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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
SNRI DI?
CYP450 inhibitor AD duplication MAOIs
25
Antidepressant - trycyclic?
amitriptyline
26
Amitriptyline MOA?
inhibits reuptake of serotonin and norepinephrine anticholinergic - not first line DO NOT STOP ABRUPTLY
27
Amitriptyline - ADR?
``` suicidality wt gain SEDATION ANTICHOLINERGIC EFFECTS: ORTHOSTASIS, SEXUAL DSYFXN CARDIAC ARGANULOCYTOSIS SEIZURES ```
28
Amitriptyline DI?
CYP450 subtrate | ADR duplication
29
Amitriptyline - avoid population?
urinary retention issue
31
MAOI MOA?
increases serotonin | half life is 2 wks
32
MAOI - ADR?
``` suicide CNS dry mouth wt gain orthostasis sexual dysfxn HTN CRISIS ```
32
Antidepressent SARI, sedative?
Trazadone
33
MAOI - DI?
MANY foods- thyromine (avacado, bananas, etc) ADR duplication serotonin syndrome
34
Trazadone?
5HT antagonist: works against increased serotonin effect (blocks signaling) used more for insomnia than depression
35
Trazadone - labs?
monitor LFT
36
Trazodone ADR?
``` suicidality ANTICHOLINERGIC EFFECTS (orthostasis) SEDATION GI upset CNS irritation BACKACHE LIVER FAILURE cardiac hypersensitivity PRIAPISM serotonin syndrome erections for hours - painful ```
37
Trazodone DI?
CYP 450 substrate | ADR duplication
38
Bupropion?
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
Bupriopion - population?
obese
40
Bupropion ADR?
``` sucidality cardiac WT LOSS GI upset CNS irritation COLITIS PANCREATITIS HEPATOXICITY PANCYTOPENIA SEIZURES hypersensitivity ```
41
Bupropion DI?
CYP 450 substrate | ADR duplication
42
Benzodiazepine?
Diazepam Lorazepam Midazolam
43
Diazepam?
``` enchances GABA dependent Cl conductionn --> hyperpolaizes the ell long acting (15-20hrs) anxiety ad insomnia ```
44
Lorazepam?
enhances GABA dependent Cl conduction --> hyperpolarizes the cell 12-14 hrs anxiety and insomina
45
Midazolam?
enhances GABA dependent Cl conduction --> hyperpolarizes cell 2-5 hrs
46
How does Dizepam, Lorazepam, and Midazolam reversed?
Flumazenil
47
Diazepam, Lorazepam, and Midazolam ADR?
CNS depression - sedation, drowsiness tolerance dependence cardiopulmonary dz pts: respiratory/cardio depression
48
Diazepam, Lorazepam, Midazolam DI?
CYP 450 substrate | CNS depressants - ETOH
49
Barbiturates?
depressant has a lot of bad side effects - benzodiazepine has better side effects elderly: death rate is high
50
Zolpidem?
hypnotic agent | INSOMNIA for SHORT TERM
51
Zolpidem ADR?
``` daytime drowsness (esp in the morning) GI upset CNS irritation fatigue COMPLEX MANNERISM suicidality CHEST PAIN TACHYCARDIA hypersensitivity HEPATIC ENCEPHALOPATHY ```
52
Antipsychotic side effects?
wt gain increase prolactin sedation
53
Lithium?
antipsychotic | helps w/ manic and depression
54
Lithium - ADR?
``` narrow therapeutic window a lot of side effects acne hypothyroidism wt gain nasuea - improves w/ time hypersensitivity pseudo tumor cerbri ```
55
Buspirone?
anti anxiety FULL 5HT agonist partial agonist NO effect on GABA binding
56
Buspirone ADR?
GI upset CNS irritation CARDIAC
57
Buspirone DI?
CYP450 substrate | risk of HTN crisis
58
ADHD?
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
Methylphenidate?
inhibits reuptake of norepinpherine annd dopamine peripheral effects are LESS than amphetamines can be discontinued abruptly long acting
60
Methylphenidate and Dextroamphetamine/amphetamine labs?
BP and ECG | wt check
61
Dextramphetamine/emphetamine?
``` 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
Dextroamphetamine/amphetamine ADR?
``` Gi upset wt loss CARDIAC - HTN AND TACHYCARDIA CNS irritation sudden death can occur ```
63
Dextroamphetamine/amphetamine DI?
phenothiazine (risk for psychosis) HTN crisis antihypertensives
64
Methyphenidate DI?
HTN crisis | antihypertensives
65
Methylphenidate ADR?
``` GI upset wt loss sleep disturbances behavioral motor tics HTN TACHYCARDIA DRUG DEPENDANCE/ABUSE ```
66
Can you stop ADHD meds abruptly?
not recommened but you can - esp if pts are not in school (weekends, vacations, etc)
68
Which ADHD has a black box warning?
methylphenidate

Behavioral Med (17 decks)

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