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66 Cards in this Set
- Front
- Back
Fluoxetine
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SSRI
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Sertaline
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SSRI
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Paroxetine
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SSRI
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Fluvoxamine
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SSRI
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Vilazodone
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SSRI
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Pros and Cons of SSRI
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Pros: Effective in 60-70%, ease of dosing, broad comorbidity coverage, lower side effects than TCA, safer in overdos
Cons: Nausea and headaches, orgasmic dysfunction, interactions with tryptophan, MAOI, fenfluramine, weight gain |
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Buproprion
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Mixed Monoamine Re-uptake inhibitor
Action: weak NA/DA reuptake inhibition Pros: Efficacy like SSRI, less sexual side effects, smoking cessation, weight loss Cons: insomnia, nausea, seizures, drug interactions |
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Venlafaxine
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Mixed Monoamine Reuptake Inhibitor
Action: 5-HT reuptake inhibitor with NA inhibition at higher doses Pros: Higher remission rates Cons: Lots of side effects |
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Duloxetine
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Mixed Monoamine Reuptake Inhibitor
Action: Dual NA and 5-HT reuptake Inhibitor Pros: Higher remission, pain syndromes, no increase in BP Cons:Insomnia, Nausea, urinary retention. |
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Trazodone
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Monoamine Receptor Antagonist
Sleep aid, not usually for depression bc of drowsiness |
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Nefazodone
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Monoamine receptor antagoinist
Mechanism: Antagonist of post synaptic 5-HT2 receptor; Weak and transient 5-HT and NA reuptake inhibitor |
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Mirtazapine
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Mechanism of action: central presynaptic a-2 adrenonergic autoreceptors on NA nuerons and heterorceptors on 5-HT neurons; 5-HT2 and 5-HT3 antatgonist.
Pros: unique pharmacology, ease of dosing, lower orgasmic dysfunction, can be combined with SSRI Cons: Somnolence, weight gain |
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Amitryptyline
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TCA - Primary
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Imipramine
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TCA - Primary
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Clomipramine
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TCA - Primary
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Doxepin
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TCA - Primary
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Nortriptyline
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TCA - Secondary
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Despramine
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TCA - Secondary
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Maprotiline
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TCA - Tertracyclics
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Tricyclic Antidepressants (mechanism)
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mechanism: MAO-inhibition of NA and 5-HT reuptake transporteres
Irreversbly Inhibit MAO-A and MAO-B, Enhancing synaptic levels of all three monoamines |
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Tricyclics Pros and Cons
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Pros: effective in 60-70%; some patients with atypical depression may respond better
cons: food restrictions, orthostatic hypotension, weight gain, sexual dysfunction, potentially lethal drug interactions |
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Valproate
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anticonvulsants
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Carbamazepine
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anticonvulsants
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Lamotrigine
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anticonvulsants
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Lithium: mechanism of action
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Increase 5-HT and Ach function
Decrease DA function Decrease Pl turnover Decrease adenylate cyclase activity |
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Lithium: Pros and Cons
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Pros: efficacy in mania established with largest supporting database; Response predictors known
Cons: Poor Tolerance, Decrease patient acceptance, Narrow therapeutic index. Tremor, neurocongnitive effects, weight gain, renal toxicity, nausea, acne |
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Lithium toxicity
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Impaired concentration, irritability, muscle weakness, tremor, slurred speech
Disorientation, confusion, drowsiness, restlessness Severe: Impaired consciousness, delirium, ataxia, general fasciculations |
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Divalproex mechanism; pros and cons
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Mechanism: Increase GABA synthesis and release, Decrease GABA catabolism, Increase effects of GABA at receptor, regulator of PKC activity
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Clozapine
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atypical neuroleptics
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olanzapine
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atypical neuroleptics
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risperidone
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atypical neuroleptics
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quetiapine
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atypical neuroleptics
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atypical neuroleptics mechanism in treating bipolar
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effective in acute mania
superior to conventional neuroleptics with respect to adverse effect possibly heterogeneous mechanism of action and clinical effects with respect to each other Limitations: limited long term data, adverse effects (like weight gain), agressive marketing push |
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Carbamazepine
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Mechanism: Decrease NE, DA, GABA, adenylate cyclase activity; block adenosine receptors
Pros: efficacy in mania establish, well tolerated Cons? efficacy in prophylaxis; Ataxia and neurocognitive effects, weight gain, nausea, hair loss, etc |
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Lamotrigine
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Anti-depressant for Bipolar Disorder
Inhibits release of excitatory amino acids (glutamate) Pros: efficacy in preventing bipolar depression relapse, well tolerated Cons: ? efficacy in actue bipolar depression, can develop Steven's Johnson Rash (fatal) |
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Long acting benzo
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diazapam
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lorazapam
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short acting benzo
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Carbamazepine
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Anticonvulsant, use with alcohol withdrawl
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Atenolol
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Adrenergic
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Disease presenting with confusion, ataxia, memory loss, confabulation, personality change
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Wernicke-Korsakoff Syndrome, Thiamine deficiency, caused by hemmhorage and necrosis of mammilary bodies
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Disulfiram
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Aldehyde dehydrogenase inhibitor;
Drinking makes you sick (hypotension, nausea, vomiting, vasodilation) |
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Naltrexone
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Opiate Antagonist-Blocks reward pathway
Works better if pt has increased craving, family history of alcholism, genetic factors that increase B endorphin binding |
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Acamprosate
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Glutamate receptor moduclator (Glutamate antagonist and GABA agonist).
Helps restore normal balance Cons: bad bioavailability, us trials show no benefit |
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Topiramate
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Antieptyleptic that can help reduce alcohol dependence
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Baclofen
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GABA-B agonist. helps reduce
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Most serious side effect of alcohol withdrawl
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Delirium Tremors: life threatening, peaks 2-5 days
Symptons: Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions) and confusion. treatment is Benzos |
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Symptons:
Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions) and confusion. |
Delirium Tremors, alcohol withdrawal.
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Buspirone
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Generalized Anxiety Disorder, 5-HT1A agonist
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B antagonists can be used from what anxiety disorder
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social anxiety, reduces tremors and tachycardia
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Augmenting agents for OCD with SSRIs
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Clonazepam (benzo)
Haloperidol and Risperidone (neruoleptics, antipsychotics) |
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Surgery options for OCD
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Anterior cingulatonomy
Anterior Capsulotomy |
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clozapine
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Atypical antipsychotic, watch for agranulocytosis, cardiomyopathy, myocarditis, weight gain,
BUT very effective |
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olanzapine
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atypical antipsychotic, weight gain is an issue
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Aripirazole
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atypical antipsychotic, less weight gain
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Haloperidol
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high potency typical antipsychotic
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Fluphenazine
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high potency typical antipsycotic
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Chlorprimazine
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Low potency typical antipsychotic
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atomoxetine
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For treating ADHD
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methylphenidate
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ritalin, treats ADHD
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dextroamphetamine
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treats ADHD
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pemoline
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ADHD, liver function tests every 2 weeks
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Bromocriptine
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Dopamine Agonist
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Pramipexole
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Dopamine Agonis
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Ropinerole
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Dopamine Agonist
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L-Dopa pros and cons
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Pros: works best, cheap, fast
Cons: drug induced movement complications, dyskinesias (looks like Corea) |
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Dopamine Agonists prs and cons
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Pros: no long term side affects
Cons: acute side effects, cost, need for L-Dopa |