Pharmacology ATI Proctored
Benzodiazepines ANS: Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam,
chlordiazepoxide, chlorazepate
Enhances GABA: increased GABA means decreased neuron activity
Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia
Usually short term; if long term do NOT stop abruptly
Antidote is flumazenil
Side effects: CNS depression - sedation and respiratory depression, amnesia, dependency, and
withdrawal effects
Atypical anxiolytic ANS: Buspirone
Can take 2-6 weeks to work, but can be long term!
Treats panic disorder, anxiety, OCD, and PTSD
Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen
like in benzo)
Trick to remember difference between Benzodiazepine and buspirone ANS: "Pam" has anxiety, so she
goes on a "benzo" and takes it for a long time but realizes that it is not healthy. So she takes a "bus" to a
"pier" to sit "alone" and decides to treat her anxiety long term with "buspirone"
Selective Serotonin Reuptake Inhibitors (SSRIs) ANS: Usually end in "ine": paroxetine, sertraline,
citalopram, escitalopram, fluoxetine, fluvoxamine
Inhibits serotonin reuptake" increases serotonin
Treats anxiety, OCD, PTSD, and depression
Side effects: nausea, fatigue, sexual dysfunction, weight gain, insomnia (paroxetine), serotonin
syndrome (agitation, hallucinations, tremors, fever, diaphoresis)
Takes about four weeks after treatment begins to take full effect.
,Atypical Antidepressants ANS: Bupropion, Trazodone - more important
Others: Vilazodone, mirtazapine, reboxetine
Treats depression and aid for smoking cessation
Side effects: headache, GI distress, insomnia, nausea, weight loss, seizures
Tricyclic antidepressants ANS: Amitriptyline
Treats depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia
Side effects: Anticholinergic effects, Sedation, Seizures, Sweating (SSS)
"Amy tripped over a tricycle in the desert."
Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert.
Anticholinergic efffects ANS: dry mouth, blurred vision, photophobia, urinary hesitancy or retention,
constipation, tachycardia
Monoamine oxidase inhibitors ANS: Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline
Side effects: CNS stimulation, Orthostatic hypotension, hypertensive crisis (especially with phenelzine).
Tyramine rich foods can lead to hypertensive crisis
Foods that contain tyramine ANS: aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish,
protein dietary supplements, soups, soy sauce, some beers, and red wine
Mood stabilizer ANS: Lithium Carbonate
Treats bipolar disorder
Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, renal toxicity,
hypothyroidism, electrolyte imbalance
Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion,
tinnitus, seizures, hypotension, coma, possibly death.
,Do not give with diuretics, NSAIDs, or anticholinergics
Need a balance of sodium and water.
Mood - stabilizing antiepileptic ANS: Carbamazepine, valproic acid
Treats Bipolar disorder and seizure disorder
Carbamazepine side effects: blood dyscrasias, hypo-osmolality
Valproic acid side effects: *hepatotoxicity,* pancreatitis, thrombocytopenia
Antipsychotics: First-generation (conventional) ANS: Chlorpromazine, Haloperidol
TONS of side effects-will only list important ones
Extrapyramidal side effects: Acute dystonia- spasms of tongue, neck, face, or back; Parkinsonism-
rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia -
involuntary movement of tongue and face
EPS effects may be able to be treated with anticholinergic medication if the patient does not have
anticholinergic side effects.
Neuroleptic Malignant Syndrome: sudden high grade fever, dysrhythmias, muscle rigidity
There is a long lasting injection for non-compliant patients.
Antipsychotics: second and third generation (atypical) ANS: Risperidone and Clozapine - most important
Often first line in treating schizophrenia
Treats negative and positive symptoms
Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension,
anticholinergic effects
Do not take with alcohol.
IM every two weeks available for those who are not compliant
Central Nervous system stimulants ANS: Methylphenidate and Amphetamine mixture
, Treats ADHD and Conduct disorder
Can cause insomnia, decreased appetite, weight loss, and growth suppression
Do not give at night. Give immediately before or after a meal. Monitor weight.
Medications to support withdrawal from alcohol ANS: Benzodiazepines:
Chlordiazepoxide, lorazepam, diazepam
First line treatment of alcohol withdrawal
Keeps vitals within expected limits, decreases risk of seizures
Clonidine and Propranolol depress autonomic response and decrease vitals
Carbamazepine Further decreases risk of seizure
Disulfiram ANS: Daily oral medication to sustain abstinence of alcohol; type of aversion therapy
Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed
Naltrexone ANS: Suppresses the craving and pleasurable effects of alcohol.
Can have monthly IM injection
Acamprosate ANS: Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety,
restlessness
Medications to support withdrawal/abstinence from opiods ANS: Methadone Substitution
Slow weening process
Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a
physical dependence
It prevents abstinence syndrome and removes the need for the client to obtain illegal substances.
Used for withdrawal and long term maintenance.
Benzodiazepines ANS: Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam,
chlordiazepoxide, chlorazepate
Enhances GABA: increased GABA means decreased neuron activity
Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia
Usually short term; if long term do NOT stop abruptly
Antidote is flumazenil
Side effects: CNS depression - sedation and respiratory depression, amnesia, dependency, and
withdrawal effects
Atypical anxiolytic ANS: Buspirone
Can take 2-6 weeks to work, but can be long term!
Treats panic disorder, anxiety, OCD, and PTSD
Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen
like in benzo)
Trick to remember difference between Benzodiazepine and buspirone ANS: "Pam" has anxiety, so she
goes on a "benzo" and takes it for a long time but realizes that it is not healthy. So she takes a "bus" to a
"pier" to sit "alone" and decides to treat her anxiety long term with "buspirone"
Selective Serotonin Reuptake Inhibitors (SSRIs) ANS: Usually end in "ine": paroxetine, sertraline,
citalopram, escitalopram, fluoxetine, fluvoxamine
Inhibits serotonin reuptake" increases serotonin
Treats anxiety, OCD, PTSD, and depression
Side effects: nausea, fatigue, sexual dysfunction, weight gain, insomnia (paroxetine), serotonin
syndrome (agitation, hallucinations, tremors, fever, diaphoresis)
Takes about four weeks after treatment begins to take full effect.
,Atypical Antidepressants ANS: Bupropion, Trazodone - more important
Others: Vilazodone, mirtazapine, reboxetine
Treats depression and aid for smoking cessation
Side effects: headache, GI distress, insomnia, nausea, weight loss, seizures
Tricyclic antidepressants ANS: Amitriptyline
Treats depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia
Side effects: Anticholinergic effects, Sedation, Seizures, Sweating (SSS)
"Amy tripped over a tricycle in the desert."
Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert.
Anticholinergic efffects ANS: dry mouth, blurred vision, photophobia, urinary hesitancy or retention,
constipation, tachycardia
Monoamine oxidase inhibitors ANS: Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline
Side effects: CNS stimulation, Orthostatic hypotension, hypertensive crisis (especially with phenelzine).
Tyramine rich foods can lead to hypertensive crisis
Foods that contain tyramine ANS: aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish,
protein dietary supplements, soups, soy sauce, some beers, and red wine
Mood stabilizer ANS: Lithium Carbonate
Treats bipolar disorder
Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, renal toxicity,
hypothyroidism, electrolyte imbalance
Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion,
tinnitus, seizures, hypotension, coma, possibly death.
,Do not give with diuretics, NSAIDs, or anticholinergics
Need a balance of sodium and water.
Mood - stabilizing antiepileptic ANS: Carbamazepine, valproic acid
Treats Bipolar disorder and seizure disorder
Carbamazepine side effects: blood dyscrasias, hypo-osmolality
Valproic acid side effects: *hepatotoxicity,* pancreatitis, thrombocytopenia
Antipsychotics: First-generation (conventional) ANS: Chlorpromazine, Haloperidol
TONS of side effects-will only list important ones
Extrapyramidal side effects: Acute dystonia- spasms of tongue, neck, face, or back; Parkinsonism-
rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia -
involuntary movement of tongue and face
EPS effects may be able to be treated with anticholinergic medication if the patient does not have
anticholinergic side effects.
Neuroleptic Malignant Syndrome: sudden high grade fever, dysrhythmias, muscle rigidity
There is a long lasting injection for non-compliant patients.
Antipsychotics: second and third generation (atypical) ANS: Risperidone and Clozapine - most important
Often first line in treating schizophrenia
Treats negative and positive symptoms
Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension,
anticholinergic effects
Do not take with alcohol.
IM every two weeks available for those who are not compliant
Central Nervous system stimulants ANS: Methylphenidate and Amphetamine mixture
, Treats ADHD and Conduct disorder
Can cause insomnia, decreased appetite, weight loss, and growth suppression
Do not give at night. Give immediately before or after a meal. Monitor weight.
Medications to support withdrawal from alcohol ANS: Benzodiazepines:
Chlordiazepoxide, lorazepam, diazepam
First line treatment of alcohol withdrawal
Keeps vitals within expected limits, decreases risk of seizures
Clonidine and Propranolol depress autonomic response and decrease vitals
Carbamazepine Further decreases risk of seizure
Disulfiram ANS: Daily oral medication to sustain abstinence of alcohol; type of aversion therapy
Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed
Naltrexone ANS: Suppresses the craving and pleasurable effects of alcohol.
Can have monthly IM injection
Acamprosate ANS: Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety,
restlessness
Medications to support withdrawal/abstinence from opiods ANS: Methadone Substitution
Slow weening process
Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a
physical dependence
It prevents abstinence syndrome and removes the need for the client to obtain illegal substances.
Used for withdrawal and long term maintenance.
