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53 Cards in this Set

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Methylphenidate
(Ritalin)
↑presynaptic NE vesicular release (like amphetamines)
ADHD
Atomoxene
(Strattera)
norepi reuptake inhibitor
ADHD, Mixed Panic Disorder

SE: tachy and hypertension (norepi effect)
Haloperidol
(Haldol)
Typical antipsychotic- high potency
Block D2 receptors: ↑intracellular cAMP; alpha1 blockage
Acute psychosis, acute mania, Tourettes (vocal tics)

Tox: stored in body fat, EPS, hyperprolactinemia, dry mouth, constipation, hypotension, sedation, Neuroleptic Malignant Syndrome, Tardive Dyskinesia
Trifluoperazine
Typical antipsychotic- high potency
Block D2 receptors: ↑intracellular cAMP
Schizophrenia (positive symptoms), Tourette's syndrome

Tox: stored in body fat, EPS, hyperprolactinemia, dry mouth, constipation, hypotension, sedation, Neuroleptic Malignant Syndrome, Tardive Dyskinesia
Fluphenazine
Typical antipsychotic- high potency
Block D2 receptors: ↑intracellular cAMP
Schizophrenia (positive symptoms), Tourette's syndrome

Tox: stored in body fat, EPS, hyperprolactinemia, dry mouth, constipation, hypotension, sedation, Neuroleptic Malignant Syndrome, Tardive Dyskinesia
Pimozide
Typical antipsychotic- high potency
Block D2 receptors: ↑intracellular cAMP
Schizophrenia (positive symptoms), Tourette's syndrome

Tox: stored in body fat, EPS, hyperprolactinemia, dry mouth, constipation, hypotension, sedation, Neuroleptic Malignant Syndrome, Tardive Dyskinesia
Chlorpromazine
Typical antipsychotic- low potency
Block D2 receptors: ↑intracellular cAMP
Schizophrenia (positive symptoms), Tourette's syndrome

Tox: lower chance of neurologic side effects, Corneal deposits
Thioridazine
Typical antipsychotic- low potency
Block D2 receptors: ↑intracellular cAMP
Schizophrenia (positive symptoms), Tourette's syndrome

Tox: lower chance of neurologic side effects, reTinal deposits
Extrapyramidal System (EPS) Side Effects
From Antipsychotics:
4 hours: acute dystonia (muscle spasm)- Rx benztropine, trihexyphenidyl, diphenhydramine
4 days: akinesia (parkinsonian symptoms)- Rx anticholinergics
4 weeks: akathisia (restlessness)- Rx propranolol, benzos
4 months: tardive dyskinesia (stereotypic oral movements, often irreversible)- Rx change to clonipine

DO NOT give bromocriptine nor L-dopa b/c they will precipitate psychosis
Neuroleptic Malignant Syndrome (NPS)
From typical/atypical antipsychotics, metoclopramide, abrupt end to antiparkinson drugs. Onset is days to weeks.

Symptoms: FEVER
Fever
Encephalopathy
Vitals unstable
Elevated enzymes (myoglobinuria)
Rigidity of muscles

Other sx: rhabdomyolysis, renal failure, myoglobinuria, elevated CPK

Rx: dantrolene, bromocriptine
Olanzapine
(Zyprexa)
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, OCD, anxiety, depression, mania, Tourette's

SE: weight gain due to insatiable appetite, glucose intolerance, ketoacidosis, metabolic syndrome

Mgmt: good for EMERGENCY calm downs (sublingual) and for those on ICE, similar to clozapine w/o risk of agranulocytosis
Clozapine
(Clozaril)
Atypical antipsychotic: block 5HT-2, α, H1, and D4 receptors
Schizo (both positive and negative symptoms)

Tox: AGRANULOCYTOSIS (regular cbc's) but see neutropenia first, arrhythmias (inc. QT interval), seizures, least likely atypical to cause EPS
Risperidone
(Risperdal)
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, Conduct disorder, stubborn hallucinations
Good for KIDS AND ELDERLY

SE: most likely atypical to cause EPS but still low, weight gain

Risperidal Consta= IM q 2weeks
Quetiapine
(Seroquel)
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, Insomnia, Panic attacks

SE: low incidence of EPS
Aripiprazole
(Abilify)
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, can be activating

SE: nausea- use phenergan
Ziprasidone
(Geodon)
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, Mania

SE: prolonged QT interval

Mgmt: fast acting; 20 in the butt is 60 in the gut
Palperidone
(Invega- PO)
(Invega Sustenna- IM)
Atypical Antipsychotic
Long acting Risperidone
Valproic Acid
(Depakote ER)
↑Na channel inactivation, ↑ GABA concentration
Bipolar, better in mixed mania and rapid cycling
Seizures

SE: HEPATOTOX, sedation, thrombocytopenia, pancreatitis
Teratogenic- NTDs, excreted in breast milk

Mgmt: metabolized by P450, measure blood levels,
Monitor CBC, LFTs, PT
Lithium
Inhibition of phosphoinositol cascade- blocks excitatory activity
Bipolar disorder, manic events- rarely used now, only to augment SSRI's or MAOI's
SIADH because it is an ADH antagonist

SE: HYPOTHYROIDISM, DIABETES INSIPIDUS, fine tremor, sedation, edema, benign leukocytosis, weight gain cardiac arrhythmias- flat or inverted T wave, DIARRHEA (main cause of noncompliance), lowers seizure threshold
Tertogenic- cardiac defects (Ebstein's anomaly), cleft palate, excreted in milk
Mgmt: narrow therapeutic window- titrate using blood levels, measure renal function

Tox can be caused by Thiazide diuretics (Li follow Na resorption) & NSAIDS & ACE inhibitors
Carbamazepine
(Tegretol)
Decreases Na channel firing
Bipolar (2nd line)/ MOOD STABILIZER, Alcohol withdrawal, Seizures

SE: ataxia, confusion, tremors, Stevens-Johnson syndrome, AGRANULOCYTOSIS, APLASTIC ANEMIA, bone marrow suppression, hepatitis

Mgmt: regular CBC, LFT's
Oxcarbamazepine
(Trileptal)
Decreases sodium, increases Ca, potentiates GABA
MOOD STABILIZER, Benzo withdrawals, Seizures

SE: ataxia, confusion, tremors, Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, hepatitis, hyponatremia

Mgmt: regular CBC, LFT's
Topiramate
(Topomax)
Decrease sodium and calcium, potentiates GABA, decreases glutamate, carbonic anhydrase inhibtor (anti-migraine)
Mood stabilizer, seizures, migraine
Causes weight loss

SE: cognitive confusion (dopomax)
Lamotrigine
(Lamictal)
Decreases Na channel firing
Bipolar (1ST LINE), obliterates depression

SE: rash,elevates LFTs, blurry vision, Stevens-Johnson

Mgmt: P450 metabolized, add slowly b/c of rash chance- takes longer to see effect
Gabapentin
(Neurontin)
Structure similar to GABA
Mood Stabilizer (1st line in PREGNANCY)- not good for anything else really, Chronic pain

SE: agranulocytosis
Buspirone
(Buspar)
Parital 5HT-1A receptor agonist
General anxiety disorder, mood stabilizer in kids, augment SSRI's
Favored in patients w/ hx of substance abuse

No sedation, no addiction, no interactions w/alcohol
Slow onset of action- not useful in panic disorder
Tricyclic Antidepressants
(TCAs)
Blocks reuptake of NE and 5HT, M1 antagonist, α1 antagonist, H1 antagonist
Major depression, chronic pain

SE: sedation, seizures, respratory depression, antiadrenergic, anticholinergic

Tox: Tri C's: Convulsions, Coma, Cardiac Arrhythmias (blockade of fast Na channels)
Use NaHCO3 for toxicity

Mgmt: Lethal in overdose, thus titrate slowly.
Check ECG before starting and afte a few days
Imipramine
TCA (3°)
Major depression, BEDWETTING, chronic pain

SE: more anticholinergic effects and sedation
Amitriptyline
(Elavil)
TCA (3°)
Depression, headaches, insomnia

SE: more anticholinergic and sedating
Desipramine
TCA
Major depression

SE: least sedating TCA
Nortriptyline
(Pamelor)
TCA (2°)
Atypical depression, headaches, panic attack
good for ELDERLY

SE:lowest side effects of TCAs
Clomipramine
Tricyclic antidepressant: blocks reuptake of NE and 5HT
Major depression, OCD
good for OCD
Doxepin
TCA
Depression
Amoxepine
TCA
Depression
SSRI's
Selective Serotonin Reuptake Inhibitor
Depression, Anxiety, OCD, PTSD

SE: sexual dysfunction, weight gain, agitation, akathisia (neuromuscular restlessness), Serotonin Syndrome (fever, myoclonus, MYDRIASIS, DIARRHEA, seizures, agitation, flushing, cardiovascular collapse)

Pros: very easy and safer than TCA's when overdosed
Cons: sexual dysfunction is common cause of noncompliance, inc suicide risk in children and teens
Fluoxetine
(Prozac)
SSRI: selective serotonin reuptake inhibitor
Depression, OCD, bulimia, body dysmorphic disorder
Good for stubborn disorders

Specific SE: agranulocytosis but see neutropenia first, weight gain

Long lasting- can be used as once weekly dosing
Approved for use in children older than 8yrs old
Use to induce male sexual dysfunction for child molestors
Most contraindicated SSRI for bipolar
Paroxetine
(Paxil)
SSRI
Depression, OCD, Panic, Pain
SEDATING, Anti-pain (due to antihistamine property)

Specific SE: may make anhedonia worse, HYPONATREMIA, SiADH, withdrawal symptoms

Treat as pregnancy cat D- very bad for fetus
Sertraline
(Zoloft)
SSRI- most prescribed
Depression, OCD, panic (use with tapering clonazapam)
Good for post-MI pt.

Most activating SSRI= low weight gain, less sexual dysfunction
Fluvoxamine
(Luvox)
SSRI
Depression, anxiety, OCD
Citalopram
(Celexa)
SSRI
OCD, depression, anxiety
highly serotonergic, few drug interactions- good for pt.'s with many comorbidities

Specific SE: variable response
Escitaprolam
(Lexapro)
SSRI
Depression, Anxiety, OCD
purest, best tolerated, most serotonergic SSRI

stereoisomer of citalopram (Celexa)
How long does it take to antidepressants to take their effects?
2-3 weeks
Serotonin Syndrome
From SSRIs, TCAs, MAOIs, SNRIs, meperidine
Onset hours to days

Symptoms: fever, myoclonus, MYDRIASIS, DIARRHEA, seizures, agitation, flushing, cardiovascular collapse

Rx: Cyproheptadine- 5HT2 & H1 antagonist
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
SNRI: serotonin and norepi reuptake inhibitor
Depression, Anxiety

SE: ↑diastolic BP, stimulant effects (insomnia, agitation, headache, nausea)

Bad DISCONTINUATON SYNDROME of SHOCKS and flu-like symptoms if not tapered
Duloxetine
(Cymbalta)
SNRI: serotonin and norepi reuptake inhibitor; strong norepi action
Depression, Diabetic Neuropathy

SE: very nauseating
avoid in renal failure and thioridazine use
Phenelzine
(Nardil)
MAOI: monoamine oxidase inhibitor= ↑amine neurotransmitter
Atypical depression, phobic anxiety, hypochondriasis

Tox: HYPERTENSIVE CRISIS w/ tyramine ingestion (wine & cheese), sympathomemetics, dentists.
Early abortive measure: Nifedipine sublingual

Contra with SSRIs and meperidine to prevent Serotonin Syndrome
Tranylcypromine
MAOI: monoamine oxidase inhibitor= ↑amine neurotransmitter
Atypical depression, anxiety, hypochondriasis

Tox: HYPERTENSIVE CRISIS w/ tyramine ingestion (wine & cheese), contra with SSRIs and meperidine to prevent Serotonin Syndrome
Isocarboxazid
MAOI: monoamine oxidase inhibitor= ↑amine neurotransmitter
Atypical depression, anxiety, hypochondriasis

Tox: HYPERTENSIVE CRISIS w/ tyramine ingestion (wine & cheese), contra with SSRIs and meperidine to prevent Serotonin Syndrome
Selegiline
Selective MAO-B Inhibitor: ↑dopamine
Atypical depression, Parkinson's

Tox: HYPERTENSIVE CRISIS w/ tyramine ingestion (wine & cheese), contra with SSRIs and meperidine to prevent Serotonin Syndrome
Buprupion
(Wellbutrin)
(Zyban)
↑NE and dopamine- inhibited reuptake; anorexigenic effect
Depression, smoking cessation (Zyban), ADHD, female Viagra, Seasonal Affective Disorder
Good for Kids (ADHD) and Bipolars (won't tip to mania)

SE: SEIZURES, no sexual effects, aggravation of psychosis, tachy, agitation, dry mouth
Mirtazapine
(Remeron)
α2 antagonist: ↑release of NE and 5HT; potent 5HT-2 antagonist
Depression @ high doses and Sedation @ low doses
Higher doses are less sedating
Effective at treating anxiety in bipolar w/o causing mania

SE: agranulocytosis, sedation, ↑appetite, weight gain, little sexual dysfunction
No GI problems- used to settle stomach
Maprotiline
Blocks NE reuptake
Depression
Tox: orthostatic hypertension
Trazodone
(Desyrel)
Polycyclic that blocks 5HT reuptake
Insomnia, Depression
Excellent sleep aid, unlikely to tip bipolars to mania

SE: sedation, priapism (prolonged erection= trazoBONE), weight gain, postural hypotension
Nefazodone
(Serzone)
Polycyclic that blocks 5HT reuptake; alpha1 agonist
Anxiety in Bipolars

SE: sedation, HEPATIC failure