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Spring Pharm Block 4 > FR Review 8 - Antidepressants, Anxiety, Antipsych, ADD/ADHD > Flashcards

FR Review 8 - Antidepressants, Anxiety, Antipsych, ADD/ADHD Flashcards

1
Q

What is the GI related AE of MAOIs and how is it mitigated?

A

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.

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2
Q

T/F: MAOIs are considered first line therapy for depression.

A

False –> patients on an MAOI have issues

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3
Q

Why are TCAs still kept on the market?

A

Off label uses - insomnia (Anti-Ach sedation), neuropathic pain, enuresis (bed wetting), migraines.

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4
Q

What is the primary AE associated with SSRIs?

A

Sexual dysfunction

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5
Q

What is the mechanism of bupropion?

A

It is a weak inhibitor of dopamine reuptake with no effect on norepinephrine or serotonin

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6
Q

What is the major advantage of prescribing bupropion?

A

No effect on sexual function

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7
Q

What is the common off-label use of bupropion?

A

Smoking cessation and other addiction disorders

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8
Q

What is the major AE associated with bupropion?

A

Decreases seizure threshold –> cannot use in PMH of seizure or in eating disorders (hyponatremia decreases seizure threshold)

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9
Q

What is the most common use of trazodone?

A

Insomnia –> the drug is highly sedating

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10
Q

What kind of drug is duloxetine and what are its primary uses other than as an antidepressant?

A

SNRI –> peripheral neuropathy, fibromyalgia, and urinary incontinence

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11
Q

What is the hallmark sign of lithium toxicity?

A

Coarse tremor

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12
Q

What lab must be monitored in patients taking lithium?

A

TSH

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13
Q

State the clinical uses of BZDs.

A

Anxiety, agitation, antiemetic (especially in chemo), insomnia, seizures, anesthetic induction, alcohol withdrawal, muscle relaxation

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14
Q

Describe the AEs associated with BZDs and state one that can sometimes be beneficial.

A

Drowsiness, confusion, sluggishness, retrograde amnesia. Retrograde amnesia is beneficial in anesthesia.

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15
Q

Which two BZDs used for anxiety have the shortest duration of action (quick on and quick off)?

A

Lorazepam and Oxazepam –> these drugs are the final metabolites of other BZDs

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16
Q

What is the dose limiting AE of BZDs?

A

Respiratory depression

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17
Q

For what patients are the short-acting BZDs preferred?

A

Elderly and liver failure –> BZDs are lipophilic, short acting agents less toxic to liver

18
Q

Where are you likely to find agitated patients that would benefit from BZDs?

A

ICUs and nursing homes

19
Q

What is the primary use of Alprazolam?

A

Panic attacks

20
Q

Describe the mechanism of action of buspirone?

A

Not a BZD –> serotonin antagonist. It is unknown exactly how it decreases anxiety.

21
Q

What is the advantage of buspirone and what patients most benefit from its use?

A

No sedative effects –> can be used by bus drivers and other workers that operate machinery

22
Q

Compare buspirone to BZDs regarding their efficacy as an anxiolytic.

A

They are as effective as BZDs but they take 3 weeks to have effect. Buspirone cannot be used acutely.

23
Q

Describe the general treatment ladder in attempting to manage insomnia.

A

Improve sleep hygiene
OTC meds: diphenhydramine or melatonin
Prescription meds: non-controlled, then controlled

24
Q

What is meant by a drug being a “non-benzo benzo” and what three drugs are in this classification?

A

These drugs bind and stimulate BZD receptors but, structurally, they are not BZDs.
Zolpidem, Zaleplon, Eszopiclone

25
Q

Differentiate positive and negative symptoms of schizophrenia.

A

Positive (I’m positive the person has schizophrenia): delusions, paranoia, hallucinations
Negative (historically difficult to resolve with treatment): apathy, withdrawal, blunt affect

26
Q

Which class of anti-psychotics are better at treating negative symptoms of schizophrenia?

A

Newer, 2nd generation medications

27
Q

Describe neuroleptic malignant syndrome (NMS).

A

Rare, life-threatening syndrome characterized by hyperpyrexia, cogwheel rigidity, rhabdo s/p rigidity.

28
Q

What are four treatment options for NMS.

A

D/C the anti-psychotic
Bicarb and fluids for rhabdo if present
Dantrolene (direct acting skeletal muscle relaxant)
Bromocriptine (DA agonist)

29
Q

What is the most common use of haloperidol?

A

Agitation in Alzheimer’s, psychosis, or ICU patients

30
Q

What is a precaution associated with haloperidol?

A

Decreases seizure threshold

31
Q

T/F: The dose limiting AE of haloperidol is respiratory depression.

A

False –> haloperidol does not cause respiratory depression

32
Q

What are the disadvantages of atypical anti-psychotics?

A

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

33
Q

What are the effects of quetiapine at various doses?

A

Low dose: hypnotic (great for insomnia)
Medium dose: antidepressant
High dose: anti-psychotic

34
Q

T/F: Clozapine is commonly used. State why or why not.

A

False: Used last line because it has 5 black box warnings

35
Q

What are the primary advantages and disadvantages of risperidone?

A

Adv: less weight gain
Disadv: significant hyperprolactinemia (must monitor prolactin level)

36
Q

What S/S result from hyperprolactinemia?

A

Galactorrhea, sexual dysfunction, bone density changes

37
Q

Describe the mechanism by which stimulant medications are beneficial in ADD/ADHD.

A

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.

38
Q

What control schedule is methylphenidate and what is unique about this?

A

C-2 –> one of the only non-opioid drugs in C-2

39
Q

What is the only non-stimulant option for treatment of ADD/ADHD discussed in class?

A

Atomoxetine

40
Q

When is atomoxetine used in the management of ADD/ADHD?

A

Second-line –> not as effective as the stimulant medications

41
Q

What are the precautions associated with use of atomoxetine?

A

Risk of SI

Weight loss –> less so than the stimulants

Spring Pharm Block 4 (17 decks)

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