class of meds

Question 1

First line tx for OCD

Answer 1

SSRIs like fluoxetine, fluvoxamine, sertraline, and escitalopram. Also sometimes clomipramine (TCA)

Question 2

first line tx for ptsd

Answer 2

SSRIs like sertraline and paroxetine

Question 3

first line tx for MDD

Answer 3

SSRIs line sertraline, escitalopram, fluoxetine, paroxetine

Question 4

first line tx for bipolar

Answer 4

mood stabilizers like lithium or depakote, sometimes atypical antipsychotics (seroquel, zyprexa, risperdal)

Question 5

first line tx for schizophrenia

Answer 5

atypical antipsychotics: preferred d/t favorable s/e profile compared to older antipsychotics.
-risperidone
-aripiprazole
-quetiapine
-olanzapine
-lurasidone

Question 6

first line tx for GAD

Answer 6

SSRIs like lexapro and zoloft, sometimes SNRIs like venlafaxine and duloxetine

Question 7

TCAs

Answer 7

effective for certain mood and pain disorders but come w/ significant s/es and risks. use judiciously w/ careful monitoring and consideration of patient-specific factors

Question 8

TCA MOA

Answer 8

inhibit reuptake of NorE and serotonin, increasing their levels in the brain to help improve mood

Question 9

common TCAs

Answer 9

amitriptyline, nortriiptyline, imipramine, doxepin

Question 10

TCA indications

Answer 10

MDD, anxiety d/os, chronic pain conditions (neuropathic pain, fibromyalgia), insomnia (d/t sedative effects)

Question 11

TCA s/es

Answer 11

sedation, drowsiness, wt gain, dry mouth, constipation, blurred vision, urinary retention, orthostatic hypotension

Question 12

TCAs and heart

Answer 12

cardiac s/e includ arrhythmias, esp in OD situations. Use w/ caution in pts w/ cardiac issues.

Question 13

TCA discontinuation

Answer 13

abrupt discontinuation of TCAs can lead to withdrawal s/s. Taper gradually & under supervision

Question 14

TCA drug interactions

Answer 14

interact w/ various meds including SSRIs and SNRIs, MAOIs, certain antihypertensives. ABSOLUTELY avoid combining w/ MAOIs

Question 15

TCA + MAOI

Answer 15

= serotonin syndrome or hypertensive crisis

Question 16

serotonin syndrome

Answer 16

s/s = agitation, restlessness, confusion, rapid HR, high BP, dilated pupils, muscle rigidity, sweating, severe cases may lead to seizures, hyperthermia, or even death

Question 17

benzodiazepines: general properties

Answer 17

sedative and anxiolytic effects, rx’d for anxiety, insomnia, muscle spasms, seizure disorders

Question 18

benzodiazepines: food interactions

Answer 18

some, like xanax, can have altered absorption when taken w/ high fat meals, which may increase peak plasma concentrations and prolong effects

Question 19

benzodiazepines: localized action

Answer 19

exert effects primarily on amygdala, contributing to anxiolytic and sedative effects

Question 20

benzodiazepines: MOA

Answer 20

Gaba receptor modulation: benzos enhance effect of GABA at GABA-A receptor
-binding at specific receptor site increases frequency of chloride channel opening when gaba is present, leading to greater inhibition of neuronal activity. Results in increased neuronal hyperpolarization, producing calming effects, reducing anxiety, inducing sedation

Question 21

benzodiazepines: indications

Answer 21

short-term mgmt of anxiety d/os, panic, insomnia, muscle spasms

Question 22

benzodiazepines: duration of use

Answer 22

recommended short term, no more 2-4wks d/t risk of tolerance, dependence, & withdrawal s/s

Question 23

1st gen antipsychotics MOA

Answer 23

BLOCK dopamine D2 receptors in brain, believed to help alleviate positive s/s of schizophrenia

Question 24

1st gen antipsychotics S/Es

Answer 24

higher risk of EPS, NMS, sedation, anticholinergic effects (dry mouth & constipation) and hormonal changes (increased prolactin levels)

Question 25

1st gen antipsychotics clinical uses

Answer 25

mainly for schizophrenia and acute psychotic episodes

Question 26

1st gen antipsychotics examples

Answer 26

haloperidol, chlorpromazine (thorazine), fluphenazine (prolixin)

Question 27

2nd gen antipsychotics MOA

Answer 27

also blocks d2 receptors but to a lesser extent and additionally affect serotonin receptors (esp 5-HT2A). This dual action helps address both pos and neg s/s of schizophrenia and is thought to reduce risk of EPS

Question 28

2nd gen antipsychotics S/Es

Answer 28

Lower risk of EPS but may still cause some movement disorders. Higher risk of metabolic S/Es like wt gain, diabetes, dislipidemia. May have more favorable effect on neg s/s and cognitive function compared to FGAs.

Question 29

2nd gen antipsychotics clinical uses

Answer 29

used for treating schizophrenia, bipolar disorder, and as adjucts for MDD

Question 30

2nd gen antipsychotics examples

Answer 30

olanzapine, risperidone, quetiapine, aripiprazole

Question 31

How does a pine differ from a done

Answer 31

pine meds have higher risk of metabolic s/es, whereas dones have greater risk of EPS, particularly at higher doses

Question 32

“pine” antipsychotics

Answer 32

olanzapine, quetiapine. Have higher affinity for serotonin (5-HT2A) receptors compared to dopamine receptors, often assoc w/ greater wt gain risk. effective in treating pos and neg schiz s/s. can be used in mood disorders

Question 33

“done” antipsychotics

Answer 33

risperidone, lurasidone. Have more balanced effect on dopamine and serotonin receptors, which may contribute to lower risk of s/e. risperidone has higher risk of EPS d/t stronger D2 receptor blockade. Effective in tx both pos and neg s/s but different s/e profile than “pine”

Question 34

prazosin: dosing guidelines

Answer 34

1mg at bedtime, may be increased by 1-2mg every few based based on bp response. for HTN, effective range 2-20mg in divided doses. in PTSD related nightmares, 2-6mg at bedtime

Question 35

Prazosin S/E

Answer 35

orthostatic hypotension, drowsiness, sedation, headache, nausea, palpitations, nasal congestion

Question 36

prazosin indications

Answer 36

HTN, PTSD, BPH

Question 37

Clozapine monitoring during tx

Answer 37

WBC and ANC monitoring
wks 1-6: monitor weekly
wks 7-12: monitor q2wks
after 12wks: if stable, monitor q4wks