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Pharm Flashcards

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1
Q

Tx for EPS (from 1st gen anti-psychotics)

A

Anti-parkinsonian agents (benztropine, diphenhydramine, etc), benzodiazepines, beta-blockers (esp. indicated for akathiasia)

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2
Q

Tx for anticholinergic symptoms (from low-potency trad antipsychotics and atypical antipsychotics)

A

as per symptom (eyedrops, stool softeners, etc)

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3
Q

Tx for tardive dyskinesia (from high-potency antipsychotics)

A

discontinue or reduce offending agent and consider using another atypical neuroleptic
- use benzodiazepines, beta-blockers, cholinomimetics in short-term
-

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4
Q

What is neuroleptic malignant syndrome?

A

Change in mental status, autonomic changes (high fever, elevated BP, tachy), “lead pipe” rigidity, sweating, elevated CPK, leukocytosis, metabolic acidosis
- prompt withdrawal of all antipsychotic medications

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5
Q

High potency vs. low-potency neuroleptic side effects

A

High potency = EPS

Low potency = anticholinergic s/es

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6
Q

What heart medication can exacerbate psychosis in predisposed pts?

A

beta-blockers and digoxin

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7
Q

side effect of thioridazine? (2)

A
  • significant QT prolongation

- irreversible retinal pigmentation at high doses

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8
Q

What is serotonin syndrome?

A

autonomic instability, hyperthermia, seizures

  • coma or death may result
  • from using MAOIs with SSRIs
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9
Q

Which antidepressant is the most lethal in overdose?

A

TCAs

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10
Q

What should one be careful for when using MAOIs?

A 
Hypertensive crisis (when used w/ sympathomimetics or ingestion of tyramine-rich foods) 
- ex. wine, beer, aged cheese, liver, smoked meats
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11
Q

Which patients are specifically unable to tolerate side effects of antidepressants?

A

elderly and pregnant women

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12
Q

What can be used to convert nonresponders (of anti-depressants) to responders ?

A

T3 (Liothyronine), T4 (Levothyroxine), lithium, L-tryptophan (serotonin precursor)

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13
Q

What are MAOIs useful for?

A

Tx of “atypical” depression or refractory depression

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14
Q

What are anticonvulsants useful for? (carbamazepine or valproic acid)

A

rapid cycling BP disorder and mixed episodes

- but associated w/ increased risk of suicide

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15
Q

Why are antidepressants discouraged as monotherapy for BP disorder?

A

b/c of concerns of activating mania or hypomania

- addition of antidepressants as adjunctive tx to mood stabilizers not shown to be effective

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16
Q

What should be given to pt w/ history of postpartum mania for subsequent pregnancies?

A

antidepressants and lithium as prophylaxis

- but these are relative contraindications to breast-feeding

17
Q

What can be given for symptomatic treatment of delirium (psychomotor agitation) while etiologic causes are treated?

A

Low-dose haloperidol (antipsychotic)

18
Q

Which drug should you avoid using in delirious pts?

A

Benzodiazepines (will exacerbate the delirium)

19
Q

When can you give benzodiazepine in delirious pts?

A

If delirium is secondary to alcohol or benzo w/d

20
Q

What can be given for treatment of REM sleep behavior disorder?

A

Clonazepam (Klonopin)

21
Q

What SSRIs are preferred in long-term treatment of panic disorder?

A

Paroxetine and sertraline

22
Q

What can be used for treatment of social anxiety disorder?

A

Paroxetine (Paxil) - SSRI

23
Q

1st line therapy for OCD?

A

SSRIs; or TCAs (clomipramine)

24
Q

What pharm therapies can be used for PTSD?

A

Antidepressants

Anticonvulsants (for flashbacks and nightmares)

25
Q

What is 1st line pharm tx for GAD?

A

SNRI (venlafaxine)

26
Q

Why should benzodiazepines (clonazepam, diazepam) be avoided in pts w/ PTSD?

A

b/c of high rate of substance abuse in these pts (and benzos have high risk of tolerance and dependence)

27
Q

What atypical antidepressant is used often in elderly? and why? (2)

A

Mirtazapine = b/c it can increase appetite and is also sedating

28
Q

What side effects of antidepressants are elderly most sensitive to?

A

anti-cholinergics

29
Q

What side effects of sedative-hypnotic drugs are more likely in elderly? (4)

A
  • memory impairment
  • ataxia
  • paradoxical excitement
  • rebound insomnia
30
Q

If sedative-hypnotics must be prescribed to elderly, what medication should be given? (2)

A

Hydroxyzine (Vistaril) or trazodone

- these are safer than the more sedating benzodiazepines

Psych (17 decks)

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