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Neuro/Psych > Medications > Flashcards

Medications Flashcards

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1
Q

Doxepin

A

TCA

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2
Q

Clozapine

A

2nd generation antipsychotic

Reserved for patients who have failed at least 2 schizophrenia antipsychotic trials due to risk of agranulocytosis
Weight gain/metabolic syndrome

For treatment-resistant schizophrenia or schizophrenia with suicidality

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3
Q

Anticholinergic toxicity signs

A

AMS, tachycardia, hyperthermia, others

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4
Q

Anticholinergic toxicity - what to do

A

ECG - TCAs can also cause QRS interval prolongation, while others that are antihistamines can cause QTc prolongation, while others can cause cardiac toxicity

Benzos for agitation and seizure
Physostigmine can inhibit cholinesterase, used for severe symptoms
Activated charcoal

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5
Q

Neuroleptic malignant syndrome signs

A
  1. Muscular rigidity
  2. Autonomic instability
  3. AMS
  4. Hyperthermia
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6
Q

Bupropion advantage/disadvantage

A

Norepinephrine-dopamine reuptake inhibitor

No adverse sexual effect or weight gain

Increases risk of insomnia
Lowers seizure threshold - contraindicated in patients with bulimia nervosa or anorexia nervosa (electrolyte abnormalities from vomiting), or epilepsy

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7
Q

Serotonin syndrome difference with NMS

A

Hyperreflexia, clonus, nausea/vomiting vs muscle rigidity in NMS
Rapid onset (within 24h)

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8
Q

What combination of drugs can cause serotonin syndrome?

A

Serotonergic agent + MAO inhibitor (e.g. phenelzine)

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9
Q

Donepezil

A

Cholinesterase inhibitor

Dementia treatment

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10
Q

Memantine

A

NMDA receptor antagonist

Dementia treatment

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11
Q

Amantadine

A

Increases dopamine release/inhibits reuptake

Parkinson treatment

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12
Q

Pramipexole

A

Dopamine agonist

Parkinson treatment

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13
Q

Trazodone

A

Mild serotonin reuptake inhibitor
Additional activity at 5-HT2A and 5-HT2C receptors

Insomnia in setting of depression

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14
Q

Lamotrigine

A

Anticonvulsant

Used for bipolar disorder

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15
Q

Imipramine

A

TCA

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16
Q

Why do 1st-generation antipsychotics cause extrapyramidal symptoms?

A

Potent dopamine D2 antagonism in nigrostriatal pathway

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17
Q

Which of the 2nd-generation antipsychotics have low metabolic risk profile?

A
  1. Aripiprazole
  2. Lurasidone
  3. Ziprasidone
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18
Q

Anticholinergics

A

Diphenhydramine
Benztropine

Used to treat medication-induced dystonia (e.g. dopamine antagonists, antipsychotics)

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19
Q

Phenelzine

A

MAO inhibitor

Do not use with SSRI due to risk of serotonin syndrome

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20
Q

Rivastigmine

A

Cholinesterase inhibitor

For cognitive impairment

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21
Q

Meclizine

A

Antihistamine

Temporary vestibular suppressant to improve symptoms from acute episodes of peripheral vertigo

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22
Q

Nimodipine

A

Subdural hemorrhage - reduces risk of delayed cerebral ischemia following subdural hemorrhage (possibly by vasodilation of small vessels)

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23
Q

Ropinirole

A

Dopamine agonist (D2, D3)

Restless leg syndrome

Adverse: impulse control disorders possibly with manic-like signs/symptoms

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24
Q

Trihexyphenidyl

A

Anticholinergic

Parkinson treatment

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25
Q

Selegiline

A

MAO type B inhibitor

Parkinson

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26
Q

Restless leg syndrome - signs, treatment

A

Dysesthesia worse at night - may be due to abnormalities of dopamine signaling (near circadian control center) or iron use in CNS

If severe and nonpharmacologic doesn’t work, treat with alpha-2-delta calcium channel ligands (pregabalin, gabapentin), possibly iron supplementation if ferritin <=75

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27
Q

Lithium toxicity

A

Ataxia
Lethargy
Slurred speech
GI distress (nausea/vomiting, diarrhea)
Nystagmus
Tremor
Hyperreflexia

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28
Q

Phenytoin toxicity

A

Cerebellar adverse effects:
Ataxia (wide-based gait), horizontal nystagmus (on lateral gaze), dysmetria

AMS, confusion
CNS depression, coma
Nausea, vomiting

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29
Q

Demedetomidine

A

A2 agonist

Used in ICU for procedural sedation

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30
Q

Cyproheptadine

A

Serotonin antagonist

Used for serotonin syndrome

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31
Q

Preferred medication for Parkinson psychosis

A

2nd-generation antipsychotic without D2R antagonism and act mainly by serotonin 5-HT2A receptor antagonism

Quetiapine (no D2R activity, 1st choice), clozapine (agranulocytosis), pimavanserin (expensive)

32
Q

What medication withdrawal can cause seizures?

A

Benzos (particularly short acting like alprazolam and abrupt discontinuation)

33
Q

Antidepressant discontinuation syndrome

A
  1. Acute onset dysphoria
  2. Fatigue
  3. Dizziness
  4. GI distress
  5. Flu-like symptoms
34
Q

What medications can cause dose-dependent seizure in those with predisposition?

A

Bupropion (dopamine/NE reuptake inhibitor)
TCA (e.g. clomipramine)

35
Q

Tardive dyskinesia

A

Involuntary movement disorder with dopamine-blocking agents, especially when dose is reduced or discontinued, due to dopamine D2 receptor supersensitivity

Rhythmic movements of face, lips, tongue
Choreoathetoid movements of trunk and extremities

36
Q

What analgesic has serotonin activity (risk serotonin syndrome)?

A

Tramadol

37
Q

Glucorticoid psych symptoms

A

Psychosis, mania, depression

38
Q

Alcoholic cerebellar degeneration - signs

A

Wide-based gait
Truncal ataxia
Nystagmus
Impaired postural coordination (tandem walk, heel-knee-shin) but intact limb coordination (finger-nose)

Later: Postural tremor of fingers and thighs, dysarthria, visual problems

39
Q

Tourette syndrome - pharmacological treatment

A

VMAT2 inhibitors
a2 agonists for comorbid ADHD or behavior symptoms

40
Q

Tourette syndrome - pharmacological treatment

A

VMAT2 inhibitors
a2 agonists for comorbid ADHD or behavior symptoms

41
Q

What can be used first-line for neuropathic pain?

A

SNRI (duloxetine, venlafaxine)
Amitriptylines
Gabapentinoids

42
Q

Phenytoin pharmacodynamics

A

Cytochrome p450 (inhibited by Bactrim, fluconazole)
Protein bound (displaced by valproic acid)
Renal or hepatic dysfunction

43
Q

Why should pralidoxime only be given after atropine first for organophosphate toxicity?

A

May cause initial AChesterase inhibition prior to reactivation, worsening toxicity

44
Q

Narcolepsy first-line

A

Modafinil

45
Q

Narcolepsy meds

A

First: Modafinil
Second: Stimulants

Significant cataplexy (emotion-induced loss of muscle tone): antidepressants, sodium oxybate

46
Q

What meds cause polyneuropathy?

A

Metronidazole, fluoroquinolones, dapsone
Digoxin, amiodarone

Acute causes burning pain as well

47
Q

Trigeminal neuralgia med

A

Carbamazepine

48
Q

Cluster headache treatment and prophylaxis

A

100% oxygen; prophylaxis with verapamil

49
Q

What meds to avoid in catatonia

A

Antipsychotics

50
Q

Antiparkinsonian medications for antipsychotic side effects

A

Benztropine (anticholinergic)
Amantadine (dopamine agonist without psychosis)

51
Q

Neuroleptic malignant syndrome - treatment

A

Benzos –> bromocriptine or amantadine –> dantrolene

As opposed to just extrapyramidal symptoms from antipsychotics: benztropine –> amantadine

52
Q

Bupropion is contraindicated in whom?

A

Hx of seizures, eating disorders (eating too little)

53
Q

Quetiapine mechanism

A

Serotonin 2A and dopamine D2 receptor antagonist

54
Q

What SSRI has a long 5-week washout period?

A

Fluoxetine

55
Q

What bipolar med can cause hyperPTH and hypercalcemia?

A

Lithium

56
Q

What seizure meds can cause Stevens-Johnson syndrome?

A

Lamotrigine
Carbamazepine

57
Q

Alcohol use disorder medications

A

First-line: naltrexone, acamprosate (glutamate modulator, more for maintenance of abstinence)

Naltrexone contraindicated in current opioid use and acute hepatitis/liver failure
Acamprosate contraindicated in siginificant renal impairment

58
Q

How should SNRIs be monitored?

A

Blood pressure - dose-dependent increase in systolic and diastolic pressures

59
Q

Primidone

A

Centrally acting anticonvulsant, barbiturate - used for essential tremor in those with contraindications to nonselective beta blockers

60
Q

What specific should be watched with ziprasidone?

A

QTc prolongation

61
Q

Diazepam
Lorazepam
Midazolam

A

Diazepam - Valium
Lorazepam - Ativan
Midazolam - Versed

62
Q

Entacapone

A

COMT inhibitor

Parkinson treatment

63
Q

When can ropinirole or pramipexole be used first in Parkinson?

A

Under 60 and tremor-predominant symptoms

64
Q

Essential tremor - treatments

A

Propranolol

If resistant: deep brain stimulation to the ventral intermediate nucleus (VIM) of the thalamus

65
Q

Alzheimer treatment categories

A
  1. Cholinesterase inhibitors (donepezil, rivastigmine)
  2. NMDA antagonist (memantine)
  3. Anti-Abeta antibody (lecanemab)
66
Q

Migraine prophylaxis: tiers

A

Tier 1: propranolol/metoprolol/timolol, candesartan, topiramate
Tier 2: Amitriptyline, valproate
Tier 3: Anti-calcitonin gene related peptide (CGRP) antibody (e.g. galcanezumab)

67
Q

Triptans are contraindicated in…

A

Atherosclerosis - due to vasoconstrictive effects

68
Q

Migraine abortive treatment - tiers

A

Tier 1: NSAIDs +/- acetaminophen/caffeine
Tier 2: NSAIDs + triptans
Tier 3: -gepants or -ditans

69
Q

Only prophylaxis for tension headaches

A

Amitriptyline

70
Q

Trigeminal neuralgia - treatment

A

Carbamazepine

71
Q

TCA overdose - what to do

A

ECG - monitor QRS
QRS >100 ms associated with increased risk of arrhythmia and seizures, so give sodium bicarbonate

Can use activated charcoal within 2h of ingestion unless ileus

72
Q

TCA overdose - cardiac effects

A

Due to inhibition of fast Na channels in His-Purkinje and myocardium:
Tachycardia with hypotension (from a1 antagonism)
Prolonged PR/QRS/QT
Arrhythmia

Use sodium bicarbonate

73
Q

When to dialyze for lithium toxicity

A

When >2.5 with symptoms or >4 and Cr >2 regardless of symptoms

74
Q

Which SSRIs are most known to cause QT prolongation?

A

Citalopram and escitalopram

75
Q

What seizure meds can cause SJS?

A

Phenytoin, carbamazepine

Neuro/Psych (7 decks)

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