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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
Key points for TCAs
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
26
What enzyme are TCAs metabolized via?
CYP2D6
27
Key points for bupropion (Wellbutrin)
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
28
Examples of MAOi
Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline (MAO-B selective)
29
MAOi MOA
Inhibit monoamine oxidase which is responsible for the breakdown of catecholamines (5-HT, NE, Epi, DA)
30
Key points for MAOi
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
31
What foods are CI with MAOi?
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
32
How long of a washout is required between fluoxetine and MAOi use?
5 weeks
33
Key points for mirtazapine (Remeron)
Tetracyclic antidepressant SE: sedation, increased appetite, weight gain, anticholineric effects, QT prolongation
34
Key points for trazodone
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
35
What is the major toxicity of nefazodone?
Hepatotoxicity
36
What medications can be used as augmentation for depression (in combo with an antidepressant)?
Buspirone Aripiprazole Olanzepine Quentiapine Lithium
37
What are examples of EPS?
Dystonias, akathisia, Parkinsonism, tardive dyskinesias
38
What are examples of negative symptoms associated with schizophrenia?
Lack of emotion/apathy Social withdrawal Loss of motivation/avolition Lack of speech/alogia loss of interest in activities Poor hygiene
39
What are examples of positive symptoms associated with schizophrenia?
Hallucinations Delusions Disorganized thinking/behavior Difficulty paying attention
40
What medications/drug can cause psychotic symptoms?
Anticholinergics Dextromethorphan Dopamine agonists Stimulants Interferons Steroids Cannabis Cocaine LSD PCP
41
Which medications are 1st line for the treatment of schizophrenia?
Second-generation antipsychotics
42
What is the primary difference between 1st and 2nd gen antipsychotics?
1st gen have a higher incidence of EPS
43
Olanzapine should not be given with what medication due to risk of sedation/resp depression?
Benzodiazepines
44
What boxed warning is present on all antipsychotics?
Increased risk of mortality when used for dementia-related psychosis in elderly patients (due to CV complications and infection)
45
1st gen antipsychotic MOA
Blocks dopamine-2 (D2) receptors, minimal serotonin blockade
46
Examples of 1st gen antipsychotics
Low potency: chlorpromazine, thioridazine Mid potency: loxapine, perphenazine High potency: haloperidol, fluphenazine, thiothixene, trifluoperazine
47
Key points for 1st gen antipsychotics
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
What drug class can be given to avoid/limit painful dystonic reactions associated with EPS?
Anticholinergics (benztropine, diphenhydramine)
49
Examples of second generation antipsychotics
Aripiprazole (Abilify) Clozapine (Clozaril) Lurasidone (Latuda) Olanzapine (Zyprexa) Paliperdone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) (There's more but these are bold)
50
SE for aripiprazole
Akathisia Can be activating or sedating
51
Key points for clozapine
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
SE for lurasidone
Somnolence, EPS (dystonias), nausea Risk of metabolic syndrome (lower than other SGAs) CI with strong CYP3A4 inducers/inhibitors
53
SE for olanzapine
Somnolence, metabolic syndrome Sedation and delirium are possible with injection - must be monitored for 3 hrs post injection
54
2nd gen antipsychotics MOA
Blocks dopamine (D2) and serotonin (5-HT1A) receptors
55
SE for paliperidone
Increased prolactin EPS (esp at high doses) Metabolic syndrome QT prolongation Available as LA injection (monthly, q3 months, and q6 months)
56
Key points for quetiapine
SE: Somnolence, metabolic syndrome Low EPS risk - used for psychosis in Parkinsons For XR: take at night w/o food
57
SE for risperidone
Increased prolactin EPS (esp at high doses) QT prolongation Metabolic syndrome
58
SE for ziprasidone
**QT prolongation** Must take w/ food
59
Which antipsychotic medications may want to be avoided in patients with CVD or DM?
2nd gen antipsychotics Metabolic syndrome can cause increased weight, cholesterol, TG, and BG
60
Which 1st gen antipsychotic has the highest risk of QT prolongation?
Thioridazine Has a boxed warning
61
Which medications are approved for the treatment of tardive dyskinesia?
VMAT2 inhibitors - Valbenazine (Ingrezza) - Deutetrabenazine (Austedo)
62
What is neuroleptic malignant syndrome (NMS)?
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
What 3 drugs are utilized in the treatment of NMS?
BZDs Dantrolene Dopamine agonist (bromocriptine) **also stop the antipsychotic causing it**
64
Bipolar I
Characterized by mania that significantly impairs social/work functioning (psychosis, delusions) or requires hospitalization
65
Bipolar II
Characterized by hypomania - does not affect social/work functioning or require hospitalization
66
First line treatment options for manic episodes (BPD)
Valproate or lithium +/- an antipsychotic
67
First line treatment options for depressive episodes (BPD)
Antipsychotics Can add on lithium, valproate, or lamotrigine if needed
68
Which BPD meds should be avoided in pregnancy?
Valproare, lithium, and carbamazepine
69
Which meds are preferred in pregnancy for BPD?
Lamotrigine Lurasidone (limited, only used for BP depression)
70
Key points for lithium
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
Which neurotransmitter does lithium primarily effect?
Glutamate
72
Equivalence between lithium citrate and lithium carbonate
5 mL (8 mEq) lithium citrate syrup = 300 mg lithium carbonate
73
First line treatment for ADHD for children ages 4-5 yo
Behavior management/classroom intervention
74
Which non-stimulant medications can be used for the treatment of ADHD?
Atomoxetine (strattera) Guanfacine ER (Intuniv Clonidine ER (Kapvay)
75
SE for stimulants
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
Which drug is the active isomer of methylphenidate
Dexmethylphenidate (Focalin)
77
Examples of stimulants
Methylphenidate (Ritalin, Concerta, Daytrana) Dexmethylphenidate (Focalin) Dextroamphetamine/amphetamine (Adderall) Lisdexamfetamine (Vyvanse)
78
What is special about Vyvanse's formulation?
Prodrug Low abuse potential, must be hydrolyzed in the blood so the "rush" is muted if the drug is injected/snorted
79
Key points for atomoxetine
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
Key points for clonidine ER and guanfacine ER
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
Drugs that can cause anxiety
Albuterol Antipsychotics Bupropion Caffeine/theophylline Decongestants Levothyroxine (OD) Steroids Stimulants
82
What meds are 1st line for anxiety?
SSRIs, SNRIs
83
What meds are 2nd line for anxiety?
Buspirone TCAs (amitriptylline, nortriptylline) Hydroxyzine Pregabalin/gabapentin (not FDA approved)
84
Key points for buspirone
CI w/ MAOi's SE: serotonin syndrome, dizziness, drowsiness No potential for abuse/misuse, tolerance, or psychological dependence CYP3A4 substrate
85
Which BZDs are preferred in elderly patients or pts with liver impairment?
LOT - undergo glucuronidation Lorazepam Oxazepam Temazepam
86
BZD MOA
Enhances GABA (inhibitory NT) --> causes CNS depression
87
Which BZD is preferred for sleep?
Temazepam
88
Which BZDs are preferred for anxiety?
Long half life, less risk of abuse Clonazepam, lorazepam, diazepam
89
Which drug is the antidote to BZDs?
Flumazenil
90
Which BZDs are metabolized via CYP3A4?
Alprazolam Diazepam Clonazepam Chlordiazepoxide Clorazepate
91
Definition of insomnia
Symptoms at least 3x per week for at least 3 months
92
Which drugs can worsen insomnia?
Donepezil Alcohol Antiretrovirals Aripiprazole Atomoxetine Bupropion Caffeine Decongestants Diuretics (nocturia) Steroids Stimulants Chantix
93
Drugs that help fall asleep only
Ramelteon Zaleplon
94
Drugs that help stay asleep only
Doxepin Suvorexant
95
Drugs that help fall asleep and stay asleep
Eszopiclone Zolpidem
96
Examples of non-BZD hypnotics
Eszopiclone (Lunesta) Zolpidem (Ambien) Zaleplon (Sonata)
97
Key points for hypnotics
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
Examples of orexin receptor antagonists
Lamborexant (DayVigo) Suvorexant (Belsomra)
99
Examples of melatonin receptor agonists
Ramelteon Tasimelteon (Not controlled substances)
100
Which medications are used in the treatment of restless leg syndrome (RLS)?
Pramipexole (Mirapex) - IR Ropinirol (Requip) - IR Rotigotine (Neupro) - patch Taken 1-3 hrs before bedtime
101
Which meds are used in the treatment of narcolepsy?
Modafinil (Provigil) Armodafinil (Nuvigil) Sodium oxybate (Xyrem) - date rape drug, have REMS program

NAPLEX Study Time (8 decks)

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