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Psych Meds

Terms in this set (62)

SSRI MOA
increase serotonin by inhibiting presynaptic pump and blocking reuptake
SSRI SE initial
n, d, vertigo
SSRI SE long term
sleep issues, WG >5lbs/yr, dec libido (25%), worsened mood (5%)
Prozac (fluoxetine)
Tx: depression, bulimia, panic disorder, OCD
longest half life
Sarafem: for PMDD
Celexa (citalopram)
Tx depression
SE: dry mouth, QT prolongation
Avoid in elderly and PPI use
Lexapro (escitalopram)
Tx: depression, GAD
Zoloft (sertraline)
Tx: depression, PMDD, OCD, panic/social anxiety, PTSD
Paxil (paroxetine)
Tx: depression, PMDD, panic d/o, social anxiety, OCD, GAD, PTSD, hot flash
SE: WG and sedation (congenital heart defects)
Luvox (fluvoxamine)
OCD: minimal anticholinergic SE
SSRI cautions
increased suicidal ideation in <25y/o
renal/hepatic dysfunction
mania
hyPOnatremia
QT prolongation
SSRI drug interactions
St John's wort
warfarin
digoxin
diuretics (worry about low Na)
Serotonin syndrome
With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs, Skelaxin, Tramadol, Dextromethorphan) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Venlafaxine (Effexor)
tx: depression and GAD
(off-label: hot flashes, insomnia, neuropathy)
SNRI warnings
sustained hypertension
lower seizure threshold
increase SI in teens
SNRI SE
dizzy, bad dreams, N/C/dry mouth, dec libido, tremor/nervousness
SNRI drug interactions
cimetidine (Tagamet - h2 blocker), MAOI, SSRI, TCA, NSAIDs, ETOH
Cymbalta (duloxetine)
SNRI
Tx: anxiety, OCD, depression, fibromyalgia, chronic pain
Milnacipran (Savella)
SNRI for fibromyalgia (CIL HTN, liver/renal dz, bleeding d/o, seizures) DI = NSAIDs
Wellbutrin (bupropion)
Tx: depression, seasonal affective d/o, (Zyban = smoke cessation)
inhibit norepi and dopamine reuptake
Wellbutrin CI
lowers seizure threshold, bulimia, anorexia, mani
Wellbutrin SE
agitation, insomnia, tachycardic, HTN, Wl, tremor, sweats, hallucinations, fatigue
Wellbutrin DI
levodopa, ETOH, lower seizure threshold, MAOIs
Remeron (mirtazapine)
tetracyclic antidepressant
Histamine, serotonin, norepi are impacted
SE: WG, fatigue, dizzy, dry mouth, C
low dose: agitated elderly who need to eat and sleep more
Trazadone (Desyrel)
Serotonin modulator
tx: depression and insomnia
SE: hypotension, N/V, nightmares, arrhythmias, priapism
Viibryd (vilazodone)
Serotonin Modulator for depression
more GI SE
Trintellix (Vortioxetine)
Serotonin Modulator
TCAs
inhibit nerve ability to reuptake norepi --> greater norepi available
some impact on serotonin and histamine
TCAs SE
SE: blurred vision (Inc IOP), dry mouth, sedation, orthostatic HoTN, palpitations, lower seizure threshold, WG, constipation, TURN URINE BLUE
TCA drugs
Elavil (amitriptyline)
Tofranil (imipramine)
TCAs tx
depression, sedation, fibromyalgia, chronic pain, neuropathy, migraine prophylaxis, hot flash, IBS
TCA CI/warning
narrow angle glaucoma, cardiac conduction d/o, hypotension, elderly
TCA DI
clonidine, warfarin, anticholinergics, SSRI, caffeine, alcohol
MAOIs
Parnate (tranylcypromine)
Nardil (phenelzine)
Selegiline (Emsam)
MAOI SE/warnings
HTN crisis
Serotonin syndrome
orthostatic hypotension
decreased libido
blurred vision
trembling/weakness
fatal interaction with Tyramine
Typical MOA
block dopamine 2 receptors in subcortical and mesolimbic
tx: positive symptoms
Typical SE
EPS (acute dystonia, tardive dyskinesia, parkinsonism, akathesia), prolong QT, hyperprolactinemia, amenorrhea, gynecomastia, galactorrhea, neuroleptic malignant syndrome
acute dystonia treatment
Benztopine (Cogentin) and diphenhydramine (Benadryl)
tardive dyskinesia treatment
valbenazine (ingrezza)
Typical Antipsychotics
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Fluphenazine (prolixin)
Thioridazine (mellaril)
Neuroleptic malignant syndrome
typical >atypical
fever, rigidity, AMS, increased HR/RR
INCREASED CPK
tX: DANTROLENE AND BROMOCRIPTINE
Atypical MOA
antagonize D2 and serotonin in frontal cortex
reduce positive and negative sx
Clozapine (Clozaril)
atypical
Agranulocytosis - use for tx resistant schizophrenia
Risperidone (Risperdal)
atypical
BBW: elderly (inc death)
Olanzapine (Zyprexa)
Atypical
IM for agitation
Atypical approved for depression
Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Quetiaprene (Seroquel)
Brexiprazole (Rexulti)
Lurasidone (latuda)
Atypical
preg cat B
Dibenzoxapine (Adasuve)
Atypical inhaled for acute agitation
Atypical SE
increased risk of death w. dementia, sedation, dizzy, GI, QT prolongation
Atypical Tx
schizophrenia, depression, alzheimers, bipolar, tourettes, prolonged hiccups
Buspirone (Buspar)
Tx: anxiety and OCD
SE: dizzy, nervous, GI, CP, tinnitus, dream changes
Hydroxyzine (Vistaril)
antihistamine
Tx: short term anxiety management
helpful at night
Prazosin (minipres)
Alpha 1 blicker
offlabel for PTSD nightmares
bedtime dosing
SE: hypotension/orthostatics
Mania tx
mood stabilizer + atypical
Hypomania tx
mood stabilizer +/- atypical
Bipolar depression
antidepressant + mood stabilizer or antipsych
(lithium, lamotrigene, atypical)
Lithium (lithobid) MOA
Mood stablilizer
inhibit Na channels in CNS
Lithium levels
goal 0.6-1.2
toxicity = 2
lithium SE
polyuria, polydipsia, hypotension, drowsy, tremor, HYPOTHYROID, pseudomotor cerebri
Divalproic Acid (Depakote)
Mood stabilizer
impacts GABA receptors
hepatotoxicity and platelet dysfunction
50-125
Carbamazepine (Tegretol)
mood stabilizer
monitor CBC - bone marrow suppression, agranulocytosis, and liver enzymes
4-12
Oxcarbazepine (Trileptal)
mood stabilizer
follow for hyponatremia
SJS, TEN, pancytopenia
SE: paresthesias, WL, GI, decrease OCP
Lamotrigene (Lamictal)
mood stabilizers
SJS/TEN
SE: GI and sleep disturbances
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