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53 Cards in this Set
- Front
- Back
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Methylphenidate
(Ritalin) |
↑presynaptic NE vesicular release (like amphetamines)
ADHD |
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Atomoxene
(Strattera) |
norepi reuptake inhibitor
ADHD, Mixed Panic Disorder SE: tachy and hypertension (norepi effect) |
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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 |
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Trifluoperazine
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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 |
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Fluphenazine
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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 |
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Pimozide
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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 |
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Chlorpromazine
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Typical antipsychotic- low potency
Block D2 receptors: ↑intracellular cAMP Schizophrenia (positive symptoms), Tourette's syndrome Tox: lower chance of neurologic side effects, Corneal deposits |
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Thioridazine
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Typical antipsychotic- low potency
Block D2 receptors: ↑intracellular cAMP Schizophrenia (positive symptoms), Tourette's syndrome Tox: lower chance of neurologic side effects, reTinal deposits |
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Extrapyramidal System (EPS) Side Effects
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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 |
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Neuroleptic Malignant Syndrome (NPS)
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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 |
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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 |
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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 |
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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 |
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Quetiapine
(Seroquel) |
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, Insomnia, Panic attacks SE: low incidence of EPS |
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Aripiprazole
(Abilify) |
Atypical antipsychotic: block 5HT-2, α, H1, and dopamine receptors
Schizo, can be activating SE: nausea- use phenergan |
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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 |
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Palperidone
(Invega- PO) (Invega Sustenna- IM) |
Atypical Antipsychotic
Long acting Risperidone |
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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 |
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Lithium
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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 |
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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 |
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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 |
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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) |
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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 |
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Gabapentin
(Neurontin) |
Structure similar to GABA
Mood Stabilizer (1st line in PREGNANCY)- not good for anything else really, Chronic pain SE: agranulocytosis |
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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 |
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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 |
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Imipramine
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TCA (3°)
Major depression, BEDWETTING, chronic pain SE: more anticholinergic effects and sedation |
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Amitriptyline
(Elavil) |
TCA (3°)
Depression, headaches, insomnia SE: more anticholinergic and sedating |
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Desipramine
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TCA
Major depression SE: least sedating TCA |
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Nortriptyline
(Pamelor) |
TCA (2°)
Atypical depression, headaches, panic attack good for ELDERLY SE:lowest side effects of TCAs |
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Clomipramine
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Tricyclic antidepressant: blocks reuptake of NE and 5HT
Major depression, OCD good for OCD |
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Doxepin
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TCA
Depression |
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Amoxepine
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TCA
Depression |
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SSRI's
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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 |
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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 |
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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 |
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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 |
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Fluvoxamine
(Luvox) |
SSRI
Depression, anxiety, OCD |
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Citalopram
(Celexa) |
SSRI
OCD, depression, anxiety highly serotonergic, few drug interactions- good for pt.'s with many comorbidities Specific SE: variable response |
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Escitaprolam
(Lexapro) |
SSRI
Depression, Anxiety, OCD purest, best tolerated, most serotonergic SSRI stereoisomer of citalopram (Celexa) |
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How long does it take to antidepressants to take their effects?
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2-3 weeks
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Serotonin Syndrome
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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 |
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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 |
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Duloxetine
(Cymbalta) |
SNRI: serotonin and norepi reuptake inhibitor; strong norepi action
Depression, Diabetic Neuropathy SE: very nauseating avoid in renal failure and thioridazine use |
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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 |
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Tranylcypromine
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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 |
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Isocarboxazid
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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 |
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Selegiline
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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 |
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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 |
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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 |
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Maprotiline
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Blocks NE reuptake
Depression Tox: orthostatic hypertension |
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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 |
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Nefazodone
(Serzone) |
Polycyclic that blocks 5HT reuptake; alpha1 agonist
Anxiety in Bipolars SE: sedation, HEPATIC failure |
