotension, anxiety, priapism (rare sustained, painful penile erection)

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Ramelteon (Rozerem)

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new, nonscheduled sleep aid,
specific melatonin agonist
affects endogenous melatonin system involved in regulation of circadian rhythms and sleep/wake cycle

Front 32

antipsychotic

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used for short-term in severe depression and in substance induced psychosis.
treatment of aggressiveness and behavioral problems with pervasive developmental disorders
useful in elderly pt. with dementia, delirium, and agitation, and psychosis.

help with positive and negative symptoms.

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Atypical Antipsychotics

work on both positive and negative symptoms

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Aripiprazole (Albilify)
Clozapine (Clozaril)
Paliperidone (Invega)
Risperidone (Risperdal, Consta, M-tabs)
Olanzapine (Zyprexa, Zydis)-melts in mouth
Quetiapine (Seroquel)
Ziprasidone (Geodon)

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Atypical Antipsychotics

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disadvantages of these drugs are they can result in metobolic syndrome (increased weight, blood sugar, bp, and can lead to diabetes and cardiac probs.

except for ziprasidone and aripiprozole

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antipsychotics that cause sedation

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Quetiapine (Seroquel)
Olanzapine (Zyprexa, Zydis)-melts in mouth
Clozapine (Clozaril)

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Ziprasidone (Geodon)

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this antipsychotic is associated with mild to moderate prolonged Q-T interval and may need monitoring of ECGs and cardiac functioning.

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Clozapine (Clozaril)

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this antipsychotic causes aggranulocytosis (lack of WBC) so monitor for infection

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Risperidone (Risperdal)

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antipsychotic that elevate serum prolactin levels; may cause extrapyramidal symptoms (EPS) at higher doses

causes boobs to get bigger or leak

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Typical Antipsychotics

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EPS - actue dystonic reactions, akathsia, parkinson syndrome

neuroleptic malignant syndrome
seizures,
angranulocytosis
photosensitivity, anticholinergice effects, or metabolic syndrome

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Acute Dystonic Reactions

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reversible spasms of major muscle groups of neck, back, eyes, that occur suddenly

Front 41

Torticollis

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stiffening neck

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Akathisia

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reversible
inability to remain still, feel like you are jumping out of your skin

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Parkinson Syndrome

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Reversible
touble starting movements (Akinesia)
cogwheel rigidity
fine tremor
shuffling gait

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Tardive Dyskinesia

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irreversible
can occur after use of conventional antipsychotics
involuntary movemnt of the tongue, lips, hands,
immediately stop med.