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178 Cards in this Set
- Front
- Back
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Major antidepressant categories of medications (4)... |
TCA |
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Antidepressant medications: similarities and differences? |
All are equally effective in treating MDD, but they differ in their side effect profiles |
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Antidepressants and abuse potential? |
The classic 4 categories have NO abuse potential because they do NOT elevate mood. Sympathomimetics (amphetamine-based) drugs have addiction potential, and they DO elevate mood. |
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The more popularly prescribed antidepressant categories and why? |
SSRI and Atypical due to safety profile |
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Indications for SSRIs (mnemonic and list)... |
POPES DIM PAD |
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General disorders for which TCAs are used (mnemonic and list) |
POPE I MIND |
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General disorders for which MAOI are used (mnemonic and list) |
SPED |
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Generals disorders for which Buproprion is used (mnemonic and list) |
DSM |
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TCA General Information |
Inhibit reuptake of serotonin and NE; not first line because can be lethal in OD |
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Examples of TCA medications (8)... |
Imipramine |
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TCA General Suffices |
-IPRAMINE |
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Clomipramine (special use and mnemonic) |
Most serotonin specific, best in treatment of OCD |
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Imipramine (special use and mnemonic) |
Enuresis |
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Nortriptyline (special use and mnemonic) |
Least likely to cause orthostatic hypotension |
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Desipramine (special use... no mnemonic yet) |
Least sedating |
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TCA overdose treatment? |
IV Sodium Bicarb |
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Why do TCA have so many side effects? |
Lack of specificity and interaction with other receptors |
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Tricyclics have 3 sets of side effects (name the 3 sets along with mnemonics) |
HAM effects |
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General action of MAOI |
Inhibit destruction of biogenic amines such as NE, serotonin, dopamine, tyramine |
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What is tyramine? |
Intermediate between tyrosine and NE |
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Specific action of MAOI |
Irreversibly inhibit MAO-A and MAO-B enzymes which increases amount of neurotransmitter in the synapse |
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MAO-A specifically deactives... |
Serotonin (5-HIAA) |
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MAO-B specifically deactivates... |
NE and Epi |
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Both MAO A+B deactivate... |
Dopamine and Tyramine |
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MAOI are very effective for... (2 conditions) |
Refractory depression |
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Examples of MAOI (3)... |
Phenelzine |
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Hallmark TCA toxicity (cardiac) |
Widened QRS (>100msec), used as a treatment treshold (can cause fatal heart block) |
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Side effect profile of MAOI (3 sets) |
Common ones... |
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Foods to avoid with MAOI (3 general categories) |
Aged cheeses |
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Medications to avoid with MAOI (3 categories, and 1 specific) |
SSRI |
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How does serotonin syndrome occur? |
When SSRI or TCA are taken together with MAOI (wait at least two weeks before switching from an SSRI to MAOI) |
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Initial findings of serotonin syndrome? |
Lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonus |
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Late findings of serotonin syndrome? |
Hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death |
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First step when suspecting Serotonin Syndrome? |
Discontinue offending medications/foods |
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How does hypertensive crisis occur? |
Taking tyramine rich foods or sympathomimetics together |
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SSRI how do they work in their mechanism of action? |
Inhibit presynaptic serotonin pumps increasing availability of serotonin in synaptic clefts |
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SSRI are preferred choice of meds due to... |
Low S/E profile |
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Examples of SSRI (6)... |
Fluoxetine |
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Side effects of SSRI... |
Sexual dysfxn |
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Drugs that can be used to relieve the negative effects of SSRI on sexual function... |
Cyproheptadine |
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What is SSRI discontinuation syndrome? |
With abrupt D/C, can get dizzy, N/V, lethargy, flu-like sx, sleep disturbance... Happens 1-3 days after last dose |
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Fluoxetine (unique) |
Longest half life due to active metabolites, does not need to be tapered |
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Sertraline (unique) |
Highest GI disturbances |
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Escitalopram (unique) |
Enantiomer of citalopram with similar efficacy, fewer S/E, much more expensive |
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Citalopram (unique) |
Very few drug interactions, good in pts with lots of comorbidities |
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4 general categories of atypical antidepressants |
1) SNRI (serotonin NE reuptake inhibitor) |
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SNRI (representative drugs) |
Venlaxafine |
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Venlaxafine (characteristics) |
Refractory depression, Panic DO |
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Duloxetine (use?) |
Neurogenic Pain |
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NDRI (representative drug) |
Buproprion |
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Bupropion uses |
Smoking cessation |
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Bupropion benefits |
Increases energy and increases concentration |
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Bupropion side effects |
Dopaminergic effects at high doses can cause psychosis |
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Do NOT use Bupropion with... |
Pts with significant anxiety |
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SARI (sample drug) |
Nefazodone |
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SARI major uses |
Refractory MDD |
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SARI major side effects |
Sedation, Priapism (esepcially with trazodone) |
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How to treat priapism associated with trazodone? |
1) Intracorporeal injection of epinephrine |
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NASA (sample drug) |
Mirtazapine |
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Mirtazapine uses |
Refractory MDD especially when weight gain is needed |
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Mirtazapine S/E |
Seadtion, weight gain, agranulocytosis |
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Mirtazapine dosing concentration dual role |
Low dose (below 15mg) is sedating |
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Typical vs. Atypical antipsychotics and their receptor indications |
Typicals block dopamine, and also HAM |
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Low potency typical antipsychotics (2) |
Chlorpromazine |
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Chlorpromazine problem? |
Pigment deposition into cornea and lens |
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Thioridazine problem? |
Pigmentary retinopathy |
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Low potency typical antipsychotics (benefits and problems in general) |
Block HAM receptors causing more problems with those |
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High potency typical antipsychotics (5) |
Haloperidol |
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Long acting forms of high potency typical AP available for... |
Haloperidol |
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High potency typical antipsychotics (benefits and problems in general) |
Higher incidence of EPSE and NMS |
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Typical and Atypical AP in terms of symptom treatment |
Both types are equally effective for positive symptoms (delusions, hallucinations) |
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Traditional Antipsychotic Side Effects |
1) EPSE |
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Tardive Dyskinesia, hypothesis of the pathogenesis? |
Increased number of dopamine receptors causing lower levels of acetylcholine |
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EPSE of typical antipsychotics |
Parkinsonism - Masklike facies, cogwheel rigidity, pill rolling tremor |
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Treatment for EPSE of typical antipsychotics |
Parkinsonism - Amantdaine or Levodopa |
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Hyperprolactinemia of typical antipsychotics |
Decreased libido |
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Ophthalmologic problems of typical antipsychotics |
Retinal pigmentation with thioridazine |
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Dermagologic problems of typical antipsychotics |
Rashes and photosensitivity |
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Seizure problems of typical antipsychotics |
Lower seizure thresholds, low potency more likely to do so than high potency |
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Tardive Dyskinesia |
Choreoathetoid (writhing) movements of mouth and tongue occur in patients who have used neuroleptics for more than 6 months |
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Rabbit Syndrome |
Uncommon side effect of typical antipsychotics, often confused with TD; but with rabbit syndrome there are chewing movements (rapid) but no tongue involvement |
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Tardive Dyskinsia Treatment |
Discontinue current antipsychotic |
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NMS of typical antipsychotics (most common group affected and presentation) |
Occurs most often in males early in tx with neuroleptics. |
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NMS often preceded by... |
Catatonic state |
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NMS Symptoms |
FALTER |
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NMS Tx |
D/C current medications! |
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Is NMS an allergic reaction? |
No |
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Can you restart the same neuroleptic that caused NMS in the first place? |
Yes |
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Examples of atypical antipsychotics (5) |
Clozapine |
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Clozapine specific side effects |
Agranulocytosis |
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Olanzapine Side Effects |
Hyperlipidemia, Glucose intolerance, Weight gain, Liver toxicity |
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Quetiapine side effects |
Causes cataracts in dogs |
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Test to get for Clozapine? |
QWeekly CBC to check agranulocytosis |
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Test to get for Olanzapine? |
LFTs to check for liver toxicity |
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Test to get for Quetiapine? |
Bi-yearly slit lamp examinations to check for cataracts |
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Which atypical antipsychotics are approved for tx of MANIA? (2) |
Ziprasidone |
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Most effective atypical antipsychotics for negative symptoms? (2) |
Olanzapine |
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Common side effects to all atypical antipsychotics |
metabolic syndrome things such as HTN, dyslipidemia, glucose intolerance, weight gain |
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Which two atypical antipsychotics cause the most weight gain, HTN, dyslipidemia? |
Olanzapine |
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Mood stabilizers and pregnancy, problem? |
Many are teratogenic, need to check for pregnancy before starting them... |
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Another name for mood stabilizers? |
Anti-Manics |
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Mood stabilizers treat mania, but what other indications? (4) |
Potentiate antidepressants in MDD |
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Mood stabilizing drugs (3) |
Lithium |
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Lithium uses |
Drug of choie for acute mania |
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Mechanism of lithium fxn? |
Alter neuronal sodium transport (as it is also monovalent) |
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Lithium excreted by... |
Kidneys |
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Lithium onset of action... |
5-7 days |
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Drawback of lithium... |
High incidence of SE |
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Therapeutic range of lithium... |
0.7 - 1.2 |
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Toxic and lethal ranges of lithium |
Toxic >1.5 |
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Things that affect lithium levels |
NSAID |
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Side FX of lithium |
Fine tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, wt gain, GI problems, benign leukocytosis, thyroid enlargement, hypothyroidism, NDI |
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Toxic levels of lithium side FX |
COARSE tremors |
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Things to regularly monitor in lithium using patients |
Thyroid function (hypothyroid) |
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Lithium toxicity tx |
Dialysis |
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How do NSAIDs cause lithium toxicity? |
Reduced formulation of prostaglandins in the renal tubules will decreased renal blood flow, causing buildup of lithium levels |
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Describe lithium tremor |
Fine tremor is benign, high frequency, worse with activities requiring fine motor control |
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Therapy for benign lithium tremors |
Decreased dose |
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Carbamazepine, trade name? |
Tegretol |
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Carbamazepine and its uses in mood disorders |
Mixed episodes |
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Carbamazepine and its use in things other than mood DO |
Trigeminal neuralgia (tic doulereaux) |
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Mechanism of action of Carbamazepine |
BLocks sodium channels inhibiting action potentials |
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Onset of action of Carbamazepine |
5-7 days, much like lithium |
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Carbamazepine S/E |
Nonspecific: Rash, ataxia, drowsy, slurred speech |
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Carbamazepine must be monitored with what labs? |
CBC (agranulocytosis, leukopenia, aplastic anemia) |
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Valproic Acid, tradename? |
Depakene |
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Valproic Acid, best for what types of mania? |
Mixed episodes and rapid cycling disorders, just like carbamazepine |
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Mechanism of action of valproic acid? |
Increase CNS levels of GABA |
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Valproic Acid S/E |
Nonspecific: sedation, weight gain, alopecia |
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What labs to monitor with valproic acid? |
CBC (thrombocytopenia) |
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Anxiolytics (sedative/hypnotics), what are the general categories? (3) |
Benzos |
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Anxiolytics, general mechanism of action? |
Diffusely depress CNS, causing sedation |
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Common indications for sedative/hypnotics (6) |
Anxiety DO |
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Teratogenicity of Lithium? |
Ebstein's anomaly |
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Teratogenicity of valproic acid and carbamazepine? |
Neural tube defects |
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BDZ main problem... |
Potential for tolerance and dependence after prolonged use |
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BDZ + Alcohol = |
Possibly death |
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BDZ mechanism of action... |
Increase frequency of chloride channel opening in GABA |
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Long acting Benzos (1-3 days) |
Chlordiazepoxide |
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Intermediate Benzos (1/2 to 1 day) |
Clonazepam |
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Short Benzos (4-8 hours) |
Oxazepam |
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Chlordiazepoxide uses (Librium) |
Alcohol detox |
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Diazepam uses |
Anxiety, Seizures |
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Flurazepam uses |
Insomnia |
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Lorazepam uses (Ativan) |
Alcohol WD |
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Temazepam uses |
Insomnia |
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Triazolam uses |
Insomnia |
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What Benzos for insomnia? |
Triazolam, Temazepam, Flurazepam |
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What benzos for anxiety attacks? |
CALm down |
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What benzos for seizures? |
Lorazepam |
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What benzo for alcohol WD? |
Lorazepam |
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What benzo for alcohol detox? |
Chlordiazepoxide |
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Varenicline (Chantix)... mechanism and indication and main SE? |
Partial nicotinic agonist |
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Acute benzo intoxication? |
Flumazenil |
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Benzo intoxication in a chronic user? |
Flumazenil may precipitate seizures, so better to protect airway and have benzos wean themselves off |
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S/E of BDZ |
Drowsiness, impaired intellect, reduced motor coordintaion |
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Lethality of BDZ |
Respiratory depression, especially when combined with alcohol |
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Zolpidem (Ambien) |
Chemically similar to BDZ but not a BDZ, but has same effect |
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Mechanism of action of Zolpidem and Zoleplon |
Selectively bind to BDZ site on GABA receptor |
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Indication for Zolpidem and Zoleplon |
Short term treatment for insomnia |
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Compared to BDZ, Zolpidem and Zoleplon do NOT have |
Anticonvulsant or muscle relaxant properties |
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Good things about Zolpidem and Zoleplon (3) |
No WD effects |
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Buspirone, mechanism of action? |
Partial agonist at 5HT-1A receptor |
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Buspirone, general indication? |
Anxiolytic |
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Buspirone time of onset? |
1-2 weeks, takes longer than BDZ |
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Buspirone + Alcohol = |
No problem as it does not potentiate alcohol effects, useful in alcoholics |
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Buspirone, abuseable? |
Low potential for addiction |
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5HT = |
Serotonin |
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Propranolol indications (3) |
Panic attacks |
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HAM side effects? |
H - Drowsy, Sedation |
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HAM S/E found mostly in... |
TCA |
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Serotonin syndrome can happen when you combine MAOI with... |
SSRI |
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Tx for Parkinson like features? |
Amantidine, Levodopa |
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Tx for Akasthisia? |
Propranolol |
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Tx for Dystonia? |
Benztropine or Benadryl |
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Dystonia, some features? |
Occurs more with high potency typical antipsychotics |
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Anticholinergics and the brain... |
Difficulty concentrating, impaired short term memory, disoriented, delirium |
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Tardive Dyskinsia, monitor... |
Abnormal Involuntary Movement Scale (AIMS) Q6 Months |
