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medications exam 2 Flashcards

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1
Q

antidepressant drug classes

A

SSRIs
SNRIs
tricyclic antidepressants (TCAs)
MAOIs

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2
Q

atypical antidepressants (smaller classes)

A

bupropion (wellbutrin)
mirtazapine (remeron)
trazadone (desyrel)

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3
Q

first line treatment for most depressive disorders, eating disorders, and anxiety disorders

A

SSRIs and SNRIs

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4
Q

why are MAOIs hardly used anymore?

A

dietary restrictions – food with tyramine

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5
Q

how are TCAs different from SSRIs or SNRIs?

A

carry more side effects and are more lethal in overdose

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6
Q

what should you ask about when giving antidepressants?

A

use of supplements like st. john’s wort

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7
Q

what should be assessed before giving TCAs and why?

A

suicidality – due to overdose potential

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8
Q

what is an important reminder for patients taking antidepressants?

A

take several weeks to work

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9
Q

there is a black box warning with children and young adults for increasing suicidal thoughts primarily with which antdepressants?

A

SSRIs and SNRIs

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10
Q

what causes serotonin syndrome?

A

too much serotonin resulting in CNS hyperactivity

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11
Q

7 symptoms of serotonin syndrome

A

hypertension
high fever
sweating
agitation
disorientation
myoclonus
hyperreflexia

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12
Q

examples of SSRIs

A

fluoxetine/prozac
paroxetine/paxil
sertraline/zoloft
fluvoxamine/luvox
escitalopram/lexapro
citalopram/celexa

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13
Q

3 common side effects of SSRIs and SNRIs

A

GI issues
headache
sexual dysfunction

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14
Q

what side effects are SOMETIMES experienced with SSRIs and SNRIs?

A

tiredness
alertness

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15
Q

what happens with abrupt withdrawal of SSRIs and SNRIs?

A

brain zaps

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16
Q

SSRI and SNRI black box warning

A

suicidal thoughts in kids and young adults

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17
Q

SNRIs examples

A

venlafaxine/effexor
duloxetine/cymbalta
desvenlafaxine/pristiq

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18
Q

what is an additional side effects of SNRIs?

A

hypertension

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19
Q

5 tricyclic antidepressant and MAOI side effects

A

sedation
weight gain
bP variations
dry mouth
constipation

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20
Q

TCA black box warning

A

suicidal thoughts in kids and adults – worry about overdose risk due to lethality of overdose

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21
Q

MAOI black box warning

A

hypertensive crisis – must avoid tyramine rich foods

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22
Q

3 side effects of Bupropoin/Wellbutrin

A

agitation
insomnia
decreased appetite

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23
Q

Mirtazapine/Remeron 2 side effects

A

significant sedation
weight gain

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24
Q

trazadone side effects

A

sedation

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25
Q

bupropion black box warning

A

lowers seizure threshold plus risk of suicidal thoughts in kids and young adults

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26
Q

mood stabilizers treat …

A

mood disorders – usually bipolar disorders

27
Q

gold standard for bipolar disorder

A

lithium carbonate

28
Q

most mood stabilizers require _____ regularly

A

bloodwork

29
Q

which mood stabilizers require blood work?

A

lithium carbonate
divalproex sodium/valporic acid (Depakote)
carbamazepine/Tegretol

30
Q

lithium patients need to be adequately ____ and eat adequate ___ in diet

A

hydrated; sodium

31
Q

which mood stabilizers require monitoring of liver and education to avoid heavy alcohol usage and tylenol?

A

divaloprex sodium
cabamezapine

32
Q

divalproex sodium and carbemazepine safety concern

A

liver

33
Q

what is the safety concern with lamotrigine/lamictal

A

monitor for rash – stevens-johnsons syndrome is black box warning

34
Q

mood stabilizer drug classes

A

lithium
anticonvulsants

35
Q

6 side effects with lithium carbonate

A

GI issues
dry mouth
headache
metallic taste
dizziness
drowsiness

36
Q

what is important to remember about lithium

A

narrow therapeutic range

37
Q

therapeutic range of lithium

A

0.6-1.2mEq/L

38
Q

what range of lithium can cause toxicity

A

1.5-2.0

39
Q

what lithium value is considered severe toxicity?

A

2.0+

40
Q

mild lithium toxicity <1.5 side effects

A

metallic taste
fine hand tremor (resting)
nausea
polyuria
polydipsia
diarrhea or loose stools
muscular weakness or fatigue
weight gain
edema
memory impairments

41
Q

moderate lithium toxicity 1.5-2.5 side effects

A

severe diarrhea
dry mouth
N/V
mild to moderate ataxia
incoordination
dizziness, sluggishness, giddiness, vertigo
slurred speech
tinnitus
blurred vision
increasing tremor
muscle irritability or twitching
asymmetric deep tendon reflexes
increased muscle tone

42
Q

severe lithium toxicity >2.5 side effects

A

cardiac arrhythmia
blackouts
nystagmus
coarse tremor
fasciculations
visual or tactile hallucinations
oliguria, renal failure
peripheral vascular collapse
confusion
seizures
coma and death

** think hyponatremia

43
Q

6 side effects of anticonvulsants

A

GI issues
mood changes
fatigue
dizziness
drowsiness
rash – lamotrigine

44
Q

what is the therapeutic level for Depakote

A

50-100 mcg/mL

45
Q

what are the therapeutic levels for tegretol?

A

4-12 mg/L

46
Q

what neurotransmitters do antipsychotics regulate

A

dopamine and sometimes serotonin

47
Q

older antipsychotics

A

typical, only work on dopamine

48
Q

newer antipsychotics

A

atypical, work on dopamine and serotonin

49
Q

which antipsychotic requires blood monitoring

A

clozapine/clozaril

50
Q

what signs should be reported when monitoring for tardive dyskinesia with antipsychotics?

A

unusual mouth movements like lip smacking or tongue protrusion

51
Q

many antipsychotics cause _____

A

weight gain

52
Q

what is a major concern to be aware of with antipsychotics

A

neurologic malignant syndrome (NMS)

53
Q

what is NMS

A

caused by depleted dopamine due to antipsychotics, resulting in CNS hyperactivity

54
Q

what are the 6 signs/symptoms of NMS?

A

hypertension
fever
sweating
agitation
disorientation
lead pipe muscle rigidity***

55
Q

what is the safety concern/black box warning with clozapine/clozaril?

A

agranulocytosis

56
Q

how should agranulocytosis be monitored with clozapine?

A

monitor for signs of infection and sickness like fever and monitor WBCs

57
Q

what are the 6 side effects of antipsychotics?

A

EPS – more common with typicals
sedation
weight gain
risk of insulin resistance
constipation
dry mouth

58
Q

what is the black box warning for antipsychotics

A

can increase risk of death in elderly dementia patients

59
Q

tricyclic antidepressant examples

A

amitriptyline (elavil)
clomipramine (anafril)
doxepin (sinequan)
nortriptyline (pamelor)
imipramine (tofranil)

60
Q

MAOI examples

A

phenelzine (nardil)
selegiline (eldepryl)
isocarboxazid (marplan)
rasagiline (azilect)
tranylcypromine (parnate)

61
Q

anticonvulsant examples

A

Divalproex sodium/valporic acid (depakote)
lamotrigine (lamictal)
carbamazepine (tegretol)
oxcarbamazepine (trileptal)
levetiracetam (keppra)
topiramate (topamax)

62
Q

typical antipsychotics examples

A

haloperidol (haldol)
chlorpromazine (thorazine)
pimozide (orap)
fluphenzaine (proxlin)

63
Q

atypical antipsychotic examples

A

clozapine (clozaril)
risperidone (risperdal)
olanzapine (zyprexa)
aripiprazole (abilify)
ziprasidone (geodon)
lurasidone (latuda)
quetiapine (seroquel)

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