Psych drugs I

eesohbel's version from 2016-04-29 00:16


Question Answer
no need to taper this SSRIFluoxetine
longest half life SSRIFluoxetine
highest risk for GI disturbance SSRISertraline
withdrawal phenomena SSRIparoxetine
good for anxiety disordersparox
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
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
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 can help fall asleep. and stimulate appetite


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 and elderly can cause confusion/hallucinations
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


Question Answer
how do they work?inhibit enzyme metabolizes 5-HT, NE, and DA
MAO-A preference?preferentially deactivates 5HT
MAO-B preference?preferentially deactivates NE/E
common SE MAO-I'sGI distress, orthostatic hypotension, sleep disturbance, dry mouth, headache
dangerous SESerotonin syndrome and hypertensive crisis
treatment for hypertensive crisisphentolamine
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)
which has amphetamine like properties?Tranylcypromine