Intro to Psych Flashcards
1
Q
Dopamine Effects
A
Control of voluntary movement, influences learning, attention, emotion; “Reward pathway”
2
Q
Dopamine related disease state
A
Parkinsonism, schizophrenia, addictive disorders
3
Q
Norepinephrine Effects
A
Alertness, arousal (vigilance), eating behavior
4
Q
Norepinephrine related disease state
A
Depressive disorders
5
Q
Serotonin Effects
A
Regulates mood, sleep, hunger, arousal
6
Q
Serotonin related disease state
A
Depressive disorders, OCD, eating disorders
7
Q
Gamma-amino butyric acid Effect
A
Inhibitory NT, regulates sleep/arousal, anxiety
8
Q
Gamma-amino butyric acid related disease state
A
Anxiety, seizures/tremors, insomnia
9
Q
Glutamate Effects
A
Excitatory NT, learning, memory
10
Q
Glutamate related disease state
A
Schizophrenia, seizures, migraines
11
Q
MDD medications
A
SSRI, SNRI, Bupropion, Mirtazapine, TCA, MAOi, Trazodone, Mood Stabilizers, Antipsychotics
12
Q
GAD medications
A
SSRI, SNRI, Mirtazapine, TCA, Benzodiazepines, Hydroxyzine, Buspirone, Antipsychotics
13
Q
PTSD medications
A
SSRI, SNRI, Mirtazapine, TCA, Mood Stabilizers, Antipsychotics
14
Q
Insomnia medications
A
Mirtazapine, TCA, Trazodone, Benzodiazepines, Hydroxyzine, Antipsychotics
15
Q
Bipolar Medications
A
Benzodiazepines, Mood Stabilizers, Antipsychotics
16
Q
Schizophrenia Medications
A
Mood Stabilizers, Antipsychotics
17
Q
SSRI disease indications
A
MDD, GAD, PTSD
18
Q
SNRI disease indications
A
MDD, GAD, PTSD
19
Q
Bupropion disease indications
A
MDD
20
Q
Mirtazapine disease indications
A
MDD, GAD, PTSD, Insomnia
21
Q
TCA disease indications
A
MDD, GAD, PTSD, Insomnia
22
Q
MAOi disease indications
A
MDD (last line)
23
Q
Trazodone disease indications
A
MDD, Insomnia
24
Q
Benzodiazepine disease indications
A
GAD, Insomnia, Bipolar (help sleep)
25
Hydroxyzine disease indications
GAD, Insomnia
26
Buspirone disease indications
GAD
27
Mood stabilizer disease indication
MDD, PTSD, Bipolar, Schizophrenia
28
Antipsychotics disease indications
ALL
MDD, GAD, PTSD, Insomnia, Bipolar, Schizophrenia
29
SSRI drug-drug interactions to think about
CI: MAOIs within 2 weeks
Serotonin syndrome with other serotonergic agents
CYP450 inhibitors
30
FDA indications: Fluoxetine
MDD, Panic d/o, OCD, Bulimia, PMDD
31
FDA indications: Sertraline
MDD, Panic d/o, OCT, PTSD, SAD, PMDD
32
FDA indications: Paroxetine
MDD, GAD, Panic d/o, OCT, PTSD, SAD, PMDD
33
FDA indications: Citalopram
MDD
34
FDA indications: Escitalopram
MDD, GAD
35
FDA indications: Fluvoxamine
OCD
36
SSRI Side Effects
QTc prolongation
Drowsiness, insomnia, anxiety, GI upset, sexual dysfunction, weight gain, increased risk of bleeding
37
SSRI longest half life
Fluoxetine
38
SSRI with most sedating effect
Paroxetine
39
SSRI with highest dose-dependent QTc prolongation
Citalopram
40
SSRI therapeutic effect
3-8 weeks
41
SNRI therapeutic effect
8-12 weeks
42
SNRI overview facts
Difference in clearance among patients
May require renal and hepatic adjustment
43
SNRI drug interactions to consider
CI: MAOIs within 2 weeks
Serotonin syndrome with other serotonergic agents
Venlafaxine more likely to result in death with overdose
44
SSRI medications
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
45
SNRI medications
Venlafaxine
Duloxetine
Desvenlafaxine
Milnacipran
Levomilnacipran
46
Venlafaxine indications
MDD, GAD, Panic d/o, SAD
47
Duloxetine indications
MDD, GAD, FM, DPN, CMP
48
Desvenlafaxine indications
MDD
49
Milnacipran indications
FM
50
Levomilnacipran indications
MDD
51
SNRI Inhibits SERT>NET
Venlafaxine
Duloxetine
Desvenlafaxine
52
SNRI Inhibits NET >SERT
Milnacipran (NET >> SERT)
Levomilnacipran
53
SNRI Caution with angle closure glaucoma
Venlafaxine
Duloxetine (avoid)
Levomilnacipran (avoid)
54
SNRI Avoid in ESRD
Milnacipran
Levomilnacipran
55
SNRI Avoid in renal/hepatic impairment
Duloxetine
56
SNRI side effects
Increased BP and HR (except duloxetine)
insomnia, anxiety, GI upset, sexual dysfunction, sweating, increased risk of bleeding,
57
SNRI side effects Levomilnacipran specific
Avoid with uncontrolled hypertension, cardiovascular conditions, dose-dependent effects on urinary hesitancy
58
Discontinuation/Withdrawal symptoms
Characterized by agitation, anxiety, chills, diaphoresis, dizziness, dysphoria, fatigue, headache, insomnia, irritability, myalgias, nausea, paresthesia, rhinorrhea, and tremor
59
Discontinuation/Withdrawal symptoms: lowest risk
fluoxetine
vortioxetine
60
Discontinuation/Withdrawal symptoms: highest risk
paroxetine, venlafaxine, fluvoxamine, vilazodone
61
Bupropion NT
Norepinephrine and Dopamine
62
Bupropion is FDA approved for
MDD, SAD, smoking cessation
63
Bupropion CI
bulimia, anorexia, seizure disorder, with MAOi use (14 days), withdrawal from alcohol, benzos, sedatives
64
Bupropion should be taken in the (morning/night) due to __
morning, mild stimulating effect
65
Bupropion Side Effects
lowers seizure threshold
insomnia, dizziness, increased BP, tachycardia, GI upset, weight loss
66
Bupropion important drug interaction
Potent 2D6 inhibitor
Metabolized by 2B6
67
Mirtazapine MOA
Blocks alpha 2 adrenergic receptor, postsynaptic 5-HT2 and 5-HT3 receptors, histamine H1 receptors
68
Mirtazapine FDA approval
MDD, off label for headache, migraine, panic d/o
69
Mirtazapine Dosing
lower the dose, the greater the sedation
70
TCA MOA
serotonin and norepinephrine reuptake transporter
works on postsynaptic muscarinic and histamine receptors
71
TCA FDA indications
MDD, OCD, insomnia
72
TCA off label
FM, Panic d/o, headache, neuropathy, IBS, interstitial cystitis, dyspepsia, bulimia, pain syndromes, incontinence
73
TCA take (morning/night)
Night, take at bedtime due to sedation
74
TCA Side effects
Dangerous in overdose (QTc prolongation, anticholinergic toxicity, seizures)
Cardiovascular side effects: orthostatic hypotension, QTc prolongation, arrhythmias, MI
seizure, blurred vision, confusion, GI upset, sexual dysfunction, weight gain, acute hepatitis
75
MAOi
Block degradation of monoamines
76
MAO-A metabolizes
dopamine, norepinephrine, serotonin
77
MAO-B metabolizes
dopamine
78
MAOi FDA approved
MDD, Parkinson’s disease (selegiline – MAO-B)
79
MAOi CI
heart failure, liver disease, pheochromocytoma
serotonergic medications due to risk of hypertensive crisis
Dietary restriction of tyramine due to hypertensive crisis
Avoid sympathomimetics (e.g., amphetamine, pseudoephedrine)
80
Serotonin Syndrome
Caused by overstimulation of central and peripheral serotonin receptors
81
MAOi Selegiline
Available as a patch
Avoid tyramine
82
MAOi side effects
Dangerous in overdose (respiratory depression, coma, pain, etc.)
Cardiovascular, neurologic, GI upset, Metabolic (liver injury, weight gain)
83
Serotonin Modulators
Nefazodone
Trazodone
Vilazodone
Vortioxetine
84
Serotonin Modulator FDA approval
MDD
85
Serotonin Modulator off label
Trazodone for agitation with dementia and insomnia
86
Serotonin Modulator therapeutic effect
8-14 weeks
87
Nefazodone highlight
CI with liver dysfunction
Hepatoxicity
88
Trazodone highlight
Priapism
89
Vilazodone highlight
GI side effects
90
Vortioxetine highlight
nausea
91
Benzodiazepines MOA
Enhance normal inhibitory action of GABA at GABA-A receptor
Increase chloride entering into the cell
92
Benzodiazepines FDA approval
anxiety, panic, insomnia, seizures, status epilepticus, alcohol withdrawal, muscle spasms
93
Benzodiazepines side effects and boxed warning
sedation, drowsiness, dizziness, ataxia, withdrawal
BBW: Profound sedation, respiratory depression, coma, and death with concomitant opioid use
Potential for abuse
94
HYDROXYZINE MOA
Competitive histamine H1-receptor agonist; also activity at muscarinic, 5-HT2, and DA receptors
95
Buspirone MOA
Unknown, thought to have high affinity for 5-HT1A and 5-HT2, moderate affinity for dopamine D2 receptors
96
Hydroxyzine FDA indications
Anxiety
97
Buspirone FDA indications
GAD
off label augmentation in depression
98
Hydroxyzine side effect
Anticholinergic (e.g., dry mouth, constipation), CNS depression, dizziness, cognitive impairment, QTc prolongation, rare dermatologic reactions
99
Buspirone side effect
Dizziness, headache, nervousness, drowsiness, insomnia, movement d/o, serotonin syndrome
100
Lithium MOA
Effects multiple systems = serotonin, norepinephrine, dopamine, GABA
Thought to be due to altered cation transport in nerves and muscles
Stimulates inhibitory neurotransmission and inhibits excitatory transmission
101
Lithium FDA approval
MDD, Bipolar disorder
102
Lithium excretion
entirely renal
103
Lithium dose
acute mania 0.8-1.2
Maintenance 0.6-1
104
Lithium CI
Severe cardiovascular or renal disease, dehydration, sodium depletion, use with diuretics
105
Lithium SE
Nausea (especially early in treatment), tremor, polyuria/polydipsia, thyroid dysfunction, hypercalcemia, diarrhea, weight gain, cognitive impairment, sexual dysfunction, arrhythmias
106
Valproic Acid MOA
GABA-receptor agonist, increases GABA in different areas of the brain, blocks voltage-gated sodium channels suppressing neuronal firing
107
Valproic Acid FDA indications
Bipolar, seizures, migraine prophylaxis
108
Carbamazepine MOA
GABA receptor agonist, modulator of GABA-A increasing chloride current
109
Carbamazepine FDA indications
Bipolar, seizures, neuropathic pain
110
Valproic acid SE
thrombocytopenia, hepatic failure
111
Carbamazepine SE
rash, agranulocytosis
112
Lamotrigine MOA
Inhibits glutamate release, inhibits voltage-sensitive Na+ channels = neuronal stabilization
Weak 5-HT3 receptor inhibitor
113
Lamotrigine FDA indication
bipolar disorder, seizures
114
Lamotrigine SE
Rash/hypersensitivity reaction
careful in structural heart disease
115
1st gen antipsychotics (FGA) MOA
Post-synaptic blockade of dopamine D2 receptors
116
FGA FDA approval
psychotic disorders including schizophrenia, behavioral disorders, hyperactivity, Tourette’s, agitation, nausea/vomiting, hiccups (chlorpromazine)
117
FGA adverse effects
Anticholinergic effects: sedation, QTC prolongation
Extrapyramidal symptoms: Tardive dyskinesia
118
2nd gen (SGA) MOA
Most block postsynaptic dopamine D2 receptors
D2 partial agonists (aripiprazole, brexipiprazole)
D3-preferring, D3/D2 partial agonis (cariprazine)
Affinity for 5-HT2 receptor > D2 = lower risk of EPS?
Affinities for other receptors corresponds to differences in side effects
119
SGA FDA approvals
schizophrenia, bipolar disorder, acute delirium and agitation, adjunct for MDD, Tourette syndrome, Parkinson’s-related psychosis (pimavanserin)
120
SGA side effects
Rare, serious include tardive dyskinesia, neuroleptic malignant syndrome, seizures, agranulocytosis, mortality for older adults with dementia
Metabolic syndrome
121
SGA highest risk of metabolic AE
Clozapine
Olanzapine
122
SGA lowest risk of metabolic AE
Aripiprazole
Lurasidone
Ziprasidone
