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Pharm 4
chap 22 other drugs
| Question | Answer |
|---|---|
| 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
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