OME: PSYCH_Pharmacology Meds
bipolar treatments
"PIRA" variants and "ZEPINES": 1. olanZEPINE (Zyprexa) obesity 2. ZIPRAsidone (Geodon) - anti-psych, QT interval 3. ARIPrazole (abilify) - anti-psych, antidepressant, bipolar, tourette's 4. carbamaZEPINE - bipolar - anticonvulsant 5. toPIRAmate - (Topamax) aka "dope-amax". Miss America pageant, weight loss and word finding difficulty.
Carbmazepine SEs:
1. hepatitis 2. agranulocytosis (more rare than for Clozapine (Clozaril) 3. Hyponatremia, 4. Derm reaactions 5. organ dysgenesis [Ocycarbazepine has lesser side effects]
Hypertensive crisis
A severe increase in blood pressure which could result in stroke HTN, HA, sweating, fever, chills, palpitations
Dystonia
Abnormal muscle tone Facial grimace Occulogyric crisis (involuntary eye spasms)
SE of antipsychotics
Anticholinergic Extrapyramidal Dystonias Akathisia Tardive dyskinesia
SSRIs
Antidepressant Interact w many meds Monitor BP Administer w snack or meal (GI disturbance) Taper dose when quitting Serotonin syndrome; can be caused by taking w OTC cold meds + MAOIs "Ser Parot Flu to see his mamaCita." Sertraline, paroxetine, fluoxetine, citalopram, escitalopram
SNRIs
Antidepressant Not tolerated as well as SSRIs But similar to them Venlafaxine Duloxetine "Vexed + Depressed"
Bupropion (Wellbutrin)
Antidepressant, smoking cessation SE: weight loss, incrz sexual desire
Barbiturates + Sedative hypnotic drugs names
Barbiturates (-barbital) Chloral hydrate Ezopiclon, Zaleplon, Zolpidem Ramelteon *Words w Z think "zzz, sleep"
Tricyclic Antidepressants (TCAs)
Blocks reuptake of norepinephrine Use w alcohol —> CNS depression Use w MAOI —> hypertensive crisis SE: cardiac toxicity + dysrhythmia, anticholinergic, sedation (take at night, don't drive), impotence Taper when dc -triptyline (tri= tricyclic antidepressant) -pramine
SE of benzodiazepines
CNS depressant (sedation, don't drive + no alcohol) Drowsiness (disappears w continued therapy) Anticholinergic Ataxia - jerky and unsteady gait (no caffeine, it could worsen)
ADHD drugs
CNS stimulants- calming effect on kids (not in adults though) Increase alertness and sensitivity to stimuli Avoid OTC Meds Take 6 hours before bed (otherwise, insomnia) Monitor height + weight, growth impeded Drug holiday Methamphetamine Methylphenidate (And name derivatives) -am(ph)(f)etamine
Increase toxicity of lithium
Diuretics Fluoxetine (ssri) Methyldopa NSAIDs
Anxiolytics
Drugs that reduce feelings of anxiety, depress CNS Benzodiazepines (AZE) "chill pill" Don't dc abruptly Safer than barbiturates Contraindicated in pt w glaucoma Short term bc tolerance can develop Antidote: flumazenil IV -Nil means no, so no to your benzo "My BENZ can't fly"
Mood Stabilizers
Drugs used to control mood swings in patients with bipolar mood disorders. Lithium (most common) "pira variants" + zepines OnlanZEPINE zIPRAsidone ARIPiprazole CarbamaZEPINE (also an anticonvulsant) ToPIRAmate
SE of SSRI & SNRIs
Dry mouth (give water/ hard candy) Blurred vision + photosensitivity (sunglasses) Insomnia (take in morning) Nervousness/ restlessness/ agitation Suicidal thoughts Anorgasmia (dcrz libido, men + women) BP changes Improve after 2 weeks
TCA overdose treatment
Gastric lavage (stomach suction/ pumping) Charcoal (absorbs) Correct HR (meds, shock into rhythm) Antidote: Physostigmine "Phys (like physical activity) for tricycle"
Typical Antipsychotics
Haloperidol (Haldol) Chlorpromazine Fluphenazine (-azine)
Atropine overdose
Hot as a hare Mad as a hatter Red as a beat Dry as a bone Anticholinergic effects can lead to this
Serotonin Syndrome
Hyperglycemia Fever (hyperthermia) Seizures, coma, death Can happen when SSRIs are given with MAOIs, statins, Dextromethorphan, St John's Wort, Odansetron
Barbiturates + Sedative-hypnotic drugs
Insomnia, sedation Put pt in deep sleep (if they wake up in middle, confusion, etc) SE: dizziness, drowsiness, confusion, blood dyscrasia, respiratory depression (adverse) Lower dose for elderly Supervise ambulation No alcohol
Negative symptoms of schizophrenia
Lack of something - lack of emotion or social connection Social withdrawal, apathy Treated w atypical antipsychotics
Lithium
Lithi-ONE - aim for a lithium level of 1. Window: 0.6-1.2 Up to 3 w for drug response Check serum level every 1-2 months Many drug- drug interactions Fetal toxicity SE: polyuria, weight gain, metallic taste, fine hand tremor Monitor: Na level (keep it up) LMNOP L- lithium M- movement (tremor -is a 1st sign of litium tox) N- nephrotoxicity O- hypOthyroidism P- pregnancy problems
Monoamine oxidase inhibitors
Lots of contraindications: avoid sedatives, stimulants, herbs, and TCAs No tyramine foods (cookout meal: cheeseburger w pickles, beer, soda) Meats, pickles, yeast, caffeine Hypertensive crisis Max effect 3 w Antidote: phentalomine Tranycypromine, selegiline, isocarboxazid, phenelzine
Atypical antipsychotics
No significant SE To negative symptoms Risperidone Quetiapine "Think whisper + quiet the voices in your head" ZIPRAsidone + ARIPiprazole (also mood stabilizers) -peridone
SE of MAOI
Orthostatic HypoTN Restlessness Insomnia (so take in morning) CNS Stimulation If palpitations or HA occur, withhold and notify HCP
Extrapyramidal Effects
Parkinsonism Tremors Masklike face Rigidity Shuffling gait Drooling
Barbiturates toxicity
Pinpoint pupils Respiratory depression Coma (Lot like opioid OD)... so give narcan or naloxone... if pt responds, then it was opioid OD. If not, then it was Barbiturate OD.
Tardive dyskinesia (TD)
Protrusion and rolling of tongue, chewing action Involuntary movements Snake like movement
Akathisia
Restlessness
Benzodiazepine toxicity S&S
Somnolence Confusion Diminished reflexes, maybe coma Treat w flumazenil
short TOM, medium CAAT, long DivorCe
TOM - short t triazolam (Halcyon) O oxazepam (Serax) M midazolam (Versed) CAAT - medium C clonazepam A alpaszolam (Xanax) A (Ativan) Lorazepam T temazepam (Restoril) DC - long D - diazepam (Valium) C - chlordiazepoxide (Librium)
SE of ADHD Drugs
Tachycardia Anorexia, weight loss Elevated BP Dizziness Agitation
Decrease toxicity of lithium
Theophylline Phenothiazine Sodium bicarbonate Incrz renal excretion
Haloperidol (Haldol)
Typical Antipsychotic High potency IM Extrapyramidal effects
Chlorpromazine (Thorazine)
Typical Antipsychotic Treats hiccups Lower potency, fewer SE than Haldol
Patient teaching for antipsychotics
Up to 6 w for full effect Blood work every 3 mo Don't dc abruptly Consult dr about OTC meds Mouth care Report any involuntary muscle movements
valproic acid (valproate, VPA)
anti-convulsant: GABA agonist (increases synaptic GABA) #1 used antieileptic /mood stabilizer in the US. target level is 50-150 (higher than that of epilepsy) SEs: 1. hepatic failure 2. hemmorrhagic pancreatitis 3. hematologic : thromocytopenia, eukocytopenia 4. Organ dysgenesis: in pregnancy "valproATE the folATE" 5. others: sedation, weight gain, N/V, alopecia
carbamazepine (CBZ)
anticonvulsant: Na channel blocker target levels:8-12. strong enzyme inducers: reduce levels of many meds. used for CBZ C- cranial nerve V - trigeminal neuralgia B - bipolar Z- Zeizures
2 types of anxiolytics: benzodiazepine and barbituates
benzodiazeine - "AZE" - increase the freq. of calcium channel opening "FRENzodiazepine" ** GABA agonist (binds to benzo site on the GABAa receptor which leads to increased effect of GABA through enhanced Ca channels. Barbituates - incr. the DURATION of calcium channel opening :Barbi-DURATES"
Lamotrigine (Lamictal)
most effective for bipolar depression (b/c no GABA like the others) GABA causes sedation... anti-convulsant: Na chalnnel blocker and glutamine antagonist most effective for bipolar depression 1. Lam-ITCH-tal (tchy rash - possibly leading to steven ohnsons syndrome)
benzodiazepines - GABA +
short, t 1/2 = 1-12 hours, panic attack, status epilepticus. TOM medium t 1/2 = 12-40 hours, anxiety, insomnia, panic disorder. CAAT. long, t 1/2 = 40-250 hours, chronic panic disorder, EtOH withdrawal. DC
drugs that cause liver necorosis
waiter serving liver saying "Have a Seat" 1. HAlothane 2. Valproic acid 3. ACETaminophen
