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Psychiatry > Pharmacology/Treatment > Flashcards

Pharmacology/Treatment Flashcards

1
Q

Buspirone

Tx? (2)
Lag time?
Sedation/cognitive impairment? (Y/N)
Addictive? (Y/N)

A

Buspirone (BuSpar)

Tx: GAD, social phobia
Lag time: 1 week
No sedation/cognitive impairment
Low potential for abuse/addiction

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2
Q

What class if the 1st line treatment for schizophrenia?

6 examples…

Which 2 are more “weight-neutral”?
–Of these 2, which 1 is associated with QT prolongation?

Which 1 is associated with agranulocytosis, seizures?

Which 1 is associated with increased prolactin?

Which 1 has the lowest extrapyramidal sfx?

What is the last 1?

A

Atypical Antipsychotics

aripiprazole, ziprasidone - weight neutral
*ziprasidone - QT prolongation

clozapine - agranulocytosis, seizures

risperidone - increased prolactin
(–> amenorrhea, infertility, galactorrhea, sexual dysfunction, weight gain)

quetiapine - lowest EPS

olanzapine

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3
Q

Which atypical antipsychotic is beneficial for tx of schizophrenia, but not first choice due to risk of agranulocytosis?

Atypical antipsychotics carry lower risk of what SFX? carry higher risk of what SFX?

A

Clozapine - agranulocytosis

Atypical antipsychotics - lower risk of extrapyramidal side effects; higher risk of metabolic syndrome

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4
Q

Name 4 examples of traditional/1st generation antipsychotics. High/low potency?

For tx of schizophrenia, these drugs are more effective at treating what symptoms?

A

Typical/1st generation antipsychotics
High potency: haloperidol, trifluoperazine
Low potency: chlorpromazine, thioridazine

more effective at treating (+) symptoms

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5
Q

High-potency traditional/1st gen antipsychotics can cause sfx:
EPS (dystonias, parkinsonism, akathisia); tardive dyskinesia; NMS

Tx for SFX?

A

High potency 1st gen - EPS (eg, dystonias, parkinsonism, akathisia); tardive dyskinesia; NMS

(high potency: haloperidol, trifluoperazine)

Tx:

  • antiparkinsonian rx: benztropine, diphenhydramine (anti-parkinsonian)
  • benzos/beta blockers (akathisia)
  • dantrolene, bromocriptine (NMS)
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6
Q

Lithium = 1st line tx for acute mania; prophylaxis for manic/depressive episodes in bipolar, schizoaffective disorders

Common SFX include AMS, fine/coarse tremors, convulsions, GI distress, weight gain

Name 4 unique SFX related to heart, site of metabolism (kidney), hematology, thyroid.

What is the fetal cardiac defect that can be caused by Lithium?

A

Lithium

Unique SFX: ECG changes, polyuria/nephrogenic DI, benign leukocytosis, hypothyroidism

Ebstein’s anomaly

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7
Q

What are 6 factors that can increase Li levels, potentially causing Li toxicity?

  • -3 conditions
  • -3 drug types
A 
Dehydration
Hyponatremia/Sweating
Impaired renal function
NSAIDs
ACE Inhibitors
Diuretics
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8
Q

SSRIs: fluoexetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram

What side effect is most likely to decrease compliance?

1) highest risk of GI sfx?
2) anticholinergic sfx?
3) safe in pregnancy and children? also longest t1/2
4) approved only for OCD?
5) maybe fewest sfx? (2)

A

SSRIs

Sexual dysfunction (typically resolve in a few weeks)

1) sertraline - GI sfx
2) paroxetine - anticholinergic sfx
3) fluoxetine - safe in pregnancy, children
4) fluvoxamine - OCD
5) citalopram, escitalopram

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9
Q

SSRIs have an FDA black box warning: increased suicidal thinking/behavior

Serotonin Syndrome: fever, diaphoresis, shivering, tachycardia, HTN, delirium, hyperreflexia

What are 3 types of drugs that can potentially cause SS when taken with an SSRI?

A

SSRI + (MAOI, cough medicine, triptans) –> Serotonin Syndrome

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10
Q

Tx for anorexia? bulimia?

A

Anorexia: family therapy
Bulimia: antidepressant (SSRI)

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11
Q

Buproprion
=NE/D reuptake inhibitor
Tx: depression, ADHD, smoking cessation

1) lack of what sfx vs SSRI?
2) two important sfx at high doses?
3) three contraindications?

A

Buproprion
=NE/D reuptake inhibitor
Tx: depression, ADHD

1) lack of sexual sfx
2) psychosis, seizures
3) seizure, active eating disorder, currently taking MAOI

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12
Q

Tx for panic disorder?

  • -Pharm - which SSRIs?
  • -Therapy?
  • -Immediate relief?
A

Antidepressants: SSRIs: paroxetine, sertraline

TCAs, MAO-Is may also be effective

CBT

Benzodiazepine

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13
Q

TCAs
Tertiary amines: amitriptyline, imipramine, clomipramine, doxepin
Secondary amines: nortriptyline, desipramine

  1. Inhibit reuptake of what two hormones?
  2. SFX?
  3. Contraindication?
  4. Tx for TCA overdose?
A

TCAs

  1. inhibit reuptake of NE, serotonin
  2. anticholinergic sfx: dry mouth, blurred vision, dizziness, pupillary dilation
  3. Previous suicide attempt
  4. not first line because lethal in overdose; tx: NaBicarb
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14
Q

Tx for PTSD?

–also tx for flashbacks/nightmares?

A

SSRIs

Anticonvulsants for re-experiences (and Prazosin!)

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15
Q

3 benzos not metabolized by liver? (LOT))

Tx for benzodiazepine overdose?

A

Lorazepam, Oxazepam, Temazepam (for chronic alcoholics or liver disease)

Flumazenil
(don’t induce withdrawal too quickly)

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16
Q

Two long-acting benzos? (DC)
Four intermediate benzos? (ALOT)
Two short-acting benzos? (TM)

A

Long Acting
–Diazepam, Clonazepam

Intermediate Acting
–Alprazolam, Lorazepam, Oxazepam, Temazepam

Short Acting
–Triazolam, Midazolam

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17
Q

To treat CNS anticholinergic effects, use ?

To treat peripheral anticholinergic effects, use ?

A

Bethanecol: tx central anticholinergic effects

Physostigmine: tx peripheral anticholinergic effects

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18
Q

Which atypical antipsychotics…

…are less sedating and have less potential for weight gain? (2)

…can cause an increased prolactin?

…has more anticholinergic sfx?

A

Ziprasidone, Aripiprazole – less sedating; less potential for weight gain

Risperidone – increased prolactin
(–> amenorrhea, infertility, galactorrhea, sexual dysfunction, weight gain)

Clozapine – more anticholinergic sfx (also agranulocytosis!)

19
Q

Tx for narcolepsy?

A

Modafinil (a non-amphetamine stimulant)

20
Q

Lamotrigine

  • tx: bipolar depression
  • common sfx: dizziness, sedation, headaches, ataxia

Most serious side effect?

A

Lamotrigine

  • tx: bipolar depression
  • common sfx: dizziness, sedation, headaches, ataxia

Stevens-Johnson syndrome

21
Q

Valproic Acid

  • tx: mixed episodes of bipolar; rapid cycling
  • tx of choice when Li is contraindicated
  1. Need to monitor what two levels?
  2. What other caution?
A

Valproic Acid
-tx: mixed episodes of bipolar; rapid cycling

  1. Need to monitor CBC, LFTs (hepatotoxicity)
  2. Teratogenic (NTDs)
22
Q

Only FDA approved tx for bipolar disorder in youth ages 12+?

What is an option for younger children?

A

Lithium

  • -1st line tx for non-psychotic mania in youth
  • -consider atypical antipsychotic in presence of psychotic symptoms

Divalproex

  • -used to tx seizures in younger children
  • -may be better choice to tx bipolar in youth
23
Q

Which two drugs are useful in treating mixed episodes or rapid-cycling bipolar disorder?

A

Carbamazepine, Valproic Acid (Depakote, Depakene)

24
Q

Carbamazapine can tx mixed episodes; rapid-cycling bipolar disorder. Common sfx include: GI; CNS (drowsiness, ataxia, sedation)

Serious sfx re:

  1. Skin
  2. Blood (4)
  3. Liver
  4. Pregnancy

How is it metabolized?

A

Carbamazapine can tx mixed episodes & rapid-cycling bipolar disorder. Common sfx include: GI & CNS (drowsiness, ataxia, sedation)

Serious sfx re:

  1. Skin: Stevens-Johnson Syndrome
  2. Blood: leukopenia, aplastic anemia, thrombocytopenia, agranulocytosis
  3. Liver: hepatitis
  4. Pregnancy: teratogenic NTDs

Metabolized via P450. Potential autoinduction, requiring higher dosages.

25
Q

Tx for Benzo overdose?

Tx for barbiturate overdose?

Tx for opiate OD?

A

Benzo OD: Tx = Flumazenil

Barbiturate OD: Tx = NaHCO3

Opiate OD: Tx = Naloxone

26
Q

Tx for ADHD

1) CNS stimulants (3)
2) 2nd line: alpha-2 agonists (2)

A

Tx for ADHD

CNS stimulants

  • -methylphenidate
  • -dextroamphetamine
  • -amphetamine salts (Adderall)

Alpha-2 Agonists

  • -clonidine
  • -guanfacine
27
Q

What side effect is much less likely with use of atypical antipsychotics versus typical?

What side effect is more common with use of atypicals?

A

Less common: Tardive dyskinesia
(no treatment)

More common: Metabolic syndrome

28
Q

1st line treatment for specific phobia?

A

Exposure Therapy (eg, systemic desensitization)

Can use benzo or beta blocker during desensitization to help control autonomic symptoms.

29
Q

What SSRI is approved for the treatment of social anxiety disorder?

What drugs are commonly used to control autonomic symptoms of performance anxiety?

A

Paroxetine

Beta Blockers (eg, propranolol)

30
Q

Name the two drugs:

  • -members of Serotonin receptor antagonists and agonists
  • -Tx: insomnia, refractory MDD, and MDD with anxiety
  • -both cause sedation as a prominent sfx

Which causes priapism?
Which carries a black box warning for liver failure?

A
  • -members of Serotonin receptor antagonists and agonists
  • -Tx: insomnia, refractory MDD, and MDD with anxiety
  • -both cause sedation as a prominent sfx

Which causes priapism?
–Trazodone

Which carries a black box warning for liver failure?
–Nefazodone

31
Q

Which SSRI has highest risk for GI disturbances?

A

Sertraline

32
Q

Which SSRI has the most anticholinergic sfx? (eg, sedation, constipation, weight gain)

A

Paroxetine

33
Q

Which SSRI is approved for treating OCD?

Which SSRI is approved for treating bulimia?

A

Fluvoxamine: OCD

Fluoxetine: Bulimia

34
Q

What are the most appropriate treatment options for a patient with MDD with psychotic features (elderly or not)?
(2 options)

A

MDD with psychotic features

  1. antidepressant/antipsychotic combo
  2. ECT
35
Q

MAO-Is
-phenelzine, tranylcypromine, isocarboxazid, selegiline

1) More effective in what type of depression?
2) SSRI + MAO-I = ?
3) MAO-I + tyramine food or sympathomimetic = ?

A

MAO-Is
-phenelzine, tranylcypromine, isocarboxazid, selegiline

1) Atypical depression (hypersomnia, increased appetite, increased sensitivity to interpersonal rejection)
2) SSRI + MAO-I = Serotonin Syndrome
3) MAO-I + tyramine food or sympathomimetic = Hypertensive Crisis

36
Q

Trazadone
Major treatment use?
–also used for refractory MDD, MDD with anxiety

Main sfx? (2)

A

Trazadone
-serotonin receptor antagonist/agonist

Tx: insomnia

Main sfx: priapism, sedation

37
Q

TCAs

  • -highly anticholinergic
  • -potentially lethal in OD

Tertiary amines include amitriptyline, doxepin, and two others

  • -one is used to treat OCD?
  • -one is used to tx enuresis, panic disorder?

Name the two secondary amines

A

TCAs

  • -highly anticholinergic
  • -potentially lethal in OD

Tertiary amines: amitriptyline, doxepin, and

  • -Clomipramine: tx OCD
  • -Imipramine: tx enuresis, panic disorder

Secondary amines: nortriptyline, desipramine

38
Q

After d/c MAO-I, how long should you wait to washout before starting an SSRI?

A

14 days

39
Q

BP drug that commonly causes depression?

A

Propranolol

40
Q

Which category of drugs should be used with caution in elderly patients due to their potential for causing confusion, disinhibition, anterograde amnesia, and reduced motor function?

A

Benzodiazepenes

41
Q

Which antidepressant can also be used for smoking cessation? Mechanism of action?

A

Buproprion

NE/D reuptake inhibitor

42
Q

Primary form of treatment for adjustment disorder?

A

Psychodynamic psychotherapy

Can use pharmacotherapy for associated symptoms (eg, insomnia, depression, anxiety)

43
Q

A non-benzodiazepene hypnotic used for short-term treatment of insomnia

SFX include GI sfx, anterograde amnesia, hallucinations, sleepwalking

A

Zolpidem

44
Q

Tx for ADHD in individuals with substance abuse problems, individuals with tics, or patients with comorbid anxiety?

A

Atomoxetine

  • -inhibits NE reuptake
  • -gradual onset, may take 2-3 weeks

NB: Dx of ADHD requires SIX+ symptoms of inattention or hyperactivity/impulsivity. Must be present for at least 6 months.

Psychiatry (6 decks)

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