Term
Monoanime Oxidase Inhibitors (MAOIs)
[Nardil, Marplan, Parnate] |
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Definition
Not well tolerated by the elderly.
MAOI-A = depression
MOA: MAO break down catecholamines (NE, E, DA)
Fatal in overdose.
Increases tyramine, which increases NE, which leads to a HTN crisis.
Be careful with OTC drugs
Interacts with certain food (has tyramine)
NO cheddar, BUT roast beef is ok!
Therapeutic lag time is 3-4 wks, with 2 wk wash-out
Taken with SSRIs, can cause "serotonin syndrome"
If you have a HA when taking MAOI, then you can take CCB |
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Term
Tricyclic Antidepressants (TCAs)
[Tofranil, Elavil, & Anafranil] |
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Definition
Not well tolerated by the elderly -> causes confusion & psychosis.
MOA: Inhibits reuptake of NE or 5-HT
s/e: Anticholinergic (Anti-SLUDGE), wt gain, sexual dysfunction, hypotension.
Therapeutic lag time: 2-3 wks
Therefore, this is NOT for suicidal pts |
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Term
Norepinephrine Dopamine Reuptake Inhiitors (NDRI)
[Wellbutrin] |
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Definition
MOA: Inhibits reuptake of NE & DA
Used in smoking cessation.
When used with SSRIs, it DECREASES the sexual dysfunction.
Precaution in pts with hx of seizures.
may cause insomnia.
NO WEIGHT GAIN |
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Term
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Definition
used for ANXIETY.
has 7-10 day lag time |
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Term
Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
[Effexor & Cymbalta] |
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Definition
Cymbalta is a new SNRI approved for DIABETIC NEUROPATHY & now for GAD.
Effexor is an ANTIDEPRESSANT
MOA: Potent inhibitor of 5-HT & NE reuptake & weak inhibitor of DA reuptake.
May be used for ANXIETY WITH DEPRESSION with anxiety component |
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Term
Selective Serotonin Reuptake Inhibitor (SSRIs)
[Prozac, Zoloft,Lexapro, Luvox, Paxil] |
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Definition
Luvox is used for treatment of OCD & ANXIETY disorders.
MOA: blocks 5-ht receptors, which INCREASES 5-HT.
Better tolerated with elderly.
S/E: fewer anti-cholinergic effects, wt loss, sexual dysfunction, akathesia
Paxil has the WORST S/E (sexual dysfunction)
Lexapro has the LEAST sexual dysfunction S/E profile
INDUCES TEGRETOL |
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Term
| Common causes of antidepressant failure |
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Definition
Not adequate dosage.
Not taking long enough.
Not taking as prescribed.
Sexual effects. |
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Term
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Definition
Anti-manic "Gold-Standard"
Reduces suicidal behavior.
Important Labs: BUN, Creatinine, TSH
Therapeutic window: 1-1.5
Tremors = toxic |
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Term
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Definition
Depakote
S/E: HA, wt gain, blurred vision
Lamictal
3rd generation anticonvulsant
FDA aprroved for BIpolar Disorders I & II
S/E: SJS (rash)
Zyprexa
S/E: wt gain
FDA approved for MIGRANES |
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Term
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Definition
2nd generation anti-convulsants.
FDA approved for ACUTE MANIA, rapid cycling MIGRAINE HA px, exlosive disorder, panic disorder, efficacy for borderline personality disorder
Monitor: CBCs & LFTs
S/E: Liver toxicity (1st 6 months), Wt gain
Comes in oil-based shot |
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Term
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Definition
3rd Gen. Anticonvulsant
NOT FDA approved for MOOD DISORDERS
used for bipolar II as djunct a lot of axiety
Poor efficacy for mood disorders
FDA approved for post herpetic neuralgia, NEUROPATHIC PAIN.
Off-Label: Sedative, hypnotic
S/E: dry month, diplopia, wt gain, sedation |
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Term
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Definition
2nd Gen. Anticonvulsant
FDA approved for rapid-cycling, explosive disorders, panic disorder.
Monitor: CBC & LFTs
REDUCES effectiveness of BIRTH CONTROL |
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Term
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Definition
3rd Gen. Anticonvulsant
NO FDA approval for mood stabilization, BUT adjunct for Bipolar Disorders I & II.
FDA approved for px of migraines
REDUCES effectiveness of BIRTH CONTROL
NO wt gain |
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Term
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Definition
Pallitaive.
MOA: Bind to GABA sites as agonist of GABA (inhibitory hormone)
Most widely used is Clonazepam (Klonopin)
Taper off by reducing to 1/2 of total dose per wk unti drug free |
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Term
Antihistamines
[Benadryl, Visteral, Atarax] |
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Definition
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Term
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Definition
MOA: REDUCES akathesia & physiological signs of anxiety
DO NOT give non-selective with asthma or COPD pts.
used in HYPERTHYROIDISM & to treat ANS symptoms of panic disorder |
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Term
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Definition
MOA: DA 2 receptor
EVERY effective antipsychotic agent know appears to block or partially block DA 2 recepts.
Blockage of GABA LOWER seizure threshold along with INCREASED DA
Increased DA in meso-cortical system may lessen negative symptoms of schizophrenia.
5-HT Antagonism reverse D2 Antagonism in nigrostriatal system to block 80% (not the near 100% blockage as a typical 1st gen. antipsychotic)
Over 80% blockage of D2 prduces the EPS of typical antipsychotics. |
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Term
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Definition
Partial agonist at the D2 receptor & 5-HT1a receptors.
Partial antagonist at the 5-HT2a receptor.
3rd Gen Anti-Psychotic
S/E: Hypotension |
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Term
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Definition
"Gold Standard" 2nd Gen Anti-Psychotic
S/E: Agranulocytosis
Monitor: WBC (>/= 3500/mm), absolute neutrophil (>/= 2000/mm)
Causes psychosis with elderly with dementia.
Always Monitor Bld Glucose & Wt Gain with they're prove to DM |
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Term
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Definition
2nd Gen Anti-Psychotic
EPS (only 2nd Gen Anti-Psychotic that has EPS)
S/E: Prolactenemia, photosensitivity, ameneuria |
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Term
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Definition
2nd Gen. Anti-Psychotic
FDA approved for psychosis, schizophrenia, bipolar, & depression.
1x daily = steady state
S/E: wt gain & sedation
Titrate up
Check Bld Glucose
Wt gain is a MAJOR PROBLEM
HIGHEST rate for type II DM |
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Term
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Definition
2nd Gen Anti-Psychotic
S/E: Sedation (give at bed) & increased Prolactin
FDA approved for schizophrenia, bipolar disorder, & depression.
Check Bld Glucose |
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Term
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Definition
2nd Gen Anti-psychotic
Initial sedation & increase prolactin
Increased QT interval ->Monitor ECG |
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Term
| High Potency vs. Low Potency |
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Definition
High potency: ie Haldol= HIGH EPS & low sedation
Low potency: ie Thorazine = LOW EPS & high sedation
Not used in elderly d/t cardiac & BD effects |
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Term
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Definition
Stimulant
Used for ADHD & Narcolepsy |
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Term
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Definition
N-methyl-D-aspartate (NMDA)
receptor agonist
Used for dementia d/t Alzheimers |
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Term
| Drugs used in Substance Dependency "C.A.R." |
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Definition
Catapres (Clonidine)
Anatabuse (Disulfiram)
ReVia (naltrexone)
Dont give "C.A.R."within 48 hrs of last drink |
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Term
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Definition
Inhibitor: Grapefruit, Praxil, Prozac, TCAs
Inducer: smoking |
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Term
| 1st vs 2nd vs 3rd Gen Anti-Psychotic |
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Definition
1st: EPS
2nd: Less EPS, except Risperdal
3rd: Lowest S/E risks |
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Term
| What is he goal of medication administration? |
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Definition
| To achieve a STEADY STATE with a balance metabolism, administration, & medicine distribution |
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Term
| What 2 anticonvulsants reduce the effectiveness of birth ontrol pills? |
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Definition
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Term
| How do you prescribe medication? |
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Definition
| Taper on, Taper off, & do NOT stop adruptly |
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Term
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Definition
Dystonia- irregular muscle movement
Akathesia- restlessness
Akinesia- Can't move
Pseudoparkinsonism- fine tremor, shuffling gailt
Tardive Dyskinesa- tongue & face movements
Uncontrolled chewing movements |
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Term
| What is the duration of action for Haldol & Prolixin? |
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Definition
| 2-4 wk duration of action |
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Term
| What drugs can be used for treatment of EPS? |
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Definition
Benadryl : Antihistamine
Artane : Anticholinergic
Symmetrel : DA Agonist
Inderal : Non-selective Beta Blocker
Cogentin : Anticholinergic
Parlodel : hyperprolactenemia agent & DA agonist
Aspirin |
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Term
| What generation of Antipsychotics does not cause TD? |
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Definition
Usually not caused by 2nd or 3rd gen.
Only 2nd gen antipsychotic that has EPS is Risperdal |
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Term
| What can be used to treat TD symptoms? |
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Definition
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Term
| What do you monitor with Clozaril? |
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Definition
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Term
| What labs should you monitor with Lithium? |
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Definition
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Term
| How longs does it take BuSpar to take effect? |
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Definition
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Term
| What drug as the least & best s/e for the elderly? |
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Definition
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Term
| Which SSRI is especially useful for treatment of OCD & anxiety? |
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Definition
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Term
| Are TCA's P450 Inducers or Inhibitors? |
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Definition
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Term
| T/F: Is lithium broken down by the liver? |
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Definition
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Term
| What drugs can be used for mania? |
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Definition
| Lithium, Lamictal, Zyprexa |
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Term
| What drugs are FDA approved for Bipolar Disorder? |
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Definition
| Lamictal, Depakene, Depakote, Lithium |
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Term
| What is the biggest risk for atypicals? |
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Definition
| metabolic syndrome (Syndrome X) |
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Term
| Do Paxil & Prozac inhibit or induce the P450 system? |
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Definition
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