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Medications Flashcards

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
Selegiline
MAO type B inhibitor Parkinson
26
Restless leg syndrome - signs, treatment
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
27
Lithium toxicity
Ataxia Lethargy Slurred speech GI distress (nausea/vomiting, diarrhea) Nystagmus Tremor Hyperreflexia
28
Phenytoin toxicity
Cerebellar adverse effects: Ataxia (wide-based gait), horizontal nystagmus (on lateral gaze), dysmetria AMS, confusion CNS depression, coma Nausea, vomiting
29
Demedetomidine
A2 agonist Used in ICU for procedural sedation
30
Cyproheptadine
Serotonin antagonist Used for serotonin syndrome
31
Preferred medication for Parkinson psychosis
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
What medication withdrawal can cause seizures?
Benzos (particularly short acting like alprazolam and abrupt discontinuation)
33
Antidepressant discontinuation syndrome
1. Acute onset dysphoria 2. Fatigue 3. Dizziness 4. GI distress 5. Flu-like symptoms
34
What medications can cause dose-dependent seizure in those with predisposition?
Bupropion (dopamine/NE reuptake inhibitor) TCA (e.g. clomipramine)
35
Tardive dyskinesia
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
What analgesic has serotonin activity (risk serotonin syndrome)?
Tramadol
37
Glucorticoid psych symptoms
Psychosis, mania, depression
38
Alcoholic cerebellar degeneration - signs
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
Tourette syndrome - pharmacological treatment
VMAT2 inhibitors a2 agonists for comorbid ADHD or behavior symptoms
40
Tourette syndrome - pharmacological treatment
VMAT2 inhibitors a2 agonists for comorbid ADHD or behavior symptoms
41
What can be used first-line for neuropathic pain?
SNRI (duloxetine, venlafaxine) Amitriptylines Gabapentinoids
42
Phenytoin pharmacodynamics
Cytochrome p450 (inhibited by Bactrim, fluconazole) Protein bound (displaced by valproic acid) Renal or hepatic dysfunction
43
Why should pralidoxime only be given after atropine first for organophosphate toxicity?
May cause initial AChesterase inhibition prior to reactivation, worsening toxicity
44
Narcolepsy first-line
Modafinil
45
Narcolepsy meds
First: Modafinil Second: Stimulants Significant cataplexy (emotion-induced loss of muscle tone): antidepressants, sodium oxybate
46
What meds cause polyneuropathy?
Metronidazole, fluoroquinolones, dapsone Digoxin, amiodarone Acute causes burning pain as well
47
Trigeminal neuralgia med
Carbamazepine
48
Cluster headache treatment and prophylaxis
100% oxygen; prophylaxis with verapamil
49
What meds to avoid in catatonia
Antipsychotics
50
Antiparkinsonian medications for antipsychotic side effects
Benztropine (anticholinergic) Amantadine (dopamine agonist without psychosis)
51
Neuroleptic malignant syndrome - treatment
Benzos --> bromocriptine or amantadine --> dantrolene As opposed to just extrapyramidal symptoms from antipsychotics: benztropine --> amantadine
52
Bupropion is contraindicated in whom?
Hx of seizures, eating disorders (eating too little)
53
Quetiapine mechanism
Serotonin 2A and dopamine D2 receptor antagonist
54
What SSRI has a long 5-week washout period?
Fluoxetine
55
What bipolar med can cause hyperPTH and hypercalcemia?
Lithium
56
What seizure meds can cause Stevens-Johnson syndrome?
Lamotrigine Carbamazepine
57
Alcohol use disorder medications
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
How should SNRIs be monitored?
Blood pressure - dose-dependent increase in systolic and diastolic pressures
59
Primidone
Centrally acting anticonvulsant, barbiturate - used for essential tremor in those with contraindications to nonselective beta blockers
60
What specific should be watched with ziprasidone?
QTc prolongation
61
Diazepam Lorazepam Midazolam
Diazepam - Valium Lorazepam - Ativan Midazolam - Versed
62
Entacapone
COMT inhibitor Parkinson treatment
63
When can ropinirole or pramipexole be used first in Parkinson?
Under 60 and tremor-predominant symptoms
64
Essential tremor - treatments
Propranolol If resistant: deep brain stimulation to the ventral intermediate nucleus (VIM) of the thalamus
65
Alzheimer treatment categories
1. Cholinesterase inhibitors (donepezil, rivastigmine) 2. NMDA antagonist (memantine) 3. Anti-Abeta antibody (lecanemab)
66
Migraine prophylaxis: tiers
Tier 1: propranolol/metoprolol/timolol, candesartan, topiramate Tier 2: Amitriptyline, valproate Tier 3: Anti-calcitonin gene related peptide (CGRP) antibody (e.g. galcanezumab)
67
Triptans are contraindicated in…
Atherosclerosis - due to vasoconstrictive effects
68
Migraine abortive treatment - tiers
Tier 1: NSAIDs +/- acetaminophen/caffeine Tier 2: NSAIDs + triptans Tier 3: -gepants or -ditans
69
Only prophylaxis for tension headaches
Amitriptyline
70
Trigeminal neuralgia - treatment
Carbamazepine
71
TCA overdose - what to do
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
TCA overdose - cardiac effects
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
When to dialyze for lithium toxicity
When >2.5 with symptoms or >4 and Cr >2 regardless of symptoms
74
Which SSRIs are most known to cause QT prolongation?
Citalopram and escitalopram
75
What seizure meds can cause SJS?
Phenytoin, carbamazepine

Neuro/Psych (7 decks)

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