Exam 3 (Final) Flashcards by kristin smith

SSRI’s list

Prozac, 
Paxil, 
Lexapro
Celexa
Zoloft,

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SNRI’s

Effexor and Cymbalta

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non-SSRI/SNRI antidepressants

Wellbutrin and Remeron

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Tricyclic Antidepressants

Elavil and Doxepin

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Mood Stabilizers

Lithium and Depakote

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Antipsychotics

Abilify
Latuda
Risperdal
Seroquel
Zyprexa

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Benzos

Klonopin,
Ativan,
Xanax and
Valium

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Dementia Drugs

Aricept

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Opiate Dependence Drugs

Suboxone and Methadone

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ADD/ADHD Drugs

Ritalin and Adderall are stimulant medications for treatment of ADD/ADHD
Strattera and Wellbutrin are non-stimulant medications for treatment of ADD/ADHD

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Define “teratogen”

Any substance (medication/toxin) that results in the development of birth defects

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In what way are Depakote (valproic acid) and Tegretol (carbamazepine) potentially teratogenic?

Tegretol- craniofacial defects, spina bifida, developmental delays, underdeveloped fingernails
Depakote- neural tube defects, craniofacial defects

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What is Epstein’s Anomaly? What is its approximate incidence in the general population vs its approximate incidence among babies of mothers taking Lithium? Is Epstein’s Anomaly repairable?

Heart valve anomaly linked to mom taking lithium during pregnancy (esp 1st trimester)
Rare- Lithium exp pop= .1%, 20x gen pop risk
Can be managed with medication or corrected with surgery in some cases

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Which mood stabilizer has research evidence to support its ability to reduce suicidal behavior?

Lithium

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Which mood stabilizer is considered a better tolerated form of Tegretol (carbamazepine)?

Oxcabazepine/Trileptal (p208)

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Be aware of Stevens-Johnson syndrome related to Lamictal (lamotrigine) treatment? Be aware of how serious it is. Also (this may take some google consultation) be aware the manner in which Lamictal can be prescribed to greatly reduce the risk of Stevens-Johnson syndrome.

Immune sypersensitivity disorder looks like a rash, epidermis separates from dermis, can be fatal, usually happens in kids- contraindicated for anyone under 16yo.
Reduce risk with lower initial dose, slower titration, do not prescribe with Valproic Acid

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Is Lamictal a better contender as a mood stabilizer or as an antidepressant?

Better for depression, does not control mania well but works for BPII (only hypomanic episodes)

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What is “manic switching” and how does it relate to SSRIs?

People with bipolar who take SSRI’s may “switch” into a manic episode- why we always assess for history of mania before dx depressive disorder

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What is the mechanism of action of Methylphenidate (Ritalin) and Amphetamine Salts (Adderall)?

Release of Norepinephrine and Dopamine from the synaptic vesicles into the synaptic cleft.

What is the reason that “drug holidays” are encouraged for children and adolescents who are treated with stimulants?

Because stimulant meds can impact their physical development (weight, height) and drug holidays can help keep on track with development.

Should patients expect a withdrawal syndrome when they stop taking a stimulant for a drug holiday?

No withdrawal symtoms

What is the mechanism of action of Bupropion (Wellbutrin)?

The exact mechanism of the antidepressant action of bupropion is not known, but is presumed to be related to noradrenergic and/or dopaminergic mechanisms. Bupropion is a relatively weak inhibitor of the neuronal reuptakeof norepinephrine and dopamine, and does not inhibit the reuptake of serotonin.

Know that there are non-stimulant medications which are FDA approved for the treatment of ADHD/ADD:

guanfacine (Tenex),
clonidine (Catapres),
bupropion (Wellbutrin),
atomoxetine (Strattera).

Know the three most common adverse effects of stimulants prescribed for ADHD/ADD (we discussed these in class).

Decreased sleep, irritability, and decreased appetite

What is generally understood to the be the mechanism of action of St. John's Wort?

2 active ingredients: hypericin & hyperforin Hypericin- reuptake inhibitor of serotonin, dopamine & norepinephrine, also binds to GABA receptors, benzodiazepine receptors & glutaminergic receptors Hyperforin- does something, but we don’t know what yet (p267)

What is the mechanism of action of Kava?

Active ingredient: kavapyrones Act as muscle relaxants, anticonvulsants, reduce excitability in limbic system. Inhibit voltage dependent sodium channels, increase GABA-A receptors, block NE reuptake, suppress release of glutamate (p269)

What is Melatonin?

Hormone released by pineal gland, binds to suprachiasmic nucleus (internal clock). Useful in initiating sleep, it blunts the SCN alerting signal

What class of medication is considered to be the primary psychopharmalogical treatment for PTSD?

SSRI’s

What are the risks of using benzodiazepines to treat PTSD-related anxiety?

Only a short-term fix, as tolerance builds, people will increase their doses until they max out at which point the symptoms return

What two other (non-psychiatric) medications were discussed in class as evidence-based off-label treatments for PTSD?

Prazosin- mediocre bp medicine, but helpful for PTSD, especially nightmares- relaxes smooth muscles that normally contract during REM sleep (dreaming) Topamax- not a great seizure medicine, but can help with migraines; helps with nightmares and bad feelings in body produced by PTSD; downside is it is taken twice a day and is bad for people with kidney stones and makes soda or sweet carbonated drinks taste bad

What is the mechanism of action of Naltrexone (ReVia)?

Used for opiate & alcohol cessation, pure opioid antagonist, prevents opiates from binding and having an effect (getting you high) mechanism of action for alcohol not fully understood, has to do with endogenous opioids

What happens when a person drinks while taking Disulfram (Antabuse)?

Blocks metabolism of ethanol, results in “extremely unpleasant” nausea/vomiting (p286)

What are the differences between buprenorphine/naloxone (Suboxone) and methadone (Dolophine) with regard to the following? - risk of death in overdose - likelihood to cause depression

Suboxone has lower risk of overdose, harder to abuse (when shooting or snorting, it induces unpleasant withdrawal sx) Suboxone has some research suggesting antidepressant properties, is prescribed off-label for depression Methadone may cause depression

What is Narcan (naloxone)? How does it work?

Blocks opiates, especially in overdose | Pure opioid inhibitor, fast acting, no euphoric effects

What two substances are discussed in the text as options for drug-assisted psychotherapy?

Psilocybin & MDMA

What is the common name (street name) for MDMA?

Ecstasy, Molly

Most commonly prescribed medication for dementia.

Aricept (donepezil)

What is the mechanism of action of Aricept (donepezil)?

Acetylcholinesterase inhibitor- this drug binds to the acetylcholinesterase enzyme that breaks down Acetylcholine (Ach)

What common, typically mild and easily treatable medical condition discussed in class can cause profound mental status changes in older adults?

Infection, especially urinary tract infections

Be aware of the Beers List recommendations for the following two classes of medications: Antihistamines and Benzodiazepines.

antihistamines and benzos are on Beer’s List as medications people over the age of 65 Benzos especially can cause these clients to become disinhibited (i.e. the man taking off all of his clothes in the airport), confusion, and falling.

Best tolerated antidepressant for older adults.

Lexapro

LEAST ideal antidepressant for older adults (due to side effects and due to drug-interactions).

Paxil

Contrast the effectiveness of ECT and TMS

ECT- high success rate (75-83%), needs continued tx or medication to keep from relapsing TMS- similar effect size to antidepressants, not fully studied or understood yet The more rounds of antidepressants a patient has tried without success, the less likely TMS may work.

Light box therapy has evidence to support it's use in both seasonal affective disorder and (more recently) major depression - what is the brightness (intensity) of light which is supported by evidence?

10,000 Lux

What is Valerian root typically used for?

Sleep disorders- especially insomnia. Can also be combined with hops or lemon to increase drowsiness. Also used for depression and anxiety.