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
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
3
Q
Which one(s)? Control NREM sleep? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?
A
5-HT
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
5
Q
What am I? - Chlordiazepoxide
A
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
6
Q
What are we? Venlafaxine Desvenlafaxine Duloxetine
A
SNRIs
7
Q
What Bipolar Medication? Requires very slow titration? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
A
Lamotrigine
8
Q
What are we? Trazodone Nefazodone
A
5-HT antagonists
9
Q
What am I? Clonidine
A
Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine
10
Q
What am I? - Chlorazepate
A
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
11
Q
Which 5-HT antagonist also weakly blocks NE reuptake and has weak alpha blocking properties? Trazodone Nefazodone
A
Nefazodone
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)
13
Q
What? Is dosed several times a day and is safer than benzos?
A
Buspirone
14
Q
What am I? Dexmethylphenidate
A
Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
15
Q
What? Has no potential for abuse, addiction, withdrawal, or use as an alcohol/sedative-hypnotic?
A
Buspirone
16
Q
What are we? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
A
Anxiety Meds Benzodiazepines
17
Q
What is the MOA for SNRIs? Venlafaxine Desvenlafaxine Duloxetine
A
5-HT and NE reuptake inhibition
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)
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)
20
Q
What benzo? Has the fastest onset? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
A
- Diazepam
21
Q
What antidepressants have shown to be safer in pregnancy?
A
Sertraline, fluoxetine, citalopram, and TCAs
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
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
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)
25
What are we? - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine
Tricyclic Antidepressants (TCAs)
26
When can patients expect to see results from their antidepressant?
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.
27
What? Acts to Inhibit the enzyme responsible for the breakdown of 5-HT, NE, and DA, thereby increasing their levels?
Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
28
What? Are the only FDA approved agents to treat depression in patients \<18 yo
Fluoxetine and Escitalopram
29
What am I? Lisdexamfetamine
Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
30
What am I? - Tranylcypromine
Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
31
Which two TCAs have the most sedative and anticholinergic properties?
Amitriptyline and imipramine
32
What ADHD medication(s)? Has the onset of up to 4 weeks? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Atomoxetine
33
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?
Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
34
What are drug interactions of TCAs?
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
35
What? May precipitate a manic episode or induce rapid cycling (except maybe in combination with a mood stabilizer) when treating Bipolar?
Antidepressants
36
Why do SNRIs easily cause withdrawal symptoms after missed doses? Venlafaxine Desvenlafaxine Duloxetine
Short half lifes
37
What is the NE and DA reuptake inhibitor drug name? (NDRI)
Bupropion
38
What ADHD medication(s)? Are less effective than stimulants, alleviate insomnia, and are adjuncts to control disruptive/aggressive behavior, - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Clonidine - Guanfacine
39
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
Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
40
What am I? Bupropion
Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine
41
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
Carbamazepine
42
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
- Bupropion
43
What is the onset of stimulants?
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.
44
What Bipolar Medications? Are Pregnancy and Postpartum Category C and D? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
\*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\*
45
What is this? Divalproex
Mood Stabilizing Agent
46
What are the AE of SNRIs? Venlafaxine Desvenlafaxine Duloxetine
Similar to SSRIs including CNS stimulation, sexual dysfunction, serotoninergic effects, nausea/GI upset, BP elevation (may need to change med), and hepatic injury
47
What are the partial 5-HT agonist drug names?
Vortioxetine and Vilazodone
48
What should you educate the patient on when tapering benzos?
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.
49
What disease am I? A disorder of self-regulation or response inhibition wherein a dysfunction of NE and DA may be key.
ADHD
50
What am I? - Selegiline
Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
51
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
- Bupropion
52
What is the MOA of Vortioxetine?
Agonists/antagonists/partial agonist at various 5-HT receptors. Affinity for beta, H, and acetylcholine receptors. (impacts AE)
53
What am I? Atomoxetine
Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine
54
Which SNRIs are more likely to cause nausea/GI upset? How can this be addressed? Venlafaxine Desvenlafaxine Duloxetine
Venlafaxine and desvenlafaxine. Start with lower dose and take with food.
55
What are the AE of the NDRI Bupropion?
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
56
What am I? - Phenelzine
Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
57
What? Has the side effects of \*sedation and is an anticholinergic\* (dry mouth, blurry vision, constipation, drowsiness, sedation, hallucinations, memory impairment, difficulty urinating)?
Hydroxyzine
58
What am I? Fluvoxamine
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
59
What are the AE of St. John's Wort?
GI irritation, HA, fatigue, nervousness
60
What? Does an increase in NE cause in anxiety?
Arousal, anxiety, and panic
61
What are we? - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
62
What? Has an onset of 2 weeks, does not have the AE of sedation, but can cause dizziness, nausea and headaches?
Buspirone
63
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?
Tremor (occurs in 50% of pts being treated for Bipolar)
64
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
Lamotrigine
65
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
- Atomoxetine
66
What theory attempts to explain depression as \*"a deficit of either NE, DA, or 5-HT at receptor synapses"\*?
Biogenic Amine and Receptor Hypothesis
67
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
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
68
What? Involves the thalamus, amygdala, cerebral cortex, RAS, GABA, and HPA-axis?
Anxiety
69
What? Has the potential for fatal overdose, orthostatic hypotension, dizziness, drowsiness/insomnia, nausea, weight gain, headache, hyperreflexia, tremors, paresthesias as well as sexual dysfunction?
Monoamine Oxidase Inhibitors (MAOIs) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
70
What? Is the serum concentration for lithium toxicity that can be life threatening?
\>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
71
What? Drug class is the most effective and commonly used treatment for \*short term management\* of anxiety?
Benzodiazepines
72
What ADHD medication(s)? Interacts with fluoxetine, and paroxetine (i.e., \*CYP2D6s\*) and so needs \*SLOW titration\*? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Atomoxetine
73
What are we? Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
Stimulants to treat ADHD
74
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?
Nephrogenic diabetes insipidus, Lithium, Treat with amiloride or HCTZ (reduce lithium dose b/c of interaction)
75
What? Is the general tx for anxiety?
Psychotherapy, pharmacotherapy, both
76
What am I? - Diazepam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
77
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?
Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
78
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
Carbamazepine
79
What am I? AE of CNS depression, drowsiness, sedation, psychmotor impairment, respiratory depression, poor recall, amnesia, disinhibition, confusion, irritability, aggression, excitement, dependence and addiction?
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
80
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?
Benzodiazepines
81
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?
SSRIs
82
ADHD alone increases a patient's risk for what disorder?
Substance abuse
83
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.
Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
84
For the treatment of ADHD, in what age group is the non-pharmacologic therapy \*behavioral therapy\* first line?
pre-schoolers
85
What am I? Fluoxetine
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
86
What? Carries drug class a blackbox warning because they increases the risk of suicidality in children and young adults?
All antidepressants
87
What is the MOA of Vilazodone?
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
What am I? Dextroamphetamine
Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
89
What Bipolar Medication? Requires caution and dose adjustments when combined with Divalproex due to life threatening SJS rash? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
Lamotrigine
90
What organic chemical does this? Regulates learning, motivation, goal setting, and memory?
DA
91
What am I? Guanfacine
Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine
92
What am I? Sertraline
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
93
What am I? Dextroamphetamine-amphetamine
Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
94
What is the MOA of 5-HT antagonists? Trazodone Nefazodone
5-HT reuptake inhibition. Potentially block 5-HT2A receptors, which allows more 5-HT to interact at postsynaptic 5-HT1A sites.
95
What? Drugs can cause anxiety?
Anticonvulsants, antidepressants, BP meds, abx, parkinson meds, bronchodilators, corticosteroids, decongestants, herbals, NSAIDs, stimulants, thyroid hormones, toxicity, and withdrawal of CNS depressants
96
What am I? Paroxetine
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
97
Which SNRIs have primarily 5-HT reuptake activity? Venlafaxine Desvenlafaxine Duloxetine
Venlafaxine Desvenalfaxine
98
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?
Hypertensive Crisis
99
What is this? Oxcarbazepine
Mood Stabilizing Agent
100
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?
5 weeks for fluoxetine (long half life) 14 days from any other SSRI Due to the increased risk of serotonin syndrome
101
Which one(s)? Mediate REM sleep? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?
Cholinergic, adrenergic
102
What? Cause sedative, anticholinergic and CV effects (toxic in overdose, Quinidine-like effects on the heart)
Tricyclic Antidepressants (TCAs) - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine
103
What? Drug class enhances transmission of the inhibitory neurotransmitter GABA and so has nonspecific antianxiety effects?
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
104
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
Divalproex Sodium and Valproic Acid (AKA Divalproex)
105
What SSRi has a short half life and missed doses can more easily cause withdrawal symptoms? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
Paroxetine
106
What are the AE of partial 5-HT agonists?
GI upset
107
What am I? Escitalopram
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
108
What am I? Metabolized by CYP3A4, glucuronide conjugation, and many metabolized to long acting active metabolites?
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
109
What ADHD medication(s)? Cause hypotension, rebound HTN, bradycardia, irregular heart beats, sudden death or sedation (usually improves)? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Clonidine - Guanfacine
110
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
Divalproex Sodium and Valproic Acid (AKA Divalproex)
111
What? Blocks the reuptake of 5-HT and NE as well as alpha-1, histamine-1 and muscarinic receptors?
Tricyclic Antidepressants (TCAs) - Amitriptyline - Imipramine - Desipramine - Nortriptyline - Amoxapine - Clomipramine - Doxepin - Maprotiline - Protriptyline - Trimipramine
112
What? Is located only in the brain where it binds to DA and pnenethylamine?
MAO-B
113
What? Are considerations when treating MDD in geriatric patients?
They are more sensitive to antidepressant AEs. Use SSRIs, bupropion, SNRIs, and mirtazapine. Avoid TCA (causes falls, urinary retention, CV problems) and MAOI
114
What is the course/prognosis of MDD? What is the suicide rate?
Symptoms develop gradually, over days to weeks. Most patients experience multiple MDE episodes. Suicide rate is 15%.
115
What do we do if a patient's antidepressant doesn't work?
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
What are the contraindications of the NDRI Bupropion?
CNS lesion, hx of seizures, head trauma, bulimia
117
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?
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
118
What are the drug interactions of 5-HT antagonists?
Significant additive AE with drugs that cause hypotensive and sedative effects
119
What organic chemical does this? Maintains alertness and attention?
NE
120
When treating ADHD, when should stimulants be administered and why?
30 min before eating and early in the day so as to avoid insomnia.
121
How long do you have to wait after d/c Linezolid or MAOI before giving TCA?
14 days
122
What are these? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
Mood Stabilizing Agents
123
What? Is non-additive and can be used either PRN or scheduled?
Hydroxyzine
124
What SSRI can cause QT prolongation? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
Citalopram
125
What? May be less effective in patients if they have been previously treated with a benzodiazepine?
Buspirone
126
What? Drug class reduces psychic symptoms (thinking - worry, apprehension), modestly reduces autonomic/somatic symptoms (tremor, HR, sweating) and has an onset 2-4 weeks?
Anti-depressants
127
What is this? Lamotrigine
Mood Stabilizing Agent
128
What Bipolar Medication? Has an antidiuretic effect and can cause hyponatremia? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
Carbamazepine
129
What? Is the treatment for Lithium toxicity when treating Bipolar disease?
d/c IV fluids (correct fluid and electrolyte imbalance) Osmotic diuresis or hemodialysis Overdose? Gastric lavage
130
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
Duloxetine
131
How long do you have to wait after d/c Linezolid or MAOI before giving Mirtazepine?
14 days
132
What is the efficacy and response rate of antidepressants?
60-80% response rate, similar efficacy across classes but AEs limit use of some (such as MAOIs and trazodone - sedation)
133
Which anti-depressant meds can cause withdrawal syndromes if d/c too fast because of their short half lives?
Venlafaxine, paroxetine, and fluvoxamine
134
What? Is an H1 blocker that is less desirable for long term treatment?
Hydroxyzine
135
What are the drug interactions of Mirtazepine?
Significant additive AEs with drugs that cause hypotensive and sedative effects
136
What am I? - Lorazepam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
137
What are the AE of Mirtazepine?
Sedation (due to H1 blocking, weight gain (due to H1 blocking), neutropenia, sertonergic-related AE (due to 5HT blocking)
138
What SSRI has a very long half like and needs a 5 week washout before starting MAOIs? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
Fluoxetine
139
What ADHD medication(s)? Antagonize central alpha 2 receptors, and, therefore, inhibit presynaptic release of NE? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Clonidine - Guanfacine
140
What is the MOA of St. John's Wort?
Mild MAO inhibiting properties. Efficacy in mild-moderate depression, minimal efficacy for moderate to severe depression.
141
What? Is an alternative agent to treat \*GAD w/o depression\*?
Buspirone
142
If depressive symptoms return during a taper, what do we do?
Go back to the original dosing quickly. Try to taper more slowly, or the patient may be a cannidate for life long treatment
143
What are we? Atomoxetine Bupropion Clonidine Guanfacine
Nonstimulants to treat ADHD Atomoxetine Bupropion Clonidine Guanfacine
144
What benzo? Is not CYP3A4 metabolized and so is \*preferred if hepatic dysfunction\*? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
Lorazepam and Oxazepam
145
What is this? Lithium
Mood Stabilizing Agent
146
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?
SSRIs
147
What am I? - Isocarboxazid
Monoamine Oxidase Inhibitor (MAOI) - Phenelzine - Selegiline - Tranylcypromine - Isocarboxazid
148
How long is depression treated for?
Acute phase: 6-12 weeks Continuation phase: 4-9 months Maintenance phase: 12 months - lifetime (But some pt can taper after a year)
149
What are important patient education points to discuss when putting a patient on an MAOI?
Counsel patients regarding interactions (foods and OTC medications), do not prescribe interacting drugs, use MAOIs as last line.
150
What are AE of stimulants?
Hallucinations, abnormal movements, growth suppression/delay, substance abuse
151
How should MDD in peds patients be treated?
SSRIs (but can cause behavioral activation). Avoid Desipramine - causes sudden death, CV issues.
152
What are ways MDD is treated?
Pharmacotherapy, CBT, ECT, light therapy, vagus nerve stimulation, transcranial magnetic stimulation, physical exercise
153
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?
Stimulants Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
154
What is the most likely diagnosis if? A patient presents with confusion, restlessness, fever, abnormal muscle movements, hyperreflexia, sweating, diarrhea and shivering?
Serotonin syndrome
155
Which 5-HT antagonist also blocks H and alpha receptors? Trazodone Nefazodone
Trazodone
156
What are the AE of SSRIs?
Sexual dysfunction (delayed/absent orgasm), CNS stimulation (nervousness, insomnia, sedation), and GI disturbance (n/d)
157
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
c) attention
158
What am I? Methylphenidate
Stimulant to treat ADHD Methylphenidate Dexmethylphenidate Dextroamphetamine-amphetamine Dextroamphetamine Lisdexamfetamine
159
How long do you have to wait after d/c Linezolid or MAOI before giving a 5-HT antagonist?
14 days
160
What is the MOA of the NDRI Bupropion?
NE and DA reuptake inhibition
161
What is this? Carbamazepine
Mood Stabilizing Agent
162
What is the MOA of Mirtazepine?
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
What? Reduce somatic symptoms like heart rate and sweating, but not does address psychic symptoms or avoidance behaviors?
Beta Blockers
164
What benzo? Has the shortest lasting effects? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
Oxazepam, Lorazepam, Temazepam, Alprazolam
165
What benzo? Has the longest lasting effects? - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
- Clonazepam - Diazepam
166
What? Do antidepressants, benzos, buspirone, hydroxyzine, beta blockers, second generation antipsychotics, and pregabalin treat?
Anxiety
167
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?
Buspirone
168
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?
1 week
169
How is ADHD monitored?
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
Which Bipolar medication? Requires renal monitoring as it is cleared by kidneys and is more likely to cause toxicity? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
Lithium
171
What am I? - Alprazolam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
172
What 5-HT antagonist causes Sedation and priapism?
Trazadone
173
What 5-HT antagonist has a Blackbox Warning fatal hepatotoxicity?
Nefazodone
174
What ADHD medication(s)? Has an onset of 1-2 months? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Bupropion
175
What am I? - Oxazepam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
176
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
Carbamazepine
177
Which one(s)? Play a role in wakefulness? 5-HT, Cholinergic, adrenergic, DA, NE, Hypocretin, substance P, histamine?
Hypocretin, substance P, histamine
178
What am I? Citalopram
SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
179
What? Medication class is equally effective at equivalent doses?
Anxiety Meds Benzodiazepines - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
180
How should anti-depressants be tapered?
Decrease dose every 3-5 days
181
What am I? - Temazepam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
182
Which SNRIs have balanced 5-HT and NE reuptake activity? Venlafaxine Desvenlafaxine Duloxetine
Duloxetine
183
What? Helps reduce somatic symptoms but not psychic symptoms?
Hydroxyzine and Beta Blockers
184
What ADHD medication(s)? Is 2nd or 3rd line? - Atomoxetine - Bupropion - Clonidine - Guanfacine
Atomoxetine
185
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
Lamotrigine
186
What Bipolar Medication? Carries less AE of weight gain? Lithium Divalproex Carbamazepine Lamotrigine Oxcarbazepine
Lamotrigine
187
What should you consider when deciding what antidepressant to choose?
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
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
d) oppositional and aggressive behaviors
189
What ADHD medication(s)? Selectively inhibits reuptake of NE and other NT. No abuse potential, not a controlled substance? - Atomoxetine - Bupropion - Clonidine - Guanfacine
- Atomoxetine
190
What is the CYP that St. John's Wort causes hell in?
CYP3A4
191
What are we? Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline
SSRIs
192
What? Drug class is more effective for somatic symptoms than for psychic symptoms in anxiety?
Benzodiazepines
193
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
Lithium
194
What? Does an increase in 5-HT cause in anxiety?
Inhibition of the firing of noradrenergic cells
195
What am I? - Clonazepam
Anxiety Med Benzodiazepine - Alprazolam - Chlordiazepoxide - Clonazepam - Diazepam - Temazepam - Lorazepam - Chlorazepate - Oxazepam
196
What perinatal sequelae are possible with antidepressants?
Poor adaptation, respiratory distress, feeding problems, and jitteriness
