i fucking hate meds

psych meds

what do anxiolytic meds treat

anxiety, panic, agitation, insomnia

what do antidepressants treat

depression, anxiety disorders, PTSD, OCD

wut do mood stabilizers treat

BPD, mania, mood cyclin

wht do antipsychotics treat

schizo, psychosis, mania, severe agitation

wut do cholinesterase inhibitors treat

cognitive symptoms in alzheimer’s

what r 3 types of anxiolytic meds

benzo, sedative hypnotics, buspirone

examples of benzos

• alprazolam (Xanax)

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Lorazepam (Ativan)

REMEMBER: rapid onset

benzo risks

sedation falls, resp depression, dependence

examples of sedative hypnotics

• Zolpidem (Ambien)

• Zaleplon (Sonata)

• Eszopiclone (Lunesta)

REMEMBER: primarily for insomnia

what is buspirone used for

• Used for generalized anxiety

• Not for immediate relief - takes time to work

• Lower dependence risk than benzodiazepine

what are common SE of anxiolytics?

• S - Sedation / Sleepiness

• L - Lethargy

• O - Orthostatic Hypotension

• W - Weakness

• B - Blurred Vision

• R - Respiratory Depression

• A - Ataxia

• I - Impaired Memory / Concentration

• N - Nausea

what are the 4 major types of antidepressants?

SSRI (first line d/t less SE!), SNRI, TCA, MAOI

SSRI MOA

ctrl serotonin lvl by blocking its reuptake. increases serotonin availability in synapse. basically more serotonin yay

examples of SSRI meds

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Sertraline (Zoloft)

Paroxetine (Paxil)

Citalopram (Celexa)

what rly bad SE can SSRI cause

serotonin syndrome

s/s of serotonin syndrome

S - sweaty & shaky

S - super hawt

R - restless/rapid VS

I - irrational/intestinal

SNRI MOA

modulates serotonins and norepi. tag teaming them both for dual action antidepressant effects 😜

examples of SNRI meds

Desvenlafaxine (Pristiq)

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

TCA MOA

modulates mostly norepi; slows HR and can cause QRS prolongation on EKG

examples of TCA meds

norTRIptyline

amiTRIptyline

imipraMINE

desipraMINE

what’s a bad SE of TCA + two critical safety points

anticholinergic SE

1. most contraindicated in post-MI period

2. letal in OD

MAOI MOA

includes serotonin, noerepi, epi, and dopamine. inhibit MAO enzyme

examples of MAOI meds

T - Tranylcypromine (Parnate)

I - Isocarboxazid (Marplan)

P - Phenelzine (Nardil)

S - Selegiline (Eldepryl, EMSAM patch)

dietary restriction w/MAOI and why

tyramine-containing foods, like aged cheese, aged, whines, cough syrups. cause HTN crisis!

antidepressant SE

S - Sleep Changes (insomnia or drowsiness)

A - Appetite Changes (increase or decrease)

D - Dry Mouth

F - Fatigue

I - Intestinal Issues (nausea, diarrhea, or

constipation)

N - Nervousness (anxiety or restlessness)

S - Sexual Dysfunction (low libido or difficulty reaching orgasm)

3 examples of atypical antidepressants (don’t fit into main trad groups) + teaching points.

Bupropion (Wellbutrin): May help depression with less sexual dysfunction but can increase seizure risk.

Mirtazapine (Remeron): May be useful when depression occurs with poor sleep, poor appetite, or weight loss because it can cause sedation and increased appetite.

Trazodone (Desyrel): Antidepressant commonly used at low doses for insomnia because it is sedating.

4 mood stabilizer meds

lithium (gold standard!)

CArbamazepine

VAlproate

LAMotrigine

key ideas for litium

requires rental clearance before initiation

baseline TSH required

narrow theraputic window; >1.5 IS TOXIC

management of lithium

L - Level 1.5 or above is TOXIC!

I - Increase fluid and sodium intake

T - Toxicity can happen - watch for warning signs

H - Hold NSAIDs (can decrease renal blood flow)

s/s of lithium toxicity

Tremor, polyuria, polydipsia

Diarrhea, vomiting, weight gain, dry mouth

CNS effects: sedation, cognitive impairment, blurred vision

what does carbamazepine treat?

BPD

s/s of SJS

random ass rash

therapeutic lvl of carbamazepine

4-12

SE of carbamazepine

SJS, anticholinergic, orthostasis, sedation, ataxia

what labs to run before initiating valproate

LFT, CBC

what does valproate treat

BPD, bipolar mixed episodev

valproate therapeutic lvl

50-100

what to monitor for with valproate

• Mood changes

• Tremor

• Thrombocytopenia

• Pancreatitis

• Hepatic failure

what is lamotrigine used for

maintenance therapy for bpd

management for lamotrigine

slow taper upwards when initiating

what’s a major SE of lamotrigine

sjs

what are the 2 types of antipsychotic

1st gen (typical) & 2nd gen (atypical)

1st gen antipsychotic:

mechanism?

eps risk?

metabolic risk?

targets?

mechanism: strong dopamine (d2) blockade

eps risk: higher

metabolic risk: lower

targets: (+) symptoms

2nd gen antipsychotic:

mechanism?

eps risk?

metabolic risk?

targets?

mechanism: Affects dopamine and serotonin (D2 + 5-HT)

eps risk: lower

metabolic risk: Higher (weight gain, diabetes)

targets: (+) and (-) symptoms

1st gen high potency antipsychotic SE

Increased EPS and Tardive Dyskinesia

1st gen examples of high potency meds

• Haloperidol (Haldol)

• Fluphenazine (Prolixin)

• Trifluoperazine (Stelazine)

• Perphenazine (Trilafon)

1st gen low potency antipsychotic SE

Less incidence of EPS, increased sedation, tachycardia, anticholinergic side effects

1st gen low potency antipsychotic example meds

• Chlorpromazine (Thorazine)

• Thioridazine (Mellaril)

• Loxapine (Loxitane)

2nd gen