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48 Cards in this Set

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  • Back
what agents are classified as SSRI?
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine
lexapro
What are the benefits of using SSRI compared to older antidepressants?
-SSRI have little effect on Norepi.
-SSRI lack anticholinergic effects:
do not cause postural hypotenstion, or delayed conduction of cardiac impulses,and no effect on the seizure threshold.
What are the most common adverse reactions associated with the use of SSRI?
nausea, anorexia, insomnia, sexual dysfunction, agitation, neromuscular restlessness.
What is the MOA of SSRI?
inhibits reuptake of seratonin only, NO anticholinergic effects
What are the most common drug interactions associated with the use of SSRI?
1. Fluoxetine-microsomal P-450 inhibitor.
2. Fluoxetine w/ MAOI's may cause serotonin syndrome (anxiety, restlessness, chills, ataxia, insomnia)
What is bupropion?
Second generation antidepressant, Inhibits reuptake of seratonin, NO anticholinergic effects
What role does bupropion have in the tx of depression?
Tx of MAJOR depression.
What is another use for bupropion besides depression?
Smoking cessation
what is the most serious adv. rx with bupropion?
Seizures
What is Venlafaxine?
Second generation antidepressant,Inhibits serotonin & norepi
What are some adv.rx. of venlafaxine?
High BP
What is trazadone?
Inhibits serotinin reuptake and may also act as a serotonin agonist.
depression, insomnia
What is a common adv.rx. with trazadone?
seddation, orthostatic hypotension, N/V
What is a rare but serious adv.rx. with trazadone?
Cardiac arrhythmias and priaprims
What is nefazadone?
inhibis srotonin uptake also alpha1 adrenergic blocking effects.
Why is nefazadone prone to drug interactions?
potent inhibitor of P-450 microsomal enzymes
What agents should be avoided or used very cautiosly in pts on nafazodone?
Benzo's
What is TCA?
tricyclic antidepressants
What is MOA of TCA?
Inhibit reuptake of norepi and serotonin
what are common adv.. rx. of TCA?
anticholinergic effects
dry mouth,
blurred vision,
tchycardia,
urinary retention,
slowed gastric emptying-risk of aspiration,
anticholinergic delirium (elderly)
What are CV effects of TCA?
otho. hypotension,
Increase HR
deprssion of cardiac impulses thru atria & vent.
Proloned PRI
wide QRS,
Flat or invert T
What is the tx of TCA overdose?
Atropine
What are common drug int. with TCA?
Drug int. may be prominent and include:
-sympathomimetics
-inhaled anesthetics
-MAOI
-anticholinergic
-antihtn
-opiods
How should periop hypotension in a pt taking TCA be managed?
-decrease dose to 1/3 usual dose of sympathomimetics.
-if pt long term, receptors may be desensitized or catecholamines stores deprelted, symp. may not be effective- give potent direct acting agent ie. norepi
what anesthetics are prone to interactions with TCA?
Halothane, pancuronium,-incresed risk in cardiac arrhythmias
KETAMINE
avoid or decrease amt of epi
Drug interactions with TCA & anticholinergics?
Increased risk of delirium and confusion (effects are additive)
What anticholinergic is preferred in pts on TCA?
Glycopyrrolate
What agents are MAOI?
Phenelzine & Tranylcypromine
What are common adv. rx. with MAOI?
*orthostatic hypotension
sedation
insomnia
impotence
aorgasmy
paresthesias
weight gain
What drugs/food should be avoided in taking MAOI?
contain tyramine & betaphenylethanolamine-HTN crisis
cheese,liver,fava,beans,avocados,chianti wine.
cyclic antidepressants, fluoxetine, cold or allergy meds, nasal decong., sympathomimetics (ephedrine, meperidine, and meperidine derivatives (fentnyl, sufentanyl)
How should anesthesia be managed in pts taking MAOI?
Regional anesthesia - avoid epi
Avoid Halothane
Can use etomidate and thiopental
does not alter NMB
What is Buspirone?
nonbenzodiazepine, tx anxiety disorder, NOT panic disorder
What are the indication for Lithium?
bipolar disorder
what are adv. rx. with lithium use?
Most common side effects are with the kidneys:
polydipsia
polyuria
20% of pts excrete >3 liters of urine per day.-tx w/ diuretic (amiloride)
-Ekg flat T
Hand tremor
what are drug interaction with lithium use?
thiazide and loop diuretics can increase the rabsorption of lithium from the proxiamal renal tuules of the kidneys and lead to potential toxicity.
NSAID may produce incresed lithium plasma concent. by altering renal blood flow.
Never use TORADOL.
what are the anesthesia implication of pts taking lithium?
Injected and inhaled drugs should be decreased due to lithium associated sedation.
High plasma conentrations of litinum may delay recovery from CNS depressant effects of barbiturates.
Depolarized and nondepolarized NMB drugs may be prolonged.
What are the most common signs of cardiac toxicity associated with lithium?
wide QRS
AV block
hypotension
arrhythmias
seizures
what are common uses for antipsychotics?
schizophrenia
mania
depression w/ psychotic fx
organic psychoses
turettes syndrome
movement disorders
antiemetics
what is the MOA of antipsychotics?
blocks dopamine receptors in basal ganglia and limbic protions of the forebrain
what are the most common adv. rx. with antipsychotic agents?
EPS, tardive dyskinesia
What are EPS?
extrapyramidal effects:
tremor, masked faces, and muscle rigidity
what is tardive dyskinesia?
abnormal involuntary movements of tongue, face, neck, upper, and lower extremities,trunk, and muscles of breathing and swallowing. rarely remits and no tx.
what is acute dystonia? Tx?
occurs in firs 72 hrs.
common in young men & w/ high potency agents.
The sudden onset of Resp. distress in a pt on neuroleptics reflect larngospasm.
tx: diphenhydramine 25-50 mg IV
what antipsychotics have limited EPS side effects?
clozapine
What is NMS? tx?
NEUROLEPTIC MALIGNANT SYNDROME
Hyperthermia,
generalized hypertonicity of sk.muscles,
alt. in systemic BP,
Tachycardia,
cardiac arrythmias,
fluctuatin levels of consciousness.
tx: supportive, direct muscle relaxant dantrolene, dopamine agonist bromocriptine, and amantadine.
What are negative symptoms with schizophrenia?
Alogia (poverty of speech)
avolition
affect flattening
anhedonia
social isolation
what antipsychotic agents are classified as atypical agents?
Aripiprazole
clozapine
olanzapine
quetiapine
risperidone
ziprasidone
What atypical agent is availabe in and injectable formulation?
ziprasidone