Psych 1 exam meds

what are sedatives for

- used to read sleep-wake disorders

- used to sedate someone

what are the three types of sedative drugs

- benzodiazapines

- nonbenzos hypnotic

- melatonin receptor agonist

what do sedatives work on

GABA neurotransmitters

what do we treat with sedatives

- do not take while operating heavy machinery

- do not take with any other CNS depressants

what are SSRIs

selective serotonin reuptake inhibitors

what is an example of an SSRI

Fluoxetine (Prozac)

what are SSRIs used for

depression

what are side effects of SSRIs

- GI upset

- insomnia

- ED

what do you teach with SSRIs

- takes 2-4 weeks for effect

- do not stop abruptly

- report suicidal thought in first weeks

what is an advert effect of SSRIs

serotonin syndrome

what is serotonin syndrome

- increased heart rate

- sweating

- dilated pupils

- tremors/twitching

- hyperthermia

- agitation

- confusion/disorientation

- hallucinations

Rare and life-threatening event

what are SNRIs

serotonin and norepinephrine reuptake inhibitors

what are SNRIs used for

depression

what is an example of an SNRI

duloxetine

what are side effects of SNRIs

- n/v

- sweating

- high BP

- insomnia

what do you teach with SNRIs

- monitor BP

- no alcohol

- taper off slowly

what is TCA

tricyclic antidepressant

what is an example of TCA

Amitriptyline (Elavil)

what is TCA used for

- depression

- pain

- insomnia

what are side effects of TCA

- anticholinergic

- arrhythmias

OD IS LETHAL (can cause arrhythmias)

what is anticholinergic

- can't see

- can't pee

- can't spit

- can't shit

what are MAOIs

monoamine oxidase inhibitors

what is an example of MAOIs

Phenelzine (Nardil)

what are MAOIs for

depression that is treatment resistant

what are side effects of MAOIs

- hypertensive crisis with charcuterie boards

what do you teach with MAOI

- no tyramine

- no other antidepressants

what is SGA

second gen antipsychotic

what is SGA used for

major depression

what is an example of SGA

Clozapine

Quetiapine

what are side effects of SGA

- weight gain

- sedation

- metabolic syndrome

what do you teach with SGA

- monitor weight and glucose

- healthy diet

- exercise

- report tremors/stiffness

what are mood stabilizers

drugs used to control mood swings in patients with bipolar mood disorders

what is an example of a mood stabilizer

lithium

what are mood stabilizers for

depression and mania (bipolar)

what are side effects of mood stabilizers

- temor

- GI upset

- polyuria

- hypothyroidism

- lithium toxicity

what do you teach with mood stabilizers

- monitor serum lithium levels

- constant salt and fluid intake

what are antiepileptic agents for

bipolar and depression

what are side effects of anti epileptic agents

- GI upset

- weight changes

- hepatoxicity rash

what is an example of an antiepiletpic agent

carbamazepine

what do we teach with anti epileptic agents

- monitor liver and CBC

- report rash

- no abrupt stopping

what is lithium

first line med for bipolar disorder

reduces risk of suicide in mood disorders

what are side effects of lithium

- hand tremor

- GI upset

- polyuria

- weight gain

- hypothyroidism

- real impairment

what do we teach with lithium

- salt and fluid intake should be consistent

what is carbamazepine for

- bipolar disorder when lithium is not tolerated

what are side effects of carbamazepine

- drowsy

- dizzy

- GI upset

- agranulocytosis

- aplastic anemia

- SIADH

- rash

- SJS

what do you teach with carbamazepine

- monitor sodium

- not grapefruit juice

what are signs of lithium toxicity

- coarse tremor

- confusion

- vomiting

- seizures

what is therapeutic range for lithium

0.6-1.2

what are anxiolytic for

treat anxiety symptoms

what are examples of anxiolytics

- benzodiazepines

- buspirone

what are examples of benzodiazepines

- alprazolam (xanax)

- chlordiazepoxide

- diazepam

- lorazepam

- clonazepam

how often do you take benzos

PRN

what neurotransmitter do benzos work on

GABA

what do we teach with benzos

- do not operate heavy machinery

- do not take with other antidepressants

- cause sleepiness

what is there a big risk for with benzos

risk of dependency bc they are a controlled substance

is busiprone controlled

no

what neurotransmitters does bisprone work on

serotonin and norepinephrine

what is busiprone for

maintenance of anxiety symptoms

what are side effects of busiprone

- sedation

- ataxia

- paradoxical reaction

- amnesia

- CNS depression

what are the three main concerns when we put people on anti anxiety and sedation meds

- Controlled substance

- abuse potential

- withdrawal potential

what is a super common symptom of anti anxiety and sedative meds

sedation

often improved as pt builds tolerance

what is ataxia

- the loss of full control of bodily movements

what is amnesia

loss of memory

what is a paradoxical reaction

opposite of what supposed to do

- anxiety and agitation

- very rare

- more common in young or old

what is CNS depression

- respiratory depression leading to death

- rare

- concomitant CNS depressant use (alc and opiates)

what do we teach with all anti anxiety meds

- caution with activities until they know how med effects them

- other CNS depressants

- potential for abuse/withdrawal

what are the 4 types of antidepressants

- MAOIs

- TCAs

- SSRIs

- SNRIs

what are the first line meds for depression

- SSRIs

- SNRIs

how long do antidepressants take to work

4-8 weeks

how do SSRIs work

block reuptake of serotonin, so no more left in brain to work

what are exampled of SSRIs

- fluoxetine

- sertraline (zoloft)

- citalopram (celexa)

- escitalopram (lexapro)

what are side effects of SSRIs

- nausea

- restlessness

- sleep disturbances

- sexual dysfunction

how do SNRIs work

- block reuptake of serotonin and norepinephrine

what are exampled of SNRIs

- venlafaxine

- desvenlafaxine

- dulozetine

- levomilnacipran

what are side effects of SNRIs

- sweating

- increased BP/HR

- same as SSRIs

what is the main concern regarding TCAs

- suicide by overdose

OD can cause cardiac arrhythmias which can lead to death

- do not give to pt with suicidal hx

how do TCAs work

work on all neurotransmitters

what are examples of TCAs

- nortriptyline

- amitriptyline

- imipramine

what is main side effects of TCAs

anticholinergic

- can't see

- cant pee

- cant spit

- cant shit

how often do we use MAOIs

we almost never use them clinically

- considered last line

why are MAOIs rarely used

- if we do use, high risk to hurt/kill someone

- drug interactions = high risk of serotonin syndrome

what is required when you start and then again when you stop taking MAOIs

washout period

how do MAOIs work

elevate all neurotranmitters

what can people on MAOIs not eat

charcuterie board foods (all high in tyramine)

- aged cheese

- cured/processed meats

- dried/overripe fruit

- sauces

what is the fear with MAOIs

lead to vasoconstriction = high BP= stroke

how many generations of antipsychotics

3

what all are antipsychotics used for

- schozphrenia

- mania

- autism

what are the types of antipsychotics

- FGA

- SGA

- TGA

how does FGA work

- block dopamine receptors

what does FGA treat

severe schizophrenia

RESCUE

how do we give FGA

in and out fast

- normally cocktail with Benadryl and benzodiazepine

when is FGA used

when shit hits the fan

what are examples of FGA

- haloperidol

- chlorpromazine

what are side effects of FGA

- anticholinergic

- weight gain

- low sex drive

how does SGA work

- blocks dopamine to lesser degree and inhibits reuptake or serotonin

- blocks dopamine and serotonin

what is SGA for

first line to MAINTAIN hallucinations/delusions

why do we like SGAs so much

bc they treat positive AND negative side effects of schizophrenia better

and fewer side effects

what are examples of SGA

- clozapine

what are side effects of SGAs

- increased BS

- increased BP

- increased cholesterol

what is an example of TGA

aripiprazole