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Pharm Flashcards

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0
Q

FGA Contraindications

A

Comatose patients

Severe CNS depression

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1
Q

Chlorpromazine indications

A

Schizophrenia
Mania
Behavioral problems in kids
Intractable hiccups

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2
Q

Chlorpromazine SE’s

A

Sedation
Anticholinergic (dry mouth, blurry vision, urinary retention)
Postural hypotension
EPS

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3
Q

Haldol indications

A

Schizophrenia
Tourette’s
Acute inpatient psychosis

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4
Q

Haldol SE’s

A

EPS & TD

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5
Q

Lithium serum levels & toxicity levels

A

Ideal levels = 0.6-1.2

Toxicity if >1.2-1.5

Dialysis if > 4

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6
Q

Lithium:
Half life
Trough
Steady State

A

Half life = 24h
Trough level at 12h
Steady state at 5d

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7
Q

Lithium SE’s

A 
LITHIUM:
	Leukocytes Increased
	Tremor
	Hypothyroidism
	Increased Urine
	Mother's beware (Ebstein's anomaly)
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8
Q

Tests to get yearly for Lithium

A

Serum level
TSH
BUN & Cr

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9
Q

Types of EPS

A

Akithisia
Pseudoparkinsonism
Dystonia (torticollus, oculogyric crisis)
Tardive Dyskinesia

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10
Q

Symptoms of NMS

A 
FALTER
	Fever
	Autonomics (BP, pulse variable)
	Leukocytosis
	Tremor
	Elevated CPK
	Rigidity (lead pipe)
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11
Q

Who is NMS seen in?

A

Young males early in their treatment. Preceded by catatonia.

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12
Q

What FGA’s are available IM?

A

Fluphenazine & Haldol

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13
Q

What psychotropics are renally excreted?

A

Lithium
Gabapentin
Mirtazapine

That’s it!

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14
Q

Indications of Depakote

A

Acute Bipolar mania
Maintenance bipolar
**1st line for mixed episode or rapid cycling

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15
Q

What is the MOA of Depakote?

A

Increases GABA

Inhibits Na+ channels and Glutamate release

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16
Q

What drugs doe Depakote interact with?

A

Carbamazepine –> decreases Depakote levels
Depakote –> ^ Carbamazepine levels
Depakote DOUBLES Lamotrigine levels
CYP inducers decrease Depakote levels

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17
Q

Depakote SE’s

A

VALPROATE

- Vomiting
- Alpecia
- Liver toxicity
- Pancytopenia
- Retention of weight
- Oedema
- Appetite^
- Tremor
- Enzyme induction

Also NTD’s in fetus

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18
Q

What drugs can be used to combat EPS?

A

Benzatropine (anticholinergic, ^Dop)
Diphenhydramine (anticholinergic)
Trihexyphenidyl (antimuscarinic)

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19
Q

What antipsychotics cause LFT elevations?

A

CHOQ full of LFT’s:

- Clozapine
- Haldol
- Olanzapine
- Quetiapine
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20
Q

What antipsychotics cause QT prolongation?

A

QT HORZ:

- Quetiapine
- Thioridazine
- Haldol
- Olanzapine
- Risperidone
- Ziprasidone

(Beginning and end cause the most)

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21
Q

SE’s of Ziprasidone

A

Cardiotoxicity (most QT prolongation)
Activating at low doses (raise dosage)
LEAST metabolic SE’s (use in obese/DM pts)

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22
Q

What SGA’s are available IM?

A

ROPA:

- Risperidone
- Olanzapine
- Palliperidone
- Abilify
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23
Q

What SGA’s are approved for Tx of bipolar?

A

Quetiapine
Lurasidone
Olanzapine
Abilify

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24
Q

MOA of Abilify

A

Partial agonist of D2 & 5-HT1a

Antagonist of 5-HT2a

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25
Q

MOA of most SGA’s

A 
D2 antagonist (positive symptoms)
5-HT2a antagonist (negative symptoms)
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26
Q

MOA of FGA’s

A

D2 antagonist

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27
Q

Abilify indications

A

Bipolar acute mania
MDD adjunct
Schizophrenia
Tourette’s

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28
Q

Switching between SGA’s

A

Washout period if switching to Abilify or could induce acute psychosis.

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29
Q

SE’s of Abilify

A

HA
Anxiety/Activation
Orthostatic hypotension
Vomiting/Diarrhea

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30
Q

Clozapine SE’s

A 
Agranulocytosis (weekly CBC's)
Weight gain & Hyperglycemia
Hypersalivation
Seizures
Anticholinergic

Lowest risk of EPS

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31
Q

Lurasidone SE’s

A

Lurasidone & Risperidone = highest risk of SGA’s for EPS

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32
Q

Olanzapine indications

A

Symbyax for Bipolar & Tx-resistant MDD
2nd line for schizophrenia
Acute agitated psychosis (sedating)

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33
Q

Olanzapine SE’s

A

Metabolic syndrome (2nd most)
Hepatotoxic (monitor LFT’s)
Anticholinergic
QT prolongation

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34
Q

Quetiapine indications

A

Psychosis
Bipolar
Preferred SGA in psychotic pt with Lewy Body dementia or Parkinson’s (no EPS)

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35
Q

Quetiapine SE’s

A 
Cataracts (slit lamp exam Q6mo)
Sedation
Orthostatic hypotension
QT prolongation
Some weight gain
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36
Q

Risperidone SE’s

A

EPS (most of SGA’s with Lurasidone)

Insomnia/Agitation

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37
Q

First psychotic episode treatment guidelines

A

SGA
Different SGA
FGA or Clozapine
Continue for 6mo-1y

If 2+ relapses in 5y –> continue indefinitely

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38
Q

What antipsychotic is used as an antiemetic?

A

Prochlorperazine

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39
Q

What SGA’s show the least metabolic syndrome?

A

Ziprasidone
Abilify
Lurasidone

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40
Q

Smoking & schizophrenia

A

75% smoke
Increases antipsychotic metabolism

Often pt will be discharged and become acutely psychotic, this is because they started smoking again.

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41
Q

What SGA should be taken with food?

A

Ziprasidone - can double bioavailability

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42
Q

What antipsychotic is sublingual?

A

Arsenapine

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43
Q

What tests should be done prior to starting Depakote?

A

LFT’s & CBC

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44
Q

Ideal Carbamazepine serum levels

A

4-12 ug/mL

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45
Q

Half life of Carbamazepine

A

Initial: 25-65h
Induced: 12-17h

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46
Q

MOA of Carbemazepine

A

Decreased Na+ channel function
Decreased Glutamate
Increased 5-HT

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47
Q

Indications for Carbemazepine

A

Acute & maintenance bipolar
Epilepsy
Trigeminal neuralgia

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48
Q

Carbamazepine SE’s

A

HAHA Carbamazepine

- Hyponatremia
- Ataxia/Sedation
- Hepatotoxicity
- Agranulocytosis/Aplastic anemia
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49
Q

What drug levels are affected by Carbamazepine?

A

CYP induction decreases:

- OCP's!!
- Benzodiazepines
- Clozapine, Olanzapine, Haldol
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50
Q

How is Oxcarbazepine different?

A

Less SE’s
No need to monitor CBC or LFT’s
Main SE is hyponatremia

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51
Q

Lamotrigine SE’s

A 
10% - benign rash
0.3% - SJS
Dizziness/Ataxia
Blurred vision
N/V
HA
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52
Q

Lamotrigine drug interactions

A

Must decrease Lamictal dose by 50% if Depakote on board

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53
Q

Lamotrigine indications

A

Bipolar DEPRESSION
Bipolar maintenance (especially if strong depressive picture)
Adjunct in MDD

54
Q

What is the MOA of Gabapentin?

A

Inhibits Ca2+ transmission –> increases GABA release

55
Q

What is Gabapentin used for?

A 
Inidcations:
	-Bipolar adjunct
	-Neuropathic pain
Off label:
	-Anxiety
	-Drug/EtOH craving
56
Q

Gabapentin SE’s

A

Sedation

Ataxia/Dizziness

57
Q

What are the uses of Topiramate?

A

EtOH abstinence
Bipolar (low efficacy)
Weight loss in psych patients

58
Q

Mood stabilizers in pregnancy

A

Lamotrigine
Gabapentin
Topiramate
(all grade C, others are D)

59
Q

What classes of drugs are used in anxiety?

A 
1st line - SSRI's/SNRI's
Buspirone
Benzos
Gabapentin
TCA's & MAOI's
60
Q

MOA of Benzodiazepines

A

Potentiates GABA at its receptor (ligand-gated Cl- channel)

61
Q

Indications for Benzodiazepines

A 
Anxiety disorders (GAD, Panic, Phobias)
Insomnia
EtOH withdrawal
Acute mania
Acute agitation
Catatonia
62
Q

Short/Med/Long acting Benzodiazepines

A 
Short:
	-Alprazolam (Xanax)
Intermediate:
	-Lorazepam (Ativan)
	-Chlordiazepoxide (Librium)
Long:
	-Diazepam (Valium)
	-Clonazepam (Klonepin)
63
Q

Benzodiazepine SE’s

A

Sedation, disinhibition, amnesia (drunkenness)
Respiratory depression
Tolerance & Dependence (taper slowly)
Pregnancy Category D

64
Q

Buspirone MOA

A

5-HT1 partial agonist

65
Q

Buspirone indication

A

GAD

66
Q

Buspirone SE’s

A

Anxiety
Dizziness
HA
Anger

67
Q

What drugs are used to treat ADHD?

A

Psychostimulants:
-Dextroamphetamine (Adderall)
-Methylphenidate (Ritalin, Focalin, Concerta)
Atomoxetine (Strattera)

68
Q

What is the MOA of psychostimulants for ADHD?

A

^DA & NE release

Decreased GABA in striatum

69
Q

What are psychostimulants used for?

A

ADHD
Stroke/TBI recovery
Obesity

70
Q

What are the contraindications to psychostimulant therapy?

A 
Marked anxiety
Seizures
Glaucoma
Hyperthyroidism
HTN
Active psychosis
71
Q

Psychostimulant SE’s

A 
Nervousness/Agitation
Insomnia
Anorexia
HA
Convulsions
Psychosis
Arrhythmia
Hyperpyrexia/Rhabdomyolysis
72
Q

What must be monitored with Naltrexone use?

Acamprosate?

A

Naltrexone - LFT’s

Acamprosate - Renal function

73
Q

MOA of Atomoxetine

A

Selective NE reuptake inhibitor

Used to treat ADHD

74
Q

What are the indications for Clonidine?

A

Adjunct in ADHD for sleep
2nd line ADHD when PS contraindicated
Opiate withdrawal

75
Q

MOA of Clonidine & Guanfacine

A

Post-synaptic Alpha2-agonist

Improves NE-mediated cognition in frontal lobe

Helps with hyperactivity of ADHD

76
Q

Alpha2-agonist SE’s

A

Hypotension
Sedation

Contraindicated in pts with cardiac Hx

77
Q

Where does 5-HT modulate mood in the brain?

A

Between Raphe nucleus & frontal cortex

78
Q

What Serotonin receptors modulate GI function?

A

5-HT3 & 5-HT4

79
Q

General SSRI SE’s

A 
GI upset
Sedation/Insomnia/Vivid dreams
Weight gain
Agitation/Anxiety if pt has comorbid anxiety
HA
Sexual dysfunction
Seizures (rare)
80
Q

What is the SSRI with the longest half life?

What is the half life?

A

Fluoxetine

Half life = 1 week

81
Q

What antidepressants are good for atypical depression?

A

Bupropion & Fluoxetine

Both are activating.

82
Q

What SSRI for pregnant pts?

A

Fluoxetine

83
Q

What is considered the safest SSRI to start with?

A

Sertraline

Best CV safety profile
Sedating

84
Q

Paroxetine (Paxil) SE’s

A

Sedation - good for anxious depression
Weight gain
Discontinuation syndrome when stopped (shortest half life)

85
Q

Citalopram SE’s

A

Sedating (H1 antagonism)
Doesn’t interact with much - good for elderly on many meds

Escitalopram is 2x more potent & less interactions

86
Q

Which SSRI has most interactions?

Least?

A

Fluvoxamine = most

Escitalopram = least

87
Q

Shortest half life of SSRI’s?

A

Fluvoxamine & Paroxetine

88
Q

What specific combination of SSRI & TCA is good for Tx-resistant OCD?

A

Fluvoxamine & Clomipramine

89
Q

Symptoms of serotonin syndrome

A

HARM:

- Hyperpyrexia
- Autonomic instability
- Rigidity
- Myoclonus
90
Q

Symptoms of antidepressant discontinuation syndrome

A

Lhermitte’s sign
Flu-like (n/v, HA, sweating)
Autonomic instability
Sleep disturbance

Must have been taking antidepressant for >4 weeks

91
Q

How long of a washout period between MAOI & SSRI?

A

2 weeks

Longer if switching from Fluoxetine

92
Q

What neurotransmitters are affected by Venlafaxine?

A

With increasing dosage:

Blocks 5-HT reuptake –> Blocks NE reuptake –> Blocks Dop reuptake

93
Q

What are the SNRI’s?

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq; metabolite of Venlafaxine)
Duloxetine (Cymbalta)

94
Q

What is Venlafaxine typically used for?

A

Anxiety & Depression comorbid
Perimenopausal hot flashes/night sweats
Neuropathic pain (Duloxetine moreso)

95
Q

Venlafaxine SE’s

A 
HTN
Sweating
n/v/d
Sedation
Sexual dysfunction
96
Q

What is Duloxetine typically used for?

A

Diabetic neuropathic pain
Painful symptoms of depression
Stress incontinence

97
Q

Duloxetine SE’s

A

Dry mouth
Sedation
Sweating
HTN (rare)

98
Q

Duloxetine contraindications

A

Hepatic insufficiency
ESRD
Cardiac problems
EtOH abuse

99
Q

What drug class is Bupropion?

A

NDRI

Norepinephrine-Dopamine Reuptake Inhibitor

100
Q

What is Bupropion typically used for?

A

Atypical depression
Depression adjunct to help with sexual dysfunction
ADHD
Smoking cessation

101
Q

Bupropion SE’s

A 
Lowers seizure threshold
Insomnia
CNS activation - can worsen anxiety
Tremor
HA
Constipation
Dry mouth
Nausea
102
Q

Contraindications for Bupropion

A

Anorexia/Bulemia
EtOH abuse/withdrawal
TBI
h/o seizure disorder

103
Q

What drug class is Mirtazapine (Remeron)?

A

NaSSa’s

Noradrenergic and Specific Serotonergic Antidepressants

104
Q

Mirtazapine SE’s

A

Sedation (low doses)
Activation (high doses)
^Appetite, weight gain

105
Q

What is Mirtazapine good for?

A

Depression with anxiety

Eating disorders

106
Q

What subpopulation shows the most weight gain on Mirtazapine?

A

Pre-menopausal women

107
Q

What are MAOI’s used for?

A

2nd line for Tx-resistant depression or anxiety

108
Q

MAOI side effects

A 
Orthostaic hypotension (a1)
Sedation & weight gain (H1)
MAOI diet (no soft cheeses, soy sauce, red wine)
109
Q

MOA of TCA’s

A

Block reuptake of 5-HT, NE, some DA

110
Q

TCA SE’s

A

Anticholinergic (dry mouth, blurred vision, urinary retention)
Antihistaminic (sedation, weight gain)
Anti-adrenergic (orthostatic hypotension)
Lethal in overdose

111
Q

What drug combinations (outside of psychotropics) can contribute to Serotonin Syndrome?

A

Tramadol & Linezolid

112
Q

Treatment for Serotonin Syndrome

A

Stop the drug

+/- Cyproheptadine (5-HT antagonist)

113
Q

What non-antidepressants can be added to treat resistant MDD?

A

Antipsychotics
Lithium
Estrogen
T4

114
Q

How long to continue antidepressant after depressive episode?

A

1st episode - 1 year
2nd episode - 5 years
3+ episodes - indefinitely

115
Q

Tx for adjustment disorder

A

Brief psychotherapy

116
Q

Anorexia treatment

A

CBT

Olanzapine if refractory

117
Q

Treatment for Bulemia & Binge Eating Disorder

A

CBT

SSRI if refractory

118
Q

Trichotillomania treatment

A

Habit reversal training

a type of CBT

119
Q

Treatment for NMS

A

Dantrolene
Amantadine
Bromocriptine

120
Q

When do Autism-spectrum disorders present?

A

2nd year of life

121
Q

Treatment of acute mania

A

Antipsychotics +/- mood stabilizers +/- benzos (if agitated)

122
Q

What effects on the fetus are seen with Lithium?

A

1st trimester - Ebstein’s anomoly (atrialization of the RV)

2nd & 3rd - Goiter & transient neuromuscular dysfunction

123
Q

Clozapine absolute contraindication

A

ANC < 1,000

WBC < 3,500

124
Q

Risperidone Indications

A

Acute & maintenance psychosis - preferred in demented pts
Acute mania or mixed episodes
Irritability in autism spectrum disorder

125
Q

What is the pattern of CBC’s for Clozapine?

A

Weekly for 6 months, then
Biweekly for 6 months, then
Monthly forever

126
Q

Treatment for NMS

A

1) Stop antipsychotic
2) Supportive (IVF, anti-pyretic)
3) No consensus:
- Dantrolene
- Bromocriptine (D2 agonist)
- Amandatine (^Dop)
- Ativan
- ECT

127
Q

What is the clinical course in most schizophrenics?

A

Chronic course > Intermittent course > Single episode

128
Q

What is lifetime prevalence of schizophrenia?

Males vs. Females?

A

1%

Males = Females

129
Q

Rate of suicide attempts in schizophrenia

Completed suicides

A

Attempts = 40%

Completed = 10%

130
Q

Risk factors for suicide in schizophrenics

A

Young, male, higher functioning
Good insight
Most risky time is right after discharge from hospital

131
Q

Poor prognostic factors in schizophrenia

A 
Poor initial response to meds (strongest predictor)
Extensive prodrome
Family history
Early onset
Male
Negative symptoms
132
Q

Life expectancy in schizophrenia

Causes

A

50y

Causes: CVD, cigarettes use, suicide

133
Q

Risk of schizophrenia:

- General population
- Parent or sibling has it
- Both parents
- Identical twins
A
  • General population = 1%
    • Parent or sibling has it = 10%
    • Both parents = 40%
    • Identical twins = 50%

Psych Clerkship (2 decks)

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