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PMHNP > Midterm Review > Flashcards

Midterm Review Flashcards

1
Q

Absorption

A

Getting the drug into the bloodstream

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2
Q

Distribution

A

Getting the drug from the bloodstream to the target organs/tissues.

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3
Q

Pharmacodynamics

A

How the Drug acts on the body

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4
Q

Pharmacokinetics

A

How the body acts on the drug

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5
Q

What is the primary excitatory neurotransmitter

A

Glutamate

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6
Q

What are the accessory excitatory neurotransmitters

A

Acetylcholine, norepinephrine, epinephrine

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7
Q

What is the primary neurotransmitter involved in schizophrenia

A

Dopamine

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8
Q

What neurotransmitters are involved in major depressive disorder

A

Dopamine, serotonin, norepinephrine

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9
Q

Reduction in what neurotransmitter produces anxiety?

A

GABA (serotonin is involved but goes down later in the process)

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10
Q

1st, 2nd line treatments for PTSD

A

1st: SSRI
2nd: SNRI

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11
Q

What combination of drugs treats Serotonin,norepinephrine and dopamine together?

A

SNRI and Welbutrin

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12
Q

What are common symptoms of loss of dopamine

A

Loss of purpose, deep sadness, low motivation

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13
Q

What is a common symptom of loss of serotonin

A

anxiety, irritability

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14
Q

What Condition can mimic ADHD in children prior to puberty?

A

depression

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15
Q

What are the most common side effects of SSRI’s

A

Weight gain, sexual dysfunction, GI symptoms

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16
Q

What is the black box warning for SSRI’s

A

All SSRI’s. Increased suicidality risk in children, adolescents and young adults with major depression and other psychiatric disorders.

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17
Q

What are the classes of antidepressants?

A

SSRI,SNRI, MAOI Inhibitor, atypical etc.

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18
Q

SIGECAPS mnemonic

A

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide

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19
Q

DIGFAST Mnemonic

A

Distractibility
Insomnia
grandiosity
Flight of Ideas
Activities: increase in goal directed activities
Speech(pressured speech)
thoughtlessness

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20
Q

When used for Anxiety, which neurotransmitter are SSRI’s primarily acting on?

A

Serotonin. (specifically Serotonin 1 A receptors ).
Increased serotonin increases calm and decreases anxiety.

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21
Q

What is the most common neurotransmitter in brain?

A

Glutamate, Primary excitatory neurotransmitter

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22
Q

What does glutamate do?

A

Excitatory neurotransmitter.
Helps learning and memory.

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23
Q

What is the gold standard treatment for bipolar

A

Lithium

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24
Q

What are the side effects of lithium

A

Nausea, dry mouth, thirst, acne, alopecia, mild fine tremor, Weight gain, psoriasis, leukocytosis

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25
Q

What are the signs of Mild toxicity of lithium?

A

T-wave depression, mild twitching, tremor, muscle weakness, Lethargy, GI side effects (mild)

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26
Q

What are the signs of moderate Lithium Toxicity

A

Severe nausea, vomiting, diarrhea
Confusion, slurred speech
ataxia, muscle twitching
EKG changes
Seizure
oliguria
circulatory failure
Coma/Death

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27
Q

What are the signs of severe lithium toxicity

A

Impaired level of consciousness,
Coma, death
increased DTR’s
Syncope
Seizures

28
Q

What patient education should be provided to the patient before prescribing lithium?

A

-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

29
Q

Contraindications for lithium use:

A

-Pregnancy (Ebstein’s anomaly)
-cardiovascular insufficiency
-untreated hypothyroidism
-long term use can cause kidney changes.
-Significant fluid loss increases risk of lithium toxicity

30
Q

What other nutrient has an inverse relationship with lithium

A

Sodium

31
Q

Define hypertensive crisis in MAOI use

A

-DBP more than 120.
-Symptoms: Occipital headache, neck stiffness, palpitations, nausea, vomiting, sweating, dilated pupils, tachycardia/bradycardia, chest pain.

32
Q

What do you need to educate your patient on before starting MAOI’s.

A

-Report signs of hypertensive crisis
-avoid tyramine, tyrosine, phenylalanine, tryptophan rich foods.
-Ferments, Fava, avocado, caffeine.

33
Q

what are the side effects of MAOI’s

A

Dizziness, headaches, orthostatic hypotension, dry mouth, constipation, drowsiness, tremor, sweating, peripheral edema, weight gain, sexual side effects

34
Q

What are the common uses of MAOI’s currently

A

Parkinson’s depression, treatment-resistant depression.

35
Q

What condition do you avoid prescribing welbutrin in?

A

anorexia, bulimia

36
Q

What effect does welbutrin typically have on appetite

A

decreases appetite

37
Q

Which antidepressant bears a risk of priapism

A

trazodone

38
Q

What are common side effects of trazodone

A

PRIAPISM, orthostasis, drowsiness, dry mouth, blurred vision, nausea, vomiting.

39
Q

What are common side effects of remeron

A

Sedating, weight gain, increased serum cholesterol, increased appetite, rare agranulocytosis/neutropenia.

40
Q

ARMS mnemonic for Serotonin syndrome

A

Anxiety
Restlessness
Myoclonus
Sweating

41
Q

What is the most worrisome side effect of lamotrigine

A

Steven’s Johnson syndrome: need to increase dose slowly.

42
Q

First and second line antidepressants with eating disorders:

A

1st line: SSRI
2nd line: SNRI

43
Q

What medications are used to treat nicotine dependence:

A

Chantix and bupropion

44
Q

What medications are used to treat Alcohol abuse

A

naltrexone, campral, disulfuram

45
Q

What medications are used to treat narcotic abuse

A

Naltrexone, narcan, suboxone

46
Q

How does smoking impact metabolism of medications?

A

Medications will likely be metabolized more quickly, will need to give a higher dose

47
Q

How does the CYP 450 system effect medication metabolism

A

Found primarily in liver and affect 90% of psych drugs.

48
Q

Depakote as mood stabilizer

A

See handwritten notes

49
Q

Which medications are used off label for anxiety

A

clonidine,prazosin, lyrica, neurontin, propranolol

50
Q

Which antidepressant class can cause urinary retention

A

Tricyclic antidepressants

51
Q

Definition of normal metabolizer

A

Persons with 1 or 2 normal copies of CYP2D6 or CYP219

52
Q

Definition of poor metabolizer

A

Persons with 2 inactivated copies of CYP2D6 or CYP219. High risk for toxicity

53
Q

Definition of ultra-rapid metabolizer

A

Persons with multiple copies of CYP2D6 or CYP 219. High risk for low efficacy of rugs.

54
Q

What medications used to treat Bipolar need bloodwork monitoring?

A

Lithium
Valproic acid: 50-125 mg/dl
Carbamazepine: 6-12 mg/dl

55
Q

Where do drugs leading to addiction increase dopamine?

A

Ventral striatum

56
Q

Where is the pleasure center in the brain?

A

Mesolimbic pathway

57
Q

Valproic acid use as a mood stabilizer

A

-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

58
Q

MOA of Depakote(valproic acid)

A

-Works by inhibiting voltage-gated sodium channels
-Boosts Action of GABA and regulation of downstream signal transduction cascades.

59
Q

Common depakote side effects

A

Weight gain
Metabolic complications
Menstrual disturbances

60
Q

Depakote Black Box Warning

A

Pancreatitis
fetal injury
hepatotoxicity

61
Q

Names of MAOI’s

A

Isocarboxazid(marplan)
Phenelzine(nardil)
Tranylcypromine(parnate)
Selegiline (transdermal)

62
Q

MAOI Mechanism of Action

A

Inhibits enzyme responsible for metabolism of serotonin, dopamine, norepinephrine and tyramine.
-Therefore increases the level of NE and Serotonin in the CNS.

63
Q

How long between transition from a serotonin agent to an MAOI?

A

5-7 days
Fluoxetine: 5 weeks

64
Q

How long between transition from MAOI to SSRI?

A

14 days

65
Q

Names of common Tricyclics

A

Amitriptyline (Elavil)
Nortriptyline(Pamelor)
Imipramine (tofranil)
Clomipramine (Anafranil)
Doxepin(Sinequan)

66
Q

Benzodiazepene Black Box Warning

A

Avoid concomitant use with opioids, monitor for sedation,
avoid in pregnancy and laceration

67
Q

Benzodiazepene Beer’s criteria

A

Avoid for insomnia, agitation,delirium

PMHNP (15 decks)

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