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Pham 2 Exam 2 > Psych and CNS > Flashcards

Psych and CNS Flashcards

1
Q

What class of drugs do Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), and (es)citalopram (Celexa, Lexapro) fall into?

A

Selective Serotonin Reuptake Inhibitors (SSRIs), antidepressants

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2
Q

How do SSRIs work?

A

Increases the amount of serotonin in the synapse

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3
Q

What are seven side effects of SSRIs?

A

Insomnia, agitation, headache, nausea, diarrhea, sexual dysfunction, and platelet dysfunction

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4
Q

Which drugs cause Hepatic cytochrome P-450 inhibition?

A

Fluoxetine, metoprolol (elimination half-life 3-4hrs), increased levels of TCAs, and some neuroleptics

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5
Q

What symptoms does a patient have with Serotonin Syndrome?

A

Anxiety, restlessness, chills, ataxia, insomnia

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6
Q

What drugs increase the potential for Serotonin Syndrome when given with SSRIs?

A

MAOIs, Carbamazepine, Linezolid (antibiotic)

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7
Q

Yes or No, Is an overdose of SSRIs typically lethal?

A

No

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8
Q

Name two other commonly used antidepressants that inhibit the reuptake of neurotransmitters other than Serotonin.

A

Venlafaxine (Effexor) and Buproprion (Wellbutrin, Zyban)

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9
Q

What are some examples of Tricyclic Antidepressants (TCAs)?

A

AmiTRIPTYLINE (Elavil), NorTRIPTLYINE, imiPRAMINE, clomiPRIMINE

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10
Q

What is the mechanism of action of TCAs?

A

Block the reuptake of norepinephrine (sometimes serotonin)

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11
Q

What are the advantages and disadvantages of TCAs?

A

Highly effective for depression, poor side-effect profiles

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12
Q

What are the side-effects of TCAs?

A

Anticholinergic side effects: dry mouth, tachycardia, urinary retention, GI slowing

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13
Q

What are some cardiogenic side effects with TCAs?

A

Orthostatic hypotension, PR prolongation, cardiac depression, (myocardial depression and ventricular dysrhythmias at higher doses)

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14
Q

What is it about TCAs that make them lethal if overdosed?

A

Narrow therapeutic index

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15
Q

What are TCAs commonly used for at lower doses?

A

Chronic pain syndromes

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16
Q

If a patient is on TCAs, what classes of drugs should be used with caution due to their potential for drug interaction or exaggerated responses.

A

Sympathomimetics (especially indirect-acting), Anticholinergics (Atropine increases likelyhood of postop delirium)
Opioids and barbiturates (potentiated)

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17
Q

What are four examples of Monoamine Oxidase Inhibitors (MAOIs)?

A

Phenelzine, tranylcypromine, isocarboxazid, selegiline

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18
Q

What is the mechanism of action for MAOIs?

A

Inhibits the enzyme (MAO) that metabolizes monoamines such as dopamine, serotonin, epi, norepi

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19
Q

True or False: MAOIs are reversible and non-selective.

A

False. Most MAOIs are irreversible and non-selective

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20
Q

What are six side effects of MAOIs?

A

Orthostatic hypotension, anticholinergic side effects, sedation, sexual dysfunction, weight gain, and requires a tyramine-free diet.

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21
Q

If the hepatic deamination of tyramine is inhibited and your patient eats food with tyramine in it, then what kind of response do we see?

A

an indirect sympathomimetic response (like pheo)

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22
Q

What are some examples of foods that have tyramine in them?

A

Avocados, cheese, liver, fava beans, chianti wine

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23
Q

Yes or No: Can an overdose of MAOIs be lethal? And what treatment has been suggested to counter the hypermetabolism, hyperthermia state from an overdose?

A

yes, Dantrolene

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24
Q

True or false: Data has been shown to support stopping MAOIs 2-3 weeks prior to anesthesia.

A

False, No data to support stopping for 2-3 weeks prior.

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25
Q

If you discover in preop that your patient has been on MAOIs for depression and anxiety for quite sometime now, what types of drugs should be used with caution or avoided all together?

A

Sympathomimetics with caution (direct > indirect)
Epi w/local anesthetics should be avoided
Opioids (potentiated); Meperidine (depressive reactions)

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26
Q

What drug is the drug of choice for bipolar (manic-depressive) disorder?

A

Lithium

27
Q

Why is it important to measure plasma concentrations of if a patient is given Lithium?

A

Lithium competes with Na for proximal tubule reabsorption in the kidney, Na is depleted causing an increase in lithium levels

28
Q

What are three side effects of lithium?

A

polydipsia, polyuria, hypothyroidism

29
Q

What drugs have a prolonged effect when given to a patient on Lithium?

A

NMB drugs (both depolarzing and non-depolarizing) are prolonged

30
Q

What are eight symptoms of Lithium toxicity.

A

Lethargy, weakness, tremor, QRS widening, heart block, hypotension, confusion, and seizures

31
Q

What exacerbates increased levels of Lithium?

A

dehydration, Na restriction, diuretics, NSAIDs

32
Q

How is Lithium toxicity treated?

A

osmotic diuresis or dialysis

33
Q

Which drugs should be avoided with a patient on Lithium?

A

Diuretics (loop, thiazide) and NSAIDs should be avoided

Neuroleptics: increase risk of extrapyramidal side effects (movement disorders) and NMS

34
Q

What is the treatment for schizophrenia (psychosis)?

A

Antipsychotic Drugs (Neuroleptic)

35
Q

What are five examples of Neuroleptic drugs?

A

Chloropromazine (Thorazine), clozapine (Clozaril), haloPERIDOL (Haldol), risPERIDONE (Risperdal), droPERIDOL

36
Q

What is the mechanism of action in Neuroleptic drugs?

A

Blocks dopamine receptors

37
Q

What is Tardive dyskinesia?

A

abnormal involuntary movements of face, neck, tongue

38
Q

What type of reaction describes acute muscle rigidity/cramping in face/neck/tongue and larynx?

A

Acute dystonic reaction

39
Q

What is the treatment for acute dystonic reaction?

A

Anticholinergics - diphenhydramine (Benadryl) or benztropine (Cogentin)

40
Q

What symptoms do we see with parkinsonism?

A

rigidity, tremor, bradykinesia/akinesia (restlessness)

41
Q

What symptoms do we see with Neuroleptic Malignant Syndrome (NMS)?

A

Hyperthermia, muscular hypertonicity, autonomic instability, mental status changes

42
Q

What is the treatment for NMS?

A

Dantrolene, amantadine/bromocriptine

43
Q

What class of drugs cause flaccid paralysis in NMS but not in MH?

A

Nondepolarizing NMBs

44
Q

What cardiovascular side effects do we see with antipsychotic drugs?

A

alpha-blockade (orthostatic hypotension), prolonged QTc (leading to VTach and toursades)

45
Q

What endocrine side effects do we see with antipsychotic drugs?

A

block inhibition of prolactin - galactorrhea, gynecomastia
decr corticotropin release - decr corticosterioids
Weight gain, hyperglycemia

46
Q

What CNS side effect does droperidol cause?

A

dysphoric response

47
Q

What drug class does antipsychotic drugs have an interaction with?

A

opioids (potentiated)

48
Q

What drugs are best used to stop a seizure quickly?

A

antiepileptic drugs: barbiturates, benzodiazepines, propofol

49
Q

What is the mechanism of action of phentoin (Dilantin)?

A

Na-channel blockade (also Ca, NMDA)

50
Q

What is the therapeutic serum level for Dilantin?

A

10-20 mcg/mL

51
Q

Which antiepileptic drug is 90% protein-bound and leads to a zero-order kinetics in the liver at high plasma levels?

A

Phenytoin (Dilantin)

52
Q

What can a fast infusion of Dilantin cause?

A

Hypotension

53
Q

What drug is a prodrug of pheytoin that can be infused rapidly without causing hypotension?

A

Fosphenytoin (Prodilantin)

54
Q

What antiepileptic drug is given orally with no significant side effects, no hepatic metabolism, and minimal protein binding?

A

Levetiracetam (Kappra)

55
Q

Which antiepileptic drug is most commonly used in chronic neuropathic pain and diabetic neuropathy?

A

Gabapentin (Neurontin)

56
Q

What is the precursor to Dopamine and crosses the blood-brain barrier?

A

levodopa (Sinemet)

57
Q

What is the enzyme that converts levadopa to dopamine?

A

Dopa Decarboxylase

58
Q

What is usually given with levadopa to prevent decarboxylation before crossing the BBB?

A

Carbidopa

59
Q

What is a side effect of levadopa?

A

orthostatic hypotension

60
Q

What symptoms can develop if levodopa is stopped abruptly?

A

Parkinsonian symptoms, NMS

61
Q

What should always be asked if your patient is taking levodopa?

A

“When was your last dose and what happens if you miss a dose?”

62
Q

What two drugs can cause Parkinsonism due to dopamine antagonism?

A

haloPERIDOL and droPERIDOL

63
Q

Which drugs should be avoided if your patient is taking haloperidol or droperidol?

A

metoclopramide (Reglan) and promethazine (phenergan)

Pham 2 Exam 2 (3 decks)

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