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Pharm 423 Exam 3 > Psych & Behavioral Disorders > Flashcards

Psych & Behavioral Disorders Flashcards

1
Q

Monitoring concerns of SSRIs

A

any drug to drug interactions- other CYP450 drugs, warfarin, any drug that prolongs QT intervals (bc SSRIs do as well), use caution in angina pts, mindful of pregnant women
caution in elderly pts

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2
Q

Other agents besides stimulants and non stimulants that could be used for ADHD

A 
selective alpha-2 agonists (clonidine)
tricyclic antidepressants (amitriptilyine)
bupropion -welbutrin (anti-depressant)- may be moderately effective but lowers seizure threshold
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3
Q

When to prescribe benzos

A

acute and short-term use in treatment of panic attacks

particularly those associated with generalized anxiety disorder and alcohol withdrawal

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4
Q

What 3 drugs are in the SNRI class

A

Effexor (venlafaxine)- also used for hot flashes, menopause in women who cannot take hormones
Cymbalta (duloxetine)
Savella (milnacipran)- also used for fibromyalgia and neuropathic pain

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5
Q

Somatic effects of anxiety

A

tachycardia, palpitations, increased BP, hyperventilation, tremor, sweating, GI -n/v/d

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6
Q

Contraindications for stimulants

A

history of schizophrenia or other psychosis

symptoms of anxiety, tension, agitation

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7
Q

Side effects of Strattera

A

**BLACK BOX –Possibility of SI- screen/closely monitor
Liver damage can occur but rare- increased LFTs can be seen in the 1st month
Effect is not always immediate

Common s/e:
GI discomfort, appetite decrease, mood swings, increased BP
RARE:
Liver injury, mania, agitation and/or mood swings

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8
Q

Major side effects of SSRIs

A

nausea, loose stools
sexual dysfunction
weight gain- how will this effect pts mental state

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9
Q

Side effects of Clonidine

A

hypotension
dry mouth
over sedation
*Rebound hypertension if abruptly stopped: ALWAYS TAPER

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10
Q

Black-box warning of SSRIs

A

must assess pt for depression/SI

increase in SI in users age 24 and under

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11
Q

Adverse effects of benzos

A

excessive sedation
respiratory depression
increase tolerance/physiologic dependance

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12
Q

When should a non stimulant be used for ADHD

A

can be less effective but used if pt doesn’t want to use stimulant or has a history of substance abuse

ex. Stattera - less potential for abuse

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13
Q

Preferred method of treatment for ADHD

A

Stimulants

start low and increase slowly until s/s resolve

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14
Q

Symptoms of serotonin syndrome

A 
Rigidity
Hyperthermia
Autonomic instability
Tremors
Confusion
Delirium
Coma
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15
Q

Serotonergic anxiolytics- Buspirone (Wellbutrin)- what is is used for

A 
approved for treatment of anxiety
chemically similar to haldol
no extrapyramidal syndromes
little risk of dependency
no effect on GABA system so it cannot be used for benzodiazepines withdrawal
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16
Q

Two most popular class of stimulants and drug names

A

Methylphenidate- Ritalin SR/LA , concerta, methylin, daytrana, metadate, Focalin/Focalin SR

Amphetamine Salts- Adderall

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17
Q

Wellbutrin (bupropion) MOA and use

A

weak inhibitor of neuronal uptake of dopamine, norepinephrine, and serotonin
helpful for smoking cessation
can be used for extended periods

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18
Q

Clonidine- class and use

A

Alpha-2 agonist
good mood stabilizer Especially for kids also approved for ADHD
effective non stimulant alternative to Strattera
capable of controlling tics
Long acting seems to work better than SA

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19
Q

MAOIs example

A

Nardil (phenelzine)- not used so much anymore, decreases metabolic inactivation of catecholamines, multiple side effects and interactions with drugs/food

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20
Q

Short acting Benzos
intermediate
Long acting benzos

A

short acting- Ativan (lorazapam), Xanax (alprazolam), serax (oxazepam)
intermediate acting- valium (diazepam)
Long acting- klonopin (clonazepam), librium

21
Q

What to discuss concerning cardiac risk in pts before starting stimulant

A

get thorough cardiac h&p including family and personal
- arrhythmias, premature heart disease, sudden death
normal vital signs
pt having any CP, palpitations, syncope (esp with exercise), fainting or SOB w/ exercise
YES to any –requires an EKG

22
Q

ADHD diagnostic criteria

A

must be consistent at least 6 months
must be present in more than one setting
must have existed before 12 years of age
must show clear impairment in functioning
no longer disqualified by comorbid diagnosis (autism)

23
Q

SSRI withdrawl symptoms

A 
FLUSH
Flu-like 
Lightheaded or dizzy
Uneasiness or restlessness
Sleepiness or sensory distubrances
Headaches

s/s stop within 24 hours after starting SSRI back up
MUST reduce SSRI gradually

24
Q

First Choice for ADHD

A

Stimulants

25
Q

First choice among antidepressants- class and drug names

A 
SSRI's --
Zoloft (sertraline)
Paxil (paroxetine)
celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)
Prozac (fluoxetine)- oldest SSRI- very useful
26
Q

pharmadynamics of SSRIs

A

widely distributed
highly protein bound
metabolism: interferes with CP450 enzymes (beware of interactions with other meds)
renal excretion

27
Q

MOA of benzodiazepines

A

bind to the molecular components of GABA alpha receptors in the CNS neuronal membranes
- potentiates GABA-ergic inhibition at all levels of CNS– firing rate of critical neurons is decreased in many regions of the brain
best used intermittently, in low doses

28
Q

Mixed retake and neuroreceptor antagonist (tricyclic)

A

Elavil (amitriptyline)

29
Q

Benzo antagonist for overdose

A

Romazicon IV

30
Q

SSRIs MOA

A

potently and selectively inhibit serotonin uptake pump on the presynaptic neuron
increase concentration of 5HT in synapse by inhibiting reuptake
weak effect on dopamine, norepinephrine reuptake

31
Q

What questions should be asked of patients before starting a stimulant for ADHD

A

cardiac history
tic disorders
Substance abuse history

32
Q

What is trazodone used for

A

antidepressant/antianxiety
is an alpha-2 antagonist
has fewer side effects than tricyclics

33
Q

Pharmacodynamics of benzos

A

high fat solubility
highly protein bound
metabolism: extensively through liver, active metabolites
excretion: renal system

34
Q

Things to know about Strattera

A

Norepinephrine reuptake inhibitor
Metabolized by CYP450 (watch drug interactions)
caution in pts with HTN, tachycardia, cardiovascular or cerebrovascular disease
can take weeks to take effect

35
Q

Domains of adults with ADHD

A

Inattention- staying on task, organizing/prioritizing, time management
Impulsivity- unwise speech and behavoirs
Hyperactivity (restlessness)- talking to much, interrupting
Emotional dysregulation- mood lability, irritability, anger outbursts, low frustration tolerance

36
Q

Which 2 drugs make up the serotonin receptor antagonists

A

Remeron (mirtazapine) and Oleptro (trazodone)

37
Q

How long does it take for SSRIs to reach full therapeutic strength

A

2 weeks

38
Q

What are some indications for SSRI use

A

effective in treating anxiety that sometimes complicates depression as well as anxiety disorder itself (citalopram)
very useful in treating obsessive compulsive disorder

39
Q

Which SSRI is indicated for age 8 and up for major depression

A

Prozac (fluoxetine) - oldest SSRI and still very useful

40
Q

Action of benzodiazepines

A 
sedation
hypnosis
decreased anxiety
muscle relaxation
amnesia
anticonvulsant activity
nausea relief
depression of respiratory drive
41
Q

Patients w/ ADHD need to understand that other issues need to be addressed separately such as…

A 
ADHD meds won't help:
anxiety 
ODD
learning disabilities
mood disorders (depression, bipolar)
substance use disorder
42
Q

Guanfacine- class and use

A

Alpha-2 agonist
Tenex SA or Intuniv LA
less sedating than clonidine
side effects same as clonidine (hypotension, dry mouth, over sedation)

43
Q

Guidelines for use of benzos

A

use cautiously with elders
NEVER use in pregnancy
monitor for escalating use
educate: avoid alcohol, kava-kava, slowly taper off, do not drive while using

44
Q

Side effects of buspirone

A 
dry mouth
lightheadedness
headache
insomnia
interaction with MAO inhibitors or SSRIs- may potential serotonin syndrome

dose TID

45
Q

First FDA-approved non stimulant

A

Strattera (Atomoxetine)

46
Q

Half lives of fluoxetine and fluvoxamine

A

Prozac (fluoxetine)- 4-6 days

Luvox (fluvoxamine) - 15-26 hours

47
Q

Causes of serotonin syndrome

A

Interaction of SSRI with certain cardiac meds
dosage is too high
interaction with MAOI
interaction with St. John’s wort- always ask about herbal sups

48
Q

rare side effects of stimulants

A 
delay in sleep onset
anorexia
induce tics
headaches
abdominal pain
increased BP
skin irritation (with daytrana)
rebound effects
49
Q

Strattera contraindications

A

patients with glaucoma or taking MAO inhibitors

cannot be used concurrently with albuterol

Pharm 423 Exam 3 (2 decks)

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