Exam 2

Question 1

Rozerem

Answer 1

Z-hypnotic. Increases melatonin. Can take a few days to weeks to take effect. Vivid dreams. Not addictive. Not PRN

Question 2

Buspirone

Answer 2

Antianxiety Benzo. Reduces anxiety without sedative effects. May take a few days to weeks to take effect. Not PRN. No hypnotic effects.

Question 3

Doxepin

Answer 3

Antidepressant. In low doses it can help people who have trouble staying asleep. Contraindicated with MAOIs, difficulty urinating, narrow angle glaucoma, severe sleep apnea

Question 4

Tricyclic Antidepressants

Answer 4

Nortriptyline (Pamelor), Amitriptyline (Elavil), Imipramine (tofranil)

Question 5

Tricyclic Antidepressant Facts

Answer 5

Can impact cardiac conduction system- second degree heart block. Do not give me than a weeks supply to an outpatient if they are potentially suicidal

Question 6

MAOI’s

Answer 6

Isocarboxazid (Marplan), Phenelizine (Nardil), Selegiline (EMSAM), Tranylcpromine (Parnate)

Question 7

MAOIs facts

Answer 7

DOES NOT PLAY WELL WITH OTHERS. Check with pharmacy when in doubt about whether another drug is compatible. Teach outpatients to read labels/check other drugs- even OTC. Tyramine free diet. Allow a two week “wash out” period when switching to or from other antidepressants. Can lead to hypertensive (and stroke) if mixed with tyramine

Question 8

SSRI’s

Answer 8

Fluoxetine (prozac), Sertraline (Zoloft), Venlafaxine (Effexor)

Question 9

SSRI’s facts

Answer 9

Safer than TCA’s and MAOIs. Most commonly prescribed anti-depressants and are typically first line drugs. Side effects may differ depending on medication.

Question 10

Trazadone

Answer 10

Antidepressant. Originally used as an antidepressant. Extremely sedating. Primary use now is for sleep; occasionally used in very small doses for anxiety. Not addictive but some people may need larger doses as time goes on

Question 11

Bupropine

Answer 11

Antidepressant. Also used for smoking cessation

Question 12

Vilzodone

Answer 12

Antidepressant. Serotonin partial agonist-reuptake inhibitor (SPARI). Can increase depression-and suicidal ideation, especially in those under 25. Can also cause anxiety, panic attacks, and hostile/angry feelings. Can cause insomnia. Give with food

Question 13

Lithium

Answer 13

Mood Stabilzer. Gold standard. PT must maintain normal salt and fluid intake; dont give to anyone on salt or fluid restricted diets. Can cause cardiac dysrhythmias, convulsions, tremor, hypothyroidsim and kidney problems. LOW THERAPEUTIC INDEX .5-1.3

Question 14

Anticonvulsants/Anti-epileptic Medications

Answer 14

Valproate (Depakote), Carbamezepine (Tegretol), Lamotrigine (Lamictal), Gabapentin (Neurontin), Topiramate (Topamax), Oxcarbazepine (Trileptal)

Question 15

Anticonvulsants/Anti-epileptic Medication Facts

Answer 15

Need therapeutic blood level monitoring. May also cause liver problems. Lamictal is not good for acute mania but is good for maintenance and depressive episodes

Question 16

Antipsychotics: First Generation

Answer 16

Halodal. Many were the first psychotropic drugs. Impact dopamine only. Only affects positive symptoms (hallucinations, delusions, etc). Can cause parkinsonism, tardive dyskinesia, akasthisia, urinary hesitancy, orthostatic hypotension, ejaculatory failure (and impotence), sedation, weight gain

Question 17

Antipsychotics: Second generation

Answer 17

Clozaril, Risperdal, Seroquel. Started with Clozaril. Clozaril can cause agranulocytosis, which can be lethal. Blood draws followed exactly and patient education. Fewer EPS signs. Most can cause varying amounts of sedation. All have risk for weight gain, DMII, hypercholesterolemia

Question 18

Antipsychotics: Third Generation

Answer 18

Aripiprazole (Abilify) is a dopamine system stabilizer. Increases dopamine where it is low and lowers it where it is high. Can cause sedation, hypotension, and anticholinergic effects.

Question 19

Invega

Answer 19

Antipsychotic. Metabolite of Risperdal but can be given once a day

Question 20

Fanapt

Answer 20

Antipsychotic. Can cause QT prolongation and orthostatic hypotension

Question 21

Latuda

Answer 21

Antipsychotic. Affects dopamine, serotonin, and noradrenaine receptors. Should be given with food. Can cause akathisia, nausea, sedation, parkinsonism.

Question 22

Saphris

Answer 22

Antipsychotic. Similar to the antidepressant Remeron. Must be given sublingually. Can cause akathisia, decreased oral sensitivity and somnolence.

Question 23

ADHD: Psychostimulants

Answer 23

Can cause agitation, exacerbation of psychosis, thought sturbances and delayed growth. Tolerance and abuse can occur.

Question 24

ADHD: Non-Stimuants

Answer 24

Strattera is norepinephrine reuptake inhibitor. Decreased appetite, weight loss. Contraindicated in patients with cardiac dx. Intuniv and Clonidine are alpha adrenergic agonists. Can cause low blood pressure. Need to increase and decrease slowly.

Question 25

Alzheimers Drugs

Answer 25

Tacrine and Donepezil are acetylcholinesterase inhibitors; they inactive the enzyme that destroys acetycholine. Memantine is an NMDA receptor antagonist and blocks glutamate from binding at those sites

Question 26

Herbal Drugs

Answer 26

Ask about these drugs in a nonjudgmental manner. Remember that “natural” doesnt mean safe

Question 27

Melatonin

Answer 27

Used to promote sleep. Interacts with anticoagulants, immunosuppressants, DM meds and BC pills

Question 28

Valerian Root

Answer 28

Used for sleep and anxiety. Alcohol and benzos can increase effects and side effects

Question 29

St. Johns Wort

Answer 29

Mild MAOI and may be useful in milder forms of depression. Can cause central serotonin syndrome if not properly weaned off this before starting any drugs that increase serotonin. Interferes with many medications. Can interfere with effectiveness of BC pills.