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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
most common cause of serotonin syndrom
combining serotogenic agents - ephedrine direct 5HT agonists- MAOIs serotonin reuptake inhibitors
26
SSRI avoid
tramadol CYP inhibitors sumatriptan meperidine fentanyl (?) dextromethorpan linezolid phenelzine
27
SSRI prototype
sertraline
28
MAOI mech
inhibit monoamine oxidase inhibits metabolism of NE, dopa, 5HT
29
MAOI avoid
ephedrine amphetamine pancuronium ketamine meperidine dextromethorpan methadone fentanyl??
30
MAOI caution
epi in LA
31
MAOI may reduce metabolism of
hepatic metabolism of barbituates and some opioids leading to incr resp depressant effects
32
best vasopressor MAOI pts
phenylephrine NE start low
33
MAOI prototype
phenelzine
34
managment of serotonin syndrome in pts on MAOIs
Chloropromazine cyproheptadine (5Ht2A and 5HT1A antagonisits)
35
drugs safe in MAOIs
propofol etomidate precedex benzos volatile agents antimuscarinics NSAIDs
36
mesolimbic system
excess dopamine
37
mesocortical system
dopa deficiency or excess 5HT
38
4 dopamine pathways
therapeutic: mesolimbic mesocrotical adverse effects: nigostriatal tuberoinfundibular
39
what avoid adverse SE
5HT2A combines with D2 block
40
mesolimbic SE
shcizophrenia
41
mesocortical SE
schizophrenia
42
1st gen antisychotic
haloperidol
43
haloperidol mech
D2 receptor antagonist
44
haloperidol SE
muscarinic block alpha 1 block H1R block
45
haloperiodl _____ seizure threshold
lowers seizure threshold
46
haloperidol EKG changes
QT prolongation
47
2nd generation psychotics
risperidone quetiapine alanzapine clozapine
48
2nd gen mech
mesolimbic: weaker D2R block mesocortical: weaker D2 and 5HT2A block
49
2nd gen SE
weight gain glucose intolerance some alpha block some antimuscarinic tachycardia hypotension diabetes prolong QT decr stress reponse NMS
50
2nd gen anesthetic impacts
decr anesthetic requirement altered pain responsivenets
51
2nd gen avoid
ketamine due to decr seizure threshold
52
NMS presents like
MH
53
NMS is most common with what dru
haloperidol
54
NMS SE
hyperthermia muscle rigidity elevated CK
55
NMS treatment
supportive dantrolene
56
which pts should continue antipsychotics before surgery
chronic schizophrenia bipolar

Fa: Pharm 3 (10 decks)

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