Gilks Med Review Table: Random Meds + SUD meds Flashcards
indications for prazosin
nightmares in PTSD
agitation in BPSD–> off label
side effects of prazosin
hypotension
fatigue
drowsiness
weakness
headache
what is the mechanism of prazosin
alpha-1 agonist
(clonidine and guanfacine are alpha-2)
indications for use of propanolol
performance anxiety
lithium tremor
TBI
FIRST CHOICE FOR AKATHESIA
is propanolol recommended in panic disorder
no
what are 2 contraindications to propanolol
CHF
asthma
what type of drug/mechanism is benztropine
anticholinergic
max dose of benztropine
6mg/day
indications for benztropine
acute dystonia
parkinsonism
akinesia
akathesia (SECOND choice)
do you use benztropine for tardive dyskinesia
NO
side effects of benztropine
sedation
constipation
urinary retention
dry mouth
tachycardia
confusion
why dont you use benztropine in TD
can worsen choreiform movements
what type of med is glycopyrrolate
anticholinergic
what do you use glycopyrrolate for
siallorhea
what type of drug is atropine
anticholinergic
what do you use atropine for
sialorrhea
what type of drug is physostigmine
cholinergic
indications for physostigmine
anticholinergic overdose–> use only in severe cases
side effects of physostigmine
bradycardia
N/V
seizures
indication for diphenhydramine/benadryl
acute dystonia
while diphenhydramine/benadryl is a histamine H1 antagonist, it also has properties of what other drug class
anticholinergic properties
what type of drug is cyproheptadine
histamine H1 antagonist
indications for cyproheptadine
mod-severe serotonin syndrome
what is the dose used for cyproheptadine
12mg/dose–> up to 32mg/day
what type of drug is tetrabenazine
VMAT-2 inhibitor
indications for tetrabenazine
huntingtons chorea
tardive dyskinesia
tourettes
there is a black box warning for tetrabenazine–> what is it for
depression and suicidality
side effects of tetrabenazine
black box–> suicidality and depression
sedation
dizziness
N/V
confusion
EPS
suicidality
what is the dosing of tetrabenazine
50mg/day in divided doses to start, up to 150mg/day
what type of drug is valbenazine
VMAT-2 inhibitor
indications for valbenazine
tardive dyskinesia
indication for dantrolene
NMS
what type of drug is dantrolene
muscle relaxant–> reduces heat production
most of the drug-drug interactions with methadone come from what source
CYP 3A4 interactions (i.e ARVs, antidepressants)
how do you need to change methadone dose in pregnancy
increase–> due to volume expansion
in which medical illness should you avoid suboxone
liver failure
which OAT therapy also has an indication for pain
buprenorphine XR/sublocade
what are first, second and third line for OUD
buprenorphine/naloxone–> first
methadone–> second
kadian (slow release oral morphine)–> third
side effects of methadone
Sedation, respiratory depression, hypotension, constipation, nausea, pruritis, erectile dysfunction, cognitive dulling, QTc prolongation, arrhythmia
side effects of buprenorphine
Sedation, respiratory depression, hypotension, constipation, nausea, hepatitis
which OAT should you avoid in pregnancy
kadian/slow release oral morphine
which meds are first line for AUD
naltrexone
acamprosate
is disulfram recommended for AUD
yes, but the guidelines suggest only in specific circumstances (i.e supportive spouse/family)–> it is only for very MOTIVATED patients
what is the dosing of naltrexone
25mg daily x 3 days then 50mg
max dose 150mg /day
list indications for naltrexone
AUD–> first line
OUD
flashbacks and dissociation in PTSD
gambling addiction
what impact does naltrexone have on drinking when used for AUD
reduces heavy drinking days and cravings
side effects of naltrexone
N/V
dizziness
fatigue
depression
muscle cramps
precipitated opioid withdrawal
rare hepatotoxicity
naltrexone should be avoided in patients with which medical comorbidity
liver failure (LFTs over 3x normal)
which AUD med should you use in the setting of liver failure
acamprosate
which AUD med should you avoid in renal impairement
acamprosate
what is the dosing of acamprosate
333mg TID x 1 week then 666mg TID (max dose)
indications for acamprosate
AUD–> 1st line
what impact does acamprosate have on drinking in AUD
helps with abstinence
acamprosate side effects
very mild and transient
headache, diarrhea, flatulence, paresthesias
what should you consider if you decide to Rx both acamprosate and naltrexone together
levels of acamprosate will increase
which is likely best AUD med for breastfeeding
likely acamprosate?
what type of med is naltrexone
opioid antagonist
what type of med is acamprosate
GABA agonist + glutamate antagonist
what type of drug is disulfram
aldehyde dehydrogenase inhibitor
how does disulfram affect drinking when Rx for AUD
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
side effects of varenicline
headache
insomnia
vivid dreams
anx/dep/irritability
hostility
N/V
can you combine varenicline with NRT
no
what type of drug is varenicline
partial nicotine agonist
what type of drug is nabilone
partial CB1 agonist
indications for nabilone
only official indication is chemo nausea
can be used to augment in alzheimers, TBI
side effects of nabilone
sedation
cognitive/memory impairment
dry mouth
orthostatic hypotension
tachycardia
psychosis
indications for melatonin
FIRST LINE for REM sleep behaviour disorder
age associated insomnia
circadian rhythm abnormality i.e jet lag
effects of melatonin overdose
hypothermia
hyperprolactinemia
confusion
what is yohimbine
an alpha-2 agonist
indicated for psychogenic erectile dysfunction
(?generally not recommended)
is st johns wort recommended?
1st line for mild to moderate MDD
2nd line for moderate to severe MDD
side effects of st johns wort
N/V/D
dizziness
confusion
sedation
photosensitivity
dry mouth
urinary frequency
anorgasmia
insomnia
what is kava kava
modulates glutamate/GABA
indication = anxiety
is a ceremonial drink from pacific islands
*many drug interactions; monitor liver function
side effects of kava kava
N/V/
dizziness
yellow skin
hepatotoxic at high doses
