Psych Flashcards
1
Q
Mesolimbic (+) SS
A
- Hallucinations
- Delusions
- Disorganized speech, Behavior, Thought
- Poor Attention
2
Q
Mesocortical (-) SS
A
- Loss of interest, motivation, emotion
- Poor Hygiene
- Social withdrawal
- Lack of speech, flat affect
- Feeling blue
3
Q
Schizophrenia Tx
A
- 2GA x2 (except Clozapine)
- 1GA
- CLOZAPINE
- ECT
4
Q
Antipsychotics MOA
A
- Blocks DOPAMINE Receptors
- 2GA also blocks SEROTONIN Receptors
- Blocks ALPHA, HISTAMINE, and PROLACTIN receptors
5
Q
What does the Mesolimbic dopamine tract do?
A
Arousal, Memory, Stimulus, Processing (sensations)
6
Q
What does the Mesocortical dopamine tract do?
A
cognition, communication, social fn
7
Q
What does the Nigrostriatal dopamine tract do?
A
Motor Mvmnt
8
Q
What does the Tuberoinfundibular dopamine tract do?
A
Regulates Prolactin release
i think incr dopamine = decr PRL release
9
Q
Antipsychotics effect on the dopamine tracts
- Mesolimbic
- Mesocortical
- Nigrostriatal
- Tuberinfundibular
A
- Mesolimbic -> DECR (+) SS
- Mesocortical -> (-) SS not often improved. 2GA may help a lil
- Nigrostriatal -> EPS
- Tuberinfundibular -> INCR PRL Release
10
Q
ALL ______ may cause death in elderly pts with dementia-related psychosis
what class of meds?
A
Antipsychotics
11
Q
Antipsychotics that may also be used as Antidepressants have a high risk of _______
A
SUICIDE
12
Q
Are SE more common in LOW or HIGH Potency 1st Gen Antipsychotics?
Typicals
A
LOW Potency 1GA
13
Q
1GA: LOW Potency SE
A
- Sedation
- Orthostatic HypoTN
- Tachy
- Anticholinergic (dry, constipated)
14
Q
1GA: HIGH Potency SE
A
EPS
- Tardive Dyskinesia -> Jerky
- Dystonia -> Continuous muscle spasms
- Bradykinesia -> SLOW Mvmnts
- Parkinsonism -> RIGIDITY, Tremors
- Akathisia -> inner RESTLESSNESS
15
Q
2 LOW Potency 1GA
A
- Chlorpromazine (Thorazine) -> also used for intractable hiccups
- Thioridazine (Mellaril) -> highest QTc prolongation risk
16
Q
Which Antipsychotic may also be used for intractable hiccups?
A
Chlorpromazine (Thorazine)
LOW Potency
17
Q
Which 1GA has the highest QTc prolongation risk?
A
Thioridazine (Mellaril)
LOW Potency
18
Q
8 HIGH Potency 1GA
A
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Loxitane)
- Molindone (Moban)
- Perphenazine (Trilaphon)
- Prochlorperazine (Compazine)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
19
Q
Which antipsychotic has a LOW risk of Wt Gain, has a LAI option, and is also used for Tourettes?
A
Haloperidol (Haldol)
HIGH Potency 1GA
20
Q
Which Antipsychotic causes WT LOSS
A
Molindone (Moban)
HIGH Potency 1GA
21
Q
Which Antipsychotics is also used for N/V and also comes as IM or a suppository?
A
Prochlorperazine (Compazine)
22
Q
2GA SE
A
- METABOLIC -> WT Gain, Incr Lipids, Incr Blood Sugar
- INCR PRL -> Gynecomastia, Galactorrhea
- LOWER, but poss risk of EPS
23
Q
Which 2GA carries the HIGHEST RISK OF SE
A
CLOZAPINE
- AGRANULOCYTOSIS (MONITOR NEUTROPHILS/ANC)
- MYOCARDITIS
- GI HYPERMOBILITY
- WT GAIN
- REMS PROGRAM
24
Q
Which 2GA are for Bipolar Mania
A
- Ziprasidone (Geodon)
- Cariprazine (Vraylar)
- Olanzapine (Zyprexa)
Risperidone (Risperdal) - Bipolar Maintenance
25
Which 2GA are for adjunct Depression
* Ariprazole (Abilify)
* Brexiprazole (Rexulti)
* Quetapine (Seroquel)
26
Which 2GAs increase PRL Release?
* Papilleridone (Invega)
* Risperdone (Risperdal)
27
Which 2GA must you take with food to ensure absorption (350cal+)
Lurasidone (Latuda)
28
Which 2GA?
* must monitor for 3Hr after injection
* causes WT GAIN
* used for bipolar mania
Olanzapine (zyprexa)
29
Which 2GA?
* WT GAIN
* LOWEST RISK OF EPS
* Adjunct for Depression
* Bipolar Depression
Quetapine (Seroquel)
30
Which 2GA?
- NO food/drink 10-15min after dose
- MOUTH NUMBESS
- HEPATIC FAILURE
- Sublingual and patch avail
Asensapine (Saphris)
31
Major Depressive DO Tx
- 1st line
- 2nd line
- 3rd line
1. SSRI/SNRI, Bupropion (Welbutrin), Mirtazapine (Remeron)
2. SWITCH SSRI/SNRI, ADD Diff antidepress, ADD 2GA
3. SWITCH SSRI/SNRI, TCA, MAOI, Esketamine, ECT
32
MDD Med Therapy Timeline
- ___ - ____ Wks -> PHYSICAL SS improve
- ____ - _____ Wks -> EMOTIONAL improvement
- ____ - ____ Wks -> FULL EFFECTS SEEN
- 1-2 Wks -> PHYSICAL
- 3-4 Wks -> EMOTIONAL
- 6-8 Wks -> FULL EFFECTS
33
6 SSRIs
* Citalopram (Celexa)
* Escitalopram (Lexapro)
* Fluoxetine (Prozac)
* Fluvoxamine (Luvox)
* Paroxetine (Paxil)
* Sertaline (Zoloft)
34
Which 2 SSRIs can cause QTc Prolongation
* Citalopram (Celexa)
* Escitalopram (Lexapro)
35
Which SSRI has the longest half-life (~50Hr)
Fluoxetine (Prozac)
36
Which SSRI is ONLY used for OCD (Off-label for depression)
Fluvoxamine (Luvox)
37
Which SSRI causes the MOST SE -> SLEEPY, WT GAIN, Anticholinergic
Paroxetine (Paxil)
38
Whcih SSRI?
- FOOD increases absorption
- HIGHEST GI (DIARRHEA)
- Slightly sedating
Sertaline (Zoloft)
39
3 Serotonin Modulators
* Trazodone (Desyrel) -> Priapism risk, Sleepy
* Vilazodone (Viibryd)
* Vortioxetine (Trintellix)
40
Which Serotonin Modulator has a risk of PRIAPISM & SLEEPY
Trazodone (Desyrel)
41
Serotonergic SE
* Hyponatremia
* GI
* Weak, Fatigue
* Sleep disturb
* Incr Risk BLEEDING (effect on PLT)
* Sexual Dysfn
* Wt Changes
42
5 SNRIs
* Venlafaxine (Effexor)
* Desvenlafaxine (Pristia)
* Duloxetine (Cymbalta)
* Levomilnacipran (Fitizima)
* Viloxazine (Qelbree)
43
_______ is also great for neuroathy
| SSRI or SNRI?
SNRI
44
Venlafaxine (Effexor) is an SSRI at ______ doses & an SNRI at ______ doses
| LOW or HIGH?
LOW Dose = SSRI
HIGH Dose = SNRI
45
Which SNRI?
* BAD For LIVER
* Risk of Acute Angle Glaucoma
Duloxetine *Cymbalta)
46
Which SNRI is for **ADHD**, NOT Depression
Viloxazine (Qelbree)
47
Noradrenergic SE
* Tremors, Jittery
* Tachy, HTN
* Sweating, Urinary Retention
48
True or False?
SSRIs & SNRIs cause Hyponatremia and are CI with MAOIs
TRUE
49
Bupropion (Welbutrin) MOA
Blocks Dopamine & Norepi reuptake
50
Bupropion (Welbutrin) Contraindications
* Hz Sz or ETOH abuse -> SEIZURE RISK
* Anorexia /Bulemia
* Acute Angle Glaucoma
51
Which Bupropion formulation is for SMOKING CESSATION?
Bupropion SR (Zyban)
## Footnote
NOT Welbutrin
52
Dopaminergic SE
* **EUPHORIA**
* **Nightmares/Odd dreams**
* **Seizures**
* Psychosis aggrivation
53
True or False: Bupropion has a LOWER RISK OF SEXUAL DYSFN and is CI with MAOIs
TRUE
54
TCAs MOA
* Blocks Serotonin and Norepi Reuptake
* Blocks Alpha-adrenergic, Histamine, Muscarinic receptors
55
TCAs -> 2ndary vs Tertiary Amines
* Amitriptyline (Elavil
* Doxepin (Sinequan)
* Desipramine (Norpramin)
* Imipramine (Tofranil)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)
**SECONDARY AMINES (DNP)**
* Desipramine (Norpramin)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)
**TERTIARY AMINES (AID)**
* Amitriptyline (Elavil
* Imipramine (Tofranil)
* Doxepin (Sinequan)
## Footnote
* Secondary amines -> more selective for norepi reuptake block -> LOWER RISK FOR SE
* Tertiary amines -> more selective for serotonin reuptake block, Histamine block, Ach block -> MORE SE
56
Which TCA is also used for
- HA prevention
- Pain syndromes
Amitriptyline (Elavil)
57
Which TCA is also used for Insomnia
Doxepin (Sinequan)
58
TCAs -> ___ Amines have MORE SE
| Secondary or Tertiary?
TERTIARY
59
True or False -> TCAs incr QTc prolongation risk and DECR Seizure threshold
TRUE
60
do TCAs cause anticholinergic or cholinergic SE?
ANTICHOLINERGIC (DRY)
61
Anti-histamine SE
- Sedation
- WT gain
- Confusion
62
Alpha-1 blcoker SE
- HypoTN
- Dizzy
63
Mirtazapine (Remeron) MOA
blocks alpha-2 adrenergic receptors -> inhibits (-) feedback -> allows for more SEROTONIN & NOREPI to be secreted and avail
64
Which antidepressant is best for MDD if **ELDERLY & WANT WT GAIN**
Mirtazapine (Remeron) SE:
* ** Decr anxiety
* INCR APPETITE**
* Insomnia
* GI upset
* Sexual dysn
## Footnote
LESS bad SE than in SSRIs
65
MAOIs MOA
blocks the MAO enzyme -> more neurotransmitters avail
## Footnote
normally, the MOA enzyme metabolizes Dopamine, Serotonin, Norepi
66
4 MAOIs
* Tranylcypromine (Parnate)
* Phenelzine (Nardil)
* Isocarboxazid (Marplan)
* Selegiline (Emsan)
67
Which Low-dose MAOI is used for Parkinson's?
Selegiline (Emsan)
## Footnote
Selefiline at LOW doses is selective for MAOB = Dopamine
68
MAOIs Considerations
**HUGE HTN RISK**
* **AVOID TYRAMINE-Rich diet** (aged cheese, smoked meats, pickled foods, red wine, craft beer, soy sauce, fava beans, yeast extract)
* DO NOT TAKE IF **Heart prob** or have **HAs**
69
SSRIs, SNRIs, and TCAs need a ___wk washout period before transitioning to/from MAOIs
2
## Footnote
to prevent Serotonin Syndrome
70
Which meds have a **HTN risk **bc they* incr Norepi & Dopamine*
* SNRIs, TCAs, Bupropion (Welbutrin)
* Stimulants
* OTC Pseudophedrine
71
Serotonin Syndrme Tx
Benzos
Cyprohepatadine
72
Neuroepileptic Malignant Syndrome
- ET?
- SS?
- Tx?
- ET: Antipsychotics (1GA>2GA), Nausea meds that incr Dopamine (Metoclopramide, Promethazine)
- SS: LONG onset & Resolution -> Bradyflexia, Muscle rigidity, Hyperthermia, Flunctuating BP
- Tx: Bromocriptine (Dopamine agonist)
73
Tx for Bipolar Acute mania or mixed episode
* Lithium
* Valproic acid
* Carbamazepine
* 2GA
* **SEVERE -> Lithium or Valproate + 2GA**
74
Bipolar Depression Tx
* Lithium or Lamotrigine
* +/- Antidepressant (NO TCAs & NEVERE AS MONOTHERAPY)
75
Bipolar Maintenance Tx
* used what worked best in the past
* only consider antipsychotics when in psychosis or trying to prevent psychosis relapse
**BREAKTHROUGH SS -> ADD ANY**
1. Lithium, Valproic acid
2. Lamotritigine, Carbamazepine
3. 2GA
4. Antidepressant
