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PAM Semester 2 > Pharm Psych exam > Flashcards

Pharm Psych exam Flashcards

1
Q

Olanzapine and fluoxetine

A

Symbax

Acute depressive episodes in bipolar 1.
Treatment resistant depression (TRD)

Box warning:
Increased mortality in elderly with dementia related psychosis, Suicidal thoughts and behaviors.

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2
Q

mirtazepine

A

(Remeron)
Antidepressant

Sedation and weight gain are two prominent side effects of this agent.

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3
Q

Dextroamphetamine, methamphetamine MOA

A

Methylphenidate and Dexmethylphenidate MOA =

Unknown but it does block reuptake and increase release of norepinephrine and dopamine extraneuronal space

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4
Q

Autistic disorder

A

lifelong disorder with few of these individuals living independently

Behavioral management techniques are used to reduce the rigid behaviors and improve social functioning

Neuroleptics are used to help decrease aggressive behaviors

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5
Q

Antipsychotics EPS

A

Extrapyramidal Symptoms=
Akathisia-subjective feeling of restlessness can be treated with a BZD like lorazepam (Ativan).

Parkinsonism such as shuffling gait, cogwheel rigidity=benztropine (Cogentin).

Acute dystonias=involuntary contractions of major muscle groups such as TD = Cogentin or Artane (trihexyphenidyl)

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6
Q

Trazodone

A

(Oleptro)

Predisposition to priapism;

Adverse Reactions:
Somnolence/sedation, dizziness, constipation, blurred vision, dry mouth, syncope, arrhythmias, hypotension,

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7
Q

MOA of SSRI’s

A

(SSRI’s block reabsorption of serotonin)

(SSRIs inhibit the serotonin reuptake pump and increase postsynaptic serotonin receptor occupancy. )

  • Major route of removal of serotonin is to reuptake of
    serotonin
  • inhibit reuptake of 5HT only
  • Cause increase in availability of 5HT Locally
  • Relieves depression
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8
Q

Enuresis Treatment

A

Desmopressin- synthetic antidiuretic hormone

Imipramine- (Tricyclic antidepressant)

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9
Q

Neurotransmitter:

Dopamine

A

Controls Complex movements, motivation, cognition, regulates emotional responses

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10
Q

Lithium labs

A

Lithium levels should be measured

Prior to beginning medication,
UA, BUN, Creatinine, Thyroid, Calcium, HCG and ECG for those over 40

BUN/Creatinine should be checked every 2-3 months for first 6 months and 6-12 months from then on.

Thyroid should be checked once or twice in first 6 months and every 6-12 months from then on.

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11
Q

buspirone

A

Buspar

The mechanism of action of buspirone is unknown.

Buspirone has a high affinity for serotonin 5-HT1Aand 5-HT2receptors, without affecting benzodiazepine-GABA receptors

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12
Q

Bulimia Nervosa

A

Normal body weight (or above normal body weight) is maintained

Treatment:
SSRIs (fluoxetine) (only FDA approved med)
TCAs
MAOIs
Individual psychotherapy, family therapy and group therapy

Russell’s sign (callous knuckles)

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13
Q

Cocaine Toxicity

A

Know Benzodiazepine (Valium) is best for agitation, Hypertension and Myocardial Ischemia

DO NOT GIVE BETA BLOCKERS such as Labetalol!!

REASON: There are theoretical concerns of coronary artery vasoconstriction and systemic hypertension, which can result from unopposed alpha-adrenergic stimulation

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14
Q

Personality disorders

Cluster B

A

Antisocial
Borderline
Histrionic
Narcissistic

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15
Q

Stimulants Cocaine

A

Cocaine—

The reinforcing properties of cocaine are mediated by its ability to block the dopamine transporter and increase dopaminergic activity in critical brain regions

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16
Q

SNRI’s

Drugs

A

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

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17
Q

sodium oxybate

A

Xyrem
(Anti-narcoleptic) (CNS depressant) (MOA is unknown)

Cataplexy or excessive daytime sleepiness in patients ≥7yrs of age with narcolepsy.

Contraindications:
Concomitant sedative hypnotics or alcohol

Boxed Warning:
CNS depression. Abuse and misuse
Risk of CNS depression.

REMS Yes

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18
Q

MOA of SSRI’s

A

(SSRI’s block reabsorption of serotonin)

  • Major route of removal of serotonin is to reuptake of
    serotonin
  • inhibit reuptake of 5HT only
  • Cause increase in availability of 5HT Locally
  • Relieves depression
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19
Q

Suicide mnemonic

A

IS PATH WARM

I = ideas/threats about suicide communicated directly
S = Substance abuse/excessive or increased
P = purposelessness, giving up, no reason to live
A = Anxiety/agitation/insomnia
T = Trapped, no way out of tough situation
H = Hopeless/nothin will ever change or get better
W = withdrawing from friends/family/society
A = Anger (uncontrolled, rage, seeking revenge
R = Recklessness/risky/don't care behaviors
M = Mood Changes (guilt/grief/ wish I was never born)
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20
Q

PMS managment

A

A number of approaches, including lifestyle measures (exercise and relaxation techniques), cognitive behavioral therapy, and medications (selective serotonin reuptake inhibitors [SSRIs]

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21
Q

Why are SSRI’s used as first line?

A

Selective serotonin reuptake inhibitors (SSRIs) are frequently used as first-line antidepressants because of their efficacy, tolerability, and general safety in overdose.

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22
Q

1st line Treatment for ADD / ADHD

A 
Pharmacotherapy (1st line treatment)
    Stimulants
        Methylphenidate (ritalin)
        Dextroamphetamine (Vyvanse)
        Dextroamphetamine /amphetamine salts (Adderall)

greatest efficacy
contraindicated in known cardiac risk/ abnormalities
Drug holidays

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23
Q

Autistic disorder

Meds

A

Irritability- 2 second generation antipsychotics
risperidone (Risperdal)
aripiprazole (Abilify)

Hyperactivity/Impulsivity
Methylphenidate (Ritalin)

Repetitive Behaviors
Selective Serotonin Reuptake Inhibitors (SSRI)
risperidone (Risperdal)
valproate (Depakote)

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24
Q

valbenazine

A

Ingrezza
(Vesicular monoamine transporter 2 (VMAT2) inhibitor)

used for Tardive dyskinesia.

Warnings:
Somnolence. Avoid in congenital long QT syndrome or arrhythmias associated with a prolonged QT interval

Adverse Reactions:
Somnolence, anticholinergic effects, balance disorders/fall,

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25
Q

Vesicular monoamine transporter 2 (VMAT2) inhibitors,

A

Deplete dopamine at presynaptic striatal nerve terminals, are a class of drugs that have long been used to treat hyperkinetic movement disorders

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26
Q

Nitrous oxide

A

Nitrous oxideis abused most commonly as “whippets

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27
Q

What is the SSRI of choice when drug - drug interactions are a concern?

A

Citalopramandescitalopraminhibit liver enzymes less than other SSRIs and are thus the SSRIs of choice for situations in which drug-drug interactions are a concern.

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28
Q

MAOI Diet

A

MAO is distributed in tissues throughout the body. The blockade of MAOIa in the gastrointestinal tract is responsible for the “cheese reaction” associated with MAOIs. This refers to a severe hypertensive crisis that can occur after patients on MAOIs ingest foods containing the sympathomimetic tyramine.

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29
Q

Neurotransmitter:

Serotonin

A

Regulation of emotions, controls food intake, sleep/wakefulness, pain control, sexual behaviors

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30
Q

Personality disorders

Cluster A

A

Paranoid
Schizoid
Schizotypal

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31
Q

PTSD & Acute Stress Disorder

Treatments

A

Support
Encouragement to discuss event
Education about a variety of coping mechanisms
Psychotherapy

MEDS:
Selective Serotonin Reuptake Inhibitors
Tricyclics
Anticonvulsants

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32
Q

Hallucinogens

A

DXM = Dextromethorphan
PCP = Phencyclidine or phenylcyclohexyl piperidine
Ketamine
LSD = Lysergic acid diethylamide
Mescaline = 3,4,5-trimethoxyphenethylamine

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33
Q

desmopressin

A

Vasopressin (synthetic).

Primary nocturnal enuresis.

Contraindications:
Moderate to severe renal impairment
(CrCl <50mL/min). History of Hyponatremia

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34
Q

MOA of bupropion

A 
Reuptake inhibition of :
Norepinephrine transporter (NET)
Dopamine transporter (DAT)

MOA may involve the presynaptic release of Norepi or dopamine

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35
Q

Treatment for ADD / ADHD (non stimulant)

A

Atomoxetine (straterra)

SSRI’s

A- agonists
Clonodine (catapres, kapvay)
Antihypertensive agents
Mechanism in ADHD unknown

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36
Q

ADHD meds

A

Adderall: dextroamphetamine/amphetamine
Adderall XR: dextroamphetamine/amphetamine
Catapres: clonidine
Concerta: methylphenidate
Dexedrine: dextroamphetamine
Effexor: venlafaxine

More meds:
Intuniv: 		guanfacine
Kapvay:		clonidine
Ritalin:	 	methylphenidate
Ritalin LA:	methylphenidate
Strattera:   	atomoxetine
Tenex:		guanfacine
Vyvanse:	 	lisdexamfetamine
Wellbutrin:	bupropion hydrochloride
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37
Q

First-generation antipsychotic medications (FGAs), also known as neuroleptics or conventional antipsychotics, cause

A

High rates of extrapyramidal side effects (EPS), including rigidity, bradykinesia, tremor, and akathisia (restlessness).

They also frequently lead to tardive dyskinesia—hyperkinetic, involuntary movements most readily observed in the face and extremities.

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38
Q

MOA of SNRI’s

A

The serotonin-norepinephrine reuptake inhibitors (SNRIs) appear to treat depression by initially blocking presynaptic serotonin and norepinephrine transporter proteins.

This inhibits reuptake of these neurotransmitters and leads to increased stimulation of post-synaptic receptors.

Side effects include nausea, dizziness, dry mouth, constipation, insomnia, and diaphoresis.

Watch out for patients with HTN!!

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39
Q

lamotrigine

A

Lamictal

Slight risk of Stevens-Johnson syndrome -(TEN)

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40
Q

Treatment of ADHD may involve

A

Behavioral/psychologic interventions,
medication,
and/or educational interventions,
alone or in combination.

Decisions regarding the choice of therapy should involve the patient and his or her parents.

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41
Q

2nd generation of atypical antipsychotics

MOA

A

Primarily Block D2 and 5HT2A receptors

1st gen blocks only D2

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42
Q

Posttraumatic Stress Disorder Treatment

A

SSRIs (paroxetine, sertraline)

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43
Q

clonidine

A

Kapvay (Central alpha-2 agonist)
used in ADHD, as monotherapy or as an adjunct to stimulant medications.

Potentiated by alcohol, other CNS depressants
(eg, benzodiazepines, antipsychotics, barbiturates)

Potentiates AV block, bradycardia with drugs that affect sinus node function or AV node conduction
(eg, digitalis, calcium channel blockers, β-blockers)

Additive effects with anti-hypertensives

Hypotensive effects may be antagonized by tricyclic antidepressants

Adverse Reactions:
Somnolence, fatigue, irritability, insomnia, nightmares, constipation, dry mouth, decreased appetite, dizziness; bradycardia

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44
Q

Postpartum Depression

A

Five or more symptoms present during 2-week period with at least one symptoms being
Depressed mood
or
Loss of interest or pleasure

Treatment:
Serotonin Reuptake Inhibitors (SSRI)

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45
Q

desmopressin MOA

A

reduction in overnight urine production
via stimulation of ADH
which causes less urine production

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46
Q

SSRI Side Effects

A

Sexual dysfunction – 17 percent
Drowsiness – 17 percent
Weight gain – 12 percent

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47
Q

Lithium General info

A

First med specifically for Bipolar disorder (1940’s)
Unknown why it works for mania

Levels should be measured
(watch for lithium toxicity)

Lithiumlevels are closely related to renal function, salt balance, and water balance.

Dehydration causes higher lithium levels,

increasing sodium intake causes lower lithium levels, and
decreased sodium intake causes an increase in serum lithium levels.

Lithiumis contraindicated in patients with significant renal impairment, sodium depletion, dehydration, significant cardiovascular disease.

Excessivelithiumlevels can lead to toxicity with severe side effects and multisystem dysfunction which can be fatal if not recognized.

Side effects included Nausea, tremor, polyuria and thirst, weight gain, loose stools, and cognitive impairment

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48
Q

Venlafaxine

A

Effexor (SNRI)

Initially 75mg/day in 2–3 divided doses; may increase at 4-day intervals in 75mg/day increments to 150mg/day;

Contraindications:
During or within 14 days of MAOIs (see Interactions).

Boxed Warning:
Suicidal thoughts and behaviors.

Warnings:
Monitor for serotonin syndrome; discontinue immediately if occurs.
Pre-existing hypertension, cardio- or cerebrovascular disease. Monitor BP before and during treatment; consider dose reduction or discontinuation if elevated BP persists. Heart disease (eg, recent MI, heart failure).

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49
Q

Extrapyramidal symptoms Time frames

A

Minutes - hours = Acute dystonic reaction
Torticollis, laygospasms, oculogyric crisis
Tx: Benztropine / anticholinergics

Days = Pseudoparkinsonism
Bradykinesia, rigidity, cogwheel rigidity, perioral tremor
Tx: Benztropine

Days-weeks = Akithisia
Tx: Benzodiazepines, Beta blockers

Long term = Tardive dyskinesia
Tx: Atypical or clozapine
(often irreversible)

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50
Q

bupropion

A

Zyban

Aid in smoking cessation.

Contraindications:
Seizure disorders.

Boxed Warning:
Suicidal thoughts and behaviors.

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51
Q

(Persistent Depressive Disorder-DSM-V)

Tx:

A

Treatment:
SSRIs, bupropion, TCAs and MAOIs
Psychotherapy (esp. effective when combined with pharmacotherapy)

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52
Q

flumazenil

A

Benzodiazepine antagonist.

Reversal of benzodiazepine sedative effects in overdose, general anesthesia or conscious sedation

Contraindications:
Patients treated with benzodiazepines for life threatening conditions

Boxed Warning:
Occurrence of seizures.

Adverse Reactions:
Seizures, local reactions, dizziness

Warnings/Precautions:
Monitor for resedation (at least 2hrs), respiratory depression, other residual benzodiazepine effects, seizures

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53
Q

Disulfiram MOA

A

inhibits acetaldehyde dehydrogenase

Results in increased acetalaldehyde in blood
causes unpleasant reaction when alcohol is consumed

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54
Q

Solriamfetol

A

Sunosi
To improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA)

Contraindications:
During or within 14 days of MAOIs.

Interactions:
May increase risk of hypertensive reaction with concomitant MAOIs.

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55
Q

Schedule III meds

A

Narcotics (Tylenol 3, Buprenorphine)

Ketamine

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56
Q

Premenstrual Dysphoric disorder

A 
Citalopram 10mg
Escitalopram 5-10mg
Fluoxetine 10mg
Paroxetine 10mg
Sertraline 25mg

SSRI’s 2nd gen antipsychs

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57
Q

phentermine

A

Lomaira
(Sympathomimetic-MOA unknown but stimulate CNS activity)

A short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index ≥30kg/m2, or ≥27kg/m2in the presence of other risk factors (eg, hypertension, diabetes, hyperlipidemia).

Contraindications:
Cardiovascular disease (eg, coronary artery disease, stroke, arrhythmias, CHF, uncontrolled hypertension). During or within 14 days of MAOIs.
Hyperthyroidism. Glaucoma. Agitated states.
History of drug abuse.
Pregnancy (Cat.X). Nursing mothers.

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58
Q

In Summary on Depression!

A

Pharmacology – initiate SSRI anti-depressant

Non-pharmacology – exercise, regular meals, socialization (Things to treat anhedonia)

Patient Education – signs/symptoms of worsening, call the office or 911-ER

Get a contract for safety and find community resources.

Follow-up – appointment made for counseling with therapist

Return to your office in one to three weeks for follow-up. Sooner with any concerns or thought of self-harm.

Make sure patient are seeing PCP!

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59
Q

Adjustment Disorder

A

Treatment
Psychotherapy remains the treatment of choice for adjustment disorder

Crisis intervention may be necessary

Pharmacological agents are not indicated except for co-existing conditions – depression, anxiety

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60
Q

What meds have anticholinergic properties

A

Antipsychotics

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61
Q

Serotonin Syndrome

A

Although classically described as the triad of

mental status changes, autonomic hyperactivity, and neuromuscular abnormalities,

serotonin syndrome is actually a spectrum of clinical findings ranging from benign to lethal.

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62
Q

Bottom Line for Schizophrenia disorders

A

Patients treated with an antipsychotic for schizophrenia should be assessed prior to treatment if possible and at regular intervals for:

Signs of a movement disorder including extrapyramidal symptoms and tardive dyskinesia.

Symptoms of metabolic syndrome including measurements of body mass index, waist circumference, hemoglobin A1c, serum lipids, and blood pressure

ECG for patients with a history of cardiac disease or when starting an antipsychotic that prolongs the QT interval.

We recommend antipsychotic medication as first-line medication treatment for acute and maintenance phase treatment for schizophrenia.

For patients with schizophrenia who have recovered from an acute psychotic episode, we suggest that antipsychotic medication should be continued indefinitely at the lowest effective dose that achieves therapeutic goals. This approach is suggested even for patients who have achieved remission from a first psychotic episode.

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63
Q

Typical or First Generation Antipsychotics

A

First-generation antipsychotics (FGAs) are characterized by strong antagonism of dopamine D2 receptors in both cortical and striatal areas.

haloperidol (Haldol)

fluphenazine (Prolixin)

chlorpromazine (Thorazine)

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64
Q

Why should olanzapine (zyprexa) not be used as a first-line agent for first-episode patients

A

olanzapineis associated with significant weight gain and metabolic adverse effects

May be considered for those that fail first line tx

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65
Q

guanfacine

A

Intuniv (Central alpha-2A agonist)
used in ADHD, as monotherapy or as an adjunct to stimulant medications.

Warnings:
Concomitant antihypertensive, other risks for hypotension, syncope, bradycardia, heart block, cardiovascular or cerebrovascular disease. Monitor heart rate and BP prior to initiation, after dose increases, and periodically during therapy. Avoid abrupt discontinuation to minimize risk of rebound hypertension

Avoid with alcohol.

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66
Q

varenicline

A

Chantix (Nicotinic receptor partial agonist)

Dosage:
Initially 0.5mg once daily on Days 1–3, then 0.5mg twice daily on Days 4–7, then 1mg twice daily thereafter.

Warnings
Monitor for neuropsychiatric adverse events (eg, behavioral changes, agitation, depression, suicidal ideation);
Pre-existing psychiatric disorders. History of seizures or other factors that can lower seizure threshold. Cardiovascular disease; monitor for new or worsening signs/symptoms

Interactions:
May affect alcohol tolerance; reduce alcohol consumption until effects are known

Adverse Reactions:
Nausea, other GI effects (eg, constipation, flatulence, vomiting), sleep disturbance (eg, abnormal dreams, insomnia); nicotine withdrawal symptoms (due to smoking cessation), neuropsychiatric symptoms (may be serious), cardiovascular events; seizures

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67
Q

Orlistat

A

Xenical-Rx or Alli-OTC

(Lipase inhibitor)

Adjunct to reduced-calorie diet in obesity management, including weight loss and weight maintenance.

Contra:
Pregnancy (Cat.X).
Chronic malabsorption syndrome.
Cholestasis.

Adverse:
GI effects (oily spotting, flatus with discharge, fecal urgency, fatty/oily stools, oily evacuation, increased defecation, fecal incontinence);
cholelithiasis;
rare: severe liver injury.

68
Q

OCD vs OCPD

A

OCD:
The person feels compelled to continue despite an awareness that the thoughts or behaviors may be excessive or inappropriate, and feels distress if they stop them such as washing hands excessively due to germs.
Tx: SSRIs (fluoxetine)-1st line, SNRIs (venlafaxine), and clomipramine (Anafranil)-TCA. Therapy.

69
Q

Narcolepsy:

A

Excessive daytime sleepiness

People with narcolepsy feel moderately or severely tired during the day

They have difficulty paying attention, concentrating, and staying awake, even if they’ve slept a lot the night before

People with narcolepsy can start out feeling rested, but have trouble staying awake for long periods of time and fall asleep during routine daytime activities

with or without cataplexy

70
Q

Whatis the only drug approved by the US Food and Drug Administration (FDA) for the short-term (up to 12 weeks) treatment of obesity

A

Phentermineis only approved by the US Food and Drug Administration (FDA) for the short-term (up to 12 weeks) treatment of obesity because of potential side effects, potential for abuse, and regulatory surveillance.

71
Q

Neurotransmitter:

Nor/Epi

A

Causes changes in attention, learning, memory and mood

72
Q

Schizoaffective disorder

A

Schizophrenia and major depression/Bipolar

73
Q

What adverse effect to look out for with atypical antipsychotics?

A

Hyperglycemia

74
Q

2nd generation Antipsychotics

A

Less likely to cause EPS and tardive dyskinesia than 1st gen (but may still occur)

More likely to have metabolic abnormalities (elevated glucose, lipids, weight gain) than 1st Gen

75
Q

Major Depressive Episode:

Dx:

A

≥ 5 of the following symptoms present in the same two week period, at least one of which is depressed mood or loss of interest

Sleep issues
Interest-diminished (anhedonia)
Guilt
Energy reduction
Concentration issues
Appetite or weight issues
Psychomotor retardation issues
Suicide thoughts or plan
76
Q

Panic Disorder etiology

A

Dysregulation of norepinephrine, serotonin, and GABA

77
Q

Neuroleptic malignant syndrome (NMS)

A

A life-threatening neurologic emergency associated with the use of antipsychotic agents and characterized by a distinctive clinical syndrome.

The diagnosis should be suspected when any two of the four cardinal clinical features
(mental status change, rigidity, fever, or autonomic instability)
appear in the setting of antipsychotic use or dopamine withdrawal.

When there is any suspicion of NMS, antipsychotic agents should be withheld

Consider dantrolene,bromocriptine, and/oramantadine

(mental status change, rigidity, fever, or autonomic instability)

78
Q

Neuroleptic malignant syndrome (NMS) Meds

A

dantrolene (Dantrium)-Muscle relaxant by decreasing intracellular calcium in skeletal muscle; good for chronic spasticity

bromocriptine (Parlodel)- Good for dystonias (dopamine agonist-inhibits anterior pituitary prolactin secretion

amantadine (Symmetrel)-Good for EPS symptoms and parkinsonism MOA is unknown; Also used for Influenza A

79
Q

What is the SSRI of choice when drug - drug interactions are a concern?

A

Citalopramandescitalopraminhibit liver enzymes less than other SSRIs and are thus the SSRIs of choice for situations in which drug-drug interactions are a concern.

These inhibit liver enzymes less

80
Q

Benzo OD

A

Flumazenil is a nonspecific competitive antagonist of the BZD receptor.

It can be used to reverse BZD-induced sedation following general anesthesia, procedural sedation, or overdose.

81
Q

Neurotransmitter:

GABA

A

Modulates other neurotransmitters

82
Q

Citalopram

A

(Celexa)

Initially 20mg once daily

Increased risk of suicidality.

Increased risk of suicidal thinking and behavior in children, adolescents and young adults;

monitor for clinical worsening and unusual changes.

Congenital long QT syndrome,

Celexa, suicide, history of long QT

83
Q

MAOI’s

Drugs

A

tranylcypromine (Parnate)
phenelzine (Nardil)
selegiline-Few Brand names

all 3 are -ine’s

84
Q

Schedule II meds

A

Narcotics (morphine, codeine, Fentanyl, oxy, hydro, methadone)
Stimulants
Cocaine
Phenobarbital

85
Q

SSRI’s

A 
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac)(Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)(Pexeva)
sertraline (Zoloft)
86
Q

benztropine

A

Cogentin (Anticholinergic) (injection)

Used as an adjunct in Parkinsonism, drug-induced extrapyramidal disorders

Warnings:
Tardive dyskinesia: not recommended. Narrow-angle glaucoma. Tachycardia

Adverse Reactions:
Anticholinergic and antihistaminic effects, weakness, confusion

87
Q

MOA of most antipsychotics

A

decrease the action of dopamine by blocking the Dopamine D2 receptors of nerves in the brain.

88
Q

1st generation Antipsychotics side effects

A

More likely to cause EPS (dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia)
than 2nd gen

Less likely to have metabolic abnormalities than 2nd gen

89
Q

Feeding and eating disorders Treatments

A

phenelzine (Nardil) MAOI 15 mg PO TID for bulimia

lisdexamfetamine (Vyvanse) 50-70 mg PO (start at 30 mg) in the morning for moderate to severe binge-eating disorder; NDRIs

fluoxetine (Prozac) SSRI 60 mg PO in the morning for bulimia

90
Q

topiramate

A

Topamax

2nd-line or off-label

Has weight loss properties!

91
Q

Major Depressive Episode:

Tx:

A

Antidepressants should be continued 3-6 weeks (if well tolerated) to determine efficacy

CBT should be included while on medications.

SSRIs (fluoxetine, paroxitine, sertraline), SNRIs, and bupropion or venlafaxine are first line
Selection based on side effect profile

92
Q 
Tricyclic Antidepressants (TCAs)
Drugs
A 
amitriptyline (Elavil)
desipramine (Norpramin)
nortriptyline (Pamelor)
protriptyline (Vivactil)
clomipramine (Anafranil)-Used for OCD
Imipramine (Tofranil)
93
Q

Atypical Antipsychotics meds to know

A

quetiapine (Seroquel)

lurasidone (Latuda)

94
Q

Other insomnia meds

A

Ramelteon
Trazadone
Doxepin

95
Q

Hallucinogen Therapy

A

We suggest that acute agitation and dysphoria from acute hallucinogen intoxication be managed with benzodiazepines.

Treatment options includemidazolam, lorazepam, ordiazepam

If psychotic features persist aggressive benzos and suggest haloperidol if persistent

Gastrointestinal (GI) decontamination via Charcoal isnotnecessary in the vast majority of cases.

96
Q

Bipolar (maintenance)

A

The goals for maintenance therapy are to reduce subsyndromal symptoms, delay or prevent recurrence of new mood episodes, reduce the risk of suicide, and promote psychosocial functioning.

For most patients who respond to acute pharmacotherapy, we suggest maintenance treatment with the same regimen, rather than switching medications.

For patients who do not respond to or toleratelithium, we suggestvalproate,quetiapine, orlamotriginerather than other medications.

For patients who do not respond to or cannot tolerate these drugs,aripiprazole,olanzapine, orrisperidoneare reasonable alternatives.

97
Q

Children and adolescents with ADHD have an increased risk of

A

increased risk of substance use,

oppositional defiant disorder or conduct disorder,

intentional and unintentional injuries

increased risk of motor vehicle accidents

98
Q

Benzodiazepines

A

Benzodiazepines exert their principal pharmacodynamic effect via CNS GABA receptors, potentiating the effects of endogenous GABA, the main inhibitory neurotransmitter.

Side effects of benzodiazepines include:
impairment of psychomotor performance, amnesia, dependence and withdrawal symptoms after long-term treatment, and rebound anxiety after short-term treatment.
Withdrawal and cognitive or learning impairment are more likely for persons taking higher doses.

99
Q

Quetiapine

A

Seroquel

Monotherapy for bipolar I
or

Adjunct to lithium or valproate (valproic acid) for acute mania and maintenance
or

Depressive episodes associated with bipolar disorder

Box warning:
Increased mortality in elderly with dementia related psychosis, Suicidal thoughts and behaviors.

Interactions:
Avoid drugs that prolong QT including
Class 1A (quinidine, procainamide)
Class 3 antiarrhythmics

100
Q

Parasomnias

A

Complex movements and behaviors during sleep

Encompass common or bizarre behaviors as well as seemingly purposeful movements, perceptions, dreaming, and autonomic output during sleep or sleep transitions.

101
Q

OCPD

A

OCPD:
List-making, hoarding, stinginess, and scheduling.
Treatment: Therapy!

102
Q

Chlordiazepoxide

A

Librium

For anxiety

103
Q

Personality disorders (3 clusters)

A

Cluster A: Social detachment w/ unusual behavior
Cluster B Drama
Cluster C Anxious and fearful

104
Q

Benzo MOA

A

Benzos potentiate GABA
at
GABA A receptors (benzodiazepine receptors)

Benzos bind at the GABA receptor separate from the GABA binding site and create an allosteric effect increasing action at the GABA receptor

This increases the length of time the that GABA activates the receptor

This allows Chloride to enter the neuron

This hyperpolarizes the neuron and makes it less likely the neuron will fire

(i.e. inhibits the firing of neurons through GABA)

105
Q

Stimulants Methamphetamine

A

Methamphetamine—

The reinforcing effects of methamphetamine are mediated both by blockade of the dopamine transporter and by stimulating the presynaptic release of dopamine.

106
Q

Duration:

Brief psychotic disorder

A

-Duration at least 1 day but less than 1 month

107
Q

Other meds for depression

A

Buproprion (Wellbutrin)

108
Q

SSRI’s

Drugs

A 
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac)(Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)(Pexeva)
sertraline (Zoloft)
109
Q

Serotonin Modulators

A

Trazadone (Desyrel or Oleptro)

110
Q

Cocaine withdrawal Tx

A

Modafinil

a mild stimulant used to treat narcolepsy and shift-work sleep disorder, has shown mixed results in several clinical trials of patients with DSM-IV cocaine dependence

Disulfiram

a medication with some evidence of efficacy in alcohol use disorder, has shown promise for cocaine use disorder

Modafinil & Disulfiram

111
Q

Duration:

Schizophreniform disorder

A

-1-6 months duration

112
Q

Clonidine and guanfacine

A

MOA= Alpha 2 agonist
modest reduction in ADHD symptoms
must taper slowly or risk rebound hypertension

113
Q

Valproic acid/Vaproate/divalproex sodium

A

Depakote

Was first used as a Anti-Convulsant and still is!

Also used for prophylaxis of migraines

Hepatic failure resulting in fatalities has occurred in patients receiving valproate.
These incidents usually have occurred during the first 6 months of treatment.

Fetal risk=Birth defects and life-threatening pancreatitis!

Common side effects ofvalproateinclude weight gain, nausea, vomiting, hair loss, easy bruising, and tremor

Contra:
Hepatic disease or significant hepatic dysfunction

Boxed Warning:
Life-threatening adverse reactions (eg, hepatotoxicity, fetal risk, pancreatitis).

114
Q

Bipolar (Acute Phase)

Second line treatment

A

Second line treatment options for these patients include:
•Olanzapineplusfluoxetine

  • Valproatemonotherapy
  • Combination therapy withquetiapineorlurasidonepluslithiumorvalproate

•Combination therapy withlithiumplusvalproateorlamotrigine

Symbax,
Depakote,
seroquel/latuda + lithium/depakote
lithium + depakote or lamictal

115
Q

Short-term insomnia

A

Short-term insomnia (less than one month) usually results from psychologic or physiologic stress.

116
Q

Lurasidone

A

Latuda (Atypical antipsychotic)

Major depressive episodes associated with bipolar 1 as monotherapy in patients over 10
or
Adjunct to lithium or valproate (valproic acid) in adults

Box warning:
Increased mortality in elderly with dementia related psychosis, Suicidal thoughts and behaviors.

117
Q

Phobias - Treatment

A

Social phobias and agoraphobia

Beta-blockers (propranolol and atenolol)
Performance anxiety
SSRIs (paroxetine)
Benzos
Venlafaxine
Buspirone
TCAs (imipramine)
118
Q

atomoxetine

A

Strattera (SNRI)
Used for ADHD

Contra:
During or within 14 days of MAOIs. Narrow angle glaucoma. history of Pheochromocytoma. Severe cardiovascular disorders that might deteriorate with clinically important increases in HR and BP

Boxed Warning:
Suicidal ideation in children and adolescents.
Monitor closely

119
Q

Schizophrenia treatment

A

Typical neuroleptic and antipsychotic medications best for decreasing positive sxs

120
Q

OTC sleep meds

A

Diphenhydramine (Benadryl): 1st generation histamine
(H1) blockers (side effects?)

Doxylamine (Unisom): 1st generation histamine (H1) blockers

Anticholinergic side effects above!

121
Q

OCD

A

OCD:
The person feels compelled to continue despite an awareness that the thoughts or behaviors may be excessive or inappropriate, and feels distress if they stop them such as washing hands excessively due to germs.
Tx: SSRIs (fluoxetine)-1st line, SNRIs (venlafaxine), and clomipramine (Anafranil)-TCA. Therapy.

OCPD:
List-making, hoarding, stinginess, and scheduling.
Treatment: Therapy!

122
Q

When can you use injectable antipsychotics

A

injectable (LAI) antipsychotic medication may be useful for patients with schizophrenia when non-adherence to oral antipsychotics leads to frequent relapse.

LAI antipsychotics are administered at two to four week intervals.

123
Q

Bupropion

A

MOA= inhibits Norepi and dopamine
Equivalent to methylphenidate
Side effects = tics, lowers seizure threshold

124
Q

Management of acute inhalant intoxication

A

Primarily consists of support of airway, breathing, and circulation

Acutely, patients with findings of inhalation abuse should undergo screening for substance use disorder, depression and suicidality

125
Q

Benzodiazepines

A 
Estazolam
Flurazepam
Lorazepam
Temazepam
Triazolam
126
Q

Drugs with a box warning of:

Increased mortality in elderly with dementia related psychosis, Suicidal thoughts and behaviors.

A

Latuda (Lurasidone)
Seroquel (Quetiapine)
Symbax (Olanzapine and fluoxetine)

127
Q

Trazadone (Oleptro) MOA

A

Trazadone (Oleptro):
Antidepressant,

MOA unknown but inhibits serotonin reuptake (serotonin modulator).

Watch out for priapism

128
Q

Antipsychotics MOA

A

most antipsychotic meds decrease the action of dopamine by blocking the Dopamine D2 receptors of nerves in the brain.

129
Q

Schedule V meds

A

cough syrups with codeine

antitussive, antiemetics with narcotics

130
Q

Postpartum Psychosis characterized by

A

Rapid onset

Treatment
Pharmacotherapy
Lithium, Valproic acid (Depakote), carbamazepine

131
Q 
Tricyclic Antidepressants (TCAs)
MOA
A

Inhibits reuptake of both serotonin and norepinephrine, which increases the amount of neurotransmitter in the synaptic cleft.

132
Q

Medications that can cause or worsen Tardive dyskinesia

A 
Meds that can cause TD:
Antipsychotics
Antiemetics
Antidepressants
Anticonvulsants
Mood stabilizers
Antihistamines
Antimalarial
Stimulants

Meds that can worsen TD:
Anticholinergics
Antiparkinsonians
Stimulants

133
Q

MOA of bupropion

A 
Reuptake inhibition of :
Norepinephrine transporter (NET)
Dopamine transporter (DAT)

MOA may involve the presynaptic release of Norepi or dopamine

134
Q

pregablin

A

Lyrica

Tolerance, withdrawal, and dependence are possible, but pregabalin is generally better tolerated than benzodiazepines

135
Q

Serotonin syndrome
vs
Neuroleptic malignant syndrome (NMS)

A

Serotonin syndrome onset = within 24 hours
NMS onset = days to weeks

Serotonin syndrome = hyperactivity (tremor, clonus)
NMS = Bradyreflexia, muscular rigidity

Serotonin syndrome causes = Serotonin agonist
NMS causes = Dopamine agonist

Serotonin syndrome Tx = Benzos, cyproheptadine
NMS Tx = Bromocriptine

Serotonin syndrome Resolves = within 24 hours
NMS resolves = days to weeks

136
Q

Non benzo benzos

A

Eszopiclone (lunesta)
Zaleplon (sonata)
Zolpidem (ambien)

137
Q

Naltrexone

A

Revia (opioid agonist)

Alcohol dependence

Adverse: Hepatic toxicity

138
Q

gabapentin

A

Neurontin

2nd-line or off-label

Side effects-mainly sedation

139
Q

bupropion

A

(Wellbutrin-and other names)

Bupropionis used to treat major depression, seasonal affective disorder, attention deficit hyperactivity disorder (ADHD), tobacco dependence (Zyban), hypoactive sexual disorder, and obesity.

Contra: seizure disorders

In addition,bupropion should be used cautiously in patients receiving other drugs that can lower seizure threshold

Some authorities classify the drug as a dopamine norepinephrine reuptake inhibitor,

140
Q

Stimulants Amphetamines

A

Amphetamines—

Amphetamines and other diverted pharmaceutical stimulants have a mechanism of action similar to methamphetamine with both blockade of the dopamine transporter as well as stimulate release of dopamine.

Methylphenidatehas a mechanism of action more similar to that of cocaine with simple blockade of the dopamine transporter.

141
Q

Schizophrenia and other Psychotic Disorders

A

Schizophrenia
- 6 months duration

Schizophreniform disorder
-1-6 months duration

Schizoaffective disorder
-Schizophrenia and major depression/Bipolar

Brief psychotic disorder
-Duration at least 1 day but less than 1 month

142
Q

Anorexia nervosa

A

Self-imposed starvation

usually resulting in less than 85% of expected

or

ideal weight for height (<17.5 BMI)

143
Q

Major Depressive Episode:

Time frame

A

Depressive signs and sxs present for most days during a 2 week period

Depressed mood or anhedonia must be present

144
Q

Benzodiazepines half lives and withdrawals

A

Benzodiazepines with shorter elimination half-lives (eg,alprazolam,lorazepam, andoxazepam) are more likely to produce acute withdrawal on abrupt cessation after prolonged use

Benzodiazepines with longer elimination half-lives (eg,clorazepate,diazepam,flurazepam, prazepam, andclonazepam) usually produce more delayed and somewhat attenuated withdrawal symptom

145
Q

Clonidine and guanfacine MOA

A

Clonidine and guanfacine =
alpha-2 agonists
but MOA is unknown

146
Q

Melatonin

A

plays a role in your natural sleep-wake cycle. Natural levels of melatonin in the blood are highest at night.

The most common melatonin side effects include:
Headache, Dizziness, Nausea, Drowsiness

Melatonin can interact with 
Anticoagulants and anti-platelet drugs
Anticonvulsants
Contraceptive drugs
Diabetes medications
Medications that suppress the immune system (immunosuppressants)
147
Q

Bipolar I major depression in patients who are not receiving antimanic drugs

A

Patients with bipolar I disorder often present with major depression in the absence of antimanic drug therapy. For these patients, we suggest initial treatment withquetiapineorlurasidonerather than other medications

Seroquel or Latuda

148
Q

modafinil

A

Provigil

The exact mechanism of action is unclear. Modafinil has been shown to significantly increase dopamine in the brain by blocking dopamine transporters; however, has a lower affinity for dopamine receptors compared to amphetamines.

To improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD)

Warnings:
History of LV hypertrophy or symptomatic mitral valve prolapse (eg, ischemic ECG changes, chest pain, arrhythmias associated with CNS stimulants): not recommended.

Adverse Reactions:
Headache, nausea, nervousness

149
Q

Panic Attacks and Panic Disorder Treatment

A

Benzos for acute management

SSRIs (paroxetine, fluoxetine and sertraline)

SNRI-venlafaxine XR

TCAs (nortriptyline, desipramine, and imipramine)

MAOIs (phenelzine, tranylcypromine)

Cognitive-behavioral Psychotherapy (alone for mild cases); relaxation, desensitization

Exposure Therapy can be used in agoraphobia

150
Q

GABA

A

Gamma amino butyric acid

most common inhibitory neuro transmitter in brain

GABA agonists cause sleep, anxiety relief, muscle relaxation and memory impairment

Modulates other neurotransmitters

151
Q

Atypical or 2nd Generation Antipsychotics

A

Like First-generation, Second-generation antipsychotics (SGAs) are characterized by strong antagonism of dopamine D2 receptors in both cortical and striatal areas.

risperidone (Risperdal)

olanzapine (Zyprexa)

quetiapine (Seroquel)

ziprasidone (Geodon)

aripiprazole (Abilify) (Aristada)

clozapine (Clozaril)=Watch out for Agranulocytosis (Low WBC)

152
Q

Duration:

Schizophrenia

A
  • 6 months duration
153
Q

Schizophrenia symptoms

A

Positive psychotic symptoms:
Hallucinations, delusions

Positive disorganization symptoms:
Disorganized speech, thought language
thought blocking, tangentiality, loose associations
disorganized behavior

Negative symptoms
Flat affect
alogia (poverty of speech)
Poor attention
Avolition (loss of motivation)
anhedonia
loss of social interest
attention deficits
154
Q

Personality disorders

Cluster C

A

Avoidant
Dependent
Obsessive compulsive

155
Q

Cocaine withdrawal

A

The dopamine agonists, long-acting amphetamine and methamphetamine, bind to the same receptor as cocaine, but are less abusable than cocaine because of their relatively slower uptake and longer duration of action

156
Q

ADHD Ages and treatment

A

For preschool children (age 4 through 5 years
behavior therapy rather than meds

For most school-aged children (≥6 years) and adolescents
medication rather than behavior therapy alone or no intervention

We suggest that behavioral interventions be added to medication therapy

157
Q

Depression symptoms

A

SIG E CAPS

Sleep issues
Interest-diminished (anhedonia)
Guilt
Energy reduction
Concentration issues
Appetite or weight issues
Psychomotor retardation issues
Suicide thoughts or plan
158
Q

acamprosate

A

Campral

Maintenance of abstinence from alcohol in alcohol-dependent patients who are abstinent at treatment initiation, in conjunction with psychosocial support.

Contraindications:
Severe renal impairment (CrCl≤30mL/min). Sulfite allergy.

Adverse Reactions:
GI upset, myalgia/arthralgia, headache, rash, syncope, impotence,

159
Q

What treatment is available for disorders such as REM sleep behavior disorder

A

Effective pharmacologic therapy is available for certain disorders, such as REM sleep behavior disorder (RBD). Melatonin or (short-term benzos)

160
Q 
Tricyclic Antidepressants (TCAs)
Side effects:
A

cardiac effects, anticholinergic effects, antihistaminic effects, decreased seizure threshold, sexual dysfunction, diaphoresis, and tremor. These drugs are dangerous in overdose by suicidal patients.

Anticholinergic side effects
Hot, red, dry, blind, mad

161
Q

Generalized Anxiety Disorder Treatment

A

SSRIs: (1st-line) paroxetine and escitalopram (FDA approved)

SNRIs: (1st line) venlafaxine XR (FDA approved)

Buspirone (Mechanism is unknown) May have affinity with Serotonin and Dopamine receptors

TCAs: imipramine

Benzodiazepines (Alprazolam, Clonazepam) (short-term)

Behavioral and insight oriented therapy

162
Q

Side effect of bupropion

A

Dry mouth – 21 percent of patients who receivedbupropion

163
Q

treatment of generalized anxiety disorder (GAD).

A

SRI’S
SSRI’s
SNRI’s

164
Q

Cannabis Treatment

A

No FDA therapy at this time.

CBT and/or support groups is the key!

165
Q

Schedule IV meds

A

Tramadol

Benzos

166
Q

Schedule I meds

A

Heroin ,marijuana, LSD

167
Q

Antipsychotic meds should be used with in caution with?

A

Anyone with seizures or orthostasis
QTC intervals or weight gain

Meds like risperidone have Alpha adrenergic blocking effects

PAM Semester 2 (22 decks)

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