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81 Cards in this Set
- Front
- Back
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Sertraline
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SSRI
-highest risk of GI problems |
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Fluoxetine
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SSRI
-longest 1/2life w/active metabolites, so no need to taper off |
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Valproic Acid (Depakene)
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Anticonvulsant
-Tx mixed manic BP episodes and rapid-cycling BP d/o -SE = hemorrhagic pancreatitis, hepatotoxicity, thrombocytopenia, sedation, wt gain, alopecia -CI in pregnancy (NTDs) |
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High Potency Traditional Antipsychotics
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Higher affiinity for DA receptors, so lower dose needed
ex: haloperidol, fluphenazine, trifluperazine, perphenazine, pimozide -higher incidence of EPS and NMS -lower incidence of anti-cholinergic and -histaminic SE -better for Tx-ing (+) psychotic Sx |
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Carbamazepine (Tegretol)
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Anticonvulsant
-Tx mixed BP episodes and rapid-cycling BP d/o -onset of action = 5-7 days -SE = luekopenia, aplastic anemia, leukopenia, hyponatremia, rash, drowsiness, ataxia, slurred speech, inceased LFTs -CI in pregnancy (NTDs) |
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Lithium
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Mood Stabilizer
DOC for acute mania and BP d/o episode (both types) prophylaxis -onset of action = 5-7 days -very narrow therapeutic index -->always check LI levels, TSH and RFTs/GFR -->toxic levels = altered mental status, convulsions, coma, death -SE = fine tremor, sedation, ataxia, thirst, metallic tast, polyuria, edema, weight gain, GI problems, benign leukocytosis, thyroid enlargement, hypothyroid, nephrogenic DI |
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Venlafaxine (Effexor)
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SNRI (5HT/NE-Reuptake Inhibitor)
Tx depression, CAP -low interaction potential -SEs = like SSRIs, plus can increase BP -w/d Sx if off for 1-3 days -->uncomfortable but not fatal --> flulike, "electric zaps" |
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Mirazapine (Remeron)
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NASA (NE and 5HT antagonist)
Tx refractory MDD, especially in patients that need to gain weight -SE = weight gain, somnolence, sedation, tremor, dizziness, agranulocytosis -->somnolence at max w/ <15 mg doses |
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Bupropion (Wellbutrin)
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NDRI 9ne/DA Reuptake Inhibitor)
Tx Smoking cessation, SAD, ADHD -SE: like SSRIs, but NO sexual SE -->increased risk of seizure and psychosis w/high doses -not optimal for pts w/significant anxiety -CI in pts w/seizure d.o, active eating d/o or on MAO-Is |
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Nefazodone (Serzone) and Trazodone (Desyrel)
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SARI (5HT Analog and Reuptake Inhibitor)
Tx MDD w/anxiety and insomnia or refractory MDD -good w/insomnia b/c sedative SE -SE = N+V, dizziness, othostatic hypotension, sedation, arrythmias, priapism -->sedation, priapism = esp trazodone |
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Antidepressant associated w/priapism
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Trazodone
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Zolpidem (Ambien)/Zaleplon (Sonata)
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Short-term insomnia Tx
-selectively bind to GABA-R at BZD site, but not a BZD -no w/d, little to no tolerance/dependence, no rebound insomnia -no anticonvulsant or muscle-relaxant effects -sonata is new version w/shorter 1/2life |
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Buspirone
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Tx for GAD
-slower onset of action than BZDs - 1-2 weeks to take effect -partial 5HT-1A agonist -no combo effect w/EtOH -low potential for abuse/addiction |
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Propranolol
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beta-blocker
Tx autonomic effects of panic attacks or performance anxiety (palpitations, sweating, tachycardia,) Tx akathesia (SE of traditional antipsychotics) |
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"HAM" Side Effects of TCAs and Low Potency Antipsychotics
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Anti-histamine --> sedation
Anti-Adrenergic --> orthostatic hypotension Anti-Muscarinic --> dry mouth, blurred vision, urinary retention |
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Imipramine
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TCA
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Amitriptyline
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TCA
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Trimipramine
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TCA
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Nortriptyline
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TCA
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Desipramine
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TCA
-least sedating -least anticholinergic SE |
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Least sedating TCA
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Desipramine
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Clomipramine
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TCA
-esp good for OCD Tx |
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Best TCA for OCD Tx
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Clomipramine
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Doxepin
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TCA
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Phenelzine
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MAO-I
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Tranylcypromine
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MAO-I
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Isocarboxazil
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MAO-I
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Paroxetine
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SSRI
-most 5HT-specific -most stimulating |
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Most stimulating SSRI
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Paroxitine
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Most 5HT-specific SSRI
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Paroxitine
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Citalopram
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SSRI
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Fluvoxamine
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SSRI
-OCD only |
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Escitolopram
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SSRI
-low side effect profile, but very expensive |
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SSRI for OCD
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Fluvoxamine
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Chlropromazine
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Low-potency typical antipsychotic
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Thioridazine
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Low-potency typical antipsychotic
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Haloperidol
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High-potency typical antipsychotic
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Fluphenazone
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High-potency typical antipsychotic
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Trifluoperazine
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High-potency typical antipsychotic
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Perphenazine
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High-potency typical antipsychotic
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Pimozide
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High-potency typical antipsychotic
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A young M patient who just started on an antipsychotic is catatonic
-Dx -Tx |
beginning of NMS --> stop meds ASAP
-can restart same meds later safely |
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Clozapine
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Atypical antipsychotic
-SE = agranulocytosis, seizures |
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Risperidone
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Atypical antipsychotic
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Quetiapine
-possible SE = cataracts |
Atypical antipsychotic
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Olanzapine
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Atypical antipsychotic
-SE = high lipids, glucose intolerance, weight gain, hepatotoxicity |
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Ziprasidone
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Atypical antipsychotic
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Chlordiazepoxide
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Long-acting BZD
-EtOH detox -presurgery anxiety |
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BZD for presurgery anxiety
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Chlodiazepoxide
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Diazepam
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Long-acting BZD (rapid onset)
-EtOH detox -anxiety -seizures |
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EtOTH w/d Tx
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Chlordiazepoxide, Diazepam
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Flurazepam
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Long-acting BZD (rapid onset)
-Tx insomnia |
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Alprazolam
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Intermediate-acting BZD
-Tx panic attacks |
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BZDs for Panic Attacks
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Alprazolam, Clonazepam, Lorazepam
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Clonazepam
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Intermediate-acting BZD
-Tx panic attacks, anxiety |
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Lorazepam
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Intermediate-acting BZD
-Tx panic attacks, EtOH w/d |
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Temazepam
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Intermediate-acting BZD
-Tx insomnia |
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BZDs for Insomnia
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Temazepam, Flurazepam, Triazolam
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Oxazepam
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Short-acting BZD
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Triazolam
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Short-acting BZD (rapid onset)
-Tx insomnia |
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Higher addiction probability w/ ___-onset meds
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rapid
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Anxiolytics
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Most widely Rx-ed psychotropic meds
-all depress CNS diffusely for sedative effect -Tx anxiety d/o, sleep d/o, m. spasm, EtOH w/d and seizure -->also anesthesia induction 4Bs = BZDs, Barbituates, Busiprone, Beta-blocker |
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Most widely Rx-ed psychotropic meds
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Anxiolytics
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Neuroleptic Malignant Syndrome
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MEDICAL EMERGENCY
-20% mortality if unTxed -rare -MC in M pts, early in antipsychotic use -preceded by catatonia Sx: Fever (MC presenting sign) Autonomic instability (BP, HR) Leukocytosis Tremor Elevated CK Rigidity (lead pipe) -tx = d/c current meds, supportive care |
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EPS
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Extrapyramidal Symptoms
SE of Typical Antipsychotics, esp high potency -parkinsonism (masked faces, cogwheel rigidity, pill-rolling tremor) -akathesia (sujective = anxiety; objective = restlessness, fidgiting) -dystonia (painful sustained contraction of neck/tongue/eye muscles) Tx = d/c meds, give antiPD/anticholinergics/antihistamines (benadryl, amantadine, benztropine) |
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Tardive Dyskinesia
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Writhing movements of mouth/tongue in patients using antipsychotics (esp traditional)
-esp older pts 50% spontaneously remit -unTxed may be permanent, Tx ASAP Tx = d/c antipsychotics, possibly give anxiolytics or cholinomimetics |
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SE of Typical Antipsychotics
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(1) Anti-DA
a) EPS (PD-like, akathisia, dystonia) b) Hyperprolactinemia (2) Anti-HAM (histaminic, adreneric and muscarinic receptors) (3) Wt gain (4) High LFTs (5) Ophthalmologic problems (6) Derm problems (7) Seizures (esp low potency) (8) TD (9) NMS |
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Low Potency Typical Antipsychotics
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Low affinity for DA-Receptors --> need higher dose
-higher anticholinergic and antihistaminic SE, lower EPS and NMS -ex: chlorpromazine, thioridazine -better for (+) psychotic Sx |
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Mood Stabilizers
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Tx acute mania and prevent manic relapses
Lithium, carbamazepine, valproic acid -can be used to potentiate antidepressants for MDD, to potentiate antipsychotics for schizophrenia, to help w/EtOH abstinence, to Tx agression/impulsivity |
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Atypical Antipsychotics
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Block DA-Receptors and 5HT-Receptors
First-Line Schizophrenia Tx -fewer SE --> some anti-HAM --> clozapine --> agranulocytosis, seizures --> olanzapine --> increase lipids, glucose intolerance, weight gain, hepatotoxicity -quetiapine --> cataracts ex: clozapine, riseridone, quetiapine, olanzapine, ziprasidone -better for (-) psychotic Sx |
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SSRIs
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Inhibit Presynaptic 5HT Pumps
-all have about same efficacy and SE profile -much safer in OD -lower SE profile than TCA/MAO-I -SE: sexual dysfunction (25-30%), GI disturbances, insomnia, HAs, anorexia, weight loss, 5HT syndrome (if used w/MAO-Is) -no food restrictions -also used w/GAD, PD, OCD, PDD< dysthymia, phobias, IBS, PTSD and autism |
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MAO-I Hypertensive Crisis
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Caused by MAO-Is if added to:
1 - sympathomimetics (like in OTC cold meds) 2 - Tyramine-rich foods (chianti, cheese, chicken livers, fava beans, cured meats) -causes catecholamine buildup --> sudden increase in BP |
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Serotonin Syndrome
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Caused by using SSRIs w/MAO-Is
-lethargy, restlessness, confusion, tremors, flushing, diaphoresis, myoclonic jerks --> hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death -wait at least 2 wks before starting a new AD -Tx = d/c meds |
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MAO-Is
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Prevent inactivation of NE/5HT/DA/Tyramine by irreversibly inhibiting MAO-A and -B
-not 1st line but good for refractory MDD -SE = orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction -avoid SSRIs --> Serotonin Syndrome -avoid sympathomimetics (like in OTC cold meds) or Tyramine-rich foods --> MAO-I Hypertensive Crisis |
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TCA Toxicity Hallmark
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QRS widened to >100 msec
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TCA OD Tx
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IV sodium bicarbonate
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TCAs
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Inhibit NE and 5HT reuptake
-OD can be lethal --> QRS widened to >100 -SE = HAMS (anti-histaminic, -adrenal and -muscarinic), wt gain, Convulsions, Cardiotoxicity (QRS), Coma |
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Antidepressants
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All abou = efficacy
70% if MDD pts respond No abuse potential Don't "elevate" mood TCAs, MAO-Is and SSRIs |
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BZDs can be lethal when mixed w/
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EtOH (respiratory depression)
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BZDs
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1st-line anxiolytics --> potentiate GABA
-potential for tolerance and dependence, so limit duration -safe at high doses -long (1-3d), intermediate (10-20h) or short-acting (3-8h) -SE = drowsiness, intellectual function impairment, lowered motor coordination -->basically, you become Keanu Reeves -toxic OD = respiratory depression |
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"HAM" Side Effects common in
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TCAs and Low Potency Antipsychotics
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