Pharmacology psych meds

what do you

1) what are some common benzodiazepines?

2) what are they used for?

1) alprazolam (xanax), diazepam (valium), clonazepam

2) anxiety short-term

how do benzodiazepines work?

they depress the CNS and potentiate GABA

why are benzodiazepines only for short-term use?

risk of tolerance, dependence, and withdrawal

what increases the effects of benzodiazepines?

alcohol and other CNS depressants

what are some major safety concerns with benzodiazepines?

• dependence and tolerance

• do not abruptly stop

• boxed warning with opioids (risk of death), drowsiness, confusion, orthostatic hypotension

• teratogenic

what type of medication is buspirone? how does it work?

- a non-benzodiazepine anxiolytic

- serotonin and dopamine agonist

is buspirone used PRN? does it cause dependence or CNS depression?

- no, it must be taken daily to be effective

- no

how does buspirone aid SSRIs?

helps with sexual side effects

buspirone can cause __________ symptoms

paradoxical

what medications are first-line for long-term anxiety?

SSRIs (slow acting)

what was the first antidepressant class?

- monoamine oxidase inhibitors (MAOIs)

what foods must be avoided with MAOIs?

• aged cheeses

• chocolate

• wine

• beer

• soy sauce/miso soup

• pepperoni/bacon

• yogurt

• sardines

• overripe fruit

• sourdough bread

• avocados

• figs

what complications can occur with MAOIs? (4)

hypertensive crisis, serotonin syndrome, seizures, and insomnia

tricyclics:

MOA?

blocks 3 (TRI) things: serotonin, norep, and histamines

1) tricyclic antidepressants (TCAs) have a strong ________ profile

2) take at night— often used for _____

1) anticholinergic

2) insomnia, very sedating

why are TCAs dangerous in overdose?

they block sodium channels which can lead to lethal arrhythmias

why are selective serotonin reuptake inhibitor (SSRIs) and serotonin-norepinephrine reuptake inhibitor (SNRIs) first-line antidepressants?

fewer side effects and safer than older drugs

common SSRI/SNRI side effects? (4)

• suicide

• increase in glucose

• hyponatremia

• serotonin syndrome

how long do SSRIs take to start working?

4-6 weeks

SSNRI (norepinephrine instead of epinephrine):

Same as SSRI but does a little bit mo

1) ADRs?

2) also used for ________ replacement

1) Urinary retention, GI slow, and seizures

2) hormonal

1) what is the role of atypical antipsychotics such as aripiprazole (abilify) when used with antidepressants?

2) what is the name of one?

1) they increase the availability of serotonin and dopamine and are used as adjuncts to enhance antidepressant treatment, helps with sexual side effects

2) buproprion

what is buproprion used for? (2)

smoking cessation and ADHD

what is the only med that inhibits reuptake of norep and dopamine together?

buproprion!

ADRs of buproprion? (4)

gambling addiction, suicide, seizures, and appetite suppression

how long do you have to wait to take something after taking an MAOI?

2 weeks!

1) s/s of serotonin syndrome? (6)

2) what to do when someone has serotonin syndrome?

1) restlessness, tachycardia, V+/D+, seizures, muscle rigidity, fever

2) stop medication, give benzos

what is the classic mood stabilizer?

lithium carbonate (salt found in mineral springs)

what is important to monitor with lithium?

lithium levels! very easy to have toxic levels

what is a big risk for lithium toxicity?

dehydration

don’t give lithium to what kind of people ?

pregnant women

what does ADAPT (extrapyramidal symptoms) stand for?

- acute dystonia (oculogyric crisis, muscle spasms of the face, neck, and throat) → treat with benztropine or diphenhydramine

- akathisia (restlessness)/akinesia (absent/impaired movememt)

- pseudoparkinsonism (tremor, shuffling, gait, drooling, rigidity)

- tardive dyskinesia (permanent) (bizarre face and tongue movements)

what do you give for EPS symptoms?

anticholinergic

1) what med is the older generation of antipsychotics?

2) rarely used, except for _____ ________

1) chlorpromazine

2) intractable hiccups

what is the new/atypical antipsychotic?

aripiprazole (abilify)

difference between chlorpromazine (typical) and aripiprazole (atypical antipsychotics)?

- typical → high EPS (extrapyramidal symptoms)

- atypical → less EPS, more metabolic effects such as weight gain and increased cholesterol and blood sugar (1st line treatment)

primary mechanism of antipsychotics?

dopamine blockade

1) what med can cause neuroleptic syndrome?

2) what do you need to watch for with that?

1) chlorpromazine

2) FEVER!!! nad muscle rigidity

1) what kind of antipsychotic is used for schizophrenia?

2) atypical antipsychotics block the receptors for dopamine, but more strongly block those for ______

1) risperidone (although i think aripiprazole can also be used for it)

2) serotonin

can antipsychotics cause serotonin syndrome?

no, only EPS and neuroleptic malignant syndrome

what is the big thing to remember for clozapine?

it can cause agranulocytosis

how do antidepressants work?

increasing serotonin, norepinephrine or dopamine

what do you need to be cautious with with TCAs?

overdose

early s/s of lithium toxicity? (3)

nausea, vomiting, and diarrhea