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Pharm Flashcards

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1
Q

Which SSRI is least associated with weight gain?

A

Sertraline

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2
Q

Which SSRI is most associated with weight gain?

A

Paroxetine

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3
Q

Which SSRI is associated with prolonged QT syndrome?

A

Citalopram

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4
Q

What are some S/Sx of serotonin syndrome?

A

Triad: altered mental status, autonomic instability, neuromuscular abnormality

  • Diaphoresis, tachycardia, HTN, sweating, hyperthermia, altered mental status, diarrhea, mydriasis (dilated pupils)
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5
Q

How is serotonin syndrome treated?

A

Cyroheptadine, a serotonin antagonist

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6
Q

Name an OTC med often involved in serotonin syndrome in a patient on prescribed antidepressants

A

Dextromethophan, cough medicine

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7
Q

With what SSRIs is a tapered discontinuation especially important?

A

Paroxetine, sertraline (shorter half life)

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8
Q

Which SSRI has the longest half life?

A

Fluoxetine

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9
Q

Which SSRI should be avoided in pregnant women?

A

Paroxetine (associated with cardiac abnormalities in pregnant women)

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10
Q

What is a good antidepressant choice for a patient with depression and fibromyalgia who failed SSRI treatment?

A

Duloxetine

SNRIs are first line for patients with pain ass’d with depression. Duloxetine is more effective than venlafaxine for patients with low back pain, OA, or fibro

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11
Q

What atypical antidepressant is associated with serotonin syndrome?

A

Trazodone

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12
Q

What atypical antidepressant is associated with sexual dysfunction?

A

Trazodone

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13
Q

Trazodone should NOT be used in combination with what two classes of psych drugs?

A

Benzos

Barbituates

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14
Q

What is the MOA of trazodone?

A

Alpha-1 blockade
H-1 blockade
Serotonin uptake inhibition

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15
Q

What are some AE of trazodone, and why do they occur?

A
  • Priapism (a-1 blockade-induced vasodilation)
  • Sedation (H-1 blockade)
  • Serotonin syndrome (serotonin reuptake inhibition)
  • Sexual dysfunction
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16
Q

What antidepressant should be avoided in patients with sickle cell?

A

Trazodone (a-1 blockade can cause occlusive crisis)

17
Q

What antidepressant should be avoided in patients with multiple myeloma?

A

Trazodone - a-1 blockade can lead to occlusive crisis

18
Q

Name two SNRIs

A

Venlafaxine

Duloxetine

19
Q

What are AEs of SNRIs?

A

Similar to SSRIs including hyponatremia

Noradrenergic AE: HTN, dizziness

20
Q

What are some AEs of SSRIs?

A
  • Sexual dysfunction
  • Weight gain
  • Some w/sedation, some w/sleep disturbances
  • Nausea
  • HA
  • Restlessness
  • Tremor
  • Suicide risk, hypo/mania
  • QT prolongation
  • *Hyponatremia
  • Serotonin syndrome
  • *Anti-platelet effects
  • *SIADH
21
Q

Buproprion is CIx in what groups of patients?

A
  • Eating disorders
  • Seizure history
  • Bad idea in schizophrenic patients (excess dopamine in these patients), may be used with close monitoring
  • MAOI use
  • Currently in drug/EtOH detox
22
Q

Potential cardiac complications associated with lithium use?

A

Cardiac arrhythmia: bradycardia, SA node block, ST-depression

Edema, hypotension, and unmasking of Brugada syndrome also reported

23
Q

Potential CNS complications associated with lithium use?

A 
Drowsiness/sedation/lethargy
Ataxia/abnormal gait
Confusion, disorientation
Slurred speech
HA
Hallucination
Seizure
24
Q

What are some medications that can reduce the clearance of lithium?

A

ACEi
ARBs
NSAIDs
Diuretics

also
Tetracyclines
Metronidazole

25
Q

What are some dermatological side effects associated with lithium?

A

Acne
Psoriasis

(Exacerbation more than new-onset)

26
Q

What are some GI effects associated with lithium?

A 
Dyspepsia
Gastritis
D/N/V
Dysgeusia
Gastritis
Abdominal pain
27
Q

What monitoring is indicated for second gen anti-psychotics?

A

Monitor for metabolic syndrome:

  • Weight gain
  • Lipids
  • DM
  • BP
  • Fasting glucose
  • Waist circumference
28
Q

What special monitoring is necessary for patients taking clozapine?

A

Absolute neutrophil count

29
Q

With what serious AE is lamotrigine associated?

A

Stevens-Johnson Syndrome

30
Q

With what serious AE is valproic acid associated?

A

GI symptoms
Hepatitis
Pancreatitis
Hepatic encephalopathy

31
Q

What are some symptoms of lithium toxicity?

A 
Ataxia
Confusion
Tremors
Seizures
GI symptoms
32
Q

What are some mood stabilizers that can be used during pregnancy in a bipolar patient who must be medicated?

A

Lamotrigine has the most favorable pregnancy profile

Pt may stay on lithium if stabilized on it – it is teratogenic (Ebstein anomaly) but occurrence is rare

AVOID valproic acid and carbamazepine

33
Q

Describe the course of EtOH withdrawal symptoms by hours

A

6-24 hours: Anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset

12-48 hours: Seizures, hallucinations

48-95 hours: DTs: confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations

Psych EOR (1 decks)

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