Neuropsychiatric Meds - Quiz 8 Flashcards by Donny Le

What should be done in the first 5 minutes of a seizure?

Rule out everything else

ABC’s

Check Blood Sugar & Labs

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What should be done in the First Phase (5-20 min) of a Seizure?

Give any Benzo

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What should be given in the Second Phase (20-40 min) of a Seizure?

Fosphenytoin

Valproic Acid

Keppra

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What should be done in the Third Phase (40-60 min) of a Seizure?

Repeat any Second Line Therapy

Anesthetic Dose of Thiopental, Propofol, Versed, or Pentobarbital

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How do Calcium Channel Blockers work as Anticonvulsants?

Blocks T-Type Ca Channels in Thalamus

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What is a major consideration with using Carbamazepine & Oxacarbazepine?

Drug Interaction - CYP inducers that reduces their own affects along with Versed & Propofol

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What electrolyte should be checked when using the -azepines?

Sodium Level - risk for Hyponatremia

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What are common side effects of -azepines?

Dizziness

PONV

Sedation

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Why was Oxcarbazepine created?

Prevent Auto-Induction of Carbamazepine

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How does Oxcarbazepine compare to Carbamazepine?

Same Side Effects, but LESS Drug Interactions & Better tolerated

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What is different about the Pharmacokinetics of Phenytoin?

Non-Linear

Need much smaller dose adjustments

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Why was Fosphenytoin created?

Prodrug for IV Administration

Can be given Safer & Faster

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What are the Side Effects of Phenytoin?

Gingival Hyperplasia

Nystagmus

Vitamin K Deficiency

Arrhythmias

Hypotension

Osteoporosis

Bleeding

Ataxia

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What can Phenytoin cause in Pregnancy?

Cleft Palate & Lip

Slowed Growth

Mental Deficiency

Congenital Heart Disease

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What is the Advantage & Disadvantage of using Lamotrigine?

Autoinducer, but very LOW drug interactions, except when given with Valproic Acid

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What happens if Lamotrigine is given with Valproic Acid?

Steven-Johnson Syndrome

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What is the main concern with Zonisamide?

Increased risk for Kidney Stones

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What is the advantage of using Locosamide?

Less Side Effects, Drug Interactions, and No CYP effects

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What is the ONLY indications for Clobazam (Onfi)

Seizures

HIGH RISK for Withdrawal

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Which Benzo has the longest duration?

Diazepam & Clonazepam d/t High Lipophilicity

Higher Lipophilicity = Faster Onset

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What is the biggest risk associated with Vigabatrin?

Permanent Vision Loss

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What is the advantage of using Gabapentin?

Neuropathy Pain Control

Not Protein Bound

No Drug Interactions

Excreted Unchanged

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What is the biggest concern with Gabapentin?

Post-Op Sedation

Severe Respiratory Distress when given with Opiates

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What is Pregablin used for?

Neuropathy

Seizure

Anxiety

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How does Pregablin compare to Gabapentin?

Similar, but risk for Ataxia

What pregnancy category risk does Valproic Acid have?

Category D - X

What are the main concerns related to Valproic Acid?

Thrombocytopenia ↑Ammonia Liver Toxicity

Which Anti-Seizure meds are Glutamate Blockers?

Felbamate Topiramate Perampanel

How does Topiramate work?

Inhibits Sodium, AMPA, and Carbonic Anhydrase & Enchances GABA

What are the main concerns with using Topiramate?

Psychomotor Slowing Depression Agitation Loss of Appetite

What is the Black Box warning for Perampanel?

**Life-Threatening Behavioral Effects** Agression Hostility Homicidal

What are the main side effects of Perampanel?

Dizziness & Threats

How does Levetiracetam work?

Inhibits Calcium via SV2A Protein to reduce Hyperexcitability

What are the advantages with using Levetiracetam?

No Protein Binding Short Half-Life No Drug Interactions

What are the side effects of Levetiracetam

General Anti-Seizure Side Effects Accidental Injury Convulsions Cognitive Impairment

How does Baclofen work?

Hyperpolarization to reduce Calcium, Glutamate, Motor Neuron Activity ↑Potassium Conduction Blocks Substance P

What happens when Baclofen is abruptly stopped?

**Severe Withdrawal** Hallucinations Agitation Seizures

How does Tizanidine work as a Skeletal Muscle Relaxant?

Alpha-2 Agonist w/ Anti-Cholinergic Effects

How does Dantrolene work as a Skeletal Muscle Relaxant?

Blocks Ryanodine to reduce Calcium from Sarcoplasmic Reticulum

What is the Black Box warning for using more than 800 mg/day of Dantrolene?

Diarrhea & Liver Toxicity

What are the main concerns with using Skeletal Muscle Relaxants?

Oversedation & Withdrawal

Which drugs are Sedative Hypnotics?

Z-Drugs Ramelteon Suvorexant Melatonin Valerian Root

What are the Disadvantages of using Sedative Hypnotics?

No Restorative / REM Sleep & Sleep Eating, Fighting, and Walking

Which meds are SSRIs?

Citalopram Fluoxetine Paroxetine Sertraline Escitalopram Fluvoxamine

Which meds are Tricyclic Antidepressants?

Amitriptyline Clomipramine Desipramine Doxepin Imipramine Nortriptyline

How do Tricyclic Antidepressants work?

Inhibits Serotonin & Norepi Reuptake Anticholinergic 1A Antiarrhythmic

What are the adverse effects of Tricyclic Antidepressants?

Anticholinergic Effects & QT Prolongation & Arrhythmias

What should be done for a Tricyclic Antidepressant overdose?

Give Sodium Bicarb to treat Acidosis

Most Serotonin Receptors are \_\_\_\_\_\_\_\_, while some are \_\_\_\_\_\_\_

Most Serotonin Receptors are **G-Coupled**, while some are **5-HT3 Antogonist**

Which Serotonin Receptors are Inhibitory?

1 & 5

What are the concerns with SSRIs?

Hyponatremia Thrombocytopenia Suicidality Arrhythmias Serotonin Syndrome N/V Weight Fluctuations

What do Neuroleptic Malignant Syndrome & Serotonin Syndrome have in common?

HTN Tachycardia Tachypnea Hyperthermia Diphoresis Hypersalivation Mental Problems Increased Muscle Tone

What are the differences between Neuroleptic Malignant Syndrome & Serotonin Syndrome?

**NMS:** HYPO-reflexia w/ Normal Pupils & Bowel Sounds **SS:** HYPER-reflexia & Clonus w/ Dilated Pupils & Hyperactive Bowels

What causes Neuroleptic Malignant Syndrome and when is its onset?

Dopamine Antagonism Happens in 1-3 days

What causes Serotonin Syndrome & when is its onset?

Serotonergic Agents Occurs in \< 12 hrs

Which meds are Serotonin Norepi Reuptake Inhibitors (SNRIs)?

Duloxetine Venlafaxine Desvenlafaxine Levomilnacipran

What are the Adverse Effects of SNRIs?

Serotonin Syndrome Liver Toxicity HTN Insomnia Tremor

What kind of med is Bupropion?

Dopamine and Norepi Reuptake Inhibitor (DNRI)

Which meds are 5HT2A Antagonists?

Mirtazepine & -azodone

What are the concerns with 5HT2A Antagonists?

Highly Sedating Increased Appetite Severe Liver Damage

What is Nuedexta used for?

Treats Pseudobulbar Affect - Inappropriate Laughing/Crying

How does Nuedexta work?

Uses Quinidine to Increase Dextromethorphan to inhibit NMDA receptors

What are the concerns with using Nuedexta?

QT Prolongation Lupus Thrombocytopenia Anemia

What does Lithium do?

Stabilizes Mood by altering Sodium Transport since it looks like Sodium

What can occur w/ Lithium Toxicity?

DI Tremors Arrhythmias Hypothyroidism Syncope Weight Gain

What is associated w/ the Mesolimbic Dopamine Pathway?

Schizophrenia & Psychosis

What is associated w/ the Mesocortical Dopamine Pathway?

Depression & Mood Disorders

What is associated w/ the NigrostriatalDopamine Pathway?

Extrapyrimidal Symptoms & Tardive Dyskinesia

What is associated w/ the Tuberohypophyseal Dopamine Pathway?

↑Prolactin

How do Antipsychotics work?

S2/D2 Blockade Anticholinergic Antihistamine Alpha-2 Blockade

What is the Black Box warning for Antipsychotics?

Dementia related Death & Agranulocytosis (Clozaril)

Patients with Parkinsons have a deficiency in \_\_\_\_\_\_\_\_\_\_

Patients with Parkinsons have a deficiency in **DOPAMINE**

Which meds are Dopamine Analogs?

Carbidopa/Levodopa/Entacapone

How does Carbidopa/Levodopa/Entacapone work?

**Carbidopa**: False Dopamine **Levodopa**: Dopamine Precursor **Entacapone**: Blocks COMT

What are the adverse effects of Dopamine Analogs?

Psychosis Hallucinations Hypotension Syncope GIB

Which meds are Dopamine Agonists?

Pramipexole Ropinirole Rotigotine Bromcriptine Apomorphine

Which Anticholinergics are used for Parkinsons?

Benztropine & Triheyxphenidyl

Which MAOB Inhibitors are used for Parkinsons?

Rasaligine & Selegiline

Which Alzheimer's meds are Acetylcholinesterase Inhibitors?

Donepezil Galantamine Rivastigmine

Which Alzheimer's meds is a NMDA Antagonist?

Memantine

When can Post-Op Delirium & Cognitive Impairment occur?

Up to 1 Year Post-Op

What is the best strategy to prevent Post-Op Delirium?

Avoid Opioids, Benzos, Hypnotics, etc..

What was found in the 2018 STRIDE Trial regarding Post-Op Delirium?

Limiting Sedation Levels provide NO SIGNIFICANT benefit

How should Post-Op Delirium be managed?

Use **1x LOW dose** Antipsychotics **ONLY IF** patient is at risk for harming self or others Benzos worsen Delirium