Drugs Flashcards
Vortioxetine, name the class of this medication
Serotonin Multimodal (S-MM) Multimodal antidepressant
Vortioxetine, is commonly prescribed for …
MDD (only approved use)
GAD
Cognitive Symptoms Associated with Depression
Geriatric Depressin
Vortioxetine increases release of the following neurotransmitters
Serotonin Norepinephrine Dopamine Glutamate Acetylcholine Histamine
Vortioxetine reduces the release of
GABA
Vortioxetine causes side effects due to
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)
Notable side effects of vortioxetine
Nausea
Vomiting
Constipation
Sexual Dysfunction
Rare, life-endangering side effects of vortioxetine
mania
seizures
SI
Hyponatremia
Are side effects of vortioxetine dose-dependent?
Yes
CANMAT dosage range of Vortioxetine
10-20mg per day
How do you stop vortioxetine?
Usually no need to taper, because long half life
Pharmacokinetics of Vortioxetine, Metabolized by…
Metabolized by CYP450 2D6 3A4/5 2C19 2C9 2A6 2C8 2B8
Mean terminal half-life of Vortioxetine
66 hours, so can abruptly be discontinued
Drug Interactions of Vortioxetine - Inhibitors of CYP_______, (increase/decrease) serum levels of vortioxetine, possibly requiring dose to be (increased/decreased)
CYP450 2D6
Increase
Decrease
CYP Inducers can (increase/decrease) serum levels of vortioxetine, possibly requiring dose to be (increased/decreased)
decrease
Increased
Do not prescribe vortioxetine if patient taking this type of medication: _________, as it may precipitate the following condition:__________
MAOI
Serotonin Syndrome
Use vortioxetine with caution in patients with a history of __________
Seizures
Is dose adjustment required in vortioxetine for
a) Renal Impairment
b) Mild to moderate hepatic impairment
c) Major hepatic impairment
a) no
b) no
c) not studied
When using vortioxetine in the elderly,
is a dose adjustment necessary?
No
Risk of _______ with SSRIs is higher in elderly.
SIADH
"Art" of psychopharmacology... Vortioxetine may have advantages in patients with \_\_\_\_\_\_\_\_\_\_\_ dysfunction \_\_\_\_\_\_\_\_\_\_\_\_ symptoms \_\_\_\_\_\_\_\_\_\_\_\_ patients Patients who do not want \_\_\_\_\_\_\_\_ Patients who have not \_\_\_\_\_\_\_\_\_\_\_
Sexual Cognitive Symptoms of Depression Elderly Patients Patients who do not want Weight gain Patients who have not responded to other antidepressants
Medications that can increase lithium level
Thiazide diuretics
NSAIDS except aspirin
ACE inhibitors
Antibiotics tetracyclines and metronidazole
Medications that can decrease lithium level
Potassium-sparing diuretics
Theophylline
Medications that can increase or decrease lithium levels
May increase or decrease lithium level
Loop diuretics
Calcium channel blockers
What tests should be done when initiating lithium?
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.
When should lithium levels be checked after dose has been changed?
5-7 Days
When should patients on lithium have their levels checked?
- 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.
For patients on lithium, which monitoring should you be doing (other than lithium levels) and when?
- 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
Lithium has a ______ therapeutic index.
Define therapeutic index
- narrow
- When the dose at which it is clinically effective is only slightly lower than the dose at which it becomes toxic
Factors that increase likelihood of lithium intoxication
- When lithium excretion is impaired
- Underlying renal insufficiency
- Effective volume depletion
- Elderly patients (low glomerular filtration rate)
Clozapine dissociates fast OR slow from D2 receptors?
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
Class of antipsychotics that dissociate slowest from D2 receptors
First Gen
Haldol and CPZ
Pregabalin Mechanism of action
Binds to alpha 2 delta subunit of voltage-sensitive Ca+ channels
Pyromania DSM Criteria
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.
Guanfacine class of drug
Alpha 2-agonist (BP medication)
Clozapine is recommended/not recommended in people with schz + substance use
RECOMMENDED
Clozapine may decrease the use of nicotine, alcohol, or other drugs of abuse among patients with schizophrenia
