Neuro Exam 1 Flashcards
(160 cards)
1
Q
laboratory tests for alcoholism
A
MCV elevation, high levels of GGT, high levels of liver enzymes, uric acid, triglycerides, ethyl glucuronide and ethyl sulfate (last 2 for ppl who need to get tested for work etc)
2
Q
ethanol effects on GABA system
A
interaction with GABA-A receptor and facilitate of GABA transmission = sedative and anxiolytic effects & withdrawal
3
Q
Wenicke’s encephalopathy symptoms
A
confusion, loss of muscle coordination, ataxia, let tremor, vision change, nystagmus, diplopia & eyelid drooping
4
Q
Wernicke’s Syndrome treatment
A
-usually from severe deficiency of thymine
-admin of IV glucose to pts who are severely malnourished can exhaust their supply of thiamine worsening confusion
thiamine before glucose!
5
Q
ethanol mechanism of action
A
-ethanol facilitates GABAergic transmission, GABA id an inhibitory NT
-ethanol blocks glutamate transmission
-glutamate is an excitatory NT
-ethanol results in the release of dopamine in the nucleus accumbens
6
Q
Symptoms of Korsakoff syndrome
A
-late/end stage of chronic = irreversible brain damage, anterograde amnesia, loss of memory, confabulation, hallucinations, results from long standing Wernickes
7
Q
Delirium tremens
A
-discorded consciousness, life threatening state = medical emergency!
-Hallmarks: hallucinations, disorientation, tachycardia, hypertension, low grade fever, agitation & diaphoresis
-sensorium clouding = pt needs to be hospitalized
8
Q
Management/prophylaxis of alcohol withdrawal
A
1- thiamine 50-100mg daily
2- D5 and 0.45 NS (after they are loaded up with thiamine then can give glucose)
3- multivitamin
4-standing order for clonidine & benzos
9
Q
Disulfiram use & SE
A
-causes the alcohol/acetyl dehy to build. up = when pts drinks they feel VERY sick
Side effects: drowsiness, headache, fatigue, rash, metallic or garlic-like after taste, impotence, hepatic failure, peripheral neuropathy, optic neuritis
10
Q
Naltrexone use
A
-acts as a competitive agonist opioid receptor sites
11
Q
Acamprosate
A
-effective in pts who can be trusted to take meds TID
-structurally similar to GABA, increases the activity of the GABA-ergic system
12
Q
addiction
A
a primary, chronic, neurobiological diseases, with genetic, psychosocial and environment factors influencing its development and manifestations (5 c’s: chronicity, impaired control over drug use, compulsive use, continued use despite harm, craving)
13
Q
drug abuse
A
maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance
14
Q
agonist
A
drugs that activate receptors on neurons
15
Q
antagonist
A
opiate that binds to receptors but blocks them rather than activating them
16
Q
partial agonist
A
drugs that bind to receptors, but not the same degree as full agonists –> ceiling effect
17
Q
sensitization
A
increased response to a drug with repeated use, shifting dose response curve to the left: cocaine-induced movement, cataplexy and seizure
18
Q
tolerance
A
a state of adaptation in which exposure to a drug induces changes that result in a diminution of one of more the drugs effected over time
-cross tolerance: tolerance to one drug leads to tolerance of other drugs in the same class
19
Q
physiological dependence
A
body adapt to presence of drug. needs drugs on broad to maintain homeostasis, specific withdrawal symptoms can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of a drug and/or administration of an antagonist
20
Q
Withdrawal symptoms
A
behaviors displayed by a user when drug use ends, typically the opposite of the. drug effect. repeated self-administration: mesolimbic doapmine system, abused drugs all tend to activate this system & has 3 stages: pleasure, associative learning through classical conditioning, incentive salience: craving, get DA release by cues/context alone
21
Q
creatinine normalize
A
(urine drug level)/(urine creatinine) x 100
-used to account for how dilute or concentrated the urine is
22
Q
ethanol effects on the CNS
A
-facilitates GABAnergic transmission, GABA is an inhibitory NT
-blocks glutamate, glutamate = excitatory NT
-results in dopamine release in nucleus accumbens
-activates opiate peptide system
-blocks NMDA receptors (neuroadapatation & withdrawal)
23
Q
BAC of 0.10-0.125
A
-sig impairment of motor coordination, illegal to drive
24
Q
BAC of 0.13-0.15
A
(in the cerebellum) gross motor impairment & lack of physical control, blurred vision & major loss of balance, euphoria is reduced and dysphoria is beginning to appear
25
BAC of 0.25, 0.30 & > 0.40
-needs assistance in walking, total mental confusion
-loss of consciousness
-onset of coma, possible death due to respiratory arrest
-these are toxic levels of alcohol!
26
ethanol absorption
-lipid and protein delay absorption
-water & carbonation speed absorption
-gastric bypass procedures inc absorption
Capacity limited metabolism: *the rate of absorption not only effects the height of the peak, but also the size of the area under the curve
27
ethanol distribution
-volume of distribution = ~ total body water (males > females > obese)
-rapidly crosses BBB
-zero order metabolism via alcohol dehydrogenase
28
*gender differences in ethanol distribution*
-ethanol distributes to total body water & lean mass (women tend to have a small volume of distributing)
-women have less efficient pre-hepatic alcohol dehydrogenase = greater bioavailability
*women have less efficient pre-hepatic alcohol dehydrogenase thus there will be greater bioavailability*
*ethanol distributes largely to total body water and lean mass thus women tend to have a smaller volume of absorption*
29
how do you treat benzo OD?
-Flumazenil 0.2 mg/min up to 3 g
-CI with tricyclic (seizures) or dependent pts
-SEs: N/V & benzo withdrawal s/s
30
Barbituates
-have similar effects to EToH
-withdrawal can be life threatening: anxiety, N/V, postural hypotension, seizures, delirium, insomnia, hyperexia
-taper: change to longer acting barb & taper, sub with anticonvulsant
31
GHB/Xyrem
-C3
-used in tx of cataplexy & daytime sleepiness in pts with narcolepsy
-effects: amnesia (used as date rape), hypotonia
-toxicity: coma, seizures, respiratory depression, vomiting
-withdrawals: agitation, mental status changes, elevated BP, HR & tachycardia
32
what drug is used for opioid overdose?
-naloxone: if pt is unconscious & respiratory depressed
-competes with and displaces narcotics at opioid receptor site
33
what drugs are used for opioid withdrawal?
-methadone
-buprenorphine
-clonidine
-lofexidine
34
what drugs are used for opioid maintance?
-methadone
-buprenorphine
35
what drugs are used for opioid abstinence?
naltrexone
36
When is methadone used in regards to opioids?
-for detox or maintenance
1) suppresses signs & symptoms of opiate withdrawal
2) extinguish opiate craving
3) block the reinforcing effects of illicit opiates
37
Sublocade
-monthly injection (do NOT give IV or IM), has BBW for serious harm or death from IV admin
38
Naltrexone
-used for abstinence maintenance
-*pt must be opiate free for 7-10 days!*
39
Vivitrol (Naltrexone XR)
-opiate dependence, recently received opiate detox --> opiate free for at least 7 days
Exclusions: acute hepatic or liver failure, receiving opiate analgesics, w/ current opiate dependence, in acute opiate withdrawal, + urine screen, known allergic reaction to naltrexone
40
Dextromethorphan (DXM)
-antitussive, at high doses its like PCP and ketamine
41
Cocaine
-NE and DA re-uptake inhibitor
-effect: euphoria, alertness, mydriasis, sweats/chills, N/V, decreased fatigue, paranoia, aggression
-toxicity: cardiac arrest, MI, stroke, arrhythmia, seizures, hallucinations
-withdrawal: depression, fatigue, nightmares, sleep disturbances, increased appetite, bradyarrhythmia & tremor
-overdose = supportive, lorazepam, holdall, agents PRN cardio complications
42
amphetamines
-block reuptake of DA and NE, increase release of DAA and NE
-effects: decreased fatigue, alert, decreased appetite, inc activity and respiration, insomnia, anxiety, paranoia, meth mouth
-withdrawal: fatigue, depression, cognitive impairment
-overdose: supportive, haldol, lorazepam (if psychosis)
43
PCP
-DA, 5HT, NE reuptake inhibitor
effects: euphoria, delusion, hostility, hallucinations, emotional lability
-low dose: sedation, ataxia, nystagmus, slurred speech, paresthesia
-high dose: inc HR, BP, temp, diaphoresis, muscle rigidity, seizures & coma
44
Ketamine
-anesthetic, CIII, produces a cataleptic-like state in which the pt is dissociated from the surrounding environment by direct action on the cortex + limbic system, reduces poly-synaptic spinal reflexes
effects: increased BP, HR, hallucinations, vivid dreams, delirium, resp. depression, hypertonia, dystonia, seizure
45
LSD
-stimulate pre-synpatic 5HT1a and 1b + post-synpatic 5HT2
46
Marijuana
cannabinoid receptors, release dopamine
47
inhalants
glues, solvents, butane, gasoline etc --> rapidly absorbed via capillaries in the lungs, penetrate BBB
48
Krokodil
-homemade formulation of potent, short-acting opioid, desomorphine, derived from cocaine
-contains gasoline, lighter fluid, iodine, hydrochloric acid, red phosphorus
49
bath salts
-synthetic stimulants known as "cathinones", belongs to phenyethalmine, enhance release and block reuptake and breakdown of NE, DA, 5HT
50
Synthetic cannabinoid
-analogs of naturally occuring chemicals found in mj (THC, CBD, CBN), cannibis like effects
51
Kratom
-legal plant product that acts as a stimulant at lower doses and opiate effects at higher doses
-can cause addiction, withdrawal, psychosis & death
-13x more potent than morphine
52
causes of non epileptic seizures
-extreme metabolic disruption, deficiency state or local effect of a brain tumor, withdrawal from sedative/hypnotic drugs including ethanol, infection, renal failure, hypoxic encephalopathy, febrile convulsions
53
non epileptic seizures (4 causes)
-metabolic
-toxic
-hemodynamic
-psychogenic
54
partial seizures
-begin at discrete + relatively limited foci; motor function w or w/o march
55
simple seizures
-spread limited; uncomplicated, affects only limited aspects of neural function, motor symptoms or sensory symptoms, consciousness + memory undisturbed
56
complex partial seizures
-alteration of consciousness follows initial simple seizure, typically appears confused or preoccupied, may exhibit automatisms (lip smacking, fumbling with clothes etc) --> 70% arise from focus in temporal lobe
57
absence seizures (petit mal seizures)
-minor impairment of neural function b/s of short duration of seizures, blank stare or other facial expression indicate impaired consciousness, 2-10 secs
--> disruption in intentional behavior, consciousness + memory but not posture, muscle tone or ongoing autonomic behavior (walking), can occur 100s times/day
58
Tonic-clonic seizures (grand mal)
--maximal seizure response of brain in which all brain systems can be recruited into paroxysmal discharge, may have 1-2 myclonic jerks upon waking on day of seizure (~50% have aura before they start)
59
Tonic-clonic seizures (tonic, clonic, terminal) phases
-tonic: 10-15 secs of muscle extension, bladder may empty, breathing stops & pupils unresponsive to light
-clonic: violent muscle spams, respiration resumes but ineffective (cyanosis)
-terminal: limp + quiet w/ normal breathing, may become conscious w/ no recollection of seizure
Status epilepticus: after finishing one seizure, starts another = medical emergency
60
signs of immediate medical attention
-seizure lasts longer than 10 secs or occurrence of second seizure
-difficulty in arousing at 10 min intervals
-complaints of difficulty with vision
-vomiting
-persistent headache after a rest period
-unconsciousness with failure to respond
-unequal size pupils or excessively dilated
61
which AEDs inc the clearance of estrogen and dec OC effectiveness
-phenobarbital
-phenytoin
-primidone
-carbamazepine
--> divalproex sodium does not effect OC but bad for tx
--> do NOT use Ocs with higher estrogen concentration = higher risk of stroke
62
Pregnancy & epilepsy- what a prego bish gotta do*
*-she should establish a pt provider relationship with experienced OBGYN & neurologist + do this before conception
*-not d/c her own anticonvulsant (seizures are a greater risk to fetus)
*-if she was treated with VA or carbamazepine (before she knew she was prego) inquire about amniocentesis
*-if she is treated w/ phenobarbital throughout her prego, neonatal phenobarbital withdrawal is likely but manageable
-diet should include folate & folate supps
**carbamazepine and VA --> neural tube defects
63
breastfeeding and epilepsy
Ethosuximide, zonisamide, clonazepam + diazepam are CI during breast feeding
64
levetiracetam
-go to drug used for all seizure types
-dose adjustment based on GFR
AEs: some weight gain & enhances CNS depressants
65
Oxcarbamazepine
-adjunctive therapy in tx of partial seizures in children 6 y/o +
-advantages: lower potential for drug interaction
-SEs: somnolence, headache, dizziness, N/V, potentially serious rash
66
Lamotrigine
-partial seizures, absence, GTC, juvenile myclonic epilepsy, lennox-gastout syndrome
-used as mono therapy in kids 2-12
-advantages: board spectrum of activity, low teratogenic potential and non-sedative!
-SJS risk!! --> higher incidence w/ fast titration + adding LTG to VPA (need to titrate slowly!)
67
**breast feeding and epilepsy q**
-maternal uncontrolled seizure pose more risk to the new born than exposure to most AED in breast milk
-if the pt was taking the same AED throughout her pregnancy her child has already been exposed to that AED at least to the same degree w/o problems
-newer agents such as topirmate seem safer than older agents but this is based on less date/experience
68
Gabapentin
-used for partial seizures, as monotherapy or add-on, TID dosing
-no pk interactions with other drugs, lower in incidence of neutrotoxic side effects, useful for co-morbid neuropathic pain or mood stabilization in bipolar pts
69
phenytoin
-generalized seizures, capacity limited hepatic metabolism + highly protein bound
--> as concentration dec, toxicity goes away
-large variability in rate + extent are sensitive to GI factors
70
phenytoin AEs
-aplastic anemia, SJS, rash, gum hypertrophy, chronic cerebellar damage, fetal vitamin K depletion
71
Fosphenytoin
-maintains seizure control + prevents the re-occurance of status epilepticus
-IV or IM injection
-cardiac and BP monitoring required
72
Valproate
Aes: N/v, diarrhea, abdominal cramps, elevation in liver function tests, spina bifida, drowsiness + ataxia
--> dec VA conc when used with: carbamazeine, lamotrigine, phenytoin, rifampin
--> inc VA conc when used with: aspirin, chlorpromazine, cimetidine or felbamate
73
Carbamazepine
**auto-induction**
-Aes: hyponatremia, water intoxication, transient leukopenia
DIs: stimulated metabolism of CYP3A4 (OCs, anticoagulants, corticosteriods, cyclosporins, doxy, haloperidol)
-monitor: baseline CBC + platelet, serum levels weekly + liver function
74
**pt is treated w/ pheyntoin for 20 years with 2/3 seizures/year. developing dental problem & switching to lamotrigine (not sedating drug), advice for nursing home staff:
-examine pt for any rash daily for a month and then at least weekly
-slow titration = gradual + simultaneous tapering of phenytoin + titration of lamotrigine is needed
-often a transient increase in seizure frequency during the tapering titration
75
**pt is taking levetiracetam 1000mg TID, presents w/ SOB, fatigue, weakness, nausea, dystaxtic gait + confusion. pt has been taking ibuprofen q4h, x5d. CrCl = 40
-stop ibuprofen immediately
-levetiracetam dose should be lowered to 250mg BID
76
***pt starts have seizure in front of you
-go to his side and record time of onset of seizure
-move him to an open area
-stay with him until he not only stopped seizing but until he is fully alert or until EMS takes over
77
***marks Topiramate was increased to 200 mg BID, complains of bilateral paresthesias in distal upper extremities
-likely due to increased dose and should subside in a few weeks
78
***george starts on carbamazepine for 8 weeks + no seizures, comes in for refill and says he had 2 seizures last week:
-assure george that it is no uncommon for the conc of carb. in hil blood to fall - get levels checked and call neuro
-worsening seizure frequency can indicate an electrolyte imbalance --> see neuro
-question george regarding compliance
79
positive schizo symptoms
-hallucinations, delusions, ideas of influence, disorganized speech + disconnected thoughts
80
negative symptoms of schizo
-flat affect, alogia, anhedonia & avolition
81
cognitive symptoms of schizo
-impaired attention, impaired working memory + impaired executive function
82
1st gen AP class related side effects
-EPS
-Qtc prolongation
-prolactin elevation
-dermatologic
-photosensitivity
-blue-grey skin
-hypotension
-altered thermoregulation
83
1st gen AP drugs
-chlorpromazine
-thioridazine
-loxapine
-molindone
-perphenazine
-trifluoperazine
-thiothixene
-fluphenazine
-haloperidol
84
2nd gen, APs class effects
-metabolic syndrome
-QTc prolongation
-blood dyscrasia
-seizure threshold
-anticholinergic effects
-sedation
-prolactin elevation
-opthalmic effect
85
2nd gen AP drugs
-Apriprazole
-Asenapine
-Brexiprazole
-Cariprazine
-clozapine
-lloperidone
-lumateperone
-lurasidone
-olanzapine
-paliperidone
-quetiapine
-risperidone
-ziprasidone
86
Apriprazole
-impulsivity
-LAI
-peds approved
-FDA: bipolar, MDD, autism & tourettes
87
Asenapene
-topical patch worn for 24 hr
-Ci in severe hepatic disease
88
Brexpiprazole
-impulsivity
-akathisia
-91 hr 1/2 life
-MDD
89
Clozapine
-blood dyscarsia, metabolic risk, constipation (need a bowel reg)
-refractory illness or suicide risk
-REMS
-pt must be adherent
90
Iloperidone
-orthostatic hypotension, slow titration is needed
-not rec in hepatic impairment
91
lurasidone
-do not use w/strong CYP3A4 inducer/inhib
92
Olanzepine
-metabolic risk, DRESS
-LAI
-peds
-sedation & 3 hr post injection monitoring
93
Paliperidone
-EPS, prolactin, QTc, priapism, TTP
-LAI
-peds
-no PO overlap required
94
Pimavanserin
-no dopamine!
-tx of hallucinations + delusions associated w/ parkinsons disease. psychosis
95
Quetiapine
-sedation, anticholinergic effects, cataracts
-peds
-bipolar & MDD
96
Risperidone
-EPS, prolactin
-peds
-LAI(Im)
-bipolar + autism symptoms
97
Ziprasidone
-do not used in those at risk of QCt prolongation, DRESS
-IM short injection used in ER
98
SGAs approved for peds & BBW
-aripiprazole
-lurasidone
-olanzapine
-paliperidone
-quetiapine
-risperidone
BBW: suicidal thots and behaviors in 24 y/o and younger
99
LAI (1st gen APs)
-fluphenazine
-haloperidol
100
LAI (2nd gen APs)
-aripiprazole
-olanzipine
-risperidone
-pailieridone
101
older LAI caused too much discomfort?
well the newer APS injections are water based and tend to be better tolerated
102
Acute Dystonia
-painful, prolonged muscle contrations, involuntary buccal, facial, occulogynic, may involve back, arms and legs --> jaw stiffness!
-caused by: fluphenazine, haloperidol
tx: anticholnergics, IM benzos
103
Pseudo-parkinsons
-bradykinesia, tremor, pill rolling, cogwheel rigidity, postural & oral abnormaility
-caused by fluphenazine, haloperidol , high doses, older females
tx: anticholnergics, dec dose, d/c drug
104
akathisia
-restlessness, pacing, shuffling, compulsion to stay in motion, subjective feeling of distress
-caused by: fluphenazine, haloperidol, aripriprazole, risperadone
TX: beta blocker , d/c or decrease dose of offending agent
105
tardive dyskinesia
-tongue thrusting, chewing, lip smacking, grimacing, limb twisting and rocking
caused by: fluphenazine, haloperidol, high doses and older females
-tx: prevention, switch drugs (clozapine)
106
Neuroleptic Malignant Syndrome (NMS)
-rare, potentially lethal
-dehydrated, mental disorder, labile BP, confusion, inc. muscle tone/rigidity, ince WBC, CPK, LFP
-tx: d/c med
107
EPS tx drugs
-po.iv.im: diphenhydramine
-po,iv,im benztropine
-po trihexylphenidyl
-po,iv,im biperiden
-amantadine
108
BBs for akathisia tx
-propranolol
-nadolol
-metoprolol
109
Benzos used for acute dystonia tx
-lorazepam
-diazepam
-clonazepam
110
***how would you describe the class related BBW that is associated with APs?
-avoid use of APs in pts with dementia related psychosis
111
***Haloperidol and jaw pain, which movement disorder have they developed?
acute dystonic reaction
112
***haloperidol + jaw pain, pt is brought to ER w/ dehydration, muscular rigidity, altered mental stare, inc CPK, and elevated body temp- could this condition have been prevented if doc was aware of class BBW?
no, the APs bbw does not apply to him + thus not related
113
***haloperidol + jaw pain, pt is brought to ER w/ dehydration, muscular rigidity, altered mental stare, inc CPK, and elevated body temp- what is the likely cause of his current state?
neuroleptic malignany syndrome, due to high potency APs when he was dehydrated
114
*** AA comes to ER after 1 IM doses of haloperidol, results in extreme jaw stiffness, what intervention do you rec?
-d/c haloperidol
-consider changing APs once stiffness resolves + if psychiatric symptoms persist
-oder diphenhydramine STAT
115
***which of the following APs are associated with DRESS?
-olanzapine
-ziprasidone
116
***AA is 23 y/o male with newly diagnosed schizo- what med do you rec?
(want any drug besides clozapine and olazapine)
-risperadone
117
***which of the following are true regarding clozapine therapy?
-con result in Qtc prolongation
-ANC values should be submitted to the REMS (weekly at first then monthly)
-gold standard for refractory illness (and suicide kids)
118
what is the BBW for depression drugs?
increased risk of suicidality in younger adults 18-24 y/o, especially at early stage of tx
119
1st line tx for depression
-SSRI, SNRI, bupropion, mirtazapine, vortioxetine
120
SSRI drugs & facts
-citalopram, escitalopram, fluoxetine, paroxetine & sertraline
-when d/c must taper due to electric shock syndrome (flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances & hyperarousal)
-sexual dysfunction? switch to bupropion
-serotonin syndrome
-risk of bleeding with NSAID use
121
citalopram
SSRI
-QTc prolongation
-MDD
122
escitalopram
SSRi
-MDD + GAD
-ped 12-17
123
fluoxetine
SSRI
-MDD, OCD, bulimia, panic disorder, premenstrual, tx resistant depression, bipolar
-once weekly tx, peds 8 y/o+
-concern for anorexia, anxiety & insomnia
124
paroxetine
SSRI
-DO NOT USE IN PREGNANCY*, akathisia & reports of bone fracture
-MDD, OCD, panic disorder, GAD, social anxiety, PTSD, menopause symptoms
125
Sertraline
SSRI
-QTc risk
-MDD, OCD, panic disorder, social anxiety, PTSD, premenstrual disorder
126
SNRIs
-devenlafaxine, venalfaxine, duloxetine, levomilnacipram
-all: abnormal bleeding due to 5HT reuptake on platelets, potential for inc risk of mania, inc BP, hyponatremia, serotonin syndrome and d/c syndrome
127
Desvenlafaxine
SNRI
-hyperlipidemia, eosinophilic pneumonia
-MDD
128
Venlafaxine
SNRI
-BP changes, eosinophilic pneumonia
-can lease to seizures, dec dose by 50% if hepatic/renal impair.
-MDD, GAD, PD, SAD
129
Duloxetine
SNRI
-dry mouth, hepatotoxicity, skin reaction, urinary retention, hypotension, avoid EToH
-MDD, GAD, diabetic peripheral neuropathic pain, fibromyalgia, chronic muscoskeletal pain
130
Levomilnacipram
SNRI
-urinary retention, inc HR
-MDD
131
tricyclic ADs (TCAs)- drugs and uses
-amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline & maprotiline
--> MDD, insomnia, nocturnal enuresis
132
TCA side effects & facts
-anticholinergic + cardio, lethal in overdose
-give at bedtime to dec. impact of sedative properties, cognitive impairment, urinary retenion possible, can also cause weight gain, sexual dysfunction
133
Cholinergic rebound
-when TCA is stopped abruptly
-insomnia, sweating, abdominal pain, diarrhea, myalgia, nausea
134
MAOIs (drugs and facts)
*last line*
-phenaelizine, selegiline, trancypromine
-after d/c med, must wait 4-5 1/2 lived of drug or active metabolite
135
MAOI side effects
-dietary restriction of tyramine = risk hypertensive crisis, monitor BP
-postural hypotension, diarrhea, anticholinergic effects, sexual dysfunction
-hypertensive crisis & serotonin syndrome
136
Serotonin modulators/ 5-HT drugs
nefazodone, trazadone, vilazodone, vortioxetine
137
Nefazodone
5-ht
-BBW: life-threatening hepatic failure
138
Trazodone
5-ht
-sedating, risk of priapism
139
Vilazodone
5-ht (valis in vagina) = less sexual dysfunction
SE: n/v, diarrhea, insomnia, dreams
140
Vortioxetine
5-ht *1st line*
-rapid onset of action, improved tolerability
SE: n/v diarrhea, dizziness
take with food
141
Bupropion
*1st line*
-risk of seizures
-caution in pts w/ eating disorders or alcohol use disorders
-CI in belemia & anorexia, has less sexual dysfunction effects
142
Mirtazapine
*1st line*
-sedating, cholesterol elevation, sig weight gain
-use in the old frail bitches
143
Esketamine
-CIII, indicated for tx resistant depression (failure of 2 drugs), designed to be used in combo with PO AD
-AEs: dissociation, dizziness, N/V, sedation, vertigo, hypoesthesia, anxiety, lethargy, inc BP, feeling drunk
BWW: sedation, dissociation, abuse + misuse, suicidal thots and behaviors
-monitor for 2 hours post admin
144
Brexanolone
-use for postpartum depression
AEs: hypoxia, sedation
145
what AD drug do you avoid in pts with seizure disorder?
bupripion
146
what AD drugs do you wanna avoid with substance abuse?
benzos/eskatamine
147
what AD drugs do you wanna avoid with GI bleeding and anticoagulation?
SSRIs
148
in elderly, what AD drug classes do you want to avoid with delirium?
all TCAs
149
in elderly, what AD drugs do you want to avoid with hx of falls or fractures?
All TCAs and SSRIs
150
what ADs can be used in children?
-Fluoxetine is the ONLY med approved for kids 8 y/o+
-escitalopram approved for kids 12 y/o+
151
augmentation 1st line drug
-lithium
152
augmentation drugs
-triiodothyronine
-SGAs
-others: buspirone, stimulants (modafinil, methylphenidate)
153
NMS symtoms
-dopaimine antagonist
-onset 1-3 days
-HTN, inc HR
-lead pip rigidity in all muscle groups
-hyporeflexia
-normal pupils
-normal or decreased bowel sounds
154
Serotonin Syndrome symptoms
-serotonon agents
-onset < 12 hrs
-hyperreflexia
-dilated pupils
-hyperactive bowel sounds
-mental status: variable, agitation, coma
155
*** which of the following SNRI is most appropriate to treat MDD and co-occuring GAD?
venlafaxine
156
*** 23 y/o diagnosed w/ 1st episode of MDD, symptoms- depressed mood, anhedonia, insomnia and impaired concentration, pt denies suicidal ideationm is the relevance of the BBW of ad?
the BBW for ADs is applicable counsel pt to notify prescriber if change in mood
157
***37 y/o male diagnosed with 2nd episode of MDD, seizures + psych family hx- which SNRI would be appropraite
venlafaxine
158
***potential adverse reaction of SNRI
-abnormal bleeding
-inc BP
-mania/hyperactivity
-hyponatremia
159
***which SNRI is fda approved for both MDD and neuropathis pain?
duloxetine
160
***pt on mdd of sertaline but continues to have difficulty cancentrating, what can she do?
-ass apriprazole 5mg
-encourage continues reporting of side effects
