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Psychiatry Studying > Drugs > Flashcards

Drugs Flashcards

1
Q

Vortioxetine, name the class of this medication

A 
Serotonin Multimodal (S-MM)
Multimodal antidepressant
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2
Q

Vortioxetine, is commonly prescribed for …

A

MDD (only approved use)
GAD
Cognitive Symptoms Associated with Depression
Geriatric Depressin

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3
Q

Vortioxetine increases release of the following neurotransmitters

A 
Serotonin
Norepinephrine
Dopamine
Glutamate
Acetylcholine
Histamine
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4
Q

Vortioxetine reduces the release of

A

GABA

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5
Q

Vortioxetine causes side effects due to

A

Increases in serotonin concentrations at serotonin receptors in parts of body and brain other than those that cause therapeutic action (eg action of serotonin at central serotonin 1A receptors causes nausea, sexual dysfunction, etc)

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6
Q

Notable side effects of vortioxetine

A

Nausea
Vomiting
Constipation
Sexual Dysfunction

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7
Q

Rare, life-endangering side effects of vortioxetine

A

mania
seizures
SI
Hyponatremia

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8
Q

Are side effects of vortioxetine dose-dependent?

A

Yes

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9
Q

CANMAT dosage range of Vortioxetine

A

10-20mg per day

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10
Q

How do you stop vortioxetine?

A

Usually no need to taper, because long half life

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11
Q

Pharmacokinetics of Vortioxetine, Metabolized by…

A 
Metabolized by 
CYP450 2D6
3A4/5
2C19
2C9
2A6
2C8
2B8
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12
Q

Mean terminal half-life of Vortioxetine

A

66 hours, so can abruptly be discontinued

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13
Q

Drug Interactions of Vortioxetine - Inhibitors of CYP_______, (increase/decrease) serum levels of vortioxetine, possibly requiring dose to be (increased/decreased)

A

CYP450 2D6
Increase
Decrease

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14
Q

CYP Inducers can (increase/decrease) serum levels of vortioxetine, possibly requiring dose to be (increased/decreased)

A

decrease

Increased

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15
Q

Do not prescribe vortioxetine if patient taking this type of medication: _________, as it may precipitate the following condition:__________

A

MAOI

Serotonin Syndrome

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16
Q

Use vortioxetine with caution in patients with a history of __________

A

Seizures

17
Q

Is dose adjustment required in vortioxetine for

a) Renal Impairment
b) Mild to moderate hepatic impairment
c) Major hepatic impairment

A

a) no
b) no
c) not studied

18
Q

When using vortioxetine in the elderly,

is a dose adjustment necessary?

A

No

19
Q

Risk of _______ with SSRIs is higher in elderly.

A

SIADH

20
Q 
"Art" of psychopharmacology... Vortioxetine may have advantages in patients with 
\_\_\_\_\_\_\_\_\_\_\_ dysfunction 
\_\_\_\_\_\_\_\_\_\_\_\_ symptoms
\_\_\_\_\_\_\_\_\_\_\_\_ patients
Patients who do not want \_\_\_\_\_\_\_\_
Patients who have not \_\_\_\_\_\_\_\_\_\_\_
A 
Sexual
Cognitive Symptoms of Depression
Elderly Patients
Patients who do not want Weight gain 
Patients who have not responded to other antidepressants
21
Q

Medications that can increase lithium level

A

Thiazide diuretics

NSAIDS except aspirin

ACE inhibitors

Antibiotics tetracyclines and metronidazole

22
Q

Medications that can decrease lithium level

A

Potassium-sparing diuretics

Theophylline

23
Q

Medications that can increase or decrease lithium levels

A

May increase or decrease lithium level

Loop diuretics

Calcium channel blockers

24
Q

What tests should be done when initiating lithium?

A 
Urinalysis
Creatinine + BUN
Thyroid function studies
Calcium
Pregnancy test for women of childbearing potential.

ECG for patients with risk factors for coronary heart disease, including diabetes mellitus, hypertension, dyslipidemia, and cigarette smoking.

25
Q

When should lithium levels be checked after dose has been changed?

A

5-7 Days

26
Q

When should patients on lithium have their levels checked?

A
  • If a dose increase is under consideration and a level has not been measured for at least two weeks
  • Patients on steady doses should have their levels checked every 6 to 12 months.
27
Q

For patients on lithium, which monitoring should you be doing (other than lithium levels) and when?

A
  • Urinalysis, BUN, and Creatinine + Thyroid function tests
  • q2-3 months during the first six months of therapy
  • q 6 to 12 months thereafter
  • Thyroid test more often in higher risk patients
  • Serum CA q 12 months
28
Q

Lithium has a ______ therapeutic index.

Define therapeutic index

A
  • narrow

- When the dose at which it is clinically effective is only slightly lower than the dose at which it becomes toxic

29
Q

Factors that increase likelihood of lithium intoxication

A
  • When lithium excretion is impaired
    • Underlying renal insufficiency
    • Effective volume depletion
    • Elderly patients (low glomerular filtration rate)
30
Q

Clozapine dissociates fast OR slow from D2 receptors?

A

FAST

  • The chemical structure of clozapine facilitates a relatively rapid dissociation from D2 receptors in striatum
  • After short-term occupation of D2 receptors, peak neural activity raises synaptic dopamine, which then displaces clozapine.
  • This is why clozapine has few EPS
31
Q

Class of antipsychotics that dissociate slowest from D2 receptors

A

First Gen

Haldol and CPZ

32
Q

Pregabalin Mechanism of action

A

Binds to alpha 2 delta subunit of voltage-sensitive Ca+ channels

33
Q

Pyromania DSM Criteria

A

A - Deliberate and purposeful fire setting on more than 1 occasion.

B - Tension or affective arousal before the act.

C - Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).

D - Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.

E - The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (e.g., in major neurocognitive disorder, intellectual disability [intellectual developmental disorder], substance intoxication).

F - The fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

34
Q

Guanfacine class of drug

A

Alpha 2-agonist (BP medication)

35
Q

Clozapine is recommended/not recommended in people with schz + substance use

A

RECOMMENDED

Clozapine may decrease the use of nicotine, alcohol, or other drugs of abuse among patients with schizophrenia

Psychiatry Studying (11 decks)

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