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NAPLEX Study Time > Psych > Flashcards

Psych Flashcards

1
Q

What is the DSM-5 criteria for depression diagnosis?

A

At least 5 of the following (must include 1 ) during the same 2 week period:
1) Mood depressed
2) Sleep inc/dec
3) Interest/pleasure diminished*
4) Guilt/feelings of worthlessness
5) Energy dec
6) Concentration dec
7) Appetite inc/dec
8) Psychomotor agitation/retardation
9) Suicidal ideation

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2
Q

Drugs that can cause/worsen depression

A

Atomoxetine
Indomethacin
Efavirenz
Rilpivirine
Beta blockers
Hormonal OC
Steroids
Antidepressants (boxed warning)
BZDs

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3
Q

Natural products used for depression

A

St John’s Wort
Valerian
5-HTP
SAMe

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4
Q

What is a suitable drug trial period for antidepressants?

A

4-8 weeks

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5
Q

What is the DOC for depression in pregnancy?

A

SSRIs (except parotexine)
They do have a warning for pulmonary HTN in newborn but are still preferred

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6
Q

What is the DOC for postpartum depression?

A

SSRI or TCAs (except doxepin)

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7
Q

Symptoms of serotonin syndrome

A

Severe nausea, dizziness, HA, diarrhea, agitation, tachycardia, hallucinations, muscle rigidity

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8
Q

Which antidepressant does not need to be tapered when discontinuing therapy?

A

Fluoxetine (self tapers with long half life)

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9
Q

What boxed warning do all antidepressants have?

A

Increased suicidal thoughts/actions in some children, teens, and young adults
MedGuides are required

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10
Q

MOA for SSRIs

A

Increase 5-HT by inhibiting its reuptake in the neuronal synapse

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11
Q

Examples of SSRIs

A

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine

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12
Q

Key points for SSRIs

A

Citalopram max dose 20 mg and escitalopram 10 mg in pts >60 yo
Warnings for QT prolongation, SIADH, bleeding
SE: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, tremor, dizziness, HA

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13
Q

Most activating SSRI

A

Fluoxetine

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14
Q

Most sedating SSRI

A

Paroxetine

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15
Q

Which SSRI is preferred in pts with cardiac risk?

A

Sertraline

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16
Q

Which SSRIs/SNRIs are CYP2D6 inhibitors?

A

Fluoxetine
Paroxetine
Fluvoxamine
Duloxetine

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17
Q

Which SSRI has the highest risk of QT prolongation?

A

Citalopram

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18
Q

How long of a washout is required between MAOi and SSRI/SNRI/TCA/bupropion use?

A

2 weeks
Can cause serotonin syndrome or hypertensive crisis

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19
Q

Key points for vilazodone (Viibryd)

A

SSRI + 5-HT1A partial agonist
Take with food
Less sexual SE than SSRIs/SNRIs

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20
Q

Key points for vortioxetine (Trintellix)

A

SSRI + 5-HT3 antagonist + 5-HT1A agonist
Can cause constipation
Must half dose when used with CYP2D6 inhibitors

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21
Q

Examples of SNRIs

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)
Levomilnacipan (Fetzima)

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22
Q

SNRI MOA

A

Inhibit reuptake of 5-HT and NE

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23
Q

Key points for SNRIs

A

Similar SE to SSRIs plus increased HR, dilated pupils, excessive sweating, constipation
Increased BP can occur with all SNRIs, esp with high dose venlafaxine

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24
Q

Examples of TCAs

A

Tertiary amines:
Amitripyline (Elavil)
Doxepin
Clomipramine (Anafranil)
Imipramine (Tofranil)

Secondary amines:
Nortriptyline (Pamelor)
Desipramine (Norpramin)

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25
Q

Key points for TCAs

A

QT prolongation w/ OD
Orthostasis
Anticholinergic SE (dry mouth, blurred vision, urinary retention, constipation)
Can cause weight gain
On Beer’s list
Tertiary amines have increased anticholinergic SE and weight gain

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26
Q

What enzyme are TCAs metabolized via?

A

CYP2D6

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27
Q

Key points for bupropion (Wellbutrin)

A

CI w/ hx of seizures, anorexia/bulimia
SE: Dry mouth, CNS stimulation, tremors/seizures, weight loss
Max XL dose = 450 mg/day
Max SR dose = 200 mg/dose

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28
Q

Examples of MAOi

A

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (MAO-B selective)

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29
Q

MAOi MOA

A

Inhibit monoamine oxidase which is responsible for the breakdown of catecholamines (5-HT, NE, Epi, DA)

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30
Q

Key points for MAOi

A

CI w/ CVD, hepatic disease, severe renal disease, pheochromocytoma
Many DDIs and food interactions - can be fatal if missed
SE: Anticholinergic, orthostasis, sedation, sexual dysfunction
Max dose for most is around 60 mg/day

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31
Q

What foods are CI with MAOi?

A

Tyramine-rich foods (increase NE): aged cheese, pickled herring, yeast, air-dried meats, sauerkraut, soy sauce, fava beans, wine/beer
Anything smoked, pickled, aged, or fermented

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32
Q

How long of a washout is required between fluoxetine and MAOi use?

A

5 weeks

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33
Q

Key points for mirtazapine (Remeron)

A

Tetracyclic antidepressant
SE: sedation, increased appetite, weight gain, anticholineric effects, QT prolongation

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34
Q

Key points for trazodone

A

Inhibits 5-HT reuptake, blocks H1 and a1 receptors
SE: sedation (used more for sleep), sexual dysfunction (pripism), additive QT risk
Sleep dosing much lower than depression dosing

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35
Q

What is the major toxicity of nefazodone?

A

Hepatotoxicity

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36
Q

What medications can be used as augmentation for depression (in combo with an antidepressant)?

A

Buspirone
Aripiprazole
Olanzepine
Quentiapine
Lithium

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37
Q

What are examples of EPS?

A

Dystonias, akathisia, Parkinsonism, tardive dyskinesias

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38
Q

What are examples of negative symptoms associated with schizophrenia?

A

Lack of emotion/apathy
Social withdrawal
Loss of motivation/avolition
Lack of speech/alogia
loss of interest in activities
Poor hygiene

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39
Q

What are examples of positive symptoms associated with schizophrenia?

A

Hallucinations
Delusions
Disorganized thinking/behavior
Difficulty paying attention

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40
Q

What medications/drug can cause psychotic symptoms?

A

Anticholinergics
Dextromethorphan
Dopamine agonists
Stimulants
Interferons
Steroids
Cannabis
Cocaine
LSD
PCP

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41
Q

Which medications are 1st line for the treatment of schizophrenia?

A

Second-generation antipsychotics

42
Q

What is the primary difference between 1st and 2nd gen antipsychotics?

A

1st gen have a higher incidence of EPS

43
Q

Olanzapine should not be given with what medication due to risk of sedation/resp depression?

A

Benzodiazepines

44
Q

What boxed warning is present on all antipsychotics?

A

Increased risk of mortality when used for dementia-related psychosis in elderly patients (due to CV complications and infection)

45
Q

1st gen antipsychotic MOA

A

Blocks dopamine-2 (D2) receptors, minimal serotonin blockade

46
Q

Examples of 1st gen antipsychotics

A

Low potency: chlorpromazine, thioridazine
Mid potency: loxapine, perphenazine
High potency: haloperidol, fluphenazine, thiothixene, trifluoperazine

47
Q

Key points for 1st gen antipsychotics

A

Warnings for QTc prolongation, orthostasis/falls, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome (NMS)
Lower potency = high sedation, low EPS
Higher potency = low sedation, high EPS

48
Q

What drug class can be given to avoid/limit painful dystonic reactions associated with EPS?

A

Anticholinergics (benztropine, diphenhydramine)

49
Q

Examples of second generation antipsychotics

A

Aripiprazole (Abilify)
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperdone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
(There’s more but these are bold)

50
Q

SE for aripiprazole

A

Akathisia
Can be activating or sedating

51
Q

Key points for clozapine

A

Warnings for neutropenia, myocarditis, cardiomyopathy, seizures
SE: agranulocytosis, seizures, constipation, metabolic syndrome (weight gain), hypersalivation
Prescribers and pharmacies must be REMS certified
To start, ANC must be > 1500
Stop if ANC <1000
Only used last line

52
Q

SE for lurasidone

A

Somnolence, EPS (dystonias), nausea
Risk of metabolic syndrome (lower than other SGAs)
CI with strong CYP3A4 inducers/inhibitors

53
Q

SE for olanzapine

A

Somnolence, metabolic syndrome
Sedation and delirium are possible with injection - must be monitored for 3 hrs post injection

54
Q

2nd gen antipsychotics MOA

A

Blocks dopamine (D2) and serotonin (5-HT1A) receptors

55
Q

SE for paliperidone

A

Increased prolactin
EPS (esp at high doses)
Metabolic syndrome
QT prolongation
Available as LA injection (monthly, q3 months, and q6 months)

56
Q

Key points for quetiapine

A

SE: Somnolence, metabolic syndrome
Low EPS risk - used for psychosis in Parkinsons
For XR: take at night w/o food

57
Q

SE for risperidone

A

Increased prolactin
EPS (esp at high doses)
QT prolongation
Metabolic syndrome

58
Q

SE for ziprasidone

A

QT prolongation
Must take w/ food

59
Q

Which antipsychotic medications may want to be avoided in patients with CVD or DM?

A

2nd gen antipsychotics
Metabolic syndrome can cause increased weight, cholesterol, TG, and BG

60
Q

Which 1st gen antipsychotic has the highest risk of QT prolongation?

A

Thioridazine
Has a boxed warning

61
Q

Which medications are approved for the treatment of tardive dyskinesia?

A

VMAT2 inhibitors
- Valbenazine (Ingrezza)
- Deutetrabenazine (Austedo)

62
Q

What is neuroleptic malignant syndrome (NMS)?

A

A medical emergency caused by D2 blockade
Rare but can be lethal
S/S: hyperthermia, extreme muscle rigidity, mental status change, tachycardia, tachypnea, elevated CK and WBC

63
Q

What 3 drugs are utilized in the treatment of NMS?

A

BZDs
Dantrolene
Dopamine agonist (bromocriptine)
also stop the antipsychotic causing it

64
Q

Bipolar I

A

Characterized by mania that significantly impairs social/work functioning (psychosis, delusions) or requires hospitalization

65
Q

Bipolar II

A

Characterized by hypomania - does not affect social/work functioning or require hospitalization

66
Q

First line treatment options for manic episodes (BPD)

A

Valproate or lithium +/- an antipsychotic

67
Q

First line treatment options for depressive episodes (BPD)

A

Antipsychotics
Can add on lithium, valproate, or lamotrigine if needed

68
Q

Which BPD meds should be avoided in pregnancy?

A

Valproare, lithium, and carbamazepine

69
Q

Which meds are preferred in pregnancy for BPD?

A

Lamotrigine
Lurasidone (limited, only used for BP depression)

70
Q

Key points for lithium

A

Therapeutic range = 0.6-1.2 mEq/L (trough)
- >1.5: ataxia, tremor vomiting
- >2.5: CNS depression, seizure, coma, arrhythmia
SE: serotonin syndrome, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism
Take w/ food to decrease nausea
Renally cleared - levels increase with salt loss (ACE/ARBs/diuretics) and NSAIDs; decrease with increased salt, caffeine, theophylline

71
Q

Which neurotransmitter does lithium primarily effect?

A

Glutamate

72
Q

Equivalence between lithium citrate and lithium carbonate

A

5 mL (8 mEq) lithium citrate syrup = 300 mg lithium carbonate

73
Q

First line treatment for ADHD for children ages 4-5 yo

A

Behavior management/classroom intervention

74
Q

Which non-stimulant medications can be used for the treatment of ADHD?

A

Atomoxetine (strattera)
Guanfacine ER (Intuniv
Clonidine ER (Kapvay)

75
Q

SE for stimulants

A

Tachycardia, HTN, CV events, pripism, psychosis (mania), increased seizure risk, loss of appetite (can decrease growth in children), serotonin syndrome, insomnia, irritability
Avoid w/ MAOi’s

76
Q

Which drug is the active isomer of methylphenidate

A

Dexmethylphenidate (Focalin)

77
Q

Examples of stimulants

A

Methylphenidate (Ritalin, Concerta, Daytrana)
Dexmethylphenidate (Focalin)
Dextroamphetamine/amphetamine (Adderall)
Lisdexamfetamine (Vyvanse)

78
Q

What is special about Vyvanse’s formulation?

A

Prodrug
Low abuse potential, must be hydrolyzed in the blood so the “rush” is muted if the drug is injected/snorted

79
Q

Key points for atomoxetine

A

Avoid with MAOi’s
Can cause hepatotoxicity (rare, within 120 days)
Same SE as stimulants
Metabolized via CYP2D6
Do not open capsule - eye irritant

80
Q

Key points for clonidine ER and guanfacine ER

A

Alpha 2a agonists
Dose-dependent CV effects, sedation, and drowsiness
Must be tapered, can cause rebound HTN
SE: Dry mouth, somnolence, fatigue, dizziness, constipation, bradycardia, hypotension
Caution with other CNS depressants

81
Q

Drugs that can cause anxiety

A

Albuterol
Antipsychotics
Bupropion
Caffeine/theophylline
Decongestants
Levothyroxine (OD)
Steroids
Stimulants

82
Q

What meds are 1st line for anxiety?

A

SSRIs, SNRIs

83
Q

What meds are 2nd line for anxiety?

A

Buspirone
TCAs (amitriptylline, nortriptylline)
Hydroxyzine
Pregabalin/gabapentin (not FDA approved)

84
Q

Key points for buspirone

A

CI w/ MAOi’s
SE: serotonin syndrome, dizziness, drowsiness
No potential for abuse/misuse, tolerance, or psychological dependence
CYP3A4 substrate

85
Q

Which BZDs are preferred in elderly patients or pts with liver impairment?

A

LOT - undergo glucuronidation
Lorazepam
Oxazepam
Temazepam

86
Q

BZD MOA

A

Enhances GABA (inhibitory NT) –> causes CNS depression

87
Q

Which BZD is preferred for sleep?

A

Temazepam

88
Q

Which BZDs are preferred for anxiety?

A

Long half life, less risk of abuse
Clonazepam, lorazepam, diazepam

89
Q

Which drug is the antidote to BZDs?

A

Flumazenil

90
Q

Which BZDs are metabolized via CYP3A4?

A

Alprazolam
Diazepam
Clonazepam
Chlordiazepoxide
Clorazepate

91
Q

Definition of insomnia

A

Symptoms at least 3x per week for at least 3 months

92
Q

Which drugs can worsen insomnia?

A

Donepezil
Alcohol
Antiretrovirals
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics (nocturia)
Steroids
Stimulants
Chantix

93
Q

Drugs that help fall asleep only

A

Ramelteon
Zaleplon

94
Q

Drugs that help stay asleep only

A

Doxepin
Suvorexant

95
Q

Drugs that help fall asleep and stay asleep

A

Eszopiclone
Zolpidem

96
Q

Examples of non-BZD hypnotics

A

Eszopiclone (Lunesta)
Zolpidem (Ambien)
Zaleplon (Sonata)

97
Q

Key points for hypnotics

A

Warnings for next-day CNS depression and abuse potential
CI w/ complex sleep behavior (sleep walking/driving/etc.)
SE: somnolence, dizziness, ataxia, HA, parasomnias
Do not take w/ large or fatty meal or alcohol
Caution with CYP3A4 inhibitors

98
Q

Examples of orexin receptor antagonists

A

Lamborexant (DayVigo)
Suvorexant (Belsomra)

99
Q

Examples of melatonin receptor agonists

A

Ramelteon
Tasimelteon
(Not controlled substances)

100
Q

Which medications are used in the treatment of restless leg syndrome (RLS)?

A

Pramipexole (Mirapex) - IR
Ropinirol (Requip) - IR
Rotigotine (Neupro) - patch

Taken 1-3 hrs before bedtime

101
Q

Which meds are used in the treatment of narcolepsy?

A

Modafinil (Provigil)
Armodafinil (Nuvigil)
Sodium oxybate (Xyrem) - date rape drug, have REMS program

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