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ACCP-Therapeutics > General Psychiatry > Flashcards

General Psychiatry Flashcards

1
Q

Pseudoparkinsonism Treatment

A

Symptoms such as bradykinesia, rigidity, tremor, or akinesia

lower or change med

oral anticholinergic agents such as diphenhydramine, trihexyphenidyl, and benztropine

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2
Q

Dystonia Treatment

A

Symptoms such as torticollis, laryngospasm, and oculogyric crisis.

Intramuscular anticholinergics

oral anticholinergics to prevent in high-risk pts

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3
Q

Akathisia Treatment

A

Somatic restlessness and inability to stay still or calm
lower or change med

propranolol (lipophilic b-blocker): first line

benzodiazepines: second line

Agents with serotonin-2 activity:
 Mirtazapine (most evidence)
 Trazodone
 Cyproheptadine

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4
Q

Tardive dyskinesia Treatment

A

Symptoms such as abnormal involuntary movements

usually involves the orofacial muscles and is often insidious

tardive dyskinesia is often irreversible

switch to clozapine

Treat with Valbenazine (Ingrezza) or deutetrabenazine (Austedo)

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5
Q

Neuroleptic malignant syndrome Treatment

A

Stop the agent and give supportive therapy

Bromocriptine and dantrolene have been used with varying success.

Do not reinitiate antipsychotics until at least 14 days after resolution of NMS symptoms

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6
Q

Hyperprolactinemia with Antipsychotics

A

High risk in FGA

Risperidone and paliperidone have the highest risk for the SGAs

Aripiprazole can lower prolactin concentrations

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7
Q

QTc prolongation with Antipsychotics

A

Of the FGAs highest with chlorpromazine, intravenous haloperidol, and thioridazine

Of the SGAs clozapine, ziprasidone, and iloperidone

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8
Q

Seizures with Antipsychotics

A

Lower the seizure threshold

Highest risk with Chlorpromazine, cariprazine, and clozapine

Lowest risk with Aripiprazole, fluphenazine, haloperidol, pimozide, risperidone, thioridazine, and trifluoperazine

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9
Q

SSRIs

A

Selectively inhibit the reuptake of serotonin into the presynaptic neuron and desensitize the presynaptic serotonin autoreceptor, resulting in increased serotonin concentrations

AE:
Have been associate with EPS
Hyponatremia
Withdrawal syndrome
Modest bleeding risk

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10
Q

Venlafaxine

A

SNRI

Dose related effect on norepinephrine

Doses less than 150mg/day is only a serotonin reuptake inhibitor

Can increase BP

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11
Q

Duloxetine

A

SNR

Also approved for diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain

Do not use in hepatic insufficiency (liver toxicity), end-stage renal disease requiring dialysis, or sever renal impartment

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12
Q

Desvenlafaxine

A

SNRI

An active metabolite of venlafaxine. Benefits over the parent drug are limited.

Because it bypasses CYP metabolism, it may be advantageous in patients with hepatic insufficiency or those taking major 2D6 inducers or inhibitors

Can increase BP and cause OH

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13
Q

Lemomilnaciparn

A

SNRI

Only approved for depression not fibromyalgia

Not recommended in end-stage renal disease

Renal dosing

Can increase HR, cause palpitations, and OH

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14
Q

Milnaciparn

A

SNRI

only approved for fibromyalgia

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15
Q

Vilazodone (Viibryd)

A

an SSRI with partial agonist at the serotonin-1A receptor (mixed)

Lower risk of sexual dysfunction

Do not use in seizure disorder

Can cause acute pancreatitis and sleep paralysis rarely

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16
Q

Vortioxetine (Trintellix)

A

An SSRI, but its pharmacologic profile differs from other SSRIs (mixed)

has additional agonist activity at the serotonin-1A receptor, partial agonist activity at the serotonin-1B receptor, and antagonistic activity at the serotonin-3, serotonin-1D, and serotonin-7 receptors

Improves cognitive function

Lower risk of sexual dysfunction

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17
Q

Trazodone (Desyrel)

A

A serotonin reuptake inhibitor that also blocks serotonin-2A receptors (mixed)

Can cause OH and sedation

Often used for insomnia but at lower doses

Risk of priapism

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18
Q

Nefazodone (Serzone)

A

a serotonin-2A antagonist like trazodone, but it also blocks the reuptake of serotonin and norepinephrine (mixed)

Lower risk of sexual dysfunction

Low risk for OH

BID dosing

Liver toxicity (Monitor LFT)

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19
Q

Mirtazapine (Remeron)

A

an antagonist of presynaptic α2 -autoreceptors and heteroreceptors, which results in an increase in norepinephrine and serotonin release in the synapse (mixed)

minimal to no sexual dysfunction

no nausea or GI disturbances

causes weight gain

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20
Q

Bupropion (Aplenzin, Forfivo, Wellbutrin)

A

an inhibitor of dopamine and norepinephrine reuptake with minimal effects on serotonin

increased risk of seizures

common adverse effects include insomnia, anxiety, irritability, headache, and decreased appetite

may improve sexual function

off-label ADHD

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21
Q

Antidepressants for Generalized anxiety disorder

A

escitalopram
paroxetine [IR and CR]
sertraline
duloxetine
venlafaxine XR

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22
Q

Antidepressants for Panic disorder

A

All SSRIs and venlafaxine XR

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23
Q

Antidepressants for Social anxiety

A

paroxetine [IR and CR]
sertraline
escitalopram
fluvoxamine [IR and CR]
venlafaxine XR

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24
Q

Antidepressants for OCD

A

escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline

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25
Antidepressants for PTSD
sertraline paroxetine fluoxetine venlafaxine XR
26
Eszopiclone (Lunesta)
GABAA agonist whose half-life is 6 hours; thus, morning effects can result if it is taken late in the night can be used for chronic insomnia. Patients should be counseled to use caution when driving or performing activities that require alertness, particularly with the 2- to 3-mg doses should be taken immediately before bed and when the patient will be in bed for at least 7–8 hours can cause a metallic taste in the mouth.
27
Zaleplon (Sonata)
nonbenzodiazepine sedative-hypnotic modulates the GABAA receptor complex For patients with sleep maintenance problems, it may not last as long has a shorter half-life (about 1 hour) and may cause fewer problems in the morning, especially if given late shortens onset to sleep but does not prolong sleep time or number of awakenings indicated only for short-term treatment of insomnia and has been used in trials for up to 5 weeks
28
Zolpidem (Ambien)
nonbenzodiazepine sedative-hypnotic modulates the GABAA receptor complex Compared with benzodiazepines, zolpidem lacks anticonvulsant action, muscle-relaxant properties, and respiratory depressant effect lower risk of tolerance and withdrawal avoided in obstructive sleep apnea good choice for patients in whom benzodiazepines should be avoided Indications vary by dosage form: -All are indicated to decrease sleep latency -The CR for sleep maintenance and longer-term therapy -The sublingual tablet formulation Intermezzo prn for patients who have difficulty falling back to sleep as long as 4 hours or more remain. Lower doses for women and alder adults
29
lemborexant (Dayvigo)
Orexin (OX1 and OX2) Receptor Antagonists decreases sleep latency and promote sleep maintenance It should be taken with at least 7 hours of remaining sleep It is metabolized by 3A4, and use should be avoided in patients taking either inducers or inhibitors of 3A4 Time to onset may be delayed if taken with food contraindicated in patients with concomitant narcolepsy
30
suvorexant (Belsomra)
Orexin (OX1 and OX2) Receptor Antagonists decreases sleep latency and promote sleep maintenance should be taken within 30 minutes of bedtime and with at least 7 hours of sleep time It is metabolized by 3A4, and the dose must be decreased in patients taking concomitant 3A4 inhibitors contraindicated in patients with concomitant narcolepsy
31
Doxepin (Silenor)
A TCA indicated for impaired sleep maintenance Doses used are lower than for depression Chances for morning effects are high because of the long half-life of both doxepin and its active metabolite, nordoxepin.
32
Ramelteon (Rozerem)
Melatonin agonist (no activity at the GABA or benzodiazepine receptor) Duration is 2–5 hours no dependence or tolerance, and it can be used long term for chronic insomnia primarily metabolized by 1A2, but inducers and inhibitors of 2C9 and 3A4 can also affect it should be avoided in patients with severe sleep apnea
33
Naltrexone for Alcohol Abuse
can also be used chronically and reduces cravings If used, it should be combined with CBT Monitor LFTs and do not use in hepatic impairment Tablet and Injection available
34
Acamprosate
Alcohol Abuse structural analog of GABA that also reduces cravings Evidence regarding efficacy is more mixed than with naltrexone. Safe to use in hepatic impairment Renally dosed and should not be used if crcl <30 Warning for suicidal ideation and should not be used in patients that are actively suicidal
35
Disulfiram
Alcohol Abuse considered aversion therapy associated with hepatotoxicity should be avoided in patients with severe myocardial disease should not be combined with metronidazole because of an increased risk of encephalopathy Patients should also be counseled to avoid alcohol-containing items, particularly medications and certain mouthwashes, because of the risk of adverse effects
36
Naltrexone for substance abuse
ER injectable is usually preferred because of better adherence The ER injectable is part of a REMS education program. Patients must be counseled on the following points: -Risk of increased opioid sensitivity and opioid overdose -Risk of severe reactions at the injection site -Risk of liver injury, including liver damage or hepatitis -Therapeutic effects of opioid medications taken for pain, cough and cold, or diarrhea may not be felt by the patient The patient must be completely off opioids for 7–10 days before naltrexone is administered (14 days if taking methadone or buprenorphine).
37
Chlorpromazine (Thorazine)
Low Potency FGA High risk of anticholinergic effects, sedation, and OH Moderate risk of EPS
38
Loxapine (Adasuve, Loxitane)
Intermediate Potency FGA Moderate risk for of anticholinergic effects, sedation, OH, and EPS
39
Perphenazine (Trilafon)
Intermediate Potency FGA Moderate risk for of anticholinergic effects, sedation, OH, and EPS
40
Trifluoperazine (Stelazine)
Intermediate Potency FGA Moderate risk for anticholinergic effects and EPS Low risk for Sedation and OH
41
Fluphenazine (Prolixin)
High Potency FGA High risk of EPS Low risk for anticholinergic effects, sedation, and OH
42
Haloperidol (Haldol)
High Potency FGA High risk of EPS Low risk for anticholinergic effects, sedation, and OH
43
Pimozide (Orap)
High Potency FGA High risk of EPS Low risk for anticholinergic effects, sedation, and OH
44
Thiothixene (Navane)
High Potency FGA High risk of EPS Low risk for anticholinergic effects, sedation, and OH
45
FGAs with highest risk of weight gain
clozapine olanzapine
46
FGAs with highest risk of glucose abnormalities
clozapine olanzapine
47
FGAs with the highest risk of dislipidemia
clozapine olanzapine quetiapine
48
FGAs with highest risk of anticholinergic effects
clozapine
49
FGAs with highest risk of sedation
clozapine quetiapine
50
FGAs with highest risk of OH
clozapine iloperidone
51
FGAs with the lowest risk of Weight gain
Aripiprazole Brexpiprazole Lumateprerone Lurasidone Ziprasidone
52
FGAs with the lowest risk of glucose abnormalities
Aripiprazole Brexpiprazole Cariprazine Paliperidone Ziprasidone
53
FGAs with the lowest risk of dyslipidemia
Aripiprazole Cariprazine Iloperidone Risperidone Ziprasidone
54
FGAs with the lowest risk of anticholinergic effects
Aripiprazole Asenapine Brexpiprazole Iloperidone Lumateperone Lurasidone Paliperidone Risperidone Ziprasidone
55
FGAs with the lowest risk of sedation
Aripiprazole Iloperidone Lumateperone Lurasidone Paliperidone
56
FGAs with the lowest risk of OH
Aripiprazole Brexpiprazole Lumateperone Lurasidone
57
FGAs with the lowest risk of Akathisia (EPS)
Clozapine Iloperidone Quetiapine
58
FGAs with the lowest risk of Parkinsonism
Aripiprazole Asenapine Brexpiprazole Cariprzine Clozapine Iloperidone Quetiapine Ziprasidone
59
Tricyclic Antidepressants
TCAs block serotonin and norepinephrine uptake adverse effects limit use cause orthostasis, sedation, and anticholinergic effects, and sexual dysfunction cardiotoxic in overdose so avoid in suicidal patients
60
Monoamine Oxidase Inhibitors
irreversibly block the enzyme responsible for the breakdown of certain neurotransmitters, such as norepinephrine avoid foods high in tyramine (e.g., aged cheese, preserved meats, wine, beer) due to risk of hypertensive crisis lots of drug interaction 2 weeks wash out when changing between antidepressant and MAOI (except for fluoxetine, in which case the waiting period should be 5–6 weeks, and vortioxetine is 3 weeks) to avoid serotonin toxicity Selegiline (MAO-B inhibitor) is available in a patch formulation for depression.
61
Bipolar I
one or more manic or mixed episodes major depressive episodes are not necessary for the diagnosis, most patients have depressive episodes
62
Bipolar I Treatment
Lithium is the gold standard (depression and mania) Divalproex/valproic acid (for rapid cycling but not for depression) Carbamazepine (acute mania and maintenance) Lamotrigine (for maintenance but not acute mania due to titration) All SGAs have received FDA approval for use in acute mania or mixed episodes except for brexpiprazole, clozapine, iloperidone, lumateperone, and lurasidone Lorazepam or diazepam is often used in the acute setting only
63
Bipolar II
Chronic disorder marked by one or more major depressive episodes, accompanied by at least one hypomanic episode depressive phase more debilitating
64
Bipolar II Treatment
Lithium is a first-line agent, but it may not achieve remission as monotherapy and takes time to relieve symptoms Quetiapine is preferred for acute symptom treatment Lurasidone can also be used Lamotrigine is a reasonable alternative for longer-term symptom control, but because of its slow titration schedule, it is not useful in the acute setting Antidepressants are used more commonly but should be used with caution, and never as monotherapy. Olanzapine and fluoxetine may thus be an option
65
Cyclothymic Bipolar disorder
Several periods of hypomania and mild depression, none of which meet the criteria for mania or major depressive episode
66
Rapid cycling Bipolar
At least four episodes of mania, hypomania, or depression in 1 year with 2 months between episodes or a switch to the opposite polarity

ACCP-Therapeutics (4 decks)

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