Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUNA 679 - ANP Pharm > Antidepressants & Antipsychotics > Flashcards

Antidepressants & Antipsychotics Flashcards

1
Q

What are the 3 mechanisms of termination of NT synaptic activity?

A

Reuptake
Enzyme degradation
Diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two types of biogenic amines?

A

ACh and Monoamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of monoamines?

A

Serotonin and Catecholamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 types of catecholamines?

A

NE, epi, DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What adverse effects are caused by blocking the DA2 receptor? (2)

A

EPS AE

Prolactin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the AEs caused by blocking the H1 receptor?

A

Sedation, impaired cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What AEs are caused by blocking the M1 receptor?

A

Opposite of DUMBBELSS (Constipation, urinary retention, blurred vision, closed-angle glaucoma, tachycardia, hypomania, dry mouth/eyes, hypohidrosis) and altered cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What AEs are caused when blocking the alpha 1 adrenergic receptor?

A

Orthostatic hypotension, reflex bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 2 tricyclic antidepressants (TCAs).

A

Amitriptyline, nortriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the MOA of TCAs?

A

Blocks NE and 5-HT uptake into presynaptic nerve terminal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common indications for TCAs?

A

Depression unresponsive to SSRIs and SNRIs, insomnia, various pain syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name all receptors blocked by TCAs (besides blocking NET and SERT).

A

M1, H1, alpha 1 adrenergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name common TCA AEs (3)

A

Lower seizure threshold
Serotonin syndrome
Cardiac toxicity (Prolonged QT, cardiac depression, life-threatening arrhythmias with OD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe TCA OD.

A

LD 8x average dose.
Symptoms - cardiotoxicity, seizures, respiratory depression, hypotension.
Arrhythmias can persist 10 days b/c t1/2 ~81 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 4 drug classes with which TCAs can interact.

A

CNS depressants (ex., opioids)
Other serotonergic drugs
Sympathomimetics (hypertension with ex., epi)
Antimuscarinics (delirium, confusion, hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA of SSRIs?

A

Inhibit 5-HT reuptake transporter (SERT).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do SSRIs have a lower risk of AEs than TCAs?

A

No/minor blockade of H1, ACh, and NE receptors; also less risk of cardiac toxicity/death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 7 common SSRIs.

A

Fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

State 2 points regarding SSRI pharmacokinetics.

A

Metabolized in liver

Variable 1/2 lives (around 20-24 hours). EXCEPTION: fluoxetine 4-9 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name 8 SSRI AEs

A 
Serotonin syndrome
Hyponatremia
Withdrawal syndrome
Bleeding
Sweating
Nausea/diarrhea
Sexual dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the s/s, time frame, and management of serotonin syndrome.

A

Agitation, confusion, hyperreflexia, clonus, diaphoresis, autonomic instability, fever, death
2-72 hours after treatment initiation
Discontinue drug and provide supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name 3 MOAs that can cause serotonin syndrome through DDIs

A

Drugs that decrease 5-HT reuptake (antidepressants, opioids, ondansetron, meth/coke)
Direct 5-HT receptor stimulators (triptans)
DDIs involving CYP enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which SSRIs affect CYP enzymes and in what way?

A

Fluoxetine and fluvoxamine INHIBIT CYP enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which SSRI is least likely to cause withdrawal syndrome?

A

Fluoxetine due to long t1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MOA of SNRIs?

A

Blocks SERT and NET activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What aspect of SNRI MOA makes this class effective for treating pain syndromes?

A

NET blockade (on label for duloxetine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Patients are at risk for what AE after taking SNRIs in addition to those imposed by SSRIs?

A

Hypertension (lower risk with duloxetine than venlafaxine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Name 2 SNRIs.

A

Venlafaxine, duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which atypical antidepressant does NOT cause sexual dysfunction?

A

Bupropion (Wellbutrin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Major mechanism of bupropion?

A

Increase synaptic NE and DA activity (block NET and DAT and increase their release); noncompetitive antagonist of nicotinic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Indications for bupropion?

A

Depression, smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bupropion AEs?

A 
CNS stimulation (agitation, insomnia, tremor)
DECREASED seizure threshold
NO sexual dysfunction!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What serotonin modulator is mainly used as a hypnotic?

A

Trazodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

MOA of trazodone?

A

Blocks 5-HT2 receptors, H1, and alpha 1 adrenergic receptors; inhibits SERT at high doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

AEs of trazodone? (2)

A

Priapism

Postural hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A 29-year-old male veteran with a 2-month history of progressively worsening lower back pain was admitted for revision of a discectomy. His routine medications included fluoxetine (Prozac) and tramadol (Ultram). His perioperative medications included several opioids.

One hour after return to his room he was found to be agitated , hypertensive, diaphoretic and with spontaneous clonus. He was subsequently diagnosed with the serotonin syndrome.

Which opioid is most likely to have triggered this response?
A. Morphine
B. Hydromorphone (Dilaudid)
C. Oxycodone (Oxycontin)
D. Fentanyl (Duragesic)
A

D

37
Q

SSRI/SNRI will generally be (continued/discontinued) perioperatively unless …? In which case…?

A

continued; the patient is a high risk for bleeding; SSRI will be held

38
Q

TCAs may be DC’s perioperatively depending on __ risk

A

CV

39
Q

Drugs with what centrally-acting receptor can increase post-op confusion and delirium?

A

Muscarinic

40
Q

Drugs blocking what receptor may decrease GI motility and cause urinary retention postoperatively?

A

Muscarinic

41
Q

Where in the body are MAO enzymes active?

A

Gut, liver, and CNS

42
Q

Monoamine oxidase inactivates what NTs?

A

5-HT, NE, DA

43
Q

What does MAO-A inactivate?

A

NE, 5-HT, and dietary tyramine

44
Q

What does tyramine cause? In the presence of MAOIs?

A

Release of NE from nerve terminals; dangerous hypertension

45
Q

What does MAO-B do? What condition are MAO-B inhibitors used to treat?

A

Inactivates DA; Parkinson’s

46
Q

Name some nonselective MAO irreversible inhibitors. (3)

A

Phenylzine, tranylcypromine, selegiline

47
Q

What is unique about selegiline?

A

Available as a patch for depression

Also, lower concentrations mainly inhibit MAO-B for Parkinson’s

48
Q

Why are MAOIs reserved for refractory or atypical depression?

A

The potential for life-threatening interactions with tyramine-containing foods (but less likely with selegeline patch)

49
Q

Discuss MAOI impact on blood pressure (2)

A

Orthostatic hypotension at normal doses
Hypertensive crisis with tyramine-containing foods (aged meats/cheese, wine/beer, yeast extracts, cured fish, fermented soybeans)

50
Q

Name 3 DDIs for MAOIs and their effects.

A

Sympathomimetics - increased hypertension
Other serotonergic drugs - serotonin syndrome
Meperidine - hyperpyrexia

51
Q

What factors can increase risk of lithium toxicity?

A

Low sodium leading to the retention of chemically-similar lithium
Renal impairment
Pregnancy/lactation - teratogenic

52
Q

DDIs with lithium?

A 
NSAIDs
ACEIs
ARBs
Thiazide diuretics
(All of the above will decrease lithium excretion)
53
Q

What are common AEs with normal levels of lithium?

A

GI efx, thirst, cardiac efx, tremor, polyuria

54
Q

What are uncommon AEs with normal levels of lithium?

A

Hypo/hyperthyroidism, renal damage, leukocytosis, dermatologic reactions

55
Q

What are AEs with toxic levels of lithium?

A

Tremor, ataxia, convulsions, hypotension, arrhythmias, coma, death

56
Q

What commonly used anesthetic drug may be prolonged by lithium?

A

NM blockers

57
Q

What labs should be checked perioperatively if the patient is on lithium?

A

Lithium levels, electrolyte levels, and thyroid hormone

Also maintain adequate hydration

58
Q

A 57-year-old woman complains of persistent pain associated with fibromyalgia. She has lost interest in most her hobbies and often feels despondent. Which of the following medications is most likely to address her pain and depression?

A. Citalopram (Celexa)
B. Bupropion (Wellbutrin)
C. Duloxetine (Cymbalta)
D. Selegiline (Emsam)
E. Phenelzine (Nardil)
A

C

59
Q

What is a non-psychiatric indication for antipsychotics?

A

Antiemetic

60
Q

What kind of antipsychotics most effectively treat positive schizophrenia symptoms?

A

Conventional OR atypical

61
Q

What class of antipsychotics most effectively treats negative symptoms of schizophrenia?

A

Atypical antipsychotics

62
Q

Cognitive symptoms of schizophrenia are NOT worsened by what kind of antipsychotics?

A

Atypicals

63
Q

What about the MOA of 1st generation antipsychotics (FGAs/neuroleptics) make them more likely to cause movement disorders than 2nd generation (SGAs/atypicals)?

A

FGAs have a higher affinity for DA2 receptor; SGAs moderately block 5-HT2 receptors and rapidly dissociate from DA2.

64
Q

What other receptors are blocked by FGA and SGAs?

A

Alpha 1 adrenergic, muscarinic, and histamine

65
Q

What is the MOA of the 3rd generation antipsychotic Abilify?

A

Dopamine system stabilizer - DA partial agonist; also 5-HT2 receptor antagonist

66
Q

What lower potency 1st generation antipsychotic places the patient at higher risk for sedation, hypotension, and antimuscarinic effects?

A

Chlorpromazine

67
Q

What medium potency antipsychotic is used primarily as an antimetic?

A

Promethazine

68
Q

What high potency SGAs place the patient at a lower risk of sedation but a higher risk of EPS symptoms?

A

Haloperidol

Droperidol

69
Q

What is a severe AE of antipsychotics caused by insufficient dopamine?

A

Acute dystonia (severe muscle spasm including torticollis, oculogyric crisis, trismus)

70
Q

How is acute dystonia treated?

A

Centrally acting antimuscarinic (benztropine) and diphenhydramine

71
Q

What is late-occurring EPS termed?

A

Tardive dyskinesia (oral, facial dyskinesias, lip smacking, choreoathoid movements)

72
Q

What are some adverse effects common to all classes of antipsychotics?

A

Reduced seizure threshold
Prolonged QT/related arrhythmias
Neuroleptic malignant syndrome

73
Q

What are risk factors for prolonged QT interval? (5)

A

Bradycardia, HF, prior MI, hypokalemia, hypomagnesemia

74
Q

What commonly-used perioperative drug is most likely to cause QT prolongation?

A 
Amiodarone
Others (inhaled anesthetics, antiemetics, methadone)
75
Q

What antipsychotics are most associated with prolonged QT? (3)

A 
Haloperidol (esp. IV)
Droperidol
Ziprasidone (Geodon)
76
Q

What s/s characterize neuroleptic malignant syndrome?

A

Fever, “lead-pipe” rigidity, dysautonomia, altered mental status

77
Q

What dopamine blockers are most implicated in NMS?

A

FGA, SGA, D2 antagonist emetics, and dopaminergic withdrawal

78
Q

Compare and contrast onset of SS and NMS.

A

Within 24 hours and within days, respectively

79
Q

Compare and contrast NM findings with SS and NMS.

A

Hyperreactivity (tremor, clonus, reflexes) and bradyreflexia/severe muscular rigidity, respectively

80
Q

Compare and contrast causative agents of SS and NMS.

A

Serotonin agonist and dopamine antagonist

81
Q

Compare and contrast resolution timeline of SS and NMS

A

Within 24 hours and days to weeks, respectively

82
Q

Describe 5 antipsychotic DDIs.

A

Epinephrine - blunted pressor effect with drugs that cause alpha blockade (such as chlorpromazine)
Antimuscarinics (additive)
CNS depressants (additive)
Levodopa (since it is metabolized to DA, antipsychotics will antagonize the effects - watch for psychosis)
Dopamine (decreased DA effectiveness)

83
Q

Name 4 second generation antipsychotics

A

Olanzapine
Ziprasidone
Risperidone
Quetiapine

84
Q

Why are SGAs preferred over FGAs?

A

They relive both positive and negative symptoms and generally have a lower SE profile

85
Q

SGAs carry an increased risk of _________ AEs over FGAs.

A

metabolic - hyperglycemia, dyslipidemia

86
Q

Which antipsychotic carries the highest risk of prolonged QT?

A

Ziprasidone

87
Q

What is the 3rd generation antipsychotic/DA system stabilizer?

A

Aripiprazole (Abilify)

88
Q 
A patient that received promethazine (Phenergan) for post-operative nausea suddenly develops a sustained, involuntary muscle contraction involving the neck.  Which of the following would most likely be used to treat this reaction? 
A. Diphenhydramine (Benadryl)
B. Chlorpromazine (Thorazine)
C. Dantrolene (Dantrium)
D. Lorazepam (Ativan)
A

A

89
Q 
A 58-year-old man with a history of schizophrenia, generalized anxiety disorder and bradycardia is in the PACU following an appendectomy. He has received ondansetron and droperidol perioperatively. He took his home medications the day of surgery. Which of the following is most likely to increase his risk of arrhythmia?
A. Aripiprazole (Abilify)
B. Ziprasidone (Geodon)
C. Sertraline (Zoloft)
D. Duloxetine (Cymbalta)
A

B

NUNA 679 - ANP Pharm (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions