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108 Cards in this Set
- Front
- Back
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Name classes of antidepressants |
SSRIs SNRIs Atypical Antidepressants TCAs MAOIs NDRIs (NRE/dopamine) SARIs (serotonin-2 antagonist) NaSSA (noradrenergic and sepcific sertonergic antidepressant) (SANRI) serontin-1 partial agonist /reuptake inhibitor |
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What are indications for antidepressants |
depression anxiety disorders eating d/o PMDD chronic pain neuropathic pain fibromyalgia/CFS ADHD |
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how long does it take for antidepressants to achieve therapeutic effects? |
~2 weeks |
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how do you administer TCAs? |
titrate it up /c of SE never give more than wees' worth of meds |
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why is TCA called a dirty drug or dual agent? |
because multiple receptor effects |
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name the 5 receptors that TCA has |
receptors for NRI and SRI
blocks muscarinic, alpha one, and histamine |
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SRI and NRI ____________ depression |
lifts |
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SE of noradrenergic |
tremors tachycardia sweating insomnia erectile and ejaculatory problems |
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SE of sertonergic |
GI distress nausea HA nervousness akathisia sexual SE- delayed orgasm anorexia
**more serotonin receptors in your gut** |
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Dopaminergic SE |
psychomotor activation aggravation of psychosis |
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SE of histamine blockade |
weight gain drowsiness |
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SE of muscarinic blockade |
Anti-SLUD constipation blurred vision drowsiness dry mouth |
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SE of alpha one blockade |
dizziness ↓ BP |
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what is TCA used for? |
unipolar depression anti-panic & anxiolytic chronic pain insomnia
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what are SE of TCA? |
weight gain cardiac effects- arrhythmias, tachycardia anti-slud nausea drowsiness |
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what happens if you OD on TCA? |
heart block
lethal dose is 3-5 x daily dose |
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What are 3 MAOIs? |
phenelzine tranylcypromine selegililne (Tx parkinson's= cardiac effects?) |
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what are MAOIs used for? |
depression anxiety
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what do you want to avoid w/ pts taking MAOIs? why? |
tryamine
tyramine increases the release of NE and the MAOI prevents MAO enzyme to destroy NE so lots of NE in the system→ ↑ BP |
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what is tryamine? |
sausage cheese pepperoni pizza beer soy sauce red wine
anything that is fermented, old |
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what are DI w/ MAOIs |
decongestants stimulants NARCOTICS (DEMEROL AKA MEPERIDINE) anesthetics |
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what is the favorite drug to use for depression? |
SSRIs |
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name some SSRIs drugs |
fluoxetine sertraline paroxetine fluvoxamine citalopram escitalopram
-basically anything that ends in -etine, -opram, and then sertraline |
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T or F: there is a big difference in the starting and usual dose in SSRIs? |
false
-usual dose is 20 mg |
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what are SSRIs used for? |
depression anxiety d/o eating d/o PMDD |
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what drug does not have OD SE? |
SSRIs |
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What are SE of SSRIs? |
nervousness insomnia GI complaints sexual dysfunction HA myoclonus |
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if you combine SSRIs and Triptans, it is a warning for ____________. |
serotonin syndrome |
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what are your 1st choices for SSRIs? |
citalopram and sertraline |
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Bupropion (Wellbutrin or Zyban) is what class of drug? what drug is it combined w/ Bupropion? |
atypical depressants- NDRI (primarily dopaminergic) -SSRIs |
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what are advantages of Bupropion? |
SMOKING CESSATION mood stabilizers no sexual dysfunction no weight gain
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what are SE of Bupropion? |
↑ seizure risk ESP IN BULIMICS no efficacy in anxiety d/o |
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what drug class is venlafaxine (Effexor)? |
SNRI |
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what are advantages of venlafaxine (effexor)? |
dual agent neuropathic pain rapid onset generic cheap |
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what are SE of venlafaxine? |
HTN discontinuation syndrome more dangerous in OD than SSRIs |
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what drug class is desvenlafaxine (Pristiq)? |
SNRI
same thing as venlafaxine but more expensive
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What class is Nefazodone? |
SARI |
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what are advantages of Nefazodone? |
-sleep enhancing -weight gain/sexual dysfunction are rare |
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SE of Nezodone |
alpha effects: sleepy and dizzy ORTHOSTATIC HYPOTENSION |
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what drug is a potent H-1 Blocker and is great for chemotherapy patients and wants to gain weight? |
Mirtazapine (Remeron) |
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what else is Mirtazapine (Remeron) good for? |
sleep-enhancing anti-emetic
ADHD kids who aren't sleeping or eating b/c of the stimulants they're on |
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so basically what are the SE of mirtazapine? |
weight gain sedation |
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what is duloxetine (Cymbalta) good for? |
diabetic peripheral neuropathic pain
but it's expensive. |
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all dual agents are good for _______ |
pain |
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a patient is prescribed an antidepressant. she becomes dizzy and falls down when she gets out of bed. what blockade of receptor is responsible? |
alpha 1 adrenergic |
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54 YO has DM and chronic neuropathic pain. which drug is most affordable, tolerable to help with this pain? |
Venlafaxine |
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22 YO F w/ bipolar II and low level of depression. she is currently taking lithium. which drug is most effective and safest, and affordable? |
Bupropion
ideally, sertraline would be your 1st choice but serotonin drugs are bad for bipolar d/o. |
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name the classes of drugs for anxiolytics and hypnotics |
benzodiazepines barbiturates some some antidepressants busipirone anticonvulsants antihistamines neuroleptics SNS blockers
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what's the mainstay treatment for anxiolytics? |
antidepressants |
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which antidepressant is not good for anxiolytics? |
bupropion (dopaminergic) |
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name the 4 functions of benzos |
anti-anxiety anti-convulsant sedative/hypnotic muscle relaxation |
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what benzo drug has the highest safety level of lethal dose?
dunno how to word this awk question |
diazepam- lethal dose is over 1000 fold greater than typical therapeutic dose |
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what benzo drug has a longer half life and can be used for withdrawal? |
clonazepam |
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why would you want to stay away from short half life benzo drugs like alaprazolam (xanax)? |
rebound anxiety |
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which benzo drug has the highest potential for addiction? |
alaprazolam (xanax) |
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what's the advantage of benzo over an antidepressant for a panic disorder? |
benzo works right away whereas anti-depressants may take up to 12 weeks to work.
so you give both a benzo and an antidepressant. |
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benzo in the presence of GABA ______ greater entry of ________ ion which _________ the cell making it more difficult to depolarize and therefore ______ neural excitability |
increases chloride hyperpolarizes reduces |
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name the SE of benzodiazepines |
behavioral disinhibition psychomotor impairment (driving) cognitive or concentration difficulties tolerance/dependence withdrawal/seizures sedation MEMORY AFFECTED ADDICTION (only a small %) |
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Buspirone is good for _______ |
GAD alcoholic patients cognitively impaired pts w/ behavioral dyscontrol |
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name the 3 adrenergic blockers that are good for anxiolytics? |
propranolol clonidine prazosin |
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Propranol is an anxiolytic that is good for __________ _____________ |
performance anxiety
good for peripheral anxiety, tremors, doesn't effect the brain |
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Prazosin is good for _________ ___________ |
PTSD nightmares |
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Name the 2 anticonvulsants that can also be used for anxiolytics |
Gabapentin (Neurontin)- good for hx of alcohol abuse and somatic anxiety and very shaky Tiagabine (Gabatril)
"kindles" phenomenon of some anxiety d/o like PTSD |
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when are neuroleptics used for anxiolytics? |
augment for most severe anxiety d/o OR anxiety assoc. w/ depression or bipolar d/o
also good for OCD/PTSD |
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what's the problem with using a benzo for insomnia? |
-worked for too long (caused too much sedation, falls, "hangover") -didn't work long enough-early awakening -tolerance, withdrawal, rebound insomnia |
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what drugs are limited to their lowest possible dose b/c of risk of medication lingering in system and interfering w/ driving? |
zolpidem and zaleplon |
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what is the prototype drug for sedative-hynpotic? |
diphenhydramine- not selective histamine so have anti-SLUD. next day "hangover" from long half life |
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anything that ends w/ -apine or -idone, i'm thinking of _______ |
neuroleptics/antipsychotics |
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what are indications for neuroleptics? |
SCHIZOPHRENIC D/O BIPOLAR mania acute psychotic reactions delirium/dementia
really used for thought d/o and mood d/o |
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meclizine and dimenhydrinate is used for nausea due to ________ |
vertigo |
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what are antiemetic agents for motion sicknesss |
scopolamine promethazine |
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what are antiemetic agents for cancer chemotherapy |
haloperidol metoclopramide prochlorperazine |
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what's the MOA of neuroleptic drugs? |
therapeutic effect- DOPAMINE BLOCKADE
dirty drug: muscarinic, anti-histamine, alpha 1 blockade |
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so now you know what receptors it blocks...what are the SE of neuroleptic drugs? |
anti-SLUD drowsiness orthostatic hypotension sexual dysfunction dry mouth arrhythmias seizure weight gain EPS |
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What is EPS? |
acute dystonia akathesia Parkinsonianism Neuroleptic malignant syndrome (NMS)→ fever, HTN, delirious, EMERGENCY! |
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EPS worsens in _______ potency agents |
high |
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What is Parkinsonism? |
caused by DA blockade of nigrostriatal pathway rigidity, tremor, akinesia mimic catatonia |
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how do you treat Parkinsonism? |
tx & prophylactically w/ anticholinergics (benzotropine)- MAINSTAY TX
-antihistamines - diphenhydramine -benzodiazepines- diazepam -beta blockers- propranolol -dopamine agonists- bromocroptine |
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what is dystonia? |
toricollis- muscles get really tight in the neck laryngospasm opisthotonos |
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how do you treat dystonia? |
IM benadryl (anticholinergic) |
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what is akathesia? tx? |
motor restlessness tx: beta blockers- PROPANOLOL |
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what are 2 reasons why aytpical or novel antispychotics are atypical? |
1. they are not pure dopamine blockers have a really high affinity for serotonin.
2. metabolic syndrome- trigylcerides, weight gain
remember serotonin blockers ↑ appetite so ↑ weight gain
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what are advantages of atypical antipsychotics? |
less EPS, less risk of Tardive dyskinesia b/c block 5HT and DA
effective mood stabilizers- can use for BIPOLAR and SCHIZO
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what atypical drug causes agranulocytosis requiring to have regular CBCs? |
CLozapine (Clozaril) |
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when do you use clozapine? what are other SE? |
do not use unless other drugs don't work
high metabolic SE high sedation anti-SLUD orthostatic low EPS/TD/hyperprolactemia |
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what atypical drug has the most metabolic SE? |
high- olanzapine (zyprexa) low- ziprasidone |
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what atypical drug has the highest hyperprolactinemia? |
risperidone (Risperdal) paliperidone (invega) |
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what drugs have moderate EPS/TD? minimal? |
moderate- Invega and Risperdal minimal- abilify |
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name the unique attributes for each: Risperidone ziprasidone and olanzapine quetiapine Aripiprazole |
Risperidone: generic, available in depot form Ziprasidone and Olanzapine- IM form for acute emergency Quetiapine- abuse potential aripirazole- only partial agonist- good SE profile but efficacy for psychosis may be lower |
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what's the best long acting drug for a homeless and uninsured patient w/ chronic psychosis? |
Risperidone
long-acting and affordable |
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what are indications for mood stabilizers? |
bipolar d/o resistant depression schizoaffective d/o psychotic states PTSD, borderline PD, impulse d/o, MR |
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what's the difference between bipolar type I and type II? |
type I- one episode of mania type II- one episode of hypomania |
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name the categories for mood stabilizers? |
lithium anti-epileptic drugs- valproate, carbamazepine, oxcarbazapine, lamotrigine 2nd generation (atypical) antipsychotics |
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what's the gold standard for mood stabilizers? |
lithium...duh? |
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what is lithium used to treat? when is it most effective? |
acute mania bipolar d/o RESISTANT DEPRESSION
most effective in pure mania, non rapid-cycling bipolar d/o
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what does lithium reduce? |
SUICIDE RISK |
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what are major SE? minor SE? |
major- renal, thyroid, cardiac t wave changes minor- N/D, diarrhea, rash tremor, leukocytosis |
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what drug has to do w/ Epstein's anomoly 1st trimester? (it's a heart defect) |
lithium...duh again? |
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what's 1st line for pts w/ mixed states or rapid-cycling bipolar d/o |
valproate |
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valproate is best at treating and preventing _______ episodes than depressive ones |
manic |
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CI in valproate...don't miss this question |
PG AND WOMAN OF CHILD BEARING AGE |
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what are other SE of valproate? |
hepatotoxicity pancreatitis thrombocytopenia weight gain alopecia ↓ IQ |
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what drug do you want to be concerned w/ aplastic anemia, agranulocytosis ? what do you use it for? |
carbamazepine (Tegretol)
acute mania and bipolar
CI: PG |
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oxcarbazepine (trileptal) look out for______ |
hyponatremia |
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what drug is effective for bipolar depression and a maintenance drug and is well tolerated? |
lamotrigine (lamictal) |
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what's the biggest concern for lamotrigine? |
SJS |
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SSRIs does not work for __________ |
bipolar |
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48 YO male w/ bipolar mania. acutely psychotic. he has DM and HTN. what's best?
Ziprasidone Haldol Clozapine Lithium Valproate |
ZIprasidone- only won't exacerbate DM and HTN |
