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Pharmacy CPS Flashcards > PSYCH: depression, anxiety related disorder, schizophrenia, bipolar, > Flashcards

PSYCH: depression, anxiety related disorder, schizophrenia, bipolar, Flashcards

1
Q

side effects with antidepressant subside within — weeks

A

2 weeks

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2
Q

patient is responding to treatment but is bothered by side effects, what do you recommend?

A

switch between the same class of agents within 3-8 weeks ( side effects subside within 2 weeks)

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3
Q

CANMAT 1st line agent for depression

A

SSRI: sertraline, fluoxetine, paroxetine, citalopram, escitalopram
SNRI: venlafaxine, duloxetine,
bupropion
Mirtazapine

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4
Q

2nd line therapy for depression

A

moclobemide
quetiapine
trazodone
tricyclic antidepressants

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5
Q

acronyms for SSRI side effects

A 
HANDS 
H= headache 
A= anxiety 
N: nausea 
D: diarrhea and other 
S: sexual dysfunction and sleep dysfunction
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6
Q

optimal response time for antidepressant

A

8 weeks

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7
Q

network analysis found the following antidepressant to be superior in efficacy

A

escitalopram, sertraline, venlafaxine, mirtazapine

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8
Q

sertraline: unique side effects

A

Unique: tends to have more diarrhea and male sexual dysfunction

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9
Q

antidepressant that has least sexual dysfunction

A

mirtazapine, bupropion, moclobemide

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10
Q

antidepressant with Low weight gain potential

A

bupropion, SNRI ( less than SSRI- paroxetine have the most weight gain

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11
Q

antidepressant that lower seizure threshold

A

bupropion, TCAs

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12
Q

antidepressant that have high potential of withdrawal symptoms and lowest

A

high: venlafaxine, paroxetine
lowest: fluoxetine (long t/2 life) and bupropion ( no withdrawal)

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13
Q

SSRI drug interactions

A

NSAIDs: bleeding risk
serotonergic agent increases serotonin syndrome
Fluoxetine and paroxetine= potent 2D6 inhibitor ( metoprolol, desipramine) avoid or use with caution
fluvoxamine= potent 1A2 inhibitor

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14
Q

SSRI: relevant PK - absorption and metabolism

A

absorption: with or without food. sertraline increases bioavailability with food
metabolism: Only fluoxetine, citalopram, sertraline form active metabolites. potential concerning in liver dysfunction

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15
Q

drug of choice for pregnancy and breast feeding

A

pregnancy: sertraline, escitalopram, citalopram
alternative: desvenlafaxine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, TCAs (except clomipramine and doxepin) and venlafaxine
avoid: paroxetine

Breast: sertraline, escitalopram or citalopram

alternative: paroxetine and nortriptyline.
avoid: fluoxetine due to long t1/2 and high levels in breast milk

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16
Q

venlafaxine unique side effects

A

unique: dose-related hypertension occurs rarely, particularly at doses ≥225 mg/day.

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17
Q

bupropion contraindications

A

contraindicated in anorexia or bulimia nervosa and seizure disorders, Abrupt discontinuation of alcohol or sedatives

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18
Q

mirtazapine MOA, adverse effects and interactions

A

Serotonin and alpha adrenegic antidepressant (can last until morning even if taken at supper), & weight gain due to increased appetite
Significantly less sexual dysfunction versus other ADs
DI: alcohol/CNS depressants intensifies mirtazapine effect on mental and motor skills, MAOI, QT prolongation drugs

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19
Q

TCA and it’s unique side effects

A

tertiary amines: Amitriptyline,
clomipramine ( the most serotonergic TCA, highest seizure risk,) is still favoured in the treatment of OCD r), imipramine, trimipramine, doxepin
Secondary: nortriptyline, desipramine ( lowest anticholinergic side effects)
Secondary are better and tertiary amines
side effects: sedation, anticholinergic effects, especially Cardiovascular toxicity (avoid TCAs in patient with history of overdose) , QT prolongation,

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20
Q

MAOIs and significant drug interaction

A

reversible: Moclobemide
irreversible: phenelzine and tranylcypromine
significant DI: tyramine ( hypertensive crisis)

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21
Q

Switching antidepressant recommended washout period

A

antidepressant–> antidepressant( no washout, crossover technique)
antidepressant—> MAOI ( stop antidepressant 2 weeks prior to initiation of MAOIs, 5 weeks for fluoxetine due to long t/12)

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22
Q

duration of therapy for depression

A

1st and 2nd episodes: 6-9 {minimum 9 months}
3rd episodes: atleast 2 years
other indication for minimum of 2 years
( older age, psychotic features, suicidality, frequent episodes, residual symptoms, difficult to treat episodes, comorbid psychiatric or medical condition)- reduced relapse by 70%

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23
Q

discontinuation syndrome side effects and how long it should last?

A

F = flu-like symptoms fatigue, lethargy, malaise, muscle aches
I = Insomnia
N = Nausea
I = Imbalance
S = Sensory disturbances paresthesias, electric-shock sensations
H = Hyperarousal anxiety, agitation
**withdrawal last for 2 weeks
fluoxetine= lowest incidence of withdrawal, bupropion= no withdrawal
When discontinuing antidepressants, taper slowly over 4–6 weeks. This is particularly important for paroxetine and venlafaxine.

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24
Q

how to manage treatment resistant depression: switch or augment with?

A 
Antidepressants can be switched either within a medication class or to a different class. 
augment with aripiprazole, olanzapine, quetiapine and risperidone, brexpiprazole, lithium and bupropion
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25
Q

Non pharm treatment for anxiety related disorder

A

avoid caffeine, alcohol, stimulants
exposure based techniques in specific phobia, stress management, sleep hygiene, aerobic exercises several times a week,
**CBT (1ST line)

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26
Q

pharmacotherapy for anxiety related disorder ( 1st, 2nd line) PD, SAD , GAD OCD, PTSD

A

PD:

1st: SSRI , SNRI ( venlafaxine for all except OCD),
2nd: TCA( imipramine and clomipramine) and mirtazapine and BZD

SAD:
1st line: SSRI and SNRI ( venlafaxine) and pregabalin
2nd: BZD, gabapentin, MAOI ( phenelzine)

GAD :
1st line: SSRI, SNIRI (both v/d), pregabalin,
2nd: BZD, Quetiapine XR, bupropion, buspirone, hydroxyzine, TCA (imipramine)

OCD:

1st: SSRI
2nd: mirtazapine, venlafaxine

PTSD: SSRI, SNRI ( venlafaxine)
2nd: mirtazpine, TCA ( phenelzine) ** avoid BZD**

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27
Q

DOC for pregnancy and breastfeeding for anxiety related disorder

A

pregnancy:
CBT, SSRI,SNRI and BZD. Avoid paroxetine

Breastfeeding:
paroxetine or sertraline
avoid BZD

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28
Q

role of BZD in anxiety

A

Benzodiazepines used for a limited period of time, e.g., up to 6–8 weeks, may also be effective in providing rapid relief from anxiety or panic attacks when needed, or to help reduce anxiety and agitation related to initiation of SSRIs and SNRIs.

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29
Q

role of propranolol in anxiety

A

used in SAD for specific task related anxiety ( fear of public speaking or stage fright- take lose dose propranolol 30 mins prior)

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30
Q

role of buspirone

A

2nd in GAD, slower onset compared to BZD , less sedating, low addiction tendencies, minimal withdrawal symptoms compared to BZD

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31
Q

role of prazosin

A

Prazosin is an alpha1-adrenergic antagonist that reduces sympathetic outflow in the brain. It is often used in clinical practice for the treatment of PTSD-associated nightmares,

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32
Q

SNRI side effects

A

venlafaxine, desvenlafaxine, duloxetine
headache, insomnia, sweating, nausea, dry mouth and sexual dysfunctions

HANDS

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33
Q

Bupropion: MOA, AE and and CI

A

MOA: NE and dopamine reuptake inhibitor (NDRI)
AE: anxiety, agitation, seizure, no sexual dysfunction (due to not inhibiting serotonin)
BID doing separately at least 8 hurst’s

CI: seizure disorder, anorexia/bulimia nervosa, electrolyte disturbances

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34
Q

trazodone MOA, side effects,

A

MOA: serotonin antagonist and reuptake inhibitor (SARI)
AE: drowsiness, sedation, orthostasis, headache, fatigue

pripasim

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35
Q

TCA: MOA, side effects, interactions

A

MOA: serotonin-NE reuptake inhibitors
Side effects: anticholinergic (urinary retention, dry mouth, constipation), worsening of heart arrhythmias, heart block, QT prolongation, weight gain
Interactions: Avoid ACH drugs, CNS depressants, MAOI ( fatal),
highly toxic in overdose due to cardiac toxicity

36
Q

MAOIs side effects and significant a/e

A

Moclomide is reversible and phenelzine and tranylcypromine and irreversible

side effects: insomnia, palpitation, tachycardia, orthostatic, hypotension and sexual dysfunction

37
Q

4 keys dopaminergic tracts involved in schizophrenia

A

Tract 2 and 3 are implicated in schizophrenia
1- nigrostriatal- dopamine receptor blockade–> EPS
2- mesolimbic—> increased dopamine –> positive symptoms
3- mesocortical –> decreased dopamine–> negative symptoms
4. tuberoinfundibular–> dopamine blockage—> increased prolactin

38
Q

do both FGA and SGA have similar efficacy?

A

All FGAs and SGAs, with the exception of clozapine, have similar efficacy in treating the positive (psychotic)
SGA They are thought to improve or at the least not worsen cognitive and negative symptoms.

39
Q

list the medication that belongs to FGA and its adverse effects

A

note FGA typically blocks Dopamine receptor and SGA blocks both Dopamine and 5HT2A
Low-potency agents (e.g., chlorpromazine, methotrimeprazine), less dopamine blockage and more other receptor blockage including H1 ( sedation, weight gain, increased appetite,) M1 receptor ( anticholinergic effects) and alpha 1 ( orthostatic hypotension)

high-potency agents (e.g., fluphenazine, haloperidol), more dopamine blockage, have greater rates of extrapyramidal side effects (EPS) (e.g., parkinsonism, tardive movement disorders such as tardive dyskinesia), neuroleptic malignant syndrome (NMS) and elevated prolactin levels

note: Zuclopenthixol Acetate (Clopixol Acuphase) – “not a LAIA or a shot acting IM AP”
Not intended for long-term use. Duration should not exceed 2 weeks. Max cumulative dosage should not exceed 400mg and number of injections should not exceed 4.

40
Q

list SGA and TGA medication and its adverse effects

A

second gen: asenapine, , clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone
AE: high risk of weight gain: THE PINE ( clozapine, olanzapine, quetiapine)
high risk of ACH >30% ( clozapine and quetiapine) - dry mouth, constipation, urinary retention
high EPS: THE DONE ( risperidone and paliperidone)
high Hyperprolactinemia : THE DONE risperidone and paliperidone)

third gen: (aripiprazole, brexpiprazole)
unique MOA: partial antagonist of Dopamine and serotonin receptor ( LOW risk of weight gain, EPS, ACH)
AE: ari has high risk of Akathisia. other ae includes anxiety, insomnia,
tremor, compulsive behaviour

41
Q

treatment for EPS symptoms including
acute dystonia
Akathisia
Tardive dyskinesia

A

acute dystonia (Severe muscle spasm – may involve tongue: BDL drugs: Benztropine Diphenhydramine and Lorazepam

akathisia (Inner restlessness, cannot sit still, excessive motor activity): if dose reduction is not effective, beta-blockers (e.g., propranolol 10–120 mg/day) are treatment of choice with monitoring for hypotension. Lorazepam and mirtazapine also provide symptom relief. Anticholinergics are ineffective.

Tardive dyskinesia (Involuntary movement of face, jaw, tongue, lips, eyes, limbs, trunk, neck) : no evidence-based treatment—prevention is key use SGA

42
Q

Why do anticholinergic agents (benztropine, diphenhydramine) treat AP-induced EPS

A

Dopamine and acetylcholine have a reciprocal relationship with each other in the nigrostriatal pathway. Therefore, AP with high anticholinergic effects are less likely to cause EPSE (e.g. clozapine!)

43
Q

treatment for treatment resistance schizophrenia?

A

clozapine

44
Q

Clozapine serious AE and monitoring parameters

A

MYOCARDITIS ( Risk of myocarditis (0.06-3.88%, highest risk in first month).
• Mortality rate 10-23%
• Troponin and CRP weekly x 4 weeks when clozapine is started

AGRANULOCYTOSIS
Risk of agranulocytosis (incidence 1-2%, 88% of cases during first 6 months)
• Dose independent.
Pharmacists must verify: 1) patient is enrolled with clozapine program 2) patients’ hematological status before dispensing
clozapine. Dispense quantity limited to freq. of bloodwork

Constipation:
Severe constipation occurs in ~15% of patients on clozapine
• Severe constipation can lead to adynamic ileus
• Mortality rate 7.3%
• Very important to ask patients about bowel function and ensure they have adequate bowel medication (e.g. sennosides,
PEG 3350)

SEIZURES: Risk: 1% at <300 mg/day; 2.7% at 300-600 mg/day;
4.4% at >600 mg/day.41 SLOW titration,  dose
(~50%), +/- antiepileptic e.g. VPA, lamotrigine, caution:
EtOH, lithium, haloperidol, TBI

45
Q

know clozapine AGRANULOCYTOSIS monitoring and management for GREEN, YELLOW AND RED results

A

GREEN ( WBC >3.5) –> monitor q weekly x 6 months, (26weeks) q2wk x 6months, then q4wk if stable
Yellow: (WBC 2-3.4) –> continue clozapine but monitor for flu like symptoms–> monitor twice weekly
RED: (WBC <2 ) –> STOP STAT D/C indefinitely –> Repeat in 24 hours, then
at least weekly x 4 weeks and prn.

46
Q

if patient missed clozapine dose?

A

Missed doses: If no clozapine for ≥48h, must restart titration from beginning

47
Q

role of long acting injectable antipsychotics (LAIs)?

know which agent is q4wk, q12wk and q2wk

A

Long-acting injectable antipsychotics (LAIs), such as aripiprazole, paliperidone palmitate or risperidone, should be offered as an option in all phases of illness, including the first episode, after first establishing tolerability with oral formulations

Q4Wk: 3rd gen ARIPiprazole (Abilify), 2nd gen Paliperidone palmitate INVEGA SUSTENNA, 1st gen Haloperidol HALDOL
Q12WK: 2nd gen Paliperidone palmitate INVEGA TRINZA Use after stable for ≥4months on INVEGA SUSTENNA
Q2WK: 2nd RisperiDONE RISPERDAL CONSTA, 1st gen Flupent(h)ixol FLUANXOL and Zuclopenthixol CLOPIXOL

48
Q

distinguish the difference between BIPOLAR I AND BIPOLAR II?
difference between MANIAC VS HYPOMANIAC?

A

Bipolar I: Manic episodes +/- depressive episodes
Bipolar II: hypomanic + major depressive episodes + no history of manic episodes
hypomania is similar to mania but episode is not severe enough to cause marked social impairment, no psychotic features and lasting at least 4 days consecutive days and present most of each days

49
Q

first line for:
acute mania
acute depression
maintenance

A

acute mania: Li, divalproex, atypical antipsychotic ( risperidone and quetiapine)
acute depression: Li, divalproex, lamotrigine, quetiapine, lurasidone
maintenance: li, divalproex, lamotrigine atypical

50
Q

what class of meds should be avoid in bipolar?

A

antidepressant Carries risk of switching (rapid
change from depression to mania ie: RAPID CYCLIC: Risk highest with TCAs & venlafaxine (>10%, avoid), followed by SSRIs
(<5%) and low risk with bupropion

antidepressant+ mood stabilizer: avoid–> not better than mood stabilizer alone

51
Q

what is the role of lamotrigine in bipolar?

A

role: acute depressive episode and maintenance . mono therapy of lamotrigine is not recommended in presence of mania

52
Q

role of lithium in bipolar, therapeutic range, when to expect efficacy and side effects / monitoring

A

role: acute mania, maintenance and mild depression
therapeutic levels:
acute mania: 0.8-1.2 mmol/L note: higher dose in mania and reduce for maitenance
maintenance: 0.6-1.0 mmol/L

side effects: 
 Weight gain, GI upset,
polyuria, polydipsia, fine tremor, ↑
WBC, hypothyroidism, ↑ potassium &
calcium

monitor: Monitor thyroid (causes hypo or hyperthoyrodism HYPO more common though) and renal function at least every 6 months.

53
Q

what increases or decreases lithium level?

A

↑lithium level: ACEIs, ARBs, CBZ, diuretics, fluoxetine, metronidazole, NSAIDs (not low-dose ASA), sodium depletion, spironolactone.
↓lithium level: caffeine, metamucil, NaCl, theophylline, topiramate. Maintain a consistent salt (Na
+
) diet and adequate fluid intake!

54
Q

how long does mood stabilizer take to see effect?

A

2-4 weeks

max: 6-8weeks

55
Q

role of divaloproex/ valproic acid, side effects and monitoring?
difference between divaloproex/ valproic

A

first in acute mania/ depressive episodes, and maintenance
side effects:
GI upset, CNS slowing (sedation and somnolence) alopecia,
weight gain,
- Rare: thrombocytopenia, decreased
WBC, hepatotoxicity

**Same as divalproex above except
that valproic acid generally has more
GI side effects
-Divalproex and valproic acid are not
interchangeable medications (need to
check serum levels if patient is
changed between agents – especially
if on treatment for seizures)
56
Q

what is one significant consideration when wanting to use valproic acid?

A

: avoid valproate in females of child-bearing potential as often
↑ risk of congenital and cognitive defects

57
Q

lamotrigine side effects and significant drug interaction?

A 
ae: Nausea, chest pain, peripheral
edema, somnolence, dysmenorrhea,
dyspepsia, nystagmus
-Rare: Risk of SJS if titrated too quickly,
aseptic meningitis, neutropenia,
leukopenia, pancytopenia, aplastic
anemia

*weight neutral**

drug interactions: ↑level: valproate (& ↑risk of rash) **reduce lamotrigine by 50%), sertraline.
↓level: OCs, CBZ, phenytoin,

58
Q

what should be do first before starting CBZ?

A

rash (check
HLA-B*1502 before starting
treatment),

59
Q

CBZ side effects and drug interaction?

A

ae: GI upset (take with food) , CNS slowing ( somnolence and dizziness), rash, decreased WBC
rare: aplastic anemia, LFTs, hyponatremia, SLE

Many. Strong 3A4 inducer  ↓levels of: antipsychs, benzos, bupropion,

3A4 substrate. ↑CBZ level: clarithro/erythromycin, diltiazem, , fluoxetine, fluvoxamine,
lamotrigine, verapamil, valproate.

↓CBZ level: phenytoin, phenobarb, St. John’s Wort, theophylline.

60
Q

bipolar DOC in pregnancy and lactation

A

pregnancy: lamotrigine
most agents have teratogenic risk, the risk increases if patient is on multiple medications (aim for
monotherapy), decrease serum concentration, try to avoid in 1st semester but must balance risk to mother/fetus of
uncontrolled bipolar vs. risk of medications

61
Q

management for patient who is experiencing tremor on lithium?

A

decreased dose
reduce caffeine
or the addition of a beta-blocker such as propranolol or atenolol.

62
Q

what is an important counselling point for patient on Ziprasidone and Lurasidone ?

A

take with food, minimum 500 calories

63
Q

complication of lithium

A 
diabetes insipidus, hypothyroidism and arrhtymias
Leukocytosis
Insipidus
Tremor/teratogenic 
Hypothroydism
64
Q

when should you check the trough lithium plasma levels in healthy adult patient?

A

t1/2 is 24 hours
check trough after 5 half lives so 120 hours, only if toxicity signs and symptoms appear sooner, you can measure trough earlier than 5 half lives

64
Q

when should you check the trough lithium plasma levels in healthy adult patient?

A

t1/2 is 24 hours
check trough after 5 half lives so 120 hours, only if toxicity signs and symptoms appear sooner, you can measure trough earlier than 5 half lives

65
Q

usual dose of haloperidol for schizeperian

A

2mg IM NOT 10mg IM

65
Q

usual dose of haloperidol for schizophrenia

A

2mg IM NOT 10mg IM

66
Q

what is the MOA of tardive dykinesia?

A

Supersensitivity of the dopamine receptors as a result of chronic D2 blockade.

67
Q

What is the rate of response expected to a trial of an antipsychotic?

A

60%

68
Q

Risperidone is a second-generation antipsychotic but it is believed that it begins to display receptor blockade similar to the FGAs at doses greater than _________

A

6mg

69
Q

The propensity of SGAs to cause weight gain can be ordered as:

A

Clozapine > Olanzapine > Quetiapine > Risperidone.

70
Q

Despite adequate treatment for schizophrenia, what percentage of patients will continue to experience chronic or severe symptoms?

A

25%

71
Q

If a patient is switched to clozapine for treatment-resistance, an adequate trial would be considered to be

A

6 months

72
Q

Which of the following antipsychotics has partial agonist activity at D2 and 5HT1A and potent antagonism activity at 5HT2A receptors?:

A

aripiprazole

73
Q

Which of the following antipsychotics has partial agonist activity at D2 and 5HT1A and potent antagonism activity at 5HT2A receptors?:

A

ziprasidone

74
Q

What are the symptoms of activation syndrome often seen with ziprasidone

A

Ziprasidone-induced activation syndrome consists of anxiety, agitation, restlessness, and insomnia. Also included: increased energy and hypomania.

75
Q

Smoking can affect the metabolism of which antipsychotics?:

A

clozapine; Smokers may require higher doses of clozapine than non-smokers, leading to increased side effects and adverse effects.

76
Q

which antipsychotics have the highest rate of weight gain

A

Among second generation antipsychotics, clozapine and olanzapine are associated with the greatest weight gain followed by quetiapine, risperidone, paliperidone and aripiprazole (3rd gen).

77
Q

what happen when CBZ is taken with aripriprazole

A

Carbamazepine (or other strong inducers of CYP2D6 or CYP3A4 can decrease aripiprazole levels significantly.

78
Q

Patients taking clozapine should have a WBC count how often?

A

Weekly for the first 26 weeks of therapy.

79
Q

hyperprolactinermia is common in which antipyschotic?

A

Hyperprolactinemia is a common side effect of all first generation antipsychotics, risperidone and paliperidone. No differences in prolactin levels have been found with quetiapine.

80
Q

Which of the following antipsychotic drugs is least likely to cause weight gain?

A

Ziprasidone

81
Q

Which is a gateway or cardinal symptom that characterizes the manic phase of bipolar disorder?

A

Elevated mood

82
Q

Antidepressant that causes significant priapism

A

Trazodone

83
Q

Which antidepressant is the most anorexic

A

Fluoxetine

Pharmacy CPS Flashcards (27 decks)

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