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74 Cards in this Set
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- Back
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What is best for chronic anxiety? List the medications under this category.
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SSRI's (Selective Serotonin Reuptake Inh.)
- Citalopram (Celexa) - Escitalopram (Lexapro) - Fluoxetine (Prozac, Sarafem) - Fluvoxamine (Luvox) - Paroxetine (Paxil) - Sertraline (Zoloft) - Viladozone (Viibryd) |
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Why are beta blockers used for anxiety?
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Treat the sympotamic symptoms associated with anxiety, esp the shakiness of "stage fright"
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What are the long half life benzos?
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Chlordiazepoxide (Librium) - alcohol withdrawal
Clonazepam (Klonopin, Clonapam) Diazepam (Valium) Flurazepam (Dalmane) - insomia |
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What is Librax?
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Chlordiazepoxide - Clinidium used for IBS
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What are the medium half life benzos?
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Lorazepam (Ativan) - anxiety/sedation
Temazepam (Restoril) - insomia Estazolam (Prosom) - insomia |
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What are the short half life benzos?
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Alprazolam (Xanax, Niravam)
Oxazepam (Serax) |
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Xanax, caution with the use of?
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Inhibitors and Inducers
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Antidote for Benzos?
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Flumazenil
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What is Vanspar? Dosing? Caution with?
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Buspirone (Buspar)
Start: 15mg Qday Max: 60mg Qday Caution with: MAOI's & inhibitors (3A4 substrate) |
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Patient counseling with Vanspar?
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Takes up to 4 weeks to work.
Bioavailability is increased by food; should be taken in a consistent manner. |
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List the OTC anxiolytic supplements (10)
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Kava - watch for hepatoxicity
Valerian root Passion fruit & flower St. John's wort Hops Chamomile B-complex L-tryptophan 5-HTP |
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What are the symptoms of Depression?
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Five or more daily for 2 weeks.
SIG E CAPS Sleep changes Interest (loss) Guilt (worthless) Energy (lack): fatigue Cognition/Concentration Appetite (wt loss or gain) Psychomotor Suicide/death preoccupation |
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Patient on Paxil wants to use an OTC drug. Which of the following can he use?
a. Valerian b. St. John's wort c. SAMe d. Kava-Kava |
None of the above. All of them may increase CNS depression and St. John's Wort will result to Serotonin syndrome
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What's the difference between Serotonin Syndrome and HTNsive crisis?
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Serotonin syndrome also results to CNS effects.
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Which SSRI's have the lowest drug interaction?
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Celexa (Citalopram)
Escitalopram (Lexapro) |
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Which SSRI's are best given in the morning?
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Paroxetine (Paxil)
Fluoxetine (Prozac) - very activating |
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What is Luvox? Indication?
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Fluvoxamine, best at bedtime.
Indication: OCD |
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Major SE for SSRI's?
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Sexual dysfunction (5HT2)
GI side effects (5HT3) Hyponatremia ***only 5HT1 is involved in DEPRESSION |
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Patient on warfarin, simvastatin, and amlodipine is given a Prozac for depression. What is a concern with this new script?
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Serotonin is required for platelet aggregation. SSRI's may increase GI bleeding. Luvox & Celexa are associated with less bleeding.
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Dosing for Celexa?
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Citalopram, max: 60mg QDay
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Lexapro dosing? Forms?
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10mg Qam or Qpm
Forms: solution and tabs |
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Indications for Prozac?
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***BOMP
Bulimia nervosa OCD MDD Premenstrual dysphoric disorder |
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What is the timeframe if patient wants to switch from MAOI's to Prozac or vice versa?
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MAOI's should be D/C for 14 days before starting Fluoxetine.
Fluoxetine should be D/C for 5 weeks before starting MAOI's. |
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Indications for Paxil? Dosing?
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***MOPPS
MDD OCD Panic Disorder Post traumatic stress disorder Social anxiety disorder Dose: 10-80mg QAM DON'T D/C ABRUPTLY |
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Indications for Zoloft? Max dose?
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MDD
OCD PTSD Panic disorder Max: 200mg DON'T D/C ABRUPTLY |
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What are the SNRI's? Major SE?
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Venlafaxine (Effexor)
Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Milnacipram (Savella) SE: Hypertension |
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Pristiq patient counseling? Dose? What if CrCl is <30mL/min?
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Keep mouth moist to prevent formation of cavities.
Max: 400mg QDay CrCl <30mL/min: 50mg QODay |
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What is Cymbalta? Dosing; CrCl <30mL/min? Avoid use with?
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Duloxetine
Max: 60mg BID CrCl <30mL/min: AVOID USE, hepatic and alcohol use, with potent inhibitors and inducers |
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What is Savella? Indication? SE? Form?
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Milnacipram, for fibromyalgia
SE: Anti-cholingergics, increases BP & pulse Form: Immediate release tabs |
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What allergy should you watch out for with Savella?
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FD&C Yellow #5: tartrazine
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Bupropion MoA? Brands?
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Dopamine & NE agonist
Wellbutrin Aplenzin (ER) Zyban Buproban |
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Wellbutrin, caution with?
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Bulimia
Alcoholics Psychosis Seizures |
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What is Viibryd? Indication? Why do you titrate the dose?
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Vilazodone, for MDD. Titrating the dose lowers GI side effects.
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Viibryd dosing?
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Vilazodone, titrate dosing
Dose: 10mg x 7 days, 20mg x 7 days, then 40mg maintenance |
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Trazodone MoA? Indications? Brands?
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Triazolopyridine, alpha adrenergic & serotonin re-uptake blocker
Indications: MDD & sleep disorder (25-50mg) Brands: Desyrel, Oleptro (ER) |
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What is Serzone? MoA? Forms?
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Nefazodone, an alpha adrenergic & serotonin reuptake blocker, is used for MDD
Forms: tabs & oral powder (contains phenylalanine) |
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What is Remeron? MoA? Forms? SE?
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Mirtazapine, increases NE & serotonin
Forms: tabs & ODT SE: somnolence, weight gain & increase in appetite, cholesterol & triglycerides |
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TCA SE?
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Anti-cholinergic effects (dry mouth, etc.)
Cardiac problems Histaminergic: weight gain, sedation Alpha adrenergic: orthostatic hypotension |
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What are the Tertiary TCA Amines?
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Timipramine (Surmontil)
Amitriptylline (Elavil) Clomipramine (Anafranil) Imipramine (Tofranil) Doxepin (Sinequan) Take Some Angry Eels Coz Ana Dove Inside the Tub |
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What are the Secondary TCA Amines?
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***PANDM
Protriptyline (Vivactyl) Amoxapine (Asendin) Nortryiptylline (Pamelor, Aventyl) Desipramine (Norpramine) Maprotiline (Ludiomil) |
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Difference between Tertiary & Secondary TCA Amines?
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Both increases SE & NE.
Tertiary: increases SE more Secondary: increases NE more |
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Indication for Clomipramine?
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Clomipramine (Anafranil), the only TCA not used for MDD, is for OCD
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Indication for Doxepine?
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Doxepine (Sinequan) is used for anxiety and depression
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Indications for Imipramine?
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Imipramine (Tofranil) is used for Depression and night time bed-wetting episodes.
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Indications for Desipramine?
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Desipramine (Norpramine) is for depression and ADHD
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TCA dosing?
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Range: 50 - 300mg QDay
Clomipramine: 150 - 250mg QDay, may cause seizures |
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MAOI's mechanism of action? Brands?
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Inhibits the body from metabolizing Serotonin, NE & Dopamine.
Marplan (Isocarboxazid) Nardil (Phenelzine) Parnate (Tranylcypromine) Pretty & Tranquil Mars Is a Nice Planet |
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What are the S/Sx of HTN-sive crisis?
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HTN, H/A, N/V
flushing, palpitation, anxiety stiff neck, photophobia |
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What are some Dx to be avoided when taking MAOI's?
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Dextromethorphan - hyperpyrexia & death may result
Meperidine - seizures, fever, death may occur Sympathomimetics - HTN crisis TCA's, SSRI's & SNRI's |
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What is Emsam?
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Selegiline, MAOI type B, is a QDay patch for MDD.
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What are the antipsychotics approved for MDD?
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Abilify (aripiprazole)
Symbyax (olanzapine/fluoxetine) Lithium Seroquel XR (Quetiapine) |
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What is the different indications and dosing for Abilify?
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***SAD
Schizophrenia, >15mg QDay Autism, <15mg Depression, <15mg QDay |
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What are the monitoring parameters when using Anti-Psychotics?
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Weight - Glucose - Lipids
BP |
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Indications for SAMe?
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Depression
OTC DoC: osteoarthritis |
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List the medications used for Bipolar?
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Aripiprazole (Abilify)
VaLProic acid (Depakote) Ziprasidone (Geodon) Lamotrigine (Lamictal) Lithium Risperidone (Risperdal) Asenaphrine (Saphris) Carbamazepine (Tegretol, Equeto) Topiramate (Topamax) |
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Major SE for Valproic Acid? Brands?
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Fatal Hepatotoxicity
Pancreatitis Brands: Depakote, Stavzor (BID-TID) |
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What happens when you add Valproic to Lamictal?
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Valproic acid increases Lamictal levels
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What is the dose of Zyprexa for acute mania?
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Zyprexa (olanzapine), 10mg IM for acute mania
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What are some SE of Carbamazepine?
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Aplastic anemia
Agranulocytosis Same SE as TCA's |
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What is a major SE of Lamictal?
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life threatening RASH
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Indications for Risperdal?
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Schizophrenia
Autistism - irritability |
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What is the effect of NSAID's to lithium?
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NSAID's, with the exception of Sulindac, retain sodium but increases Lithium levels.
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Where is Lithium metabolized? It's effect on WBC? How long does it take for its effects to work?
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Renal; increases WBC like corticosteroids.
Lithium effects usually begin in 1 week & full effect is seen by 2-3 weeks. |
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What is the dose of Lithium for the Elderly & Renal patients?
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Starting dose <300mg QDay, with frequent serum level monitoring (usual effective dose = 0.4 to 0.6 mmol/L)
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Patient on Lithium finds out that she's pregnant. What should you do?
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Advise doctor to increase the dose of Lithium.
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Lithium dosing? Effective dose? Therapeutic levels (acute & maintenance)?
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Dose: 600 - 3000mg QDay
Effective dose: 900 - 1800mg Acute: 0.8 - 1.5 meq/L Maintenance: 0.6 - 1.2 meq/L |
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Is lithium with or without food?
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With food to decrease GI upset.
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Lithium comes in what forms?
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Lithium carbonate: IR caps and tabs, SR
Lithium citrate: syrup |
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How do you prevent Lithium SE?What are the early SE?
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Divide doses to avoid SE's.
GI, N/V Fine intentional hand tremor Polyuria/polydipsia |
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Lithium late SE?
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***LHAN
Leukocytosis (increases WBC) Hypothyroidism - Bradycardia & Weight Gain Acne & Alopecia Nephrogenic Diabetic Insipidus like syndrome (use IR formulation instead) |
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What are the Lithium toxicity levels with their respective S/Sx?
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>1.5meq/L: ***VTACS vomiting, tremor, ataxia, confusion, slurred speech
>2meq/L: ***CAS coma, arrhythmias, seizure, |
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Lithium toxicity management
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Give 0.9% NaCl IV infusion or hemodialysis
Resp/Cardio support Benzo PRN agitation and/or seizure Phenytoin PRN seizure |
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What is the effect of alkalinating drugs to Lithium?
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It increases the amount of Lithium excreted in the urine.
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What are the Lithium Monitoring Parameters?
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BUN & Cr
Urine Specific Gravity CBC Electrolytes TSH EKG Glucose |
