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70 Cards in this Set
- Front
- Back
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EPS (Extrapyramidal Symptoms)?
Drug induced Responsive to anticholinergic drugs (benztropine) |
Parkinsonism
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Spasm of muscle groups: torticollis, laryngospasm
Responsive to anticholinergics |
Dyskinesia
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Somatic restlessness
Inability to stay calm lipophilic beta-blockers (propranolol) |
Akathisia
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Side effect?
More than 6 months Jaw or oral musculature clozapine is DOC |
Tardive Dyskinesia
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side effects:
Blocks other receptors Anticholinergic: dry mouth, constipation, urinary hesitancy Antihistaminic: sedation, wt gain Alpha 2 adrenergic: orthostatic hypotension, drowsiness |
FGAs 1st gen. antipsychotics
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Side effects:
Neuroleptic Malignant syndrome-rare but fatal Sexual dysfunction Ophthalmologic changes Lower seizure threshold Q-T prolongation in heart |
FGAs
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Oral, lowest dose
Monthly depot for noncompliant patients Look for EPS Long half life Steady state in 1 week |
Initiating Therapy
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Interaction?
Pre-existing CVD Orthostatic hypotension Seizure Concomitant depressants EtOH Beta blockers Hepatice and P450 isoenzymes |
Drug drug interactions
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D2 blockers
Efficacy related to positive symptoms EPS is side effect Other side effects due to blockade |
FGA's for Schizophrenia
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Type?
Clozapine Risperidone Olanzapine Quetiapine Zipransidone Aripiprazole Paliperidone |
Second Generation Antipsychotics
Atypicals |
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Drug?
Most efficacious Must monitor Contraindicated in WBC less than 3500 |
Clozapine (Clozaril)
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Drug?
Least anticholinergic and sedating No EPS at low doses Give elderly low dose Oral form tab-dissolves in cheek |
Resperidone (Risperdal)
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Close to clozapine
No EPS Weight gain |
Olanzapine (Zyprexa)
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Lowest incidence of EPS at any dose
DOC for parkinson's |
Quetiapine (Seroquel)
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Weight loss and metabolic effects
Potential for QT-prolongation available IV |
Ziprasidone (Geodon)
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Different MOA
oral, IV |
Aripiprazole (Abilify)
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Active metabolite of risperidone
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Paliperidone (invega)
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Atypicals
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Dual DA/5-HT antagonism
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Study?
Chroniz schizophrenia Olanz did best Perphenazine comparable in efficacy to each atypical |
Catie trial
clinical antipsychotic trials |
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Health issues of all schizophrenia patients
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DM
CVD Agression |
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Population?
Aggression, delusions,etc 1.6-1.7 fold higher risk for mortality when SGAs used in elderly Use extreme caution |
Safety in Patients with Dementia
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Comparable efficacy
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Between FGAs and SGAs
DOC is SGAs |
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Challanged the tolerability/effecacy advantage for SGAs
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CATIE and CUtLASS trials
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Likely association between DM and?
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Schizophrenia
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$30-80/month for FGA vs. $400-600/month for SGA
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Important pharmacoeconomic issues
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Drug?
Full dose and appropriate duration is critiical before alternatives considered |
Antidepressants
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Commonly prescribed by the non-psychiatrist specialist
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Antidepressants
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Errors?
In prescribing antidepressants |
Inadequate duration
Inad. dose |
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Based on hx of response
Drug drug interactions $$ 3rd party coverage and adherence |
Drug of choice
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Classes:
TCAs (tricyclic) MAOIs (monoamine oxidase inhibitor) SSRIs (selective serotonin reuptake inhibitors) SNRIs (serotonin-norepi reuptake inhibitors) Misc. |
Classes of Antidepressants
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Inhibit reuptake of NE and 5-HT
Affinity for alpha 1 andrenergic, HA, muscarinic receptors |
TCAs
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Inhibit enzyme responsible for breakdown of NE and 5-HT
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MAOIs
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SSRIs
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"Selective" inhibition of 5-HT reuptake; low affinity for other receptors
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NSRIs
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inhibit reuptake of NE and 5-HT
Some inhibition of DA reuptake |
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Drug?
Effective but overdose is common Now used for neuropathies, sleepers, trigeminal neuralgias, bed wetting tertiary and secondary amines |
Tricyclic antidepressants
TCAs |
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Side effects?
TCAs |
Anticholinergic: dry mouth, constipation, urinary hesitance
Sedation |
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Orthostatic hypotension (elderly)
Cardiac conduction abnorm. additive with other drugs interact with P450 |
Side effects of TCAs
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Blocks the enzyme responsible for degration of NE and serotonin
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Monoamine Oxidase inhibitors
MAOIs |
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Potential?
Patient eats tyramine-containing foods (old cheese/cured meats, banana peel, sauerdraut, draft beer, red wine) |
Severe hypertensive crisis
MAOI interaction ****USMLE************ |
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Drug interaction?
Caffeine OTC decongestants Demerol |
MAOIs
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Isocarboxazid (Marplan)
Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline (Emsam) |
Commercially available MOAIs
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Syndrome?
drug drug interactions last 4-8 hrs a day |
Serotonin Syndrome
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SE?
Headache restlessness Sexual dysfunction |
SSRIs
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Generic name?
Citalopram |
Celexa
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Generic name?
Escitalopram |
Lexapro
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Generic name?
Fluvoxamine |
Luvox
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Generic name?
Fluoxetine |
*Prozac
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Generic name?
Paroxetine |
Paxil
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Generic name?
Sertraline |
Zoloft
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Currently available drugs?
Duloxetine (Cymbalta) Venlafaxine (Effexor) Desvenlafaxine (Prisiq) |
SNRIs
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Concern with SNRIs?
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BP increases
Don't give to HTN patient Never abruptly withdrawl any antidepressant |
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Class of Drug?
Bupropion (Wellbutrin) nervousness, headache, insomnia, psychosis IMPROVES Sexual fxn |
Miscellaneous antidepressants
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Dose?
High risk of Seizure with Bupropion |
More than 450 mg of IR or 400mg of SR daily
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Misc. drug?
Increases NE and serotonin provides anti-anxiety and anti-emetic properties alph-2 blockade SSRI |
Mirtazepine (Remeron)
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Substrate for P450
Check for liver enzyme increase Sedation Substrate for P450 |
Mirtazepine
remeron |
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liver toxicity
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Nefazodone
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Consider as 2nd or 3rd line drug?
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Trazodone and nefazodone
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Cardio-beta blockers, clonidine
Hormonal agents-coricosteroids, estrogens, progestins, tamoxifen misc-interferon, narcotics |
Drug induced depression
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antidepressant DOC
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SSRIs
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Mood Stabilizers
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Lithium
Valproic acid Carbamazepine Benzos |
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DOC in bipolar
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Lithium
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*Renal excretion
half life 20-24 hours |
Lithium
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normal plasma concentration
Acute 0.8-1.2mEq/L |
Lithium
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leukocytosis
renal toxicity polyuria cadiac toxicity weight gain hypothyroid teratogenic |
Lithium
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SE:
Fine tremor GI upset Diarrhea hyptothyriod rash |
Lithium
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Check blood every 5-6 days in beginning
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Lithium
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anticonvulsant
Plasma conc. 50-150mg/L watch for hepatic malfunt. in kids teratogenic |
Valproic acid
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Mech related to GABA
useful for rapid cyclers extensive hepatice metabolism toxicity Se increase at hight doses |
Valproic acid
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Hyponatremia
Rash-severe May be added to lithium Induces OWN metabolism |
carbamazepine
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used for agitation in bipolar
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Benzodiazepines
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