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Behavioral Med > Pharm > Flashcards

Pharm Flashcards

0
Q

Norepinephrine?

A

alterness
concentraiton
energy

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1
Q

Cause of depression?

A

unknown

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2
Q

Serotonin?

A

obession
complusion
memory
muscle constrictor

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3
Q

Dopamine?

A

reward

motivation

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4
Q

Tryptophan?

A

precursor for serotonin

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5
Q

Serotonin in the body?

A

10% in the CNS

90% in the gut - excess taken up by platelets –> vasoconstrictor

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6
Q

Not enough serotonin? (gut)

A

constipation
mood is not regulated
appetite is decreased
sleep is disrupted

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7
Q

Serotonin sickness?

A

like the flu + diarrhea + vomiting

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8
Q

Serotonin metabolized?

A

liver and kidney

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9
Q

How to select antidepressant?

A

PMH
FH
drug characteristics
costs

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10
Q

Timeline of depression?

A

relapses and remitting can occur

or may need the drugs forever and sx will never go away

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11
Q

Effectiveness of therapy?

A

takes time for drugs to kick in
50-60% of response rate
success is related to tolerance of ADR and effectiveness and tx resistance

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12
Q

General info for pts taking antidepressants?

A

do not just stop taking meds- take the whole therapy
there is a 2-3wk lag before drugs start working
early side effects of drugs will go away
sexual dysfxn (female and male)
young pts: mood may worsen and increase suicidality (b/c they gain energy instead of feeling tired all the time)

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13
Q

Antidepressant doses?

A

TITRATE!!

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14
Q

Antidepressant - drug withdrawal?

A

care when switching antidepressants (cross tapering)
may cx seizures
TAPER by 25% over 2-4wks

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15
Q

What are the SSRI antidepressants?

A

fluoxetine
sertraline
escitalopram

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16
Q

SSRI antidepressant?

A

inhibit reuptake of serotonin (primarily)
SSRI are most common drugs used for depression
DO NOT STOP ABRUPTLY

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17
Q

Which works better for anxiety?

A

SNRI&raquo_space; SSRI

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18
Q

SSRI ADR?

A 
suicidality
GI upset
CNS irritation
sexual dysfxn
wt gain
prolonged QT
hypersensitivity
bleeding
serotonin syndrome 
can be TIRED or WIRED (like benadryl)
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19
Q

Resolving ADR for SSRI?

A

drug holiday

giving viagra, etc - helps w/ erectile dsyfxn not libido

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20
Q

SSRI DI?

A

CYP 450 inhibitor
ADR duplication
protein bound drugs

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21
Q

What are the antidepressants SNRI?

A

duloxetine

venlafaxine

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22
Q

SNRI MOA?

A

inhibit reuptake of serotonin and norepinephrine
works effectively w/ GAD than SSRI
DO NOT STOP ABRUPTLY

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23
Q

SNRI ADR?

A 
suicidality
GI upset
CNS irritation
sexual dysfxn
wt gain
hypersensitivity
bleeding
serotonin sydnrome
DIAPHROESIS
HTN CRISIS
MI
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24
Q

SNRI DI?

A

CYP450 inhibitor
AD duplication
MAOIs

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25
Q

Antidepressant - trycyclic?

A

amitriptyline

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26
Q

Amitriptyline MOA?

A

inhibits reuptake of serotonin and norepinephrine
anticholinergic - not first line
DO NOT STOP ABRUPTLY

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27
Q

Amitriptyline - ADR?

A 
suicidality
wt gain
SEDATION
ANTICHOLINERGIC EFFECTS: ORTHOSTASIS, SEXUAL DSYFXN
CARDIAC
ARGANULOCYTOSIS
SEIZURES
28
Q

Amitriptyline DI?

A

CYP450 subtrate

ADR duplication

29
Q

Amitriptyline - avoid population?

A

urinary retention issue

31
Q

MAOI MOA?

A

increases serotonin

half life is 2 wks

32
Q

MAOI - ADR?

A 
suicide CNS
dry mouth
wt gain
orthostasis
sexual dysfxn 
HTN CRISIS
32
Q

Antidepressent SARI, sedative?

A

Trazadone

33
Q

MAOI - DI?

A

MANY foods- thyromine (avacado, bananas, etc)
ADR duplication
serotonin syndrome

34
Q

Trazadone?

A

5HT antagonist: works against increased serotonin effect (blocks signaling)
used more for insomnia than depression

35
Q

Trazadone - labs?

A

monitor LFT

36
Q

Trazodone ADR?

A 
suicidality
ANTICHOLINERGIC EFFECTS (orthostasis)
SEDATION
GI upset 
CNS irritation 
BACKACHE
LIVER FAILURE
cardiac
hypersensitivity
PRIAPISM
serotonin syndrome
erections for hours - painful
37
Q

Trazodone DI?

A

CYP 450 substrate

ADR duplication

38
Q

Bupropion?

A

antidepressant
weakly inhibits reuptake of DOPAMINE and norepinephrine
may promote release of DOPAMINE an norepinephrine
NOT likely to cx sexual dysfxn
NOT likely to cx withdrawal sx w/ abrupt stop of meds

39
Q

Bupriopion - population?

A

obese

40
Q

Bupropion ADR?

A 
sucidality
cardiac
WT LOSS
GI upset
CNS irritation
COLITIS
PANCREATITIS
HEPATOXICITY
PANCYTOPENIA
SEIZURES
hypersensitivity
41
Q

Bupropion DI?

A

CYP 450 substrate

ADR duplication

42
Q

Benzodiazepine?

A

Diazepam
Lorazepam
Midazolam

43
Q

Diazepam?

A 
enchances GABA dependent Cl conductionn --> hyperpolaizes the ell
long acting (15-20hrs)
anxiety ad insomnia
44
Q

Lorazepam?

A

enhances GABA dependent Cl conduction –> hyperpolarizes the cell
12-14 hrs
anxiety and insomina

45
Q

Midazolam?

A

enhances GABA dependent Cl conduction –> hyperpolarizes cell
2-5 hrs

46
Q

How does Dizepam, Lorazepam, and Midazolam reversed?

A

Flumazenil

47
Q

Diazepam, Lorazepam, and Midazolam ADR?

A

CNS depression - sedation, drowsiness
tolerance
dependence
cardiopulmonary dz pts: respiratory/cardio depression

48
Q

Diazepam, Lorazepam, Midazolam DI?

A

CYP 450 substrate

CNS depressants - ETOH

49
Q

Barbiturates?

A

depressant
has a lot of bad side effects - benzodiazepine has better side effects
elderly: death rate is high

50
Q

Zolpidem?

A

hypnotic agent

INSOMNIA for SHORT TERM

51
Q

Zolpidem ADR?

A 
daytime drowsness (esp in the morning)
GI upset
CNS irritation
fatigue
COMPLEX MANNERISM
suicidality
CHEST PAIN
TACHYCARDIA
hypersensitivity
HEPATIC ENCEPHALOPATHY
52
Q

Antipsychotic side effects?

A

wt gain
increase prolactin
sedation

53
Q

Lithium?

A

antipsychotic

helps w/ manic and depression

54
Q

Lithium - ADR?

A 
narrow therapeutic window
a lot of side effects
acne
hypothyroidism
wt gain
nasuea - improves w/ time
hypersensitivity 
pseudo tumor cerbri
55
Q

Buspirone?

A

anti anxiety
FULL 5HT agonist
partial agonist
NO effect on GABA binding

56
Q

Buspirone ADR?

A

GI upset
CNS irritation
CARDIAC

57
Q

Buspirone DI?

A

CYP450 substrate

risk of HTN crisis

58
Q

ADHD?

A

over dx’d in children
Methylphenidate
dextroamphetamine/amphetamine
takes about a semester for drugs to kick in but SHOULD see SOME improvement w/in a month - titrate!

59
Q

Methylphenidate?

A

inhibits reuptake of norepinpherine annd dopamine
peripheral effects are LESS than amphetamines
can be discontinued abruptly
long acting

60
Q

Methylphenidate and Dextroamphetamine/amphetamine labs?

A

BP and ECG

wt check

61
Q

Dextramphetamine/emphetamine?

A 
inhibits reuptake of norepinephrine ad dopamine
STIMULATE RELEASE OF NE, DA, 5HT
AGONIZE CENTRAL 5HT RECEPTORS
LESS peripheral activity but MORE POTENT
MORE ADRs 
short acting
62
Q

Dextroamphetamine/amphetamine ADR?

A 
Gi upset
wt loss
CARDIAC - HTN AND TACHYCARDIA
CNS irritation 
sudden death can occur
63
Q

Dextroamphetamine/amphetamine DI?

A

phenothiazine (risk for psychosis)
HTN crisis
antihypertensives

64
Q

Methyphenidate DI?

A

HTN crisis

antihypertensives

65
Q

Methylphenidate ADR?

A 
GI upset
wt loss
sleep disturbances
behavioral
motor tics
HTN
TACHYCARDIA
DRUG DEPENDANCE/ABUSE
66
Q

Can you stop ADHD meds abruptly?

A

not recommened but you can - esp if pts are not in school (weekends, vacations, etc)

68
Q

Which ADHD has a black box warning?

A

methylphenidate

Behavioral Med (17 decks)

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