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Pharm 4

chap 22 other drugs

Clozapine se fewer extrapyramidal side effects, BUT significant sedation and autonomic side effects
Clozapine indication against negative symptoms of schizophrenia
Clozapine moa antagonist of a large number of receptors => difficult to attribute to a particular mechanism of action
clozapine special se agranulocytosis
clozapine monitor monitor leukocyte counts during first 6 months
Olanzapine chemical analog of clozapine
olanzapine comparison causes fewer autonomic side effects than clozapine, and fewer EPS
olanzapine indication positive symptoms of schizophrenia = haloperidol, better than haloperidol in negative symptoms, fewer EPS than haloperidol
olanzapine se sedation and weight gain
olanzapine high dose se akathisia,pseudoparkinsonism,dystonias
risperidone indications negative and positive syndrom of schizo
risperidone se less sedation,more orthostatic hypotension, higher EPS than olanzapine, cardiac arrhythmias, torsades de pointes
ziprasidone, aripiprazole,paliperidone same as risperidone
choices to make btw typical when treating schizophrenia all are equal, but low doses are as effective as higher doses but fewer side effects
typical vs atypical atypical produce a lower EPS effects and more effective against negative symptoms of schizophrenia
abruptly discontinuation of antipsychotic drugs tardive dyskinesia, withdrawal symptoms (insomina,nightmares,nausea,vomiting,diarrhea,restlessness, salivation,sweating)
Drugs for depression Tricyclic's, SSRI's, MAOs (last choice)
Drugs for bipolar disorders mood-stabilizer drugs: lithium
Tricyclic TCA administer at bedtime b/c sedation effect
SSRI administer in the morning b/c increasing alertness
Tricyclic s/e autonomic effects, cardiac arrhythmia
autonomic side effects hypotension, sinus tachycardia, excessive sedation, seizures
SSRI side effects male sexual dysfunction, nervousness, dizziness, insomnia
SSRI caution not for pt with seizure disorders, hepatic disorders, diabetes, bipolar disorder
amitriptyline, imipramine (Tricyclic) tertiary amines
nortriptyline (tricyclic) secondary amines
tertiary amines vs secondary amines tertiary amines produce more sedation and autonomic side effects than secondary
choices of tricyclic higher sedation for highly agitated or anxious pt with depression,lower sedation for more apathetic or withdrawn pt
SSRI vs tricyclic SSRI: fewer autonomic side effects and less sedation and cardiovascular, safer in overdose
SSRI vs tricyclic SSRI: block serotonin, less on norepinephrine; tricyclic: block both serotonin and norepinephrine
fluoxetine indication depression, bulimia nervosa, anorexia nervosa
fluoxetine other differences has longer duration than other drugs = a disadvantage if severe adverse effects occur; cause more drug interaction than do other SSRIs
fluoxetine contrain not for diabetic patients (impair the regulation of blood glucose)
fluoxetine cause syndrome of inappropriate antidiuretic hormone secretion
fluvoxamine indication and s/e treatment of OCD, depression, panic disorder, have sedative effects
Paroxetine more sedating than fluoxetine or sertraline``
Sertraline preferred for elderly pt; among SSRI, preffered in pt who are taking other drugs that interact with SSRIs
citalopram and escitalopram chemical structure unrelated to SSRI and tricyclic
selegiline treat depression (transdermal patch: Emsam),Parkinson's diseasse
bupropion depression, adjunct therapy for pt attempting to quit smoking cigarettes
bupropion s/e agitation,insomnia,nausea,weight loss
mirtazapine better tolerated and causes fewer adverse reactions than TCAs
mirtazapine s/e agranulocytosis
mirtazapine antidepressant and antianxiety, structually different from other antidepressant
trazodone cause sedation and orthostatic hypotension
venlafaxine and duloxetine s/e same as SSRI
SSRI and tricyclic in depression use either of them, but SSRI are better tolerated by pt, fewer adverse effects, safer in overdose. But higher cost and more drugs interactions
when TCA and SSRI are not effective... use mirtazapine and ventafaxine (low sedation, autonomic side effects and cardiac toxi
lithium s/e low margin of safety (therapeutic index), earliest signs of overdose: nausea and vomiting
lithium s/e drowsiness, weight gain
lithium s/e fine hand tremor, polyuria
lithium s/e hypothyroidism
lithium moa reduce the formation of inositol triphosphate (IP3)
lithium drug interaction nonsteroidal anti-inflammatory drugs and diuretics decrease lithium clearance, increase lithium level, other increase lithium neurotoxicity
lithium indication calming effect, treat and prevent manic phase of bipolar disorder
alternatives of lithium antiepileptic drugs: carbamazepine - as effective and causes fewer adverse effects; valproate: in pt with repid cycling of manic and depressive episodes
atomoxetine unique norepinephrine reuptak inhibitor, nonamphetamine
modafinil off label drug for ADHD
ADHD drugs treatment amphetamine, methylphenidate, modafinil, lisdexamfetamine, atomoxetine (
Narcolepsy drugs treatment (also obstrutive sleep apnea/hypopnea and shift work sleep disorder amphetamine, methylphenidate, modafinil, and armodafinil (all except lisde, atomo, phentermine)
obesity amphetamins, methamphetamine (short term), phentermine (appetite suppressants). those have lower dependence liability than amphetamine, tolerance
CNS stimulants drugs side effects cardiovascular incidents (high BP, MI,death), decrease in growth and weight gain in children
amphetamine derivatives lisdexamphetamine
active isomer of modafinil armodafinil
methylphenidate, modafinil, armodafinil inhibit dopamine reuptake (different from amphetamine), cause less irritability, anxiety and anorexia than amphetamine
Created by: prinluu