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Behavioral Health Module > Pharm > Flashcards

Pharm Flashcards

1
Q

What are common SSRI’s?

A

Fluoxetine (Prozac), Sertraline (Zoloft), escitalopram (Lexapro)

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2
Q

What are indications for SSRIs?

A

depression, anxiety, and many more

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3
Q

What drug classes are used to treat depression and anxiety?

A

SSRI (most common), SNRI, Tricyclic, SARI

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4
Q

ADRs of SSRI

A

suicidal thoughts, GI upset, CNS irritation, sexual dysfunction, weight gain, prolonged QT, serotonin syndrome

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5
Q

DIs of SSRI

A

CYP450 inhibitor, protein bound drugs

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6
Q

MOA of SSRI

A

inhibit reuptake of serotonin

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7
Q

MOA of SNRI

A

inhibit reuptake of serotonin and norepinephrine

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8
Q

ADR of SNRI

A

same as SSRIs except MI and hypertensive crisis instead of QT prolongation

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9
Q

What are two common SNRI drugs (generic and drug names)?

A

Duloxetine (Cymbalta), Venlafaxine (Effexor)

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10
Q

What are symptoms of serotonin syndrome?

A

Occurs within several hours of taking new drug or increasing dose

Agitation/restlessness, confusion, rapid HR, high BP, dilated pupils, twitching, muscle rigidity, sweating, diarrhea

Severe, life-threatening sx’s: high fever, seizures, irregular heartbeat, LOC

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11
Q

DI of SNRI

A

CYP450 inhibitor, MAOIs (causes hypertensive crisis)

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12
Q

What drugs common in depression treatment can cause hypertensive crisis?

A

SNRIs

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13
Q

MOA of amitriptyline

A

inhibits repute of serotonin and NE; also an anticholinergic

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14
Q

Drug class of amitriptyline

A

Tricyclic

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15
Q

How should antidepressants be d/c’d?

A
  • taper by 25% over 2-4 wks

- cross taper if switching antidepressants

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16
Q

ADR of TCAs

A

anticholinergic effects, suicide, weight gain, sedation, cardiac, agranulocytosis, seizures

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17
Q

Which anti-depression drug class has anticholinergic effects?

A

Tricyclics

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18
Q

Which anti-depressant also used for neuropathic pain, HA, GI upset?

A

amitriptyline

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19
Q

Black box warning of all anti-depressants

A

suicide

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20
Q

3 monoamine neurotransmitters involved in behavioral medicine and what emotions they control?

A

serotonin = obsession, compulsion, memory

NE = alertness, concentration, energy

dopamine = reward, motivation

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21
Q

Pathway of serotonin synthesis

A

L-tryptophan -> 5-hydroxy-L-tryptophan -> 5-HT (serotonin)

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22
Q

Where is serotonin go in body?

A

10% to CNS - mood, appetite, sleep
90% to gut - intestinal movement

metabolized in liver and excreted in kidneys

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23
Q

How long does it take for a anti-depressant to take effect?

A

4-6 weeks

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24
Q

Example of SARI antidepressant

A

Trazodone

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25
Q

MOA of MOAI drugs

A

inhibits MOAs that breakdown cytoplasmic catecholamines in presynaptic terminal

  • decrease 5-HT (serotonin) metabolism
  • increase presynaptic concentration of 5-HT
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26
Q

Why are MOAIs rarely used?

A

Many ADR and DIs

ADRs: suicide, CNS, dry mouth, weight gain, orthostasis, sexual dysfunction

DIs: MANY foods (cheese, tap beer, raspberries, avocados, bananas), ADR duplication, serotonin syndrome risk

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27
Q

2 types of MOA proteins inhibited by MOAIs?

A

A: serotonin and norepinepherine
B: phenylethylamine

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28
Q

Trade name of Bupropion

A

Wellbutrin

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29
Q

Bupropion MOA

A

weakly inhibits reuptake of dopamine and NE, may promote release of dopamine and NE

30
Q

Antidepressant that can be used for smoking cessation and obesity

A

Bupropion (Wellbutrin)

31
Q

How are Bupropion ADRs different than other antidepressants?

A

fewer ADRs for sexual dysfunction or withdrawal symptoms (can stop abruptly)

still has suicide risk, tachycardia, weight loss, GI, CNS, cardio…

32
Q

Antidepressant that may be used to treat insomnia

A

Trazodone

33
Q

Indication of low dose benzodiazepines

A

anti-anxiey

34
Q

Meds in Benzodiazepine class?

A

Diazepam (Valium), Lorazepam (Ativan), Midazolam (Versed)

35
Q

What are best uses of diazepam and lorazepam? Why?

A

diazepam has long half-life (15-20 hrs) so best for anxiety

lorazepam shorter half-life so better for insomnia

36
Q

ADRs of benzodiazepines

A

respiratory/cardiovascular depression in patient with cardiopulmonary disease (e.g. asthma)

CNS depression (sedation, drowsiness), tolerance, dependance

37
Q

New Benzodiazepine used for acute sedation for procedures

A

Midazolam (Versed)

38
Q

DIs of Benzodiazepine

A

CNS depressants like alcohol

39
Q

MOA of Benzodiazepines

A

Enhances GABA-dependenet Cl- channels -> hyperpolarize cell -> inhibit neuron excitability

40
Q

Generic name of Ambien

A

Zolpidem

41
Q

Indication of Zolpidem (Ambien)

A

Acute insomnia

42
Q

Range of indications of diazepam

A

anxiety, panic attacks, alcohol withdrawal, seizures (acute), muscle relaxant, sedation

43
Q

How do benzo and barbiturates differ in effect on GABA?

A

Barbs increase efficacy of GABA (duration Cl- channel open)

Benzos increase potency of GABA (number of Cl- channels open)

44
Q

In general anti-psychotics are used for ________.

A

Schizophrenia (hallucinations, delusions)

45
Q

Main ADRs of anti-psychotics

A

Extra pyramidal side effects (like Torticollis), weight gain, increased prolactin, sedation

46
Q

MOA of anti-psychotics

A

block dopaminergic receptors

47
Q

Most widely prescribed anti-psychotic drug

A

Risperidone

48
Q

Indications for lithium

A
  • Mood stabilizing

- Mainly bipolar disorder (mania and maintenance)

49
Q

MOA of lithium

A

alters Na transport in nerve and muscle cells and results in a shift toward intraneuronal metabolism of catecholamines (INCREASE SEROTONIN RELEASE)

50
Q

Lithium ADRs

A

acne, hypothyroid, weight gain, nausea, tremor, hyperreflexia

51
Q

signs of possible lithium toxicity

A

polyuria, increased thirst, ataxia, blurred vision, tinnitus

52
Q

How to treat insomnia?

A

Zolpidem (Ambien)

others lorazepam, trazodone

53
Q

MOA of Ambien

A

hypnotic agent that binds to benzodiazepine receptor in brain to increase GABA

54
Q

Main concern of Ambien duration

A

serum levels stay high after awakening the next morning

driving, low reaction time, etc.

55
Q

ADRs of Ambien

A

GI upset, CNS irritation (dizziness, “drug state”, HA), fatigue

serious: complex mannerisms, chest pain, hypersensitivity

56
Q

Buspirone indications

A

anxiety, depression

57
Q

Buspirone MOA

A

full 5-HT agonist, partial dopamine agonist

58
Q

Which meds have risk of hypertensive crisis with MAOIs?

A

SNRI, Buspirone, ADHD meds

59
Q

Trade names of Methylphenidate

A

Ritalin, Concerta

60
Q

Trade names of Dextroamphetamine

A

Adderall

61
Q

Methylphenidate MOA

A

inhibits reuptake of NE and dopamine

62
Q

What should be monitored on ADHD drugs?

A

BP, ECG, weight periodically

63
Q

Amphetamine MOA

A
  • inhibits reuptake of NE and dopamine
  • stimulates NE, DA, 5HT release
  • may agonize central 5HT receptors
64
Q

amphetamine DI

A

phenothiazines (risk for psychosis), risk of hypertensive crisis, antihypertensives

65
Q

How does amphetamine compare to methylphenidate?

A
  • Amphetamine has less peripheral activity and more ADRs

- Same DIs: risk of hypertensive crisis and antihypertensives

66
Q

Difference between Ritalin and Concerta

A

both Methylphenidates but Ritalin duration 2-4 hrs and Concerta 32 hrs

67
Q

2 drug types that treat ADHD

A

methylphenidates

amphetamines

68
Q

General psychostimulant ADRs

A

weight loss, sleep disturbances, suicidal ideation, depression, insomnia, anxiety, aggression

69
Q

Black box warning of Methylphenidate

A

drug dependance and abuse

70
Q

SNRIs are better than SSRIs at treating _________.

A

General Anxiety Disorder

Behavioral Health Module (14 decks)

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