laracrystalo's version from 2015-07-22 01:06


Question Answer
no need to taper this SSRIFluoxetine
longest half life SSRIFluoxetine
highest risk for GI disturbance SSRISertraline
withdrawal phenomena SSRIparoxetine
is there a correlation between efficacy of SSRI's and plasma levels or side effects?NO
how long should you give a patient antidepressant before considering changing?1-2 months at full dose
antidepressant + cough medicine?SEROTONIN SYNDROME!
how to treat sexual side effects of SSRI?augment regimen with bupropion, change to non-SSRI, add meds like sildenafil for men
more anticholinergic side effects like sedation, constipation, weight gainParoxetine
SSRI approved for OCDfluvoxamine
nausea and vomiting are more common side effectfluvoxamine
fewest drug-drug interactionsCitalopram
citalopram vs escitalopram?escitalopram is the levo-enantiomer. Similar efficacy, but more expensive
why do SSRI's have their side effects?bc extensive number of serotonin receptors throughout the body
SSRI side effectssexual dysfunction, GI disturbance, insomnia, headache, anorexia, restlessness, seizures
most documented side effect in children and adolescents?"increased suicidal thinking and behavior"
hyperreflexia and "electric jolt" limb movementsserotonin syndrome
what do SSRI's do to warfarin?increase levels

SNRI and Rando

Question Answer
overall avoid SNRIs in...patients with HTN!
what do you need to be careful for with Venlafaxine?can increase Bp, so do NOT use with patients with untreated or labile BP
what is Venlafaxine used for?depression, GAD, ADHD
what is Duloxetine used for?depression and neuropathic pain. Fibromyalgia.
side effects of Duloxetine?same as SSRI, but more dry mouth and constipation bc of NE effects
what should you be careful for with Duloxetine?liver side effects and patients with liver disease or heavy alcohol use
what is Bupropion good for?depression, ADHD, no sexual side effects
how does Bupropion work?NE and DA reuptake inhibitor
what should you be careful for with Bupropion?increase risk of seizures and psychosis at high doses and increases anxiety in some. C/I in patients with seizures or active eating disorders and those on MAOIs
what is Trazodone used for?treats refractory MDD, with anxiety too, and insomnia
why consider Trazodone?no sexual side effects and do not affect REM sleep
side effects of Trazodone?nausea, dizzy, orthostatic, arrhythmia, sedation, PRIAPISM
black box warning for Nefazodone?liver failure
how do Trazodone and Nefazodone work?5HT blocker
how does Mirtazapine work?alpha 2 blocker
what is Mirtazapine for?refractory major depression, especially in patients who need to gain weight
side effects of Mirtazapine?sedation, weight gain, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis. No sexual side effects
depression in elderly?Mirtazapine


Question Answer
useful in chronic pain, migraines, insomniaAmitriptyline
useful in enuresis and panic disorderImipramine
useful in OCD treatmentClomipramine
Tertiary aminesamitriptyline, Imipramine, Clomipramine, Doxepin
Secondary aminesNortriptyline, Desipramine
least likely to cause orthostatic hypotensionNortriptyline
least anticholinergicdesipramine
TCA overdose treatment?sodium bicarb and magnesium
Tetracyclic antidepressantsAmoxapine, Maprotiline
Careful with Maprotiline?Higher rates of seizures, arrhythmia, and fatality on overdose
major complications of TCAsCardiotoxicity, Convulsions, Coma
why do TCA's act with so many drugs?highly protein bound and lipid soluble and lack of specificity
antihistamine property of TCA?sedation
antiadrenergic property of TCA?orthostatics, dizzy, reflex tacky, arrhythmia, ECG changes
who should you avoid TCAs in?in patients with preexisting conduction abnormalities or recent MI
antimuscarinic effects of TCAs?dry mouth, constipation, urinary retention, blurred vision, tacky, exacerbate narrow angle glaucoma
what should you assess before giving a TCA?suicide risk! bc lethal in overdose (wide QRS/long QT --> tornadoes --> Vfib)
seratonergic effects of TCAs?erectile/ejaculatory dysfunction in males, anorgasmia in females
least likely to cause orthostatic hypotensionNortriptyline
least sedating, fewest anticholinergic SEDesipramine
most 5HT specificClomipramine
used in treating OCDClominpramine
used in treating chronic pain and headachesImipramine, Amitriptyline, Doxepin


Question Answer
how do they work?prevent the inactivation of biogenic amines like NE, 5HT, DA, tyramine by irreversibly blocking MAOA and B, they increase the number of NTs available in synapses
MAO-A preference?preferentially deactivates 5HT
MAO-B preference?preferentially deactivates NE/E
Both MAO A and B act on?DA and tyramine
what are MAOI's good for?refractory depression, atypical depression, and in refractory pain/anxiety disorder
which are the MAOIs?phenelzine, tranylcypromine, isocarboxazid
which MAOI does not need dietary restriction?Selegiline at low dosages (but still avoid decongestants, opiates, and serotonergic drugs)
how do you manage serotonin syndrome?discontinue medication. Try a calcium channel blocker (Nifedipine). If carefully monitored, try chlorpromazine or phentolamine
SSRI to MAOI how long do you wait?2 weeks! (5 wks with fluoxetine)
side effect in people with pyridoxine deficiency?paresthesia (treat with B6)
which has amphetamine like properties?Tranylcypromine


Question Answer
OCDSSRI in high doses, TCAs (clomipramine)
Panic disorderSSRI, TCA (imipramine), MAOI
Eating disorderSSRI (high dose), TCAs, MAOI
Social phobiaSSRI, TCA, MAOI
GADSSRI, SNRI (venlaflaxine), TCA
Posttraumatic stress disorderSSRI
EnuresisTCA (imipramine)
Neuropathic painTCAs (amitriptyline and nortriptyline), duloxetine
Chronic painSSRI, TCA
MigraineTCA (amitriptyline), SSRI
Smoking CessationBupropion
Premenstrual dysphoric disorderSSRI
Depressive phase of manic depressionSSRI
InsomniaMirtazapine, TCA (amitriptyline)

TYPICAL ANTIPSYCHOTICS (FIRST GENERATION) --- similar efficacy, vary in potency

Question Answer
long acting injectableHaloperidol and Fluphenazine
approved for use in pediatric patientsChlorpromazine (lower potency)
name the typicalsHaloperidol, Fluphenazine, Perphenazine, Chlorpromazine
how do typical work?D2 blockade
disadvantages of typical?EPS
fewer anti-ACH SE?Haloperidol
highest EPS?Haloperidol
highest anti-ACH SE?Chlorpromazine
side effect of Chlorpromazine?sedation and weight gain
sedation side effectChlorpromazine
low potencyChlorpromazine, Thioridazine
bluish skin discolorationChlorpromazine
treats intractable hiccupsChlorpromazine
can treat N/VChlorpromazine
associated with retinitis pigmentosaThioridazine
Mid-potencyLoxapine, Thiothixene, Trifluoperazine, Perphenazine
can cause ocular pigment changesthiothixene
can reduce anxietyTrifluoperazine
High potencyhave greater affinity for receptors, less seadation and SE, but greater EPS and TD (Haloperidol, Fluphenazine, Pimozide)
mesolimbic pathway nuclei and parts?accumbens, fornix, amygdala, hippocampus
EPS symptoms occur through which path?DA path of nigrostriatum
increased prolactin is due to which path?increased DA in tuberoinfundibulnar path
treatment of EPS?lower dose, give benztropine (anticholinergic), diphenhydramine (antihistamine), and amantadine (antiparkinsonian)
NMS?Fever, Autonomic instability, Leukocytosis, Tremor, Elevated CPK, Rigidity, Excessive sweating, Delirium. NOT ALLERGIC RXN.
how do you treat NMS?discontinue current med and start hydrating and cooling. Sodium Dantrolene, Bromocriptine, amantadine used infrequently bc of side effects.
onset of neuroleptic side effects?Acute dystonia (hrs to days), Akathisia (days to months), TD (months to yrs),
how should you monitor TD?use AIMS scale to quantify and monitor TD
if someone is getting metabolic syndrome from olanzapine, what can you switch them to?ziprasidone or aripiprazole or typical (but need to cross taper)


Question Answer
hyperprolactinemia side effectrisperidone
long acting form?risperidone
high EPS?risperidone
how do most work?mixed D2R blockade and 5HT2A blocker
metabolic syndromeOlanzapine
CATIE study effectiveOlanzapine
akathisia side effectAripiprazole
how to treat akathisia?propranolol
adjunctive andidepressantAripiprazole
theoretically weight neutralaripiprazole
mood stabilizer mono therapyquetiapine
side effects of quetiapinesedation, weight gain, orthostatic hypotension
Ziprasidone side effect?QT prolongation
must be taken with food?Ziprasidone
lowers seizure threshold?Clozapine
most effective antipsychotic?Clozapine
D2 and D4 blockadeClozapine
side effects of ClozapineAgranulocytosis, Cardiomyopathy, Cyalorrhea (drooling), significant sedation, weight gain, lowers seizure threshold
decrease suicideClozapine and lithium
name the atypicalRisperidone, Olanzapine, Aripiprazole, Quetiapine, Ziprasidone, Clozapine
why do you need to be careful with these in the elderly?increase of all-cause mortality and stroke when using in the elderly
may be more effective at treating...the negative symptoms compared to the typical (but overall they are all better at treating the positive symptoms)
what do you do if absolute neutrophil count drops below 1500?stop clozapine!
partial D2 agonistAripiprazole
which atypicals can also treat mania?quitiapine, olanzapine, aripiprazole, risperidone, ziprasidone
what to monitor with clozapine?CBC--weekly blood draws for first 6 months to check neutrophil count and WBC


Question Answer
decrease suicidalitylithium
blood levels are useful for?lithium, valproic acid, carbamazepine, clozapine
avoid what with a patient on lithium?ibuprofen
factors that affect lithium levels?NSAIDS (decrease), aspirin, dehydration (increase), salt deprivation (increase), sweating (increase), impaired renal fun (increase), diuretics and thiazides
what is lithium used for?acute mania, cyclothymia, unipolar depression
prior to starting lithium, what should you do?ECG, basic chemistries, thyroid function tests, CBC, pregnancy test
how long does lithium take to work?5-7 days
do blood levels of lithium correlate to clinical efficacy?YES, check after 5 days, then every 2-3 until therapeutic
draw backs to lithium?high side effects and narrow therapeutic index (0.6-1.2 is therapeutic. >1.5 is toxic. >2 is lethal)
lithium side effects?polyuria, polydipsia, NDI, sedation, coarse tremor, ataxia, MS changes, CONTRAINDICATED IN RENAL DISEASE, weight gain, ebstein anomaly
valproic acid side effects?sedation, weight gain, alopecia, pancreatitis, hepatotoxicity, thrombocytopenia, teratogenic, NYSTAGMUS, ataxia, N/V, coma, lethargy
what is valproic acid best for treating?mixed episodes and rapid cycling bipolar
what is carbamazepine best for?mixed episodes and rapid cycling bipolar, less effective for depressed phase
how does carbamazepine work?blocks Na+ channels and blocks APs
what do you need to obtain before starting carbamazepine?CBC, LFTs
side effects of carbamazepine?GI and CNS (drowsy, ataxia, sedation, confusion), SJS, SIADH, leukopenia, hyponatremia, hepatitis, teratogenic (neural tube defects)
auto induction of CYP?carbamazepine
nystagmus in toxicity?carbamazepine
what to monitor with valproic acid?LFTs and CBC
what is lamotrigine useful for?bipolar depression (prevention only, not acute episode)
how does lamotrigine work?works on Na+ channels that modulate glutamate and aspartate
side effects of lamotrigineSJS, teratogen, TITRATE SLOWLY to avoid SJS!!!
valproate and lamotrigine relationship?valproate increases lamotrigine levels, and lamotrigine will decrease valproate levels
topiramate usepromote weight loss, tx headaches, impulse control in borderline PD
side effects of topiramatekidney stones, hypochloremic non-anion gap metabolic acidosis
most limiting side effect of topiramate?cognitive slowing
as effective as carbamazepine in mood stabilization but better tolerated?Oxcarbazepine
adjunctive to help with anxiety and sleep?Gabapentin
Used in generalized anxiety and fibromyalgiapregabalin


Question Answer
benzos that are best for alcoholics or liver disease?ones that are NOT metabolized by liver (Lorazepam, Oxazepam, Temazepam)
used for difficulty falling asleeptriazolam
used for panic attacksalprazolam
what is bad about alprazolam?HIGHLY ADDICTIVE (short onset of action and euphoria)
less potential for abuse?Clonazepam
used for EtOH withdrawal?Chlordiazepoxide
common uses for anxiolytics?anxiety disorders, muscle spasm, seizures, sleep disorder, alcohol withdrawal, anesthesia induction
long acting benzos?diazepam, clonazepam
avoid with renal dysfunctionclonazepam
intermediate actingalprazolam, lorazepam, oxazepam, tamezepam
short actingtriazolam, midazolam
treats insomniatriazolam
used in surgical/medical settings?midazolam or triazolam
side effects of bentosdrowsy, impaired intellectual function, reduced motor coordination, anterograde amnesia, withdrawal can be life threatening and causes seizures, respiratory depression in overdose, especially when combined with alcohol
Zolpidemshort term insomnia treatment
side effects of zolpidemstrange dreams, dissociative symptoms, less effective after 2 weeks (avoid in hospitals to reduce falls)
diphenhydraminebenadryl, antihistamine. sedation, dry mouth, constipation, urinary retention, blurry vision
chloral hydrate side effectlethal in overdose, causes hepatic or liver failure. Not commonly prescribed due to tolerance and dependence.
ramelteonselective melatonin MT1 and MT2 agonist. no tolerance or dependence
benzo reversal?flumazenil
5HT partial agonist?buspirone
hydroxyzineantihistamine that is good for fast, short term med but cannot take bentos


Question Answer
what to monitor with dextroamphetamines and amphetamines?Bp and watch for wight loss and insomnia
what to watch for with methylphenidate?leukopenia, anemia, increased LFTs (monitor labs)
possible increase in SI?Atomoxetine
less appetite suppression and insomnia?atomoxetine
used in narcolepsy?modafanil
anticholinesterases for dementia?Donepezil, Galantamine, Rivastigmine, Tacrine, Memantine


Question Answer
procainamide and quinidine?confusion, delirium
albuterolanxiety, confusion
nifedipine, verapamildepression
cimetidinedepression, psychosis
steroidsaggressiveness/agitation, hypomania, anxiety, psychosis