Medications Flashcards

Question

``` MOA (non-bzd sedatives/anxiolytics): Buspirone Hydroxyzine Propranolol Clonidine Zolpidem Zaleplon Eszopiclone Ramelteon Doxepin ```

Answer 1

``` Buspirone - 5HT1 AGONIST Hydroxyzine - Anti-H Propranolol - beta-block Clonidine - Alpha 2 - AGONIST Zolpidem - BZD1 AGONIST Zaleplon - " " Eszopiclone- " " Ramelteon - Melatonin receptor agonist Doxepin - TCA/Anti-H (50x stronger than benadryl) ```

Answer 2

``` Modafinil Armodafinil Methylphenidate (Ritalin, Concerta) Amphetamine Salts (Adderall) Dextroamphetamine Lis-dexamptheamine Methamphetamine ``` *****These 3 are FDA approved for ADHD but are NOT Stimulants:***** Atomoxetine (SNRI) Guanfacine (alpha 2 agonist) Clonidine (alpha 2 agonist)

Answer 3

``` Methadone --> Morphine (opioid) Buprenorphine - opioid agonist Naloxone - opioid antagonist Acamprosate - NMDA antagonist Naltrexone - Opioid antagonist Varenicline - Nictonic Receptor antagonist Bupropion - DNRI ```

Answer 4

Dystonia - spasm of face,neck and tongue Parkinsonianism - resting tremor, rigidity, bradykinesia Akathisia - restless

Answer 5

Anti-Parkinsons Drugs - benztropine, diphenhydramine) BZD Beat Blocker (FOR AKATHISIA)

Answer 6

Metabolic Syndrome - increase blood pressure - increased insulin and excess waistline fat - INCREASED risk of CV disease,

Answer 7

Apriprazole - only 2nd gen | First Gen antipsych

Answer 8

BZD Beta-blocker Cholinomimetics

Answer 9

Look for leukocytosis, fever, rigidity, elevated CPK, metabolic acidosis,

Answer 10

TYPICAL anti-psychotic | causes IRREVERSIBLE retinal pigmentation

Answer 11

Typical Anti-psychotic | causing corneal and lens deposits

Answer 12

FIRST LINE --> Lithium If can't use Lithium (renal issues, pregnant, etc) --> USE VALPROATE

Answer 13

Spina Bifida if pregnant Pancreatitis Low Platelets Agranulocytosis

Answer 14

Carbamazepine (also for Trigeminal neuralgia) | Lamotrigine

Answer 15

``` Indications -ADD -Narcolepsy Contraindications - Co-admin w/ MAO-I - Narrow angle glaucoma ```

Answer 16

Adverse - Anxiety Insomnia Anorexia Tachycardia

Answer 17

Drug Dependence HTN Cardiac Arr CV Collapse (rare)

Answer 18

Narcolepsy ADD Primary and Secondary Hypersomnia

Answer 19

Co-admin with MAO-I

Answer 20

``` HA Nausea Rhinitis Anxiety Insomnia ```

Answer 21

``` CNS Stimulant used for - ADD Contraindicated - Co-admin with MAO-I - Narrow Angle Glaucoma ```

Answer 22

``` Dyspepsia N/V Anorexia Dizziness Insomnia Sexual dysfxn ```

Answer 23

Suicidal ideation | Severe Liver Injury

Answer 24

Target the D2 pathway in MESOLIMBIC D2 Block in other pathways causes side effects - Block of Nigrostriatal --> EPS - Block of tuberoinfundibular --> HyperPL - Block of Mesocrotical --> Worsens negative sx and cognition Typical Antipsych - also block Ach, Alpha adrenergic, and H1 receptors

Answer 25

``` Holperidol Fluphenazine Pimozide Thiothixene Trifluphenazine ```

Answer 26

Perphenazine Molindone Loxapine

Answer 27

HIGH Potency -- worse EPS LOW Potency -- more Anti-Ach, Anti-H1, and Anti-alpha adrenergic MID Potency - more balanced profile

Answer 28

Chlorpromazine Mesoridazine Thioridazine

Answer 29

HIGHLY sedating Significant hypotension and Anti-Ach LOW EPS sideeffects!!

Answer 30

Least EPS of all the Typicals Significant QT prolongation doses >800mg/day --> retinitis pigmentosa

Answer 31

Psychotic Disorders - Schizophrenia - Shizoaffective d/o - Brief Psychotic d/o - Substance and Med - induced psychosis Psychotic Symptoms in Mood D/o - MDD w/ psychotic features - Acute Manic, depressed,and mixed manic states of bipolar disorder Tourette's Huntington's

Answer 32

EPS - Akathisia, Parkinsonian, Dystonia - tx Akathisis w/ Anti-Act, Betablock or BZD - tx Dystonia w/ Anti-Act (po or IM) - tx Parkinsonian w/ Anti-Act, Dopaminergics, or Beta-blockers ``` Sedation Weight Gain Anti-Ach side-effects Orthostatic HypoTN Dec.Seizure threshold Sexual Dysfxn Dermatologic effects (dermatitis, and photosensitivity) ```

Answer 33

hyperpyrexia ANS instability Rigidity Delerium

Answer 34

Block D2 and 5HT2A - the 5HT2a is responsible for mitigating the D2 related EPS side effects and the D2 block in other pathways also block Muscurinic-Ach, Alpha Adrenergic, and H1 to varying degress MORE Metabolic side effects and LESS EPS - hyperglycemia - DM2 - Hyper-Lipidemias

Answer 35

Indications - Tx- refractory Schizo - Schizo with concurrent Tard.Dyskinesia Contraindications - Granulocytopenia - DM/hyperlipidemias

Answer 36

``` Sedation Anti-Ach + ECG changes Orthostatic HypoTn Hypersalivation Weight Gain (substantial) Seizures (high dose or fast titration) Metabolic problems (DM and HLD) ``` Serious Effects include Agranulocytosis (requires frequent CBC checks)

Answer 37

Acute Mania

Answer 38

``` Orthostatic HypotTN Reflex Tachy Dizziness Insomnia Agitation HyperPL if >6mg/day --> EPS MAY develop Metabolic Problems ```

Answer 39

Acute Mania Bipolar Maintainence Contraindications in DM and HLD pts

Answer 40

``` Anti_Ach + ECG Changes Orthostatics and dizziness Sedation Weight Gain hyperglycemia --> DM2 --> DKA HLD ```

Answer 41

Sedation Weight Gain, to lesser extent than clozapine, olanzapine, and risperidone Metabolic problems, including diabetes and hyperlipidemias, probably at a lower rate than olanzapine and clozapine Possible increased risk for prolongation of QT interval

Answer 42

Also good for Bipolar Maintainence

Answer 43

Weigth Gian, but less than Clozapine, Olanzapine, and Risperidone Metabolic problems

Answer 44

Olanzapine and Apriprazole

Answer 45

Panic | Enuresis

Answer 46

fewer side effects less sedating safer in OD Desipramine, Nortiptyline, Protriptyline

Answer 47

Cardiac conduction delays | Cardiac Arr

Answer 48

Nortriptyline

Answer 49

Desipramine

Answer 50

pain, insomnia, anxiety

Answer 51

highly seritonergic | indicated for OCD

Answer 52

PAIN headache, insomnia

Answer 53

``` MDD Bipolar Depression Dysthymia Panic d/o Gen Soc. Phobia GAD OCD (clomipramine) Panic D/o (migrains/neuralgias) ```

Answer 54

``` weight gain, Anti-Ach Sedation Orthostatic HYPOtn sex dysfxn + anorgasmia in women seizures mania in bipolar patients ```

Answer 55

Cardiotoxicity --. slow the condunction --> EKG changes, ARR, and AV block Neurotox --> tremor ataxia Overdose --> agitation, delerium, coma, and death

Answer 56

``` MDD Atypical Depression Panic d/o Social Phobias OCD ``` ``` DO NOT GIVE w/ demerol another SSRI Sympathomimetic drugs Tyramine ```

Answer 57

``` Weight gain sex dys fxn insomnia myoclonus. mm pains, and paresthesia mania orthostatic hypoTN ```

Answer 58

longest half-;life | good for bulemia

Answer 59

more sedating than fluoxetine and sertraline

Answer 60

less sedating than paroxetine

Answer 61

indicated for OCD

Answer 62

5HT3 - in GI sys --> N/V/D 5HT2C - CNS --> anxiety and mental agitation 5HT2A - CNS, spinal cord--> anxiety, mental agitation, akathisia, insomnia, myoclonus, and sex dysfxn

Answer 63

HA, Dizziness, Irrtiability, and Fatigue on abrupt discontinuation

Answer 64

SNRI - best efficacy for antidepresion - MDD - GAD - Panic d/o - Gen Soc. Phobia DO NOT co-admin with MAO-I

Answer 65

``` Tremor Agitation Tachy/HTN N/V/D Anxiety and Mental Agitation Akathisia Insomnias Myoclonus Sex Dysfxn Seizures (rare) Mania ``` Discontinuation syndrome is the same as SSRI

Answer 66

DM Neuropathy Nausea Fibromyalgia Pain for OA

Answer 67

good MDD but do NOT give with MAO-I

Answer 68

Sedation INC Appetite and Weigh Gain Serious effects --> agranulocytosis and blood dyscrasias

Answer 69

MDD and Dysthymia | do not give w/ MAO-I

Answer 70

Trazodone - priapism Nefazodone - liver tox (black box) since 5HT2A is blocked sex dys is avoided

Answer 71

``` MDD Dysthymia Bipolar Depression ADHD Smoking Cessation BPH Weight Loss ```

Answer 72

Anorexia Bulemia Seizure d/o co-admin with MAO-I

Answer 73

Activation Insomnia Nausea Tremor Seizure at high dose

Answer 74

Alprazolam - very addictive Lorazepam Oxazepam Temazepam (sleep aid)

Answer 75

Clonazepam Diazepam (fast onset but active metabolite) Chlordiazepoxide - etoh Detox

Answer 76

``` GAD Situation Anxiety Phobias Panic d/o epilepsy muscle spasm akathisia etoh w/d agitation anxiety in other psych d/o ```

Answer 77

Flumazenil <-- BZD antagonist

Answer 78

5HT1A AGONIST - good for GAD and adjunct in MDD - takes at least 2 wks to kick in

Answer 79

Dizzy/HA/Fatigue/Gi distress NO sedation or addictive potential like BZD

Answer 80

good for situational anxiety (anti-H)

Answer 81

Sedation Weight gain Anti-Ach

Answer 82

``` Zolpidem Zaleplon Eszoplicone Diphenhydramine remelteon ```

Answer 83

Zaleplon is short acting | Eszoplicone - not supposed to have tolerance

Answer 84

Zolpidem - N/V/D/ Gi distress Zaleplon - Dizzy, Dyspepsia Eszoplicone - headaches

Answer 85

can counter oculogyric crisis | but also good for insomnia

Answer 86

Dizzy and Fatigue

Answer 87

``` Bipolar 1 (esp euphoric mania_ Bipolar 2 Bipolar Maintainence Intermittent Explosive D/O Adjunct to anti-depressant ```

Answer 88

Pregant women --> ebsteins anomanly renal fx/dx patients -Caution w/ diuretics, ACE-Inh, NSAIDS <-- all can raise Li levels

Answer 89

periodic therapeutic blood monitoring thyroid kidney function testing.

Answer 90

``` GI irritation Polyuria polydipsia, nephrogenic DI Tremor, subtle incoord, Cognitive Blunting Benign Leukocytosis Weight Gain ```

Answer 91

``` Li tox - oliguira - N/V/D - oliguria - ataxia - coarse tremor - inc DTR's - obtundation - seizure - death Thyrotox Long-term nephrotox Cardiac Arr + T-wave flattening ```

Answer 92

Bipolar 1 (mixed mania and rapid cycling) Bipolar 2 Epilepsy and Neuralgias EtOH w/d

Answer 93

Pregnant women - -> cleft lip, palate, - ->neural tube defects - ->learning d/o

Answer 94

``` N/V/D Seadation Lightheaded Tremor Coginitive blunting Hyponatremia Anti-Ach effects Rash --> SJS Weight Gain ```

Answer 95

``` Blood dyscrasias (aplastic anemia, agranulocytosis and thrombocytopenia) Hepatotox ``` OD --> coarse tremor, coma, death

Answer 96

Therapeutic levels CBC LFT metabolic fxn tests

Answer 97

if Leukopenic at 3000-3500 (2x/week CBC and continue Clozapine) If leukopenic at 2000-3000 stop Clozapine and check CBC daily. CAN restart if it resolves if Agranulucytosis (uncomplicated or complicated) STOP --> Protective isolation - CANNOT RESTART CLOZAPINE

Answer 98

>3mEq --> Dialysis

Answer 99

Theophyline and Cisplatin = DEC Carbamazepine Carbamazepine will cause a drop in Warfarin and Hormonal contraceptives Eryhtromycin will INC Carbamazepine levels

Answer 100

clonidine or beta blocker

Answer 101

``` flu-like (chills and aches) Nausea Vomiting Dizzy Sensory and sleep disturbance usually occurss 1-3 days after last dose since Sertraline and paroxetine are short half-life --> taper since fluoxetine is long half life - can stop abruptly ```

Answer 102

leukocytosis elevated Transaminases myoglobinuria

Answer 103

can use beta blocker, cessation of caffeine and dose reduction/slow release of lithium to tx