Pharm Flashcards
Clomipramine
Class: TCAD
Use: OCD in kids and adults
Treatment of OCD
TCADs, SSRIs
CNS stimulants for ADHD (three)
dextroamphetamine
methylphenidate
pemoline
Management of leukopenia caused by clozapine
Mild (3000-3500): 2x per week CBC with diff
More serious (2000-3000): daily CBCs, cessation of clozapine, reinstitute clozapine after WBCs normalize
Agranulocytosis: protective isolation, d/c clozapine, obtain bone marrow specimen. If progenitor cells suppressed, don’t restart clozapine.
Management of lithium toxicity
Mild-mod: supportive therapy with IV saline, Is/Os, frequent lithium levels
Severe (>3mEq/L): emergency dialysis
Lab monitoring with carbamazepine therapy
Prior to initiation: CBC, PLT, retic, lytes, LFTs, preg test
After initiation: LFTs and LDH every month for first 2 months, then ever three months due to risk of hepatotoxicity
Antidepressants and weight gain
TCAD > SNRI/MAOI > SSRI
Uses of St John’s wort
depression, sedative, anxiolytic
Uses of Ginseng
stimulant for fatigue, depression
Treatment of bipolar in pregnancy
Valproic acid category X
Lithium category D (preferred)
Treatment of acute dystonia 2/2 antipsychotic treatment
Treat acutely with benztropine or diphenhydramine
Long term consider decreasing antipsychotic, prescribing benztropine or diphenhydramine to prevent recurrence
Antipsychotics with highest risk of glucose abnormalities
olanzapine, clozapine
Management of akathisia 2/2 antipsychotics
Reduce offending med if possible. Propranolol for symptom reduction.
ECT anesthesia
Methohexital as anesthetic
Succinylcholine as muscle relaxant
Anticholinergics to reduce salivation, prevent bradycardia
Uses of buproprion
Depression
Hypoactive sexual desire disorder
Treatment of tourette disorder
Antipsychotics
Treatment of narcolepsy
Daytime sleepiness: stimulants (methylphenidate, pemoline, amphetamine)
Cataplexy: meds that decrease REM (TCAs, SSRIs)
Modafinil: decreases number of sleep attacks and improves psychomotor performance
SNRI metabolism
Metabolized by P450. 5-10% of caucasions metabolize nortriptyline and desipramine slower and can develop toxic levels at low doses.
Management of clozapine induced seizure
Temporarily d/c clozapine and start phenobarbitol. Then restart clozapine at 50% previous dose and gradually uptitrate.
Antipsychotics and postural hypotension
Lowest risk with high potency FGAs which have fewer anticholinergic side effects
MOAIs hypertensive crisis
Can be precipitated by tyramine or symphatomimetics
Imipramine
Class: TCA
Uses: ADHD with comorbid anxiety or tics, nocturnal enuresis
Most significant side effect of sildenafil
risk of MI due to increased O2 demand and stress on heart during sex (indirect effect)
