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Cognitive-Behavioral > Psych And Psych Meds > Flashcards

Psych And Psych Meds Flashcards

1
Q

Which SSRIs have the FEWEST drug-drug interactions?

A

Citalopram and escitalopram

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2
Q

Major side effects of atypical antipsychotics (as a group)

A
  • Weight gain
  • DM2
  • dyslipidemia
  • antimuscarinic, anticholinergic, antiadrenergic
  • negative inotropic effect (thioridazine, haldol, ziprasidone, quetiapine)
  • sedation (H1, esp quetiapine)
  • hyperprolactinemia, amenorrhea (tuberoinfundibular pathway antagonism)
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3
Q

List the Cluster A personality disorders

A

Paranoid

Schizoid (loner, blunted affect)

Schizotypal (odd, eccentric, magical thinking, paranoid)

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4
Q

How do tertiary TCAs (amitriptyline, clomipramine, imipramine) affect warfarin levels?

A

Tertiary tricyclics compete with warfarin for CYP enzymes and may increase warfarin levels

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5
Q

amitriptyline, doxepin, and imipramine are [DRUG CLASS] that work by [DRUG MECHANISM]

A

Amitriptyline, doxepin, and imipramine are TCAs that work by inhibiting BOTH serotonin and nroepi reuptake

clomipramine is a TCA that primariliy inhibits 5HT reuptake

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6
Q

List the atypical antipsychotics and primary mechanism of action

A

ATYPICAL ANTIPSYCHOTICS

  • clozapine
  • olanzapine
  • quetiapine
  • risperidone
  • ziprasidone
  • aripiprazole

Mainly work by blocking serotinergic 5HT2A receptors; D2 antagonism is secondary (so fewer EPS but not 0)

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7
Q

Mechanism of action of donepezil

A

noncompetitive, REVERSIBLE AchE inhibition (organophosphates are IRreversible)

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8
Q

Principal site of serotonergic neuronal cell bodies is the __________ in the _________

A

Principal site of serotonergic neuronal cell bodies is the RAPHE NUCLEI of the brainstem

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9
Q

List the TCAs

A

TCAS

  • Amitriptyline
  • Clomipramine
  • Imipramine
  • Nortriptyline
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10
Q

serotonin is SYNTHESIZED from ______ via _____ and _______

serotonin is METABOLIZED by ______

A

serotonin is SYNTHESIZED from tryptophan via tryptophan hydroxylase and aromatic L-amino acid decarboxylase

serotonin is METABOLIZED by MAO-A

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11
Q

Antidepressant class leading to convulsions, coma, and cardiac arrhythmias in overdose (3C’s)

A

TCAs

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12
Q

mechanism of action of galantamine

A

inhibition of AchE and modulation of nicotinic AchR

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13
Q

Which OTC narcotic can inhibit serotonin reuptake and cause serotonin syndrome?

A

Tramadol

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14
Q

List the SSRIs

A

SSRIs

Fluoxetine

Fluvoxamine

Sertraline

Paroxetine

Citalopram

Escitalopram

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15
Q

Amitriptyline, nortriptyline, doxepin, clomipramine, and imipramine are [DRUG CLASS]. Their side effects are related to their [OFF TARGET EFFECTS] and therefore include [SIDE EFFECTS]

A

Amitriptyline, nortriptyline, doxepin, clomipramine, and imipramine are TCAs. Their side effects are related to their off target binding to muscarinic, alpha-adrenergic, and histamine H1 receptors, and therefore include:

Antimuscarinic: dry mouth, constipation, urinary retention, tachycardia, blurry vision (with inc risk of glaucoma)

Antihistamine: sedation, xerostomia, weight gain

Adrenergic: conduction abnormalities (rare), postural hypotension

ALSO: fine rapid tremors, delirium, weight gain

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16
Q

contrast histrionic vs borderline personality disorders

A

Histrionic: attention-seeking, constant need to be center of attention, inappropriately seductive or provocative, use their physica appearance, emotional lability

Borderline: pervasive instability in self image, affect, relationships; splitting; fear of abandonment; suicidal gestures or threats, comorbid bulemia

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17
Q

in depression, ______ is hypOmetabolic and _________ is hypERmetabolic

A

in depression, dorsolateral prefrontal cortex is hypOmetabolic and orbitofrontalcortex is hypERmetabolic

18
Q

What is the mechanism of MAO inhibitors?

A

MAO-A noradrenergic

MAO-B serotinergic

MAO is an enzyme on mitochondrial envelope

MAOI eventually increase synaptic catecholaimine (serotonin, dopa, norepi) lelvels

19
Q

mechanism of action of rivastigmine

A

inhibition of AchE and butyrylcholinesterase

20
Q

Name 3 psych drugs that can cause seizure

A
  1. Buproprion (acts via da, norepi)
  2. Clozapine (atypical antipsychotic, high dose)

amitriptyline (TCA in overdose)

21
Q

Which 3 schiz are pyschotic disorders and which 2 are personality disorders?

A

Psychotic disorders

  • schizophrenia (+sx > 1 mo; total sx >6 mos)
  • schizophreniform (1 mo < sx < 6 mo)
  • schizoaffective (schizophrenia + mood disorder sometimes, but also psychotic w/o mood changes, vs eg depression with psychotic sx)

Personality disorders

  • schoizoid = loner, doesn’t want close friends
  • schizotypal = odd, magical thinking, can be paranoid, can have social anxiety and be uncomfortable with relationships
22
Q

Which psych med(s) cause hypERnatremia

A

Lithium causes DI, which causes hypERnatremia

(recall that SSRIs cause SIADH -> hypOnatremia)

23
Q

Which class of antidepressant is most likely to induce a manic switch if used to treat depression in a bipolar patient?

A

TCAs

24
Q

mechanism of action of memantine

A

NMDAR ANTAGonist

25
Q

List four typical antipsychotics?

  1. Low potency at D2
    - ________________
    - ________________
  2. High potency at D2
    - ________________
    - ________________
A

List four typical antipsychotics?

  1. Low potency at D2
  • chlorpomazine
  • thioridazine
  • antihistamine, antimuscarinic, antiadrenergic effects predominate
  1. High potency at D2
  • haloperidol
  • fluphenazine
  • EPS predominate
26
Q

List the SNRIs

A

SNRIs

  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine
  • Milnacipran
27
Q

Which SSRI has the MOST drug-drug interactions?

A

Fluvoxamine.

28
Q

Side effects of lithium

A
  • Tremor
  • thyroid dysfunction
  • acne
  • nephrogenic DI (with HYPERna)
  • contraindicated in sick sinus b/c of neg chronotropy
29
Q

Dangerous side effect of clozapine?

A

agranulocytosis

30
Q

Which antipsychotic causes agranulocytosis?

A

Clozapine

31
Q

List the cluster C personality disorders (3)

A
  1. Avoidant personality disorder (hypersentitivity to criticism, avoid occupation or activity b/c fear of rejection, criticism)
  2. Dependent personality disorder (clingy, submissive, passive, can’t make own decisions)
  3. OCPD (perfectionist, different from OCD b/c OCPD lacks insight, obsessions, and compulsions)
32
Q

Which psych med(s) cause hypOnatremia

A

SSRIs cause SIADH -> hypOnatremia

Most likely with fluoxetine and paroxetine

risk factors: old, female, on diuretics already. Usually occurs within first month of tx (but sometimes not for a few mos.)

(Recall that Li causes DI –> hypER natremia)

33
Q

What are the symptoms of SSRI withdrawal?

A

Symptoms of SSRI withdrawal

  • dizziness
  • paresthesias
  • dysphoria
  • sometimes encephalopathy
34
Q

Most common side effect of TCAs?

A

Orthostatic hypotension

35
Q

Which dopaminergic pathways are implicated in schizophrenia?

A
  • mesolimbic
  • mesocortical

(think of limbic and cortical dysregulation)

36
Q

LIst the MAOIs

A

MAOI

  • Phenelzine
  • selegeline
  • Tranylcypromine
  • Isocarboxazid
  • moclobemide
37
Q

This OCT cough medicine can can inhibit serotonin reuptake and cause serotonin syndrome

A

Dextromethorphan

38
Q

orthostatic hypotension and antidepressant

Which antidepressant class typically causes orthostatic hypotension

A

Orthostatic hypotension is the most common side effect of TCAs

39
Q

Which SSRI is least sedating

A

sertraline

40
Q

Which SNRI can cause angle closure glaucoma and hypertension?

A

Venlafaxine

41
Q

Which SNRI can cause angle closure glaucoma and should be avoided in patients with renal or hepatic problems?

A

Duloxetine

Cognitive-Behavioral (5 decks)

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