Neuropsychiatric meds Flashcards
Which antiepileptic is the treatment of choice for status epilepticus according to most recent treatment guidelines?
lorazepam (Ativan)
Order of meds to give for seizure
- Benzodiazepine
If benzo not available try: phenobarbital IV, diazepam rectal, nasal or buccal midazolam
- Second phase: fosphenytoin IV, valproic acid IV, levetiracetam IV
- Repeat of any second line therapy
Anesthetic doses of thiopental, midazolam, pentobarbital, or propofol
Which sodium channel blocker has the most side-effects, drug interactions, and causes hyponatremia?
Carbamazepine
Which sodium channel blocker induces its own metabolism (reduces its own levels)?
Carbamazepine
Which sodium channel blocker has unpredictable pharmacokinetics and has similar antiarrhythmic properties as lidocaine?
Phenytoin (fosphenytoin is the oral prodrug)
Which sodium channel blocker causes gingival hyperplasia, arrythmias due to class 1B antiarrythmic association, and can cause cleft palate/congenital heart disease/slowed growth rate/mental deficiency if given during pregnancy?
Phenytoin
Which sodium channel blocker, when given with depakote, can cause TERRIBLE rash that is life-threatening and basically Steven-Johnson X 1,000?
Lamotrigine (lamictal)
Lam”oh my god”trigine
Which sodium channel blocker has the highest rates of kidney stones?
Zonisamide
Kidney ZONES…zonisamide!
KIDNEYZONISAMIDE
STONEISAMIDE
Which sodium-channel blocker has the best safety profile?
Lacosamide
La”coast”amide
Which benzodiazepine has the highest rates of withdrawal?
Clobazam (Onfi)
Which benzo is the most and least lipophilic?
clobazam and temazepam
______ is only available through a very specific program with REMS monitoring because of risk of permanent vision loss,
Vigabatrin
Vi”sual”gabatrin
What is gabapentin mostly used for?
Neuropathic pain or anxiety. Helps reduce pain post-operatively
Which combination of medications greatly increases the risk of hyponatremia?
SSRIs and Carbamazepine (Tegretol)
What is a fairly common yet weird side-effect of pregabalin?
Difficulty walking, gait abnormalities
This seizure medication may raise ammonia levels leading to possible confusion, agitation, and delirium
Valproic Acid
Valproic A”mmonia”cid
With in utero exposure, ______ can lower IQ in children compared to other anti-epileptics (category D-X)
Hint: it also raises ammonia levels
Valproic Acid
“Valprammonia”
Which anticonvulsant can make you feel like your mind and body are disconected?
Topiramate
Top”off”iramate
This seizure med can cause SEVERE cognitive impairment? Example of professors friend who would forget everything
Levetiracetam (keppra)
What the fuck does dantrolene do
Blocks ryanodine channel, reduces Ca ++ release from SR
Med of choice for malignant hyperthermia
Which class of antidepressant has significant anticholinergic properties?
TCAs- tricyclic antidepressants
Tricyclic anticholinergic antidepressants..
What do you give for a tricyclic antidepressant overdose?
NaHCO3 d/t metabolic acidosis, supportive therapy
What do all anti-depressants have BLACK BOX WARNING FOR?
Suicidal ideations
Which SSRI has a black box for QT prolongation
Citalopram (Celexa)
______ are the most highly sedating anti-depressants
5HT2A antagonist (trazadone is an example)
_______ is used for Pseudobulbar affect (laughing inappropriately)
Nuedexta
“Nuts”dexta
Which generation of antipsychotics are supposed to be safer, but aren’t really?
2nd
_______ have a black box warning for dementia related death, agranulocytosis
Antipsychotics
Levodopa is a ______, and carbidopa is _______
Levodopa = dopamine precursor
Carbidopa = false dopamine
What are the two classes of Alzheimer’s Medications
Acetylcholinesterase Inhibitors
NMDA receptor antagonists
What is the most common side effect of AChEi
Rest/digest side effects
Bradycardia
Loose stools
OAB
What do alzheimers meds do to succinylcholine and other NMB?
POTENTIATE succinylcholine
REDUCE blockade of other NMB
Antipsychotics - too much dopamine
Parikinsons - not enough dopamine
Yep
Carbidopa/Levodopa (Sinemet) improves Parkinson’s symptoms via which mechanism of action?
Dopamine receptor agonist
One way to predictably reduce the incidence of post-operative delirium is to use lighter sedation.
FALSE
Aricept (Donepezil), a medication used for Alzheimer’s disease, may antagonize the effects of succinylcholine.
FALSE
Which seizure medication has similar antiarrhythmic properties as Lidocaine?
Phenytoin (Dilantin)
An FDA safety communication from 12/2019 stated that gabapentinoids (like Gabapentin) increase the risk of which side effect when combined with opiates?
Respiratory depression
