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ADPY 7500 > 18. Psychopharmacology > Flashcards

18. Psychopharmacology Flashcards

1
Q

“HAM” side effects

A

antiHistamine: sedation, weight gain
antiAdrenergic: hypotension
antiMuscarinic: dry mouth, blurred vision, urinary retention, constipation

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2
Q

What classes of drugs have HAM side effects?

A

TCAs

Low-potency antipsychotics

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3
Q

Serotonin syndrome classically occurs when which 2 classes of drugs are combined

A

MAOIs

SSRIs

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4
Q

When does a hypertensive crisis occur?

A

A buildup of stored catecholamines

Caused by the combination of MAOIs with tyramine-rich foods or with sympathomimetics

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5
Q

First line treatment for extrapyramidal symptoms causes by antipsychotics

A

Benztropine

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6
Q

3 categories of EPS

A

Parkinsonism: masklike face, cogwheel rigidity, bradykinesia, pill-rolling tremor

Akathisia: restlessness, need to move, agitation

Dystonia: sustained, painful contraction of muscles of neck, tongue, eyes, diaphragm

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7
Q

Hyperprolactinemia is caused by which drugs

A 
Risperidone
Typical (first) generation antipsychotics
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8
Q

Occurs after YEARS of antipsychotic use

A

Tardive dyskinesia

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9
Q

What is tardive dyskinesia

A

Choreoathetoid muscle movements: usually of mough and tongue

Usually irreversible

More likely to occur due to high-potency, first-generation antipsychotics

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10
Q

Symptoms of neuroleptic malignant syndrome

A 
MENTAL STATUS CHANGES
fever
tachycardia
hypertension
tremor
elevated CPK
Lead pipe rigidity

*Can be caused by any antipsychotic after a short or long time

20 % mortality rate

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11
Q

Characteristics of acute dystonia

A

twisting and abnormal postures

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12
Q

Bradykinesia

A

decreased or slow body movement

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13
Q

Common side effect of anticholinergic meds

A

constipation

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14
Q

Anticholinergic meds exacerbate what type of disorders?

A

Neurocognitive

Dementias

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15
Q

Important CYP450 Inhibitors

A 
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline
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16
Q

Over the counter cough suppressant that increases serotonin

A

Dextromethorphan

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17
Q

Location of serotonin pumps inhibited by SSRIs

A

Presynaptic

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18
Q

SSRI with longest t1/2

A

Fluoxetine (Prozac)

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19
Q

FDA blackbox warning for SSRIs

A

May increase suicidal thinking and behavior

*applies to children up to age 25, but may be accurate for adults as well

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20
Q

SSRI with higher risk for GI upset

A

Sertraline (Zoloft)

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21
Q

SSRI with short t1/2 leading to withdrawal phenomena if not taken consistently

A

Paroxetine (Paxil)

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22
Q

SSRI currently approved only for sue in OCD

A

Fluvoxamine (Luvox)

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23
Q

SSRI with dose dependent QTc prolongation

A

Citalopram (Celexa)

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24
Q

Enantiomer of citalopram, possibly fewer side effects, also has dose dependent QTc prolongation

A

Escitalopram (Lexapro)

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25
Q

What class of drugs that is used for headaches can cause serotonin syndrome when used with SSRIs?

A

Triptans

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26
Q

Used in fibromyalgia

A

Duloxetine

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27
Q

SNRI major uses

A

Depression

Neuropathic pain

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28
Q

SSRIs can increase the level of what drug?

A

Warfarin

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29
Q

Carries a blackbox warning for rare but serious liver failure

A

Nefazodone

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30
Q

Sedation
Weight gain
Used in treatment of major depression

A

Mirtazapine

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31
Q

MOA of TCAs

A

inhibit reuptake of NE and serotonin, increasing availability of monoamines in the synapse

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32
Q

Treatment for TCA overdose

A

Sodium bicarbonate

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33
Q

TCA: useful in chronic pain, migraines, insomnia

A

Amitriptyline

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34
Q

Useful in enuresis (2nd line)

A

Imipramine

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35
Q

TCA used in treatment of OCD

A

Clomipramine

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36
Q

Secondary amines (2) that are metabolites of tertiary amines so they are less anticholinergic, antihistaminic, and antiadrenergic

A

Nortriptyline

Desipramine

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37
Q

Tetracyclic antidepressant

A

Amoxapine

*metabolite of antipxychotic loxapine

38
Q

Majof complications of TCAs

A

Cardiotoxicity
Convulsions
Coma

39
Q

More effective in depression with atypical features: MAOIs or TCAs?

A

MAOIs

40
Q

Highly protein bound and lipid soluble

A

TCAs

41
Q

Transdermal MAOI patch that does not require patients to follow dietary restrictions

A

Selegiline

42
Q

MAOIs reversible of irreversible?

A

Irreversible

43
Q

The MAOIs

A

Phenelzine
Tranylcypromine
Isocarboxazid

44
Q

When are MAOIs used?

A

Refractory depression

45
Q

First step when suspecting serotonin syndrome

Next?

A

discontinue meds

Supportive care, benzodiazepines

*The serotonin antagonist cyproheptadine can also be used

46
Q

Patients should supplement with what vitamin when taking MAOIs?

A

B6

47
Q

Why do low potency typical antipsychotics require higher doses than high potency typicals?

A

Because they have lower affinity for the dopamine receptors

48
Q

Commonly causes orthostatic HTN
Can cause blue-gray skin discoloration
can cause photosensitivity

A

Chlorpromazine

49
Q

Retinitis pigmentosa association

A

Thioridazine

50
Q

Low potency typicals

A

Chlorpromazine

Thioridazine

51
Q

High potency typicals

A

Haloperidol
Fluphenazine
Trifluoperazine
Pimozide

52
Q

Category with greater risk for EPS and TD

A

High potency typical antipsychotics

53
Q

Positive symptoms of Schizophrenia pathway

A

mesolimbic

54
Q

negative symptoms of schizophrenia pathway

A

mesocortical

55
Q

Extrapyramidal symptoms occur through blockade of what pathway

A

DA in nigrostriatum

56
Q

Most common presenting symptom of neuroleptic malignant syndrome

A

fever

57
Q

category of antipsychotics more likely to lower seizure threshold

A

low-potency

58
Q

There is a ____ % chance of developing tardive dyskinesia for each year treated with a typical antipsychotic

A

5

59
Q

Atypical antipsychotics less associated with weight gain

A

Ziprasidone

Aripiprazole

60
Q

Scale used to quantify and monitor tardive dyskinesia

A

AIMS: Abnormal involuntary movement scale

61
Q

Hypersalivation

A

Clozapine

62
Q

Myocarditis

A

Clozapine

63
Q

Agranulocytosis

A

Clozapine

64
Q

When must clozapine be stopped?

A

ANC below 1500/microliter

65
Q

Only antipsychotic shown to decrease the risk of suicide

A

Clozapine

66
Q

QTc prolongation

Must be taken with food

A

Ziprasidone

67
Q

Elevated LFTs or ammonia may be present

A

2nd generation antipsychotics

68
Q

Metabolic syndrome

A

2nd generation antipsychotics

69
Q

Patients on Clozapine must have weekly blood draws for how long?

A

6 months

70
Q

Only mood stable shown to decrease suicidality

A

Lithium

71
Q

Drug of choice for acute mania

A

Lithium

72
Q

Drug of choice as prophylaxis for both manic and depressive episodes in bipolar & schizoaffective disorders

A

Lithium

73
Q

What is it important to monitor in patient taking Lithium?

A

Creatinine

Thyroid function tests

74
Q

Blood levels coorelate with clinical efficacy

A

Lithium

75
Q

Blood levels are used for what drugs

A

Lithium
Valproic acid
Carbamazapine
Clozapine

76
Q

Factors that increase Lithium levels

A 
NSAIDs
Aspirin (may)
Thiazides
Dehydration
Salt deprivation
Sweating
Impaired renal function
77
Q

Good for rapid cycling bipolar disorder

A

Carbamazepine

78
Q

Side effect of leukocytosis

A

Lithium

79
Q

Induces its own metabolism (autoinduction)

A

Carbamazepine

80
Q

Neural tube defects

A

Carbamazepine

81
Q

Efficacious for bipolar depression but not acute mania

A

Lamotrigine

82
Q

May be helpful with impulse control disorders
Side effect of weight loss
Side effect of cognitive slowing
Can cause metabolic acidosis, kidney stones

A

Topiramate

83
Q

Long acting benzos

A

Diazepam (Valium)

Clonazepam (Klonopin)

84
Q

Short acting benzos

A

Triazolam

Midazolam

85
Q

Partial agonist at 5HT-1A

A

Buspirone

86
Q

NMDA glutamate receptor antagonist

A

Memantine

87
Q

Anticholinergics and antihistamines may cause _______

A

confusion/delirium

88
Q

Corticosteroids may cause__________

A

depression

89
Q

Antibiotic that may cause psychosis

A

Isoniazid

90
Q

Most effective treatment for Major Depressive Disorder

A

ECT

ADPY 7500 (17 decks)

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