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Pharmacotherapy III > Exam 4 Misc > Flashcards

Exam 4 Misc Flashcards

1
Q

MOA - Trintellix

A

SERT, 5HT1A partial agonist, 5HT3

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2
Q

Vilazodone

A

SERT, 5HT1A partial agonist

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3
Q

Maprolitine

A

NET Inhibitor

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4
Q

Amoxapine

A

NET inhibitor

D2 antagonist

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5
Q

Mirtazapine

A

Alpha 2 antagonist
5HT2 and 5HT3 antagonist
H1 antagonist

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6
Q

Bupropion

A

DAT, NET, SERT Inhibitor

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7
Q

Trazodone

A

5HT2A antagonist

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8
Q

Nefazodone

A

5HT2A antagonist

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9
Q

Rebosetine

A

NSRI

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10
Q

Atomoxetine

A

NSRI

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11
Q

Tesofensine

A

SDNRI

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12
Q

Tesofensine alternative use

A

appetite suppressant

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13
Q

Etomidate

A

GABA - A Receptor, acts on Beta -2 and 3 subunits

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14
Q

Propofol

A

GABA - A receptor - acts on Beta 2 and 3 subunit

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15
Q

Picrotoxin

A

GABA channel blocker

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16
Q

How does GABA - B work?

A

Inhibitory - decreases Ca on presynaptic and increases K+ on postsynaptic

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17
Q

What is tasimelteon used for?

A

non-24-hour sleep wake disorder in the blind

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18
Q

What NTs are associated with anxiety?

A

Serotonin (Low)
Norepinephrine (high)
GABA (low)
CRF (high)

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19
Q

What are the non stimulants for ADHD?

A 
Atomoxetine
TCAs
Bupropion
Clonidine/guanfacine
(not modafinil)
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20
Q

What are the severity classifications for anorexia?

A

Mild: >17
Moderate: 16-17
Severe: 15-16
Extreme: <15

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21
Q

WHat are the severity classifications for bingeing/bulimia?

A

Mild: 1-3 per week
Moderate: 4-7 per week
Severe: 8-13 per week
Extreme: >13 per week

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22
Q

How do you refeed with anorexia? Inpatient

A

500 cal/day increase every 4 days

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23
Q

How do you refeed with anorexia? outpatient

A

500 cal/day increase every week

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24
Q

What electrolytes are implicated in refeeding syndrome?

A

K, Phosphate, Mg

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25
Q

What hormone causes refeeding syndrome?

A

Insulin – increases from switching to lots of glucose metabolism

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26
Q

ADHD side effects: Reduced appetite/weight loss

A

Eat high calorie meal when concentration is low (breakfast/dinner)

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27
Q

ADHD side effects: Stomachache?

A

Take with food, lower dose if possible

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28
Q

ADHD side effects: Insomnia?

A

Lower last dose, take earlier in day, add sleep med of needed

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29
Q

ADHD side effects: Headache?

A

Divide dose, give with food, APAP

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30
Q

ADHD side effects: Rebound symptoms?

A

Longer acting; antidepressant; atomoxetine

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31
Q

ADHD side effects: Irritability/jitteriness?

A

Lower dose; reconsider diagnosis; atypical antipsychotic/mood stabilizer

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32
Q

ADHD side effects: Dysphoria?

A

Lower dose or change stimulant

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33
Q

ADHD side effects: Zombie-like?

A

Lower dose or change stimulant

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34
Q

Tics/abnormal movement?

A

Lower dose, consider alternate therapy

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35
Q

ADHD side effects: increase BP/HR?

A

Lower dose, change stimulant

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36
Q

ADHD side effects: Hallucinations?

A

D/C stimulant; consider atypical antipsychotics/mood stabilizer

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37
Q

ADHD side effects: Sudden cardiac death?

A

Evaluate for FH of early CV disease, heart structure issues that are already present

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38
Q

What warning is associated with methylphenidate (and atomoxetine to some extent)?

A

Priapism

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39
Q

What warning is associated with all stimulants?

A

Raynaud’s

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40
Q

What medication is in Daytrana?

A

Methylphendiate

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41
Q

What medication is in Vyvanse?

A

lisdexamfetamine

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42
Q

How long before needed effect should Daytrana be applied?

A

2 hours

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43
Q

Is Vyvanse SR?

A

No - but still swallow whole

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44
Q

What are ADEs of Strattera?

A

Gi upset, anorexia, weight loss

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45
Q

What are warnings for Strattera?

A

Liver toxicity, suicidal thinking

46
Q

Is atomoxetine first line for ADHD?

A

Nope - stimulants are

47
Q

HOw long do alpha-2 adrenergic agonists take to work?

A

4 weeks

48
Q

What are guanfacine/clonidine good at treating? (which ADHD symptoms?)

A

Impulsivity

49
Q

What MP needed for clonidine/guanfacine?

A

EKG - cardiac effects

50
Q

Why do you taper guanfacine/clonidine?

A

rebound tachycardia

51
Q

What are TCA used for associated w/ADHD?

A

insomnia normally

52
Q

Bupropion is contraindicated with what?

A

Seizures and eating disorders

53
Q

Modafinil is abusable ? T/F

A

True

54
Q

Modafinil has shown evidence of ___

A

SJS

55
Q

What mood stabilizers have also shown some effect w/ ADHD?

A

Carbamazepine
Valproic acid
NOT lithium

56
Q

T/F: atypical antipsychotics can be used as monotherapy in patients with ADHD

A

FALSE

57
Q

What weight is it recommended to use IR stimulant?

A

<15 kg

58
Q

What meds are used for pediatric bipolar disorder WITH psychosis?

A

Lithium or valproate or carbamazepine WITH ATYPICAL ANTIPSYCHOTIC

59
Q

What meds are used for pediatric bipolar disorder WITHOUT psychosis?

A

Lithium or valproate or carbamazepine or risperidone or olanzapine or quetiapine

60
Q

What meds are used for pediatric depressive disorder?

A

Lithium + SSRI/Bupropion (adjunct)

61
Q

What antidepressant is approved for 8+

A

Fluoxetine

62
Q

What antidepressant is approved for 12+

A

Escitalopram

63
Q

What antidepressant should NOT be used in children?

A

Paroxetine

64
Q

What is first line therapy for pediatric depression?

A

CBT

65
Q

What is first-line treatment for DMDD?

A

Stimulants + SSRIs

66
Q

What is DMDD?

A

Disruptive Mood Dysregulation Disorder - basically throwing hella tantrums

67
Q

What medications can be used for behavioral issues with Autism?

A

Risperidone, Aripiprazole (for irritability/aggression)

Haloperidol (for social isolation)

68
Q

What medication is preferred if comorbid ADHD and autism?

A

Methylphenidate

69
Q

What meds are used for repetitive behaviors in autism?

A

Antipsychotics (haloperidol, risperidone, aripiprazole)
SSRIs
Divalproex

70
Q

Treatment of separation anxiety disorder?

A

SSRIs and CBT

71
Q

Treatment of ODD/CD?

A

Stimulants and clonidine/guanfacine (ADHD common underlying condition)

72
Q

What is 2nd line treatment of ODD/CD?

A

Atypical antipsychtoics - used for severe persistent aggression, serious oppositional behaviors (defiance)

73
Q

Should ODD/CD be polypharmacy or monotherapy?

A

Monotherapy - only use poly if mono fails

74
Q

Treatment for Tourette’s?

A

Dopamine blockade - haloperidol, aripiprazole, risperidone/paliperidone (not FDA approved)
Pimozide

75
Q

What is the warning associated with pimozide?

A

WTc prolongation

76
Q

What CYP does pimozide have?

A

3A4 substrate

77
Q

Buspirone MOA?

A

5HT1a receptor agonist

78
Q

Buspirone proper dosing?

A

10 mg TID

79
Q

How long does buspirone take to work?

A

3-4 weeks

80
Q

Side effects of benzos?

A

Sedation, paradoxical excitement, swallowing difficulties, impairment of memory/recall, psychomotor impairment

81
Q

How long to d/c benzo?

A

Months

82
Q

Avoid benzos in who?

A

Elderly - fall risk!

83
Q

Hydroxyzine mechanism?

A

5HT2A antagonist and H1 antagonist (sedation/anticholinergic)

84
Q

Avoid hydroxyzine in who?

A

Elderly - fall risk and anticholinergic effects

85
Q

What can Kava cause?

A

Hepatotoxicity

86
Q

What can valerian cause?

A

hepatotoxicity and teratogenicity

87
Q

First line in anxiety?

A

SSRIs and SNRIs

88
Q

When is buspirone potential first line?

A

GAD

89
Q

When should benzos be used?

A

Only if necessary

90
Q

What anxiety disorders can atypical antipsychotics be considered in?

A

PTSD and treatment-resistant OCD

91
Q

GAD treatment?

A

SSRI –> SNRI –> Buspirone

Benzos used to bridge until onset of SSRI

92
Q

Social anxiety disorder treatment?

A

SSRI –> SNRI –> Mirtazapine/benzos/anticonvulsants
Phenelzine
Beta-blockers for performance

93
Q

What anxiety is phenelzine used in?

A

Social

94
Q

Panic disorder treatment?

A

SSRIs
SNRIs
TCAs, mirtazapine, MAOIs
Benzos - like last line as maintenance; can be used as bridge

95
Q

OCD treatment?

A

SSRIs
Clomipramine (TCA after a few SSRI failures)
Venlafaxine
Antipsychotics as augmentation - RISPERIDONE

96
Q

PTSD treatment?

A

SSRI/SNRI

MIrtazapine (if first failed)

97
Q

PTSD nightmare treatment?

A

Prazosin

98
Q

What drugs to avoid in PTSD?

A

Benzos!

99
Q

What meds could maybe prevent PTSD?

A 
Opioids
Beta blockers (propranolol)
100
Q

SSRIs/SNRIs can produce what symptom that seems like worsening anxiety?

A

Jitteriness

101
Q

Max response for SSRI/SNRI?

A

6 weeks

102
Q

When to use benzos as bridge?

A

If anxiety disorder severely impacts function

103
Q

What anti-anxiety really needs to be tapered

A

Benzodiazepines–prevent life threatening seizures!

104
Q

What non-pharma treatment is used for anxiety?

A

CBT and psychotherapy (mainstays of treatment)

105
Q

Insomnia treatment?

A 
Sleep hygiene/CBT
Z-hypnotics
Benzos
Melatonin
Doxepin
Suvorexant
106
Q

Sleep apnea treatment?

A

Weight loss
CPAP
Armodafinil/Modafinil for daytime sleepiness

107
Q

Narcolepsy treatment? Cataplexy

A

Sodium oxybate - twice per night, dose at bedtime and 2.5-4 hours later

108
Q

Sodium oxybate blackbox warning?

A

Cardiac depression and misues risk

109
Q

Excessive daytime sleepiness - narcolepsy treatment?

A

Stimulants
Armodafinil/Modafinil
Sodium oxybate
Selegiline

110
Q

Shift Work Sleep Disorder

A

Armodafinil/Modafinil 1 hour before shift

SLEEP HYGIENE

111
Q

RLS

A 
Dopamine agonist (ropinirol, pramipexole)
LD/CD
Gabapentin enacarbil
(Fe if Fe deficient)
Clonazepam
(NOT OPIATES)

Pharmacotherapy III (12 decks)

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