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MAYO > CHAPTER 6 PSYCH3 > Flashcards

CHAPTER 6 PSYCH3 Flashcards

1
Q

irreversibly inhibit monoamine
oxidase, blocking metabolism of monoamine
neurotransmitters

A

MAOIs:

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2
Q

Indications of MAOI

A

atypical depression, panic disorder, social
phobia, posttraumatic stress disorder, OCD, bulimia
nervosa, pain management

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3
Q

Severe hypertension and complications of malignant hypertension if taking MAOIs and _____

A

tyramine-containing substance or food is ingested

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4
Q

___________ if MAOIs taken in combination
with SSRIs or other antidepressants, over-the-counter
medications, meperidine, stimulants, sympathomimetics

A

Serotonin syndrome

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5
Q

MAOI

better than SSRIs for ______
also used for insomnia, pain, obsessive-compulsive
disorder, panic, anxiety

A

melancholic depression,

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6
Q

Contraindications of MAOI:

A 
recent myocardial infarction, 
bundle branch block, 
widened QRS,
 narrow-angle glaucoma,
cardiac disease, 
prostatic hypertrophy,
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7
Q

Mixed-mechanism antidepressants:

A

bupropion, duloxetine,

mirtazapine, nefazodone, trazodone, venlafaxine

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8
Q

Mechanism of Bupropion

A

Dopamine-NE reuptake inhibitor: preferentially
increases dopamine (weak inhibitor of dopamine
reuptake)

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9
Q

Clinical use of Buproprion

A

FDA-approved for depression,
smoking cessation;
non-FDA–approved—attention

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10
Q

Buproprion Can increase seizure risk at doses more than ________

A

450 mg/day

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11
Q

Contraindications of Buproprion: patients with ___ and _______

A

seizure disorders,

eating disorders

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12
Q

Duloxetine (Cymbalta) clinical use

A

Clinical uses: FDA-approved for depression, diabetic

peripheral neuropathic

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13
Q

Enhances release of NE and 5HT, inhibits 5HT2 and
5HT3 receptors, also potent histamine antagonist,
moderate α2-adrenergic antagonist

A

Mirtazapine (Remeron)

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14
Q

Indications for Mirtazapine (Remeron)

A

FDA-approved for depression; non-

FDA–approved—improves appetite and sleep

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15
Q

SE of Mirtazapine

A

early sedation, weight gain, possible

agranulocytosis

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16
Q

Serotonin (5HT2) receptor-antagonist, weak
inhibitor of 5HT reuptake (5HT2 antagonist/reuptake
inhibitor

What anti-depressant

A

Nefazodone (Serzone)

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17
Q

Serotonin (5HT2) receptor-antagonist, weak inhibitor
of 5HT reuptake (5HT2 antagonist/reuptake inhibitor

Clinical uses: FDA-approved for depression; non-
FDA–approved—insomnia

A

Trazodone (Desyrel)

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18
Q

Inhibits 5HT reuptake at lower doses, inhibits NE
reuptake at moderate doses, and dopamine reuptake
at higher doses

A

Venlafaxine (Effexor)

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19
Q

Examples of Typical anti-psychotics

A

chlorpromazine (Thorazine), mesoridazine
(Serentil), thioridazine (Mellaril), fluphenazine
(Prolixin), perphenazine (Trilafon), trifluoperazine
(Stelazine), thiothixene (Navane), loxapine (Loxitane),
haloperidol (Haldol), molindone (Moban)

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20
Q

1) Favorable side-effect profile (useful in emergency
settings)
2) Useful for positive symptoms but not negative symptomsof schizophrenia
3) High potential for dose-dependent acute extrapyramidalside effects and sexual dysfunction

A

Haloperidol: high-potency agent

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21
Q

_________ also has potential to cause retinitis pigmentosa, retrograde ejaculation, QTc prolongation

A

Thioridazine

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22
Q

1) Effective for positive symptoms, less effective for negative symptoms of schizophrenia
2) Has a relatively favorable risk versus benefit ratio, so is
widely used

A

Thiothixene, perphenazine, trifluoperazine: medium

potency agents

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23
Q

Atypicals: _____________

A

clozapine, risperidone, olanzapine, quetiapine,

aripiprazole, ziprasidone

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24
Q

Clozapine (Clozaril): low-potency agent, for _____

1) Choice for patient with______ and ____
2) Effective for ____ and _____ symptoms of
schizophrenia
3) Should have had at least three failed trials of antipsychotics from different classes and at least one depot formulation trial

A

refractory schizophrenia

tardive dyskinesia or at high risk for tardive dyskinesia
positive and negative

25
Q

Serious side effects of Clozapine:

A

agranulocytosis, seizures

26
Q

Risperidone (Risperdal): high-potency agent
1) Effective for ______ and ______ symptoms of
schizophrenia
2) Reduced potential for acute or chronic extrapyramidal
side effects
3) Can significantly increase serum _______, more
_________ is possible

A

positive and negative

prolactin levels

sexual dysfunction

27
Q

1) Is structurally similar to and acts like clozapine but
with less risk for agranulocytosis and seizures
2) Acute extrapyramidal side effects no more frequent
than reported for placebo, low chance for chronic
extrapyramidal side effects

A

Olanzapine (Zyprexa): medium- to high-potency agent

28
Q

SE of Olanzapine

A

weight gain, hypertriglyceridemia, sedation,

diabetes (?) , elevated liver function enzymes

29
Q

low potency, few EPS, less

sexual dysfunction, no prolactin increase antipsychotic

A

Quetiapine (Seroquel)

30
Q

Antipsychotics

Typicals bind to _______, blocking dopamine at the
site, more prone to extrapyramidal side effects

A

D2 receptors

31
Q

Antipsychotics

Atypicals are weaker D2 receptor antagonists but are
potent ______ receptor antagonists and also have ______ and ______

A

5HT2A

anticholinergic
and antihistaminic activity

32
Q

______ and _____dopaminergic pathways

are affected by antipsychotics

A

Mesocortical and mesolimbic

33
Q

Adverse effects of anti-psychotics

_____________- abnormal involuntary movements
(usually mouth and/or tongue) after long-term use

-Elderly, women, and those with mood disorders more
susceptible

A

Tardive dyskinesia:

34
Q

Adverse effects of anti-psychotics

__________ (tremor, rigidity, hypokinesia): treat by
lowering dose of antipsychotic or adding antiparkinsonian
agent

A

Parkinsonism

35
Q

Adverse effects of anti-psychotics

______ (subjective feelings of anxiety, tension, agitation):
treat by lowering dose of antipsychotic, try β-
blocker, clonidine, amantadine, or benzodiazepine

A

Akathisia

36
Q

Adverse effects of anti-psychotics

sustained contraction of muscles of neck, mouth, tongue): treat with intravenous benztropine
or diphenhydramine

A

Acute dystonic reaction

37
Q

Adverse effects of anti-psychotics

________ (dry mouth, urinary retention,
blurry vision, constipation, exacerbation of narrowangle
glaucoma): treat by reducing dose or change to
more potent antipsychotic or to atypical antipsychotic

A

Anticholinergic side effects

38
Q

Adverse effects of anti-psychotics

Agranulocytosis (associated with low-potency antipsychotics and especially clozapine; potentially fatal):
requires weekly blood counts for_____ and ____

A

first 6 months, then

every 2 weeks thereafter

39
Q

Adverse effects of anti-psychotics

rigidity, high fever, delirium, autonomic instability,
increased serum levels of creatine kinase and liver
enzymes): treat by stopping offending drug, supportive
care, try dantrolene or bromocriptine, ECT for severe
cases

A

Neuroleptic malignant syndrome

40
Q

Rapid removal of medications with dopaminergic
properties such as those used to treat _______
can also cause neuroleptic malignant-like syndrome

A

Parkinson’s disease

41
Q

________: most often prescribed psychotropic

medications

A

Anxiolytics

42
Q

BZD with long half life

A 
chlordiazepoxide (Librium), 
clonazepam (Klonopin), 
clorazepate (Tranxene), 
diazepam (Valium),
flurazepam (Dalmane
43
Q

BZD with Medium half-life:

A

estazolam (ProSom), lorazepam

Ativan), temazepam (Restoril

44
Q

BZD with Short half-life:

A

alprazolam (Xanax), oxazepam (Serax),

triazolam (Halcion)

45
Q

Preferred benzodiazepines for the elderly:

A

oxazepam,

lorazepam, temazepam (“out the liver”)

46
Q

anxiolytics, sedative-hypnotics

1) Used for generalized anxiety disorder: effects seen
after 1 to 2 weeks
2) Relatively nonsedating, no abuse potential

A

Buspirone (BuSpar)

47
Q

Electric current applied across scalp electrodes, producing a grand mal seizure

A

ECT

48
Q

ECT may improve both mood and motor symptoms of patients with _______, but effects may be short-lived from days to weeks to 6 months, according to various
studies

A

advanced Parkinson’s disease

49
Q

MOA of Lithium

A

inhibits inositol-1-phosphatase

50
Q

Indications of Lithium therapy

A

mania, augmentation of antidepressants,
prophylaxis of mania/depression,
schizoaffective disorder, aggression, impulsivity

51
Q

Concerns for Lithium:

A

thyroid/kidney, pregnancy (Ebstein’s

anomaly

52
Q

Clinical indications for Amphetamine:

A

1) Narcolepsy and other sleep disorders, attentiondeficit/
hyperactivity disorder in children, obesity
2) Has also been used for depression by augmenting
antidepressant effects, neurasthenia, AIDS dementia,
encephalopathy from brain injury

53
Q

MOA of Amphetamine

A

1) Causes direct release of dopamine and NE from
neurons
2) Blocks reuptake of catecholamines
3) Peak plasma levels in 1 to 3 hours

54
Q

___________ related to
amphetamine, but milder stimulant (little or no abuse
potential)

A

Methylphenidate (Concerta, Ritalin):

55
Q

________ novel stimulant for narcolepsy

A

Modafinil (Provigil):

56
Q

Sympathomimetics decrease efficacy of many antihypertensive

agents, especially ______ and _______

A

guanethidine (Ismelin) and

guanethidine-hydrochlorothiazide (Esimil)

57
Q

Techniques for behavioral therapy

A

classic conditioning, operant conditioning,
positive reinforcers, negative reinforcers, relaxation training,
systematic desensitization, flooding, behavioral
modification

58
Q

a person’s evaluation of a perceived adverse
event largely determines the degree and type of
emotional state experienced

A

Cognitive-behavioral therapy:

MAYO (4 decks)

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