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Fa: Pharm 3 > 4. Psych > Flashcards

4. Psych Flashcards

1
Q

antidepressants

A

TCA
SSRI
MAOI

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2
Q

TCA mech

A

block reuptake of NE and/or 5HT
(possibly dopamine)

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3
Q

TCA SE

A

muscarinic block
H1 block
alpha 1 block

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4
Q

chronic TCA SE

A

decr NE stores

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5
Q

what drugs should you avoid with TCA

A

anti-muscarinic (additive)
pancuronium
ketamine
meperidine
epi

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6
Q

why avoid pancuronium w/TCA

A

pancuronium blocks reuptake of NE

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7
Q

why avoid ketamine w/TCA

A

ketamine blocks reuptake of NE

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8
Q

why avoid meperidine w/TCA

A

weak block of reuptake of serotonin

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9
Q

why avoid epi w/TCA

A

adrenergic agonist incr NE

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10
Q

best vasopressor for pts on TCA

A

phenylephrine

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11
Q

TCA prototype

A

amitriptyline

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12
Q

general antidepressant protocol before surgery

A

continuation

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13
Q

why do you not stop antidepressants

A

causes discontinuation syndrome

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14
Q

discontinuation syndrome timeline

A

starts 1-2 days after stopping
lasts 2- 3 weeks

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15
Q

discontinuation syndrome SE

A

nausea/GI pain
insomnia
sweating
low mood

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16
Q

TCA ECG changes

A

wide QRS
QT prolongation
conduction abnormalities

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17
Q

SSRI mech

A

inhbit reuptake of 5HT
* greater serotonin block than other anti-depressants*

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18
Q

SSRI drug interaction

A

fluoxetine
drugs that inhibit CYP450
drugs that block serotinin reuptake
drugs that inhibit MAO
drugs that enhance serotonin release

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19
Q

SSRI caution

A

serotonin syndrome

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20
Q

serotonin syndrome triad

A

cognitive
autonomic
somatic

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21
Q

serotonin syndrome triad: cognitive

A

delerium
confusion
coma

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22
Q

serotonin syndrome: autonomic

A

labile BP
tachycardia
hyperthermia

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23
Q

serotonin syndrom: somatic

A

myoclonus
hyperreflexia
tremor

24
Q

severe serotonin syndrome SE

A

rhabdo
seizures
renal failure
arrythmia
coma
death

25
Q

most common cause of serotonin syndrom

A

combining serotogenic agents
- ephedrine
direct 5HT agonists-
MAOIs
serotonin reuptake inhibitors

26
Q

SSRI avoid

A

tramadol
CYP inhibitors
sumatriptan
meperidine
fentanyl (?)
dextromethorpan
linezolid
phenelzine

27
Q

SSRI prototype

A

sertraline

28
Q

MAOI mech

A

inhibit monoamine oxidase
inhibits metabolism of NE, dopa, 5HT

29
Q

MAOI avoid

A

ephedrine
amphetamine
pancuronium
ketamine
meperidine
dextromethorpan
methadone
fentanyl??

30
Q

MAOI caution

A

epi in LA

31
Q

MAOI may reduce metabolism of

A

hepatic metabolism of barbituates and some opioids leading to incr resp depressant effects

32
Q

best vasopressor MAOI pts

A

phenylephrine
NE

start low

33
Q

MAOI prototype

A

phenelzine

34
Q

managment of serotonin syndrome in pts on MAOIs

A

Chloropromazine
cyproheptadine
(5Ht2A and 5HT1A antagonisits)

35
Q

drugs safe in MAOIs

A

propofol
etomidate
precedex
benzos
volatile agents
antimuscarinics
NSAIDs

36
Q

mesolimbic system

A

excess dopamine

37
Q

mesocortical system

A

dopa deficiency
or excess 5HT

38
Q

4 dopamine pathways

A

therapeutic:
mesolimbic
mesocrotical
adverse effects:
nigostriatal
tuberoinfundibular

39
Q

what avoid adverse SE

A

5HT2A combines with D2 block

40
Q

mesolimbic SE

A

shcizophrenia

41
Q

mesocortical SE

A

schizophrenia

42
Q

1st gen antisychotic

A

haloperidol

43
Q

haloperidol mech

A

D2 receptor antagonist

44
Q

haloperidol SE

A

muscarinic block
alpha 1 block
H1R block

45
Q

haloperiodl _____ seizure threshold

A

lowers seizure threshold

46
Q

haloperidol EKG changes

A

QT prolongation

47
Q

2nd generation psychotics

A

risperidone
quetiapine
alanzapine
clozapine

48
Q

2nd gen mech

A

mesolimbic: weaker D2R block
mesocortical: weaker D2 and 5HT2A block

49
Q

2nd gen SE

A

weight gain
glucose intolerance
some alpha block
some antimuscarinic
tachycardia
hypotension
diabetes
prolong QT
decr stress reponse
NMS

50
Q

2nd gen anesthetic impacts

A

decr anesthetic requirement
altered pain responsivenets

51
Q

2nd gen avoid

A

ketamine due to decr seizure threshold

52
Q

NMS presents like

A

MH

53
Q

NMS is most common with what dru

A

haloperidol

54
Q

NMS SE

A

hyperthermia
muscle rigidity
elevated CK

55
Q

NMS treatment

A

supportive
dantrolene

56
Q

which pts should continue antipsychotics before surgery

A

chronic schizophrenia
bipolar

Fa: Pharm 3 (10 decks)

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