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תרופות Flashcards

1
Q

SSRI - fluoxetine (prozac)

  • Side effects include…[1],…[2] and…[3]
  • Have the…[4] t1/2 of…[5]
  • Active metabolites are present in…[6]
  • Have some…[7] and…[8] activity
A
  1. Anxiety
  2. Weight loss
  3. Seizure
  4. Longest
  5. 4-6 days
  6. 7-9 days
  7. Anti-cholinergic
  8. Anti-histaminic
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2
Q

SSRI - fluvoxamine (favoxil)

  • A lot of side effects, its causes…[1]
  • It have…[2] effect and it is beneficial of…[3]
  • It t1/2 is…[4]
A
  1. Weight gain
  2. Sedative (relaxing)
  3. OCD
  4. 15 hours
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3
Q

SSRI - paroxetine (seroxat, paxxet)

  • It causes…[1]
  • And have…[2] side effects due to its…[3] activity
  • It is the most…[4] SSRI and thus it is beneficial for…[5]
  • Have t1/2 of…[6]
A
  1. Weight gain
  2. Anti cholinergic
  3. Anti cholinergic
  4. Sedative (relaxing)
  5. Panic disorder
  6. 21 hours
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4
Q

SSRI - sertraline (lustral)

  • Side effects of…[1] and [2]
  • Have t1/2 of…[3]
  • Active metabolites in the blood for…[4]
A
  1. Anxiety
  2. Diarrhea
  3. 26 hours
  4. 3-5 days
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5
Q

SSRI - escitalopram (cipralex) and citalopram (recital)

  • Escitalopram side effects include…[1]
    • Its t1/2 is…[2]
  • Citalopram t1/2 is…[3]
A
  1. Anxiety
  2. 27-32 hours
  3. 35 hours
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6
Q

SSRI - GI side effects

  1. Resolves usually after…[1]
  2. Most commonly associated with…[2]
A
  • GI discomfort, vomiting, nausea, anorexia, dyspepsia, diarrhea
  • GI side effects are the main side effect
  1. Resolves usually after 2 weeks
  2. Sertraline (lustral) have the most prominent GI side effects
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7
Q

SSRI - sexual dysfunction

  • Occurs in…[1] of the patients
  • Does not…[2]
  • Change to drung that does not effect sexual acitivity including…[3] and…[4]
A
  1. 50-80%
  2. Resolve
  3. Mirtazapine
  4. Buproprion
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8
Q

SSRI - CNS side effects

  • Can increase…[1] in the first few weeks
  • Rarely and most commonly in old patients can cause…[2]
  • Very low rate (0.02%) of…[3]
  • The associated drug is…[4]
A
  1. Anxiety
  2. EPS
  3. Seizures
  4. Fluoxetine
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9
Q

SSRI - misc. side effects

  • Weight loss occurs only with…[1] the rest will cause weight gain
  • …[2] that will lead to hyponatremia and delirium in old patients
  • Anti-cholinergic side effects with…[3]
  • 4% will have…[4]
  • Deficieny in…[5] of…[6]
  • Emotional…[7]
A
  1. Fluoxetine
  2. SIADH
  3. Paroxetine
  4. Skin rash
  5. Aggregation
  6. Platelets
  7. Blunting
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10
Q

SSRI discontinuation syndrome

  • Leads to…[1] disorder and…[2] discomfort
  • Also…[3],…[4] and…[5]. Also auras of…[6]
  • Accompanied with…[7] problems
  • Occurs in…[8] of the patients
  • Becuase…[9] have long t1/2 it is the treatment
A
  1. Balance
  2. GI
  3. Tierdness
  4. Insomnia
  5. Parasthesias
  6. Migraine
  7. Psychiatric
  8. 33%
  9. Fluoxetine
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11
Q

Typical anti-psychotics - high potency drugs

  • …[1],…[2],…[3] and…[4]
  • Have low…[5], and high…[6] effects
A
  1. Trifluphenazine
  2. Fluphenazine
  3. Haloperidol
  4. Pimozide
  5. Anti-cholinergic
  6. EPS
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12
Q

Typical anti-psychotics - low potency drugs

  • …[1],…[2]
  • Have low…[3], and high…[4] effects
  • …[5], have the lowest effect of…[6], because its potency is…[7]
A
  1. Chloropromazine
  2. Thioridazine
  3. EPS
  4. Anti-cholinergic
  5. Prephenazine
  6. EPS
  7. Medium
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13
Q

EPS - parkinsonism

  • Occurs in…[1]
  • After…[2] days
  • Most common in…[3]…[4]
  • Treatment
A
  1. 15% - the most common
  2. 5-90
  3. Elderly
  4. Females
  5. Anti-cholinergics / amantadine / diphenhydramine (benedril)
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14
Q

ESP - acute dystonia

  • Occurs in…[1]
  • Most commonly in…[2],…[3]
  • Prevention
  • Treatment
A
  1. 10%
  2. Young
  3. Males
  4. Anti-cholinergics / diphenhydramine (benedril) / clonazepam
  5. Anti-cholinergics / anti-histamines IM/IV
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15
Q

EPS - acute akathisia

  • Treatment
A
  • Consider reducing the dose or replacing the drug
  • Best responds to propranolol (deralin).
    • Can also use benzodiazepines, anti-cholinergics or cyproheptadine
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16
Q

EPS - tardive dyskinesia

  • In…[1] of the patients after 12 months, and in…[2] of the patients after 4 years
  • Isnt reversible in…[3] of the cases
  • Prevention
  • Treatment
A
  1. 15%
  2. Over 25%
  3. 50%
  • Treat with the lowest dose possible. Treat with atypicals (clozapine have the lesser rate)
  • Decrease the dose or stop acutely the drug, and change to atypical (clozapine).
    • If cannot tolerate clozapine - benzo/lithium/carbamazepine
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17
Q

Typical anti-psychotics - general adverse effects

  • Hyper…[1]
  • Anti-…[2]
  • Orth…[3]
  • Anti-histaminergic…[4]
  • Hematologic…[5]
  • Cardial…[6]
  • Skin…[7]
  • Liver…[8]
  • Decreased…[9]
A
  1. Prolactinemia - gynecomastia, impotence, galactorrhea, amenorrhea, anorgasmia. OSTEOPORESIS
  2. Cholinergic - both central and peripheral
  3. Orthostatism - due to alpha-1 blockade
  4. Increased appetite and sedative
  5. Mild leuckopenia, rarely, agranulocytosis
  6. Prolonged PR and QT intervals
  7. Photosensitive rash
  8. Cholestatic jaundice
  9. Seizure threshold
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18
Q

Atypical anti-psychotics

  • Anti-psychotic effect
  • Reistent to treatment
A
  • Appears after 3 weeks with full dose
  • No reaction after 4-10 week with the full dose
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19
Q

Atypical anti-psychotics - metabolic syndrome

A
  • Central obesity, increased TG, decreased HDL, increased blood fasting glucose, hypertension
  • Clozapine and olanzapine have the highest effect
  • Aripiprazole have the lowest
  • Aripiprazole < quetiapine < risperidone < olanzapine < clozapine
20
Q

Atypical anti-psychotics - agranulocytosis

  • Occurs in…[1] of the patients treated with…[2]
  • Requires intensive follow up, that include bloodworks every…[3], for the first…[4], followed by once a…[5] for…[6]
A
  1. 1%
  2. Clozapine (leponex)
  3. Week
  4. 18 weeks
  5. Month
  6. EVER
21
Q

Atypical anti-psychotics - other adverse effects

A
  1. Salivation - mainly due to the use of clozapine. Treat with anti-cholinergics or with clonidine
  2. Genitourinary disturbances including impotence
  3. In high dose it can exacerbate OCD
22
Q

Atypical anti-psychotics - clozapine

  • Used for…[1],…[2] and…[3]
  • Works for…[4] that are resistent to therapy
  • Works also on…[5]
  • Adverse effects include…[6-11]
  • 3 Contraindications for clozapine…[12]
A
  1. Resistent schizophrenia (3 other drugs before)
  2. Severe suicidal ideations
  3. Tradive dykinesia
  4. 30%
  5. Negative symptoms
  6. Sedation
  7. Metabolic syndrome
  8. Anti-cholinergic AE’s including QT prolongation
  9. Agranulocytosis (1-2%)
  10. Decreased seizure threshold
  11. Myocarditis
  12. WBC <3500, bone marrow disorders, history of agranulocytosis with clozapine
23
Q

Atypical anti-psychotics - risperidone (risperidal)

A
  • 3-4 times higher risk for hyperprolactinemia
  • In high dose can trigger EPS
  • Usually used as first line
24
Q

Atypical anti-psychotics - olanzapine (zyprexa)

A
  • Higher rate of H1 AE’s - metabolic syndrome.
  • Orthostatism
  • Constipation
  • Decreased seizure threshold
  • Can also be used as mood stablizer
25
Atypical anti-psychotics - quetiapine (seroquell)
* Lesser motoric side effects * Have anti-cholinergic effects * Good for patients with metabolic syndrome
26
Atypical anti-psychotics - ziprezidone (geodon)
* Have risk for QT prolongation * There is almost none metabolic effects * Can be used for OCD
27
6 contraindications for treatment with neuroleptics
1. Severe allergic reaction 2. Interactions with drugs that will lead to CNS depression 3. Risk for seizures 4. Severe cardiac abnormalities 5. Narrow angle glaucoma 6. Tradive dyskinesia (?)
28
Lithium - characteristics * Excreted by the...[1] * Have narrow...[2] * Before starting the therapy, and every...[3] - blood works for...[4],...[5],...[6],...[7] and...[8] * Also do...[9] * Wanted lithium levels in acute mania...[10], and in maintenance therapy...[11]
1. Kidney 2. Therapeutic range 3. 6 months 4. Renal function 5. Electrolytes (calcium included) 6. Blood count 7. TSH 8. beta-HCG 9. ECG 10. 1-1.5 mEq/L 11. 0.4-0.8 mEq/L
29
Lithium - GI side effects
* Appears in the beginning of the therapy * Nausea, vomiting, diarrhea, weight gain, dyspepsia, fluid retention
30
Lithium - CNS side effects 1. Cerebellar 2. Cognitive 3. Neuron toxic syndrome
1. Postural tremor, akathisia 2. Dysphoria, slow response * MG like response, decreased seizure threshold, parkinsonism 3. Acute confusional state, that is sometimes non reversible, that appears with combination with anti-psychotics
31
Lithium - renal side effects
* In 33% of the patients nephrogenic DI * Intersitial fibrosis * Nephrotic syndrome In the kidney lithium acts the same way as sodium - pay attention to patients that prescribed low sodium diet (cardial patients)
32
Lithium - thyroid, parathyroid side effects
* Goiter * Hypothyroidism - more commonly in females * Treat with levothyroxin (Eltroxin) * Hyperparathyroidism --\> hypercalcemia
33
Lithium - cardial side effects
* ECG that gives picture of hypokalemia - flattening of T waves * SA node suppression - contraindicated in patients with sick sinus syndrome
34
Lithium - skin
* Acne * Exacerbation of psoriasis * Hair loss
35
Lithium - hematologic side effects
* Leukocytosis without clinical relevance * Rarely, thrombocytosis - thrombotic events are rare
36
Lithium - teratogenicity
* 4-12% risk for Ebstein anomaly * If women is taking lithium during the pregnancy - keep the minimal possible dose * 2 weeks before delivery maintain levels of 0.6 mEq/L * Follow up on TSH for risk of fetal hypothyroidism, follow up also on the heart of the fetus * Lithium is transferred in milk
37
Valproic acid (depalept) 1. GI side effects 2. CNS 3. Weight... 4. 5 other side effects 5. Teratogenicity level
1. Frequent in the first month of the therapy. Abdominal discomfort, jaundice 2. Sedation, tremor (reacts well to beta blockers) 3. Gain 4. Alopecia (5-15%), increased LFT's, changes in lipid profile, polycystic ovary, SIADH 5. Level X - absolutly contraindicated * Due to relatively small amount of side effects it is the drug that is recommended for children and elderly
38
Carbamazepine (tegretol) - physiologic effects 1. Hematologic 2. Endocrine 3. Liver 4. CVS 5. Skin 6. ...-like syndrome
1. Benign leukopenia 2. SIADH, increased thyroid hormones 3. Increased liver enzymes - can interfere with other drugs metabolism 4. Contraindicated in patients with AV block 5. Rash 6. SLE
39
Carbamazepine (tegretol) - side effects 1. Hematologic 2. Liver 3. Skin 4. Pancreas 5. GI 6. CNS 7. Heart
1. in 1:250,000 - aplastic anaemia and agranulocytosis * Blood count every 3 months in the first year * In the first months blood count every 2 weeks 2. Hepatitis, jaundice, cholestasis 3. Risk for SJS and TEN 4. Pancreatitis 5. Most commonly - nausea, vomiting, abdominal discomfort, dyspepsia, constipation, anorexia 6. Acute confusional state can occur when combined with neuroleptics 7. Increased conduction time --\> contraidicated in patients with AV block
40
Carbamazepine (tegretol) - precautions * Contraindications include...[1],...[2] and...[3] * Precaution with...[4],...[5] and...[6] * Tertogenicity
1. Hematologic disease 2. Liver disease 3. AV block 4. Glaucoma 5. BPH 6. Diabetes 7. Increased risk for neural tube defects, intracranial hemorrhage * Pass in milk
41
Lamotrigine (lamictal) * The only anti-epileptic that is useful for...[1] * The only one that is allowed in...[2] * Side effects: * Neurologic [3] * Skin [4] * Cannot be given to patients under...[5]
1. Depression 2. Pregnancy 3. Tiredness, headache, ataxia, blurred vision 4. Benign rash in 8% * Risk for SJS and TEN 5. 16
42
Benzodiazepines - side effects * Mainly of...[1] * If taken with...[2] can cause...[3] and...[4] * In therapeutic range: * Can cause...[5], this is why patients should not...[6] * Risk for...[7] and...[8] there is high risk for...[9] in the elderly
1. CNS 2. Alcohol 3. Disinhibition 4. Respiratory depression 5. Sedation 6. Operate heavy mechinary 7. Ataxia 8. Diziness 9. Falls
43
Benzodiazepines - precautions 1. Pregnancy 2. Diseases of... 3. Dont take with... 4. Precaution with...[4],...[5],...[6],...[7] and...[8]
1. Teratogenic. * Decrease fetal motility * In the third trimester there is risk for fetal withdrawl syndrome * Passed in milk - lactation is contraindicated * D-level 2. Liver and kidney 3. Alcohol 4. COPD 5. OSA 6. Drug abuse 7. Cognitive disorders 8. Myasthenia gravis
44
Benzodiazepines - long acting * 2 drugs
1. Diazepam (valium, assival) * Highly lipid soluble * 20-50h 2. Clonazepam (clonex) * High potency * 18-39h * Dont forget that not only t1/2 determine the action time
45
Benzodiazepines - short acting * 3 drugs
1. Brotizolam (bondromin) 2. Lorazepam (lorivan) * Have active metabolite (?) * 10-20h 3. Oxazepam (vaben) * 3-21h
46
Benzodiazepine - intermediate acting * 1 drug
1. Alprazolam (xanax) * Lipid soluble * 6-20h
47
Benzodiazepines - lipid soluble * 3 drugs
1. Midazolam (not really psychiatric drug) 2. Alprazolam (xanax) * Intermediate acting * 6-20h 3. Diazepam (valium, assival) * Long acting * 20-50h

פסיכיאטריה (3 decks)

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