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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
Q

Antidepressants for PTSD

A

sertraline
paroxetine
fluoxetine
venlafaxine XR

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26
Q

Eszopiclone (Lunesta)

A

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.

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27
Q

Zaleplon (Sonata)

A

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
Q

Zolpidem (Ambien)

A

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
Q

lemborexant (Dayvigo)

A

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
Q

suvorexant (Belsomra)

A

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
Q

Doxepin (Silenor)

A

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
Q

Ramelteon (Rozerem)

A

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
Q

Naltrexone for Alcohol Abuse

A

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
Q

Acamprosate

A

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
Q

Disulfiram

A

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
Q

Naltrexone for substance abuse

A

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
Q

Chlorpromazine (Thorazine)

A

Low Potency FGA

High risk of anticholinergic effects, sedation, and OH

Moderate risk of EPS

38
Q

Loxapine (Adasuve, Loxitane)

A

Intermediate Potency FGA

Moderate risk for of anticholinergic effects, sedation, OH, and EPS

39
Q

Perphenazine (Trilafon)

A

Intermediate Potency FGA

Moderate risk for of anticholinergic effects, sedation, OH, and EPS

40
Q

Trifluoperazine (Stelazine)

A

Intermediate Potency FGA

Moderate risk for anticholinergic effects and EPS

Low risk for Sedation and OH

41
Q

Fluphenazine (Prolixin)

A

High Potency FGA

High risk of EPS

Low risk for anticholinergic effects, sedation, and OH

42
Q

Haloperidol (Haldol)

A

High Potency FGA

High risk of EPS

Low risk for anticholinergic effects, sedation, and OH

43
Q

Pimozide (Orap)

A

High Potency FGA

High risk of EPS

Low risk for anticholinergic effects, sedation, and OH

44
Q

Thiothixene (Navane)

A

High Potency FGA

High risk of EPS

Low risk for anticholinergic effects, sedation, and OH

45
Q

FGAs with highest risk of weight gain

A

clozapine
olanzapine

46
Q

FGAs with highest risk of glucose abnormalities

A

clozapine
olanzapine

47
Q

FGAs with the highest risk of dislipidemia

A

clozapine
olanzapine
quetiapine

48
Q

FGAs with highest risk of anticholinergic effects

A

clozapine

49
Q

FGAs with highest risk of sedation

A

clozapine
quetiapine

50
Q

FGAs with highest risk of OH

A

clozapine
iloperidone

51
Q

FGAs with the lowest risk of Weight gain

A

Aripiprazole
Brexpiprazole
Lumateprerone
Lurasidone
Ziprasidone

52
Q

FGAs with the lowest risk of glucose abnormalities

A

Aripiprazole
Brexpiprazole
Cariprazine
Paliperidone
Ziprasidone

53
Q

FGAs with the lowest risk of dyslipidemia

A

Aripiprazole
Cariprazine
Iloperidone
Risperidone
Ziprasidone

54
Q

FGAs with the lowest risk of anticholinergic effects

A

Aripiprazole
Asenapine
Brexpiprazole
Iloperidone
Lumateperone
Lurasidone
Paliperidone
Risperidone
Ziprasidone

55
Q

FGAs with the lowest risk of sedation

A

Aripiprazole
Iloperidone
Lumateperone
Lurasidone
Paliperidone

56
Q

FGAs with the lowest risk of OH

A

Aripiprazole
Brexpiprazole
Lumateperone
Lurasidone

57
Q

FGAs with the lowest risk of Akathisia (EPS)

A

Clozapine
Iloperidone
Quetiapine

58
Q

FGAs with the lowest risk of Parkinsonism

A

Aripiprazole
Asenapine
Brexpiprazole
Cariprzine
Clozapine
Iloperidone
Quetiapine
Ziprasidone

59
Q

Tricyclic Antidepressants

A

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
Q

Monoamine Oxidase Inhibitors

A

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
Q

Bipolar I

A

one or more manic or mixed episodes

major depressive episodes are not necessary for the diagnosis, most patients have depressive episodes

62
Q

Bipolar I Treatment

A

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
Q

Bipolar II

A

Chronic disorder marked by one or more major depressive episodes, accompanied by at least one hypomanic episode

depressive phase more debilitating

64
Q

Bipolar II Treatment

A

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
Q

Cyclothymic Bipolar disorder

A

Several periods of hypomania and mild depression, none of which meet the criteria for mania or major depressive episode

66
Q

Rapid cycling Bipolar

A

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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