FR Review 8 - Antidepressants, Anxiety, Antipsych, ADD/ADHD Flashcards
What is the GI related AE of MAOIs and how is it mitigated?
MAO in the colon metabolizes vasoactive substances that we eat (tyramine) before they enter the bloodstream. MAOIs allow absorption of these vasoactive chemicals. Patient must adhere to a special diet or suffer risk of hypertensive emergency and urgency.
T/F: MAOIs are considered first line therapy for depression.
False –> patients on an MAOI have issues
Why are TCAs still kept on the market?
Off label uses - insomnia (Anti-Ach sedation), neuropathic pain, enuresis (bed wetting), migraines.
What is the primary AE associated with SSRIs?
Sexual dysfunction
What is the mechanism of bupropion?
It is a weak inhibitor of dopamine reuptake with no effect on norepinephrine or serotonin
What is the major advantage of prescribing bupropion?
No effect on sexual function
What is the common off-label use of bupropion?
Smoking cessation and other addiction disorders
What is the major AE associated with bupropion?
Decreases seizure threshold –> cannot use in PMH of seizure or in eating disorders (hyponatremia decreases seizure threshold)
What is the most common use of trazodone?
Insomnia –> the drug is highly sedating
What kind of drug is duloxetine and what are its primary uses other than as an antidepressant?
SNRI –> peripheral neuropathy, fibromyalgia, and urinary incontinence
What is the hallmark sign of lithium toxicity?
Coarse tremor
What lab must be monitored in patients taking lithium?
TSH
State the clinical uses of BZDs.
Anxiety, agitation, antiemetic (especially in chemo), insomnia, seizures, anesthetic induction, alcohol withdrawal, muscle relaxation
Describe the AEs associated with BZDs and state one that can sometimes be beneficial.
Drowsiness, confusion, sluggishness, retrograde amnesia. Retrograde amnesia is beneficial in anesthesia.
Which two BZDs used for anxiety have the shortest duration of action (quick on and quick off)?
Lorazepam and Oxazepam –> these drugs are the final metabolites of other BZDs
What is the dose limiting AE of BZDs?
Respiratory depression
For what patients are the short-acting BZDs preferred?
Elderly and liver failure –> BZDs are lipophilic, short acting agents less toxic to liver
Where are you likely to find agitated patients that would benefit from BZDs?
ICUs and nursing homes
What is the primary use of Alprazolam?
Panic attacks
Describe the mechanism of action of buspirone?
Not a BZD –> serotonin antagonist. It is unknown exactly how it decreases anxiety.
What is the advantage of buspirone and what patients most benefit from its use?
No sedative effects –> can be used by bus drivers and other workers that operate machinery
Compare buspirone to BZDs regarding their efficacy as an anxiolytic.
They are as effective as BZDs but they take 3 weeks to have effect. Buspirone cannot be used acutely.
Describe the general treatment ladder in attempting to manage insomnia.
Improve sleep hygiene
OTC meds: diphenhydramine or melatonin
Prescription meds: non-controlled, then controlled
What is meant by a drug being a “non-benzo benzo” and what three drugs are in this classification?
These drugs bind and stimulate BZD receptors but, structurally, they are not BZDs.
Zolpidem, Zaleplon, Eszopiclone
Differentiate positive and negative symptoms of schizophrenia.
Positive (I’m positive the person has schizophrenia): delusions, paranoia, hallucinations
Negative (historically difficult to resolve with treatment): apathy, withdrawal, blunt affect
Which class of anti-psychotics are better at treating negative symptoms of schizophrenia?
Newer, 2nd generation medications
Describe neuroleptic malignant syndrome (NMS).
Rare, life-threatening syndrome characterized by hyperpyrexia, cogwheel rigidity, rhabdo s/p rigidity.
What are four treatment options for NMS.
D/C the anti-psychotic
Bicarb and fluids for rhabdo if present
Dantrolene (direct acting skeletal muscle relaxant)
Bromocriptine (DA agonist)
What is the most common use of haloperidol?
Agitation in Alzheimer’s, psychosis, or ICU patients
What is a precaution associated with haloperidol?
Decreases seizure threshold
T/F: The dose limiting AE of haloperidol is respiratory depression.
False –> haloperidol does not cause respiratory depression
What are the disadvantages of atypical anti-psychotics?
Weight gain, even more than typical anti-psychotics
Acceleration of development of DM
Hyperlipidemia –> increase cardiovascular morbidity and mortality in patients older than 65
Cost
What are the effects of quetiapine at various doses?
Low dose: hypnotic (great for insomnia)
Medium dose: antidepressant
High dose: anti-psychotic
T/F: Clozapine is commonly used. State why or why not.
False: Used last line because it has 5 black box warnings
What are the primary advantages and disadvantages of risperidone?
Adv: less weight gain
Disadv: significant hyperprolactinemia (must monitor prolactin level)
What S/S result from hyperprolactinemia?
Galactorrhea, sexual dysfunction, bone density changes
Describe the mechanism by which stimulant medications are beneficial in ADD/ADHD.
The problem in ADD/ADHD is the brain cannot organize the multitude of sensory information that is coming in. Stimulants activate the parts of the brain responsible for organizing sensory input.
What control schedule is methylphenidate and what is unique about this?
C-2 –> one of the only non-opioid drugs in C-2
What is the only non-stimulant option for treatment of ADD/ADHD discussed in class?
Atomoxetine
When is atomoxetine used in the management of ADD/ADHD?
Second-line –> not as effective as the stimulant medications
What are the precautions associated with use of atomoxetine?
Risk of SI
Weight loss –> less so than the stimulants
