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FUN MED Spring 2018 > Pharm Exam1 > Flashcards

Pharm Exam1 Flashcards

1
Q

What Bipolar Medication? When combined with clozapine has an additive risk of life threatening agranulocytosis? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Carbamazepine

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2
Q

What am I? Contraindicated for older adults (fall risk), current/past chemical alcohol dependency (risk of addiction), sleep apnea (risk of respiratory depression), on CNS depressants like alcohol/opioids (risk of respiratory depression). Avoid for long term anxiety tx?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

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3
Q

Which one(s)? Control NREM sleep? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?

A

5-HT

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4
Q

Which Bipolar medication? Has a narrow therapeutic index and so requires serum monitoring of its concentration, esp early on? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lithium

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5
Q

What am I? - Chlordiazepoxide

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

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6
Q

What are we? Venlafaxine Desvenlafaxine Duloxetine

A

SNRIs

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7
Q

What Bipolar Medication? Requires very slow titration? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lamotrigine

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8
Q

What are we? Trazodone Nefazodone

A

5-HT antagonists

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9
Q

What am I? Clonidine

A

Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine

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10
Q

What am I? - Chlorazepate

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

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11
Q

Which 5-HT antagonist also weakly blocks NE reuptake and has weak alpha blocking properties? Trazodone Nefazodone

A

Nefazodone

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12
Q

What are ways to address the sexual dysfunction AE of SSRIs?

A

May improve with time, decrease dose, drug holiday, PDE-5 inhibitors, or switching antidepressants (to bupropion or mirtazapine)

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13
Q

What? Is dosed several times a day and is safer than benzos?

A

Buspirone

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14
Q

What am I? Dexmethylphenidate

A

Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

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15
Q

What? Has no potential for abuse, addiction, withdrawal, or use as an alcohol/sedative-hypnotic?

A

Buspirone

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16
Q

What are we? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

A

Anxiety Meds Benzodiazepines

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17
Q

What is the MOA for SNRIs? Venlafaxine Desvenlafaxine Duloxetine

A

5-HT and NE reuptake inhibition

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18
Q

What are TCAs not first line for suicidal patients?

A

Toxic in overdose. Lethal dose can be achieved in less than 1 month supply (30mg/kg)

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19
Q

What Bipolar Medication? AEs: GI, Tremor, Drowsiness, and Weight Gain (50% of pts) Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Divalproex Sodium and Valproic Acid (AKA Divalproex)

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20
Q

What benzo? Has the fastest onset? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

A
  • Diazepam
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21
Q

What antidepressants have shown to be safer in pregnancy?

A

Sertraline, fluoxetine, citalopram, and TCAs

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22
Q

What? Is located only in the gut (dietary restrictions are necessary) where it binds to 5-HT, DA, NE, and epinephrine?

A

MAO-A

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23
Q

What? Interacts with and has its levels *increased by MAOIs and CYP3A4 inhibitors* (verapamil, diltiazem, itraconazole, fluvoxamine, erythromycin) and its levels *reduced by CYP enzyme inducers* (Rifampin)?

A

Buspirone

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24
Q

What Bipolar Medication? Has a wide therapeutic index, and so an acute toxicity or overdose are not life threatening? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Divalproex Sodium and Valproic Acid (AKA Divalproex)

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25
Q

What are we? - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine

A

Tricyclic Antidepressants (TCAs)

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26
Q

When can patients expect to see results from their antidepressant?

A

Not immediately! Physical symptoms like sleep, appetite, and energy may improve in 1-2 weeks. Emotional symptoms like sadness and anhedonia may take >2-4 weeks Usually 6-8 weeks for full antidepressant effect.

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27
Q

What? Acts to Inhibit the enzyme responsible for the breakdown of 5-HT, NE, and DA, thereby increasing their levels?

A

Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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28
Q

What? Are the only FDA approved agents to treat depression in patients <18 yo

A

Fluoxetine and Escitalopram

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29
Q

What am I? Lisdexamfetamine

A

Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

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30
Q

What am I? - Tranylcypromine

A

Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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31
Q

Which two TCAs have the most sedative and anticholinergic properties?

A

Amitriptyline and imipramine

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32
Q

What ADHD medication(s)? Has the onset of up to 4 weeks? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Atomoxetine
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33
Q

When treating ADHD, what drug class? Is 1st line for children 6+ with a response rate of 70-90% and is generally safe and effective?

A

Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

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34
Q

What are drug interactions of TCAs?

A

Can cause additive effects with drugs that cause sedation, hypotension, and anticholinergic (causing too much). Interacts with MAOIs and Linezolid (increases serotonin) - can cause serotonin syndrome

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35
Q

What? May precipitate a manic episode or induce rapid cycling (except maybe in combination with a mood stabilizer) when treating Bipolar?

A

Antidepressants

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36
Q

Why do SNRIs easily cause withdrawal symptoms after missed doses? Venlafaxine Desvenlafaxine Duloxetine

A

Short half lifes

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37
Q

What is the NE and DA reuptake inhibitor drug name? (NDRI)

A

Bupropion

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38
Q

What ADHD medication(s)? Are less effective than stimulants, alleviate insomnia, and are adjuncts to control disruptive/aggressive behavior, - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Clonidine - Guanfacine
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39
Q

What? Has *MAJOR RISK FOR* dietary restrictions, drug interactions, serotonin syndrome, and *hypertensive crisis!**? *Especially if combined with *sympathomimetic drugs or foods rich in tyramine*, such as ephedrine, pseudoephedrine, phenylephrine, phenylpropanolamine, amphetamines, methyphenidate,, or foods such as tap beers, aged cheeses, fava beans, yeast extracts, liver, dry sausage, sauerkraut, tofu, AND MORE

A

Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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40
Q

What am I? Bupropion

A

Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine

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41
Q

What Bipolar Medication? Is an Autoinducer, which means that it induces it’s own metabolism, and so may need inc dose after 1 mo therapy? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Carbamazepine

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42
Q

What ADHD medication(s)? *Weakly inhibits the reuptake of NE and DA*, is generally *well tolerated*, has minimal side effects and is a good choice if the patient *also has depression*? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Bupropion
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43
Q

What is the onset of stimulants?

A

30 minutes. A 3 month trial is useful Switch to a different stimulant if 1st fails. If 2nd fails, could try a 3rd and/or re-evaluate the diagnosis.

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44
Q

What Bipolar Medications? Are Pregnancy and Postpartum Category C and D? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

*D- Lithium* -Ebstein anomaly: 0.1% -Renal clearance increases as pregnancy progresses—may need to dec or d/c at term/onset of labor -AVOID Breastfeeding: Hypotonicity, cyanosis in neonate– “floppy baby syndrome” *D- Divalproex* -Neural tube defects (spina bifida) in 1st tri (weeks 3&4): 9% - Facial growth abnormalities *D- Carbamazepine* -Vitamin K deficiency—clotting factor issues *C- Lamotrigine* -Increased risk of oral clefts *C- Oxcarbazepine*

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45
Q

What is this? Divalproex

A

Mood Stabilizing Agent

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46
Q

What are the AE of SNRIs? Venlafaxine Desvenlafaxine Duloxetine

A

Similar to SSRIs including CNS stimulation, sexual dysfunction, serotoninergic effects, nausea/GI upset, BP elevation (may need to change med), and hepatic injury

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47
Q

What are the partial 5-HT agonist drug names?

A

Vortioxetine and Vilazodone

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48
Q

What should you educate the patient on when tapering benzos?

A

Minor withdrawal symptoms and discomfort likely when tapering. Rebound symptoms are possible and ok if transient, does not indicate a relapse necessarily. However, 50% of pt may experience a relapse/recurrence of anxiety during taper.

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49
Q

What disease am I? A disorder of self-regulation or response inhibition wherein a dysfunction of NE and DA may be key.

A

ADHD

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50
Q

What am I? - Selegiline

A

Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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51
Q

What ADHD medication(s)? Worsen *tics and movement disorders*, increases *seizure and suicide risk* and are *contraindicated if seizure and eating disorders*? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Bupropion
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52
Q

What is the MOA of Vortioxetine?

A

Agonists/antagonists/partial agonist at various 5-HT receptors. Affinity for beta, H, and acetylcholine receptors. (impacts AE)

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53
Q

What am I? Atomoxetine

A

Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine

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54
Q

Which SNRIs are more likely to cause nausea/GI upset? How can this be addressed? Venlafaxine Desvenlafaxine Duloxetine

A

Venlafaxine and desvenlafaxine. Start with lower dose and take with food.

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55
Q

What are the AE of the NDRI Bupropion?

A

Activation - weight loss, GI upset, insomnia, nightmares, decreased appetite, anxiety, tremors, seizures Insomnia/nighmares can be addressed by taking the last daily dose in late afternoon

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56
Q

What am I? - Phenelzine

A

Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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57
Q

What? Has the side effects of *sedation and is an anticholinergic* (dry mouth, blurry vision, constipation, drowsiness, sedation, hallucinations, memory impairment, difficulty urinating)?

A

Hydroxyzine

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58
Q

What am I? Fluvoxamine

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

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59
Q

What are the AE of St. John’s Wort?

A

GI irritation, HA, fatigue, nervousness

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60
Q

What? Does an increase in NE cause in anxiety?

A

Arousal, anxiety, and panic

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61
Q

What are we? - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

A

Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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62
Q

What? Has an onset of 2 weeks, does not have the AE of sedation, but can cause dizziness, nausea and headaches?

A

Buspirone

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63
Q

What? In treating Bipolar with Lithium would prompt you to switch the patient to either a sustained release version, a smaller dose more frequently, or a low dose beta blocker, such as Propranolol?

A

Tremor (occurs in 50% of pts being treated for Bipolar)

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64
Q

What Bipolar Medication? Is most effective for *maintenance treatment* of bipolar and is *more effective for depression relapse prevention* than for mania relapse prevention Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lamotrigine

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65
Q

What ADHD medication(s)? Is similar to stimulants, increase BP and HR and causes *growth retardation*, weight loss, *severe hepatotoxicity* and an increase in suicidal ideation? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Atomoxetine
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66
Q

What theory attempts to explain depression as *“a deficit of either NE, DA, or 5-HT at receptor synapses”*?

A

Biogenic Amine and Receptor Hypothesis

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67
Q

What am I? Anxiety med class that requires a SLOW 2-8 week taper if treatment was 2-6 months, or 2-4 month taper if it was 12 months long and reduced by 25% q5-7 days until at 1/2 original dose, then 10-12% q7

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

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68
Q

What? Involves the thalamus, amygdala, cerebral cortex, RAS, GABA, and HPA-axis?

A

Anxiety

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69
Q

What? Has the potential for fatal overdose, orthostatic hypotension, dizziness, drowsiness/insomnia, nausea, weight gain, headache, hyperreflexia, tremors, paresthesias as well as sexual dysfunction?

A

Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

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70
Q

What? Is the serum concentration for lithium toxicity that can be life threatening?

A

>2mEq/L Maintenance goal = 0.6 to 1.4 mEq/L Toxicity is more likely if fluid/sodium loss from hot weather/exercise *dehydration* or drug interactions that inc lithium concentration

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71
Q

What? Drug class is the most effective and commonly used treatment for *short term management* of anxiety?

A

Benzodiazepines

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72
Q

What ADHD medication(s)? Interacts with fluoxetine, and paroxetine (i.e., *CYP2D6s*) and so needs *SLOW titration*? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Atomoxetine
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73
Q

What are we? Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

A

Stimulants to treat ADHD

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74
Q

Which Bipolar medication? If a patient is being treated for Bipolar and presents with Polyuria and polydipsia, what is the patient suffering from, what medication caused these symptoms and how do you correct it?

A

Nephrogenic diabetes insipidus, Lithium, Treat with amiloride or HCTZ (reduce lithium dose b/c of interaction)

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75
Q

What? Is the general tx for anxiety?

A

Psychotherapy, pharmacotherapy, both

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76
Q

What am I? - Diazepam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

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77
Q

When treating ADHD, what drug class? Has the formulations of either short, intermediate, or extended release and has a starting dose that needs to be tapered up and titrated to meet the patient’s symptoms and monitored for and adjusted according to the drugs AE’s?

A

Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

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78
Q

What Bipolar Medication? Has more serious blood count abnormalities, such as aplastic anemia and agranulocytosis, and so can be life threatening and requires monitoring? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Carbamazepine

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79
Q

What am I? AE of CNS depression, drowsiness, sedation, psychmotor impairment, respiratory depression, poor recall, amnesia, disinhibition, confusion, irritability, aggression, excitement, dependence and addiction?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

80
Q

What? Drug class is not effective for the treatment of depression in anxiety, and has a risk of dependency and abuse as well as rebound anxiety in between doses?

A

Benzodiazepines

81
Q

What? Drug class has the MOA of modulating either synaptic 5-HT, NE or DA reuptake or neuronal signal transduction, thereby modifying the patient’s gene expression and their response to stress?

A

SSRIs

82
Q

ADHD alone increases a patient’s risk for what disorder?

A

Substance abuse

83
Q

When treating ADHD, these are contraindications to what? Glaucoma, severe HTN, CV disease, hyperthyroidism, severe anxiety, previous illicit/stimulant drug abuse. Also, use cautiously if seizures, tourette syndrome, and motor tics.

A

Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

84
Q

For the treatment of ADHD, in what age group is the non-pharmacologic therapy *behavioral therapy* first line?

A

pre-schoolers

85
Q

What am I? Fluoxetine

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

86
Q

What? Carries drug class a blackbox warning because they increases the risk of suicidality in children and young adults?

A

All antidepressants

87
Q

What is the MOA of Vilazodone?

A

5-Ht reuptake inhibition and partial agonist at 5-HT1A receptors. Also may reduce negative feedback on 5-HT receptors which may improve antidepressant effect.

88
Q

What am I? Dextroamphetamine

A

Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

89
Q

What Bipolar Medication? Requires caution and dose adjustments when combined with Divalproex due to life threatening SJS rash? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lamotrigine

90
Q

What organic chemical does this? Regulates learning, motivation, goal setting, and memory?

A

DA

91
Q

What am I? Guanfacine

A

Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine

92
Q

What am I? Sertraline

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

93
Q

What am I? Dextroamphetamine-amphetamine

A

Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

94
Q

What is the MOA of 5-HT antagonists? Trazodone Nefazodone

A

5-HT reuptake inhibition. Potentially block 5-HT2A receptors, which allows more 5-HT to interact at postsynaptic 5-HT1A sites.

95
Q

What? Drugs can cause anxiety?

A

Anticonvulsants, antidepressants, BP meds, abx, parkinson meds, bronchodilators, corticosteroids, decongestants, herbals, NSAIDs, stimulants, thyroid hormones, toxicity, and withdrawal of CNS depressants

96
Q

What am I? Paroxetine

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

97
Q

Which SNRIs have primarily 5-HT reuptake activity? Venlafaxine Desvenlafaxine Duloxetine

A

Venlafaxine Desvenalfaxine

98
Q

What is the most likely diagnosis if? A patient presents with sharply elevated BP, occipital headache, stiff/sore neck, nausea, vomiting, and sweating while taking an MAOI for treatment ofMDD?

A

Hypertensive Crisis

99
Q

What is this? Oxcarbazepine

A

Mood Stabilizing Agent

100
Q

How long do you have to wait to give a patient an MAOI if the patient was previously on Fluoxetine, specifically, or if they were on any other SSRI? More importantly, why?

A

5 weeks for fluoxetine (long half life) 14 days from any other SSRI Due to the increased risk of serotonin syndrome

101
Q

Which one(s)? Mediate REM sleep? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?

A

Cholinergic, adrenergic

102
Q

What? Cause sedative, anticholinergic and CV effects (toxic in overdose, Quinidine-like effects on the heart)

A

Tricyclic Antidepressants (TCAs) - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine

103
Q

What? Drug class enhances transmission of the inhibitory neurotransmitter GABA and so has nonspecific antianxiety effects?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

104
Q

What Bipolar Medication? Is *equally as effective as lithium for treating bipolar mania*, is only modestly effective for rapid cycling, mixed mode features and a substance abuse comorbidity and is widely used for *maintenance therapy*? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Divalproex Sodium and Valproic Acid (AKA Divalproex)

105
Q

What SSRi has a short half life and missed doses can more easily cause withdrawal symptoms? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

A

Paroxetine

106
Q

What are the AE of partial 5-HT agonists?

A

GI upset

107
Q

What am I? Escitalopram

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

108
Q

What am I? Metabolized by CYP3A4, glucuronide conjugation, and many metabolized to long acting active metabolites?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

109
Q

What ADHD medication(s)? Cause hypotension, rebound HTN, bradycardia, irregular heart beats, sudden death or sedation (usually improves)? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Clonidine - Guanfacine
110
Q

What Bipolar Medication? Interacts with many medications, such as anticonvulsants and antidepressants, but is *especially dangerous in combination with Lamotrigine* due to life threatening SJS Rash? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Divalproex Sodium and Valproic Acid (AKA Divalproex)

111
Q

What? Blocks the reuptake of 5-HT and NE as well as alpha-1, histamine-1 and muscarinic receptors?

A

Tricyclic Antidepressants (TCAs) - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine

112
Q

What? Is located only in the brain where it binds to DA and pnenethylamine?

A

MAO-B

113
Q

What? Are considerations when treating MDD in geriatric patients?

A

They are more sensitive to antidepressant AEs. Use SSRIs, bupropion, SNRIs, and mirtazapine. Avoid TCA (causes falls, urinary retention, CV problems) and MAOI

114
Q

What is the course/prognosis of MDD? What is the suicide rate?

A

Symptoms develop gradually, over days to weeks. Most patients experience multiple MDE episodes. Suicide rate is 15%.

115
Q

What do we do if a patient’s antidepressant doesn’t work?

A

Extend trial, try higher doses, switch to a different antidepressant in the same or different class, psychotherapy, add another antidepressant, or add a non-antidepressant med like anti-anxiety, mood stabilizer, ect.

116
Q

What are the contraindications of the NDRI Bupropion?

A

CNS lesion, hx of seizures, head trauma, bulimia

117
Q

What am I? Anxiety med class that requires careful tapering so as to avoid withdrawal symptoms, such as seizures, rebound anxiety, relapse (high rates!), or, if stopped abruptly, death?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

118
Q

What are the drug interactions of 5-HT antagonists?

A

Significant additive AE with drugs that cause hypotensive and sedative effects

119
Q

What organic chemical does this? Maintains alertness and attention?

A

NE

120
Q

When treating ADHD, when should stimulants be administered and why?

A

30 min before eating and early in the day so as to avoid insomnia.

121
Q

How long do you have to wait after d/c Linezolid or MAOI before giving TCA?

A

14 days

122
Q

What are these? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Mood Stabilizing Agents

123
Q

What? Is non-additive and can be used either PRN or scheduled?

A

Hydroxyzine

124
Q

What SSRI can cause QT prolongation? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

A

Citalopram

125
Q

What? May be less effective in patients if they have been previously treated with a benzodiazepine?

A

Buspirone

126
Q

What? Drug class reduces psychic symptoms (thinking - worry, apprehension), modestly reduces autonomic/somatic symptoms (tremor, HR, sweating) and has an onset 2-4 weeks?

A

Anti-depressants

127
Q

What is this? Lamotrigine

A

Mood Stabilizing Agent

128
Q

What Bipolar Medication? Has an antidiuretic effect and can cause hyponatremia? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Carbamazepine

129
Q

What? Is the treatment for Lithium toxicity when treating Bipolar disease?

A

d/c IV fluids (correct fluid and electrolyte imbalance) Osmotic diuresis or hemodialysis Overdose? Gastric lavage

130
Q

What SNRI is contraindicated in chronic liver disease or mod-heavy alcohol use because it is more likely to cause hepatic injury? Venlafaxine Desvenlafaxine Duloxetine

A

Duloxetine

131
Q

How long do you have to wait after d/c Linezolid or MAOI before giving Mirtazepine?

A

14 days

132
Q

What is the efficacy and response rate of antidepressants?

A

60-80% response rate, similar efficacy across classes but AEs limit use of some (such as MAOIs and trazodone - sedation)

133
Q

Which anti-depressant meds can cause withdrawal syndromes if d/c too fast because of their short half lives?

A

Venlafaxine, paroxetine, and fluvoxamine

134
Q

What? Is an H1 blocker that is less desirable for long term treatment?

A

Hydroxyzine

135
Q

What are the drug interactions of Mirtazepine?

A

Significant additive AEs with drugs that cause hypotensive and sedative effects

136
Q

What am I? - Lorazepam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

137
Q

What are the AE of Mirtazepine?

A

Sedation (due to H1 blocking, weight gain (due to H1 blocking), neutropenia, sertonergic-related AE (due to 5HT blocking)

138
Q

What SSRI has a very long half like and needs a 5 week washout before starting MAOIs? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

A

Fluoxetine

139
Q

What ADHD medication(s)? Antagonize central alpha 2 receptors, and, therefore, inhibit presynaptic release of NE? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Clonidine - Guanfacine
140
Q

What is the MOA of St. John’s Wort?

A

Mild MAO inhibiting properties. Efficacy in mild-moderate depression, minimal efficacy for moderate to severe depression.

141
Q

What? Is an alternative agent to treat *GAD w/o depression*?

A

Buspirone

142
Q

If depressive symptoms return during a taper, what do we do?

A

Go back to the original dosing quickly. Try to taper more slowly, or the patient may be a cannidate for life long treatment

143
Q

What are we? Atomoxetine Bupropion Clonidine Guanfacine

A

Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine

144
Q

What benzo? Is not CYP3A4 metabolized and so is *preferred if hepatic dysfunction*? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

A

Lorazepam and Oxazepam

145
Q

What is this? Lithium

A

Mood Stabilizing Agent

146
Q

What? Is the drug class of choice for treating chronic GAD, SAD, and panic disorder due to its tolerable side effects, no risk of dependency and good efficacy in treating common comorbid conditions?

A

SSRIs

147
Q

What am I? - Isocarboxazid

A

Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid

148
Q

How long is depression treated for?

A

Acute phase: 6-12 weeks Continuation phase: 4-9 months Maintenance phase: 12 months - lifetime (But some pt can taper after a year)

149
Q

What are important patient education points to discuss when putting a patient on an MAOI?

A

Counsel patients regarding interactions (foods and OTC medications), do not prescribe interacting drugs, use MAOIs as last line.

150
Q

What are AE of stimulants?

A

Hallucinations, abnormal movements, growth suppression/delay, substance abuse

151
Q

How should MDD in peds patients be treated?

A

SSRIs (but can cause behavioral activation). Avoid Desipramine - causes sudden death, CV issues.

152
Q

What are ways MDD is treated?

A

Pharmacotherapy, CBT, ECT, light therapy, vagus nerve stimulation, transcranial magnetic stimulation, physical exercise

153
Q

When treating ADHD, what drug class? Blocks the reuptake of DA and NE, thereby improving fidgeting, finger taping, on-task behavior, positive interactions and conduct and anxiety disorders?

A

Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

154
Q

What is the most likely diagnosis if? A patient presents with confusion, restlessness, fever, abnormal muscle movements, hyperreflexia, sweating, diarrhea and shivering?

A

Serotonin syndrome

155
Q

Which 5-HT antagonist also blocks H and alpha receptors? Trazodone Nefazodone

A

Trazodone

156
Q

What are the AE of SSRIs?

A

Sexual dysfunction (delayed/absent orgasm), CNS stimulation (nervousness, insomnia, sedation), and GI disturbance (n/d)

157
Q

For the treatment of ADHD, *medication alone* is generally superior in improving what? a) oppositional behaviors b) aggressive behaviors c) attention d) oppositional and aggressive behaviors

A

c) attention

158
Q

What am I? Methylphenidate

A

Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine

159
Q

How long do you have to wait after d/c Linezolid or MAOI before giving a 5-HT antagonist?

A

14 days

160
Q

What is the MOA of the NDRI Bupropion?

A

NE and DA reuptake inhibition

161
Q

What is this? Carbamazepine

A

Mood Stabilizing Agent

162
Q

What is the MOA of Mirtazepine?

A

Blocks presynaptic alpha 2 autoreceptors causing increases in NE and 5-HT synaptic concentrations. Also blocks post synaptic 5-HT receptors and H1 receptors.

163
Q

What? Reduce somatic symptoms like heart rate and sweating, but not does address psychic symptoms or avoidance behaviors?

A

Beta Blockers

164
Q

What benzo? Has the shortest lasting effects? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

A

Oxazepam, Lorazepam, Temazepam, Alprazolam

165
Q

What benzo? Has the longest lasting effects? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

A
  • Clonazepam - Diazepam
166
Q

What? Do antidepressants, benzos, buspirone, hydroxyzine, beta blockers, second generation antipsychotics, and pregabalin treat?

A

Anxiety

167
Q

What? Is a 5-HT1A partial agonist, reduces presynaptic 5-HT firing, has no potential for abuse, addiction, withdrawal, or use as an alcohol/sedative-hypnotic?

A

Buspirone

168
Q

How long do you have to wait to give a patient an MAOI if they were previously on an MAOI, a TCA, carbamazepine or cyclobenzaprine?

A

1 week

169
Q

How is ADHD monitored?

A

Consult with family and teachers. Standardized rating scales. Evaluate every 2-4 weeks for efficacy and BP. After, follow up every 3 months and monitor height, weight, and AE.

170
Q

Which Bipolar medication? Requires renal monitoring as it is cleared by kidneys and is more likely to cause toxicity? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lithium

171
Q

What am I? - Alprazolam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

172
Q

What 5-HT antagonist causes Sedation and priapism?

A

Trazadone

173
Q

What 5-HT antagonist has a Blackbox Warning fatal hepatotoxicity?

A

Nefazodone

174
Q

What ADHD medication(s)? Has an onset of 1-2 months? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Bupropion
175
Q

What am I? - Oxazepam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

176
Q

What Bipolar Medication? Is *effective for mood stabilization* but is less desirable due to *safety and drug interactions* and should be used only if the patient has *failed lithium or suffers from rapid cycling or mixed bipolar disorder*? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Carbamazepine

177
Q

Which one(s)? Play a role in wakefulness? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?

A

Hypocretin, substance P, histamine

178
Q

What am I? Citalopram

A

SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

179
Q

What? Medication class is equally effective at equivalent doses?

A

Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

180
Q

How should anti-depressants be tapered?

A

Decrease dose every 3-5 days

181
Q

What am I? - Temazepam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

182
Q

Which SNRIs have balanced 5-HT and NE reuptake activity? Venlafaxine Desvenlafaxine Duloxetine

A

Duloxetine

183
Q

What? Helps reduce somatic symptoms but not psychic symptoms?

A

Hydroxyzine and Beta Blockers

184
Q

What ADHD medication(s)? Is 2nd or 3rd line? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A

Atomoxetine

185
Q

What Bipolar Medication? Carries the AE of *Maculopapular rash* (10%), which is usually benign and temporary but can progress to life-threatening SJS? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lamotrigine

186
Q

What Bipolar Medication? Carries less AE of weight gain? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lamotrigine

187
Q

What should you consider when deciding what antidepressant to choose?

A

Patient’s history of response, any history of first degree relatives who have used the drug, AEs, interactions, use of contraindicated medications, comorbidities, risk of overdose and affordability

188
Q

For the treatment of ADHD, *behavioral therapy + stimulant* is generally superior in improving what? a) oppositional behaviors b) aggressive behaviors c) attention d) oppositional and aggressive behaviors

A

d) oppositional and aggressive behaviors

189
Q

What ADHD medication(s)? Selectively inhibits reuptake of NE and other NT. No abuse potential, not a controlled substance? - Atomoxetine - Bupropion - Clonidine - Guanfacine

A
  • Atomoxetine
190
Q

What is the CYP that St. John’s Wort causes hell in?

A

CYP3A4

191
Q

What are we? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

A

SSRIs

192
Q

What? Drug class is more effective for somatic symptoms than for psychic symptoms in anxiety?

A

Benzodiazepines

193
Q

Which Bipolar medication? Is an antimanic that prevents relapse, is only modestly effective for acute bipolar depression, but greatly reduces suicidal behavior by 70%? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine

A

Lithium

194
Q

What? Does an increase in 5-HT cause in anxiety?

A

Inhibition of the firing of noradrenergic cells

195
Q

What am I? - Clonazepam

A

Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam

196
Q

What perinatal sequelae are possible with antidepressants?

A

Poor adaptation, respiratory distress, feeding problems, and jitteriness

FUN MED Spring 2018 (1 decks)

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