Behavioral Health Meds 2

Question 1

Imipramine is useful for _____ and _____

Answer 1

Enuresis in children and panic disorder

Question 2

What is the least sedating and least anticholinergic TCA?

Answer 2

Desipramine

Question 3

Which TCA is the least likely to cause orthostatic hypotension?

Answer 3

Nortriptyline

Question 4

Which TCA is best tolerated?

Answer 4

Nortriptyline

Question 5

______ is good for smoking cessation

Answer 5

Bupropion

Question 6

Bupropion causes less ___, ____ and ____ than SSRIs (AEs)

Answer 6

Sexual dysfunction, weight gain and GI effects

Question 7

Bupropion MOA

Answer 7

Dopamine and norepinephrine reuptake inhibitor

Question 8

What is Bupropion indicated for?

Answer 8

MDD and SAD

Question 9

Bupoprion AKA

Answer 9

Wellbutrin

Question 10

What is a serious neurological AE of bupropion?

Answer 10

Lowers seizure threshold

Question 11

What are AEs of Wellbutrin? (7)

Answer 11

-Dry mouth
-Nausea
-Insomnia
-Agitation
-Weight loss
-HTN
-HA

Question 12

Bupropion can increase risk of _____ at high doses

Answer 12

Psychosis

Question 13

Avoid ___ _____ in Bupropion

Answer 13

abrupt withdrawl

Question 14

When is Bupropion contraindicated?

Answer 14

-Increased seizure risk
-MAOI use in the last 2 weeks

Question 15

What conditions would cause a state of increased seizure risk?

Answer 15

-Epilepsy
-Eating disorders (anorexia, bulemia)
-Discontinuing alcohol, benzos, barbiturates or antieptileptic)

Question 16

What are the nonselective MAOIs?

Answer 16

Penelzine
Tranylcypromine
Isocarboxazid

Question 17

What is the MOA of nonselective MAOIs?

Answer 17

Blocks breakdown of norepinephrine, serotonin (plus dopamine, epinephrine and tyramine) by inhibiting monoamine oxidase

Question 18

What is the indication for nonselective MAOIs?

Answer 18

Refractory depression or refractory anxiety disorders

Question 19

What is the most common AE of MAOIs?

Answer 19

Orthostatic hypotension

Question 20

What are other AEs of MAOIs?

Answer 20

Insomnia
Anxiety
Weight gain
Sexual dysfunction

Question 21

What is the crisis that can happen with MAOIs?

Answer 21

Hypertensive crisis following ingestion of foods high in tyramine (aged cheese, smoked/picked/cure meats/poultry/fish, red wine, draft beer and chocolates)

Question 22

What is the drug-drug interaction concern with MAOIs?

Answer 22

Serotonin syndrome with SSRIs, SNRIs, St John’s Wort, MDMA, cocaine, Meperidine, Tramadol and Dextromethorphan

Question 23

How long do you need to wait between switching between SSRIs and MAOIs?

Answer 23

2 weeks (5 for fluoxetine due to long half life)

Question 24

MAOI + TCAs may cause…

Answer 24

delirium and hypertension

Question 25

What are the serotonin receptor antagonists and agonists?

Answer 25

Trazodone and Nefazodone

Question 26

What is the MOA of Trazodone?

Answer 26

Post synaptic inhibitor, reuptake inhibition and serotonin agonist. Plus Alpha-1 adrenergic receptor antagonist

Question 27

What is trazodone indicated for

Answer 27

Antidepressant with anxiolytic and hypnotic effects (useful for insomnia)

Question 28

Low dose trazodone may be used as a ___ ____

Answer 28

sleep aid

Question 29

Unlike SSRIs, Trazodone does not affect _____

Answer 29

REM sleep or sexual side effects

Question 30

What is the most common AE of Trazodone?

Answer 30

Sedation

Question 31

What are other AEs of Trazodone?

Answer 31

-Dizzy -Dry mouth -Nausea -Orthostatic hypotension -HA -Suicidality in children / young adults -Cardiac arrhythmias

Question 32

What is a rare but classic AE of Trazodone?

Answer 32

Priapism

Question 33

What is the black box warning on Nefazodone?

Answer 33

Rare but serious fulmiant hepatitis

Question 34

What is Serotonin Syndrome?

Answer 34

Life threatening syndrome caused by increased serotonergic activity in the CNS

Question 35

When does Serotonin Syndrome most commonly occur?

Answer 35

Within 24 hours (especially six) of initiation of change in serotonergic drugs

Question 36

What medications/substances that are not mental health drugs can contribute to Serotonin Syndrome?

Answer 36

-St. John's Wort -MDMA -Cocaine -Amphetamines

Question 37

What categories of effects are seen in Serotonin Syndrome? (5)

Answer 37

-Cognitive -Autonomic instability -GI -Neuromuscular hyperactivity -Occular

Question 38

What cognitive effects are seen in Serotonin Syndrome?

Answer 38

-AMS -Agitation -Confusion -Hallucinations -Hypomania

Question 39

What autonomic instability effects are seen in Serotonin Syndrome?

Answer 39

-Hyperthermia -Tachycardia -Diaphoresis -BP changes

Question 40

What GI effects are seen in Serotonin Syndrome?

Answer 40

-Diarrhea -N/V -Increased bowel sounds

Question 41

What neuromuscular effects are seen in Serotonin Syndrome?

Answer 41

-Spontaneous or inducible clonus -Hypertonia (increased DTRs) -Tremor -Akathisia

Question 42

What occular effects are seen in Serotonin Syndrome?

Answer 42

-Mydriasis -Dry mucus membranes -Flushed skin

Question 43

How is Serotonin Syndrome diagnosed?

Answer 43

Clinical diagnosis with Hunter Criteria

Question 44

How is mild Serotonin Syndrome managed?

Answer 44

1. Prompt discontinuation of offending drugs 2. Supportive care with O2, IV fluids and Benzos

Question 45

Why are benzos used to treat Serotonin Syndrome?

Answer 45

-Reduce agitation, hyperthermia and correct mild increases in HR and BP

Question 46

How is moderate Serotonin Syndrome treated?

Answer 46

Same as mild plus Cyproheptadine

Question 47

What is Cyproheptadine?

Answer 47

Serotonin antagonist

Question 48

Should antipyretics be used in hyperthermia of Serotonin Syndrome?

Answer 48

No