FIrst Aid: Psychopharmacology Flashcards
1
Q
What antidepressant class is used to treat enuresis?
A
TCAs
2
Q
What antidepressant class is used to treat Autism?
A
SSRIs
3
Q
What antidepressant class is used to treat premenstrual dysphoric d/o?
A
SSRIs
4
Q
What is the treatment for the depressive phase of manic depression?
A
SSRIs, bupropion
5
Q
What is the treatment for insomnia?
A
- Mirtazapine
- TCAs
6
Q
What antidepressant class is used to treat neuropathic pain?
A
TCAs
7
Q
What antidepressant class is used to treat dysthymia?
A
SSRIs
8
Q
What is the MOA of TCAs?
A
-Inhibit reuptake of NE and 5-HT
9
Q
Why are TCAs not first-line agents?
A
higher incidence of side effects, require greater monitoring of dosing and are lethal in overdose
10
Q
What is the hallmark of TCA toxicity?
A
widened QRS (>100 msec)
11
Q
List examples of TCAs
A
-ipramine
-triptyline
Doxepin
12
Q
Which TCA is least likely to cause orthostatic hypotension?
A
nortriptyline
13
Q
Which TCA is least sedating (least anticholinergic side effects)?
A
desipramine
14
Q
Which TCA is the most serotonin specific?
A
Clomipramine
15
Q
What is clomipramine specifically used to treat?
A
OCD
16
Q
How do you treat a TCA overdose?
A
IV sodium bicarbonate
17
Q
What are the major TCA side effects?
A
- antiHistamine (sedation)
- antiAdrenergic (orthostatic hypotnesion, tachycardia, arrhythmia)
- antiMuscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia)
- weight gain
- lethal in overdose
- 3 C’s
18
Q
What dosage of TCA’s is lethal in OD?
A
1 week supply
19
Q
What are the 3 C’s of TCAs?
A
- Convulsions
- Coma
- Cardiotoxicity
20
Q
What is the MOA of MAOIs?
A
prevent the inactivation of biogenic amines such as NE, 5-HT, dopamine, and tyraminMOA-e (increase amount of these transmitters available in synapses)
21
Q
MAO-A preferentially deactivates what neurotransmitter?
A
serotonin
22
Q
MOA-B preferentially deactivates what neurotransmitter?
A
NE/epinephrine
23
Q
MOAIs are very effective for what conditions?
A
- Refractory depression
- Refractory panic disorder
24
Q
List some examples of MAOIs.
A
- Phenelzine
- Tranylcypromine
- Isocarboxazid
25
What are the common side effects of MAOIs?
- Orthostatic hypotension
- Drowsiness
- Weight gain
- Sexual dysfunction
- Dry mouth
- Sleep dysfunction
26
What happens when SSRIs and MAOIs are taken together?
serotonin syndrome (lethargy, restlessness, confusion, flushing, diaphoresis, tremor and myoclonic jerks)
27
What does serotonin syndrome progress into?
```
Hyperthermia
Hypertonicity
Rhabdomyolysis
Renal Failure
Convulsions
Coma
Death
```
28
What is the first step when suspecting serotonin syndrome?
discontinue medication
29
How long must you wait before you switch from an SSRI to MAOIs?
at least 2 weeks
30
When would you get a hypertensive crisis when on MAOIs?
if you take it with tyramine-rich food or sympathomimetics
31
What type of foods have tyramine?
- Chianti wine
- Cheese
- Chicken liver
- Fava beans
- Cured meats
32
Why do you get a hypertensive crisis when you take an MAOI with foods with tyramine?
causes a build-up of stored catecholamines
33
What is the MOA of SSRIs?
Inhibit presynaptic serotonin pumps, leading to increased availability of serotonin in synaptic clefts
34
Why are SSRIs the most commonly prescribed antidepressants?
- Low incidence of side effects
- No food restrictions
- Much safer in overdose
35
List the SSRIs.
- Fluoxetine, Fluvoxamine
- Paroxetine
- Sertraline
- Citalopram (and escitalopram)
36
Which SSRI has the longest half-life (so no need to taper)?
fluoxetine
37
Which SSRI has the highest risk of GI disturbances?
sertraline
38
Which SSRI is most serotonin specific and most activating?
paroxetine
39
Which SSRI is currently only approved for use in OCD?
fluvoxamine
40
Which SSRI is the levo enantiomer of citalopram?
escitalopram (much more expensive and fewer side effects)
41
What neurotransmitters do the SSRIs not act on?
histamine
adrenergic
muscarinic
42
What are the common side effects of SSRIs?
- Sexual dysfunction
- GI disturbance
- Insomnia
- HA
- Anorexia, weight loss
- Serotonin syndrome when used with MAOIs
43
Atypical antidepressants include which classes of drugs?
SNRIs (serotonin/NE)
NDRIs (NE/DA)
SARIs (5-HT antagonist)
NASAs (NE/5-HT)
44
What is the example of an SNRI?
venlafaxine
45
What is a side effect of venlafaxine?
can increase BP
46
What happens if you miss 1-3 doses?
potential withdrawal (flu-like symptoms and electric-like shocks or zaps)
47
What is the example of NDRIs?
Buproprion (Wellbutrin)
48
What are the major uses for buproprion?
- Smoking cessation
- Seasonal affective disorder
- Adult ADHD
49
What is the most significant advantage of buproprion?
Lack of sexual side effects
50
At high doses, what could buproprion do?
it's dopaminergic effect can exacerbate psychosis
51
What are some side effects of buproprion?
increased sweating
increased risk of seizures
psychosis
52
What patients should not take buproprion?
- Pts with significant anxiety
| - Contraindicated in patients with seizure or active eating disorder
53
List the examples of SARIs.
- Nefazodone
| - Trazodone
54
What are the uses of SARIs?
- Refractory major depression
- Major depression with anxiety
- Insomnia (secondary to its sedative effects)
55
What are the side effects of SARIs?
- Nausea
- Dizziness
- Orthostatic hypotension
- Cardiac arrhythmias
- SEDATION
- PRIAPISM
56
List an example of a NASA?
Mirtazapine
57
What is mirtazapine used for?
Refractory major depression (especially in patients who need to gain weight)
58
What are the side effects of mirtazapine?
- sedation
- weight gain
- dizziness
- somnolence
- tremor
- agranulocytosis
59
What is the dose of mirtazapine with the maximal sedative effect?
15 mg of less
60
What happens to the sedative effect of mirtazapine at higher doses?
increases NE uptake and is less sedating
61
What is the MOA of traditional (typical) anipsychotics?
block dopamine receptors
62
What is the MOA of atypical antipsychotics?
block both dopamine and serotonin receptors
63
Why do atypical antipsychotics have fewer side effects than typical?
their effect on dopamine is weaker
64
List the 2 low potency traditional antipsychotics.
Chlorpromazine
| Thioridazine
65
What does "low potency" mean as far as antipsychotics go?
lower affinity for dopamine receptors (so higher doses are required)--DOES NOT MEAN LOWER LEVEL OF EFFICACY
66
True or false: low potency typical antipsychotics have higher incidence of anticholinergic and antihistaminic side effects
TRUE
67
True or false: low potency typical antipsychotics have higher incidence of EPS and NMS than high potency typical antipsychotics
FALSE- high potency do!
68
List the 5 major high potency typical antipsychotics.
```
Haloperidol
Fluphenazine
Trifluoperazine
Perphenazine
Pimozide
```
69
What does "high potency" mean as far as antipsychotics go?
greater affinity for dopamine receptors and a relatively low dose is needed to achieve effect
70
Which high potency typical antipsychotics are available in long-acting forms (decanoate)?
haloperidol and fluphenazine
71
How often must you give IM injections of haloperidol decanoate?
every 4-5 weeks
72
How often must you give IM injections of fluphenazine decanoate?
every 2-3 weeks
73
Dopamine naturally inhibits what chemicals?
Prolactin
| Acetylcholine
74
List the 4 antidopaminergic effects.
- Parkinsonism
- Akathisia
- Dystonia
- Hyperprolactinemia
75
What word is used to describe the EPS of masklike face, cogwheel rigidity and pill rolling tremor?
parkinsonism
76
What word is used to describe the EPS of subjective anxiety and restlessness and objective fidgetiness?
akathisia
77
What word is used to describe the EPS of sustained contraction of muscles of neck, tongue, eyes (painful)?
dystonia
78
What does hyperprolactinemia cause?
- Decreased libido
- Galactorrhea
- Gynecomastia
- Impotence
- Amenorrhea
- Osteoporosis
79
How do you treat EPS?
Reducing dose of antipsychotic +treatment with antiparkinsonian, anticholinergic, or antihistaminic medications (ex. amantadine, benadryl, or benzotropine)
80
What is another name for benzotropine?
cogentin
81
What are some anti-HAM side effects of antipsychotics?
- Anti-Histamine- sedation
- Anti-Alpha Adrenergic- orthostatic hypotension, cardiac abnormalities, sexual dysfunction
- Anti-Muscarinic- dry mouth, tachycardia, urinary retention, blurry vision, constipation
82
What is another general side effect of antipsychotics?
WEIGHT GAIN
83
What hepatic side effects are associated with antipsychotics?
Elevated liver enzymes
| Jaundice
84
What opthalmologic problems are associated with antipsychotics?
- Irreversible retinal pigmentation with high doses of thioridazine
- Deposits in lens and cornea with chlorpromazine
85
What dermatologic problems are associated with antipsychotics?
- Rashes
- Photosensitivity
- Blue-gray skin discoloration (chlorpromazine)
86
What type of antipsychotics are more likely to cause seizures?
low-potency (lower seizure threshold)
87
What is the word for choreoathetoid (writhing) movements of mouth and tongue that occur in pt's with long-term neuroleptic use?
tardive dyskinesia
88
What causes tardive dyskinesia?
Increase in number of dopamine receptors (causing lower levels of Ach)
89
How long do you take neuroleptics before you get tardive dyskinesia?
> 6 months (usually in older women)
90
What is the prognosis for tardive dyskinesia?
50% of cases spontaneously remit
| Untreated cases may be permanent
91
Who gets neuroleptic malignant syndrome?
males early in treatment
92
What is the prognosis for NMS?
20% mortality rate if untreated
93
What often precedes NMS?
catatonic state
94
What are the s/s of NMS?
FALTER
Fever (most common)
Autonomic instability (tachycardia, labile hypertension, diaphoresis)
Leukocytosis
Tremor
Elevated CPK
Rigidity (lead pipe rigidity almost universal)
95
How do you treat NMS?
- Discontinue current medications
- Administer supportive medical care (hydration, cooling, etc.)
- Sodium dantrolene, bromocriptine, amantadine
96
Is NMS an allergic reaction?
no
97
Can you ever restart a specific neuroleptic after it causes NMS?
yes!
98
What is the MOA of atypical antipsychotics?
Block both dopamine and serotonin receptors
99
Why are atypical antipsychotics sometimes preferred over typical?
less side effects (rarely cause EPS, tardive dyskinesia, or NMS)
100
List some examples of atypical antipsychotics.
```
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
```
101
What atypical is FDA approved as an adjunct for depression?
aripiprazole
102
Which atypicals are FDA approved for the treatment of mania?
quetiapine
| ziprasidone
103
Which atypical is only used in severe refractory cases?
clozapine
104
Which is the only generic atypical?
risperidone
105
Which atypical requires weekly blood draws to check WBCs due to 1% risk for agranulocytosis?
clozapine
106
True or false: atypical antipsychotics do not have anti-HAM side effects?
false! they do have some
107
Other than agranulocytosis, what is the major side effect of clozapine?
2-5% incidence of seizures
108
What must be monitored in patients on olanzapine?
LFTs (can cause liver toxicity
109
What is another common problem with olanzapine?
METABOLIC ISSUES
| Weight gain, hyperlipidemia, glucose intolerance
110
Which atypical requires slit lamp eye exams every 6 months?
quetiapine
111
Which typical antipsychotic performs as well as the atypicals?
perphenazine
112
What is another term for mood stabilizers?
antimanics
113
What are mood stabilizers used for?
- acute mania
| - preventing relapses of manic episodes
114
How might mood stabilizers be good in an agitated demented or mentally retarded individual?
can be used to treat aggression and impulsivity
115
Mood stabilizers are used to potentiate what 2 classes of drugs?
- Antidepressants (in refractory MDD)
| - Antipsychotics (in treatment of schizophrenia)
116
What is the use for mood stabilizers in treating alcoholism?
enhancement of abstinence
117
List the mood stabilizers.
Lithium
Carbamazepine
Valproic acid
118
What is the proposed MOA for lithium?
alters neuronal sodium transport
119
What is the mechanism of excretion for lithium?
secreted by kidney
120
How long does it take lithium to work (onset of action)?
5-7 days
121
What is the major drawback of lithium?
VERY narrow therapeutic index (.7-1.2)
Toxic above 1.5
Lethal above 2
122
What factors affect lithium levels?
- NSAIDS (decrease)
- Aspirin
- Dehydration (increase)
- Salt deprivation (increase)
- Impairedrenal function (increase)
- Diuretics
123
What are some unique side effects of lithium?
```
Thyroid enlargement
Hypothyroidism
Nephrogenic DI
Metallic taste
Benign leukocytosis
Edema
```
124
What does a patient look like who has lithium toxciity?
- AMS
- Coarse tremors
- convulsions
- death
125
What should be monitored regularly in a patient on lithium?
- Blood levels of lithium
- TFTs
- Kidney function (GFR)
126
What drugs are used to treat mixed episodes and rapid-cycling bipolar disorder?
```
carbamazepine (tegretol)
valproic acid (depakene)
```
127
What can carbamazepine also be used to treat?
trigeminal neuralgia
128
What is the MOA of carbamazepine?
blocks sodium channels and inhibits action potentials
129
What is the onset of actionf or carbamazepine?
5-7 days
130
What are some unique side effects of carbamazepine?
- Leukopenia
- Hyponatremia
- Aplastic anemia
- Agranulocytosis
131
What must be taken before starting a patient on carbamazepine or valproic acid and regularly after starting?
CBC
| LFTs
132
What is the teratogenic effect of taking carbamazepine or valproic acid during pregnancy?
neural tube defects
133
What is the proposed MOA of valproic acid?
increases CNS levels of GABA
134
What are some unique side effects of valproic acid?
- Hepatotoxicity
- Thrombocytopenia
- Hemorrhagic pancreatitis
- Alopecia
135
What are the most widely used class of psychotropic medications?
anxiolytics
136
What is an advantage of benzos over barbiturates?
Benzos are safer at high doses (but can be lethal if mixed with alcohol)
137
What is the MOA of benzos?
Potentiating effects of GABA (increase frequency of Cl- channel opening)
138
List examples of long acting (1-3 days) benzos.
Chlordiazepoxide
Diazepam
Flurazepam
139
What is chlordiazepoxide used to treat?
- alcohol detox
| - presurgery anxiety
140
What is diazepam used to treat?
- anxiety
| - seizure control
141
What is flurazepam used to treat?
insomnia
142
List the rapid onset benzos.
- Diazepam
- Flurazepam
- Triazolam
143
List some intermediate acting (10-20 hours) benzos.
Alprazolam
Clonazepam
Lorazepam
Temazepam
144
What is a common use for alprazolam, clonazepam and lorazepam?
panic attacks
145
What is another common use for orazepam?
alcohol withdrawal
146
What is temazepam used for?
insomnia
147
List the short acting (3-8 hr) benzos.
Oxazepam
| Triazolam
148
What is triazolam used for?
insomnia
149
List some SE of benzos.
Drowsiness
Impaired intellectual function
Reduced motor coordination
150
What occurs with benzo toxicity?
respiratory depression in overdose (expecially if combined with ETOH)
151
What are zolpidem (ambien) and zaleplon used for?
short term treatment of insomnia
152
What is the MOA of zolpidem and zaleplon?
Selectively bind to benzodiazepine binding site on GABA receptor
153
What is an advantage of using zolpidem or zaleplon for insmonia?
- No withdrawal effects
- Minimal rebound insomnia
- Litter or no tolerance/dependence with long term use
154
What is the difference between zaleplon and zolpidem?
Zaleplon is a newer insomnia drug with a shorter half life than zolpidem
155
Are zaleplon and zolpidem benzos?
NO
156
What is buspirone used for?
Alternative to Benzos or venlafaxine for treating GAD
157
What is the onset of action for busprione?
1-2 weeks
158
What is the MOA of buspirone?
partial agonist at 5-HT-1a receptor
159
Can you use buspirone in alcoholics?
YES- does not potentiate CNS depression of alcohol
160
What is the use of propranolol in psych patients?
treats autonomic effects of panic attacks, performance anxiety and can be used to treat akathisia (side effect of typical antipsychotics)
161
Which psychotropic drugs have anti-HAM side effects?
TCAs
| Low potency antipsychotics
162
What psychotropic drugs cause serotonin syndrome?
SSRIs + MAOIs
163
What is used to monitor patients on antipsychotics for tardive dyskinesia every 6 months?
AIMS (abnormal involuntary movement scale)
| DISCUS
