Pharmacology Flashcards
How long of a trial of an SSRI is needed to determine it unsuccessful?
4-6 weeks
What is first-line treatment for acute mania?
Valproic acid
What are the medications of choice for treating persistent depressive disorder (previously known as dysthymia)?
Bupropion and venlafaxine
What mood disorders can prednisone cause?
Depression, mania, and psychosis
What medication is preferred for treating mania caused by sleep deprivation in a bipolar patient?
Benzodiazepines - allows patient to return to normal sleep pattern and abort the manic episode
What antidepressant is preferred for adjunctive therapy to a mood stabilizer in a patient with bipolar depression?
Bupropion
What labs should be monitored in a patient taking lithium?
Lithium levels, thyroid function tests, creatinine, and urinalysis
What is optimal treatment of adolescent depression?
CBT and SSRI
What adjunctive therapies to an antidepressant are useful for treating refractory depression?
Lithium, thyroid hormones, estrogen, light therapy, and stimulants.
What treatment is most effective for MDD with melancholic features?
TCAs have been shown to be more effective than other antidepressants
What antidepressant class is generally most effective in MDD with atypical features?
MAOIs
What medication combination is useful for sedating combative patients?
IM haloperidol and IM lorazepam
What are characteristics of malignant hyperthermia?
May result from the administration of neuromuscular junction blockers (e.g. succinylcholine, halothane, etc.). It results in symptoms of hyperthermia, muscle rigidity, arrhythmias, hypotension, rhabdomyolysis, and DIC. Hypersensitivity to these meds runs in families.
What is neuroleptic malignant syndrome?
Caused by use of neuroleptics. Three sets of symptoms appear rapidly: alteration in level of consciousness, autonomic instability (e.g. hyperthermia, tachycardia, labile hypertension, and tachypnea), and “lead pipe” muscle rigidity. Elevated CPK and leukocytosis are common findings secondary to muscle damage.
What is serotonin syndrome?
Can occur with concurrent administration of an SSRI with an MAOI, l-tryptophan, or lithium. Symptoms: diarrhea, restlessness, extreme, agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, uncontrollable shivering, rigidity, delirium, coma, status epilepticus, and death.
How is cataplexy (sudden loss of muscle tone triggered by strong emotions) treated?
With medications that reduce REM sleep (e.g. antidepressants). Thought to be caused by the intrusion of REM sleep during periods of wakefulness.
What receptors are targeted by atypical antipsychotics?
5-HT6 and D4
What receptor does buspirone target?
5-HT1A
How do propranol, cannabis, methadone, and digoxin affect male sexual function?
Impaired erection
How does perphenazine affect male sexual function?
Impaired ejaculation
What psychotropic medications are metabolized by the CYP450 system?
Buproprion, meperidine, various benzodiazepines, and SSRIs.
What is meperidine?
Pethidine, also known as meperidine and Demerol, is a synthetic opioid pain medication. It’s metabolite, norpethidine, can accumulate resulting in a range of toxic effects, mainly convulsions, but also myoclonus and hyponatremia.
What SSRIs have FDA approval for treatment of OCD in children?
Fluoxetine, sertraline, and fluvoxamine
What level of leukopenia should a psychiatrist stop clozapine until the levels increase again?
WBC of 2000-3000. Patients should get daily WBCs and the clozapine can be restarted when levels are back to normal. A mild leukopenia (3000-3500) just requires twice weekly monitoring (can continue clozapine). Patients who develop agranulocytosis should not be restarted.
What medical treatment is indicated for severe lithium toxicity (level >2.5 nEq/L)?
Emergency dialysis. Moderate toxicity (usually at levels below 2.0) just requires supportive treatment - IV saline, monitoring urine output and lithium level.
What are contraindications for ramelteon use?
Severe hepatic impairment, severe sleep apnea, or severe COPD.
What is the mechanism of action of ramelteon?
Mimics melatonin - has a high affinity for melatonin receptors MT1 and MT2. It reduces the time to sleep, and to a lesser extent, increases the time spent asleep.
What medications can be given to treat severe dystonia?
Benztropine IM or diphenhydramine IM (can transition to PO eventually to prevent recurrence if patient remains on the neuroleptic)
What adjunctive medication can help with symptoms of akathisia?
A beta blocker
What anesthetic is commonly used for ECT?
Methohexital
What medication is approved for shift work sleep disorder?
Modafinil
What medication is preferred for treating psychotic symptoms in a patient with Parkinson’s disease?
Quetiapine - has sedative effects and relative lack of EPS risk
What is the half life of lithium?
~20 hours
What medications are particularly useful for treating the symptoms of hyperarousal seen in PTSD?
Clonidine and beta blockers
Sympathomimetic agents (e.g. pseudoephedrine)should be avoided with which antidepressant class?
MAOIs - they inhibit the metabolism of the sympathomimetic potentially leading to a hypertensive crisis
What antidepressant classes are useful for treating cataplexy?
SSRIs, TCAs, and MAOIs - all suppress REM sleep
What antidepressant has been found to be helpful treating both nocturnal enuresis and ADHD?
Imipramine
What is the mechanism of action atypical antipsychotics?
Blockade of serotonin 2A and dopamine D2 receptors.
Out of the second-generation antipsychotics, which two are the most associated with weight gain?
Olanzepine and clozapine
How is neuroleptic malignant syndrome treated?
Discontinue the neuroleptic, give dantrolene or bromocriptine, and supportive care (rehydration, cooling)
What antipsychotic is the least likely to cause tardive dyskinesia?
Clozapine
What drugs have interactions with lithium?
Thiazide diuretics, NSAIDs( not aspirin), ACE Is, tetracycline, and metronidazole
What is the best medication to treat ADHD in patients with a history of addiction?
Atomoxetine (non-addictive)
For how many weeks should an SSRI be stopped before starting an MAOI?
At least 2 weeks (except fluoxetine which has a long half life and requires 5 weeks)
What is treatment for acute dystonia?
Benztropine or diphenhydramine (due to cholinergic effects)
