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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
MOA of MOAI drugs
inhibits MOAs that breakdown cytoplasmic catecholamines in presynaptic terminal - decrease 5-HT (serotonin) metabolism - increase presynaptic concentration of 5-HT
26
Why are MOAIs rarely used?
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
27
2 types of MOA proteins inhibited by MOAIs?
A: serotonin and norepinepherine B: phenylethylamine
28
Trade name of Bupropion
Wellbutrin
29
Bupropion MOA
weakly inhibits reuptake of dopamine and NE, may promote release of dopamine and NE
30
Antidepressant that can be used for smoking cessation and obesity
Bupropion (Wellbutrin)
31
How are Bupropion ADRs different than other antidepressants?
fewer ADRs for sexual dysfunction or withdrawal symptoms (can stop abruptly) still has suicide risk, tachycardia, weight loss, GI, CNS, cardio...
32
Antidepressant that may be used to treat insomnia
Trazodone
33
Indication of low dose benzodiazepines
anti-anxiey
34
Meds in Benzodiazepine class?
Diazepam (Valium), Lorazepam (Ativan), Midazolam (Versed)
35
What are best uses of diazepam and lorazepam? Why?
diazepam has long half-life (15-20 hrs) so best for anxiety | lorazepam shorter half-life so better for insomnia
36
ADRs of benzodiazepines
respiratory/cardiovascular depression in patient with cardiopulmonary disease (e.g. asthma) CNS depression (sedation, drowsiness), tolerance, dependance
37
New Benzodiazepine used for acute sedation for procedures
Midazolam (Versed)
38
DIs of Benzodiazepine
CNS depressants like alcohol
39
MOA of Benzodiazepines
Enhances GABA-dependenet Cl- channels -> hyperpolarize cell -> inhibit neuron excitability
40
Generic name of Ambien
Zolpidem
41
Indication of Zolpidem (Ambien)
Acute insomnia
42
Range of indications of diazepam
anxiety, panic attacks, alcohol withdrawal, seizures (acute), muscle relaxant, sedation
43
How do benzo and barbiturates differ in effect on GABA?
Barbs increase efficacy of GABA (duration Cl- channel open) Benzos increase potency of GABA (number of Cl- channels open)
44
In general anti-psychotics are used for ________.
Schizophrenia (hallucinations, delusions)
45
Main ADRs of anti-psychotics
Extra pyramidal side effects (like Torticollis), weight gain, increased prolactin, sedation
46
MOA of anti-psychotics
block dopaminergic receptors
47
Most widely prescribed anti-psychotic drug
Risperidone
48
Indications for lithium
- Mood stabilizing | - Mainly bipolar disorder (mania and maintenance)
49
MOA of lithium
alters Na transport in nerve and muscle cells and results in a shift toward intraneuronal metabolism of catecholamines (INCREASE SEROTONIN RELEASE)
50
Lithium ADRs
acne, hypothyroid, weight gain, nausea, tremor, hyperreflexia
51
signs of possible lithium toxicity
polyuria, increased thirst, ataxia, blurred vision, tinnitus
52
How to treat insomnia?
Zolpidem (Ambien) others lorazepam, trazodone
53
MOA of Ambien
hypnotic agent that binds to benzodiazepine receptor in brain to increase GABA
54
Main concern of Ambien duration
serum levels stay high after awakening the next morning driving, low reaction time, etc.
55
ADRs of Ambien
GI upset, CNS irritation (dizziness, "drug state", HA), fatigue serious: complex mannerisms, chest pain, hypersensitivity
56
Buspirone indications
anxiety, depression
57
Buspirone MOA
full 5-HT agonist, partial dopamine agonist
58
Which meds have risk of hypertensive crisis with MAOIs?
SNRI, Buspirone, ADHD meds
59
Trade names of Methylphenidate
Ritalin, Concerta
60
Trade names of Dextroamphetamine
Adderall
61
Methylphenidate MOA
inhibits reuptake of NE and dopamine
62
What should be monitored on ADHD drugs?
BP, ECG, weight periodically
63
Amphetamine MOA
- inhibits reuptake of NE and dopamine - stimulates NE, DA, 5HT release - may agonize central 5HT receptors
64
amphetamine DI
phenothiazines (risk for psychosis), risk of hypertensive crisis, antihypertensives
65
How does amphetamine compare to methylphenidate?
- Amphetamine has less peripheral activity and more ADRs | - Same DIs: risk of hypertensive crisis and antihypertensives
66
Difference between Ritalin and Concerta
both Methylphenidates but Ritalin duration 2-4 hrs and Concerta 32 hrs
67
2 drug types that treat ADHD
methylphenidates | amphetamines
68
General psychostimulant ADRs
weight loss, sleep disturbances, suicidal ideation, depression, insomnia, anxiety, aggression
69
Black box warning of Methylphenidate
drug dependance and abuse
70
SNRIs are better than SSRIs at treating _________.
General Anxiety Disorder

Behavioral Health Module (14 decks)

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