Midterm Review Flashcards
Absorption
Getting the drug into the bloodstream
Distribution
Getting the drug from the bloodstream to the target organs/tissues.
Pharmacodynamics
How the Drug acts on the body
Pharmacokinetics
How the body acts on the drug
What is the primary excitatory neurotransmitter
Glutamate
What are the accessory excitatory neurotransmitters
Acetylcholine, norepinephrine, epinephrine
What is the primary neurotransmitter involved in schizophrenia
Dopamine
What neurotransmitters are involved in major depressive disorder
Dopamine, serotonin, norepinephrine
Reduction in what neurotransmitter produces anxiety?
GABA (serotonin is involved but goes down later in the process)
1st, 2nd line treatments for PTSD
1st: SSRI
2nd: SNRI
What combination of drugs treats Serotonin,norepinephrine and dopamine together?
SNRI and Welbutrin
What are common symptoms of loss of dopamine
Loss of purpose, deep sadness, low motivation
What is a common symptom of loss of serotonin
anxiety, irritability
What Condition can mimic ADHD in children prior to puberty?
depression
What are the most common side effects of SSRI’s
Weight gain, sexual dysfunction, GI symptoms
What is the black box warning for SSRI’s
All SSRI’s. Increased suicidality risk in children, adolescents and young adults with major depression and other psychiatric disorders.
What are the classes of antidepressants?
SSRI,SNRI, MAOI Inhibitor, atypical etc.
SIGECAPS mnemonic
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide
DIGFAST Mnemonic
Distractibility
Insomnia
grandiosity
Flight of Ideas
Activities: increase in goal directed activities
Speech(pressured speech)
thoughtlessness
When used for Anxiety, which neurotransmitter are SSRI’s primarily acting on?
Serotonin. (specifically Serotonin 1 A receptors ).
Increased serotonin increases calm and decreases anxiety.
What is the most common neurotransmitter in brain?
Glutamate, Primary excitatory neurotransmitter
What does glutamate do?
Excitatory neurotransmitter.
Helps learning and memory.
What is the gold standard treatment for bipolar
Lithium
What are the side effects of lithium
Nausea, dry mouth, thirst, acne, alopecia, mild fine tremor, Weight gain, psoriasis, leukocytosis
What are the signs of Mild toxicity of lithium?
T-wave depression, mild twitching, tremor, muscle weakness, Lethargy, GI side effects (mild)
What are the signs of moderate Lithium Toxicity
Severe nausea, vomiting, diarrhea
Confusion, slurred speech
ataxia, muscle twitching
EKG changes
Seizure
oliguria
circulatory failure
Coma/Death
What are the signs of severe lithium toxicity
Impaired level of consciousness,
Coma, death
increased DTR’s
Syncope
Seizures
What patient education should be provided to the patient before prescribing lithium?
-Avoid exercising in hot weather
-Balance fluid intake
-Take medication as directed at the same time daily
-Report Vomiting, tremor, sedation, weakness, vertigo
-May need change in dose with illness, fever, sweating
-Lithium levels need to be drawn 8-12 hours after last dose
Contraindications for lithium use:
-Pregnancy (Ebstein’s anomaly)
-cardiovascular insufficiency
-untreated hypothyroidism
-long term use can cause kidney changes.
-Significant fluid loss increases risk of lithium toxicity
What other nutrient has an inverse relationship with lithium
Sodium
Define hypertensive crisis in MAOI use
-DBP more than 120.
-Symptoms: Occipital headache, neck stiffness, palpitations, nausea, vomiting, sweating, dilated pupils, tachycardia/bradycardia, chest pain.
What do you need to educate your patient on before starting MAOI’s.
-Report signs of hypertensive crisis
-avoid tyramine, tyrosine, phenylalanine, tryptophan rich foods.
-Ferments, Fava, avocado, caffeine.
what are the side effects of MAOI’s
Dizziness, headaches, orthostatic hypotension, dry mouth, constipation, drowsiness, tremor, sweating, peripheral edema, weight gain, sexual side effects
What are the common uses of MAOI’s currently
Parkinson’s depression, treatment-resistant depression.
What condition do you avoid prescribing welbutrin in?
anorexia, bulimia
What effect does welbutrin typically have on appetite
decreases appetite
Which antidepressant bears a risk of priapism
trazodone
What are common side effects of trazodone
PRIAPISM, orthostasis, drowsiness, dry mouth, blurred vision, nausea, vomiting.
What are common side effects of remeron
Sedating, weight gain, increased serum cholesterol, increased appetite, rare agranulocytosis/neutropenia.
ARMS mnemonic for Serotonin syndrome
Anxiety
Restlessness
Myoclonus
Sweating
What is the most worrisome side effect of lamotrigine
Steven’s Johnson syndrome: need to increase dose slowly.
First and second line antidepressants with eating disorders:
1st line: SSRI
2nd line: SNRI
What medications are used to treat nicotine dependence:
Chantix and bupropion
What medications are used to treat Alcohol abuse
naltrexone, campral, disulfuram
What medications are used to treat narcotic abuse
Naltrexone, narcan, suboxone
How does smoking impact metabolism of medications?
Medications will likely be metabolized more quickly, will need to give a higher dose
How does the CYP 450 system effect medication metabolism
Found primarily in liver and affect 90% of psych drugs.
Depakote as mood stabilizer
See handwritten notes
Which medications are used off label for anxiety
clonidine,prazosin, lyrica, neurontin, propranolol
Which antidepressant class can cause urinary retention
Tricyclic antidepressants
Definition of normal metabolizer
Persons with 1 or 2 normal copies of CYP2D6 or CYP219
Definition of poor metabolizer
Persons with 2 inactivated copies of CYP2D6 or CYP219. High risk for toxicity
Definition of ultra-rapid metabolizer
Persons with multiple copies of CYP2D6 or CYP 219. High risk for low efficacy of rugs.
What medications used to treat Bipolar need bloodwork monitoring?
Lithium
Valproic acid: 50-125 mg/dl
Carbamazepine: 6-12 mg/dl
Where do drugs leading to addiction increase dopamine?
Ventral striatum
Where is the pleasure center in the brain?
Mesolimbic pathway
Valproic acid use as a mood stabilizer
-Used off-label to treat acute manic phase of bipolar(1st line for mania per multiple guidelines)
-Long-term use to minimize future manic episodes
-May help prevent future depressive episodes
-Helps with rapid cycling and mixed manic episodes
MOA of Depakote(valproic acid)
-Works by inhibiting voltage-gated sodium channels
-Boosts Action of GABA and regulation of downstream signal transduction cascades.
Common depakote side effects
Weight gain
Metabolic complications
Menstrual disturbances
Depakote Black Box Warning
Pancreatitis
fetal injury
hepatotoxicity
Names of MAOI’s
Isocarboxazid(marplan)
Phenelzine(nardil)
Tranylcypromine(parnate)
Selegiline (transdermal)
MAOI Mechanism of Action
Inhibits enzyme responsible for metabolism of serotonin, dopamine, norepinephrine and tyramine.
-Therefore increases the level of NE and Serotonin in the CNS.
How long between transition from a serotonin agent to an MAOI?
5-7 days
Fluoxetine: 5 weeks
How long between transition from MAOI to SSRI?
14 days
Names of common Tricyclics
Amitriptyline (Elavil)
Nortriptyline(Pamelor)
Imipramine (tofranil)
Clomipramine (Anafranil)
Doxepin(Sinequan)
Benzodiazepene Black Box Warning
Avoid concomitant use with opioids, monitor for sedation,
avoid in pregnancy and laceration
Benzodiazepene Beer’s criteria
Avoid for insomnia, agitation,delirium
