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Psych Shelf > Lange Somatic Tx and Psychopharm > Flashcards

Lange Somatic Tx and Psychopharm Flashcards

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1
Q

What receptors does clozapine work on. Antagnonism at which receptor mediates psychotic sx.

A

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.

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2
Q

What is donezipil?

A

Anticholinesterase inhibitors used for dementia

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3
Q

What kind of effects does TCA have on heart? When should TCAs be avoided?

A

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.

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4
Q

What can be given to decrease alcohol cravings?

A

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

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5
Q

Naltrexone vs naloxone?

A

Naltrexone = decrease alcohol cravings (opioid antagnist), NALXONE = opiate antagonist used to acutely reverse the effects of opiate intoxication

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6
Q

What is efficacious against nightmares and other such sx in PTSD?

A

Prazosin

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7
Q

What is prazosin

A

Alpha 1 adrenergic receptor blocker - traditionally used to treat HTN and benign prostatic hypertrophy.

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8
Q

What is perphenazine

A

1st generation antipschotic

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9
Q

What is flumazenil

A

Benzo antagonist used in benzo overdose

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10
Q

why do you have to be careful using quetiapine in elderlly?

A

There’s a black box warning about sudden death in elderly with dementia related psychosis

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11
Q

What is trazodone, what is it used for?

A

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

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12
Q

Patients who come to ER with severely altered levels of consciousness must be evaluated quickly for reversable causes including

A

Hypoglycemia, opioid overdose, alcohol intoxication

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13
Q

Hypoglycemia, opioid overdose, alcohol intoxication in ER - give what?

A

IV dextrose, Naloxone, Thiamine

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14
Q

Duloxetine is what kind of drug and what is it used for?

A

SNRI. Used for major depression and tx of pain, especially neuropathic pain and fibromyalgia

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15
Q

Risperidone has activity at which receptors

A

5HT2a, D2 and alpha 1 receptors. Blocking of alpha 1 receptors causes orthostatic hypotension.

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16
Q

Benign leukocytosis occurs with what drug

A

Lithium

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17
Q

Bupropion is contraindicated in?

A

Patients with eating disorders because it lowers the seizure threshold

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18
Q

What is topiramate? When is it used?

A

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

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19
Q

What is the most common side effect of transcranial magnetic stimulation?

A

Headache at site of application.

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20
Q

Cessation or abrupt reduction in which drugs may develop within a few hours and is very dangerous?

A

Sedative-hypnotics, anxiolytics

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21
Q

Which antipsychotic is most likely to cause hyperglycemia and lead to development of diabetes?

A

Clozapine

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22
Q

What is a dangerous side effects of SSRIs in kids (up to 24 yo)

A

Suicidal thoughts.

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23
Q

Which mood stabilizer carries warning of an increased risk of pancreatitis?

A

Valproic acid.

24
Q

Which mood stabilizer causes polyuria and nephrogenic DI?

A

lithium

25
Q

which meds cause agranulocytosis?

A

Carbamazpine and clozapine

26
Q

What is the recommendend length of treatment for unipolar depression?

A

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

27
Q

What is sialorrhea

A

excess salivation

28
Q

Sialorrhea is a side effect of?

A

Clozapine (up to 30% of patients) but not usually reason to d/c the medication

29
Q

Patients on clozapine develop what kind of cardiac thing?

A

Develop sinus tachycardia that usually does not require cessation of tx. Often it resolves without needing further intervention. But if required, use propanlol.

30
Q

Which benzos are not metabolized by liver?

A

LOT - lorazepam, oxazepam, and temazepam

31
Q

What medication is most appropriate for middle insomnia (falling asleep but frequently awaking during ngiht?)

A

Zaleplon - non benzo half life of 4 hours.

32
Q

IV haldol can have what kind of cardiac effect?

A

Increase QTc

33
Q

Opisthotonos

A

Spasm of neck and back that causes patient to arch forward

34
Q

Pleurothotonos

A

AKA pisa syndrome, leaning posture induced by spasm of torso muscles

35
Q

Which antidepressants don’t cause sexual side effects?

A

Mirtazipine, bupropion, nefazodone

36
Q

What is one of the risks of topiramate?

A

1.5% get renal stones. Also often causes cognitive impariment, particularly word finding.

37
Q

What is blepharospasm

A

Spasm of the eyelinds

38
Q

Rabbit syndrome

A

rare side effect of long term antipsychotic use - fine rhythmic motions of the mouth and lips

39
Q

What kind of electrolytic balance is a common side effect of oxcarbazepine

A

Hyponatremia.

40
Q

What are the long acting benzos

A

Chlordiazepoxide, diazepam, clonzepam

41
Q

Akathisia is worse in which antipsychotics?

A

Second generation according to Lange

42
Q

If akathisia persists with no other EPS sx, how to treat?

A

Proponalol

43
Q

What is the most common compliation of NMS

A

Rhabdomyolsis

44
Q

Wht are the 1st line mood stabiliers for BPAD ! And II

A

1) Lithium 2) Lamotrigine and 3) Quetiapine (? Per lange) and second line is depakote

45
Q

NMS vs Serotonin syndrome

A

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

46
Q

What is the most potent benzo

A

Clonazepam

47
Q

What is the pharm tx for tourettes

A

Antipsychotics. D2 receptor antagonism. Traditinally 1st generation like haldol used/provides greatest relief. Clonidine alpha 2 agonist is preferable for mild tourettes

48
Q

What is the only medication that may improve tardive dyskinesia

A

Clozapine

49
Q

What is one of the most serious risks of SSRI use during pregnancy?

A

Persistent pulmonary HTN of newborn.

50
Q

What effect on fetus by using depakote and carbamazepine

A

Neural tube defects

51
Q

Using depakote has what effect on fetus?

A

Infant developmental delay, neural tube defects

52
Q

What is SSRI D/c syndrome. Which one is the worse culprit

A

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

53
Q

Using which mood stabilizer concurrently with oral contraceptives is bad

A

Lamotrigine. Contraceptive clears out the lamotrigine quickly. They effect each othesr clearance

54
Q

What kind of ekg changes does lithium cause

A

T wave depression or inversion. The changes are not clinically significant, however

55
Q

What meds decrease clearance of lithium

A

THIAZIDE DIURETICS, spironolactone, triamterene, NSAIDS (except aspirin and sulindac), metronidazole, tetracycline

Psych Shelf (13 decks)

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