Psych 9 Flashcards
What are anti-histamine side effects
Sedation, weight gain
What are anti-adrenergic side effects?
Hypotension
What are anti-muscarinic side effects?
Dry mouth, blurred vision, urinary retention, constipation
What is hypertensive crisis
Caused by a build up of catecholamines; caused by combo of MAOIs with tyramine-rick foods (e..g red wine, cheese, chicken liver, cured meats)
4 components of extra-pyramidal side effects
- Dystonia
- Akathisia
- Parkinsonism
- Tardive dyskinesia
Tx of EPS caused by antipsychotics
Benztropine
What psych drugs cause hyperprolactinemia
FGA, Risperidone
Inducers of CYP-450
♣ Corona, Guinness, 'N' PBRS induce Chronic alcoholism • C - Carbamazepine • G - Griseofulvin • N - Nevirapine • P - Phenytoin • B - Barbiturates • R - Rifampin • S - St. John's Wort • Chronic alcoholism
Psych meds that inhibits CYP-450
SSRIs (Fluoxetine, Paroxetine, Duloxetine, Sertraline)
What is the withdrawal phenomenon associated with antidepressants
Flu-like sx: Dizziness, HA, nausea, insomnia, malaise
Side effects of TCAs
THINK: 3 C’s
o Antihistamine = weight gain, sedation
o Antiadrenergic = orthostatic hypotension, arrhythmias (block cardiac sodium channel), ECG changes (widened QRS, QT, and PR intervals)
o Antimuscarinic = dry mouth, constipation, urinary retention, blurred vision, tachycardia
o Serotonergic = erectile/ejaculatory dysfunction, anorgasmia
o Seizures
Tx of TCA overdose
IV sodium bicarbonate
What are the names of the MAOIs
o Tranylcypromine = “try a sip of wine”
o Phenelzine = funnel
o Isocarboxazid = boxed wine
o Selegiline = sledge hammer
Describe how Tyramine toxicity/Hypertensive crisis occurs
- Tyramine is a naturally occurring monoamine compound found in aged meats, alcoholic beverages, and fermented dairy products
- Tyramine acts as a catecholamine releasing agent, but before it gets to the general circulation it is metabolized in the GI tract by MAO-A
- But if you inhibit MAO-A, all the Tyramine flows in the circulation and acts as a sympathomimetic agent, displacing NE from neuronal storage vesicles
Tx of hypertensive crisis
Phentolamine (a1 and a2-blocker)
What are the low potency FGA
Thioridazine, Chlorpromazine
Side effect specific to Chlorpromazine
Blue-gray skin discoloration
side effect specific to Thioridazine
Retinal deposits
Which antipsychotics are available as long-acting injectables (decanoate)
THINK: How Ridiculous, Paying For A hOle
H = Haloperidol R = Risperidone P = Paliperidone F = Fluphenazine A = Aripiprazole O = Olanzapine
Is tardive dyskinesia reversible?
50% of cases are permanent
What is the only antipsychotic shown to decrease the risk of suicide
Clozapine
Side effect of Clozapine
Metabolic syndrome, agranulocytosis, myocarditis, seizures
What is the only mood stabilizer shown to decrease the risk of suicide
Lithium
What lab levels should be monitored while on Lithium
Lithium levels, creatinine, thyroid function
What SSRI is used to treat bulimia
Fluoxetine (Prozac)
Super high dose
Anorexia is most associated with which personality disorders
OCPD and Dependent
Bulimia is most associated with which personality disorder
Borderline
What drug can be used to treat anorexia
No FDA approved
What SSRI has the longest half life
Fluoxetine
What SSRI has the shortest half life
Fluvoxamine (think of the V as a down arrow to remember lowest)
Paroxetine/Paxil is the MOST common SSRI with short half life
What SSRI has the highest rate of QTc prolongation
Citalopram/Celexa
But Escitalopram is an isomer of Citalopram that works almost exactly the same but you can use half the dose and still be as effective
What does withdrawal from SSRI feel like
Flu-like symptoms + ZAPS (feeling of an electric shock starting at some part of the body and radiating)
Which SSRIs are most associated with discontinuation/withdrawal syndrom
Paroxetine/Paxil and Fluvoxamine
Because these are the ones with the shortest half life
Put these SSRI cards in study guide
Maybe. Hi!
How long should you wait for SSRIs to kick in
6-8 weeks
How long should you wait after patient has reached expected dose before you up-titrate SSRI
1 week
Most common side effect of SSRI
GI distress
How long does it take for GI effects of SSRI to go away
3-5 days (80% of patients)
3 weeks (90% of patients)
What do you give to a male patient on an effective SSRI but with erectile dysfunction
Add Bupropion/Wellbutrin
Time frame for mania
7 days
Or hospitalization
Or mania + psychosis
Time frame for hypomania
4 days
What SSRI should you give to non-compliant patients
Fluoxetine (because it has the longest half-life)
What effect does SSRI have on suicide?
Can increase suicidal thought in teens and young adults
But no known increase in suicide completion
What classifies as an “adequate” trial of SSRI
Lasting 6-8 weeks at the dose you expect to work (not the starting dose, because you always titrate up)
When should PCP consult psychiatry for SSRI
- Failed 2 adequate trials of SSRI
- High severity
- Many medications
- Co-morbid psychiatric disorders
Effects in adulthood of untreated ADHD
Higher rate of substance use, depression, anxiety disorders, oppositional defiant disorder
What is an appropriate age to start ADHD kids on stimulants
Usually 5-6
How many inattentive symptoms must a patient have to classify as ADHD, inattentive type
6/9
How many hyperactive symptoms must a patient have to classify as ADHD, hyperactive type
6/9
What are the criteria for combined type ADHD
6/9 inattentive + 6/9 hyperactive type
On Vanderbilt ADHD scale, what numbers count as yes and what as no
0-1 = no 2-3 = yes
What drugs are used to treat ADHD
Amphetamines/Adderall
Methylphenidates/Ritalin
Most common side effect of stimulants
Appetite suppression
Do you start with short or long-acting stimulants in ADHD
Long-acting (XR)
Why do drug-reps say that Vyvanse cannot be abused
Because Vyvanse is a pro-drug - needs to be processed by the liver before it becomes active drug
What is the biggest risk factor for development of ADHD
Genetics - highest genetic association of any psych disorder
Treatment options for ADHD
First line = stimulants (methylphenidate, dextroamphetamines)
Second line = Atomoxetine or Bupropion
Alpha-2 agonists (Clonidine, Guanfacine) can be used instead of or as adjunctive therapy to stimulants
Other risk factors for ADHD
In utero exposure to alcohol or nicotine, low birth weight
Describe sx of prion disease
- Insidious onset with rapidly progressive cognitive decline
- Difficulties with concentration, memory, and judgment occur early
- More than 90% of patients experience myoclonus
- Depression, apathy and hypersomnia are also common
- Basal ganglia and cerebellar dysfunction, manifesting as ataxia, nystagmus, and hypokinesia, are present in a majority of individuals
Presentation of Huntington’s Disease
- Triad of motor, cognitive, and psychiatric symptoms
- Cognitive decline and behavioral changes can precede onset of motor signs by up to 15 years
- Executive function is the primary cognitive domain affected
- Psychiatric manifestations include depression, apathy, irritability, obsessions, and impulsivity
- Patients are often aware of deteriorating mentation
- Movement disorders include chorea and bradykinesia
