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161 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Fluoxetine
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SSRI
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Sertraline
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SSRI
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Paroxetine
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SSRI
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Fluvoxamine
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SSRI
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Citolopram
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SSRI
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Escitalopram
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SSRI
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Venlafaxine
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SSNRI
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Duloxetine
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SSNRI
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Amitriptyline
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tri-tetracyclic
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Doxepin
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tri-tetracyclic
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Imipramine
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tri-tetracyclic
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Clomipramine
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tri-tetracyclic
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Trimipramine
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tri-tetracyclic
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Desipramine
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tri-tetracyclic
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Nortriptyline
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tri-tetracyclic
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Protriptyline
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tri-tetracyclic
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Amoxapine
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tri-tetracyclic
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Nefazodone
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Serotonin-2 antagonist and SSRI
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Trazodone
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Serotonin-2 antagonist and SSRI
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Mertazapine
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Noradrenergic and specific serotonin ANTAgonist
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useful for refractory depression who need to gain weight
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Bupropion
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NE + Dopamine reuptake inhibitor
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GI: nausea, anorexia, less sex problems; risk seizure at high dose
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Phenelzine
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Isocarboxazid
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Selegiline
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Trancypromine
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Fluoxetine
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SSRI
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sex/GI/agitation/akathisia
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Sertraline
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SSRI
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more diarrhea than other in this class
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Paroxetine
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SSRI
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SEDATING/dry mouth/nause/sex/GI/agitation/akathisia
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Fluvoxamine
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SSRI
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nausea, vomit >, drug interaction > more than others in this class
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Citolopram
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SSRI
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fewer sex side effects, less anxiety than other in this class
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Escitalopram
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SSRI
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fewer sex side effects, less anxiety than other in this class
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Venlafaxine
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SSNRI
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Anxiety may increase blood pressure at higher doses; headache; insomnia, sweating
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Duloxetine
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SSNRI
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Nausea, constipation, dry mouth, insomnia, sweating, dizziness
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Amitriptyline
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tri-tetracyclic
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very anti-cholinergic; very sedating
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Doxepin
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tri-tetracyclic
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very anti-cholinergic; very sedating
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Imipramine
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tri-tetracyclic
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very anti-cholinergic;
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Clomipramine
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tri-tetracyclic
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very anti-cholinergic; very sedating
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Trimipramine
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tri-tetracyclic
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very anti-cholinergic; very sedating
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Desipramine
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tri-tetracyclic
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not sedating; least anti-cholinergic in its class
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Nortriptyline
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tri-tetracyclic
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less anti-cholinergic than others
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Protriptyline
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tri-tetracyclic
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psychomotor stimulation; not sedating; less anti-cholinergic
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Amoxapine
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tri-tetracyclic
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extrapyramidal syndrome; NMS (metabolite of loxapine)
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Nefazodone
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Serotonin-2 antagonist and SSRI
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Sedation, hepatotoxicity
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Trazodone
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Serotonin-2 antagonist and SSRI
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priapism, orthostatic HypoTN, sedation
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Mertazapine
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Noradrenergic and specific serotonin ANTAgonist
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weight gain, deation
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Bupropion
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NE + Dopamine reuptake inhibitor
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GI: nausea, anorexia, less sex problems; risk seizure at high dose
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Phenelzine
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Isocarboxazid
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Selegiline
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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Trancypromine
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MOA inhibitor
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Orthostatic Hypotention, somnolence, weight gain
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antidepressant no sex problems, no nausea, no diarrhea
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Mertazapine
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Noradrenergic and specific serotonin ANTAgonist
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SSRI mechanism
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block presynaptic reuptake pump
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increase amount of serotonin in synapse
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Tricyclics and heterocyclics mechanism
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increase level of monoamines in the synapse by reducing the reuptake of NE and Serotonin
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More NE and serotonin
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Monoamine oxidase inhibitors mechanism
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irreversibly blocking monoamine oxidase, the enzyme responsible for the oxidative deamination of neurotransmitters such as serotonin, norepinephrine, and dopamine.
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More Serotonin, NE, Dopamine
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Lithium mechanism
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inhibits adenylate cyclase enzyme
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mood stabilizer
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Valproic acid mechanism
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opens Chloride channels
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mood stabilizer
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Carbamazepine mechanism
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inhibits repetitive firing action potentials by inactivating Sodium channels
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mood stabilizer
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1st gen antipsychotics mechanism
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block central dopamine receptors
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more dopamine
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2nd gen mechanism
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serotonin dopamine antagonist
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abilify mechanism
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partial agonist at dopamine D2 receptors, activating the receptor but eliciting a reduced response compared to the natural neurotransmitter. The drug is also a partial agonist at serotonin 5HT1a receptors, but an antagonist at 5HT2a, H1, and alpha-1-adrenergic receptors.
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antipsychotic
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Chrorpromazine
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1st gen antipsycotic
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sedation, orthostatic HTN
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Haloperidol
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1st gen antipsycotic
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Extrapyramidal sydnrome very common
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Thioridazine
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1st gen antipsycotic
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higher cardiac problems,
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Mesoridazine
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1st gen antipsycotic
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cardiac arrhythmias
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Molindone
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Fluphenazine
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Trifluoperazine
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Thiothexine
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Perphenazine
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Loxapine
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Pimozide
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1st gen antipsycotic
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Extrapyramidal symptoms, TD, sedation
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Clozapine
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2nd gen antipsycotic
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Agranulocytosis, anticholinergic, weight gain, sedation, NML
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Resperidone
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2nd gen antipsycotic
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Extrapyramidal symptoms high doses, postural HTN, increased prolactin, sedation, weight gain, decreased concentration
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Olanzapine
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2nd gen antipsycotic
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Increased prolactin, ortho HTN, anticholinergic se, weight gain, somnolence
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Quetiapine
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2nd gen antipsycotic
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cataracts Orthostatic HTN, somnolence, transient increase in weigh
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Ziprasidone
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2nd gen antipsycotic
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dose related QT interval prolongation; postural HTN, sedation
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Aripiprazole
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2nd gen antipsycotic
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headache, nausea, anxiety, insomnia, somponelnce
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Paliperidone
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2nd gen antipsycotic
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same as respiridone
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Retinitis pigmentosa
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Thioridazine
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antipsychotic
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torsades de pointes
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Mesoridazine
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antipsychotic
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weekly CBC and differential for 6 mo, biweekly after
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Clozapine
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antipsychotic
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Present in breast milk
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Resperidone
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antipsychotic
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cataracts - slit eye lamp exam
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Quetiapine
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antipsychotic
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QT interval prolongation; present in breast milk; LESS WEIGHT GAIN
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Ziprasidone
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antipsychotic
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non sedating, no weight gain, no diabeties antipsychotic
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Aripiprazole
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antipsychotic
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Lithium
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Mood stabiliser
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nausea, tremor, hypothyroid, cardiac dysrhythmia, diarrhea, diabetis insipidus: thurst, urination, weight gain, acne; TOXIC LEVELS: mental status alt, coma, death
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Valproic acid
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Mood stabiliser
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thrombocytopenia, pancreatitis, weight gain, hair loss, GI, neural tube deffect in pregnancy
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Carbamazepine
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Mood stabiliser
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nausea, vomit, clurred speech, dizziness, drowsiness, low WBC, high liver function test, cognitive slowing, craniofacial defect in newborn
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Lamotrigine
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Mood stabiliser
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leukopenia, rash, hepatic failure, nausea, vomit, diarrhea, somnolence, dizzi
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Gabapentin
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Mood stabiliser
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somnolence, dizziness, ataxia, fatigue, leukopenia, weight gain
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level: every 3 mo once stabilised
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Lithium
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WBC, electrolyte, thyroid and renal, fasting glucose, pregnancy test, ECG - before treatment and early, every 6 mo for TSH and creatinine
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neural tube deffect in pregnancy
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Valproic acid
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serum hCG in childbering
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pancreatitis,
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Valproic acid
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CBC, liver function, pancreatic enzymes, serum hCG in childbering
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rash, steven johnson
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Lamotrigine
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CBC with platelet count every 6-12 mo
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used for diabetic neuropaty, depression with pain
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gabapentin /neurontin
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diabetis insipidus
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Lithium
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tremor with lithium, what to give
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propranolol may help with tremor; benign increase in WBC
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hyperthermia; diaphoresis; slow, continuous, horizontal, eye movements (referred to as ocular clonus); hypertonia; hyperreflexia; tremor; and ankle clonus. Neuromuscular findings are generally more pronounced in the lower extremities; Mental status changes can include anxiety, agitated delirium, restlessness, and disorientation ; Patients may startle easily. Autonomic manifestations can include diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, and diarrhea ; Neuromuscular hyperactivity can manifest as tremor, muscle rigidity, myoclonus, hyperreflexia, and bilateral Babinski sign. Hyperreflexia and clonus are particularly common; these findings, as well as rigidity, are more often pronounced in the lower extremities
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Serotonin syndrome
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tetrad of symptoms typically evolves over one to three days. Each feature is present in 97 to 100 percent of patients:
1)Mental status change is the initial symptom in 82 percent of patients - gitated delirium with confusion rather than psychosis. Catatonic signs and mutism can be prominent. Evolution to profound encephalopathy with stupor and eventual coma is typical. 2) Muscular rigidity is generalized and is often extreme. The increased tone can be demonstrated by moving the extremities and is characterized by "lead pipe rigidity" or stable resistance through all ranges of movement. Superimposed tremor may lead to a ratcheting quality or a cogwheel phenomenon. Patients can also have prominent sialorrhea, dysarthria, and dysphagia. 3) Hyperthermia 4) Autonomic instability- tachycardia, labile or high blood pressure, tachypnea, Diaphoresis is often profuse typical course of mental status changes appearing first, followed by rigidity, then hyperthermia, and autonomic dysfunction |
Neuroleptic malignant syndrome
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FATAL CARDIOARRHYTHMIA if overdose; Anti-cholinergic: dry mouth; blurry vision; urinary retention; constipation; sedation; ortho HTN, tachy, prolongationo of QT interval; weight gain (antihistamin 1 effect)
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Tricyclics/Tetracyclics
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Cardiovascular: Cardiac arrhythmia, hypotension, sinus node dysfunction, flattened or inverted T waves (reversible), edema, bradycardia, syncope
Central nervous system: Blackout spells, coma, confusion, dizziness, dystonia, fatigue, headache, lethargy, pseudotumor cerebri, psychomotor retardation, restlessness, sedation, seizure, slowed intellectual functioning, slurred speech, stupor, tics, vertigo Dermatologic: Dry or thinning of hair, folliculitis, alopecia, exacerbation of psoriasis, rash; acne Endocrine & metabolic: Euthyroid goiter and/or hypothyroidism, hyperthyroidism, hyperglycemia, diabetes insipidus/polyuria Gastrointestinal: Polydipsia, anorexia, nausea, vomiting, diarrhea, xerostomia, metallic taste, weight gain, salivary gland swelling, excessive salivation Genitourinary: Incontinence, polyuria, glycosuria, oliguria, albuminuria Hematologic: Leukocytosis Neuromuscular & skeletal: Tremor, muscle hyperirritability, ataxia, choreoathetoid movements, hyperactive deep tendon reflexes, myasthenia gravis (rare) Ocular: Nystagmus, blurred vision, transient scotoma Miscellaneous: Coldness and painful discoloration of fingers and toes |
Lithium
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high risk for parkinsonian extrapyramidal side effects (EPS), including rigidity, bradykinesia, tremor, and akathisia (subjective and objective restlessness). In addition, they carry a 5 to 7 percent per year cumulative risk of late-onset choreoathetotic movements known as tardive dyskinesia
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1st gen antipsycotics
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dosed in hundreds of milligrams, tend to be quite sedating, have strong anticholinergic properties, and are somewhat less likely to cause EPS
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Low potency antipsycotics
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dosed in one to tens of milligrams, are less sedating, less anticholinergic, and more likely to cause EPS
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High potency antipsycotics
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Late onset of choreiform and athetoid movements of trunk, extremities, or mouth: Oral, facial, and lingual dyskinesia are especially conspicuous in elderly patients. These may include:
Protruding and twisting movements of the tongue Pouting, puckering, or smacking movements of the lips Retraction of the corners of the mouth Bulging of the cheeks Chewing movements Blepharospasm Tongue movements are insidious in onset and at first may be limited to subtle back and forth or lateral movements Dyskinesia of the limbs also occur, such as: Twisting, spreading, and "piano-playing" finger movements Tapping foot movements Dystonic extensor postures of the toes Limb involvement is often more severe in younger individuals in whom dystonic postures and ballistic movements may occur. Dyskinesia of the neck and trunk may include the following: Retrocollis Torticollis Axial dystonia Shoulder shrugging Rocking and swaying movements Rotatory or thrusting hip movements |
Tardive Dyskinesias
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akinesia (inability to initiate movement) and akathisia (inability to remain motionless). pseudoparkinsonism: drug-induced parkinsonism (muscular lead-pipe rigidity, bradykinesia/akinesia, resting tremor, and postural instability; more frequent in adults and the elderly).
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Extrapyramidal symptoms
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Orthostatic hypotension - mechanism
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Alpha adrenergic blockade
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Temp, no finding of infection, low wbc 800 cells/mm - clozapine = neutropenic fever - do not confuse with NMS; The usual definition of drug-induced neutropenia or agranulocytosis excludes the use of known cytotoxic agents (eg, cyclophosphamide, doxorubicin) or diseases (eg, vitamin B12 deficiency, chronic liver disease) that can cause neutropenia, and requires that the drug has been administered within four weeks of the onset of neutropenia. Discontinuation of the drug generally results in correction of the neutrophil count within 30 days. neutrophil count <500 Significant risk of infection; fever should always be managed on an inpatient basis with parenteral antibiotics; few clinical signs of infection
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Agranulocytosis
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Alprazolam
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Benzo- Intermediate
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Chlordiazepoxide
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Benzo- Intermediate
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Clonazepam
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Benzo- fast
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Clorazepate
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Benzo- fast
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Diazepam
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Benzo- fast
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Halazepam
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Benzo- Intermediate
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Lorazepam
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Benzo- Intermediate
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Oxazepam
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Benzo -slow
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Prazepam
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Benzo -slow
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Flurazepam hydrochloride
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Benzo- Intermediate
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Used primarily to treat insomnia
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Quazepam
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Benzo- fast
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Used primarily to treat insomnia
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Temazepam
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Benzo- Intermediate
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Used primarily to treat insomnia
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Triazolam
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Benzo- Intermediate
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Used primarily to treat insomnia
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Less useful in Pt who used benzos, should not be used with MOI
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Buspirone
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headache, GI, dizzi
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insomnia; increased effect with alcohol or SSRI
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Zolpidem
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headache, drowsiness, dizzi, nausea, diarhhea
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headache, peripheral edema, amnesia, dizzi, rash, nausea, tremor
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Zaleplon
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used for insomnia
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headache, galactorrhea
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ramelteon
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melatonin receptor agonist, no affinity for GABA receptor complex
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melatonin receptor agonist, no affinity for GABA receptor complex
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ramelteon
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used for insomnia
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treatment for parkinsonian side effects
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amantadine and levodopa
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treatment for akathesia
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propranolol, benzodiazepines
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treatment for dystonia
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benztropine, biperiden, diphenhydramine, trihexyphenidyl
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anti-cholinergic agent
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benztropine
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treatment for dystonia
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anti-cholinergic agent
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biperiden
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treatment for dystonia
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anti-cholinergic agent
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diphenhydramine
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treatment for dystonia
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anti-cholinergic agent
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trihexyphenidyl
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treatment for dystonia
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anti-cholinergic agent
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lithium cleared by
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kidney
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avoid with renal insufficiency
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teratogenic mood stabilizer
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valproic acid
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what test for Neuroleptic malignant syndrome
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CK level and WBC
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both high
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tricyclic that causes EPS
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amoxapine
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1st 5 symptoms of serotonin syndrome
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diarhhea, restlessness, agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, delurium, coma, death
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convulsions, cardiotoxicity, coma
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Tricyclics
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least sedating TCA
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Desipramine
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least likely to cause orthostatic hypotention TCA
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Nortriptyline
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TCA, used for OCD, most serotonin specific
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Clomipramine
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Antimuscarinic side effect
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dry mouth, constipation, urinary retention, blurred vision, tachy
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TCA side effect
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Anti histaminic side effect
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sedation
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TCA side effect
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Anti-adrenergic side effect
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cardiovascular: orthostatic hypotension (most life treatening), tachy, arrhythmia
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TCA side effect
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what diactivitates MAO-B
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norepi, epi
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MAOIs, both A and B act on dopamine and tyramine
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what diactivitates MAO-A
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serotonin
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MAOIs, both A and B act on dopamine and tyramine
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treatment for eunuresis
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TCAs
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treatment for neuropathic pain
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TCAs
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treatment for autism
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SSRI
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treatment for insomnia
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Mirtazapine, TCA
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sedating doses of mirtazapine
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lower, with higher NE reuptake increases
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contraintuitive
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anticonvulsant used for mixed and rapid cycling bipolar do
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Carbamazepine
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blocks Sodium channeles and inhibit action potential; onset 5-7 days
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anticonvulsant used for trigeminal neuralgia
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Carbamazepine
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blocks Sodium channeles and inhibit action potential; onset 5-7 days
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drug used for bipolar: leukopenia, hyponatremia, aplastic anemia, agranulocytosis
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Carbamazepine
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benzo used in alcohol detox
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chrordiazepoxide
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benzo used for anxiety, rapid onset
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Diazepam
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benzo used for insomnia, rapid onset
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Flurazepam
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treatment for panic atacs, benzo, 6-20 hr
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alprazolam
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treatment for panic atacs, benzo, 18-50 hr
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clonazepam
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panic attacs, alcohol withdraw
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lorazepam
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