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phm 701 neuro/psych/sub abuse > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Non Pharm Treatment for schizo

A

Realistic goals and time course
-social rehabilitation
-psych education
-targeted cognitive therapy
-active community treatment
-therapeutic alliance
-comprehensive care ( psych services and psych med)

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2
Q

General Approach for schizo

A

-Optimized monotherapy, combo for treatment resistant (clozapine)
-lack of evidence supporting APS polypharmacy
-2nd gen A> 1st gen A
-Substantial risk of suicide or attemp- add clozapine

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3
Q

CATIE trial

A

-equal efficiency between old and newer antipsych
-newer agents have more permanent SEs and more expensive

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4
Q

Dopamine antagonism effects

A

-Movement disorders
-Relief of psychosis
-akathisia
-increased prolactin (causes abnormal periods and gynecomastia)
-impulsivity

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5
Q

clozapine class, major se, dosing

A

-only m4 agonist; 2nd gen antipsych
-se inc hyper-salivation (add scopolamine patch), severe constipation, orthostatsis
-if dose interrupted for more than 48hrs, re-titrate fro starting dose

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6
Q

Clozapine DDI

A

Antiepileptics dec ANCs
-Lithium helps by inc ANC

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7
Q

Clozapine BBW and REMS

A

Blood dyscrasis

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8
Q

when to start clozapine

A

must trail 2 other antipsych b/f (treatment resistant)
-if severe risk of suicide can start clozapine earlier

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9
Q

Clozapine DDI

A

benzos especially lorazepam IM

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10
Q

Treatment considerations for schizo

A

-lifelong for most; rare possibility of d/c
-relapse is high
-watch out for incomplete switch/titrations
-recommend IM meds for initial rapid relief of sym
-limit time over MDD to 2-4 weeks and re-eval

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11
Q

who is considered treatment resistant in schizo, include time frame

A

lack of improvement with at least 2 APS from different classes at optimal dose for 8 weeks

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12
Q

What should you do for treatment augmentation in schizophrenia

A

-add non-APS agent with mood stabilizers
-ECT and/or ziprasidone with clozapine

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13
Q

1st gen antipsych (6)

A

ChlorprOmaziNe
Fluphenazine
halopeRidOl
perpheNazine
ThioridAzine
ThIOthixeNe
(confrontation)

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14
Q

1st gen antipsych SE (8)

A

-Extrapyramidal side effects
-OT prolongation
-Prolactin elevation (w/ longer use)
-Dermatologic
-photosensitivity
-blue gray skin
-orthostatic hypotension
-altered thermoregulation

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15
Q

Antipsych BBW

A

-dementia related psychosis inc mortality
-pt has dementia and schio is okay to use antipsych but if they experience psychosis d/c

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16
Q

2nd gen antipsych LAI approved for BP

A

Aripiprazole
Risperdone

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17
Q

2nd gen antipsych SE (8)

A

-Metabolic syndrome (inc trigycleride, glycemia and weight gain)
-QT prolongatio
-Blood dyscrasia/Neutopenias
-Seizure threshold
-Anticholingeric
-Sedation
-prolactin inc
-Ophthalmic effects

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18
Q

Only approved medication for agitation in alzheimers

A

Brexpiprazole

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19
Q

2nd gen approved for MMD (4)
All brokies owe five quarters

A

Aripiprazole
Brexpiprazole
Olanzapine w/ Fluoxetine
Quetiapine
- no LAI

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20
Q

Olanzapine
-Class, se, monitoring

A

2nd gen antipsych
-se for metabolic risk in younger men
-REMS for post inj delirium with LAI
-dress
-3 hr monitoring (rems)

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21
Q

which drug is in niosh and why

A

Ziprasidone
-2nd gen
-se : DRESS
-short acting inj requiring reconstitution, tablet

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22
Q

LAI pearls

A

-good for non-adherent patients
-should stabilize on mono therapy before initiating
-oral challenge with the same drug
-oral overlap needed b/c LAI take a while to show effect

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23
Q

which 2 first gen antipsychs are high potency and consequence

A

fluphenazine & haloperidol
*inc risk of EPS b/c target D2

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24
Q

which 2 first gen antipsychs are low potency and consequence

A

Chlorpromazine & thioridazine
*high anticholingeric risk

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25
Q

New combination therapy for schizo & BD and its moa

A

Lybalvi (olanzapine & samidorphan)
- treat acute and maintenance
-mono or adj
-samidorphan is a opioid system modulator acts on mu receptor to reduce metabolic effects of olanzapine
-CI use of opioids
*less weight gain

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26
Q

special populations

A

-elderly: start low go slow, avoid anticholingerics risk of fall; use SSRI first for depression
-Preg: better to be on therapy; use SSRI

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27
Q

What 1st gen drugs are LAI (2)

A

Fluphenzaine & Haloperidol

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28
Q

What 2nd gen drugs are LAI (4) and indication

A

Aripiprazole
Olanzapine
Risperidone
Paliperidone
*water based and better tolerated
- for schizo

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29
Q

Paliperidone LAI

A

invega hafyera has a dosing interval of 6 months

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30
Q

which 2nd gens cause weight gain (3)

A

Clozapine
Olanzipine
Quetiapine

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31
Q

2nd gen antipsych that cause EPS

A

Risperidone & Paliperidone

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32
Q

2nd gen antipsych that cause inc prolactin

A

Risperidone & Paliperidone

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33
Q

Acute Dystonias symptom, risk and treatment

A

-Symptom: painful prolong muscle contraction
-Risk: high potency or high dose FGA, younger men
-Treatment: Anticholingersics (benzotropic or diphenhydramine), IM> PO Benzo, dec dose or d/c offending agent

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34
Q

Psuedo-parkinsonism symptom, risk and treatment

A

-Symptom: Tremor, rigidity, etc.
-Risk: high potency or high dose FGA, older age, female
-Treatment: Anticholingerics, dec dose or d/c offending agent

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35
Q

Akathisia symptom, risk and treatment

A

-Symptom: restlessness, distress, etc
-Risk: high potency FGA, aripiprazole, risperidone
-Treatment: Beta blockers dec dose or d/c offending agent

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36
Q

Tardive dyskinesia symptom, risk and treatment

A

-Symptom: tongue thrusting, lip smacking, etc
-Risk: high potency or high dose FGA, female, older age, AA
-Treatment: DC offending agent, dont use anticholingeric, VMAT2i (Valbenazine & Deutetrabenazine)

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37
Q

NMS symptom, at risk, treatment

A

-Symptom: rapidly over 24-72 hrs, inc muscle rigidity, inc wbc/lfts/bp, normal pupils, dec or norm bowel sounds
-Rare potentially lethal, seen with high potency drugs and ALL antipsychs
-at risk: dehydrated, organic mental disorder
-Treatment: d/c antipsychs & da agonist like bromo
-re-challenge in 2 weeks

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38
Q

Serotonin syndrome

A
  • Onset: less than 12 hours
  • inc muscle tone
  • Hypereflexia
  • Dilated pupils
  • Inc bowel sounds
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39
Q

Which drugs have CYP1A2 activity

A

Clozapine and Olanzapine

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40
Q

Medication class that can cause depression (7)

A

-CV: Beta blockers, Calcium Channel Blockers
-Hormonal: oral contraceptives and steroids
-Antiepileptics: Levetiracetam & Topiramate
-Opioids
-Stimulants

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41
Q

SSRI approved in MDD (5)

A

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline

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42
Q

SNRI approved in MAD

A

Desvenlafaxine
Duloxetine
Levomilnacipran
Venlafaxine

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43
Q

SSRI approved in GAD (2)

A

Escitalopram
Paroxetine

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44
Q

SNRI approved in GAD (2)

A

Duloxetine
Venlafaxine

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45
Q

SSRI approved for OCD (4)

A

Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

46
Q

SSRI approved for PAD (3)

A

Fluoxetine
Paroxetine
Sertraline

47
Q

SNRI approved for PAD

A

Venlafaxine

48
Q

SSRI approved for PTSD

A

Paroxetine
Sertaline

49
Q

SSRI approved for SAD

A

Paroxetine
Sertraline

50
Q

SNRI approved for SAD

A

Venlafaxine

51
Q

best 2ng gen antipsych

A

Lurasidone, Aripiprazole, Ziprasidone
-less metabolic effects

52
Q

Which antipsychs cause DRESS

A

Olanzapine & Ziprasidone

53
Q

Asenapine class and clinical pearls

A

2nd gen
comes in sublingual tab and transdermal patch

54
Q

hallmark NMS symptoms

A

-autonomic instability
-altered mental
-muscle ridigity
-fever

55
Q

what drug is approved for agitation in schizo and bipolar depression

A

Dexmedetomidine

56
Q

Bupropion se and caution

A

-caution in eating disorders and both hepatic and renal function
-se hypertension, insomnia, activation and anxiety

57
Q

Mirtazapine se

A

very sedating, inc cholestrol and extreme weight gain, inc LFTs

58
Q

Esketamine se, CI, clinical pearls

A

-Nasal spray
-Control sub; reserved for resistant patients
-SE: impaired ability to drive, inc BP, cog impairment
-CI: aneurysm and intracranial hemorrhage

59
Q

Eskatamine BBW and CI

A
  • Sedation, disassociation, abuse and misuse, suicidal thoughts and behaviors
  • REMS given under supervision of healthcare provider w/ 2 hr observation
  • CI anerysm intracerebral hemorrhage
60
Q

Brexanolone use, dosing, ae, who to avoid

A

-postpartum depression
-IV inf over 2.5 days
-ae: hypoxia and excessive sedation
not recommended in preg
-Avoid in end stage renal disease

61
Q

What med to avoid in pts with seizures and eating disorders

A

Bupropion

62
Q

what med to avoid in patients w/ substance abuse

A

benzo

63
Q

what med to avoid in patients with cardiac complications

A

TCA : amitriptyline, amoxapine, clomipramine, doxepin

64
Q

what med to avoid in pts w/ GI bleeding and anticoag

A

SSRI

65
Q

What should you use to as augmentation in Depression

A
  • mood stabilizer: lithium, valproate
  • 2nd gen antipsych
  • triiodothyronidine
66
Q

Nefazodone class and clinical pearl

A

-5HT3 modulator
-BBW: Hepatic failure (child pough)

67
Q

MAOI clinical pearls

A

-washout periods vary b/w 2-5 wks
-usually takes 4-5 half lives
-DDI w/ Tyramine foods; hypertensive crisis

68
Q

Treatment for PTSD nightmares

A

Antiadrenergrics: Prazosin, Clonidine, (add trazodone for sleep)

69
Q

Treatment for PSTD anger

A

Anticonvulsants: Lamotrigene

70
Q

Treatment for PTSD psychosis/flashbacks/dissocation

A

Antipsych: Quetiapine, Rispersidone, Olanzapine

71
Q

FDA approved anticonvulsants and when are they used

A

Valproate - acute mania & mixed episodes; mood stabilizer
Lamotrigene - maintenance (slowly titrate to avoid SJS)
Carbamazepine - acute mania & mixed episodes

72
Q

What two agents can be used in all 3 stages of bipolar depression (acute mania, maintenance, acute depression)

A

Olanzapine and quetiapine

73
Q

2nd gen antipsychotics that can not be used in BP
Can’t use In BiPolar

A

Clozapine, iloperidone, Brexpiprazole, Paliperidone, pimavanserin.

74
Q

Which 2nd gen drugs can cause akathisia

A

Aripiprazole and risperidone

75
Q

Valproate se & formulations

A
  • se: weight gain & alopecia
  • er formulation less bioavailability
76
Q

Valproate BBW

A

Hepatic toxicity (childs pough), teratogenic , pancreatitis

77
Q

What are beta blockers indicated in and how to take it

A
  • used in SAD
  • helps with autonomic symptoms but not curative
  • take 1 hr prior to event.
78
Q

Which benzo is not metabolized heptically (no cyp metabolism)

A

Over the liver
- oxazepam, temazepam, lorazepam

79
Q

Which SSRI can be used in patients with bulimia

A

Fluoxetine

80
Q

High risk of nms

A

High potency antipsychotics ( haloperidol & fluohenazine)
But all antipsychotics can lead to it

81
Q

TCA Side effects

A
  • anticholingeric, delirium, lethal overdose, suicide attempts
82
Q

lithium toxicity and DDI that might worsen it (affects renal)

A

greater or equal to 1.5 is toxic, monitor ANC, can cause Blood dyscrasis *renal metabolism
- ACEs, ARBs, Loops, CCB (Dilitiazem, Amlodipine, Nifedipine), ECT (neuro complications)

83
Q

Lithium ADE

A

Hypothyroidism

84
Q

What is SIADH and what drugs can cause this

A

SIADH (syndrome of inappropriate secretion of antidiuretic hormone) can lead to water retention that leads to HYPONATREMIA na <135
- Carbamazepine (and metabolite), SSRI, SNRI

85
Q

LAI FDA approved for Bipolar

A

Aripiprazole
Risperidone

86
Q

What meds are teratogenic

A
  • Valproate
  • Paroxetine
  • Carbamazepine
  • Lithium
  • Lamotrigine
  • Divalproex
87
Q

Buspirone indication

A
  • GAD on a scheduled basis
88
Q

Venlafaxine class and indication

A

SNRI
- MDD, GAD, PAD, SAD

89
Q

Fluvoxamine class and indication

A

SSRI
OCD

90
Q

Fluoxetine class and indication

A
  • SNRI
  • MDD, OCD, PAD, PMDD, Bulimia
91
Q

Which antipsychotics are sedating

A

Low potency FGA
Clozapine
Quetiapine

92
Q

When to dose adjust for SSRI

A

Hepatic dysfunction (childs pough)

93
Q

Citalopram dosing adj in MDD

A

hepatic dysfunction, 60yrs and older, poor cyp2c19 metabolizer

94
Q

escitalopram dosing adj in MDD

A

Hepatic dysfunction; 10 mg

95
Q

floxetine dosing

A

once weekly doing due to long half life, comes in liquid

96
Q

What drug class should be avoided in Bipolar Depression and why

A

SNRI and TCA cause manic episodes

97
Q

What meds can be used in Acute Depression as monotherapy
(Our queen loves little cakes)

A

Olanzapine, Quetiapine, Lumateperone, Lurasidone, Cariprazine

98
Q

When to use Benzos

A

GAD and PAD after they fail SSRI

99
Q

Dec lipophilic Benzos and its effect

A

Lorazepam (best tolerated), Oxazepam
-slower absorption, longer duration

100
Q

Inc Lipophilic Benzos and its effect

A

Dizepam, Clorazepam
-faster absorption, shorter duration, more misuse, cross BBB

101
Q

HAMD

A

inc score= inc severity depression

102
Q

MADRS

A

tells treatment response depression

103
Q

Duloxetine indications

A

MDD, GAD, pain

104
Q

Doxepin indications

A

TCA
- Depression and Insomnia

105
Q

High potency benzos and indication

A
  • Alprazalam, clonzapem, lorazepam
  • Rapid relief in panic disorder
106
Q

Which two 2nd gen antipsychs are most sedating

A

Quetiapine & Clozapem

107
Q

Which two 1st gen antipsych are most sedating

A

Low potency; Chlorpromazine & Thioridazine

108
Q

Which antipsych is most activating

A

Aripiprazole

109
Q

In which anxiety disorder is CBT most often used and what is always CI w/ that treatment

A
  • PTSD
  • Benzos can interfere w/ CBT
110
Q

Which 1st gen antipsychotic can be used for a cute psychosis

A

Chlorpromazine

phm 701 neuro/psych/sub abuse (3 decks)

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