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BCPS 2020 > Psych > Flashcards

Psych Flashcards

1
Q

clozapine REMS monitoring

A

Risk of severe neutropenia (< 500).

Initiate treatment if ANC > 1500 for general population or > 1000 for BEN patients and monitor weekly for 6 months, then every other week for 6 months, then monthly.

If ANC < 500, interrupt treatment and do not rechallenge. If rechallenged, treat as a “new” patient.

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2
Q

Highest risk of QTc prolongation (FGA/SGA)

A

FGA: chlorpromazine, haloperidol (avoid IV use), thioridazine
SGA: clozapine, ziprasidone, and iloperidone

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3
Q

Akathisia

A

restlessness - lower dose or change to an SGA with lower EPS risk.

Insufficient data on use of propranolol, but it is used
BZD’s can reduce sx but beware if substance abuse disorder.

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4
Q

FDA approved tx for tardive dyskinesia

A

Valbenazine, deutetrabenazine (black box warning for increased risk of suicide)

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5
Q

Neuroleptic malignant syndrome

A

Treat with bromocriptine or dantrolene. High mortality rate.

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6
Q

Clozapine

A

Neutropenia
Seizures
OH/bradycardia/syncope
Myocarditis and cardiomyopathy

Can add lamotrigine in patients on clozapine with a partial response schizophrenia

Metabolized by CYP1A2, which is induced by smoking. So if smoking cessation, causes supratherapeutic levels.

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7
Q

Aripiprazole

A

Akathisia
Pathological gambling

LAI requires 21 day overlap with PO agent

Low risk of hyperprolactinemia or EPS

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8
Q

Asenapine

A

SL formulation
Hypersentivity reactions
Avoid eating or drinking for 10 minutes after administration
High risk of sedation/orthostasis

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9
Q

Brexpiprazole

A

Schizopherenia/MDD
Akathisia, weight gain, and somnolence
Compulsive behaviors

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10
Q

Cariprazine

A

Mixed/manic episodes type I bipolar
Low incidence of weight gain
Can cause GI sx, parkinsonism, and seizures.
Don’t use if CrCl < 30

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11
Q

Iloperidone

A

Low risk of metabolic side effects

QTc prolongation

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12
Q

Lurasidone

A

Low risk of metabolic/cardiac effects
Take with minimum of 350 calories of food
Adjust for renal, hepatic, and CYP3A4 inhibitors

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13
Q

Olanzapine

A

High risk of diabetes
Olanzapine pamoate - LAI, REMS for delirium/sedation
Can only be administered in an approved institution

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14
Q

Quetiapine

A

Somnolence, weight gain
Low risk of EPS

Also indicated for depression associated with bipolar

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15
Q

Risperidone

A

Tolerated better than haloperidol
Weight gain, sexual dysfunction, hyperprolactinemia
Monthly SC injection, no PO overlap required

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16
Q

Ziprasidone

A

QTc prolongation
Take with 500 calories of food
Warning - skin reactions such as eosinophila and systemic syndrome (DRESS)

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17
Q

Schizophrenia

A

SGA > FGA
*SGA may reduce negative symptoms/affect mood due to additional serotonin effects

Can use benzo’s for acute phase (agitation/anxiety) but careful due to risk of substance abuse behaviors

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18
Q

Dystonia

A

EPS - torticollis, laryngospam, oculogyric crisis.

Treated with anticholinergics

19
Q

Adjunctive treatment options for schizophrenia

A

Lamotrigine + clozapine for partial response

Benzo’s in initial phase for agitation/anxiety

20
Q

SSRI’s

A

ADE: Sexual dysfunction, insomnia, GI,

Increase risk of bleeding, increased incidence of bone fractures, hyponatremia in adults.

21
Q

Levomilnacipran

A

Approved for depression; SNRI

Causes hyponatremia/bleeding risk, BP elevations, OH, do not open capsule. CYP3A4 inhibitor.

22
Q

Vilazodone

A

Viibryd - SSRI
Max dose 40 mg, take with food
Lower incidence of sexual dysfunction
Do not use in hx of seizures

23
Q

Vortioxetine

A

Trintellix - SSRI, also improves cognitive function. Lower incidence of sexual dysfunction. Max daily dose is 20 mg.

24
Q

Serotonin syndrome

A

SNRI, SSRI, lithium, MAO, linezolid, dextromethorphan
Sx: neuromuscular (tremors, rigidity), AMS, autonomic instability.

Tx includes DC’ing offending agent, clonazepam for myoclonus, nifedipine for BP and anticonvulsants

25
Q

Lithium Drug Interactions - increase toxicity risk

A

Thiazides, furosemide, NSAIDs, ACEI’s
Renal dysfunction
Dehydration, salt restriction (lithium can cause hyperkalemia and hyponatremia)

26
Q

Lithium Drug Interactions - low Li levels

A

Theophylline

Lithium can result in hypothyroidism

27
Q

Buspirone

A

Used for anxiety, long onset of action (weeks). Must cover with another agent. Dosed 2-3 times per day

28
Q

GAD - first line agents

A

SSRI’s - escitalopram, paroxetine, sertraline

SNRI’s - duloxetine, venlafaxine XR

29
Q

PTSD - first line

A

SSRI’s fluoxetine, sertraline, paroxetine
Venlaxfaxine XR

Use BZD’s for sleep disturbances, but use is limited

30
Q

ADE for BZD’s insomnia

A 
Tolerance (effective for only 2-4 weeks)
Residual daytime sedation
Rebound insomnia
Anterograde amnesia
Withdrawal
Risk of falls
31
Q

Eszopiclone

A

Lunesta
Used for chronic insomnia, must take immediately before bed, sleep for 7-8 hours (hangover effects)
Metallic taste in mouth

32
Q

Ramelteon

A

Melatonin agent
Used for chronic insomnia, use long-term
Does not prolong sleep, but reduces sleep latency.

33
Q

Suvorexant

A

Belsomra

Decreases sleep latency and promotes sleep maintenance. Take within 30 minutes of bedtime, at least 7 hours of sleep.

34
Q

Zaleplon

A

Similar to zolpidem, shortens onset to sleep but does not promote sleep time. Short half life/short-term maintenance.

35
Q

Zolpidem

A

Reduces sleep latency.

CR tablets can help with staying asleep.

36
Q

Disulfram

A

If alcohol is used with it, can develop sx
Use with caution in liver dx
Reserved for patients with high motivation for adherence

37
Q

Naltrexone

A

Reduces alcohol cravings
BBW - hepatocellular injury
Extended release formulation - Vivitrol

Must be off of opioids for 7-10 days before administration of LAI (14 days if buprenorphine/methadone)

38
Q

Acamprosate

A

Not metabolized by the liver
Taken TID
Reduce for renal dysfunction

39
Q

Methadone

A

Opioid agonist - blocks the euphoric effects of other opioids. Long half life. Preferred in pregnancy
QTc prolongation
Significant drug interactions - metabolized by CYP3A4

40
Q

Buprenorphine/naloxone

A

4:1 dosing, gives “ceiling effect” while naloxone reduces abuse potential. Drug interactions with CYP3A4

Taper patient to methadone 30mg/equivalent or less before initiation.
12-24 hours after last dose of short-acting opioid.
First dose given in office (4/1 dose) and observed for 2 hours. If withdrawl sx not relieved, administer another 4/1 and maintenance dose will be 8/2. Adjust based on withdrawl sx, max is 32/8.
Can continue indefinitely, or DC by tapering.

41
Q

NRT

A

If > 10 cigs per day, start with 21mg patch x 2 weeks. If less, start with 14mg patch.

Chew between 9-24 pieces of gum. Pts > 25 cigs/day start with 4mg dose.

Lozenges - if smoke within first 30 minutes of wakening - 4mg. Max 20 lozenges in 24 hours

42
Q

Bupropion SR (Smoking Cessation)

A
  • Initiate 7 days prior to quit date

- Tx for a minimum of 8 weeks, continue for up to 6 months

43
Q

Varenicline

A

Nicotine receptor partial agonist.
Start 1 week before quit date (or up to 35 days).
Continue for a total of 12 weeks.
BBW for depression, suicide, pyschosis, etc.
Use with caution in CrCl < 30mL/min

BCPS 2020 (9 decks)

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