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Pharm Flashcards

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1
Q

Phenelzine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A

brand name: (Nardil)

type/mech: MAO Inhibitor –> less metabolism of 5HT, NE, DA

  • advantages/uses: depression
  • disadvantages/side effects: serotonin syndrome, hypertensive crisis w/ tyramines
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2
Q

Tranylcypromine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A

brand name: (Parnate)

type/mech: MAO Inhibitor –> less metabolism of 5HT, NE, DA

  • advantages/uses: amphetamine-like properties
  • disadvantages/side effects: serotonin syndrome, hypertensive crisis w/ tyramines
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3
Q

Isocarboxazid

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A

brand name: (Marplan)

type/mech: MAO Inhibitor –> less metabolism of 5HT, NE, DA

  • advantages/uses: depression
  • disadvantages/side effects: serotonin syndrome, hypertensive crisis w/ tyramines
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4
Q

Selegiline

  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A

type/mech: MAO-B Inhibitor –> less metabolism of 5HT, NE, DA

  • advantages/uses: parkinsons, transdermal available
  • disadvantages/side effects: serotonin syndrome, hypertensive crisis w/ tyramines
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5
Q

What are common and dangerous side effects of MAO Inhibitors?

A

common: GI distress, orthostasis hypotension, sleep disturbance, dry mouth, headache
dangerous: serotonin syndrome (flushing, diaphoresis, myoclonic jerks) and hypertensive crisis (w/ tyramine)

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6
Q

Nortriptyline

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: pamelor
  • drug type / mech of action: TCA, inhibits 5HT and NE reuptake
  • advantages/uses: least likely to cause orthostasis
  • disadvantages/side effects: lots of side effects, lethal in overdose
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7
Q

Desipramine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: norpramin
  • drug type / mech of action: TCA, inhibits 5HT and NE reuptake
  • advantages/uses: lest sedating, fewer anticholinergic SEs
  • disadvantages/side effects: lots of side effects, lethal in overdose
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8
Q

Clomipramine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: anafranil
  • drug type / mech of action: TCA, inhibits 5HT and NE reuptake
  • advantages/uses: most 5HT specific, use to treat OCD
  • disadvantages/side effects: lots of side effects, lethal in overdose
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9
Q

Amitryptiline

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: elavil
  • drug type / mech of action: TCA, inhibits 5HT and NE reuptake
  • advantages/uses: use to treat chronic pain, headaches, neuropathy
  • disadvantages/side effects: lots of side effects, lethal in overdose
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10
Q

Which TCAs can be used to treat chronic pain or neuropathy?

A

imipramine, amitryptyline (elavil), doxepin

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11
Q

What are the common and dangerous side effects of TCAs?

A

common:

  • anti-Histamine: sedation
  • anti-adrenergic: orthostatic hypotension, tachy, arrhythmia
  • anti-muscarinic: dry mouth, constipation, urine retention, blurred vision, tachycardia
  • weight gain

dangerous: contraindicated if pre-existing cardiac conduction abnormalities, lethal in overdose –> wide QRS –> torsades –> Vfib

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12
Q

What is treatment for TCA overdose?

A

sodium bicarb and magnesium to stabilize arrythmia

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13
Q

Fluoxetine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: prozac
  • drug type / mech of action: SSRI
  • advantages/uses: activating, long half life (no need to taper, use in pts with variable compliance), depression
  • disadvantages/side effects: most side effects (esp. sex dysfunction), can worsen anxiety
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14
Q

Paroxetine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: paxil
  • drug type / mech of action: SSRI
  • advantages/uses: sedating, use in anxiety disorders, depression
  • disadvantages/side effects: short half life –> can cause discontinuation syndrome, cannot miss doses
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15
Q

Sertraline

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: zoloft
  • drug type / mech of action: SSRI
  • advantages/uses: few drug drug interactions, use in medically ill and elderly, anxiety disorders, depression
  • disadvantages/side effects: causes GI upset esp. at start, shorter half life can lead to discontinuation syndrome
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16
Q

Citalopram/Escitalopram

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: celexa / lexapro
  • drug type / mech of action: SSRI
  • advantages/uses: few drug-drug interactions, low side effects, go-to drug for depression
  • disadvantages/side effects: dose limited to 40mg adults, 20mg geri due to long QT (citalopram only)
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17
Q

Fluvoxamine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: luvox
  • drug type / mech of action: SSRI
  • advantages/uses: only approved for OCD and social anxiety disorder (not depression)
  • disadvantages/side effects: BID dosing, p450 interactions, short half life can lead to discontinuation syndrome
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18
Q

Venlafaxine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: effexor
  • drug type / mech of action: SNRI
  • advantages/uses: can help with chronic pain
  • disadvantages/side effects: contraindicated in pts with poorly controlled HTN; short half life, withdrawal syndrome
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19
Q

Duloxetine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: cymbalta
  • drug type / mech of action: SNRI
  • advantages/uses: can help with chronic pain
  • disadvantages/side effects: very expensive, can cause nausea
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20
Q

What are common side effects of SSRIs?

A

sex dysfunction, GI upset, headache

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21
Q

What are common side effects of SNRIs?

A

sex dysfunction, GI upset, headache, more activating than SSRIs

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22
Q

Buproprion

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: wellbutrin
  • drug type / mech of action: inhibits reuptake NE and DA
  • advantages/uses: rare to have sex side effects, relatively activating, helpful in smoking cessation
  • disadvantages/side effects:
    similar SE to SSRI (GI upset, headache), rarely sexual side effects
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23
Q

Mirtazapine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: remeron
  • drug type / mech of action: 5Ht2a/c, 5Ht3a antagonist
  • advantages/uses: useful in pts with poor appetite, useful as sleep aid at low dose
  • disadvantages/side effects: sedates at low dose, appetite stimulation –> can lead to weight gain
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24
Q

Haloperidol

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: haldol
  • drug type / mech of action: 1st gen antipsychotic, D2 blockade
  • advantages/uses: high efficacy, fewer anti-ACh SEs, short acting injectable available, long acting decanoate
  • disadvantages/side effects: high incidence of EPS
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25
Q

Fluphenazine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: prolixin
  • drug type / mech of action: 1st gen antipsychotic, D2 blockade
  • advantages/uses: similar to haldol (high efficacy, few anti-ACh SEs) long acting decanoate
  • disadvantages/side effects: high incidence of EPS
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26
Q

Perphenazine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: trilafon
  • drug type / mech of action: 1st gen antipsychotic, D2 blockade
  • advantages/uses: moderate potency, lower risk of EPS
  • disadvantages/side effects: BID dosing
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27
Q

Chlorpromazine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: thorazine
  • drug type / mech of action: 1st gen antipsychotic, D2 blockade
  • advantages/uses: low potency so can use in pediatri population, fewer EPS side effects
  • disadvantages/side effects: lots of anti-ACh SEs –> dry mouth, tachy, urine retention, blurry vision, constipation, sedation (anti-H), weight gain, low potency
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28
Q

Risperidone

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: risperdal
  • drug type / mech of action: 2nd gen antipsychotic, D2R blocker, 5HT2a receptor antagonist
  • advantages/uses: high potency, dissolving form, long acting consta form
  • disadvantages/side effects: hyperprolactinemia, high incidence of EPS
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29
Q

Olanzapine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: zyprexa
  • drug type / mech of action: 2nd gen antipsychotic, D2R blocker, 5HT2a receptor antagonist
  • advantages/uses: very effective, zydis form = dissolving tab
  • disadvantages/side effects: can cause significant metabolic risk –> central obesity, htn, DM, high TG/low HDL
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30
Q

Aripiprazole

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: abilify
  • drug type / mech of action: 2nd gen antipsychotic, mixed agonist/antagonist
  • advantages/uses: adjunctive antidepressant, can be activating, weight neutral
  • disadvantages/side effects: can get akathesias
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31
Q

Quetiapine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: seroquel
  • drug type / mech of action: 2nd gen antipsychotic, D2R blocker, 5HT2a receptor antagonist
  • advantages/uses: useful as sleep aid, approved as monotherapy mood stabilizer, can be used in bipolar depression
  • disadvantages/side effects: sedation, qeight gain, dizziness, hard to tolerate
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32
Q

Ziprasidone

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: geodon
  • drug type / mech of action: 2nd gen antipsychotic, D2R blocker, 5HT2a receptor antagonist
  • advantages/uses: weight neutral
  • disadvantages/side effects: QT prolongation, must be taken with food
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33
Q

Clozapine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: clozaril
  • drug type / mech of action: 2nd gen antipsychotic, D2 and D4 blockade, 5HT2A receptor antagonist
  • advantages/uses: extremely effective
  • disadvantages/side effects: significant sedation, weight gain, drooling, cardiomyopathy (in first 6 wks), agranulocytosis (need frequent blood monitoring), lowers seizure threshold
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34
Q

Lithium

  • brand name
  • drug type / mech of action
  • advantages/uses
  • common side effects
  • dangerous side effects
  • disadvantages
A
  • brand name: eskalith
  • drug type / mech of action: mood stabilizer
  • advantages/uses: effective, not associated w/ weight gain
  • common side effects: polyuria, polydipsia, sedation, tremor
  • dangerous side effects: nephrogenic DI, renal impairment, thyroid dysfunction
  • disadvantages/side effects: lots of blood draws (Li level, BUN/Cr, T4/TSH), narrow therapeutic window –> can become toxic (N/V/D, COARSE TREMOR, MS change, renal failure, coma), contraindicated in renal disease, diuretic use, NSAID use
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35
Q

Valproic acid

  • brand name
  • drug type / mech of action
  • advantages/uses
  • common side effects
  • dangerous side effects
  • disadvantages/side effects
A
  • brand name: depakote
  • drug type / mech of action: mood stabilizer
  • advantages/uses: slightly wider therapeutic window
  • common side effects: sedation, weight gain, alopecia
  • dangerous side effects: pancreatitis, hepatotoxicity, thrombocytopenia
  • disadvantages/side effects: blood draws to monitor levels, platelets, LFTs, p450 interactions, teratogen, potential for toxicity (N/V, ataxia, NYSTAGMUS, coma)
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36
Q

Carbamazepine / Oxcarbazepine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: tegretol / trileptal
  • drug type / mech of action: mood stabilizer / anti-epileptic
  • advantage/uses: mood stabilization
  • disadvantages/side effects: BM suppression, SIADH, autoinducer (induces own P450 metabolism –> can have decrease level at higher dose), many drug drug interactions (deactivates birth control, etc)
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37
Q

Lamotrigine

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: lamictal
  • drug type / mech of action: mood stabilizer / anti-epileptic
  • advantages/uses: good for prevention bipolar depression (not acute episode)
  • disadvantages/side effects: titrate very slowly b/c risk Stevens-Johnson
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38
Q

Topiramate

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: topamax
  • drug type / mech of action: mood stabilizer / anti-epileptic
  • advantages/uses: can promote weight loss, also treats headache, impulse control in borderline PD
  • disadvantages/side effects: no evidence of efficacy in mood stabilization, cognitive dulling (dopamax), kidney stones
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39
Q

Triazolam

  • brand name
  • drug type
  • use
  • onset of action/half-life
A
  • brand name: halcion
  • drug type: benzo
  • use: use for difficulty falling asleep
  • onset of action/half-life: fast onset, short half-life = high addictive potential, higher withdrawal
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40
Q

Alprazolam

  • brand name
  • drug type
  • onset of action/half-life
A
  • brand name: xanax
  • drug type: benzo
  • use: panic attacks
  • onset of action/half-life: fast/intermediate action, short/intermediate half life = highly addictive, higher risk withdrawal
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41
Q

Lorazepam

  • brand name
  • drug type
  • onset of action/half-life
A
  • brand name: ativan
  • drug type: benzo
  • use: catatonia, acute agitation
  • onset of action/half-life: intermediate onset + half life
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42
Q

Clonazepam

  • brand name
  • drug type
  • onset of action/half-life
A
  • brand name: klonipin
  • drug type: benzo
  • use: go-to benzo
  • onset of action/half-life: slow onset and intermediate/long half life = less potential for abuse
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43
Q

Diazepam

  • brand name
  • drug type
  • onset of action/half-life
A
  • brand name: valium
  • drug type: benzo
  • onset of action/half-life: fast onset, long half-life
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44
Q

chlordiazepoxide

  • brand name
  • drug type
  • onset of action/half-life
A
  • brand name: librium
  • drug type: benzo
  • use: EtOH withdrawal
  • onset of action/half-life: intermediate onset, long half-life
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45
Q

Zolpidem

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: ambien
  • drug type / mech of action: hypnotic, difficulty sleeping
  • advantages/uses: widely available
  • disadvantages/side effects: can cause strange dreams, dissociative symptoms, less effective after 2 weeks
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46
Q

Zaleplon

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: sonata
  • drug type / mech of action: hypnotic
  • advantages/uses: very short acting, may be taken if wake in middle of night
  • disadvantages/side effects: can be habit-forming
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47
Q

Ramelteon

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: rozerem
  • drug type / mech of action: hypnotic
  • advantages/uses: similar to melatonin, unlikely to be habit-forming
  • disadvantages/side effects: expensive
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48
Q

Eszopiclone

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: lunesta
  • drug type / mech of action: hypnotic
  • advantages/uses: can take for longer periods than other hypnotics
  • disadvantages/side effects: expensive, metal taste, withdrawal syndrome
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49
Q

Trazodone

  • brand name
  • drug type / mech of action
  • advantages/uses
  • disadvantages/side effects
A
  • brand name: desyrel
  • drug type / mech of action: hypnotic
  • advantages/uses: benign, common on inpatient unit
  • disadvantages/side effects: morning grogginess, priapism
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50
Q

What are the HAM side effects?

A

H = antiHistamine: sedation, weight gain
A = anitAdrenergic = hypotension
M antiMuscarinic = dry mouth, blurred vision, urine retention

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51
Q

What are some types of drugs that have lots of HAM side effects?

A

TCAs and low potency first gen antipsychotics (chlorpromazine, thioridazine)

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52
Q

What are sx in 5HT syndrome?

A

confsuion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicitiy, rhabdo, renal failure

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53
Q

What is drug of choice for EPS sx produced by neuroleptics?

A

benztropine

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54
Q

What is treatment for 5HT syndrome?

A

stop drugs = 1st line –> then maybe give cyproheptadine or ca channel blocker (nifedipine)

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55
Q

What foods to avoid in MAOI?

A

tyramine –> red wine, cheese, liver, cured meats

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56
Q

When do EPS sx occur?

A

with high potency traditional antipsychotics, wthin days of stating med

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57
Q

Which drugs cause hyperprolactinemia?

A

high potency traditional antipsychotics (haldol) and risperidone

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58
Q

When does tradvice dyskinesia occur?

A

years after antipsychotic use esp. high potency, can be irreversible

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59
Q

What are sx of NMS?

A

fever, tachycardia, hypertension, tremor, high CPK, lad pipe rigidity

occurs most with high potency, 20% mortality rate

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60
Q

What is treatment for NMS?

A

stop the medication and supportive

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61
Q

What are some important CYP450 inducers?

A
  • smoking
  • carbamazepine
  • barbiturates
  • st johns wor
62
Q

What are some important CYP450 inhibitors?

A
  • fluvoxamine
  • fluoxetine
  • paroxetine
  • duloxetine
  • sertraline
63
Q

What is the difference in response rates among antidepressants? med vs placebo response?

A

all same response rates –> 70% respond to med, 30% of this is placebo response

big difference is really in safety and side effects

64
Q

How long should you try antidepressant?

A

1-2 months at full dose before consider medication change

65
Q

What are unique feat of fluoxetine?

A
  • longest half life –> no need to taper
  • safe in pregnancy
  • FDA approved in kids
    activating –> more common sleep changes and anxiety
66
Q

What are some unique features of sertraline?

A
  • highest risk of GI upset
67
Q

What are some unique features of paroxetine?

A
  • more anticholinergic –> sedating, constipation, weight gain, delirium / cognitive decline
  • short half life so significant discontinuation yndrome
68
Q

What are some unique features of fluvoxamine?

A
  • only currently approved for OCD and social anxiety, no MDD

- lots of p450 interactions

69
Q

What are some unique features of citalopram?

A
  • fewer sex side effects

- dose limited to 40mg in adults, 20mg in geri due to prolonging QT

70
Q

What are some unique features of escitalopram?

A

fewest side effects, go to drug of choice

71
Q

What is interaction SSRI and warfarin?

A

SSRI can increase level of warfarin so need to monitor when starting and stopping

72
Q

What is clinical use of venlafaxine? major side effect?

A

MDD, GAD

similar SE to SSRI plus can cause increase BP

73
Q

What is clinical use of duloxetine?

A

MDD with neuropathic pain or fibromyalgia

74
Q

When is bupropion contraindicated?

A

epilepsy, eating disorder, currently on MAOI

75
Q

What is clinical use of trazodone and nefazodone?

A

treat refractory major depression, MDD with anxiety, and insomnia

76
Q

What are unique features of trazodone?

A

no sexual side effects, no affect on REM sleep

SE: sedation and priapism

77
Q

What are unique features of nefazodone?

A

no sexual side effects, no affect on REM sleep

SE: sedation, black box warning of serious liver failure

78
Q

What is clinical use of mirtazapine?

A

refractory major depression esp. in patients who need help with sleep and appetite/weight gain

*no sex side effects

79
Q

What is mech of action of TCAs?

A

inhibit reuptake of NE and 5HT

80
Q

What are the two TCAs with less anticholinergic effects?

A

nortriptyline, desipramine

81
Q

What is treatment for TCA overdose?

A

IV sodium bicarbonate

82
Q

What are unqiue features of amitriptyline?

A

can use to treat chronic pain, migraines, insomnia

83
Q

What are unique features of clomipramine?

A

can use to treat OCD

most 5HT specific

84
Q

What are unique features of doxepin?

A

can treat chronic pain, sleep aid in low doess

85
Q

What are unique features of imipramine?

A

use in enuresis and panic disorder

86
Q

What are unique features of nortriptyline?

A

least likely to cause orthostasis –> use in elderly

can use to treat chronci pain

87
Q

What are unique features of deipramine?

A

leas sedating and most activating of all TCAs

88
Q

What is amoxapine?

A

tetracyclic antidepressants, can cause EPS

89
Q

What are side ffects of TCAs?

A

highly protein bound and lipid soluble so interact with other meds that have high protein binding

antiH –> sedation
anti-A –> orthostasi, reflex tachycardia, arrhythmia, ekg change (wide QRS, QT, PR)
anti-M –> dry mouth, cognition, etc

90
Q

What drug is considered most effect in atypical depression?

A

MAOIs

91
Q

What are effects of TCA overdose?

A

hypoventilation from CNS depression, delirium, myoclonus, hyperreflexia, seizure, coma

92
Q

Which MAOI does not require following dietary restrictions?

A

selegiline

93
Q

What is mech of action MAOIs?

A

pevent inactivation of biogenic amines like NE, 5HT, doapmine, tyramine by irrversibly inhibitiong MAO

MAO-A = 5HT
MAO-B = NE
both = dopamine, tyramine
94
Q

When do you use MAOI?

A

certain types of refractory depression/panic/anxiety

95
Q

How long do you have to weight when swithcing SSRI to MAOI?

A

2 wks, 5-6 wks if fluoxetine due to long half life

96
Q

What is most common side effect of MAOI?

A

orhthostatic hypotension

97
Q

What is mech of action typical vs atypical antipsychotics?

A 
typical = block D2
atypical = block D2 and serotonin 2A

both effective at blocking + sx, atypical more effective at negative

98
Q

What is unique about chlorpromazine?

A

low potency typical antipsychotic –> more anti-ACh effects (orthostasis), fewer EPS

can cause bluish skin discoloration
approved in pediatrics

99
Q

What is unique about thioridazine?

A

low potency typical antipsychotic

can cause retinitis pigmentosa

100
Q

What is unique about thiothixeine?

A

midpotency typical antipsychoticic

can cause ocular pigment cahnges

101
Q

Which 3 antipsychotics have long acting IM forms?

A

haloperidol, fluphenazine, risperidone

102
Q

What is unique about pimozide?

A

high potency typical antipsychotic

associated w/ heart block VT, acrdiac effects

103
Q

What are the 4 dopamine paths and their relation with neuroleptics?

A

mesolimbic = postivie sx of schizpohrneia treated by medication = nucleus accumbens, fornix, amygdala, hippocampus

mesocortical = negative sx of schizophrenia

nigrostrial = EPS sx of dopmine blockade

tuberoinfundibular = increased prolactin SE of dopamine blockade

104
Q

What are treatment options for EPS sx of neuroleptics?

A
  • reduce dose of antipsychotic
  • benztropine (anticholinergic)
  • diphenhydramine (antihistamine)
  • amantadine (antiparkinson)
105
Q

What is treatment of tardive dyskinesia?

A

discontinue current med and change med with less potential for tardvice

106
Q

What are opthalmologic problems associated with antipsychotics?

A

irreversible retinal pigmentation with high dose thioridazine
deposits in lens/cornea with chlorpromazine

107
Q

Which type of antipsychotics most associated with lower seizure threshold?

A

low potency more than high potency

108
Q

What are clinical uses of atypical antipsychotics?

A

acute mania, bipolar, adjunct to unipolar

109
Q

What are unique features of clozapine?

A
  • only antipsychotic shown to be more efficacious, good for treatment-resistant
  • high risk of agranulocytosis, seizures, metabolic, drooling
  • decreases risk of suicide
110
Q

What are unique features of risperidone?

A

most likely to cause increased prolactin
most EPS of atypicals
long acting injetable

111
Q

What are unique features of olanzapine?

A

most likely to cause weight gain besides clozapine

112
Q

What are unique features of ziprasidone?

A

weight neutral

113
Q

What are unique features of aripiprazole?

A

unique partial D2 agonism and D4 antagonism
more activating (akathisia)
less potential for weight gain

114
Q

What is the only mood stabilizer that decreases suicidality?

A

lithium

115
Q

What is drug of choice in acute mania and prophylaxis of manic/depressive?

A

lithium

116
Q

Where is lithium metabolized?

A

kidney

117
Q

How long before onset of action in lithium?

A

5-7 days

118
Q

What are some factors that increase lithium levels?

A
  • dehydration
  • salt deprivation
  • sweating (salt loss)
  • impaired renal function
119
Q

What are some factors that decrease lithium levels?

A
  • NSAIDs
120
Q

What is specific use of carbamazepine?

A

useful in treating mixed episodes and rapid cycling bipolar, also trigeminal neuralgia

121
Q

What tests should you order before starting carbamazepine?

A

CBC and LFTs –> can cause high LFTs leading to hepatitis and agranulocytosis/leukopenia

122
Q

What are major side effects of lithium?

A 
benign leukocytosis
hypothyroid
flat T wave on EKG
GI disturbance
weight gain
nephrogenic DI
fine tremor
123
Q

What are specific uses of valproate?

A

mixed epsidoes bipolar and rapid cycling

124
Q

What should you monitor in valproate?

A

LFTs and CBC –> can cause hepatitis

125
Q

What is relationship valproate and lamotrigine levesl?

A

valproate increases lamotrigine

lamotrigine decreaes valproate

126
Q

What is clinical use of lamotrtigien?

A

bipolar depression, modulate glutamate and aspartate via sodium channels

127
Q

What is psych use of gabapentin?

A

adjunct for anxiety/sleep

128
Q

What is psych use of pregabalin?

A

GAD and fibromyalgai

129
Q

What are clinical uses of topiramate?

A

impulse vcontrol, anxiety

130
Q

What is unique about topiramate?

A

can cause weight loss
hypohchloremic non anion gap met acidosis and kidney stones
cognitive slowing

131
Q

When should you avoid clonazepam?

A

avoid w/ renal dysfunction

132
Q

What is mech of action of zolpidema/zaleplon/escopiclone?

A

selective receptor binding tp benzo receptor 1 that is responsible for sedation

use for short term treatment of insomnia

133
Q

What is mech of action buspirone?

A

partial agonist at 5HT-1a

not as effective as other options so often used in bombo with SRI for anxiety

134
Q

What is mech of action hydroxyzine?

A

antihistamine used for quick acting short term anxiety

135
Q

What are psych uses of propanolol?

A

autonomic effects of panic attacks or performance naxiety

akathisia

136
Q

What should you watch out for in methylphenidate use?

A

wach for leukopenia, anemia, high LFTs

monitor BP and watch for weight loss, insmonia

137
Q

What should you watch out for in atomoxetine?

A

rare liver toxicity, possible increase SI in kids/adolescents

138
Q

What are some drugs that can cause psychosis?

A

sympathomimetics, analgesics, antibiotics (INH), anticholinergics, anticonvulsants, antihistamines, steroids, anti-PD

139
Q

What are some drugs that can cause agitation/confusion/delirium?

A

antipsychotics, antidepressants, antiarrhythmics, steroids, glycosides, NSAIDS, antiasthmatics, antibiotics, anti PD, thyroid hormone

140
Q

What are some drugs that can cause depression?

A

antihypertensives, antiPD, steroids, Ca cahnel blockers, NSAIDS, antibiotics, peptic ulcer drugs

141
Q

What is psych effect of procainamide/quinidine?

A

confusion, delirium

142
Q

What is psych effect of albuterol?

A

anxiety, confusion

143
Q

What is psych effect of isoniazid?

A

psychosis

144
Q

What is psych effect of tetracycline?

A

depression

145
Q

What is psych effect of nifedipine, verapamil?

A

depression

146
Q

What is psych effect of cimetidine?

A

depression, psychosis

147
Q

What is psych effect of steroids?

A

aggressive/agitation, hypomania, anxiety, psychosis

148
Q

what determines effectiveness of ECT?

A

length of postictal suppression not seizure duration

149
Q

What are indications for ECT?

A

depression w/ psychotic feat, acute mania, catatonia, pts who fail other treatment or cannot tolerate

150
Q

What is use of DBS?

A

chronic pain, PD, tremor, dystonia, MDD

151
Q

What is use of repetitive transcranial magnetic stimulation?

A

weak electric current induced by rapidly changing mangentic field

152
Q

What is use of light therapy?

A

sesonal affect d/o

Psych Clerkship (3 decks)

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