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49 Cards in this Set
- Front
- Back
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Black box warning for antipsychotics
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Increased mortality in elderly patients with dementia-related psychosis
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Classical/Typical Antipsychotics
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Chlorpromazine, Haloperidol
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Chlorpromazine
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Thorazine
Classical Antipsychotic MoA: 1. Blockade of dopamine 2 receptors is responsible for reducing the positive signs of psychosis and improving other behaviors 2. Multiple receptor types are blocked by most antipsychotic drugs d/t D2 receptors belonging to a Receptor Superfamily that share a high degree of sequence homology Side effects: Antimuscarinic: sedation, blurred vision, tachycardia, dry mouth and dental cavities, constipation, difficulty urinating Antihistamine: sedation, weight gain alpha-blockade: orthostatic hypotension D2 blockade: neuroleptic malignant syndrome, extrapyramidal sxs, tardive dyskinesia, galactorrhea, amenorrhea, infertility impotence Cardiac K channel block: Prolonged QTc, Torsade de Pointes |
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Haloperidol
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Haldol
Classical antipsychotic MoA: Very potent D2 blocker Indications: one of the most widely used typical antipsychotics. tx of psychosis. Tourette's syndrome. Side effects: Similar to chlorpromazine, but w/ less anticholinergic, antihistamine, and autonomic side effects. Thus produces relatively less sedation, weight gain and orthostatic hypotension. Potent D2 blockade - produces highest level of EPS and higher incidence of tardive dyskinesia Torsade de pointes (prolonged QT) Rare - neuroleptic malignant syndrome |
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Haloperidol decanoate
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Depot formulation that is injected IM
Usually administered monthly or every 4 weeks |
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Atypical antipsychotics
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Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone
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Aripiprazole
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Abilify
Atypical antipsychotic MoA: Partial agonist at D2 and 5-HT2A receptors Will reduce dopamine effects in areas of the brain with high dopamine levels, but can also result in a net increase in stimulation of dopamine receptors in areas that have low dopamine levels Side effects: NV, constipation, HA, dizziness, insomnia, QT prolongation (like all antipsychotics |
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Clozapine
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Clozaril
Atypical antipsychotic MoA: Blocks D2 and 5-HT2A receptors Indications: treatment resistant schizophrenia Side effects: AGRANULOCYTOSIS - weekly blood counts for 1st 6 months of therapy, hypersalivation, increase risk of seizures, weight gain |
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Olanzapine
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Zyprexa
Atypical antipsychotic MoA: blocks D2 and 5-HT2a receptors Indications: psychosis, bipolar, tx-resistant depression Side effects: drowsiness, flu syndrome, increased salivation, nausea, tardive dyskinesia, weight gain, hyperglycemia, QT prolongation |
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Quetiapine
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Seroquel
Atypical antipsychotic MoA: Blocks H1> alpha 1> M1,3> D2> 5HT2a Side effects: perhaps less weight gain that olanzapine and clozapine, QT prolongation |
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Risperidone
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Risperdal
Atypical antipsychotic MoA: blocks D2 and 5-HT2A receptors Side effects: dose-dependant EPS |
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Common characteristics of antidepressants
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Several weeks (3-4) off drug therapy are required before therapeutic effects typically appear.
concomitant use of MAOI's (w/i 14 d) can cause potentially fatal hyperpyretic crisis and sz's (serotonergic syndrome) Similar drug interactions can occur w/ other CNS acting drugs SSRIs are substrates and/or inhibitors of different isoforms of cyp450 Many SSRIs produce sexual dysfunction TCAs and SSRI/SNRI antidepressants can unmask mania |
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Antidepressant black box warning
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Increase risk of SI in children, adolescents and young adults
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TCA's
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Amitriptyline, Imipramine
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Amitiyptyline
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Elavil
TCA MoA: blocks reuptake of norepi and serotonin. Na channel blocker. Antimuscarinic. Antihistamine. Alpha receptor blocker Side effects: TCAs are among the most common Rx drugs involved in life-threatening drug overdose Antimuscarinic, antihistamine, anti-ANS Prolonged QRS and potentially fatal cardiac arrhythmias and seizures QTc prolongation |
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Imipramine
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TCA
MoA: Blocks reuptake of norepi and serotonin. Na channel blocker. Antimuscarinic, antihistamine, alpha receptor blockade Indications: depression, chronic pain |
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SSRIs
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Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
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Citalopram and Escitalopram
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SSRIs
MoA: most selective SSRIs Side effects: HA, nausea, nervousness or insomnia, agitation. Sexual dysfunction |
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Fluoxetine
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Prozac
SSRI Indications: depression, OCD, bulimia, panic disorder, premenstrual dysphoric disorder Side effects: HA, nausea, nervousness or insomnia, agitation, sexual dysfunction Pharmacokinetics: half life of 8 days - longest half life of all SSRIs |
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Paroxetine
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SSRI
Side effects: sexual dysfunction, teratogenic effects Preg risk category D Notes: avoid abrupt w/d, as sxs can be more severe than "advertised" by manufacturer. |
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Sertraline
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Zoloft
SSRI Side effects: sexual dysfunction |
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Atypical antidepressants
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SNRIs and NDRIs
Bupropion, Duloxetine, Venlafaxine |
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Bupropion
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NDRI
MoA: weak reuptake inhibitor for norepi and dopamine Indications: 1. MDD, 2. SAD, 3. Smoking cessation, 4. SSRI-induced sexual dysfunction Contraindications: Pts w/ a sz disorder, pts w/ current or prior dx of bulimia or anorexia |
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Duloxetine
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Cymbalta
SNRI |
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Venlafaxine
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Effexor
SNRI |
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MAOI's
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Phenelzine, Selegiline, Trancypromine
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Phenelzine
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MAOI
Indications: Atypical depression Major drug interactions: other serotoninergic agents Consumption of tyramine-rich foods - can produce hypertensive crisis |
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Selegiline
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Eldepryl, Zelapar
MAOI MoA: selective irreversible inhibitor of MAO-B Retards breakdown of dopamine Contraindications: serotonin syndrome |
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Tanylcypromine
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MAOI
Parnate Pharmacokinetics: faster recovery of MAO activity d/t its weaker bond to the enzyme |
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Lithium
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Mood stabilizer
MoA: Alters Na transport in nerve and muscle cells. Inhibits recycling of neuronal membrane phosphoinositides Indication: tx of manic stage of bipolar First line drug for maintenance tx of bipolar Side effects: polyuria (nephrogenic DI), polydipsia, ND, weight gain, mild ataxia, drowsiness Toxicity: very narrow therapeutic index Major drug interactions: diuretic-induced sodium loss can increase risk of toxicity NSAIDs ACE I's |
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Chlordiazepoxide
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Benzo
Anxiolytic |
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Alprazolam
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Xanax
Benzo |
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Clonazepam
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Klonopin
Benzo - anxiolytic |
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Diazepam
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Valium
Benzo - anxiolytic |
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Flurazepam
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Benzo
hypnotic insomnia tx |
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Lorazepam
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Ativan
Benzo |
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Temazepam
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Restoril
Benzo |
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Flumazenil
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Benzo receptor antagonist
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Non-Benzo Sleep aids
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Zaleplon (Sonata)
Zolpidem (Ambien) Eszopiclone (Lunesta) - best documented agent to be safe for long term use Ramelteon |
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Ramelteon
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Melatonin receptor agonist
For insomnia |
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Phenobarbital
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Barbiturate
MoA: potentiates GABA mediated inhibitory stimuli in the presence of GABA. At higher therapeutic concentrations, it also inhibits Na and Ca channels and blocks excitatory AMPA receptors. May also directly open GABA receptors w/o presence of GABA Drug interactions: induce cyt p450 |
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Buspirone
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Anxiolytic
MoA: Partial agonist of 5-HT1A serotonin receptor Indications: short term tx of pts w/ GAD, including pts w/ h/o drug dependence |
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Hydroxyzine
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Anxiolytic
MoA: H1 antagonist |
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Methylphenidate
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Ritalin
CNS stimulant MoA: may act by blocking the reuptake of dopamine and norepi Indications: ADHD, narcolepsy Side effects: nervousness, insomnia, HA's, dizziness, drowsiness, chorea, nausea, anorexia DEA Schedule II drug w/ abuse potential |
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Dextroamphetamine or Amphetamine
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CNS stimulant
MoA: increases release of monoamines from vesicular storage sites w/i presynaptic terminals Competes w/ monoamines for reuptake via DAT, NET or SERT Facilitates the release of cytoplasmic presynaptic monoamines by inducing "reverse" transporter exchange Weakly inhibits MAO May have some direct receptor agonist actions Indications: ADHD, narcolepsy |
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MDMA
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MoA: similar mech as amphetamines, but w/ a preferential effect on SERT, and thereby strongly increases the extracellular concentration of serotonin
Reported to produce a distorted sense of time and perception, to facilitate interpersonal communication and act as a sexual enhancer Side effects: hyperthermia w/ dehydration |
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LSD
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MoA: agonism and/or antagonism at 5-HT receptor subtypes
Side effects: Delusions and visual hallucinations, a user's sense of time and self may change, sensations may seem to "cross over", giving the user the feeling of hearing colors and seeing sounds. |
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PCP
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MoA: blocks NMDA-type glutamate receptors
Side effects: acute psychosis, dissociation, disorientation, loss of sense of pain, sweating, amnesia, numbness, nystagmus, catatonic posturing, aggressive behavior, in high doses may cause coma Most dangerous hallucinogen |
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Ketamine
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MoA: poorly understood, blocks NMDA-type glutamate receptors.
Rapidly produces a hypnotic state (dissociative anesthesia) where pts exhibit analgesia, are unresponsive to commands, and have amnesia SIde effects: similar to PCP: catatonia, elevated HR, CO and BP, sensory and perceptual illusions, vivid dreams |
