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Pharmacology Flashcards

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1
Q

What are the “HAM” side effects?

What drugs are associated with these ADRs?

A

-anti-“H”istamine (sedation, weight gain)
-anti-“A”drenergic (hypotension)
-anti-“M”uscarinic (dried out)
TCAs, low potency antipsychotics

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2
Q

Symptoms of serotonin syndrome?

Classic cause?

A
  • confusion
  • flushing, diaphoresis
  • tremor, jerks
  • rhabdo –> renal failure –> death

SSRIs + MAOi combination

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3
Q

Classic drug related cause of HTN crisis

A

-MAOis + tyramine rich foods or sympathomimetics

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4
Q

First line treatment for extrapyramidal symptoms assc with antipsychotics

A

benztropine (Cogentin)

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5
Q

Hyperprolactinemia is assc with what drug class?

A

-typical antipsychotics + risperdone

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6
Q

Neuroleptic malignant syndrome: symptoms

A
  • CPK^^
  • lead pipe rigidity
  • hypertension
  • fever
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7
Q

Important psych meds that are cyp INHIBITORS:

A 
Many SSRIs:
-fluvoxamine 
-fluoxetine (Prozac)
-paroxetine (paxil)
-sertraline 
Also 1 SNRI: 
-duloxetine
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8
Q

Three major categories of antidepressants

A
  • SSRIs/SNRIs
  • TCAs
  • MAOis
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9
Q

Time needed for antidepressant to take effect

A

3-6 weeks

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10
Q

Which SSRI has weekly dosing option?

A

Fluoxetine (Prozac); longest half life of antidepressants

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11
Q

OTC drug that may increase serotonin levels

A

dextromethorphan

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12
Q

Common side effects of SSRIs

A
  • N/V
  • sexual side effects
  • insomnia/ anxiety
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13
Q

Sertraline (Zoloft): most notable ADR

A
  • highest incidence of GI disturbance

(s) ertraline upsets the (s)tomach

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14
Q

Paroxetine (Paxil): three considerations

A
  • protein bound –> drug interactions
  • shortest half life (withdraw)
  • anticholinergic effects
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15
Q

Fluvoxamine (Luvox): current FDA approved use

A

OCD only

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16
Q

Citalopram (Celexa): two considerations

A

-least drug interactions
-but known for QTc prolongation
(dose capped at 40mg due to cardiac risks, most patients need 80mg! Makes drug nearly useless. Consider Lexapro instead. It is the “s isomer” of citalopram…. Dr. Melvin likes this fact.)

**Note: 4mg selexa= 1 mg Lexapro

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17
Q

What is the generic name for the following SSRIs:

  • celexa
  • Lexapro
  • paxil
  • Prozac
  • Zoloft
A
  • celexa:citalopram
  • Lexapro: excitalopram
  • paxil: paroxetine
  • Prozac: fluoxetine
  • Zoloft: sertraline
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18
Q

Venlafaxine (Effexor):

  • MOA
  • Most notable side effect
A
  • SNRI

- can raise BP, don’t give to patients with untreated hypertension, can also cause orthostatic hypoTN

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19
Q

How does desvenlafaxine compare to venlafaxine?

A

Pristiq

  • active metabolite
  • pricey
  • no known benefit over duloxetine (Effexor)
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20
Q

Duloxetine (Cymbalta):

  • use
  • two considerations
A
  • good for depression + neuropathic/fibromyalgia pain
  • hepatotoxic with alcohol use
  • pricey
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21
Q

Bupropion (Wellbutrin):

-advantages (3)

A
  • few sexual side effects
  • might help with ADHD
  • might help with smoking cessation
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22
Q

Major contraindication to Wellbutrin:

A

**You will be asked this by multiple people in both neuro and psych!! KNOW THIS.

INCREASES SEIZURE RISK. AND ITS REAL/ TRUE. DO NOT GIVE THIS TO EPILEPTIC PATIENT!!!!!!

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23
Q

Trazadone/ nefazadone:

-use

A

-major depression, but mostly insomnia

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24
Q

What limits trazadones use?

A
  • orthostatic hypotension at higher doses
  • possible priapism
  • usually have to combine low dose trazadone with SSRI to treat insomnia + depression.
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25
Q

Nefazadone black box warning:

A

-liver failure, so rarely used.

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26
Q

Remeron/Mirtazapine:

MOA

A

a2 antagonist –> causes ^^5HT and NE

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27
Q

Why are TCAs rarely first line?

A
  • higher incidence of side effects
  • dosing requires titration
  • LETHAL IN OD!!!! (THIS IS REAL!!!, WE SAW THIS HAPPEN WITH AMITRIPTYLINE!)
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28
Q

Special use for:
imipramine
clomipramine
amitriptyline

A
  • imipramine: enuresis
  • clomipramine: OCD
  • amitryptiline: migraines
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29
Q

Doxepine:
MOA
Uses

A
  • TCA

- chronic pain, sleep aid

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30
Q

What neurotransmitters are increased at synapse by TCAs?

A

NE, 5HT

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31
Q

What are “secondary amines” and why are they useful?

A
  • metabolites of tertiary amines (TCAs)

- less HAM ADRs

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32
Q

List two secondary amines

A
  • desipramine

- nortriptyline

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33
Q

How many TCAs are needed to cause lethality?

A

-1 week supply!!!! OR LESS IF PATIENT IS TAKING OTHER SEDATING MEDS!!!!

34
Q

3 major complications of TCAs

A
  • convulsions
  • cardiotox
  • coma
35
Q

What antidepressants are preferably in atypical (hypersomnia, hyperphagia, mood reactivity) depression?

A

MAOis (except not really in real life because its too hard for patients to avoid tyramine)

36
Q

What is the MOA of MAOis?

A

-^^ ALL monoamines, least selective, blocks MAO-A and B

NE, 5HT, DOPA, tyramine

37
Q

List three MAOis

A

phenelzine
tranylcypromine
isocarboxazid

38
Q

Three drugs indicated for insomnia

A

trazadone
TCAs
mirtazapine

39
Q

How do antipsychotics effect the elderly?

A

treat behavioral symptoms but ^ risk all cause mortality

40
Q

MOA for typical vs atypical antipsychotics

A
  • typical: block D2C receptors

- atypical: block D2 and 2A receptors

41
Q

What side effects are present in LOW POTENCY TYPICAL antipsychotics? What are two low potency antipsychotics?

A

HAM ADRs
More lethality in OD due to QT prolongation

  • chlorpromazine
  • thioridazine
42
Q

Chlorpromazine:
weird ADR
weird use

A

blue grey skin discoloration

N/V, hiccups

43
Q

Thiroidazine: weird ADR

A

retinitis pigmentosa

44
Q

Loxapine:

two considerations

A
  • increases seizure risk

- metabolite = antidepressant (luvox, fluvoxetine)

45
Q

Thiothixene weird ADR

A

ocular pigment changes

46
Q

List four high potency antipsychotics

A
  • Haldol
  • fluphenazine
  • pimozide
  • trifluphenazine

Thugs pressed homicidal fairies

47
Q

Which of the high potency antipsychotics is assc with QTc prolongation + v tach?

A

pimozide

48
Q

List six atypical antipsychotics

A
  • aripiprazole
  • risperdone
  • clozapine
  • olanzapine
  • quetiapine
  • ziprasidone

Aardvarks Really Can Offer Quilts (to) Zebras!

49
Q

Lurasidone/Latuda:
What is it?
Use?

A
  • used for bipolar depression

- new antipsychotics, expensive

50
Q

How are acute manic episodes treated?

How is bipolar maintained?

A
  • acute mania: atypical + mood stabilizer

- maintenance: monotherapy with atypicals

51
Q

Black box warning clozapine

A

agranulocytosis

52
Q

Special use for clozapine?

A

-psychosis in Lewey Body demenentia because LESS DOPA BLOCKADE

53
Q

What are the mood stablizers?

A
  • lithium

- AEDs (valproate, lamotrigine, carbamazepine)

54
Q

For what conditions is lithium DOC?

A
  • acute mania
  • px for episodes in bipolar/ schizoaffective d/o
  • cyclothymic disorder
55
Q

When prescribing lithium, what levels must be monitored?

A
  • creatinine **(renal fxn may decrease, beware also giving NSAIDs)
  • thyroid function
  • lithium levels
56
Q

What is the major drawback of lithium?

A

narrow therapeutic index

also NDI/ nephro/thyro toxic

57
Q

What psych drugs require getting “levels’

A
  • lithium
  • valproate
  • carbamazepine
  • clozapine
58
Q

How does lithium effect CBC?

A

leukocytosis, may be helpful if fiven with clozapine which= agranulocytosis

59
Q

Carbamazepine:
MOA
labs needed to start treatment

A
  • blocks sodium channels

- CBC, LFTs

60
Q

Notable side effects of carbamazepine:

A

-hyponatremia**
(which is in itself a seizure risk. If patient is refractory to carbamazepine check Na before stopping.)
-agranulocytosis

61
Q

For what is carbamazepine used in psychiatry?

A

-mania + mixed features or rapid cycling BP

62
Q

Carbamazepine metabolic consideration

A

autoinduction of metabolism= requires increasing dosages

63
Q

Valproate MOA

A

blocks Na channels and increases GABA

64
Q

Labs that must be done when using valproate

A

CBC
LFTs
Drug levels

65
Q

Lamotrigine: use in psychiatry

Most serious side effect

A

bipolar depression

stevens johnsons syndrome

66
Q

What drug increases the level of lamotrigine?

A
  • increased by valproate

- decreases valproate

67
Q

Oxcarbazepine (trileptal):

  • What should be monitored?
  • What preferable over carbamazepine if possible?
A
  • sodium
  • less rash, less hepatox

(more effective for mood disorders, less for seizures)

68
Q

Most limiting side effect of topiramate?

Use in psych?

A
  • cognitive slowing (also kidney stones, acidosis, weight loss)
  • impulse control disorders
69
Q

Antidote for BDZ withdraw

A

Flumazenil

70
Q

List 1 short 1 med 2 long acting benzos

A

short: lorazepam
med: diazepam
long: clonazepam, chlordiapoxide something another

71
Q

What is the most effective treatment for major depressive disorder +/- psychotic symptoms?

A

ECT

72
Q

Atypicals clearly have a better side effect profile than typical psychotics. So why do we give typicals?

A

-typicals can be given IM (depot) once a month and are needed in poorly compliant patients

(also some patients were started on typicals decades ago before atypicals existed)

73
Q

Rules for dosing SSRIs

A
  • try for 6 weeks
  • treat for 6 months
  • 3 weeks wash out
  • max the dose
74
Q

Who shouldn’t get bupropion?

A
  • bulimics

- epileptics

75
Q

Valproate ADRs

A
  • NTDs
  • pancreatitis
  • low platelets
  • agranulocytosis
76
Q

Order of drug choices for mood stabilizers

A

1) lithium
2) valproate
3) carbamazepine/lamotrigine

77
Q

Order of choices for antipsychotics

A

1) atypicals
2) typicals
3) clozapine

78
Q

Contrast specificity and potency of atypical and typical antipsychotics

A
  • atypicals: poor potency, good specificity

- typicals: good potency, poor specificity

79
Q

ADRs assc with carbamazepine

A
  • AV block

- cleft palate

80
Q

Weird ADR assc with lamotrigine

A

blurred vision

81
Q

What’s in “B52”?

A

Haldol
lorazepam
diphenhydramine

Psych (16 decks)

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