chap 22 other drugs
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| Clozapine se | fewer extrapyramidal side effects, BUT significant sedation and autonomic side effects
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| Clozapine indication | against negative symptoms of schizophrenia
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| Clozapine moa | antagonist of a large number of receptors => difficult to attribute to a particular mechanism of action
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| clozapine special se | agranulocytosis
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| clozapine monitor | monitor leukocyte counts during first 6 months
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| Olanzapine | chemical analog of clozapine
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| olanzapine comparison | causes fewer autonomic side effects than clozapine, and fewer EPS
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| olanzapine indication | positive symptoms of schizophrenia = haloperidol, better than haloperidol in negative symptoms, fewer EPS than haloperidol
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| olanzapine se | sedation and weight gain
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| olanzapine high dose se | akathisia,pseudoparkinsonism,dystonias
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| risperidone indications | negative and positive syndrom of schizo
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| risperidone se | less sedation,more orthostatic hypotension, higher EPS than olanzapine, cardiac arrhythmias, torsades de pointes
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| ziprasidone, aripiprazole,paliperidone | same as risperidone
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| choices to make btw typical when treating schizophrenia | all are equal, but low doses are as effective as higher doses but fewer side effects
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| typical vs atypical | atypical produce a lower EPS effects and more effective against negative symptoms of schizophrenia
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| abruptly discontinuation of antipsychotic drugs | tardive dyskinesia, withdrawal symptoms (insomina,nightmares,nausea,vomiting,diarrhea,restlessness, salivation,sweating)
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| Drugs for depression | Tricyclic's, SSRI's, MAOs (last choice)
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| Drugs for bipolar disorders | mood-stabilizer drugs: lithium
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| Tricyclic TCA | administer at bedtime b/c sedation effect
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| SSRI | administer in the morning b/c increasing alertness
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| Tricyclic s/e | autonomic effects, cardiac arrhythmia
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| autonomic side effects | hypotension, sinus tachycardia, excessive sedation, seizures
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| SSRI side effects | male sexual dysfunction, nervousness, dizziness, insomnia
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| SSRI caution | not for pt with seizure disorders, hepatic disorders, diabetes, bipolar disorder
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| amitriptyline, imipramine (Tricyclic) | tertiary amines
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| nortriptyline (tricyclic) | secondary amines
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| tertiary amines vs secondary amines | tertiary amines produce more sedation and autonomic side effects than secondary
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| choices of tricyclic | higher sedation for highly agitated or anxious pt with depression,lower sedation for more apathetic or withdrawn pt
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| SSRI vs tricyclic | SSRI: fewer autonomic side effects and less sedation and cardiovascular, safer in overdose
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| SSRI vs tricyclic | SSRI: block serotonin, less on norepinephrine;
tricyclic: block both serotonin and norepinephrine
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| fluoxetine indication | depression, bulimia nervosa, anorexia nervosa
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| fluoxetine other differences | has longer duration than other drugs = a disadvantage if severe adverse effects occur; cause more drug interaction than do other SSRIs
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| fluoxetine contrain | not for diabetic patients (impair the regulation of blood glucose)
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| fluoxetine | cause syndrome of inappropriate antidiuretic hormone secretion
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| fluvoxamine indication and s/e | treatment of OCD, depression, panic disorder, have sedative effects
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| Paroxetine | more sedating than fluoxetine or sertraline``
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| Sertraline | preferred for elderly pt; among SSRI, preffered in pt who are taking other drugs that interact with SSRIs
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| citalopram and escitalopram | chemical structure unrelated to SSRI and tricyclic
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| selegiline | treat depression (transdermal patch: Emsam),Parkinson's diseasse
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| bupropion | depression, adjunct therapy for pt attempting to quit smoking cigarettes
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| bupropion s/e | agitation,insomnia,nausea,weight loss
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| mirtazapine | better tolerated and causes fewer adverse reactions than TCAs
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| mirtazapine s/e | agranulocytosis
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| mirtazapine | antidepressant and antianxiety, structually different from other antidepressant
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| trazodone | cause sedation and orthostatic hypotension
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| venlafaxine and duloxetine | s/e same as SSRI
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| 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
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| when TCA and SSRI are not effective... | use mirtazapine and ventafaxine (low sedation, autonomic side effects and cardiac toxi
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| lithium s/e | low margin of safety (therapeutic index), earliest signs of overdose: nausea and vomiting
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| lithium s/e | drowsiness, weight gain
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| lithium s/e | fine hand tremor, polyuria
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| lithium s/e | hypothyroidism
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| lithium moa | reduce the formation of inositol triphosphate (IP3)
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| lithium drug interaction | nonsteroidal anti-inflammatory drugs and diuretics decrease lithium clearance, increase lithium level, other increase lithium neurotoxicity
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| lithium indication | calming effect, treat and prevent manic phase of bipolar disorder
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| alternatives of lithium | antiepileptic drugs: carbamazepine - as effective and causes fewer adverse effects; valproate: in pt with repid cycling of manic and depressive episodes
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| atomoxetine | unique norepinephrine reuptak inhibitor, nonamphetamine
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| modafinil | off label drug for ADHD
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| ADHD drugs treatment | amphetamine, methylphenidate, modafinil, lisdexamfetamine, atomoxetine (
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| Narcolepsy drugs treatment (also obstrutive sleep apnea/hypopnea and shift work sleep disorder | amphetamine, methylphenidate, modafinil, and armodafinil (all except lisde, atomo, phentermine)
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| obesity | amphetamins, methamphetamine (short term), phentermine (appetite suppressants). those have lower dependence liability than amphetamine, tolerance
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| CNS stimulants drugs side effects | cardiovascular incidents (high BP, MI,death), decrease in growth and weight gain in children
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| amphetamine derivatives | lisdexamphetamine
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| active isomer of modafinil | armodafinil
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| methylphenidate, modafinil, armodafinil | inhibit dopamine reuptake (different from amphetamine), cause less irritability, anxiety and anorexia than amphetamine
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