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Psych drugs Flashcards

1
Q

SGA that cause hypertriglyceridemia

A

Clozapine, Olanzapine, Quetiapine

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2
Q

SGA that cause significant weight gain

A

Clozapine and Olanzapine

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3
Q

SGA that might cause weight gain

A

Aripiprazole, Brexipiprazole, Cariprazine, Lurasidone, Ziprasidone

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4
Q

SGA that cause EPS ADEs

A

Risperidone and Paliperidone

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5
Q

SGA least likely to cause EPS ADEs

A

Quetiapine and Clozapine

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6
Q

SGA that increase prolactin

A

Risperidone and Paliperidone

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7
Q

SGA that prolong QTc

A

Clozapine, Ziprasidone, Paliperidone, Quetiapine, Iloperidone

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8
Q

SGA with anticholinergic

A

Olanzapine, Quetiapine, *Clozapine

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9
Q

SGA that cause orthostatic HoTN

A

Clozapine, Iloperidone
-Moderate: Quetiapine, Risperidone, Paliperidone

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10
Q

SGA that cause sedation

A

Clozapine
-Moderate: Olanzapine, Quetiapine, Ziprasidone

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11
Q

SGA that cause seizures

A

Clozapine (dose dependent)

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12
Q

SGA with hematologic effects

A

Clozapine

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13
Q

MOA of FGA

A

block D2 receptors, minimal 5-HT2A blockade

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14
Q

FGA ADEs

A

EPS- Acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia
NMS
Dermatologic
Hyperprolactinemia
QTc prolongation (Thioridazine Haloperidol)
M1/H1/Alpha1

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15
Q

Acute dystonia management

A

Occurs w/in 24-96 hours
NO ORAL MEDS! Diphenhydramine/Benztropine IM

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16
Q

Pseudoparkinsonism management

A

Occurs w/in first month
decrease dose/swith to SGA
Benztropine, Trihexyphenidyl, or Amantadine Tx for several months

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17
Q

Akathisia management

A

Occurs w/in 3 months
Swith to SGA
Tx w/ Propranolol

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18
Q

Tardive Dyskinesia management

A

Long term exposure
discontinue anticholinergics
Ingrezza or Austedo (VMAT2 inhibitors)

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19
Q

Neuroleptic Malignant Syndrome (NMS) management

A

supportive care
Dantrolene, Bromocriptine, BDZs
wait at least 2 weeks to restart new antipsychotic therapy

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20
Q

Asenapine pearl

A

SL only, no food/drink for 10 minutes after dose

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21
Q

Cariprazine pearl

A

steady state takes several weeks

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22
Q

Lurasidone pearl

A

must take w/ at least 350 calories

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23
Q

Paliperidone pearls

A

bioavailability increased when taken w/ food

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24
Q

Quetiapine pearl

A

hypnotic at 50mg, antidepressant at 300mg, antipsychotic at 600mg

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25
Q

Ziprasidone pearl

A

must take w/ at least 500 calories

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26
Q

Clozapine pearls

A

DOC for Tx resistant Schizo (failed 2 others)
titrate slowly due to orthostatic HoTN
REMS due to risk of neutropenia- monitor ANC= total WBC x [%neutrophils (segs+bands)/100]
can initiate if ANC >1500 for most or >1000 if BEN. monitor ANC q week for 6 moths then every other week from months 6-12 then monthly after 12 months

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27
Q

Clozapine ADEs

A

-HoTN, Bradycardia, Syncope, CArdiac arrest (during initiation)
-Seizures are dose dependent
-Myocarditis and cardiomyopathy most likely in first 8 weeks of Tx. DO NOT CHALLENGE
-weight gain, hypertriglyceridemia, QT prolongation, anticholinergic, orthostatic HoTN, sedation, seizure, hematologic

28
Q

Acute mania treatment

A
  1. LITHIUM 300mg TID level 0.6-1.2mEq/L
  2. VPA or Carbamazepine
  3. SGA
    +/- Benzos
29
Q

Lithium side effects

A

short term: GI, hand tremor, polyuria/polydipsia
long term: cognitive, hypothyroidism, derm, weight gain

30
Q

Lithium DDIs

A
  1. NSAIDs increase Li+
  2. HCTZ incrase Li+
  3. ACEi increase Li+
  4. Sodium decreases Li+
31
Q

Valproic Acid ADEs

A

alopecia, sedation, dizzy, tremor, GI, INCREASED LFTs, increased ammonia, TCP, hepatotoxicity/pancreatitis rare

32
Q

Carbamazepine ADEs

A

for Tx failure w/ Li+ or VPA
hyponatremia, nausea, dizziness, hepatotox, SJS, agranulocytosis

33
Q

Oxcarbazepine ADEs

A

3rd line acute mania, 4th line maintenance
somnolence, h/a, dizzy, hyponatremia, derm, less heme effects than Carb

34
Q

Lamotrigine ADEs

A

ONLY Maintenance
h/a, RASH, drowsy, nausea, ataxia, SJS

35
Q

Bipolar maintenance monotherapy options first line

A
  1. Lithium
  2. Divalproex, Lamotrigine, Quetiapine, Olanzapine, Aripiprazole, Ziprasidone
36
Q

Bipolar maintenance second line

A

Carbamazepine, Paliperidone, Asenapine, Combos with lithium/divalproex

37
Q

Treatment of bipolar depression

A
  1. Lithium
  2. Quetiapine, Lurasidone
  3. Olanzapine, Fluoxetine
  4. Lamotrigine, Valproate
38
Q

Anxiety Treatment

A
  1. Antidepressants- Paroxetine, Escitalopram, Sertraline, Duloxetine, Venlafaxine (TCAs were but only Imipramine used now)
  2. Buspirone, BDZs (not for long term Tx)
  3. Hydroxyzine, Quetiapine, Pregabalin
39
Q

Panic disorder Tx

A
  1. Sertraline, Fluoxetine, Paroxetine, Venlafaxine
  2. switch to another SSRI or Venlafaxine
  3. Imipramine, Venlafaxine, or another SSRI
  4. Beta blocker, Clonazepam, Alprazolam
40
Q

Social anxiety disorder tx

A
  1. Paroxetine, Sertaline, Venlafaxine
    -if partial response add Buspirone or Klonopin
41
Q

Performance anxiety treatment

A

Propranolol 10-80mg or Atenolol 25-100mg

42
Q

OCD Tx

A
  1. Fluoxetine, Fluvoxamine, Sertraline, Paroxetine, Clomipramine
  2. try different SSRI
  3. Clomipramine
43
Q

PTSD Tx

A
  1. Sertraline, Paroxetine, Venlafaxine
  2. TCAs or Mirtazapine
  3. MAOIs
  4. Prazosin
44
Q

Depression Tx

A
  1. SSRIs, SNRIs, Bupropion, Mirtazapine
  2. TCAs, MAOIs, serotonin modulator (Trazodone, Viibryd, Britellix)
45
Q

SSRI ADEs

A

N/V/D, h/a, tremor, akathisia, serotonin syndrome
*sexual dysfunction most common reason to d/c

46
Q

Serotonin syndrome SEs

A

Shivering
Hyperreflexia
Increased temp
Vital signs unstable
Encephalophathy
Restlessness
Sweating

47
Q

Serotonin syndrome Tx

A

mild- lorazepam for agitation
moderate to severe- cyproheptadine, chlorpromazine
propranolol

48
Q

Best SSRI in cardiac patients

A

Sertraline

49
Q

SSRIs that cause QTc prolongation

A

Citalopram and Escitalopram

50
Q

Sedating SSRI

A

Paroxetine

51
Q

Activating SSRI

A

Fluoxetine

52
Q

SNRIs

A

n/v/d, sexual dysfunction, insomnia, dizziness, h/a, dry mouth, increased HR
Increase in DBP

53
Q

Duloxetine ADEs

A

urinary difficulty, hepatotoxicity

54
Q

TCA ADEs

A

dry mouth, constipation, blurry vision, urinary retention, weight gain, memory, delirium

55
Q

Bupropion ADEs

A

seizures**, h/a, anxiety, n/v, weight loss, insomnia

56
Q

Mirtazapine ADEs

A

somnolence, dry mouth, increased appetite, weight gain, sedation, minimal sexual dysfunction

57
Q

Esketamine Intranasal (Spravato)

A

for treatment resistent depression w/ oral antidepressant 56mg twice weekly (28mg each nostril)
ADEs: HTN, sedation

58
Q

Depression in Pediatrics

A

Fluoxetine and Escitalopram

59
Q

Depression in pregnancy

61
Q

Olanzapine ADEs

A

Weight gain
Hypertriglyceridemia
Anticholinergic
Sedation

62
Q

Risperidone ADEs

A

EPS
Increased prolactin
Orthostatic HoTN

63
Q

Risperidone ADEs

A

EPS
Increased prolactin
Orthostatic HoTN

64
Q

Quetiapine ADEs

A

Hypertriglyceridemia
QTc prolongation
Anticholinergic
Orthostatic HoTN
Sedation

65
Q

Paliperidone ADEs

A

EPS
increased prolactin
QTc prolongation
Orthostatic HoTN

66
Q

Ziprasidone ADEs

A

QTc prolongation
Sedation

IPCS 3 (5 decks)

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