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8. Psychopharmacology > Gilks Med Review Table: Random Meds + SUD meds > Flashcards

Gilks Med Review Table: Random Meds + SUD meds Flashcards

1
Q

indications for prazosin

A

nightmares in PTSD

agitation in BPSD–> off label

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2
Q

side effects of prazosin

A

hypotension

fatigue

drowsiness

weakness

headache

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3
Q

what is the mechanism of prazosin

A

alpha-1 agonist

(clonidine and guanfacine are alpha-2)

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4
Q

indications for use of propanolol

A

performance anxiety

lithium tremor

TBI

FIRST CHOICE FOR AKATHESIA

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5
Q

is propanolol recommended in panic disorder

A

no

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6
Q

what are 2 contraindications to propanolol

A

CHF

asthma

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7
Q

what type of drug/mechanism is benztropine

A

anticholinergic

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8
Q

max dose of benztropine

A

6mg/day

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9
Q

indications for benztropine

A

acute dystonia

parkinsonism

akinesia

akathesia (SECOND choice)

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10
Q

do you use benztropine for tardive dyskinesia

A

NO

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11
Q

side effects of benztropine

A

sedation

constipation

urinary retention

dry mouth

tachycardia

confusion

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12
Q

why dont you use benztropine in TD

A

can worsen choreiform movements

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13
Q

what type of med is glycopyrrolate

A

anticholinergic

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14
Q

what do you use glycopyrrolate for

A

siallorhea

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15
Q

what type of drug is atropine

A

anticholinergic

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16
Q

what do you use atropine for

A

sialorrhea

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17
Q

what type of drug is physostigmine

A

cholinergic

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18
Q

indications for physostigmine

A

anticholinergic overdose–> use only in severe cases

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19
Q

side effects of physostigmine

A

bradycardia

N/V

seizures

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20
Q

indication for diphenhydramine/benadryl

A

acute dystonia

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21
Q

while diphenhydramine/benadryl is a histamine H1 antagonist, it also has properties of what other drug class

A

anticholinergic properties

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22
Q

what type of drug is cyproheptadine

A

histamine H1 antagonist

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23
Q

indications for cyproheptadine

A

mod-severe serotonin syndrome

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24
Q

what is the dose used for cyproheptadine

A

12mg/dose–> up to 32mg/day

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25
Q

what type of drug is tetrabenazine

A

VMAT-2 inhibitor

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26
Q

indications for tetrabenazine

A

huntingtons chorea

tardive dyskinesia

tourettes

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27
Q

there is a black box warning for tetrabenazine–> what is it for

A

depression and suicidality

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28
Q

side effects of tetrabenazine

A

black box–> suicidality and depression

sedation

dizziness

N/V

confusion

EPS

suicidality

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29
Q

what is the dosing of tetrabenazine

A

50mg/day in divided doses to start, up to 150mg/day

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30
Q

what type of drug is valbenazine

A

VMAT-2 inhibitor

31
Q

indications for valbenazine

A

tardive dyskinesia

32
Q

indication for dantrolene

A

NMS

33
Q

what type of drug is dantrolene

A

muscle relaxant–> reduces heat production

34
Q

most of the drug-drug interactions with methadone come from what source

A

CYP 3A4 interactions (i.e ARVs, antidepressants)

35
Q

how do you need to change methadone dose in pregnancy

A

increase–> due to volume expansion

36
Q

in which medical illness should you avoid suboxone

A

liver failure

37
Q

which OAT therapy also has an indication for pain

A

buprenorphine XR/sublocade

38
Q

what are first, second and third line for OUD

A

buprenorphine/naloxone–> first

methadone–> second

kadian (slow release oral morphine)–> third

39
Q

side effects of methadone

A

Sedation, respiratory depression, hypotension, constipation, nausea, pruritis, erectile dysfunction, cognitive dulling, QTc prolongation, arrhythmia

40
Q

side effects of buprenorphine

A

Sedation, respiratory depression, hypotension, constipation, nausea, hepatitis

41
Q

which OAT should you avoid in pregnancy

A

kadian/slow release oral morphine

42
Q

which meds are first line for AUD

A

naltrexone

acamprosate

43
Q

is disulfram recommended for AUD

A

yes, but the guidelines suggest only in specific circumstances (i.e supportive spouse/family)–> it is only for very MOTIVATED patients

44
Q

what is the dosing of naltrexone

A

25mg daily x 3 days then 50mg

max dose 150mg /day

45
Q

list indications for naltrexone

A

AUD–> first line

OUD

flashbacks and dissociation in PTSD

gambling addiction

46
Q

what impact does naltrexone have on drinking when used for AUD

A

reduces heavy drinking days and cravings

47
Q

side effects of naltrexone

A

N/V

dizziness

fatigue

depression

muscle cramps

precipitated opioid withdrawal

rare hepatotoxicity

48
Q

naltrexone should be avoided in patients with which medical comorbidity

A

liver failure (LFTs over 3x normal)

49
Q

which AUD med should you use in the setting of liver failure

A

acamprosate

50
Q

which AUD med should you avoid in renal impairement

A

acamprosate

51
Q

what is the dosing of acamprosate

A

333mg TID x 1 week then 666mg TID (max dose)

52
Q

indications for acamprosate

A

AUD–> 1st line

53
Q

what impact does acamprosate have on drinking in AUD

A

helps with abstinence

54
Q

acamprosate side effects

A

very mild and transient

headache, diarrhea, flatulence, paresthesias

55
Q

what should you consider if you decide to Rx both acamprosate and naltrexone together

A

levels of acamprosate will increase

56
Q

which is likely best AUD med for breastfeeding

A

likely acamprosate?

57
Q

what type of med is naltrexone

A

opioid antagonist

58
Q

what type of med is acamprosate

A

GABA agonist + glutamate antagonist

59
Q

what type of drug is disulfram

A

aldehyde dehydrogenase inhibitor

60
Q

how does disulfram affect drinking when Rx for AUD

A

if taking disulfram, and you drink alcohol, you feel like shit

i.e N/V, headache, HTN, flushing, chest pain, vertigo, thirst

this is because disulfram causes build up of acetaldehyde

61
Q

side effects of varenicline

A

headache
insomnia
vivid dreams
anx/dep/irritability
hostility
N/V

62
Q

can you combine varenicline with NRT

A

no

63
Q

what type of drug is varenicline

A

partial nicotine agonist

64
Q

what type of drug is nabilone

A

partial CB1 agonist

65
Q

indications for nabilone

A

only official indication is chemo nausea

can be used to augment in alzheimers, TBI

66
Q

side effects of nabilone

A

sedation

cognitive/memory impairment

dry mouth

orthostatic hypotension

tachycardia

psychosis

67
Q

indications for melatonin

A

FIRST LINE for REM sleep behaviour disorder

age associated insomnia

circadian rhythm abnormality i.e jet lag

68
Q

effects of melatonin overdose

A

hypothermia

hyperprolactinemia

confusion

69
Q

what is yohimbine

A

an alpha-2 agonist

indicated for psychogenic erectile dysfunction

(?generally not recommended)

70
Q

is st johns wort recommended?

A

1st line for mild to moderate MDD

2nd line for moderate to severe MDD

71
Q

side effects of st johns wort

A

N/V/D

dizziness

confusion

sedation

photosensitivity

dry mouth

urinary frequency

anorgasmia

insomnia

72
Q

what is kava kava

A

modulates glutamate/GABA

indication = anxiety

is a ceremonial drink from pacific islands

*many drug interactions; monitor liver function

73
Q

side effects of kava kava

A

N/V/

dizziness

yellow skin

hepatotoxic at high doses

8. Psychopharmacology (21 decks)

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