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Psych 1 > Meds > Flashcards

Meds Flashcards

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1
Q

BOXED WARNING: antidepressants increase the risk compared to placebo in suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders

A

check

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2
Q 
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
A

Selective Serotonin Reuptake Inhibitors (SSRI’s)

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3
Q

Onset of action takes 3-8 weeks (or even longer in some cases)

A

Selective Serotonin Reuptake Inhibitors (SSRI’s)

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4
Q

Most activating SSRIs?

A

: fluoxetine and sertraline

does in morning, avoid in patients with troubl sleepign

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5
Q

Most sedating SSRIs?

A

: paroxetine and fluvoxamine

does in evening

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6
Q

SSRIs can cause weight gain. Which is the worst?

A

paroxetine

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7
Q

Sexual dysfxn
CNS events (agitation, anxiety, panic esp. in early phase)
Weight gain
Seratonin syndrome (rare but severe)

A

SSRI adverse events

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8
Q

Serotonin syndrome… triad of cognitive effects, NM and autonomic dysfxn

A 
-Cognitive
Confusion
Agitation
Coma
Anxiety
-NM
myoclonus
hyperreflexia
muscle rigidity
tremors
-Autonomic
hyperthermia
diaphoresis
sinus tachy
HTN
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9
Q

Avoid abrupt d/c of SSRIs (exception is fluoxetine)

What SSRI may cuase QT prolongation at doses higher than 40 mg?

A

citalopram

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10
Q

SNRIs?

A

duloxetine

venlafaxine

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11
Q

TCAs CIed in?

A

pts w/ SI, CV condtions, closed angle glaucoma, urinary retention, severe prostate hypertrophy

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12
Q

NDRI?

A

Buproprion

Associated with less sexual dysfunction than other anti-depressants

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13
Q

Contraindication: patients at risk for seizures including patients with seizure disorders, history of anorexia or bulimia, or using or withdrawing from medications such as alcohol or benzodiazepines

A

Buproprion

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14
Q

Serotonin Receptor Antagonists

A

Trazodone
Mirtazapine
Nefazodone

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15
Q

Used for depression, typically with an SSRI, profound sedative effect

A

Mirtazapine

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16
Q

Used for anxious depression, or when SSRI causes too much sexual dysfunction
Black box warning for liver failure

A

Nefazodone

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17
Q 
Clinical Use:
Atypical depression (hypersomnia, hyperphagia, and mood reactivity)

Patients refractory to other anti-depressant agents

A

Monoamine Oxidase Inhibitors (MAOI’s)

Hypertensive crisis induced by MAOIs is considered a medical emergency

Interactions: the infamous food-drug interactions caused by these medications occur because they inhibit MAO in the GI track that normally breakdown tyramine

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18
Q

Hypertensive Crises: increased levels of catecholamines, which can be the result of ingestion of tyramine containing foods
Serotonin Syndrome: when levels of 5HT become too high usually as the result of multiple serotonergic agents
Weight gain
Sexual dysfunction

A

Monoamine Oxidase Inhibitors (MAOI’s)

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19
Q

Adequate trial of any agent includes full therapeutic doses for 2-8 weeks and in some cases for up to 12 weeks
If no response at that point, the drug can be considered a failure

A

Antidepressants:

Response and Remission: usually defined as a 50% reduction in symptoms

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20
Q

Short Term (acute): goal is to resolve symptoms (usually takes 4-6 weeks)

Continuation: keep symptoms in remission by using full-dose therapy (continues 4-9 additional months)

Maintenance: long-term therapy at full doses that are required in high-risk patients to prevent relapse

A

Antidepressants:

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21
Q

effective for treatment resistant depression

A

Lithium:

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22
Q

One study linked ___ in the third trimester to low birth weight; generally considered safe

A

fluoxetine (antiDs)

23
Q

___ is associated with heart defects

A

Paroxetine (antiDs)

24
Q

Response to medications is NOT immediate, maximal treatment response may take 6 months or longer to be observed

After treatment response observed; maintain current therapy for a minimum of 6 months

A

Antipsychotics

atypical first, unless pt has strong histroy w/ typical

25
Q

Black Box Warning: increase mortality in elderly patients with dementia-related psychosis

A

Antipsychotics:

26
Q 
Extrapyramidal Symptoms (EPS)
Dystonia: abnormal tonicity; severe muscle spasm of the head, neck and tongu
A

Antipsychotics

27
Q 
Tardive Dyskinesia (may not be reversible)
Syndrome of involuntary movements of the face, mouth, tongue, trunk and limbs
A

Antipsychotics

28
Q

Akathesia (most common EPS)

Desire to be in constant motion (inability to sit still, pacing).

A

Antipsychotics

29
Q

Chlorpromazine (Thorazine) IV/ PO

Thioridazine (Mallari) PO

A

Low Potency Typical Antipsychotics

30
Q

Trifluoperazine (Stelazine) PO
Fluphenazine (Prolixin) IM
Haloperidol (Haldol) IV/IM/PO

A

High Potency Typical Antipsychotics

31
Q

Response to medications is NOT immediate, maximal treatment response may take 6 months or longer to be observed
After treatment response observed; maintain current therapy for a minimum of 6 months

A

Antipsychotics

32
Q

Developed to reduce EPS, tardive dyskinesia and improve efficacy
Clinical Use: similar efficacy for positive symptoms except Clozapine
Characteristics:
Risk of EPS is lower than with typical antipsychotics at usual clinical doses
Risk of tardive dyskinesia is reduced

A

Atypical (2nd Generation Anti-psychotics)

Olanzapine (Zyprexa) PO/IV
Risperidone (Risperdal) PO/IM
Quetiapine (Seroquel) PO
Aripiprazole (Abilify) PO/IV

33
Q

Olanzapine (Zyprexa) PO/IV
Risperidone (Risperdal) PO/IM
Quetiapine (Seroquel) PO
Aripiprazole (Abilify) PO/IV

A

Atypical (2nd Generation Anti-psychotics)

34
Q

not contraindicated in pregnancy

Most antipsychotic medications are FDA category?

A

C

35
Q

Patients should not stop using their medications if they become pregnant without consulting a healthcare provider

A

Antipsychotics

36
Q

Effects last throughout the day
Withdrawal symptoms may be less pronounced
Less breakthrough symptoms
More “hangover” symptoms

A

BZD with Long Half-Life

37
Q

Quicker control of the symptoms
Used for acute management
Tolerance of the hypnotic effect develops rapidly
Withdrawal is common (breakthrough symptoms)

A

BZD with short half-Life

38
Q

Midazolam (Versed)

Triazolam (Halcion)

A

Short Acting Agents

BZDs

39
Q

Alprazolam (Xanax)
Estazolam (ProSom)
Lorazepam (Ativan)
Temazepam (Restoril)

A

Intermediate Acting Agents

BZDs

40
Q

Clonazepam (Klonipin)

Diazepam (Valium)

A

Long Acting Agents

BZDs

41
Q

Occur when BZD discontinued abruptly

Most often seen with short and intermediate acting agents

A

Rebound Insomnia

42
Q

Treatment periods should be restricted to 3-4 months
Usually to get an adequate trial on an antidepressant
Used to bridge initiation of chronic therapy

A

BZDs

Long-term uses of benzodiazepine must be tapered (months to >1 year to complete)

43
Q

Altered physiologic state; requires continuous drug administration to prevent withdrawal syndromes

Occurs within weeks to months of continued use

Short elimination half life medications are more likely to cause dependence

Abrupt cessation may lead to withdrawal

A

BZDs

44
Q

BZDs avoided in?

A

pregnancy and geriatrics

45
Q

If must use BZDs in geriatrics, what do you use?

A

If must use try lorazepam, oxazepam, or temazepam (LOT), lower risk of accumulation

46
Q

Effective for manic and depressive components
Acts as a mood stabilizer during manic phase
Does not work well in patients who are rapid cyclers (four or more episodes per year)

A

lithium

47
Q 
CBC
Electrolytes
Renal function
Thyroid function tests
Urinalysis
Electrocardiogram (ECG)
Pregnancy test (childbearing age)
A

prelithium workup

48
Q

Narrow therapeutic index: requires serum blood level monitoring ___ level (0.8-1.2mEq/L is therapeutic)

A

lithium

49
Q 
Lethargy
Tremor
Confusion
Neurologic and Psychiatric: Higher plasma levels can cause tremors, convulsions, confusion
Seizures
Coma 
Cardiac Effects: dysrhythmias can occur at \_\_\_\_ toxicity, which can result in death
Decreased Thyroid Function
A

lithiium

50
Q

BOTTOM LINE: conditions that affect the Na+ and fluid balance (Dehydration, fever, vomiting, crash diets, NSAIDs and sodium restricted diets) should be avoided in these patients

A

lithiium

51
Q

Valproic Acid derivatives
Carbamazepine (Tegretol, Equetro)
Lamotrigine (Lamictal)
Topiramate (Topamax)

A

anticonvulsants for bipolar

52
Q

Studies have shown valproic acid compounds, carbamazepine, and lamotrigine may be more effective than lithium in:

A

Rapid cycling
Comorbid substance abuse
Secondary bipolar disorder
Mixed mania

53
Q

Less EPS side effects?

A

atypical antipsychotics

Psych 1 (9 decks)

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