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Psych drugs

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eesohbel's version from 2016-07-31 22:14

ANTIDEPRESSANTS IN OTHER DISORDERS

Question Answer
OCDSSRI in high doses, TCAs (clomipramine)
Panic disorderSSRI, TCA (imipramine), MAOI
Eating disorderSSRI (high dose), TCAs, MAOI
DysthymiaSSRI
Social phobiaSSRI, TCA, MAOI
GADSSRI, SNRI (venlaflaxine), TCA
Posttraumatic stress disorderSSRI
IBSSSRI, TCA
EnuresisTCA (imipramine)
Neuropathic painTCAs (amitriptyline and nortriptyline), duloxetine
Chronic painSSRI, TCA
FibromyalgiaSSRI
MigraineTCA (amitriptyline), SSRI
Smoking CessationBupropion
Premenstrual dysphoric disorderSSRI
Depressive phase of manic depressionSSRI
InsomniaMirtazapine, TCA (amitriptyline)
acute maniaantipsychotic first hten lithium
maintenence bipolarlithium/valproate +/- SSRU
second line maint bipolarcarbemazepine/lamotrigine
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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
photosensitivityChlorpromazine
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)
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ATYPICAL ANTYPSYCHOTICS (SECOND GENERATION)

Question Answer
hyperprolactinemia side effectrisperidone
long acting form?risperidone
high EPS?risperidone
how do most work?mixed D2R blockade and 5HT2A blocker
metabolic syndromeOlanzapine and clozapine
CATIE study effectiveOlanzapine but associated with metabolic
akathisia inner restlessness side effectAripiprazole
how to treat akathisia?propranolol
adjunctive andidepressantAripiprazole
theoretically weight neutralaripiprazole and ziprasidone
mood stabilizer mono therapy bipolar depressionquetiapine
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
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MOOD STABILIZERS

Question Answer
decrease suicidalitylithium
blood levels are useful for?lithium, valproic acid, carbamazepine, clozapine
avoid what with a patient on lithium?NSAIDS and diuretics esp. thiazides
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?BUN, creatinine, calcium, urinalysis, thyroid function, pregnancy test, ECG in patients w/CVD rf
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?narrow therapeutic index (0.7-1.2 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
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SEDATIVE HYPNOTICS

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 xanax
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 bentoswithdrawal can be life threatening
Zolpidemshort term insomnia treatment
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
difference between onset of action and half lifefaster OA more addictive. shorter half life increases risk of withdrawal seizures
fast OAalprazolam (xanax), diazepam (valium), triazolam
short HLalprazolam and traizolam
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STIMULANTS and RANDO

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
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SIDE EFFECT LIST

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