Lange Somatic Tx and Psychopharm Flashcards
What receptors does clozapine work on. Antagnonism at which receptor mediates psychotic sx.
Works on many receptors D1, D2, D4, histamine 1, muscarininc, alpha 1 adrenergic, and 5Ht2, 5HT2c and 5HT3. much more potent antagonist effect on D4. likely mediates anytispychotics through that.
What is donezipil?
Anticholinesterase inhibitors used for dementia
What kind of effects does TCA have on heart? When should TCAs be avoided?
Has cardiovascular effects - slowing down effects like quinidine. Do not use if there are ekg changes such as prolonged QT, widening of QRS, av conduction abnormlities etc.
What can be given to decrease alcohol cravings?
Naltrexone is an opioid antagonist that has shown to decrease the number of days a person with alcohol dependence drinks and to increase time before relaps
Naltrexone vs naloxone?
Naltrexone = decrease alcohol cravings (opioid antagnist), NALXONE = opiate antagonist used to acutely reverse the effects of opiate intoxication
What is efficacious against nightmares and other such sx in PTSD?
Prazosin
What is prazosin
Alpha 1 adrenergic receptor blocker - traditionally used to treat HTN and benign prostatic hypertrophy.
What is perphenazine
1st generation antipschotic
What is flumazenil
Benzo antagonist used in benzo overdose
why do you have to be careful using quetiapine in elderlly?
There’s a black box warning about sudden death in elderly with dementia related psychosis
What is trazodone, what is it used for?
It’s a serotonergic agent. Often used for insomnia. Also for refractory depression, major depression with anxiety. DOES NOT HAVE SEXUAL SIDE EFFECTS OF SSRI. Causes priapism, orthostattic hyptoension, sedation, N/dizziness
Patients who come to ER with severely altered levels of consciousness must be evaluated quickly for reversable causes including
Hypoglycemia, opioid overdose, alcohol intoxication
Hypoglycemia, opioid overdose, alcohol intoxication in ER - give what?
IV dextrose, Naloxone, Thiamine
Duloxetine is what kind of drug and what is it used for?
SNRI. Used for major depression and tx of pain, especially neuropathic pain and fibromyalgia
Risperidone has activity at which receptors
5HT2a, D2 and alpha 1 receptors. Blocking of alpha 1 receptors causes orthostatic hypotension.
Benign leukocytosis occurs with what drug
Lithium
Bupropion is contraindicated in?
Patients with eating disorders because it lowers the seizure threshold
What is topiramate? When is it used?
It’s an anticonvulsant that is used for tx for people with bulimia and binge eating disorder. Shown to promote weight lose and decrease frequency of binging episodes
What is the most common side effect of transcranial magnetic stimulation?
Headache at site of application.
Cessation or abrupt reduction in which drugs may develop within a few hours and is very dangerous?
Sedative-hypnotics, anxiolytics
Which antipsychotic is most likely to cause hyperglycemia and lead to development of diabetes?
Clozapine
What is a dangerous side effects of SSRIs in kids (up to 24 yo)
Suicidal thoughts.
Which mood stabilizer carries warning of an increased risk of pancreatitis?
Valproic acid.
Which mood stabilizer causes polyuria and nephrogenic DI?
lithium
which meds cause agranulocytosis?
Carbamazpine and clozapine
What is the recommendend length of treatment for unipolar depression?
At least 6 months, usually on scale of 8 to 12 months, and possibly longer depending on patient factors. D.c within first 16 weeks => high risk for relapse
What is sialorrhea
excess salivation
Sialorrhea is a side effect of?
Clozapine (up to 30% of patients) but not usually reason to d/c the medication
Patients on clozapine develop what kind of cardiac thing?
Develop sinus tachycardia that usually does not require cessation of tx. Often it resolves without needing further intervention. But if required, use propanlol.
Which benzos are not metabolized by liver?
LOT - lorazepam, oxazepam, and temazepam
What medication is most appropriate for middle insomnia (falling asleep but frequently awaking during ngiht?)
Zaleplon - non benzo half life of 4 hours.
IV haldol can have what kind of cardiac effect?
Increase QTc
Opisthotonos
Spasm of neck and back that causes patient to arch forward
Pleurothotonos
AKA pisa syndrome, leaning posture induced by spasm of torso muscles
Which antidepressants don’t cause sexual side effects?
Mirtazipine, bupropion, nefazodone
What is one of the risks of topiramate?
1.5% get renal stones. Also often causes cognitive impariment, particularly word finding.
What is blepharospasm
Spasm of the eyelinds
Rabbit syndrome
rare side effect of long term antipsychotic use - fine rhythmic motions of the mouth and lips
What kind of electrolytic balance is a common side effect of oxcarbazepine
Hyponatremia.
What are the long acting benzos
Chlordiazepoxide, diazepam, clonzepam
Akathisia is worse in which antipsychotics?
Second generation according to Lange
If akathisia persists with no other EPS sx, how to treat?
Proponalol
What is the most common compliation of NMS
Rhabdomyolsis
Wht are the 1st line mood stabiliers for BPAD ! And II
1) Lithium 2) Lamotrigine and 3) Quetiapine (? Per lange) and second line is depakote
NMS vs Serotonin syndrome
NMS: autonomic instability (Tachy, diaphoresis, HTN), fever, delirium, LEAD PIPE RIGIDITY, LEUKOCYTOSIS, RHABDOMYOLISIS, INCREASED CPK LEVELS. Serotonin syndrome: Hyperthermia, autonomic instability (Tachy, htn), delirum, HYPERREFELXIA (myoclonic jerks), hypertonicity, renal failure, death
What is the most potent benzo
Clonazepam
What is the pharm tx for tourettes
Antipsychotics. D2 receptor antagonism. Traditinally 1st generation like haldol used/provides greatest relief. Clonidine alpha 2 agonist is preferable for mild tourettes
What is the only medication that may improve tardive dyskinesia
Clozapine
What is one of the most serious risks of SSRI use during pregnancy?
Persistent pulmonary HTN of newborn.
What effect on fetus by using depakote and carbamazepine
Neural tube defects
Using depakote has what effect on fetus?
Infant developmental delay, neural tube defects
What is SSRI D/c syndrome. Which one is the worse culprit
Occurs within 1-3 days of stopping meds. Physical sx like dizziness, N/V, fatigue, lethargy, anxiety, irritability, crying. Paroxetine is the biggest culprit. Short half life with no active metabolites
Using which mood stabilizer concurrently with oral contraceptives is bad
Lamotrigine. Contraceptive clears out the lamotrigine quickly. They effect each othesr clearance
What kind of ekg changes does lithium cause
T wave depression or inversion. The changes are not clinically significant, however
What meds decrease clearance of lithium
THIAZIDE DIURETICS, spironolactone, triamterene, NSAIDS (except aspirin and sulindac), metronidazole, tetracycline
