Pharm Blessings last time ever AYO Flashcards
this is about to be a blast
PSYCH!
^^^^see what I did there^^^^
anyway, no, this is not about to be fun
are hallucinations a positive or negative psychosis symptom
positive
how do you treat positive psychosis symptoms?
WELL, historically, they use FGA if someone has only positive symptoms. BUT in class they said: SGA like risperidone [risperdal] or quetiapine [seroquel] So make of that what you will.
drugs that increase _______ cause sexual dysfunction in the 2nd gen antipsychotics
prolactin
does quetiapine [seroquel] increase prolactin levels?
no
the majority of the time, do we use FGA (first gen antipsych) or SGA (second gen antipsych)?
SGA
what are the 2 methods of giving risperidone [risperdal]?
PO or IM
disorganized speech, flat affect, and decreased short-term memory… positive or negative sx?
negative
what are the most prominent side effects of FGA
serious EPS*
sedation*
and more but who cares about those, i know i don’t
when on FGAs, you need to do an AIMS score every ___ months
6
What are the most prominent s/e of SGA?
metabolic*
what are the s/e of a dopamine antagonist?
uninhibited prolactin release
you have a patient with PD and agitation. what do you rx?
SGA like quetiapine [seroquel]
You have a pt with unipolar depression and hypomania. they want to know if Lurasidone [Latuda] or Quetiapine [Seroquel] is better for their mixed depressive symptoms?
Quetiapine [Seroquel]
less TD, less neuromusc sx, cheaper!
If on Clozapine [Clozaril], you need weekly blood tests to check for _______
agranulocytosis
T2DM hyperlipidemia obesity angina tobacco use are all relative c/i to what type of drug
SGA
elderly people on SSRIs have increased risk of what?
QTc prolongation
which SSRI drug has the biggest increased risk for QTc prolongation?
Citalopram [Celexa]
citalopram [celexa] + ziprasidone [geodon] causes what label of interaction?
X
how many psychotherapists does it take to change a light bulb?
Just one
as long as the lightbulb wants to change
pt is on lithium and halperidol [haldol] and has a new onset eye twitch. what’s going on?
med s/e
decrease Li
change to SGA like risperidone [risperdal]
do AIMS score
what is the average dose of halperidol [haldol]
4mg
TD is almost never seen before ______
and is usually seen after _________
not seen before 6 months
usually after 2-3y
after you fix TD, how long does it take to go away?
sometimes years
EEEEEEEEK
do FGA or SGA have an increased risk of CVD and hepatic/renal impairment?
SGA
are FGA or SGA more expensive?
SGA
just in general, _____% of people will fill their prescription by 2 weeks, and ____ will refill a second time
50
1/3
if you are on an SSRI and start Tramadol, you could get _____________
serotonin syndrome
WHEN I SAY increased heart rate, increased temp, agitation, hyperreflexes, confusion, and myoclonus YOU SAY _________
serotonin syndrome
how long does it take for fluoxetine [prozac] to clear from the system
6-8 weeks
What can tramadol cause in the elderly
seizures
THROWBACK BUT ALSO KIND OF RELATED:
what is the drug you rx for dementia in parkinson’s or alzheimer’s?
aricept
patient with dementia has increasing agitation.
what do you do?
“find the root cause. are they in pain? are they hungry?” - Maria Egger
“give ‘em the haldol” - Tom White
what drug is given for agitation, but can actually increase agitation in some?
Why is this?
benzos
work on PFC and decrease self control
what is a long-term treatment for aggression in dementia?
SGA
what is the short-term treatment for panic attacks?
benzos
what is the longest amount of time you should put a person on benzos for?
4 weeks — addicting d/t dopamine surge!!
what are two long-term therapy options for panic disorder?
SSRIs
SNRIs
what is the MC s/e of SSRIs in men (also happens in women)?
sexual dysfunction
if a pt is on an ssri and gets sexual dysfunction then what should you rx instead?
long-term hooker services
and if that doesn’t work then Buproprion [Wellbutrin]
what is the DOC for post-partum depression
sertraline [zoloft] and CBT
ssri’s are passed in the breast milk. how long should you wait after taking them before breast feeding?
7-9 hours
which ssri has the lowest concentration in breast milk?
sertraline [zoloft]
what is the definition of ADHD
brb gonna make a smoothie
no but really what’s the definition of ADHD
it occurs over 2 settings
you are hyperactive/impulsive AND can’t pay attention
you can’t make a serious deck of flash cards to save your life
so likkkeeeee you’ve got a pt with GAD and PTSD and we talked about TWO.. that’s right.. TWO drugs that can treat this. what are they
sertraline [zoloft]
paroxetine [paxil]
so SSRIs I’m guessingq
what happens if you combine a non-benzo + a benzo?
not like that’s broad or anything
combined hypnotic sedation effect
I know you know this by now. what is the DOC for anxiety and depression?
SSRI
what can you give off-label for insomnia?
trazadone
what is the + response rate of SSRIs
60-80%
how long does it take to get a full effect from SSRIs?
6-8 weeks
Which SSRI drug is the only one that self-titrates itself down in one week?
fluoxetine [prozac]
a pt started fluoxetine [prozac] and is now agitated and anxious with insomnia. help him please
it’s a drug s/e because this drug is stimulating
start on a less stimulating SSRI
so, which SSRIs are less stimulating/are sedative?
paroxetine [paxil]
citalopram [celexa]
eschitalopram [lexapro]
what is a c/i to buproprion [wellbutrin]?
seizure disorder
it lowers the seizure threshold
this drug that’s called Belsomra [suvorexant] (never heard of it) increases the s/e of what?
suicidal thoughts
What 2 drugs treat OCD?
Fluoxetine [prozac]
Venlafaxine [effexor]
if there is a test question that looks like this: what treats OCD? a) irrelevant answer b) something totally unrelated c) fluoxetine [prozac] d) venlafaxine [effexor] then what should you answer on the exam
fluoxetine [prozac]
because SSRIs are bae
what happens if a person is bipolar and you put them on an ssri for treatment, thinking that they have major depression?
congrats you just killed a patient
totally just kidding, it just unmasks their symptoms of mania
so in this case SSRIs are not bae
what seizure drug is also a mood stabilizer
valproate
a pt with MDD has had no effect with ssri, snri, tca, tetracyclics, or atypical antidepressants. what option is left?
MAOI
what can’t you eat with MAOIs
tyramine (bread, beer, sauerkraut)
which SSRI is on the $4 list or $5 list or what ever dollar amount it is list?
paroxetine [paxil]
how long do you have to down-titrate paroxetine [paxil]? what happens if you dont?
over 3-4 weeks
if you don’t, then insomnia, dizziness, paresthesias
SSRIs are Cat C in pregnancy except _______ which is Cat D
paroxetine [paxil]
what do SSRIs increase in the elderly?
flexibility
armpit hair
QTc prolongation
(spoiler alert: only one of those is correct)
(spoiler alert 2: i think this was already a flash card)
pt has PTSD with hallucinations
what do you put him on
SGA
pt has PTSD with hallucinations but he has DM so can’t go on an SGA. what do you put him on?
lol idk
beyond my scope
punt to psychiatry
what is a dehydrogenase inhibitor used in alcohol abuse?
yes I know that’s the politically incorrect way to say it but I already typed it so I can’t delete it now sorryyyyyy
disulfram [antabuse]
which makes them puke if they have alcohol
when would you use oxazepam [serax] in alcohol USE DISORDER
i said it correctly that time
if they had liver cirrhosis or severe hepatitis
why can you use oxazepam [serax] with liver damage?
because it produces no additional active metabolites
you only treat ADHD with drugs if the child is over _____
overly obnoxious
or over 6y
what is the DOC for ADHD
meth concerts
i mean METH-ylphenidate [CONCERT-a]
what 2 drugs can you rx if the ADHD patient fails meth concert treatment?
amphetamine [adderall]
atomoxetine [strattera]
what is the 3rd line treatment for ADHD?
Clonidine [latapres]
which ADHD drug from our table is a stimulant?
what is the treatment response when put on stimulants?
the meth concerts obviously because that sounds super stimulating
70-90% response
what should you do for your pt who wants to quit cocaine?
no rx - just detox
can give benzos to help with withdrawal symptoms
reassure that they won’t die from cocaine withdrawals
what should you do for your pt who has anorexia nervosa?
supportive tx
screen for depression and treat for that
can you mix 2 opioids
lol no dummy don’t do that
what drug can you give for both chronic pain + depression?
duloxetine [cymbalta]
“weed” will also be accepted as an answer
what’s the big deal with why we probably can’t prescribe methadone as a form of pain control as PAs?
well you see methadone has a 1/2 life of 5 days so it’s very easy for a patient to overdose without achieving pain control
also they have trust issues with us… with good reason because we all use sarcastic flash cards to learn pharmacology and then are like, what the fuck did we just learn anyway
what kind of side effects do TCAs have?
severe anticholinergic side effects
what will a psychiatrist prescribe for bipolar disorder?
lithium
what will you probably prescribe for bipolar disorder while waiting for the patient to get in for a psych eval?
SGA like quetiapine [seroquel]
patient is on lithium for bipolar d/o and has become sleepy with a fine tremor and has polyuria, polydipsia, and weight gain. WHAT ON EARTH
Diabetes insipidus is a s/e of lithium
switch to valproate
a patient has MDD. they started fluoxetine [prozac] and got anxious, just like the other patient you had earlier today.
how do you differentiate a med s/e from mania?
just ask them how many ovens they have
mania = buying lots of ovens
great education being provided at UNE
how many times per year is rapid cycling
4
what drug can you give for smoking cessation + depression?
buproprion [wellbutrin]
what is the tetracyclic antidepressant that causes sedation?
mirtazapine [remeron]
there is an opioid overdose
what drug is its anti-drug?
naloxone [narcan] IV
what opioid use drugs might you use for long-term therapy?
suboxone and methadone
drugs that bind to and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist
partial agonist drugs
omg that drug that i’ve never heard of is back
we’re going to learn about it
what is the MOA of suvorexant [belsomra]?
works on orexin receptors (primarily wake receptors)
what are the s/e of suvorexant [belsomra]
complete muscle laxity, falls, borderline narcolepsy, suicidal thoughts, unusual dreams
sounds solid
all jokes aside, I do take mental health very seriously
but these are my pharm blessings and in pharm blessings i do what i want
well my little psychology and psychiatry nerds, I hope these help and these are my LAST. FUCKING. PHARM. BLESSINGS. EVER.
BLESS YOU A TON BLESSINGTON
I’d like to thank all my fans, but also Blessington, Jesus, cinnamon toast crunch cereal, my ADD, and lastly my mother for making me weird
