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CDM 4 Exam 2 > Intro to Psych > Flashcards

Intro to Psych Flashcards

1
Q

Dopamine Effects

A

Control of voluntary movement, influences learning, attention, emotion; “Reward pathway”

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2
Q

Dopamine related disease state

A

Parkinsonism, schizophrenia, addictive disorders

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3
Q

Norepinephrine Effects

A

Alertness, arousal (vigilance), eating behavior

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4
Q

Norepinephrine related disease state

A

Depressive disorders

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5
Q

Serotonin Effects

A

Regulates mood, sleep, hunger, arousal

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6
Q

Serotonin related disease state

A

Depressive disorders, OCD, eating disorders

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7
Q

Gamma-amino butyric acid Effect

A

Inhibitory NT, regulates sleep/arousal, anxiety

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8
Q

Gamma-amino butyric acid related disease state

A

Anxiety, seizures/tremors, insomnia

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9
Q

Glutamate Effects

A

Excitatory NT, learning, memory

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10
Q

Glutamate related disease state

A

Schizophrenia, seizures, migraines

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11
Q

MDD medications

A

SSRI, SNRI, Bupropion, Mirtazapine, TCA, MAOi, Trazodone, Mood Stabilizers, Antipsychotics

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12
Q

GAD medications

A

SSRI, SNRI, Mirtazapine, TCA, Benzodiazepines, Hydroxyzine, Buspirone, Antipsychotics

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13
Q

PTSD medications

A

SSRI, SNRI, Mirtazapine, TCA, Mood Stabilizers, Antipsychotics

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14
Q

Insomnia medications

A

Mirtazapine, TCA, Trazodone, Benzodiazepines, Hydroxyzine, Antipsychotics

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15
Q

Bipolar Medications

A

Benzodiazepines, Mood Stabilizers, Antipsychotics

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16
Q

Schizophrenia Medications

A

Mood Stabilizers, Antipsychotics

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17
Q

SSRI disease indications

A

MDD, GAD, PTSD

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18
Q

SNRI disease indications

A

MDD, GAD, PTSD

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19
Q

Bupropion disease indications

A

MDD

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20
Q

Mirtazapine disease indications

A

MDD, GAD, PTSD, Insomnia

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21
Q

TCA disease indications

A

MDD, GAD, PTSD, Insomnia

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22
Q

MAOi disease indications

A

MDD (last line)

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23
Q

Trazodone disease indications

A

MDD, Insomnia

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24
Q

Benzodiazepine disease indications

A

GAD, Insomnia, Bipolar (help sleep)

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25
Q

Hydroxyzine disease indications

A

GAD, Insomnia

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26
Q

Buspirone disease indications

A

GAD

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27
Q

Mood stabilizer disease indication

A

MDD, PTSD, Bipolar, Schizophrenia

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28
Q

Antipsychotics disease indications

A

ALL
MDD, GAD, PTSD, Insomnia, Bipolar, Schizophrenia

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29
Q

SSRI drug-drug interactions to think about

A

CI: MAOIs within 2 weeks

Serotonin syndrome with other serotonergic agents

CYP450 inhibitors

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30
Q

FDA indications: Fluoxetine

A

MDD, Panic d/o, OCD, Bulimia, PMDD

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31
Q

FDA indications: Sertraline

A

MDD, Panic d/o, OCT, PTSD, SAD, PMDD

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32
Q

FDA indications: Paroxetine

A

MDD, GAD, Panic d/o, OCT, PTSD, SAD, PMDD

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33
Q

FDA indications: Citalopram

A

MDD

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34
Q

FDA indications: Escitalopram

A

MDD, GAD

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35
Q

FDA indications: Fluvoxamine

A

OCD

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36
Q

SSRI Side Effects

A

QTc prolongation
Drowsiness, insomnia, anxiety, GI upset, sexual dysfunction, weight gain, increased risk of bleeding

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37
Q

SSRI longest half life

A

Fluoxetine

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38
Q

SSRI with most sedating effect

A

Paroxetine

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39
Q

SSRI with highest dose-dependent QTc prolongation

A

Citalopram

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40
Q

SSRI therapeutic effect

A

3-8 weeks

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41
Q

SNRI therapeutic effect

A

8-12 weeks

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42
Q

SNRI overview facts

A

Difference in clearance among patients

May require renal and hepatic adjustment

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43
Q

SNRI drug interactions to consider

A

CI: MAOIs within 2 weeks

Serotonin syndrome with other serotonergic agents

Venlafaxine more likely to result in death with overdose

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44
Q

SSRI medications

A

Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine

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45
Q

SNRI medications

A

Venlafaxine
Duloxetine
Desvenlafaxine
Milnacipran
Levomilnacipran

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46
Q

Venlafaxine indications

A

MDD, GAD, Panic d/o, SAD

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47
Q

Duloxetine indications

A

MDD, GAD, FM, DPN, CMP

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48
Q

Desvenlafaxine indications

A

MDD

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49
Q

Milnacipran indications

A

FM

50
Q

Levomilnacipran indications

A

MDD

51
Q

SNRI Inhibits SERT>NET

A

Venlafaxine
Duloxetine
Desvenlafaxine

52
Q

SNRI Inhibits NET >SERT

A

Milnacipran (NET&raquo_space; SERT)

Levomilnacipran

53
Q

SNRI Caution with angle closure glaucoma

A

Venlafaxine

Duloxetine (avoid)

Levomilnacipran (avoid)

54
Q

SNRI Avoid in ESRD

A

Milnacipran

Levomilnacipran

55
Q

SNRI Avoid in renal/hepatic impairment

A

Duloxetine

56
Q

SNRI side effects

A

Increased BP and HR (except duloxetine)

insomnia, anxiety, GI upset, sexual dysfunction, sweating, increased risk of bleeding,

57
Q

SNRI side effects Levomilnacipran specific

A

Avoid with uncontrolled hypertension, cardiovascular conditions, dose-dependent effects on urinary hesitancy

58
Q

Discontinuation/Withdrawal symptoms

A

Characterized by agitation, anxiety, chills, diaphoresis, dizziness, dysphoria, fatigue, headache, insomnia, irritability, myalgias, nausea, paresthesia, rhinorrhea, and tremor

59
Q

Discontinuation/Withdrawal symptoms: lowest risk

A

fluoxetine
vortioxetine

60
Q

Discontinuation/Withdrawal symptoms: highest risk

A

paroxetine, venlafaxine, fluvoxamine, vilazodone

61
Q

Bupropion NT

A

Norepinephrine and Dopamine

62
Q

Bupropion is FDA approved for

A

MDD, SAD, smoking cessation

63
Q

Bupropion CI

A

bulimia, anorexia, seizure disorder, with MAOi use (14 days), withdrawal from alcohol, benzos, sedatives

64
Q

Bupropion should be taken in the (morning/night) due to __

A

morning, mild stimulating effect

65
Q

Bupropion Side Effects

A

lowers seizure threshold

insomnia, dizziness, increased BP, tachycardia, GI upset, weight loss

66
Q

Bupropion important drug interaction

A

Potent 2D6 inhibitor
Metabolized by 2B6

67
Q

Mirtazapine MOA

A

Blocks alpha 2 adrenergic receptor, postsynaptic 5-HT2 and 5-HT3 receptors, histamine H1 receptors

68
Q

Mirtazapine FDA approval

A

MDD, off label for headache, migraine, panic d/o

69
Q

Mirtazapine Dosing

A

lower the dose, the greater the sedation

70
Q

TCA MOA

A

serotonin and norepinephrine reuptake transporter

works on postsynaptic muscarinic and histamine receptors

71
Q

TCA FDA indications

A

MDD, OCD, insomnia

72
Q

TCA off label

A

FM, Panic d/o, headache, neuropathy, IBS, interstitial cystitis, dyspepsia, bulimia, pain syndromes, incontinence

73
Q

TCA take (morning/night)

A

Night, take at bedtime due to sedation

74
Q

TCA Side effects

A

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
Q

MAOi

A

Block degradation of monoamines

76
Q

MAO-A metabolizes

A

dopamine, norepinephrine, serotonin

77
Q

MAO-B metabolizes

A

dopamine

78
Q

MAOi FDA approved

A

MDD, Parkinson’s disease (selegiline – MAO-B)

79
Q

MAOi CI

A

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
Q

Serotonin Syndrome

A

Caused by overstimulation of central and peripheral serotonin receptors

81
Q

MAOi Selegiline

A

Available as a patch
Avoid tyramine

82
Q

MAOi side effects

A

Dangerous in overdose (respiratory depression, coma, pain, etc.)
Cardiovascular, neurologic, GI upset, Metabolic (liver injury, weight gain)

83
Q

Serotonin Modulators

A

Nefazodone
Trazodone
Vilazodone
Vortioxetine

84
Q

Serotonin Modulator FDA approval

A

MDD

85
Q

Serotonin Modulator off label

A

Trazodone for agitation with dementia and insomnia

86
Q

Serotonin Modulator therapeutic effect

A

8-14 weeks

87
Q

Nefazodone highlight

A

CI with liver dysfunction
Hepatoxicity

88
Q

Trazodone highlight

A

Priapism

89
Q

Vilazodone highlight

A

GI side effects

90
Q

Vortioxetine highlight

A

nausea

91
Q

Benzodiazepines MOA

A

Enhance normal inhibitory action of GABA at GABA-A receptor
Increase chloride entering into the cell

92
Q

Benzodiazepines FDA approval

A

anxiety, panic, insomnia, seizures, status epilepticus, alcohol withdrawal, muscle spasms

93
Q

Benzodiazepines side effects and boxed warning

A

sedation, drowsiness, dizziness, ataxia, withdrawal

BBW: Profound sedation, respiratory depression, coma, and death with concomitant opioid use
Potential for abuse

94
Q

HYDROXYZINE MOA

A

Competitive histamine H1-receptor agonist; also activity at muscarinic, 5-HT2, and DA receptors

95
Q

Buspirone MOA

A

Unknown, thought to have high affinity for 5-HT1A and 5-HT2, moderate affinity for dopamine D2 receptors

96
Q

Hydroxyzine FDA indications

A

Anxiety

97
Q

Buspirone FDA indications

A

GAD
off label augmentation in depression

98
Q

Hydroxyzine side effect

A

Anticholinergic (e.g., dry mouth, constipation), CNS depression, dizziness, cognitive impairment, QTc prolongation, rare dermatologic reactions

99
Q

Buspirone side effect

A

Dizziness, headache, nervousness, drowsiness, insomnia, movement d/o, serotonin syndrome

100
Q

Lithium MOA

A

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
Q

Lithium FDA approval

A

MDD, Bipolar disorder

102
Q

Lithium excretion

A

entirely renal

103
Q

Lithium dose

A

acute mania 0.8-1.2
Maintenance 0.6-1

104
Q

Lithium CI

A

Severe cardiovascular or renal disease, dehydration, sodium depletion, use with diuretics

105
Q

Lithium SE

A

Nausea (especially early in treatment), tremor, polyuria/polydipsia, thyroid dysfunction, hypercalcemia, diarrhea, weight gain, cognitive impairment, sexual dysfunction, arrhythmias

106
Q

Valproic Acid MOA

A

GABA-receptor agonist, increases GABA in different areas of the brain, blocks voltage-gated sodium channels suppressing neuronal firing

107
Q

Valproic Acid FDA indications

A

Bipolar, seizures, migraine prophylaxis

108
Q

Carbamazepine MOA

A

GABA receptor agonist, modulator of GABA-A increasing chloride current

109
Q

Carbamazepine FDA indications

A

Bipolar, seizures, neuropathic pain

110
Q

Valproic acid SE

A

thrombocytopenia, hepatic failure

111
Q

Carbamazepine SE

A

rash, agranulocytosis

112
Q

Lamotrigine MOA

A

Inhibits glutamate release, inhibits voltage-sensitive Na+ channels = neuronal stabilization
Weak 5-HT3 receptor inhibitor

113
Q

Lamotrigine FDA indication

A

bipolar disorder, seizures

114
Q

Lamotrigine SE

A

Rash/hypersensitivity reaction

careful in structural heart disease

115
Q

1st gen antipsychotics (FGA) MOA

A

Post-synaptic blockade of dopamine D2 receptors

116
Q

FGA FDA approval

A

psychotic disorders including schizophrenia, behavioral disorders, hyperactivity, Tourette’s, agitation, nausea/vomiting, hiccups (chlorpromazine)

117
Q

FGA adverse effects

A

Anticholinergic effects: sedation, QTC prolongation

Extrapyramidal symptoms: Tardive dyskinesia

118
Q

2nd gen (SGA) MOA

A

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
Q

SGA FDA approvals

A

schizophrenia, bipolar disorder, acute delirium and agitation, adjunct for MDD, Tourette syndrome, Parkinson’s-related psychosis (pimavanserin)

120
Q

SGA side effects

A

Rare, serious include tardive dyskinesia, neuroleptic malignant syndrome, seizures, agranulocytosis, mortality for older adults with dementia

Metabolic syndrome

121
Q

SGA highest risk of metabolic AE

A

Clozapine
Olanzapine

122
Q

SGA lowest risk of metabolic AE

A

Aripiprazole
Lurasidone
Ziprasidone

CDM 4 Exam 2 (13 decks)

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