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48 Cards in this Set
- Front
- Back
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what agents are classified as SSRI?
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Fluoxetine
Sertraline Paroxetine Fluvoxamine lexapro |
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What are the benefits of using SSRI compared to older antidepressants?
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-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. |
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What are the most common adverse reactions associated with the use of SSRI?
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nausea, anorexia, insomnia, sexual dysfunction, agitation, neromuscular restlessness.
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What is the MOA of SSRI?
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inhibits reuptake of seratonin only, NO anticholinergic effects
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What are the most common drug interactions associated with the use of SSRI?
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1. Fluoxetine-microsomal P-450 inhibitor.
2. Fluoxetine w/ MAOI's may cause serotonin syndrome (anxiety, restlessness, chills, ataxia, insomnia) |
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What is bupropion?
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Second generation antidepressant, Inhibits reuptake of seratonin, NO anticholinergic effects
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What role does bupropion have in the tx of depression?
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Tx of MAJOR depression.
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What is another use for bupropion besides depression?
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Smoking cessation
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what is the most serious adv. rx with bupropion?
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Seizures
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What is Venlafaxine?
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Second generation antidepressant,Inhibits serotonin & norepi
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What are some adv.rx. of venlafaxine?
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High BP
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What is trazadone?
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Inhibits serotinin reuptake and may also act as a serotonin agonist.
depression, insomnia |
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What is a common adv.rx. with trazadone?
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seddation, orthostatic hypotension, N/V
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What is a rare but serious adv.rx. with trazadone?
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Cardiac arrhythmias and priaprims
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What is nefazadone?
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inhibis srotonin uptake also alpha1 adrenergic blocking effects.
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Why is nefazadone prone to drug interactions?
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potent inhibitor of P-450 microsomal enzymes
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What agents should be avoided or used very cautiosly in pts on nafazodone?
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Benzo's
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What is TCA?
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tricyclic antidepressants
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What is MOA of TCA?
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Inhibit reuptake of norepi and serotonin
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what are common adv.. rx. of TCA?
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anticholinergic effects
dry mouth, blurred vision, tchycardia, urinary retention, slowed gastric emptying-risk of aspiration, anticholinergic delirium (elderly) |
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What are CV effects of TCA?
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otho. hypotension,
Increase HR deprssion of cardiac impulses thru atria & vent. Proloned PRI wide QRS, Flat or invert T |
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What is the tx of TCA overdose?
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Atropine
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What are common drug int. with TCA?
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Drug int. may be prominent and include:
-sympathomimetics -inhaled anesthetics -MAOI -anticholinergic -antihtn -opiods |
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How should periop hypotension in a pt taking TCA be managed?
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-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 |
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what anesthetics are prone to interactions with TCA?
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Halothane, pancuronium,-incresed risk in cardiac arrhythmias
KETAMINE avoid or decrease amt of epi |
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Drug interactions with TCA & anticholinergics?
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Increased risk of delirium and confusion (effects are additive)
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What anticholinergic is preferred in pts on TCA?
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Glycopyrrolate
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What agents are MAOI?
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Phenelzine & Tranylcypromine
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What are common adv. rx. with MAOI?
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*orthostatic hypotension
sedation insomnia impotence aorgasmy paresthesias weight gain |
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What drugs/food should be avoided in taking MAOI?
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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) |
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How should anesthesia be managed in pts taking MAOI?
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Regional anesthesia - avoid epi
Avoid Halothane Can use etomidate and thiopental does not alter NMB |
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What is Buspirone?
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nonbenzodiazepine, tx anxiety disorder, NOT panic disorder
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What are the indication for Lithium?
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bipolar disorder
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what are adv. rx. with lithium use?
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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 |
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what are drug interaction with lithium use?
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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. |
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what are the anesthesia implication of pts taking lithium?
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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. |
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What are the most common signs of cardiac toxicity associated with lithium?
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wide QRS
AV block hypotension arrhythmias seizures |
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what are common uses for antipsychotics?
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schizophrenia
mania depression w/ psychotic fx organic psychoses turettes syndrome movement disorders antiemetics |
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what is the MOA of antipsychotics?
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blocks dopamine receptors in basal ganglia and limbic protions of the forebrain
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what are the most common adv. rx. with antipsychotic agents?
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EPS, tardive dyskinesia
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What are EPS?
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extrapyramidal effects:
tremor, masked faces, and muscle rigidity |
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what is tardive dyskinesia?
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abnormal involuntary movements of tongue, face, neck, upper, and lower extremities,trunk, and muscles of breathing and swallowing. rarely remits and no tx.
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what is acute dystonia? Tx?
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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 |
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what antipsychotics have limited EPS side effects?
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clozapine
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What is NMS? tx?
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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. |
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What are negative symptoms with schizophrenia?
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Alogia (poverty of speech)
avolition affect flattening anhedonia social isolation |
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what antipsychotic agents are classified as atypical agents?
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Aripiprazole
clozapine olanzapine quetiapine risperidone ziprasidone |
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What atypical agent is availabe in and injectable formulation?
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ziprasidone
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