GoConqr tid bits Flashcards
Mechanism by which serotonin syndrome can be lethal
Rhabdomyolysis => renal failure => death
-this is why giving something such as a calcium channel blocker (ex: dantraline) to decrease muscle rigidity- can help in serotonin syndrome support (prevent rhabdomyolysis)
Which antipsychotics have the highest risk of NMS?
High potency typicals (Haldol)
Non-psychiatric drugs to avoid w/ MAOIs
- opiates (Demerol)
- some OTC cough meds can increase 5HT
Which antidepressant can (rarely) cause agranulocytosis
Mirtazapine
Grimacing and tongue protrusion
Characteristic of Tardive dyskinesia
Twisting and abnormal postures
Characteristic of acute dystonia
SSRI w/ the fewest drug-drug interactions
Citalopram (celexa)
Differentiate SSRI use for depression vs OCD
OCD- Fluvoxamine
-use much higher dose in OCD
Which antidepressant should not be used (or used sparingly) in pt w/ liver disease
Duloxetine (SNRI, cymbalta)
-may have more liver side effects
Antidepressant w/ high risk of dry mouth and constipation
Duloxetine (SNRI) b/c of NE properties
Which antidepressant should be avoided in pts w/ untreated HTN or labile BP?
Venlafaxine (SNRI) b/c may increase BP
Which neurotransmitters are deactivated by
(a) MAO-A
(b) MAO-B
(c) both
Nt deactivated by
(a) MAO-A = 5HT (hence why MAO-A is needed for the antidepressant effect)
(b) MAO-B = NE
(c) Both breakdown DA and tyramine
SSRI w/ the
(a) fewest drug-drug interactions
(b) most drug-drug interactions
SSRI w/ the
(a) fewest = sertraline
(b) most = paroxetine
Treating serotonin syndrome
(1) discontinue the meds
(2) can try CCBs (ex: Nifedipine) to prevent rhabdomyolysis => renal failure
If very carefully monitored can give
- phentolamine (alpha antagonist)
- chloiprazine
Non-TCA antidepressant indicated for depression + neuropathic pain
Depression + neuropathic pain/fibromyalgia:
Duloxetine (SNRI)
TCAs: amitriptyline, nortriptyline
Least sedating TCA
Desipramine
SSRI w/ the least sexual side effects
Citalopram
TCA that comes in IM form
Imipramine (enuresis and panic d/o)
Pt populations that should be careful about taking TCAs
- suicidal pts: b/c TCAs are so lethal in overdose (just one weeks supply can be lethal)
- history of MI or arrhythmia b/c of the cardiovascular toxicity (slows conduction)
What should be monitored in a pt on Li
- creatinine (kidney fxn)
- white count
- thyroid levels
- serum levels of Li
Describe the mechanism of lethality from low potency typicals
Low potency typicals => QTc prolongation => AV block, arrhythmia, DV
Dermatologic side effects of chlorpromazine
- blueish skin discoloration
- photosensitivity
Most common side effect of chlorpromazine
Chlorpromazine most common side effect = orthostatic hypotension
Name the typical antipsychotic associated w/ heart block and VT
Pimozide = associated w/ heart block and VT
Name 4 structures in the mesolimbic pathway
Mesolimbic pathway:
- amyglada
- fornix
- hippocampus
- nucleus accumbens
Mechanism by which antipsychotics cause narrow-angle glaucoma
Antimuscarinic effect
Most common population that gets
(a) TD
(b) NMS
Most common population that gets
(a) TD- elderly women
(b) NMS- young men
NMS
(a) most common presenting feature
(b) most universal feature
(c) 2 lab findings
NMS
(a) most common presenting feature = fever
(b) most universal feature = lead-pipe rigidity
(c) elevated CPK and leukocytosis (elevated white count)
