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Pharm 2 Exam 2 > Psych 2 > Flashcards

Psych 2 Flashcards

1
Q

Why are SSRIs preferred over TCAs?

A

Less lethal upon overdose
Lack cardiovascular and anticholinergic effects
Offer convenient dosing

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2
Q

SSRIs examples

A

citalopram - Celexa
fluoxetine - Prozac
paroxetine - Paxil
sertraline - Zoloft
escitalopram - Lexapro

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3
Q

SSRI MOA

A

Selectively inhibit 5-HT neuronal reuptake at selected nerve terminals in the CNS

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4
Q

How long do SSRIs take to work?

A

6 wks

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5
Q

SSRI uses

A

Major depression
Panic disorder
Obsessive-compulsive disorder
Generalized anxiety disorder (GAD)
Posttraumatic stress disorder
Eating disorders

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6
Q

SSRI SE

A

Nausea, diarrhea, xerostomia
Sexual disorders
insomnia, sedation

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7
Q

SSRI interactions

A

MOAI/ TCAs/ Antipsychotics
Linezolid (Zyvox)
Tramadol
NSAIDs

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8
Q

SSRI pregnancy rating

A

Category C pregnancy risk

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9
Q

How to avoid SSRI withdrawal syndrome?

A

To avoid withdrawal syndrome, some SSRIs require a tapering down of the dosages over a 1-2 week period

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10
Q

Why should NSAIDs not be taken w/ SSRIs?

A

Advise not to take NSAIDs concurrently because any bleeding problem could be aggravated.

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11
Q

Which SSRI may not require taper dosing?

A

Fluozetine

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12
Q

Fluoxetine is used in pts with ___ because?

A

with flat affect and fatigue because its the most stimulating

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13
Q

Most sedating of the SSRI is?

A

Paroxetine

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14
Q

What is the middle-of-the-road SSRI?

A

Sertraline - Middle-of-the-road SSRI: less sedating than Paxil but less stimulating than Prozac

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15
Q

Which SSRI has the least effect on CYP450?

A

Citalopram

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16
Q

SNRI examples

A

venlafaxine
duloxetine
descenlafaxine

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17
Q

SNRI MOA

A

Inhibit both serotonin and norepinephrine reuptake in the CNS and, to a much lesser extent, dopamine

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18
Q

Uses of SNRIs

A

Major depressive disorder (MDD)
Generalized anxiety disorder (GAD)
Social phobia
Panic disorders
Neuropathic pain associated with diabetes
Vasomotor symptoms associated with menopause
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)

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19
Q

SNRI SE

A

Increased BP
Nausea, dry mouth, constipation
Sexual disorders
fatigue, drowsiness, insomnia, headache

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20
Q

SNRI contraindications

A

MAOI use (within 14 days of use)
Linezolid (Use with extreme caution, if at all)
Hepatic impairment
Severe renal impairment
Uncontrolled narrow –angle glaucoma

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21
Q

High dose of venlafaxine (150 mg) can increase the risk of?

A

Rhabdomyolysis

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22
Q

NDRI examples

A

bupropion (Wellbutrin)

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23
Q

Bupropion MOA

A

Inhibit neuronal reuptake of dopamine and norepinephrine, increasing the availability of dopamine and norepinephrine at postsynaptic receptor sites

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24
Q

Which antidepressant has the least sexual SE?

A

bupropion

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25
Q

Bupropion use

A

Depression, especially in patients with seasonal affective disorder (SAD)
Smoking cessation (as Zyban only)
Attention-deficit/hyperactivity disorder
To increase sexual desire in women

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26
Q

Which form of bupropion is used for smoking cessation?

A

Zyban

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27
Q

Bupropion SE

A

Tachycardia
Blurred vision
nausea, constipation, and dry mouth
Tremors, insomnia, headache, agitation

28
Q

In which pts should bupropion NOT be used?

A

Pts w/ hx of seizures, anorexia, and bulimia

29
Q

When should bupropion be taken during the day?

A

patients do not take it after 5 p.m. d/t associated insomnia

30
Q

How long does bupropion take to work?

A

Optimal results may take 2-4 weeks of treatment, but some improvement may be seen after 7-10 days.

31
Q

Trazadone MOA

A

Alters serotonin reuptake in the CNS - NOT selective

32
Q

Trazadone use

A

In patients with major depression who also have insomnia*
Sedative-hypnotic

33
Q

Trazadone SE

A

Orthostatic hypotension (for 4-6 hours after taking a dose)
Nausea, vomiting, dry mouth
Priapism, impotence
Drowsiness, dizziness, headache

34
Q

What does trazadone do to Digoxin and warfarin?

A

trazodone may increase the free plasma concentration of protein-bound drugs, such as digoxin and warfarin

35
Q

Trazadone contraindications

A

MAOI use within 14 days
Linezolid

36
Q

What can enhance trazadone’s effect?

A

May enhance effects of alcohol, barbiturates, and other CNS depressants.

37
Q

Mirtazapine MOA

A

TeCA - Directly acts as an antagonist at presynaptic alpha receptors, which in turn increases levels of synaptic norepinephrine and serotonin (DOES NOT INHIBIT REUPTAKE)

38
Q

Mirtazapine use

A

Major depressive disorder
Post-traumatic stress disorder (PTSD)
Tension headache

39
Q

Mirtazapine SE

A

Increased serum cholesterol
Weight gain, constipation, dry mouth, increased appetite
abnormal dreams
Sedation

40
Q

What are lithium carbonate, sodium divalproex, or carbamazepine use for?

A

Mainstay bipolar tx

41
Q

Agent of choice of bipolar tx

A

Lithium

42
Q

Which SSRI can be used to tx bipolar disorder?

A

The only SSRI that currently has FDA approval for the management of unipolar depression in adolescents is fluoxetine (Prozac)

43
Q

What can SSRIs cause in bipolar disorder?

A

SSRIs have a long half-life and because of its potential to exacerbate manic symptoms when not co-administered with an antimanic or mood-stabilizing agent

44
Q

Which antipsychotics are used to tx bipolar disorder?

A

olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify)

45
Q

Lithium use

A

Mood stabilizer that is used for both prophylaxis and treatment of the manic phase of manic-depressive/bipolar disorder

46
Q

Prior to lithium tx, what should be checked?

A

serum urea, electrolytes, thyroid function test, and an ECG

47
Q

How often should a pt on lithium have labs done?

A

every 3 months

48
Q

Lithium MOA

A

Theorized to be the result of stimulating exit of Na+, where Na+ is elevated

49
Q

What will occur in a pt taking Lithium if they reduce their salt intake?

A

Blood levels closely linked to sodium levels, thus reduction in salt intake will prolong lithium’s half-life to the level at which toxic levels are produced

50
Q

Use of Lithium

A

Bipolar disorder (both manic and depressive episodes respond)
Adjuvant with other antidepressants to treat major depression
Adjuvant with antipsychotics to treat schizophrenia

51
Q

Lithium SE

A

Edema
hypothyroidism
hand tremor, muscle twitching, headache

52
Q

Sxs of Lithium toxicity

A

CV: Severe hypotension, arrhythmias, ECG changes, circulatory failure
NEURO: Ataxia, blurred vision, giddiness, tinnitus, seizures
GU: Oliguria, nephrogenic diabetes insipidus

53
Q

Tx of Lithium toxicity

A

NS

54
Q

Which drugs should be avoided in pts on Lithium?

A

Patients should avoid the use of diuretics and NAIDs

55
Q

Lithium contraindications

A

Significant renal impairment or disease
Significant cardiovascular disease
Significant thyroid disease
Diabetes
Severe dehydration
Sodium depletion
Pregnancy

56
Q

Dietary requirements of Lithium

A

Drink 10–12 glasses of fluid per day to reduce thirst and maintain normal fluid balance.
Maintain consistent dietary intake of sodium.

57
Q

How are Valproates used as a mood stabilizer?

A

an initial dose of 750 mg per day of Depakote (regular release tablets) is usually prescribed in divided doses to reduce manic episodes then titrated up

58
Q

What are benzos best used for?

A

acute situational anxiety disorder and adjustment disorder where the duration of pharmacotherapy is anticipated to be 6 weeks or less
Also used for the rapid control of panic attacks

59
Q

Long term use of benzos leads to?

A

Tolerance does not usually develop to the beneficial effects of the anxiolytic; rather, it develops to the sedation and the euphoria experienced by the patient.

60
Q

Benzo examples

A

alprazolam
chlordiazepoxide
clonazepam
diazepam
lorazepam
triazolam

61
Q

Benzo MOA

A

Depress all levels of the CNS by enhancing the action of GABA, a major inhibitory neurotransmitter in the brain and CNS

62
Q

Which benzo has the longest duration of action?

A

diazepam

63
Q

Which benzo is best used for sedation prior to surgery d/t is short onset?

A

midazolam

64
Q

Benzo uses

A

Anxiety disorders
Anticonvulsants
Muscle relaxants
Adjuvants in anesthesia
For treatment of alcohol addiction and drug withdrawal

65
Q

Benzos SE

A

drowsiness, lethargy
Memory dysfunction

66
Q

Benzo contraindication

A

severe hypotension, angle-closure glaucoma, or sleep apnea

67
Q

What should be avoided w/ the use of benzos?

A

Avoid driving and other activities requiring alertness.
Avoid alcohol

Pharm 2 Exam 2 (8 decks)

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