Psych Pharm Quiz

• 1. Lorazepam (Ativan) 
• 2. Alprazolam (Xanax)
• 3. Oxazepam (Serax)
• 4. Diazepam (Valium)
• 5. Clonazepam(Klonopin) 
• _____________________
• 6. Buspirone (BuSpar)
• 7. Zolpidem (Ambien)

Drowsiness, sedation, ataxia, dizziness

• Agitation, anorexia, anxiety, dizziness, headache, seizures
• (seizure precaution, fall risk, hydration, minimize env't stimulants, prn pain meds)

• 1. Citalopram (Celexa)
• 2. Fluoxetine (Prozac)
• 3. Fluvoxamine (Luvox)
• 4. Paroxetine (Paxil)
• 5. Sertaline (Zoloft)

Headache, nausea, diarrhea

• 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

Prozac may take 2-6 weeks to see any results and side effects will subdue in 7-10days

• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)
• Nefazodone (Serzone)
• Trazadone (Desryl)
• Venlafaxine (Effexor)

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

• Amytriptyline (Elavil)
• Nortriptyline (Pamelor)
• Imipramine (Tofranil)
• Desipramine (Norpramin)

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

• Phenalzine (Nardil)
• Tranylcypromine (Parnate)

• 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

• Teach pt about:
• 1. Side effects
• 2. Food to avoid
• 3. Warning signs of Hypertensive Crisis

• 1. Lithium (Eskalith, Lithobid)
• 2. Valproic Acid (Depakote)
• 3. Carbamazepine (Tegretol)
• 4. Oxycarbazine (Trileptal)
• 5. Lamotrigine (Lamictal) - Anticonvulsant

• 1. Haloperidal (Haldol)
• 2. Trifluoperazine (Stelazine)
• 3. Fluephenazine (Prolixin)
• 4. Fluephenazine decanoate (Proloxin D)

• 1. Aripiprazole (Abilify)
• 2. Clozapine (Clozaril)
• 3. Risperidone (Risperdal)
• 4. Olanzapine (Zyprexa)
• 5. Quetiapine (Seroquel)
• 6. Ziprasidone (Geodon)

• 1. Benztropine (Cogentin)
• 2. Trihexyphenidyl (Artane)
• 3. Diphenhydramine (Benadryl)

• 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

• 1. Fine hand tremor
• 2. Gastric irritation
• 3. N/V/Diarrhea
• 4. Increase/Decrease wt. gain
• 5. Fatigue/Lethargy
• 6. Headache

• 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

Drowsiness, dizziness, ataxia, dbl or blurred vision, nausea and fatigue

Serious SE--> Check for agranuloytosis (drop in WBC count)

Sedation, dizziness, double vision, nausea, headache

Dizziness, HA, dbl vision, unsteadiness, sedation, and uncomplicated rash

• 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)

Metabolic Side Effects: Weight gain, diabetes, CVD

Agraulocytosis with Clozaril

EPS and Tardive Dyskinesia are rare

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.

• 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

• Intoxication > 2.5 mEq/L:
• 1. Fever
• 2. Decreased urine output
• 3. Decreased BP
• 4. Impaired consciousness
• 5. Seizure
• 6. Coma
• 7. Death

• 1. Take with Food
• 2. Anyone over 1.0 mEq/L
• 3. Precautions about OD

• 1. Predrome Symptoms
• 2. Lithium Intoxication

Positive: Hallucinations, delusions, disorganized speech and behavior

Negative: Apathy, lack of initiation, paucity of speech, lack of interest

• Thorazine, Mellaril (don't go above 600mg --> blindness)
• --> sedating

• Target both positve and negative symptoms of psychosis
• Drugs of choice
• Action: block at dopamine and serotonin receptors (DA and 5HT antagonists)

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.