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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
Bupropion use
Depression, especially in patients with seasonal affective disorder (SAD) Smoking cessation (as Zyban only) Attention-deficit/hyperactivity disorder To increase sexual desire in women
26
Which form of bupropion is used for smoking cessation?
Zyban
27
Bupropion SE
Tachycardia Blurred vision nausea, constipation, and dry mouth Tremors, insomnia, headache, agitation
28
In which pts should bupropion NOT be used?
Pts w/ hx of seizures, anorexia, and bulimia
29
When should bupropion be taken during the day?
patients do not take it after 5 p.m. d/t associated insomnia
30
How long does bupropion take to work?
Optimal results may take 2-4 weeks of treatment, but some improvement may be seen after 7-10 days.
31
Trazadone MOA
Alters serotonin reuptake in the CNS - NOT selective
32
Trazadone use
In patients with major depression who also have insomnia* Sedative-hypnotic
33
Trazadone SE
Orthostatic hypotension (for 4-6 hours after taking a dose) Nausea, vomiting, dry mouth Priapism, impotence Drowsiness, dizziness, headache
34
What does trazadone do to Digoxin and warfarin?
trazodone may increase the free plasma concentration of protein-bound drugs, such as digoxin and warfarin
35
Trazadone contraindications
MAOI use within 14 days Linezolid
36
What can enhance trazadone's effect?
May enhance effects of alcohol, barbiturates, and other CNS depressants.
37
Mirtazapine MOA
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
Mirtazapine use
Major depressive disorder Post-traumatic stress disorder (PTSD) Tension headache
39
Mirtazapine SE
Increased serum cholesterol Weight gain, constipation, dry mouth, increased appetite abnormal dreams Sedation
40
What are lithium carbonate, sodium divalproex, or carbamazepine use for?
Mainstay bipolar tx
41
Agent of choice of bipolar tx
Lithium
42
Which SSRI can be used to tx bipolar disorder?
The only SSRI that currently has FDA approval for the management of unipolar depression in adolescents is fluoxetine (Prozac)
43
What can SSRIs cause in bipolar disorder?
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
Which antipsychotics are used to tx bipolar disorder?
olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify)
45
Lithium use
Mood stabilizer that is used for both prophylaxis and treatment of the manic phase of manic-depressive/bipolar disorder
46
Prior to lithium tx, what should be checked?
serum urea, electrolytes, thyroid function test, and an ECG
47
How often should a pt on lithium have labs done?
every 3 months
48
Lithium MOA
Theorized to be the result of stimulating exit of Na+, where Na+ is elevated
49
What will occur in a pt taking Lithium if they reduce their salt intake?
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
Use of Lithium
Bipolar disorder (both manic and depressive episodes respond) Adjuvant with other antidepressants to treat major depression Adjuvant with antipsychotics to treat schizophrenia
51
Lithium SE
Edema hypothyroidism hand tremor, muscle twitching, headache
52
Sxs of Lithium toxicity
CV: Severe hypotension, arrhythmias, ECG changes, circulatory failure NEURO: Ataxia, blurred vision, giddiness, tinnitus, seizures GU: Oliguria, nephrogenic diabetes insipidus
53
Tx of Lithium toxicity
NS
54
Which drugs should be avoided in pts on Lithium?
Patients should avoid the use of diuretics and NAIDs
55
Lithium contraindications
Significant renal impairment or disease Significant cardiovascular disease Significant thyroid disease Diabetes Severe dehydration Sodium depletion Pregnancy
56
Dietary requirements of Lithium
Drink 10–12 glasses of fluid per day to reduce thirst and maintain normal fluid balance. Maintain consistent dietary intake of sodium.
57
How are Valproates used as a mood stabilizer?
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
What are benzos best used for?
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
Long term use of benzos leads to?
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
Benzo examples
alprazolam chlordiazepoxide clonazepam diazepam lorazepam triazolam
61
Benzo MOA
Depress all levels of the CNS by enhancing the action of GABA, a major inhibitory neurotransmitter in the brain and CNS
62
Which benzo has the longest duration of action?
diazepam
63
Which benzo is best used for sedation prior to surgery d/t is short onset?
midazolam
64
Benzo uses
Anxiety disorders Anticonvulsants Muscle relaxants Adjuvants in anesthesia For treatment of alcohol addiction and drug withdrawal
65
Benzos SE
drowsiness, lethargy Memory dysfunction
66
Benzo contraindication
severe hypotension, angle-closure glaucoma, or sleep apnea
67
What should be avoided w/ the use of benzos?
Avoid driving and other activities requiring alertness. Avoid alcohol

Pharm 2 Exam 2 (8 decks)

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