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pharm Flashcards

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1
Q

SSRIs

A 
escitalopram (Lexapro)
citalopram (Celexa)
fluoxetine (Prozac/Sarafem)
paroxetine (Paxil, Pexeva, Brisdelle)
sertraline (Zoloft)
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2
Q

SSRI SEs

A

decreased libido, sexual dysfunction, prolonged ejaculation

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3
Q

SNRIs

A

desvenlafaxine (Pristiq)
venlafaxine (Effexor)
duloxetine (Cymbalta)

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4
Q

SNRI SEs

A

cleaner than SSRIs but more expensive

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5
Q

antidepressant used for smoking cessation, lowers seizure threshold in bulimic pts

A

buproprion

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6
Q

what is mirtazipine used for primarily

A

appetite stimulant

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7
Q

antidepressant used as sleep aid

A

trazodone

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8
Q

TCAs

A

-triptylines
imipramine (enuresis)
doxepin

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9
Q

main use of TCAs

A

neuropathic pain

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10
Q

SEs TCAs

A

3 Cs: convulsions, cardiac toxicity, coma

also anticholinergic SEs

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11
Q

MAO-i

A

Selegeline
Phenylzine
*cause HTN emergency when eating wine/cheesd (high tyramine)

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12
Q

mood stabilizers for acute mania

A

1st line: lithium or valproic acid (Depakote)
2nd line: quetiapine (Seroquel) alone or with the above agents; lamotrigine (Lamictal)
3rd line: carbamazepine

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13
Q

lithium SEs

A

teratogen
nephrotoxic, nephr. DI
narrow therapeutic index

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14
Q

valproic acid SEs

A

spina bifida
pancreatitis
thrombocytopenia
agranulycytosis

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15
Q

quetiapine SEs

A

weight gain
QTc prolongation (get EKG)
somnolence

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16
Q

other uses for carbamazepine

A

trigeminal neuralgia, absence seizures in kids

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17
Q

life-threatening SE of valproic acid

A

pancreatitis

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18
Q

carbamezipine good for ?

risks?

A

bipolar and trigeminal neurolagia

SEs: SJS (also lamotrigine), agranulocytosis

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19
Q

anticonvulsants decrease efficacy of ?

A

OCPs and warfarin

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20
Q

EPS

A

Parkinsonism
Akathisia: restlessness
Dystonia: sustained, painful contraction of muscles of neck, tongue, eyes, diaphragm
-occur early: hrs-days of starting meds, reversible
-occurs with high-potency, typical anti psychs (1st gen)

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21
Q

FL for EPS

A

benztropine (Cogentin)

or Benadryl

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22
Q

Tardive dyskinesia

A

choreoathetoid muscle movements (mouth, tongue typ)

  • occurs YEARS after antipsychotic use (high-potency 1st gen)
  • typically irreversible
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23
Q

Important CYP 450 inducers – decrease drug levels

A

Tobacco, carbamazepine, barbiturates, Saint johns wort

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24
Q

Important CYP 450 inhibitors – increase drug levels

A

Fluvoxamine, fluoxetine, Paroxetine, duloxetine, sertraline

I.e. Lots of SSRIs

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25
Q

Most antidepressants take how long to see effect

A

3 to 4 weeks, maybe a short as 1 to 2 or as long as 6 to 8

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26
Q

SSRI withdrawl phenomenon

A

Dizziness, headache, nausea, insomnia, malaise; taper to avoid

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27
Q

What is one hypothesis why SSRIs often have delayed effect

A

They may cause downstream effects increasing brain plasticity

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28
Q

meds that may increase risk serotonin syndrome

A

Dextromethorphan – cold remedy
Triptan’s used for migraines
MAOIs: Don’t use SSRIs within two weeks

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29
Q

Distinct advantages of sSRIs

A

Low incidence of side effects, most of which resolve with time, no food restrictions, safer in overdose

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30
Q

How to deal with the sexual side effects of SSRIs

A

Reduce the dose, changed to non SSRI, augment with bupropion, and Viagra

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31
Q

Fluoxetine -brand name?

safe for? SEs?

A

Prozac
longest half life, safe in pregnancy and for kids
common SEs: insomnia, anxiety, sexual dysfunction
can ^ levels of antipsychs, ^SEs

32
Q

Sertraline -brand name?

SEs?

A

Zoloft
higher risk of GI disturbances
very few drug interactions
same SEs as Prozac: insomnia, anxiety, sexual dysfunction

33
Q

Paroxetine -brand name?

problem with 1/2 life?

A

Paxil
protein bound, so drug interactions
SEs: anticholinergic (sedation, constipation, weight gain), sexual dysfunction
*withdrawal phenomenon due to short half-life

34
Q

Fluvoxamine -brand name?

Currently approved only for?

A

Luvox
Only for use in OCD
side effects: nausea and vomiting
multiple drug interactions due to CYP inhibition

35
Q

Citalopram -brand name?

What unique problem?

A

Celexa
Fewest drug interactions
dose dependent QTC prolongation

36
Q

Escitalopram -brand name?

Similar to?

A

Lexapro
Levo-enantiomer of citalopram
Similar efficacy, possibly fewer side effects
also dose depending QTC prolongation

37
Q

SSRI black box warning

A

Potentially increasing suicidal thinking and behavior – applies to kids and young adults to age 25, but maybe accurate for adults as well

38
Q

Why do SSRIs have significantly fewer side effects and TCAs and MAOIs

A

Serotonin selectivity – do not act on histamine, adrenergic, muscarinic receptors

39
Q

Other SSRI side effects

A

G.I.: nausea, diarrhea - eat with food
Insomnia, vivid dreams, headache, anorexia, weight loss
Sexual dysfunction 30 to 40%: decreased libido, anorgasmia, delayed ejaculation
Restlessness: akathisia like
Serotonin syndrome
Hyponatremia: rare
Seizures: 0.2% rate, lower than TCAs

40
Q

Serotonin syndrome

A

Fever, diaphoresis, tachycardia, hypertension, delirium, neuromuscular excitability: especially hyperreflexia and electric jolt limb movements
Rhabdomyolysis, renal failure, may lead to death

41
Q

Venlafaxine – brand-name?

A

Effexor, used for depression, Anxiety, neuropathic pain
Low drug interaction
XR form available for once a day dosing
side effects like SSRIs but increase BP as well

42
Q

New form of “venlafaxine”

A

DesVenlafaxine – Pristiq

Expensive, no known benefit over venlafaxine

43
Q

Duloxetine – Brandname?

A

Cymbalta
depression, neuropathic pain, fibromyalgia
side effects like SSRIs, more dry mouth and constipation – NE effects, hepatotoxicity in those at risk, expensive

44
Q

Bupropion- Brandname?

Advantages over SSRIs?

A

Wellbutrin (NE-Dopamine RI)
Relative lack of sexual side effects compared to sSRIs, some efficacy in treating adult ADHD, smoking cessation
side effects include increasing anxiety, increased risk of seizures and psychosis at high doses, countraindicated in patients with seizure or eating disorders or on MAOI

45
Q

Trazadone- brand name? class?

other similar drug?

A

Desyrel, other: Nefazodone (Serzone)
Serotonin Receptor Antagonist/Agonist
MDD, MDD + anxiety, insomnia (typically initiated with SSRI for insomnia)

46
Q

Trazadone and Nefazodone SEs

A

nausea, dizziness, othostatic hypotension, arrhythmias, sedation, priapism
DO NOT have sexual SEs of SSRIs and do not affect REM
Nefazodone: black box for liver failure, not commonly used!

47
Q

Mirtazapine- brand name? class?

A

Remeron, Adrenergic receptor antagonist
MDD, esp. if weight loss or insomnia good for elderly
SE: sedation, weight gain, dizziness, tremor, dry mouth, constipation, agranulocytosis (rare)
fewer drug interactions and sexual SEs compared to SSRIs

48
Q

TCA action

A

inhibit reuptake of NE and serotonin

long 1/2 lives, most dosed daily

49
Q

Amitriptyline- brand name? type and use?

A

Elavil, tertiary TCA

chronic pain, migraines, insomnia

50
Q

Imipramine- brand name? type and use?

A

Tofranil, tertiary TCA

IM form, enuresis, panic disorder

51
Q

Clomipramine- brand name? type and use?

A

Anafranil, tertiary TCA

OCD, more serotonin specific

52
Q

Doxepin- brand name? type and use?

A

Sinequan, tertiary TCA

chronic pain, sleep aid in low doses

53
Q

Nortriptyline

A

Pamelor, Aventyl, secondary TCA
lease likely to cause orthostatic hypotension
chronic pain

54
Q

Desipramine

A

Norpramin, secondary TCA

more activating, less sedating, least anticholinergic

55
Q

tertiary vs secondary amines

A

tertiary are highly anticholinergic/histaminergic/adrenergic (more sedating with greater lethality in OD)
secondary are metabolites of tertiary (less anti-HAM)

56
Q

Amoxapine

A

Asendin, tetracyclic antidepressant

may cause EPS, metabolite of loxapine (antipsychotic)

57
Q

how much TCA can be lethal in OD?

A

1-2 g (a 1-week supply)

58
Q

antidepressants for atypical depression

A

MAOIs considered more effective than TCAs

atypical features: ^sleep, ^appetite, leaden paralysis, ^sensitivity to interpersonal rejection

59
Q

TCA SEs

A

highly protein bound and lipid soluble: can interact with other meds
SEs due to lack of specificity
antihistaminic: sedation, weight gain
serotonergic: erectile/ejaculatory dysfunction in males, anorgasmia in females

60
Q

TCA antiadrenergic SEs

A

CV: orthostatic hypotension, dizziness, reflex tachycardia, arrhythmias (block Na2+ channels), EKG changes: wide QRS, QT, PR intervals)
do not use in pts with conduction abnormalities or recent MI

61
Q

TCA antimuscarinic effects

A

dry mouth, constipation, urinary retention, blurred vision, tachycardia, exacerbation of narrow angle glaucoma

62
Q

TCA OD symptoms

A

agitation, tremores, ataxia, arrhythmias, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures, coma

63
Q

seizure rate with TCAs

A

0.4%, more common at higher plasma levels and with tetracyclics and clomipramine

64
Q

Naltrexone- brand names? how it works?

A

Revia, 50 mg/d up to 100 mg/d
IM- Vivitrol, 380 mg every four weeks

Opioid receptor blocker, works by decreasing desire/craving and “high” associated with alcohol
Maybe greater benefit seen in men with family history of alcoholism
In patients with opioid dependence, will precipitate withdrawal
Contraindicated in acute hepatitis or liver failure
Modifies HPA axis to suppress ethanol consumption

65
Q

Acamprosate- brand name? how it works?

A

Campral, 666 mg TID, 333 mg if renal impairment
GABA agonist/glutamate antagonist
Should be started post – detox for relapse prevention and patients who have stopped drinking
major advantage – can be used in patients with liver disease but countraindicated in to be a renal disease
COMBINE Trial shows limited effectiveness Campral compared to placebo (while Naltrexone was effective)

66
Q

Disulfiram- brand name? how it works?

A

Antabuse
Blocks aldehyde dehydrogenase in the liver and causes adverse reaction to alcohol: Flushing, headache, nausea/vomiting, palpitations, shortness of breath
Contraindicated in severe cardiac disease, pregnancy, psychosis
Monitor LFTs
best used in highly motivated patients need med adherence

67
Q

Topiramate- brand name? how it works?

A

Topamax, Second line
Anticonvulsant – potentiates GABA and inhibits glutamate receptors
reduces cravings for alcohol and decreases alcohol use

68
Q

Score used to screen for alcohol use disorder

A

AUDIT-C

scored 0 to 12 with positive for men 4+ and women 3+

69
Q

Timing of initiating alcohol abstinence pharmacotherapy

A

Naltrexone can be initiated while the individual is still drinking – permits treatment in a community setting at point of maximum crisis without need for enforced abstinence or detox
Disulfiram should only be used by abstinent patients
Acamprosate should only be used once abstinence is achieved

70
Q

Naltrexone- genetics

A

Maybe effective in individuals with Asp-40 allele variant of OPRM1 gene

71
Q

First generation versus second generation antipsychotics

A

First generation: block dopamine D2 receptors

Second generation: block dopamine D2 and serotonin 2A receptors, More effective for treating negative symptoms

72
Q

low potency typical antipsychotics

A

Chlorpromazine -Thorazine
Side effects: orthostatic hypotension, blue gray skin discoloration, photosensitivity,
also used to treat nausea, vomiting, intractable hiccups
Thioridazine- Mellaril
Associated with retinitis pigmentosa

73
Q

General side effects of low potency typical antipsychotics

A

Higher HAM effects: antihistamininc, anti-adrenergic, Anti-muscarinic. Compared to high potency
Lower incidence of EPS and possibly NMS, more lethal an OD due to QTC prolongation and potential for heart block and Vtach
Rare risk for agranulocytosis and slightly higher seizure risk that high potency

74
Q

Mid potency typical antipsychotics

A 
Loxapine: Loxitane
Higher risk of seizures, metabolite is an anti-depressant
Thiothixene: Navane
Can cause ocular pigment changes
Molindone: Moban
Perphenazine: Trilafon
75
Q

Hi potency Typical antipsychotics

A

Les sedation, Orthostatic hypotension, and anti-cholinergic effects
Greater risk for EPS and TD
Haloperidol: Haldol – can be given PO/IM/IV, decanoate – long-acting – form available
Fluphenazine: Prolixin – decanoate form available
Pimozide: Orap- associated with QTC prolongation and VTach

psych (5 decks)

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