Exam 4 Misc Flashcards
1
Q
MOA - Trintellix
A
SERT, 5HT1A partial agonist, 5HT3
2
Q
Vilazodone
A
SERT, 5HT1A partial agonist
3
Q
Maprolitine
A
NET Inhibitor
4
Q
Amoxapine
A
NET inhibitor
D2 antagonist
5
Q
Mirtazapine
A
Alpha 2 antagonist
5HT2 and 5HT3 antagonist
H1 antagonist
6
Q
Bupropion
A
DAT, NET, SERT Inhibitor
7
Q
Trazodone
A
5HT2A antagonist
8
Q
Nefazodone
A
5HT2A antagonist
9
Q
Rebosetine
A
NSRI
10
Q
Atomoxetine
A
NSRI
11
Q
Tesofensine
A
SDNRI
12
Q
Tesofensine alternative use
A
appetite suppressant
13
Q
Etomidate
A
GABA - A Receptor, acts on Beta -2 and 3 subunits
14
Q
Propofol
A
GABA - A receptor - acts on Beta 2 and 3 subunit
15
Q
Picrotoxin
A
GABA channel blocker
16
Q
How does GABA - B work?
A
Inhibitory - decreases Ca on presynaptic and increases K+ on postsynaptic
17
Q
What is tasimelteon used for?
A
non-24-hour sleep wake disorder in the blind
18
Q
What NTs are associated with anxiety?
A
Serotonin (Low)
Norepinephrine (high)
GABA (low)
CRF (high)
19
Q
What are the non stimulants for ADHD?
A
Atomoxetine TCAs Bupropion Clonidine/guanfacine (not modafinil)
20
Q
What are the severity classifications for anorexia?
A
Mild: >17
Moderate: 16-17
Severe: 15-16
Extreme: <15
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
22
Q
How do you refeed with anorexia? Inpatient
A
500 cal/day increase every 4 days
23
Q
How do you refeed with anorexia? outpatient
A
500 cal/day increase every week
24
Q
What electrolytes are implicated in refeeding syndrome?
A
K, Phosphate, Mg
25
What hormone causes refeeding syndrome?
Insulin -- increases from switching to lots of glucose metabolism
26
ADHD side effects: Reduced appetite/weight loss
Eat high calorie meal when concentration is low (breakfast/dinner)
27
ADHD side effects: Stomachache?
Take with food, lower dose if possible
28
ADHD side effects: Insomnia?
Lower last dose, take earlier in day, add sleep med of needed
29
ADHD side effects: Headache?
Divide dose, give with food, APAP
30
ADHD side effects: Rebound symptoms?
Longer acting; antidepressant; atomoxetine
31
ADHD side effects: Irritability/jitteriness?
Lower dose; reconsider diagnosis; atypical antipsychotic/mood stabilizer
32
ADHD side effects: Dysphoria?
Lower dose or change stimulant
33
ADHD side effects: Zombie-like?
Lower dose or change stimulant
34
Tics/abnormal movement?
Lower dose, consider alternate therapy
35
ADHD side effects: increase BP/HR?
Lower dose, change stimulant
36
ADHD side effects: Hallucinations?
D/C stimulant; consider atypical antipsychotics/mood stabilizer
37
ADHD side effects: Sudden cardiac death?
Evaluate for FH of early CV disease, heart structure issues that are already present
38
What warning is associated with methylphenidate (and atomoxetine to some extent)?
Priapism
39
What warning is associated with all stimulants?
Raynaud's
40
What medication is in Daytrana?
Methylphendiate
41
What medication is in Vyvanse?
lisdexamfetamine
42
How long before needed effect should Daytrana be applied?
2 hours
43
Is Vyvanse SR?
No - but still swallow whole
44
What are ADEs of Strattera?
Gi upset, anorexia, weight loss
45
What are warnings for Strattera?
Liver toxicity, suicidal thinking
46
Is atomoxetine first line for ADHD?
Nope - stimulants are
47
HOw long do alpha-2 adrenergic agonists take to work?
4 weeks
48
What are guanfacine/clonidine good at treating? (which ADHD symptoms?)
Impulsivity
49
What MP needed for clonidine/guanfacine?
EKG - cardiac effects
50
Why do you taper guanfacine/clonidine?
rebound tachycardia
51
What are TCA used for associated w/ADHD?
insomnia normally
52
Bupropion is contraindicated with what?
Seizures and eating disorders
53
Modafinil is abusable ? T/F
True
54
Modafinil has shown evidence of ___
SJS
55
What mood stabilizers have also shown some effect w/ ADHD?
Carbamazepine
Valproic acid
NOT lithium
56
T/F: atypical antipsychotics can be used as monotherapy in patients with ADHD
FALSE
57
What weight is it recommended to use IR stimulant?
<15 kg
58
What meds are used for pediatric bipolar disorder WITH psychosis?
Lithium or valproate or carbamazepine WITH ATYPICAL ANTIPSYCHOTIC
59
What meds are used for pediatric bipolar disorder WITHOUT psychosis?
Lithium or valproate or carbamazepine or risperidone or olanzapine or quetiapine
60
What meds are used for pediatric depressive disorder?
Lithium + SSRI/Bupropion (adjunct)
61
What antidepressant is approved for 8+
Fluoxetine
62
What antidepressant is approved for 12+
Escitalopram
63
What antidepressant should NOT be used in children?
Paroxetine
64
What is first line therapy for pediatric depression?
CBT
65
What is first-line treatment for DMDD?
Stimulants + SSRIs
66
What is DMDD?
Disruptive Mood Dysregulation Disorder - basically throwing hella tantrums
67
What medications can be used for behavioral issues with Autism?
Risperidone, Aripiprazole (for irritability/aggression)
| Haloperidol (for social isolation)
68
What medication is preferred if comorbid ADHD and autism?
Methylphenidate
69
What meds are used for repetitive behaviors in autism?
Antipsychotics (haloperidol, risperidone, aripiprazole)
SSRIs
Divalproex
70
Treatment of separation anxiety disorder?
SSRIs and CBT
71
Treatment of ODD/CD?
Stimulants and clonidine/guanfacine (ADHD common underlying condition)
72
What is 2nd line treatment of ODD/CD?
Atypical antipsychtoics - used for severe persistent aggression, serious oppositional behaviors (defiance)
73
Should ODD/CD be polypharmacy or monotherapy?
Monotherapy - only use poly if mono fails
74
Treatment for Tourette's?
Dopamine blockade - haloperidol, aripiprazole, risperidone/paliperidone (not FDA approved)
Pimozide
75
What is the warning associated with pimozide?
WTc prolongation
76
What CYP does pimozide have?
3A4 substrate
77
Buspirone MOA?
5HT1a receptor agonist
78
Buspirone proper dosing?
10 mg TID
79
How long does buspirone take to work?
3-4 weeks
80
Side effects of benzos?
Sedation, paradoxical excitement, swallowing difficulties, impairment of memory/recall, psychomotor impairment
81
How long to d/c benzo?
Months
82
Avoid benzos in who?
Elderly - fall risk!
83
Hydroxyzine mechanism?
5HT2A antagonist and H1 antagonist (sedation/anticholinergic)
84
Avoid hydroxyzine in who?
Elderly - fall risk and anticholinergic effects
85
What can Kava cause?
Hepatotoxicity
86
What can valerian cause?
hepatotoxicity and teratogenicity
87
First line in anxiety?
SSRIs and SNRIs
88
When is buspirone potential first line?
GAD
89
When should benzos be used?
Only if necessary
90
What anxiety disorders can atypical antipsychotics be considered in?
PTSD and treatment-resistant OCD
91
GAD treatment?
SSRI --> SNRI --> Buspirone
| Benzos used to bridge until onset of SSRI
92
Social anxiety disorder treatment?
SSRI --> SNRI --> Mirtazapine/benzos/anticonvulsants
Phenelzine
Beta-blockers for performance
93
What anxiety is phenelzine used in?
Social
94
Panic disorder treatment?
SSRIs
SNRIs
TCAs, mirtazapine, MAOIs
Benzos - like last line as maintenance; can be used as bridge
95
OCD treatment?
SSRIs
Clomipramine (TCA after a few SSRI failures)
Venlafaxine
Antipsychotics as augmentation - RISPERIDONE
96
PTSD treatment?
SSRI/SNRI
| MIrtazapine (if first failed)
97
PTSD nightmare treatment?
Prazosin
98
What drugs to avoid in PTSD?
Benzos!
99
What meds could maybe prevent PTSD?
```
Opioids
Beta blockers (propranolol)
```
100
SSRIs/SNRIs can produce what symptom that seems like worsening anxiety?
Jitteriness
101
Max response for SSRI/SNRI?
6 weeks
102
When to use benzos as bridge?
If anxiety disorder severely impacts function
103
What anti-anxiety really needs to be tapered
Benzodiazepines--prevent life threatening seizures!
104
What non-pharma treatment is used for anxiety?
CBT and psychotherapy (mainstays of treatment)
105
Insomnia treatment?
```
Sleep hygiene/CBT
Z-hypnotics
Benzos
Melatonin
Doxepin
Suvorexant
```
106
Sleep apnea treatment?
Weight loss
CPAP
Armodafinil/Modafinil for daytime sleepiness
107
Narcolepsy treatment? Cataplexy
Sodium oxybate - twice per night, dose at bedtime and 2.5-4 hours later
108
Sodium oxybate blackbox warning?
Cardiac depression and misues risk
109
Excessive daytime sleepiness - narcolepsy treatment?
Stimulants
Armodafinil/Modafinil
Sodium oxybate
Selegiline
110
Shift Work Sleep Disorder
Armodafinil/Modafinil 1 hour before shift
| SLEEP HYGIENE
111
RLS
```
Dopamine agonist (ropinirol, pramipexole)
LD/CD
Gabapentin enacarbil
(Fe if Fe deficient)
Clonazepam
(NOT OPIATES)
```
