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Theraputics > Exam 4 spring P2 > Flashcards

Exam 4 spring P2 Flashcards

pass exam hopefully

1
Q

1st generation antipsychotics

A

-movement problems: EPS and tardive dyskinesia
- very effective for treating positive symptoms ( worse negative/ cognitive symptoms)

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2
Q

chlorpromazine (thorazine)

A

-antihistamine effects
- 1st antipsychotic

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3
Q

promethazine (phenergan)

A

-antihistamine effects
-antiemetic

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4
Q

fluepenazine (oermitil,proxilin)

A

-eps

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4
Q

thoridazine (mellaril)

A

-anticholingeric AEs
-sedation
-sexual dysfunction
- cv risk

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5
Q

prochlorperazine (compazine)

A

-antiemetic

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6
Q

perpehnazine (trilafon)

A

-CATIE studies-> combo with anticholinergics

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7
Q

thiothixene (navane)

A

-modest EPS

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8
Q

Haloperidol (haldol)

A

-EPS
-most commonly used routine and PRN
-most common standing order

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9
Q

haloperidol decanoate

A

IM injection
-z-track technique

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10
Q

Milindone (Moban)

A

-moderate EPS

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11
Q

Pimozide (orap)

A

-used in tourettes to supress tics

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12
Q

2nd gen antipsychotics

A
  • reduced EPS but more metabolic side effects
  • D2 (postsynaptic) and 5HT2A (presynaptic) antagonism -> increased synthesis and release of DA
    -13
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13
Q

clozapine (clozaril)

A

-weight gain, sedation, dry mouth, constipation, hypersalvation, GI hypomobility
- 1st atypical antipsychotic (very effective)
-agranulocytosis-> weekly blood monitoring
-third line
- risk of diabetes
- 1A2 substrate
- warning: neutropenia, orthostasis, bradycardia, syncope, seizures, myocarditit, cardiomyipathy
-QTc prolongation
-REMS: weekly, biweekly then every 4 weeks

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14
Q

Olanzapine (zyprexa)

A

-significant weight gain
-sedation
-risk of diabetes
-1A2 substrate
-high risk metabolic syndrome
-DRESS warning

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15
Q

Olanzapine/ samidorphan (lybalvi)

A

combo mitigates metabolic syndrome

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16
Q

zyprexa relpravv

A

-IM injection
-REMS program
-post dose delirium sedation syndrome -> Over dose (CNS depressant)
-can happen 24h later

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17
Q

loxapine (loxitane)

A

-older agent
-NET Inhibitor

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18
Q

adasuve (loxapine)

A

nasal spray for inhalation
-not commonly used

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19
Q

Quetiapine (seroquel)

A

-hypotension (alpha)
-sedation (H1)
-weight gain
-metabolite with antidepressant activity
-decent antipsychotic
-risk of diabetes
-3A4 substrate
-boxed warning -> suicidal ideation

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20
Q

risperidal consta

A

IM weekly
-must supplement with oral risperidone for first 4 weeks of treatment

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21
Q

perseris (risperidone)

A

q4w subQ injection
-abdominal
-3A4 inducer - 120mg dose
-may need oral supplementation

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22
Q

rykindo (risperidone)

A

q2w IM injection
-oral dose overlap is shorter than costa (7 days vs 21-28 days)

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23
Q

Uzedy (risperidone)

A

-abdominal or upper arm SubQ injection
-monthly or every other month

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24
Q

Risperidone (risperidol)

A

-low eps
-weight gain
-sedation
-hyperprolactinemia
-orthostasis
- designed to be both 5HT2A and D2 receptor antagonist A24
-2D6 substrate

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25
Q

paliperidone (invega)

A

-eps
-weight gain
- sedation
- hyperprolactinemia
-orthostasis
-renally eliminated (dose adjustment)
-QTc prolongation

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26
Q

invega sustenna (paliperidone)

A

-IM injection
-loading dose and booster w/in 7 days then every 4 weeks
-initial loading and booster given in deltoid
-no need for oral overlap
-may require dose adjustment -> renally eliminated

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27
Q

invega trinza (paliperidone)

A

-q3 months
- deltoid injection
-may be given to patient after 4 months of sustenna
-recommended for deltoid
-renal considerations

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28
Q

invega hafyra (paliperidone)

A

q6m gluteal IM injection
-may be initiated after sustenna 4 months or 1 dose of trinza
-gluteal only

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29
Q

IIoperidone (fanapt)

A

-structurally related to risperidone
-very potent at alpha 1 receptors
-high risk for orthostasis and syncope
-QTc prolongation
-2D6 substrate

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30
Q

aloperidone

A

sucks

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31
Q

ziprasidone (Geodon/ Zeldox)

A
  • QT prolongation
    -5HT2A, D2, alpha 1 affinity
    -QTc prolongation
    -DRESS warning
  • take with food
    -3A4 substrate
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32
Q

asenapine (saphris)

A

-antihistamine
-dopaminergic
-alpha antimuscarinic AE
-5HT2A
-D2 antagonist
-Sublingual ONLY
-and patch formulations
-1A2 substrate
-QTc prolongation

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33
Q

asenapine transdermal patch

A

apply every 24h
-reduce dose if given with strong 1A2 inhibitors-> fluvoxamine

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34
Q

lurasidone (latuda)

A

-less weight gain and metabolic effects
-fast onset
-low doses effectiveness similar to high dose
-rapid titration
-3A4 substrate
-higher risk for akathisia
-warning for suicide
-take with food

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35
Q

pimavanserin (nuplazid)

A

-inverse 5HT2A agonist
-used for PD psychosis
-3A4 substrate

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36
Q

D2/D3 receptor partial agonist

A

-stabilize DA transmission
- associated with more akathisia
-adjunct in depression
-warning for suicide

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37
Q

brexpiprazole (rexulti)

A

-moderate akathesis
-low moderate weight gain
-2D6 and 3A4 substrate

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38
Q

cariprazine (vraylar)

A

-akathesia
-low moderate weight gain
-3A4 substrate

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39
Q

lumateperone (caplyta)

A

-low risk for weight gain
-metabolic side effects
-EPS
-akathesia
-3A4 susbtrate
-once daily

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40
Q

aripiprazole (abilify)

A

-weight gain
-low risk for D2 effets
-moderate akathesia
-high affinity to 5HT2 and D2
-partial agonist at 5HT1A receptors (depression)
-prodrugs
-2D6 and 3A4 substrate -> interactes with fluoxetine

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41
Q

abilify maintena

A

-IM deltoid or gluteal q4w
-must overlap with oral aripiprazole for at least 14 days

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42
Q

abilify asimtufii

A
  • gluteal IM q2m
    -continue oral aripiprazole for 2 weeks after 1st injection
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43
Q

aristada

A

-prodrug of aripiprazole
- overlap with oral aripiprazole for 1st 3 weeks

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44
Q

aristada initio

A

-avoids 21 day overlap of antipsychotic
-avoid in pts who are poor 2D6 metabolizers
-avoid with strong 3A4 or 2D6 inhibitors

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45
Q

VMAT inhibitors

A

-inhibit VMAT to decrease storage/ increase release DA serotonin and NE
-treat TD
-dose adjustment for 2D6 inhibitors or 3A4 inducers

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46
Q

valbenazine (ingrezza)

A

-QTc prolongation
-weight gain
- rash
-anxiety
2D6 and 3A4 substrate

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47
Q

Deutetrabenazine (austedo)

A

-QTc prolongation
-anxiety
-2D6 substrate

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48
Q

Antipsychotics

A

increased risk of death in elderly pts with dementia with related behaviors
-fall risk assessment

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49
Q

2D6

A

fluoxetine, paroxetine are inhibitors

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50
Q

1A2

A

cigarette smoke decreases antipsychotic serum concentrations
-FLUVOZAMINE is a 1A2 inhibitor

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51
Q

3A4

A

inhibitors- conazole, mycin, grapefruit
inducers- phenobarbital, phenytoin, st. johns wort
CARBAMAZEPINE is inducer

52
Q

Buspirone (buspar)

A
  • 5HT1A receptor agonist
    -partial agonist on brain 5HT1A receptors
    -moderate affinity for D2 receptors
    -1st line-> GAD
    -not good for panic disorder
    -AEs: sedation, paradoxical effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
    -target dose of 10-15mg TID
    -3-4 weeks for efficacy
53
Q

alprazolam (xanax)

A

-BZD
-works on GABA to increase opening frequency
-2nd line if necessart
-short term use after sertonergic trial
-BRIDGE therapy
-approved for panic disorder
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
-no active metabolites
-D/C requires taper

54
Q

lorazepam (ativan)

A

-BZD
-increase GABA opening frequency
-2nd line if necessary
-preferred in elderly
-bridge therapy
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment

55
Q

clonazepam (klonopin)

A

-BZD
-increase GABA opening frequency
-2nd line
-bridge therapy
-approved for panic
-AEs: sedation, paradoxial effects, swalloing difficulties, impairment of memory/recall, psychomotor impairment

56
Q

diazepam (valium)

A

-BZD
-increase GABA opening frequency
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
-2nd line
-bridge therapy
-LONG ACTING metabolite-> accumulation

57
Q

oxazepam (serax)

A

-BZD
-increase GABA opening frequency
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
-2nd line
-bridge therapy
-preferred in elderly
-no active metabolite

58
Q

temazepam (restoril)

A

-BZD
-increase GABA opening frequency
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
-2nd line
-bridge therapy
-short term hypnotic
-preferred in elderly
-no active metabolite

59
Q

midazolam (rversed)

A

-BZD
-increase GABA opening frequency
-AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
-rapid anesthesia

60
Q

hydroxyzine

A

-5HT2A antagonist
-histamine (H1) receptor antagonist
-GAD
-prn anxiety or insomnia
-avoid in elderly
-AEs: sedation, anticholinergic, QTc prolongation, fall risk

61
Q

Propranolol (inderal)

A

-beta blocker
-low dose for anxiety
-acute physiological symptoms of anxiety
-preformance and situational anxiety
-AEs: hallucination, vivid dreams, lethargy, impotence, CV effects
-evaluate CV conditions
-may require test dose

62
Q

Gabapentin/ pregabalin

A

-occasionally prescribed for GAD
-good for those with bipolar disorder with anxiety symptoms or neuropathic pain

63
Q

quetiapine

A

-not endorsed
-theorized to have anxiolytic properties at low doses
-used for anxiety and sleep

64
Q

paroxetine/escitalopram

A

-SSRI
-1st line for all anxiety disorders
-jitteriness syndrome-> start at low doses
-AEs: insomnia, n/v, drowsiness
-25-50% reduction in OCD symptoms
-onset of action is 2-4 weeks

65
Q

duloxetine/ venlafaxine

A

-SNRI
-useful 1st line in GAD if pt also has pain syndrome
-venlafaxine applicable for social and panic
-jitteriness syndrome-> start low
-onset of action ~2-4 weeks

66
Q

aripiprazole/ risperidone

A

-atypical antipsychotics (serotonergic and dopaminergic blockade)
-NOT FDA approved for anxiety
-clinical evidence suggest efficac for tx resistant OCD (in addition to SSRI)
-AEs: weight gain, low EPS risk, akathasia, jitteriness, constipation
-do not drink on this medication -> enhance CNS depression

67
Q

clomipramine

A

-TCA
- 2nd line for OCD

68
Q

azosin

A
  • used for sleep nightmares associated with PTSD
69
Q

clonidine (catapres)

A

-alpha 2 agonist
-panic attacks, anxiety associated with withdrawl

70
Q

fluoxetine (prozac)

A

-SSRI
-jitteriness syndrome -> start low
-AEs: insomnia, appetite supression, ED, n/v, drowsiness

71
Q

setraline (zoloft)

A

-SSRI
-PTSD
-AEs: dizziness, trouble sleeping

72
Q

Romazicon

A

-tx BZD overdose (and z-hypnotics)
-AEs: agitation, confusion, nausea, vomiting, HA

73
Q

BZDs

A

NOT USED IN PTSD

74
Q

Zalepon (sonata)

A

-z-hypnotic
-interacts with alpha 1 subunit of GABA-A receptor
-sleep onset
-SHORT TERM
-AEs: somnolence, dizziness, ataxia, HA, parasomnia, n/v
-rapid action and elimination
-little tolerance or dependence
-3A4 metabolite
-flumazenil for OD

75
Q

Eszopiclone (lunesta)

A

-z-hypnotic
-interacts with alpha 1 subunit of GABA-A receptor
-sleep onset and maintenance
-LONG TERM
-AEs: hangover, metallic taste, somnolence, dizziness, ataxia, HA, parasomnia, n/v
-active enantiomer of zopiclone
-only Z-hypnotic approved for long term use
-3A4 metabolite
-flumazenil for OD

76
Q

zolpidem (ambien)

A

-z-hypnotic
-interacts with alpha 1 subunit of GABA-A receptor
-sleep onset and maintenance
-SHORT TERM
-AEs: somnolence, dizziness, ataxia, HA, parasomnia, n/v
-intital dose in women and elderly is lower (5mg)
-ambien CR for sleep maintenance
-3A4 metabolite
-flumazenil for OD

77
Q

temazepam

A

-BZD
-sleep onset and maintenance
-Benzo drug of choice for sleep
-AEs: drowsiness, dizziness, cognitive impairment, increased fall risk

78
Q

Triazolam

A

-BZD
-sleep onset

79
Q

barbiturate moa

A

bind GABA-A
-increase DURATION of channel opening

80
Q

phenobarbital (luminal)

A

-barbituate
-anticonvulsant
- dependence, tolerance, abuse, withdrawl, after effect, respiratory and CNS depression at high doses
- Higher risk of CNS/ respiratory depression

81
Q

pentobarbital (nembutal)

A

-barbituate
-sedative/hypnotic
-not commonly used
-dependence, tolerance, abuse, withdrawl, after effect, respiratory depression and CNS depression at high doses
-HIGHER risk of CNS/respiratory depression

82
Q

melatonin agonist

A

-high affinity for MT1 and 2 receptors
-sleep onset
-ramelteon
-tasimelteon

83
Q

Ramelton (rozerem)

A

-melatonin agonist
-sleep onset
-AEs: GI upset, next day somnolence, hyperprolactinemia, prolactinoma
-1A2 substrate
-contraindiacets w/ fluvoxamine
-NO abuse, withdrawl/dependency

83
Q

Tasimelton (hetlioz)

A

-melatonin agonist
-sleep onset
-FDA approved for non-24 sleep wake disorder in adults
-orphan product

83
Q

orexant receptor antagonist

A

-high affinity for OX1 and 2 receptors in the hypothalamus
-decrease arousal and attention
-reduce rewarding stimuli (DA release) that modulate mesolimbic projection between VTA and nucleus accumbens
-Sleep maintenance
-narcolepsy like side effects, morning impairment likely
-3A4 substrates
-contraindicated in narcolepsy
-7 hours of sleep
-potential for worsening depression and suicidal ideation
-Suvorexant (belsomra)
-lemborexant
-daridorexant

84
Q

Dozepin (silenor)

A

-TCA
-low doses exert effect through H1 receptor antagonism
-sleep maintenance
-AEs: suicidality warning, sleep behaviors, anticholinergic side effects

85
Q

trazadone

A

-antidepressant
-NOT FDA approved for insomnia
-daytime hangover

86
Q

mirtazapine

A

-sleep agent for depressed pts
-sedation and weight gain

87
Q

quetiapine

A

-atypical antipsychotic
- low dosed
-not recommended without comoribid psychiatric disorder

88
Q

modafinil

A

-wakefulness drug for excessive daytime sleepiness
-sleep apnea and narcolepsy
- shift work disorder
-AE: rash
-tx obstructive sleep apnea before recommending sedative/hypnotic drug

89
Q

armodafinil

A

-wakefulness drug
-sleep apnea and narcolepsy
- low dose
-only if other psychiatric comorbidity present
-shift work disorder
-AE: rash
-tx sleep apnea FIRST

90
Q

sorlamfetol

A

-tx excessive daytime sleepiness
-treast sleep apnea first

91
Q

sodium oxbyabte (GHB) -Xyrem

A

-binds to GABA-B, GABA-A, and GHB receptors
-narcolepsy
-AEs: loss of consciousness/reflexes, amnesia, n/v, HA, seizures, death
-HIGH sodium content
-2x night dosing
-presribing program
- can cause increased wakefulness in combo with stimulant -> CNS depression (dizziness, drowsiness, COMA

92
Q

Sodium oxybate (GHB) - Xywav

A
  • narcolepsy
    -lower sodium content
    -2x night dosing
93
Q

sodium oxybate (GHB) - lumryz

A

-narcolepsy
-ER dose
-adult only
-HIGH sodium content

94
Q

pitolisant (wakix)

A

-H3 receptor antagonist/ reverse agaonist
-excessive daytime sleepiness (narcolepsy)
- prolongs QTc interval
- contraindicated in hepatice impairment
-2D6/3A4 substrate
-weak 3A4 inducer -> decreases effect of oral contraceptives
-avoid use with OTC antihistamines

95
Q

solriamfetol (sunosi)

A

-dopamine noreponephrine reuptake inhibitor (DNRI)
-wakefulness drug for excessive daytime sleepiness (sleep apnea and narcolepsey)
-AEs: increases BP and HR
-renal dosing 37.5mg
-avoid use in unsatble CV disease and arrythmias
-caution in pts with a history of psychosis or bipolar

96
Q

restless leg syndrome

A

-gabapentin enacarbil
-pramipexole
-ropinerol

97
Q

Anorexia

A

-refeeding inpatient: 2-3lbs/ week
-outpatient is 0.5-1lb/ week
-increase calories slowly: inpatient- 500 cals/day, outpatient- 1200-1500 cal/day
-no approved drug therapy

98
Q

olanzapine (zyprexa)

A

-atypical antipsychotic
-anorexia
-WEIGHT GAIN

99
Q

SSRIs

A

-anorexia
-little benefit for core symptoms

100
Q

lisdexamfetamine (vyvanse)

A

-stimulant
-FDA approved for binge eating disorder

101
Q

drugs studied for binge eating

A

-atomoxetine
-TCAs
-armodafinil

102
Q

fluoxetine (prozac)

A

-SSRI
-FDA approved for bulimia nervousa

103
Q

well studied for bulimia

A

-citalopram
-sertaline

104
Q

stimulant AEs

A

-loss of appetite
-abdominal pain
-sleep disurbances
-decreased growth-hallucinations or other psychosis symptoms
-increased BP and HR
-sudden cardiac death (rara)
-priapism
-peripheral Raynauds

105
Q

Methylphenidate

A

-1st line for preschool or elementary/middle school kids or adults
-HTN, tachycardia, bipolar, anorexia, tourettes, seizure disorder
-monitor CV health, height, and weight
-IR for pts <16kg

106
Q

amphetamine

A

-1st line for elementary/middle school aged children
-HTN, tachycardia, bipolar, anorexia, tourettes, seizure disorder

107
Q

mixed amphetamine salts

A

mydayis

108
Q

methylphenidate LA

A

-daytrana
-patch stimulant

109
Q

lisdexamfetamine (vyvanse)

A

-1st line for adults
-prodrug converted to dextroamphetamine
-conversion requirement = missue detterent

110
Q

methylphenidate HCL

A

-journay PM
-take dose in the evening to cover next morning

111
Q

alpha 2 agonist

A

-2nd line choice for elementary/middle school aged kids, adjunct tx with stimulants
-AEs: decreased HR/BP, orthostasis, somnolence, dizziness, rebound hypertension
-must be tapered to avoid rebound HTN

112
Q

guanfacine ER (intuniv)

A

-3A4 substrate

113
Q

clonidine ER

A

kapvay

114
Q

atomoxetine (strattera)

A

-2nd line for elementary/middle school kids
-Norepinephrine reuptake inhibitor
-AEs: increase HR and BP, increase in suicidal thinking
-2D6 substrate
-weight based dosing around 70kg
-monitor liver fxn

115
Q

Vilozazine (quelbree)

A

-NET inhibitor
-2D6 substrate/ UGT substrate
-strong 1A2 inhibitor
-swallow whole

116
Q

bupropion (welbutrin)

A

-not FDA approved for ADHD
-2D6 inhibitor
-CI in siezure and eating disorder
-3rd line

117
Q

modafinil (provigil)

A

-FDA approved for narcolepsy, obstructive sleep apnea, shift work sleep disorder
-AEs: HA, decrease appetite, GI intolerance
-Warning for SJS/TENS

118
Q

desipreamine

A

-TCA
-AE: cardiac conditions -> sudden cardiac death

119
Q

Carbamazepine and Valproate

A

-atypical antipsychotics
-useful in comorbid bipolar, conduct disorder, intermittent explosive disorder
-NOT MONOTHERAPY

120
Q

clonidine (kapvay)

A

-1st line for tics-> 30% decrease
-atypical antipsychotic

121
Q

guanfacine (intuniv)

A

-tic disorder

122
Q

aripiprazole

A

-2nd line for tics ->30-60% decrease
-atypical antipsychotic

123
Q

risperidone

A

-tic disorder

124
Q

Haloperidol

A

-3rd line for tics -> 80% reduction
-typical antipsychotic

125
Q

pimozide

A

-tic disorder

126
Q

Oppositional Defiant Disorder/ Conduct Disorder

A
  • 1st line combo of stimulants and clonidine/guanfacine

Theraputics (4 decks)

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