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Pharmacy School Spring P2 > Exam 4 psych > Flashcards

Exam 4 psych Flashcards

1
Q

What are the questionnaires used for depression?

A

Patient Health care questionnaire (PHQ-9) & Beck depression inventory (BDI)
-both patient rated
Hamilton Depression (HAM-D, HDRS) & Montgomery-Asberg Depression Rating Scale (MADRS)
-both clinician rated (used in clinical trials)

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2
Q

What evidence exists for the Glutamate hypothesis in Schizophrenia?

A

Phenycyclidine and ketamine (inhibitors of NMDA) exacerbate psychosis and cognition deficits

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3
Q

What evidence exists for the Serotonin hypothesis in Schizophrenia?

A

5HT2a receptors are bad for schizophrenia; they modulate dopamine release, gluamate release and NMDA receptors
5HT2c recetors may be good for schizophrenia

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4
Q

What evidence exists for the dopamine hypothesis in Schizophrenia?

A

-strong correlation between binding affinity and clinical effectiveness of D2 receptor antagonists
-Dopaminergic agents (L-DOPA, amphetamine, bromocriptine) exacerbate schizophrenia symptoms

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5
Q

What drug induced movement disorders are associated with D2 antagonism?

A

Extrapyramidal Symptoms (EPS)
Tardive Dyskinesia
Neuroleptic Malignant Syndrome (NMS)

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6
Q

When do the movement disorders associated with D2 antagonism occur?

A

EPS- early, days/weeks, reversible
Tardive Dyskinesia- later, months/year, irreversible
Neuroleptic Malignant Syndrome- rapid, serious 10% fatality

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7
Q

What are the treatments for EPS associated with D2 antagonism?

A

Drug induced Parkinson’s- Benztropine, trihexphenidyl, diphenhydramine (Benedryl), Amantadine
Akathisia- propranolol
Acute Dystonia- IM benzotripine 2 mg, IM diphenhydramine 50 mg

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8
Q

What are the treatments for tardive dyskinesia associated with D2 antagonism?

A

Prevention
-low dose, less risky agents, newer agents
-VMAT inhibitors
*Tetrabenazine, Valbenazine, Deutetrabenazine

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9
Q

What are the treatments neuroleptic malignant syndrome associated with D2 antagonism?

A

-DA agonists, diazepam, dantrolene
-Discontinue drug asap

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10
Q

What is important to know about clozapine& monitoring?

A

agranulocytosis, risk of diabetes, QTc prolongation
monitoring timeline: weekly x6 months, biweekly x6 months, then every 4 weeks

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11
Q

What is important to know about Olanzapine?

A

weight gain, risk of diabetes, DRESS warning, sedation

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12
Q

What is the interaction between cigarette smoking and CYP1A2?

A

smoke induces 1A2 which decreases serum concentration of 1A2 substrate antipsychotics (olanzapine, asenapine, clozapine, loxapine)

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13
Q

What are the typical antipsychotics?

A

Haloperidol, Fluphenazine, Loxapine, Chlorpromazine, Perphenazine, Thioridazine

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14
Q

What are the atypical antipsychotics?

A

Aripiprazole, Asenapine, Brexpiprazole, Cariprazine, Clozapine, Iloperidone, Lumateperone, Lurasidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Ziprasidone

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15
Q

What are the partial agonist antipsychotics

A

-increased akathisia
-aripiprazole, Brexpiprazole, cariprazine

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16
Q

What is important to know about Quetiapine?

A

boxed warning for suicidal ideation, sedation, weight gain

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17
Q

What is important to know about Asenapine?

A

-SL and patch formulations

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18
Q

What antipsychotics have QTc prolongation?

A

Asenapine, Clozapine, Quetiapine, iloperidone, Ziprasidone (Contraindication), Paliperidone

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19
Q

What are the risperidone long-acting injections?

A

Risperdal Consta -3/4 weeks oral overlap
Perseris- abdonimal SC injection
Rykindo -1 week overlap (every 2 week IM injection)
Uzedy- can give every 1 or 2 months

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20
Q

What are the paliperidone long-acting injections?

A

Invega sustenna
Invega trinza
Invega Hafyera

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21
Q

What are the aripiprazole long-acting injections?

A

Abilify Maintena- overlap for 2 weeks; adjust dose if on 2D6 or 3A4 inhibitor/inducers
Abilify Asimtufii- overlap for 2 weeks; every 2 month dosing
Aristada- prodrug; overlap for 3 weeks
Aristada Initio- no overlap; avoid in poor 2D6 metabolizers & strong 3A4/2D6 inhibitors

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22
Q

What medications are used for psychiatric emergenices?

A

most common: Haloperidol
chlorpromazine, fluphenazine, Olanzapine IM (CI with benzo’s)
loxapine (inhalation formulation)

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23
Q

What is important to know about Lumateperone?

A

-newest agent
-lower risk for EPS, akathisisa, metabolic AE’s, 3A4 substrate

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24
Q

What is the indication for Pimaranserin?

A

hallucinations/delusions in a patient with parkison’s disease, 3A4 substrate

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25
Q

What medications have an increased risk for DRESS syndrome?

A

Ziprasidone, Olanzapine

26
Q

What medications need to be taken with food to increase absorbtion?

A

Lurasidone, Ziprasidone
-both 3A4 substrates

27
Q

What is the benzodiazepine and Z-hypnotics antagonist?

A

Flumazenil
AE’s: induces convulsions; panic attacks for those who developed dependence

28
Q

Where do Barbiturates bind?

A

bind to all GABAa 1-5 and increase the duration of channel opening; and direct effects on GABAa channel; higher risk

29
Q

Where do Benzodiazepines bind?

A

bind to all GABAa 1-5 and increase frequency of GABAa channel opening; medium risk

30
Q

Where do Z-Hypnotics bind?

A

bind to GABAa BZ1 receptors increase FREQUENCY of GABAa channel opening; lower risk

31
Q

What is the Orexin Receptor Antagonist drug?

A

Suvorexant (Belsomra), Lemborexant, Daridorexant
-3A4 substrates
-CI in narcolepsy

32
Q

What are the melatonin agonist medications?

A

Ramelteon (Rozerem), Tasimelteon (Hetlioz)
-Tasimelteon approved for non-24 sleep-wake disorder in adults (blind people)
-Ramelton CI with fluvoxamine
both are 1A2 substrates -watch for inhibitors/inducers

33
Q

What neurotransmitters are involved in anxiety?

A

Norepinephrine -dysregulated in GAD,
GABA- signaling is reduced
Serotonin- reflects tone at multiple receptors

34
Q

What is the mechanism of action of Buspirone?

A

partial agonist on 5HT1a receptors; leads to an adaptive response

35
Q

What drugs do you take as an elderly for benzodiazepines?

A

lorazepam, oxazepam, temazepam

36
Q

What is the first line treatment for Generalized Anxiety Disorder?

A

SSRI antidepressants
-takes 2-4 weeks to find initial symptom relief
-paroxetine and escitalopram
-2nd line SNRIs/Benzos

37
Q

What is the first line treatment for Social Anxiety Disorder?

A

SSRI antidepressants
2nd line- SNRIs (Venlafaxine)

38
Q

What is the first line treatment for Panic Disorder

A

SSRIs
2nd line- SNRIs (Venlafaxine)
-benzos are not really recommended

39
Q

What is the first line treatment for OCD?

A

SSRIs
-25-50% reduction in symptoms can be expected
2nd line: Clomipramine
adjunct therapy possible with risperidone

40
Q

What is the first line treatment for Posttraumatic Stress Disorder?

A

SSRIs/SNRIs
-Prazosin may be helpful for nightmares
-Benzos not recommended

41
Q

What side effects can arise from using SSRIs and SNRIs for anxiety therapy?

A

-Jitteriness
-initial doses should be lower than doses used for depression to minimize jitteriness

42
Q

What are some drugs that are associated with insomnia?

A

Modafinil, Buproprion, Thyroid meds, Mood disorders

43
Q

What is first line treatment for Insomnia disorders?

A

1st line: non-pharm –sleep hygeine
2nd line: Zolpidem, eszopiclone, zaleplon)
eszopiclone- complaints of metallic taste
-all can cause parasomnias (weird sleep behaviors)
-additive effects with other CNS depressants
-3A4 substrates -metabolism is impacted by 3A4 Inhibition and induction

44
Q

What potential benzodiazepines can be used for sleep?

A

Temazepam

45
Q

What other drugs can be used for insomnia?

A

Doxepin -TCA; low doses; high anticholinergic adverse effects
Trazodone- not FDA approved, low doses, may have a daytime hangover
Mirtazepine- useful if patient also has depression
Quetiapine- low dose only recommended if there is a co-morbid psychiatric disorder

46
Q

What is the narcolepsy tetrad?

A

Cataplexy (sudden loss of muscle tone triggered by emotion), Hallucinations, Sleep paralysis, EDS (extreme daytime sleepiness)

47
Q

What medications treat cataplexy?

A

Sodium oxybate (Xyrem), GHB (high sodium content, most effective)
Xywav -lower sodium, approved for 7 & up
Lumryz -adults only, ER dosage, high sodium content

48
Q

What medications treat excessive daytime sleepiness?

A

modafinil/armodafinil, sodium oxybate, Pitolisant, Solriamfetol

49
Q

What are some important counseling points for Pitolisant?

A

avoid with OTC antihistamines; may reduce efficacy of oral contraceptives; CI in severe hepatic impairment; QTc prolongation
-MOA is a H3 receptor antagonist

50
Q

What are some important counseling points for solriamfetol?

A

-caution in patients with CV issues (increases BP and HR); caution in patients with psychosis/bipolar disorders

51
Q

What are common counseling points for Aripiprazole, Brexpiprazole?

A

2D6 and 3A4 substrate
low weight gain vs low-moderate for brexpiprazole
moderate akathisia

52
Q

What alpha 2 agonists are indicated in ADHD?

A

guanfacine ER -3A4 substrate
clonidine ER -must be tapered to avoid rebound hypertension if discontinued

53
Q

What are the Norepinephrine Reuptake Inhibitors?

A

Atomoxetine -weight based dosing
Viloxazine
*boxed warning for increase in suicidal thinking

54
Q

What are the ADHD guidelines for adults?

A

1st line: Methylphenidate or lisdexamfetamine
2nd line: Dextroamphetamine
3rd line: Atomoxetine

55
Q

What is the treatment for Tourette’s disorder?

A

rule of thirds!
1st line: clonidine; Guanfacine (ER)
2nd line: Aripiprazole - weight based dosing,
3rd line: Haloperidol, Pimozide

56
Q

What are the indications for Risperidone in peds?

A

Bipolar disorder; Irritability with autism; Schizophrenia

57
Q

What are the indications for Aripiprazole in peds?

A

Bipolar disorder; Tourette’s Disorder; Schizophrenia; Irritability with Autism

58
Q

What antipsychotics have a boxed warning for suicidal ideation?

A

Lurasidone, Quetiapine, Aripiprazole, brexpiprazole, Cariprazine

59
Q

What is the treatment for Bulimia Nervosa?

A

Fluoxetine is FDA-approved

60
Q

What is the treatment for Binge Eating Disorder?

A

Lisdexamfetamine (Vyvanse) is FDA-approved
-CBT + medication = best outcome

61
Q

What drug is CI in anorexia nervosa?

A

Bupropion is contraindicated

Pharmacy School Spring P2 (11 decks)

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