Psych Pharm Quiz

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Author:
roseyvu
ID:
170803
Filename:
Psych Pharm Quiz
Updated:
2012-09-17 08:14:59
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Psych Pharm Meds
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Description:
Benzos, SSRIs, TCAs, MAOIs, Mood Stabalizers, Typical and Atypical Anti-Psychotics
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  1. Anti-anxiety Benzodiazapines (Drug Class)
    Anti-­anxiety-­/Sedative Hypnotics(other)
    • 1. Lorazepam (Ativan) 
    • 2. Alprazolam (Xanax)
    • 3. Oxazepam (Serax)
    • 4. Diazepam (Valium)
    • 5. Clonazepam(Klonopin) 
    • _____________________
    • 6. Buspirone (BuSpar)
    • 7. Zolpidem (Ambien)
  2. Benzo Side Effects and withdrawl syndrome
    Drowsiness, sedation, ataxia, dizziness

    • Agitation, anorexia, anxiety, dizziness, headache, seizures
    • (seizure precaution, fall risk, hydration, minimize env't stimulants, prn pain meds)
  3. SSRIs (Selective serotonin Reuptake Inhibitors)
    Anti-depressants
    • 1. Citalopram (Celexa)
    • 2. Fluoxetine (Prozac)
    • 3. Fluvoxamine (Luvox)
    • 4. Paroxetine (Paxil)
    • 5. Sertaline (Zoloft)
  4. SSRIs side effects
    Headache, nausea, diarrhea
  5. SSRIs Dosage Range
    • 1. Citalopram (Celexa):       20-40mg
    • 2. Fluoxetine (Prozac):       20-60mg
    • 3. Fluvoxamine (Luvox):      100-200mg
    • 4. Paroxetine (Paxil):      20-60mg
    • 5. Sertaline (Zoloft):      50-200mg
  6. SSRIs Pt Education
    Prozac may take 2-6 weeks to see any results and side effects will subdue in 7-10days
  7. Other Anti-Depressants
    • Bupropion (Wellbutrin)
    • Mirtazapine (Remeron)
    • Nefazodone (Serzone)
    • Trazadone (Desryl)
    • Venlafaxine (Effexor)
  8. Other Anti-Depressant Side Effects
    Tremors, tachycardia, erectile dysfxn, hypotension, sedation, weight gain

    • Extra:
    • Bupropion (Wellbutrin) - Off label: smoking cessation/ADD
    • Mirtazapine (Remeron) - anticholinergic effects 
    • Trazadone (Desryl) - Low dose @ night
    • Venlafaxine (Effexor) - AE: Can't stop using abruptly -> seizure
  9. TCAs (Tricyclic Antidepressants)
    • Amytriptyline (Elavil)
    • Nortriptyline (Pamelor)
    • Imipramine (Tofranil)
    • Desipramine (Norpramin)
  10. TCAs (Tricyclic Anti-depressants) Side Effects
    Anticholinergic, sedation, weight gain, orthostatic hypotension, dizziness

    • Anticholinergic: Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.
    • Cardiac side effects - palpitations, orthostatic hypotension, dry mouth, blurred vision
    • Overdose => death
  11. MAOIs (Monoamine Oxidase Inhibitors)
    • Phenalzine (Nardil)
    • Tranylcypromine (Parnate)
  12. MAOIs Side Effects and Precautions
    • Food Cautions: aged cheese, wines, any aged/fermented food with taurine; Caution with EtOH, caffeine...everything.
    • Hypertensive Crisis Warning Signs: Increased BP, palpitations, HA --> Sweating, fever, N/V, photosensitivity--> can result in stroke, death
  13. MAOIs Pt Education
    • Teach pt about:
    • 1. Side effects
    • 2. Food to avoid
    • 3. Warning signs of Hypertensive Crisis
  14. Mood Stabalizing Drugs
    • 1. Lithium (Eskalith, Lithobid)
    • 2. Valproic Acid (Depakote)
    • 3. Carbamazepine (Tegretol)
    • 4. Oxycarbazine (Trileptal)
    • 5. Lamotrigine (Lamictal) - Anticonvulsant
  15. Typical Anti-Psychotics (High Potency - req low dose)
    • 1. Haloperidal (Haldol)
    • 2. Trifluoperazine (Stelazine)
    • 3. Fluephenazine (Prolixin)
    • 4. Fluephenazine decanoate (Proloxin D)
  16. Atypical Anti-Psychotics
    • 1. Aripiprazole (Abilify)
    • 2. Clozapine (Clozaril)
    • 3. Risperidone (Risperdal)
    • 4. Olanzapine (Zyprexa)
    • 5. Quetiapine (Seroquel)
    • 6. Ziprasidone (Geodon)
  17. Extrapyrmidal Side Effect Treatment
    • 1. Benztropine (Cogentin)
    • 2. Trihexyphenidyl (Artane)
    • 3. Diphenhydramine (Benadryl)
  18. Atypical Anti-Psychotic Dosage Ranges
    • 1. Aripiprazole (Abilify):     5-30mg
    • 2. Clozapine (Clozaril):       100-900mg
    • 3. Risperidone (Risperdal):       25-50mg
    • 4. Olanzapine (Zyprexa):     5-20mg
    • 5. Quetiapine (Seroquel):      150-750mg
    • 6. Ziprasidone (Geodon):      40-160mg
  19. Lithium (Eskalith, Lithobid) Side Effects
    • 1. Fine hand tremor
    • 2. Gastric irritation
    • 3. N/V/Diarrhea
    • 4. Increase/Decrease wt. gain
    • 5. Fatigue/Lethargy
    • 6. Headache
  20. Valproic Acid (Depakote) Side Effects
    • GI: anorexia, N/V/D, increased appetite and wt. gain. 
    • Neuro: tremor, sedation, HA, dizziness, ataxia
    • Thrombocytopenia --> bruising/bleeding/hematoma

    *most commonly used in US to treat bipolar d/o
  21. Carbamazepine (Tegretol) Side Effects
    Drowsiness, dizziness, ataxia, dbl or blurred vision, nausea and fatigue

    Serious SE--> Check for agranuloytosis (drop in WBC count)
  22. Oxycarbazine (Trileptal) Side Effects
    Sedation, dizziness, double vision, nausea, headache
  23. Lamotrigine (Lamictal) Side Effects
    Dizziness, HA, dbl vision, unsteadiness, sedation, and uncomplicated rash
  24. Typical Anti-Psychotic Side Effects
    • 1. Extrapyramidal Symptoms (EPS): Parkinsonian-like
    • 2. Akathisia: Inner restlessness
    • 3. Seizures
    • 4. Agranulocytosis: drop in WBC count --> risk for infection
    • 5. Photosensitivity
    • 6. Tardive Dyskinesia: Lip smacking, tongue protrudes, choreiform movements, chewing, foot tapping
    • 7. Neuroleptic Malignant Syndrome (NMS): Flu-like symptoms, incontinence, stupor --> seizure, coma, renal failure, death --> tx: hydration and dialysis (for renal failure)
  25. Atypical Anti-Psychotics Side Effects
    Metabolic Side Effects: Weight gain, diabetes, CVD

    Agraulocytosis with Clozaril

    EPS and Tardive Dyskinesia are rare
  26. Serotonin Syndrome
    What are symptoms and how is it treated?
    Serotonin Syndrome occurs when you mix SSRIs with serotonergic drugs --> life threatening crisis: Agitation or restlessness, N/V/Diarrhea, increased HR, Hallucinations, Increased body temp, Loss of coordination, Overactive reflexes, Rapid changes in BP.

    Tx: Benzos and fliuds by IV.
  27. Lithium Toxicity
    • Toxicity (0.6-1.4 mEq/L)>2.0 mEq/L: Predrome Symptoms
    • 1. Anorexia/N/V/Diarrhea
    • 2. Coarse hand tremor
    • 3. Ataxia
    • 4. Weakness
    • 5. Drowsiness
  28. Lithium Intoxication
    • Intoxication > 2.5 mEq/L:
    • 1. Fever
    • 2. Decreased urine output
    • 3. Decreased BP
    • 4. Impaired consciousness
    • 5. Seizure
    • 6. Coma
    • 7. Death
  29. Lithium Pt Education
    • 1. Take with Food
    • 2. Anyone over 1.0 mEq/L
    • 3. Precautions about OD
  30. Lithium AE
    • 1. Predrome Symptoms
    • 2. Lithium Intoxication
  31. Anti-Psychotic Drugs Positive and Negative Symptoms
    Positive: Hallucinations, delusions, disorganized speech and behavior

    Negative: Apathy, lack of initiation, paucity of speech, lack of interest
  32. Typical Anti-Psychotics - Low Potency (High dose)
    • Thorazine, Mellaril (don't go above 600mg --> blindness)
    • --> sedating
  33. Atypical Anti-Psychotic Pharmacotherapeutics
    • Target both positve and negative symptoms of psychosis
    • Drugs of choice
    • Action: block at dopamine and serotonin receptors (DA and 5HT antagonists)
  34. Atypical Anti-Psychotic Pt Education
    Diet, exercise and healthy lifestyle. Make sure to take meds or they can get the EPS or tardive dyskinesia when they don't follow regiment.

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