Common Drugs - PMHNP

Lamotrigine

Lamictal

lamictal

is the brand name for Lamotrigine, which is prescribed to manage epilepsy and bipolar disorder by stabilizing mood and preventing seizures.

Valproate

is a medication used to treat seizure disorders, bipolar disorder, and to prevent migraine headaches. It works by increasing the availability of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain.

Valproate

Depakote is a brand name, commonly prescribed for seizure disorders and bipolar disorder.

Gabapentin

is an anticonvulsant medication used to treat epilepsy by preventing seizures through modulation of neurotransmitter release.

Gabapentin - brand name

Neurontin

Serotonin

effects including mood, cognition, sleep and memory - decreased amount can cause fatigure, dysregulated sleep, lack of appetitie and nausea; increased amount can cause increased fear and anxiety

SSRI uses

major depressive disorder and generalized anxiety disorder

SSRI - what is the name and class?

Selective Serotonin Reuptake inhibitors - antidepressant class

What is the only SSRI that is technically FDA approved for treatment of OCD, but is also used for major depressive disorder and generalized anxiety disorder?

Fluvoxamine

Fluoxetine - what is it and what is it used for?

OCD, panic disorder, also used for anxiety and depression

What are the 6 SSRIs?

Citalopram, Excitalopram, Fluoxetine, Fluvoxamine, Sertraline, Paroxetine

How do SSRI’s work?

They harness naturally occurring serotonin to regulate it for optimal benefits in mood, sleep, and appetite; they bind to inhibit serotonin reuptake transporters to increase the amount of available serotonin in the synaptic cleft, therefore increasing the amount of available serotonin for receptor activation / Simplifeid (double negative) Decreased (inactivation) reuptake of serotonin => Increased active serotonin to stimulate receptors

Generalized side effects of SSRI’s

Weight gain, insomnia, nausea, vomiting, fatigue, sexual dysfunction

Common side effect of Fluvoxamine

Most often causes GI upset (nausea and vomiting)

Common side effect if Sertraline

Most often causes insomonia

Common side effect of Fluoxetine

Most often causes Weight loss

Common side efect of Escitalopram

Most often causes decreased libido

Common side effect of Citalopram

Most often causes sedation and somnolence

Common side effect of Paroxetine

Most often causes weight gain

FDA SSRI’s black box warning

Suicidal ideation in adolescents

What is serotonin syndrome?

When SSRI agents are combined with other drugs that increase serotonin, the risk of this can be higher. It causes seizures, fever, altered mental status, tachycardia and if not recognized can be fatal.

Neurotransmitters are what?

Chemical messengers that your brain uses to carry information that results in a bodily change

What are the 5 neurotransmittors

Dopamine, Serotonin, Norepinephrine, gaba, glutamate

Dopamine

pleasure, reward, voluntary movement

Serotonin

Mood regulation, appetitie, intestinal movement, sleep regulation

Norepinephrine

“fight or flight” including heart rate, blood sugar, blood flow from heart to body, increases arousal, alertness, and attention

Decreased norepinephrine (NE) can cause fatigue, lack of motivation, and low mood

Too much norepinephrine can cause anxiety, which, if persistent, can lead to depression

GABA

Main inhibitory neurotransmitter, sleep awake cycle regulation

Glutamate

Maine excitatory neurotransmittter, involved in learning and memory

Acetylcholine

a primary neurotransmitter—a chemical messenger—used by both the central and peripheral nervous systems to send signals between nerve cells, muscles, and glands. It plays a crucial role in regulating involuntary muscle movements, attention, arousal, and memory.

fluvoxamine - what’s the brand name?

Luvox

Escitalopram - what’s the brand name?

Lexapro

Citalopram -what’s the brand name?

Celexa

Fluoxetine - what’s the brand name

Prozac

Sertraline - what’s the brand name?

Zoloft

Paroxetine - what’s the brand name?

Paxil

What are the flight or fight effects of norepinephrine and the Sympathetic nervous system (SNS)? (hint: think STRESSED)

sweat, tachycardia, respiration (open airways), energy release (blood glucose), suppressed digestion, small blood vessels (vasoconstriction, excretion reduction (urination/defection), and dry mough

Venlafaxine - what’s the brand name?

Effexor

What are the uses of Venlafaxine/effexor?

generalized anxiety disorder, panic disorder, social anxiety disorder and major depressive disorder

Major side effects of Venlafaxine?

(they mirror the typical effects of norepinephrine) lack of appetitie, constipation, dry mouth, sweating

Is Venlafaxine/ Effecor a SSNI or a SSRI?

SSNI (Selective Serotonine Norepinephrine re-uptake inhibitor)

What is a SSNI?

(Selective Serotonin Norepinephrine re-uptake inhibitor) - Binds to inhibit serotonin and norepinephrine re-uptake transporters to increase the amount of each available in the synaptic cleft, therefore increasing the amount available for receptor activation

Simplified (double negatiave) decreased re-uptake (inactivation) of norepinephrine and serotonin => Increased active serotonin and norepinephrine to stimulate receptors

What is the warning with SSNIs and SSRI’s?

Do not use with a monoamine oxidase inhibitor (MAOI) or within 14 days of stopping an MAOI because of the risk of serotonin syndrome

What is the generic name of Atomoxetine?

Strattera

What class is Atomoxetine/Strattera/

SNRI (selective norepinephrine re-uptake inhibitor)

What is Atomoxetine used for?

ADHD - Since it’s an SNRI - norepinephrine increases the brain’s avility to focus, give attention to task and form strong memories

What is the mechanism of action for Atomoxetine?

binds to inhibit norepinephrine re-uptake transporters to increase the amount of available norepinephrine in the synaptic cleft, therefore increasing the amount of available norepinephrine for receptor activation / Simplified (double negative) - decreased re-uptake (inactivation) of norepinephrine +> increased active norepinephrine to stimulate receptors

Major side effects of atomoxetine

constipation, dray mouth, lack of appetite

Warnings for Atomoxetine:

Use with caution in patients with the following conditions that may worsen with the use of this drug: Urinary retention or obstruction, cardiovascular disease, bipolar disorder, liver disease, QT prolongation, history of psychosis

Amphetamines - name them

lisdesamfetamine and methylphenidate

Brand name for lisdexamfetamine

Vyvanse

Brand name for Methylphenidate

Ritalin

What class of drugs are amphetamines

CNS stimulants

what are amphetamines used for

ADHD and narcolepsy

Mechanism of action of amphetamines

they are sympathomimetic drugs that induce the release of stimulatory neurotransmitters, specifically dopamine and norepinephrine

Simplifed - increased release of dopamine and norepinephrine => increased effects including focus, attention and memory

NOTE: amphetamines may also block the re-uptake of these neurotransmitters, increasing their availability by another means

Side effects of amphetamines

lack of apetitie, increased heart rate, anxiety, constipation (note the similarity in side effects between atomoxetine and amphetamines. They are similar due to their mutual effects on norepinephrine

Contraindications of amphetamines

Do not use with MAOI or within 14 days of stopping a MAOI due to risk of serotonin syndrome

Warnings for ampthetamines

They should be used ith caution as they can worsen many common conditions. They may also result in dependence and addiction if misused. Think SCRAPS (they may increase the risk of Cardiovascular events, result in Addiction, Suppress normal growth, result in Psychosis (even in undiagnosed patients), cause vascular issues, including rRynaud’s and increase th risk of Serotonin syndrome.

Wht neurotransmitter is involed in the medhanism of celexa?

Serotonin

Avoid the use of strattera in patients with which of the followin conditions?

Cirrhosis

What is the brand name of Sertraline?

Zoloft

What is the brand name of Alprazolam?

Xanax

hat is the brand name for Clonazepam?

Klonopin

What is the brand name for Diazepam?

Valium

What is the brand name for Lorazepam?

Ativan

What is the brand name for Temazepam?

Restoril

Alporazolam - short, intermediate or long acting?

short <24 hours

Tempazepam short, intermediate or long acting?

short <24 hours

Clonazepam - short, intermediate or long acting?

Intermediate 24-48 hours

Lorazepam short, intermediate or long acting?

Intermediate 24-48 hours

Diazepam short, intermediate or long acting?

Long >48 hours

Why doe benzodiazepines vary in duration of effect?

The duration of effect differs significantly between each member of this class. Shorter-acting benzos may be advantageous for acute control of anxiety or seizures. Longer-acting benzos may be more likely to accumulate or “dose stack,” therefore increasing the risk of adverse effects.

General adverse effects of benzos

drowsiness, hypotension, confusion, headache, dry mouth, dizziness, tachycardia, seizures, tremor

Black box warnings of benzodiazepines

respiratory depression, coma and death & risks of abuse, addiction, physical dependence and withdrawl reactions if stopped too quickly that acan result in seizures which can be life threatening

Benzodiazepines uses

anxiety, seizures, including status epilepticus, they also have many off label uses including alcohol withdrawal, catatonia, nausea and vomiting, serotonin syndrome and vertigo

What are the top 5 benzodiazepines that are in the top 200 drugs?

Alprazolam, clonazepam, diazepam, lorazepam, temazepam

What is the mechanism of action of benzodiazepines?

binds to GABA - A recptor complexes present throughout the centeral nervous system. Through this action, they increase chloride exchange across the neuronal membranep effectively enhancing the effects of GABA

Simplified

Amplify typical inhibitory effects of GABA => Reduced neuronal firing. REDUCED seizures and anxiety