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PMHNP > 8013 week 1 pharm review > Flashcards

8013 week 1 pharm review Flashcards

1
Q

3 monoamine neurotransmitters

A

Dopamine
Norepinephrine
Serotonin

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2
Q

Dopamine NT receptors

A

D1-5

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3
Q

Dopamine is responsible for

A

movement control, emotional response, pleasure and pain

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4
Q

Dopamine
Too little:
Too much:

A

Parkinsons

Psychosis and mood disorders

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5
Q

Norepinephrine receptors

A

Adrenergic NT binds to alpha & beta adrenergic receptors

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6
Q

NE increase in adrenergic activity causes…

A

causes increased HR, BP, alertness, anxiety and hyperactivity

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7
Q

NE reuptake inhibitors do what…

NE Agonists do what…

A

increase NE and improve symptoms of depression

decrease NE and help with symptoms of anxiety

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8
Q

Serotonin receptors…

A

5HT 1-7

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9
Q

Serotonin regulates…

A

sleep
mood
pain
peristalsis
Appetite
vasoconstriction

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10
Q

5HT 1A is associated with

A

depression

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11
Q

5HT 2A is associated with

A

psychosis

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12
Q

Gaba vs Glutamate (how they work)

A

inhibitory (hyperpolarizing a receptor preventing it from firing and results in anti-anxiety, anti-epileptic, and sedative effect)

excitatory (master switch that works on any receptor and contributes to learning and memory. Excess can lead to neurodegeneration like Parkinsons/Alzheimers/Schizophrenia)

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13
Q

All antipsychotics block the ___ system in the brain

A

DA

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14
Q

Low potency FGAs require…

A

higher dosing and vice versa

potency of rx determines dose needed to elicit response

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15
Q

high potency FGA cause AE due to..

A

not hitting ACH

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16
Q

Low potency FGA example

A

Chlorpromazine/Thorazine

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17
Q

2 moderate potency FGAs

A

Loxapine/Loxitane

Perphenazine/Trilafon

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18
Q

2 high potency FGAs

A

Haloperidol/Haldol

Fluphenazine/Prolixin

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19
Q

How do FGAs work

A

Antagonism of D2 receptors with an optimal effect at a 60-70% D2 receptor blockade

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20
Q

low potency FGAs have a high potency for which receptors

A

cholinergic and andrenergic

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21
Q

high potency FGAs block ___ but not ___

A

DA

ACH

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22
Q

low potency FGAs AE

A

Anticholinergic: Dry mouth, constipation, blurred vision, orthostatic hypotension

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23
Q

high potency FGAs AE

A

Extrapyramidal : Akathesia, akinesia, dyskinesia, dystonia, tardive dyskinesia

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24
Q

FGAs target all DA which may result in ___

A

increased neg AE, EPS, hyperprolactinemia

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25
Q

NMS risk from FGA is high with ____ but increased with ___

A

high dose FGA

dehydration, exercise, exhaustion

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26
Q

10 SGAs

A

Clozapine/Clozaril
Aripiprazole/abilify
Asenapine/saphris
Cariprazine/vraylar
Iloperidone/fanapt
Lurasidone/Latuda
Olanzapine/Zyprexa
Quetiapine/Seroquel
Risperidone/Risperdal
Ziprasidone/geodon

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27
Q

How do SGAs work?

A

Both DA and 5ht antagonist counterbalancing DA depletion in areas of the brain that cause EPS, hyperprolactinemia, and negative sx reducing occurrence

shorter duration of DA block than FGAs

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28
Q

SGA AEs

A

cardiometabolic syndrome: Wt gain, HTN, inc lipids, inc glucose

Also sedation, EPSE, anticholinergic possible

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29
Q

SGAs with least likely cardiometabolic syndrome AE

A

Abilify and Geodon

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30
Q

How do SSRIs work?

A

inhibit uptake of 5ht, some DA, NE

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31
Q

Most common AE for SSRI

A

GI
Neuropsych
Sex dysfunction

Also consider: SI, SS, W/D, Apathy

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32
Q

4 SNRIs

A

Desvenlafaxine/Pristiq
Duloxetine/Cymbalta
levomilnacipran./Fetzima
Venlafaxine/Effexor xr

33
Q

How do SNRIs work?

A

inhibit 5ht and NE

34
Q

Most common SNRI AE

A

Drowsy
Dry mouth
Dizzy
Constipation
Nervous
Sweat
Anorexia

35
Q

NDRI example

36
Q

How does Bupropion (NDRI) work

A

inhibit NE and DA (not 5ht)

impacts adrenergic system

37
Q

Bupropion CI and most common AE

A

CI: Sz hx

AE: Insomnia and agitation (no dec libido)

38
Q

If anxiety is worse than depression choose

A

SSRI over NDRI

39
Q

NASSA example

A

norandrenergic and specific serotonergic antidepressants

Mirtazapine/Remeron

40
Q

How does Mirtazapine (NASSA) work?

A

Antagonnist of adrenergic and specific serotonin receptors

antagonist of histamine

tx Major depression

41
Q

Mirtazapine (NASSA) AE

A

Wt gain
somnolence (dec with higher dosing)
ortho hypo
dizzy

less libido issues than SSRI

Poss to cause agranulosis

42
Q

Serotonin modulator and stimulator example

A

Vilazodone/viibryd

43
Q

How does Viibryd work

A

inhibit and partial agonist of 5ht
does not bind to NE or DA

take with food
metab CYP3A4

comes with starter kit but expensive

44
Q

Viibryd AE

45
Q

SRI example

A

Serotonin reuptake inhibitor

Vortioxetine/brintellix

46
Q

How does Brintellix work?

A

inhibit 5ht

very long half life and high protein bound

47
Q

Brintellix caution

A

Do not use with Bupropion due to inc blood level

48
Q

SSRI/Antipsychotic combo rx

A

Symbyax/fluoxetine-olanzapine

49
Q

How does Symbyax/fluoxetine-olanzapine work?

A

Agonist of 5ht/DA/NE

Used to tx BP1 acute depression and tx resistant depression

50
Q

Symbyax/fluoxetine-olanzapine AE

A

Dry mouth
somnolence
inc apetitie
peripheral edema
drowsiness
blurred vision

51
Q

TCA examples

A

Amitriptyline/Elavil
Clomipramine/Anafranil
Imipramine/Tofranil
Desipramine/norpramin
Nortriptyline/Pamelor
Protriptyline/vivactil

52
Q

How does a TCA work

A

Block 5ht and NE

Used to tx severe depression

53
Q

TCA AE and caution

A

drowsy, wt gain, hypotension, dizzy

lethal in overdose with poss arrhythmia and Sz

54
Q

1st line tx for anxiety

A

SSRI/SNRI

THEN

Anxyolitics

55
Q

3 anxyolitics

A

BZO
Buspirone
Clonidine

56
Q

1 short BZD and length and what better for

A

Triazolam/Halcion=short

<12 hrs

sleep/insomnia

57
Q

3 long BZD and length

A

Chlordiazepoxide/Librium=long
Clonazepam/klonopin=long
Diazepam/valium=long

> 24 hours

58
Q

4 intermediate BZD and length

A

Alprazolam/Xanax=intermediate
Lorazepam/Ativan=intermediate
Oxazepam/serax=intermediate
Temazepam/Restoril=intermediate

12-24 hours

59
Q

How does a BZD work?

A

Increase the inhibitory effect of GABA as an agonist

60
Q

How does Buspirone work?

A

partial 5ht agonist

61
Q

Gold standard and only true mood stabilizer

62
Q

Lithium manages…

A

Depressive and Manic phases of BP for acute and prophylaxis

63
Q

Other rx considered mood stabilizers

A

Anticonvulsants: carbamazepine, Lamictal and valproic acid and some atypical antipsychotics

64
Q

Sx of manic phase of BP

A

grandiosity, elevated mood, hyperactivity, irritability, pressured speech, reduced need for sleep, flight of ideas, impulsivity and agitation

65
Q

Sx of depressive phase of BP

A

sadness, anhedonia, hypersomnia, weight gain, fatigue, indecisiveness, and suicidality

66
Q

Lithium reduces the risk of suicidality in BP to

67
Q

Lithium onset

A

slow (6-10 days)

may need to be paired with antipsychotic for faster effect

68
Q

Lithium therapeutic index

A

0.6-1.2

> 1.5 is toxic

69
Q

How often check serum lithium

A

q2wks during mania

q2mo for maintenance

70
Q

Lithium AE early

A

Diarrhea
commit
drowsy
muscular weakness
lack of coordination

71
Q

Lithium AE intermediate

A

Ataxia
Tinnitus
Blur vision
polyuria

72
Q

Lithium AE severe

A

Multiple organ involvement

73
Q

Lithium CI

A

Renal and cardiac dz
severe dehydration
sodium depletion

74
Q

Anticonvulsant rx

A

Valproic acid/Depakene
Divalproex/Depakote
Carbamazepine/Tegretol
Lamotrigine/Lamictal
Oxcarbazepine/Trileptal
Gabapentin/Neurontin
Topiramate/topamax

75
Q

Anticonvulsant black box warning

A

hepatotoxicity and pancreatitis

76
Q

Anticonvulsant AEs

A

Inc SI, depression

Lamictal associated with SJS

Lithium/Carbamazepine/Valproate may cause hypothyroid

77
Q

6 atypical antipsychotics FDA approved for BP

A

Aripiprazole/abilify
Clozapine/Clozaril
Olanzapine/Zyprexa
Quetiapine/Seroquel
Risperidone/Risperdal
Ziprasidone/Geodon

but none have significant evidence for prophylaxis of BP and dont prevent new mania or depression episodes

PMHNP (26 decks)

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