Lecture 1 - Intro to Psych

Question 1

Dopamine associated with which disorders

Answer 1

Parkinsonism
Schizophrenia
addictive disorders

Question 2

Norepinephrine associated with which disorder

Answer 2

Depressive disorders

Question 3

Serotonin associated with which disorders.

Answer 3

Depressive disorders
OCD
eating disorders

Question 4

GABA associated with which disorders…

Answer 4

anxiety
Seizures & tremors
Insomnia

Question 5

Glutamate associated with which disorders

Answer 5

Schizophrenia
seizures
migraines

Question 6

box warning for all antidepressants?

Answer 6

inc risk of suicidality in children, adolescents and young adults < 24

risk just be balanced with clinical need

no inc risk > 24yrs old, reduction in risk > 65 yrs old

close monitoring for all pts on anti depressants for worsening or unusual behaviors

Question 7

SSRI overview

Answer 7

1st line
3-8 wks for effect, longer in older ppl
starting dose 50% in > 65yrs old

CI = MAOI (in linezolid) w/I 14 days
Serotonin syndrome with additional serotonergic agents
CYP 450inhib

Question 8

Fluoxetine Half life

Answer 8

4-6 days, mad long

Question 9

Citalopram info…

Answer 9

has bunch of drug interactions, QTc prolongation

Escitalopram is like 2.0, better

Question 10

how to enhance absorption with sertraline?

Answer 10

Food

Question 11

Paroxetine claim to fame

Answer 11

weakly anticholinergic

dont use older adults, us at night

Question 12

Fluvoxamine usually used for…

Answer 12

OCD

Question 13

SSRI warnings, precautions, side effects

Answer 13

QTc prolongation, most w/ citalopram
most can induce mania

Neurologic, GI, Gentiourinary (sexual dysfunction), weight gain, Hyponatremia (possible SIADH), inc risk of bleeding

Question 14

Venlafaxine OD info

Answer 14

more likely to cause death in overdose than an SSRI

Question 15

Which SNRI should be avoided in ESRD?

Answer 15

Milnacipran (Savella)
Levomilnacipran ER Tab (Fetzima)

Question 16

Which SNRI should be avoided in glaucoma?

Answer 16

Venlafaxine (Effexor)
Duloxetine (Cymbalta)

Question 17

SNRI warnings, precautions, Side effects

Answer 17

Inc Blood pressure and HR (except Duloxetine)

Sweating, Weight loss, GI

Question 18

Levomilnacipran avoid statement

Answer 18

avoid in uncontrolled HTN, cardiovascular conditions, dose-dependent effects on urinary hesitancy

Question 19

Discontinuation/Withdrawal syndrome of drugs

Answer 19

characterized by agitation, anxiety,chills, dizziness, headache, insomnia

consider with meds hat have short half life, higher doses and duration of treatment (> 5 weeks)

least risk = fluoxetine, vortioxetine
greatest = paroxetine, venlafaxine, fluvoxamine, vilazodone

counseling = avid stopping on own, med specific approach if D/c

Question 20

Bupropion info

Answer 20

CI = bulimia nervosa, anorexia, seizure disorder
CI = MAOI w/I 14 day. withdrawal from alc/benzo/sedatives

Good for smoking cessation & people who have sexual dysfunction

Take AM due to mild stimulating effect

Question 21

What does Bupropion inhibit?

Answer 21

2D6 = potent

Question 22

Bupropion Side effects

Answer 22

Special concern: Lowers seizure threshold = inc risk those

Insomnia, anxiety, BP, nausea, can cause weight loss

Question 23

Mirtazapine dosing info

Answer 23

are sedative at lower doses than at higher doses due to amount of alpha it blocks

Question 24

TCA info

Answer 24

liver metabolism and lipophilic..problematic in OD

Lots of adverse effects and time for drugs to go away due to going in fat

Question 25

TCA warnings, precautions, SE

Answer 25

Dangerous in OD, QTc prolongation, anticholinergic toxicity, seizures bad, lots of SE/ interactions

Question 26

MAOI overview

Answer 26

CI = HF, liver disease, pheochromocytoma Avoid sympathomimetics Dietary restriction of tyramine due to HTNsive crisis CI with serotonergic med due to inc risk HTNsive crisis

Question 27

MAOI warnings, precautions, SE

Answer 27

Dangerous in OD careful transition from other antidepressants Sexual side effects, HTNsive crisis, postural hypotension, weight gain

Question 28

Clinical pearls Nefazodone (Serzone)

Answer 28

CI with liver dysfunction Concerns for hepatoxdcity

Question 29

Trazadone (Desyrel) clinical pearls

Answer 29

Hypotension, priapism, sedation, arrhythmias

Question 30

Vilazodone (Viibryd) clinical pearls

Answer 30

Take w/ food to inc absorption (GI side effects) dose rec w/ 3A4 inhib/inducers

Question 31

Vortioxetine (Trintellix) clinical pearls

Answer 31

may improve cognitive impairment Nausea most common side SE

Question 32

Which Benzo used if hepatic impairment?

Answer 32

Lorazepam Oxazepam Temazepam B/C Undergo Glucuronidation

Question 33

Hydroxyzine precautions/SE

Answer 33

QTc prolongation Rare derm reaction Anticholinergic CNS depression

Question 34

Buspirone precautions/SE

Answer 34

Dizziness HA nervousness drowsiness insomnia serotonin syndrome

Question 35

Monitoring Req for Lithium

Answer 35

12hrs after last dose acute mania = 0.8-1.2 Maintenance = 0.6-1 Renal excretion so dose adjustments req

Question 36

Valproic Acid info

Answer 36

Highly protein bound extensive liver metabolism SE : thrombocytopenia, hepatic failure

Question 37

Carbamazepine info

Answer 37

req monitoring, induces own metabolism SE: rash (SJS/TEN), agranulocytosis, bunch of SE

Question 38

Lamotrigine info

Answer 38

Rash/hypersensitivity reaction req stict dose initiation, titration and adherence due to life threatening rash have to reiterate if pt is on and stops ( > 7 days)

Question 39

2nd gen metabolic side effects

Answer 39

Highest Risk - > Lowest Clozapine/Olanzapine Risperidone/Paliperidone Aripirazole. Lurasidone, Ziprasidone

Question 40

2nd gen associated with QTc prolongation

Answer 40

Ziprasidone

Question 41

2nd gen associated with EPS

Answer 41

risperidone

Question 42

2nd gen associated with Agranulocytosis

Answer 42

Clozapine, special monitoring

Question 43

2nd gen associated with anticholinergic effects

Answer 43

Clozapine, Olanzapine, Quetiapine