Term
| Typical (First-Generation or "Older") Antipsychotics |
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Definition
Main therapeutic action: Reduce overt psychotic symptoms (hallucinations, delusional thoughts) by blocking dopamine in specific areas of CNS
Extrapyramidal side effects (EPSE): movement disorders (dystonia, pseudoparkinsonism, akathesia, tardive dyskinesia) caused by dopamine block in EP nerve tracts
Anticholinergic side effects caused by acetylcholine block: dilated pupils, dry mouth, slow urination, constipation; rapid pulse and confusion with high doses
Other side effects: Sedation, weight gain, orthostatic hypotension, changes in endocrine & sexual function, sensitivity to sunlight, lower seizure threshold
Neuroleptic malignant syndrome (NMS) – rare but serious!Severe EPSE plus fever, tachycardia, and hypertension |
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Term
| What are high potency typical antipsychotics? |
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Definition
HIGH POTENCY
Haloperidol (Haldol)
Trifluoperazine (Stelazine)
Fluphenazine (Prolixin)
Thiothixine (Navane) |
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Term
| What are medium potency typical antipsychotics? |
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Definition
MEDIUM POTENCY
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon) |
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Term
| What are the low potency typical antipsychotics? |
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Definition
LOW POTENCY
Chlorpromazine (Thorazine)
Chlorprothixene (Taracton)
Thioridazine (Mellaril) |
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Term
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Definition
Major therapeutic actions: Reduction of overt psychotic symptoms (similar to older meds); also increase motivation, alertness, & energy (selective serotonin 5-HT-2 blockade)
Side effects
Can cause side effects associated with older meds – EPSE, anticholinergic effects, etc. – but incidence is much lower
Can lead to metabolic syndrome: weight gain, hyperglycemia, hyperlipidemia, increased risk of Type II diabetes and cardiovascular problems
Neuroleptic malignant syndrome (NMS) is rare but does occur with newer drugs |
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Term
| What atypical antipsychotic causes for the patient to get bloodwork done every week? |
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Definition
| Clozapine (Clozaril)* – significant incidence of potentially-fatal agranulocytosis – requires CBC check & prescription refill weekly |
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Term
| Which atypical antipsychotic causes the most amount of weight gain? |
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Definition
| Olanzepine (Zyprexa, Zydis)* |
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Term
| Which atypical antipsychotic causes the least amount of weight gain? |
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Definition
Asenapine (Saphris)**
Ziprasidone (Geodon)** |
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Term
| What are the names of the atypical antipsychotics? |
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Definition
Clozapine (Clozaril)*
Olanzepine (Zyprexa, Zydis)*
Asenapine (Saphris)**
Risperidone (Risperdol), Risperdol consta
Paliperidone (Invega, Invega sustaina)
Quetiapine (Seroquel)
Ziprasidone (Geodon)**
Aripiprazole (Abilify)
*Highest incidence of wt. gain
**Least wt. gain |
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Term
| Anticholinergic Antiparkinson drugs used to manage EPSE |
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Definition
Anticholinergic action (acetylcholine block) causes muscle relaxation that will minimize parkinsonian side effects associated with antipsychotic-induced dopamine block
Anticholinergic side effects include blurred vision to due dilated pupils, dry mouth due to decreased salivation, slowness of urination and peristalsis due to relaxation of smooth muscle in GU and GI tracts. Pt. complaints:
“Can’t see, can’t pee, can’t spit, can’t sh..t!”
REMEMBER: Antipsychotic drugs can also have anticholinergic side effects. When an anticholinergic is used concurrently to manage EPSE the additive effect can be significant. Tachycardia and confusion can occur with large doses. |
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Term
| What anticholinergic and antiparkinson drugs are used to treat EPSE caused by antipsychotics? |
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Definition
Most commonly used:
Benztropine (Cogentin)
Diphenhydramine (Benadryl)
Other antiparkinsonian drugs could also be used |
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Term
| Benzodiazepine Anxiolytics |
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Definition
Schedule IV controlled substances
Action – potentiate gamma aminobutyric acid (GABA); effects include sedation, anxiety reduction, skeletal muscle relaxation, treatment of seizures
Most common side effect is drowsiness
Best used short term due to potential for dependence |
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Term
| What are some examples of benzodiazepines? |
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Definition
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
Chlorazepate (Tranxene) |
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Term
| What drugs are used as substitutions for benzodiazepines? |
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Definition
Buspirone (BuSpar) – less sedating than benzos and not a controlled substance; takes effect in about 3 weeks, and usually not effective if patient has previously been on benzos
Antihistamines - histamine blockade in CNS causes sedation; not controlled substances; take effect right away, and if effective are very safe alternatives to benzos |
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Term
| What drugs are examples of non-benzodiazepine anxiolytics? |
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Definition
Buspirone (BuSpar)
Antihistamines:
Hydroxyzine (Vistaril, Atarax)
Diphenhydramine (Benadryl) |
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Term
| Mood Stabilizer: Lithium Carbonate |
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Definition
Modifies transport of sodium ions across neuronal cell membranes
Narrow margin of safety!
Side effects common at therapeutic blood levels:mild nausea, fine tremor of hands, polyuria
Weight gain over time also common
Toxic effects (seen at higher blood levels) include coarse tremor, poor coordination, severe nausea, vomiting, and diarrhea, dehydration, seizures, coma, death |
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Term
| What are some brand names of lithium carbonate? |
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Definition
| Various brand names: Carbolith, Duralith, Eskalith, Lithane, Lithicarb, Lithizine, Lithobid, Lithonate, Lithotabs, Quilinom |
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Term
| Antileptic Drugs (AEDs) used as Mood Stabilzers |
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Definition
Possible actions include enhancement of GABA and stabilization of ion transfer across neuronal cell membranes
Most common side effects are sedation, poor coordination, and ataxia
CBC, renal and liver function tests need to be done periodically due to potential toxic effects
valproate/divlporate (depakote, depakene)
carbamazapine (tegretol)
lamotrogine (lamictal)
These 3 are FDA approved as mood stabilizers; however, you may see other AEDs prescribed for this purpose |
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Term
| Which AED requires liver function tests? |
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Definition
| Valproate/divalproate (Depakote, Depakene) – need to monitor liver function tests (LFT) |
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Term
| Which AED requires liver function tests and complete blood counts? |
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Definition
| Carbamazapine (Tegretol) – need to monitor LFT and CBC (can cause agranulocytosis , aplastic anemia, and liver damage |
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Term
| Which AED has the potential to cause Stevens-Johnson syndrome? |
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Definition
| Lamotrogine (Lamictal) – can cause rare but life threatening skin reaction (Stevens-Johnson Syndrome) |
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Term
| SSRI Antidepressants: Selective Serotonin Reuptake Inhibitors |
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Definition
Inhibition of serotonin increases levels at receptor sites
First line therapy for depression and anxiety disorders
Common side effects: Initial nausea, diarrhea; headache; insomnia; sense of feeling “wired” or “spaced out”
Significant incidence of sexual problems
Rare occurrence of serotonin syndrome |
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Term
| What are some examples of SSRIs? |
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Definition
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Fluvoxamine (Luvox)
Escitalopram (Lexapro) |
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Term
| Newer Dual Action (Novel) Antidepressants |
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Definition
Also first line therapy for depression and anxiety disorders - incidence of sexual side effects much lower than SSRIs
Most are SNRIs (Serotonin Norepinephrine Reuptake Inhibitors)
Buproprion (Wellbutrin) is an NDRI (Norepinephrine Dopamine Reuptake Inhibitor)
NOTE: Trazadone is a much older drug used only as a bedtime sedative. Safe to use in combination with SSRIs. |
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Term
| What are some examples of Newer Dual Action Antidepressants? |
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Definition
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Mirtazapine (Remeron)
Duloxetine (Cymbalta)
Buproprion (Wellbutrin, Zyban)
Trazadone (Desyrel) – Used only as bedtime sedative |
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Term
| Tricyclic Antidepressants |
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Definition
Older group of antidepressants still widely used
Inhibit reuptake of norepinephrine and serotonin
Significant sedation – take at bedtime
High incidence of anticholinergic side effects
Tachycardia can be problematic
Increased appetite and weight gain common |
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Term
| What are some examples of TCAs? |
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Definition
Amitriptyline (Elavil)
Amoxapine (Asendin)
Desipramine (Norpramine)
Doxepin (Sinequan)
Imipramine (Tofranil)
Nortriptyline (Aventyl)
Protriptyline (Vivactil)
Trimipramine (Surmontil)
Maprotiline (Ludiomil) |
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Term
| Monoamine Oxidase Inhibitors (MAOI Antidepressants) |
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Definition
Inhibits monoamine oxidase (enzyme that destroys norepinephrine and serotonin)
Not first line therapy due to multiple side effects and risk of hypertensive crisis due to interactions with foods and other medications
Problem foods are those high in tyramine
Problematic medications include some commonly purchased over-the-counter IE Sudafed and other adrenergics
High risk of serotonin syndrome if taken concurrently with other antidepressants |
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Term
| What are some examples of MAOI Antidepressants? |
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Definition
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Seligiline (EmSam) transdermal patch – does not require dietary modification at standard doses |
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Term
| What are some of the foods that are contraindicated for patients taking MAOIs? |
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Definition
Aged cheeses
Cured meats, such as sausage, pepperoni and salami
Sauerkraut
Soy sauce
Yeast-extract spreads, such as Marmite
Improperly stored or spoiled foods
Broad bean (fava bean) pods
Banana peels
Tap (draft) beer or unpasteurized beer
Some wines |
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Term
| CNS Stimulants and Other Meds Used in Treatment of ADHD |
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Definition
Selective increase in CNS levels of norepinephrine improves ability to focus
Appropriate use in ADHD appears to calm person down (paradoxical effect)
Insomnia a problem if med given late in day
Decreased appeatite leading to stunted growth in children may require “drug holidays” on week-ends and/or summer vacations
Recreational use in persons who do not have ADHD causes a “high” and can lead to dependence |
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Term
| What are some examples of CNS stimulants? |
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Definition
Stimulants that are controlled substances:
Methylphenidate (Ritalin, Concerta)
Amphetamine mixture (Adderal)
Dextroamphetamine (Dexedrine)
Amoxetine (Strattera) – norepinephrine reuptake inhibitor
Pemoline (Cylert) – potentiates action of norepinephrine |
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Term
| Which CNS stimulants for ADHD are contolled substances? |
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Definition
Methylphenidate (Ritalin, Concerta)
Amphetamine mixture (Adderal)
Dextroamphetamine (Dexedrine) |
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Term
| Which CNS stimulant for ADHD is a norepinephrin reuptake inhibitor? |
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Definition
| Amoxetine (Strattera) – norepinephrine reuptake inhibitor |
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Term
| Which CNS stimulant for ADHD potentiates the action of norepinephrine? |
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Definition
| Pemoline (Cylert) – potentiates action of norepinephrine |
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Term
| What drugs reduce the cognitive decline of alzheimers disease? |
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Definition
Acetylcholinesterase inhibitors – increase CNS levels of acetylcholine by inhibiting the enzyme that destroys it
N-methyl-D-aspartate (NMDA) receptor antagonists bind with glutamate receptors that may be overactivated in Alzheimer’s disease
Goal of therapy: stabilize cognitive function, delay decline, and improve quality of life
Increased levels of acetylcholine can result in diarrhea and eventual weight loss; especially problematic in very frail patients |
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Term
| Which Alzhiemer medications are acetylcholinesterase inhibitors? |
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Definition
Donepezyl (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl) |
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Term
| Which Alzheimers disease medication is a NMDA receptor? |
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Definition
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Term
| Drugs to promote abstinence in substance abuse patients? |
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Definition
Synthetic opioids (opiate agonists) bind with opiate receptors in brain and have actions similar to heroin & morphine, but are less potent, less addicting, and can be obtained legally by prescription in US
Opiate antagonists bind with opiate receptors in brain but do not have opiate actions; however they may help reduce cravings for opiates & alcohol
Certain other meds have been noted to help reduce cravings, but their mechanism of action is unknown
Aldehyde dehydrgenase inhibitors block the liver enzyme required to break down alcohol in the body; person who consumes alcohol in any form (alcoholic beverages, alcohol-based cough medicines, deodorants, after-shave lotions, etc) will immediately develop severe nausea! |
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Term
| What are examples of opiate agonist? |
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Definition
Methadone – opiate agonist that is a Schedule II controlled substance; less potent than heroin & dispensed to hard-core heroin addicts from methadone maintenance clinics
Buprenorphine (Stadol) – partial opiate agonist, less potent than heroin, can be prescribed by private physician
Naltrexone (ReVia, Vivitrol) – opiate antagonist, reduces cravings for opiates and alcohol |
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Term
| What are some other drugs that reduce drug cravings? |
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Definition
Acamprosate (Camprol)
Clonidine (Catapres)
Disulfiram (Antabuse) – aldehyde dehydrogenase inhibitor used long term to promote sobriety in alcoholics; person taking antabuse must abstain from alcohol in any form to avoid extreme nausea/vomiting |
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