Psych FINAL Flashcards
What is the first-line treatment for all phases of Bipolar Disorder (BPD)?
Lithium
What are the most common mood stabilizers used for BPD?
Lithium, Valproate (VPA), Lamotrigine, Carbamazepine, Oxcarbazepine
Which mood stabilizer is the most effective for preventing manic relapse?
Lithium
Which medication is preferred for rapid cycling or substance use comorbidity in BPD?
Valproate (VPA)
What is the primary use of Lamotrigine in BPD?
Maintenance therapy for bipolar depression
Which medication is a second-line option after Lithium and Valproate?
Carbamazepine
What is the monitoring schedule for Lithium therapy?
Check blood levels after 5 days, then weekly until stable, then every 3 months
What organ function must be monitored when taking Lithium?
Kidney (serum creatinine, UA) and Thyroid (TFTs every 6 months)
Why should Lithium be avoided in the first trimester of pregnancy?
Risk of cardiac malformations
What are common side effects of Lithium?
Nausea, diarrhea, tremor, polyuria, polydipsia, hypothyroidism
Which medication is effective for acute mania but not for maintenance therapy?
Valproate (VPA)
Which medication is the preferred treatment for bipolar depression?
Lamotrigine
Why must Lamotrigine be titrated slowly?
To reduce the risk of serious rash (Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis)
Which mood stabilizer is known to cause weight gain, sedation, and increased liver enzymes?
Valproate (VPA)
What should be monitored when prescribing Valproate?
CBC, liver function tests (LFTs), ammonia levels
Which mood stabilizers require serum Na+ monitoring?
Lithium, Carbamazepine, Oxcarbazepine
What is the risk of using Carbamazepine in pregnancy?
Neural tube defects and developmental delays
Which second-generation antipsychotics (SGAs) are used for acute mania?
Olanzapine, Risperidone, Aripiprazole, Ziprasidone, Quetiapine
Which SGA is most effective for acute mania stabilization?
Olanzapine
What is the recommended duration of an adequate trial for an SGA in acute mania?
3-4 weeks at the maximum tolerated dose
Why should antidepressants be used cautiously in BPD?
They may induce mania or rapid cycling
Which antidepressant is least likely to trigger mania in BPD?
Bupropion
What is the combination therapy rule when using antidepressants in BPD?
Never use an antidepressant as monotherapy; combine with a mood stabilizer like Lithium, Quetiapine, or Lamotrigine
What lifestyle modifications can help manage BPD?
Regular sleep, diet, exercise, therapy, medication adherence
What is the first-line drug class for MDD?
Selective Serotonin Reuptake Inhibitors (SSRIs).
Name the commonly prescribed SSRIs.
Fluoxetine (Prozac), Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft).
What is the mechanism of action (MOA) of SSRIs?
Block serotonin reuptake, increasing 5-HT levels in the synaptic cleft.
How long does it take for SSRIs to have a full therapeutic effect?
2 weeks for initial improvement, 12 weeks for maximum effect.
Which SSRI has the longest half-life?
Fluoxetine (Prozac), with an active metabolite (S-norfluoxetine) that lasts an average of 10 days.
Which SSRI is most associated with QT prolongation?
Citalopram.
Which SSRIs are FDA-approved for childhood MDD?
Fluoxetine and Escitalopram.
What are common adverse effects of SSRIs?
Headache, sweating, nausea, agitation, sexual dysfunction, weight changes, insomnia or somnolence.
What is the risk of combining SSRIs with MAOIs?
Serotonin syndrome (hyperthermia, muscle rigidity, sweating, mental status changes, unstable vitals).
What are SNRIs, and how do they work?
Serotonin-Norepinephrine Reuptake Inhibitors; they inhibit the reuptake of both serotonin and norepinephrine.
Name common SNRIs.
Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Milnacipran (Savella), Levomilnacipran (Fetzima).
Which SNRI is used for chronic pain conditions?
Duloxetine (Cymbalta).
Which antidepressant has minimal sexual dysfunction risk?
Bupropion (Wellbutrin).
What is the MOA of Bupropion?
Inhibits dopamine and norepinephrine reuptake.
Why should Bupropion be avoided in patients with seizure disorders or bulimia?
It lowers the seizure threshold, increasing the risk of seizures.
Which atypical antidepressant is associated with weight gain and sedation?
Mirtazapine (Remeron).
Which antidepressant is often used off-label for insomnia?
Trazodone.
What are common adverse effects of TCAs?
Dry mouth, blurred vision, urinary retention, cardiac toxicity, weight gain, sedation.
What is the major risk of TCA overdose?
Life-threatening arrhythmias.
Which TCA is the prototype drug?
Amitriptyline (Elavil).
Name the common TCAs.
Amitriptyline, Imipramine, Nortriptyline, Desipramine, Clomipramine, Doxepin, Protriptyline.
What is the main use of Clomipramine?
Treatment of Obsessive-Compulsive Disorder (OCD).
Before. Not anymore
Why are MAOIs rarely used?
They have significant drug and food interactions, leading to hypertensive crisis.
Name the common MAOIs.
Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Selegiline (Emsam patch).
What food should be avoided when taking MAOIs?
Tyramine-rich foods (aged cheese, smoked meats, red wine) due to hypertensive crisis risk.
Which antidepressant works as a serotonin reuptake inhibitor and 5-HT1a receptor partial agonist?
Vilazodone (Viibryd).
Which antidepressant inhibits serotonin reuptake and also antagonizes 5-HT3/5-HT7 receptors?
Vortioxetine (Trintellix).
Which antidepressant is the best choice for a patient with MDD and chronic pain?
Duloxetine (Cymbalta).
Which antidepressant is most effective for OCD?
Paroxetine.
Which antidepressant is best for reducing SSRI-induced sexual dysfunction?
Bupropion.
What is the recommended wash-out period when switching from an SSRI to an MAOI?
2 weeks (except Fluoxetine, which requires a 6-week washout).
Which antidepressant has strong alpha-1 antagonism and is not ideal for older adults?
Amitriptyline.
Which atypical antipsychotics are used adjunctively for treatment-resistant depression?
Aripiprazole, Brexpiprazole, Quetiapine, Fluoxetine + Olanzapine.
What is the first-line augmentation strategy for partial responders to antidepressants?
Adding an atypical antipsychotic (e.g., Aripiprazole, Brexpiprazole, Quetiapine).
What is the role of lithium in depression treatment?
Second-line augmentation; reduces suicide risk.
What is the first-line treatment for chronic insomnia?
Cognitive Behavioral Therapy for Insomnia (CBT-I).
Which neurotransmitter system do benzodiazepines and Z-drugs act on?
GABA-A receptor system.
Which benzodiazepine is not recommended for older adults due to long half-life?
Flurazepam.
Which benzodiazepine has the shortest half-life and is associated with amnesic effects?
Triazolam.
What is the prototype Z-drug?
Zolpidem (Ambien).
Which Z-drug has the shortest half-life and minimal next-day sedation?
Zaleplon (Sonata).
Which Z-drug is effective for both sleep onset and maintenance?
Eszopiclone (Lunesta).
Which hypnotic is a melatonin receptor agonist?
Ramelteon (Rozerem).
Which hypnotic is FDA-approved for non-24-hour sleep-wake disorder?
Tasimelteon (Hetlioz).
Which hypnotic is a dual orexin receptor antagonist (DORA)?
Suvorexant (Belsomra).
Which hypnotic is contraindicated with Fluvoxamine due to CYP1A2 inhibition?
Ramelteon (Rozerem).
Which medication is a low-dose TCA used for sleep maintenance?
Doxepin (Silenor).
Which hypnotic has a risk of next-day impairment, requiring caution for driving?
Zolpidem at high doses.
Which hypnotic has an off-label use for insomnia and is also an antidepressant?
Trazodone.
Which benzodiazepine is preferred for short-term sleep onset treatment?
Temazepam.
Which class of drugs should not be prescribed to pregnant women due to teratogenicity?
Benzodiazepines and Z-drugs.
Which over-the-counter medication is commonly used for situational insomnia?
Diphenhydramine (Benadryl).
Which drug classes used for sleep has been linked to increased Alzheimer’s disease risk?
Benzodiazepines and Z-drugs.
Which hypnotic has been shown to be effective for insomnia up to six months?
Eszopiclone (Lunesta).
Which Z-drug is available in a low-dose sublingual formulation for middle-of-the-night awakenings?
Zolpidem SL (Intermezzo).
What are common side effects of Z-drugs?
Headache, dizziness, next-day sedation, sleep-walking, sleep-driving.
Which non-benzodiazepine hypnotic should be used cautiously in patients with liver disease?
Eszopiclone and Zolpidem.
Which sleep medication is best for a patient with a history of substance abuse?
Doxepin.
What is the primary concern with long-term use of benzodiazepines?
Tolerance, dependence, and withdrawal symptoms.
Which hypnotic should be avoided within three hours of eating?
Doxepin.
Which hypnotic increases prolactin levels and should be avoided in hormonal disorders?
Ramelteon.
What is the definition of substance misuse?
Excessive use or misuse of drugs or ethanol (ETOH) for intoxicating or nonmedicinal purposes.
Which neurotransmitters are involved in the stimulant effects of drugs like cocaine?
Norepinephrine (NE), Dopamine (DA), Serotonin (5-HT).
How does cocaine exert its stimulant effects?
Inhibits reuptake of NE, dopamine, and serotonin, increasing their levels in the synapse.
Why is crack cocaine more addictive than powdered cocaine?
It is smoked, reaching the brain rapidly, causing intense euphoria followed by a crash.
What is cocaethylene?
A cardiotoxic metabolite formed when cocaine is consumed with ethanol.
What are common symptoms of cocaine toxicity?
Agitation, paranoia, seizures, hyperthermia, chest pain, tachycardia.
What is the first-line treatment for cocaine toxicity?
Calming the patient with Lorazepam, cooling measures, short-acting antihypertensives.
How do amphetamines differ from cocaine in terms of effects?
They enhance the release of biogenic amines and last longer than cocaine with less euphoria.
What is MDMA commonly known as?
Ecstasy or Molly.
Which neurotransmitter is most affected by MDMA?
Serotonin (5-HT).
What are the primary dangers of MDMA use?
Hyperthermia, serotonin syndrome, bruxism, jaw clenching.
What are synthetic cathinones commonly known as?
Bath salts.
How do synthetic cathinones work?
Increase release and inhibit reuptake of NE, dopamine, and serotonin.
What are the treatment strategies for bath salt intoxication?
BZDs for agitation, cooling measures, supportive care.
How does LSD exert its hallucinogenic effects?
Potent agonist at 5-HT2a receptors.
What are the most concerning adverse effects of LSD?
Loss of judgment, impaired reasoning, tachycardia, HTN.
What is the primary psychoactive component of marijuana?
Δ9-tetrahydrocannabinol (THC).
What are the medical uses of marijuana?
Chemotherapy-induced nausea, chronic pain, epilepsy, MS, glaucoma, anxiety.
What are the withdrawal symptoms of marijuana?
Cravings, insomnia, depression, irritability.
What is the major danger associated with synthetic cannabinoids?
Extreme hallucinations, seizures, acute kidney injury (AKI), death.
How does ethanol exert its CNS effects?
Enhances GABA, alters serotonin and dopamine, releases endogenous opioids.
What is the treatment for acute ethanol toxicity?
Supportive care, thiamine, folate, hydration.
Which medications are used to treat alcohol dependence?
Disulfiram (Antabuse), Naltrexone (ReVia, Vivitrol), Acamprosate (Campral).
How does Disulfiram help with alcohol dependence?
Inhibits aldehyde dehydrogenase, causing unpleasant symptoms when alcohol is consumed.
What are the risks of prescription drug abuse?
Opioid dependence, increased heroin use, overdose deaths.
What is the most common cause of MDMA-related death?
Hyperpyrexia (severe hyperthermia).
Which substance causes a cardiotoxic metabolite when combined with cocaine?
Ethanol.
Which drug is most likely causing hypertension, hyperthermia, and altered mental status?
Bath salts.
What is the treatment of choice for an agitated, tachycardic cocaine user?
Lorazepam to calm the patient, decrease BP and temperature.
What is a common adverse effect of adolescent marijuana use?
Short-term memory loss.
What are antipsychotics primarily used to treat?
Schizophrenia, psychotic disorders, and manic states.
What are the two major classes of antipsychotics?
First-generation (FGAs) and Second-generation (SGAs).
Which antipsychotics are considered low-potency FGAs?
Chlorpromazine (Thorazine), Thioridazine (Mellaril).
Which antipsychotic is the prototype high-potency FGA?
Haloperidol (Haldol).
Which SGAs are commonly prescribed?
Clozapine, Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone, Lurasidone.
Which SGA is considered the most effective for treatment-resistant schizophrenia?
Clozapine.
Which SGAs are approved for irritability in autism?
Risperidone, Aripiprazole.
What is the mechanism of action (MOA) of FGAs?
Block dopamine D2 receptors, reducing psychotic symptoms.
What additional receptors do SGAs block?
Dopamine D2 and serotonin 5-HT2A receptors.
Which FGAs have the highest risk of extrapyramidal symptoms (EPS)?
High-potency agents like Haloperidol and Fluphenazine.
Which SGAs have the highest risk of metabolic side effects?
Olanzapine, Clozapine.
What are common side effects of FGAs?
EPS, sedation, orthostatic hypotension, anticholinergic effects.
What is a serious adverse effect of Clozapine?
Agranulocytosis (requires regular CBC monitoring).
Which antipsychotic has the highest risk of QT prolongation?
Ziprasidone.
What is the first-line treatment for schizophrenia?
SGAs due to lower EPS risk compared to FGAs.
What is the main advantage of SGAs over FGAs?
Lower risk of EPS and better efficacy for negative symptoms.
Which FGA has significant antiemetic properties?
Prochlorperazine (Compazine).
What is tardive dyskinesia (TD)?
Involuntary movements that may develop with long-term antipsychotic use.
Which medications are used to treat tardive dyskinesia?
Valbenazine (Ingrezza), Deutetrabenazine (Xenazine).
What is neuroleptic malignant syndrome (NMS)?
A life-threatening reaction with rigidity, fever, and autonomic instability.
What is the treatment for NMS?
Discontinue antipsychotic, supportive care, Dantrolene or Bromocriptine.
Which antipsychotics are available in long-acting injectable (LAI) formulations?
Haloperidol Decanoate, Risperdal Consta, Invega Sustenna, Abilify Maintena.
Which antipsychotic is most associated with hyperprolactinemia?
Risperidone.
Which SGAs are approved for bipolar depression?
Lurasidone (Latuda), Quetiapine (Seroquel).
What are contraindications for antipsychotic use?
Seizure disorders, elderly patients with dementia-related psychosis.
How long should maintenance therapy last for schizophrenia?
At least 5 years for patients with 2 or more psychotic episodes.
Which antipsychotic is most effective for treating apathy and blunted affect?
Risperidone.
Which EPS symptom is characterized by intense restlessness?
Akathisia.
Which EPS symptom is characterized by sustained muscle contractions?
Dystonia.
Which EPS symptom presents as Parkinson-like tremors and rigidity?
Parkinsonism.
What are common side effects of SGAs?
Weight gain, diabetes risk, sedation, QT prolongation.
Which antipsychotic is used for intractable hiccups?
Chlorpromazine.
Which FGA is used for Tourette Syndrome?
Pimozide (Orap).
Which antipsychotics are used as adjuncts for treatment-resistant depression?
Aripiprazole, Brexpiprazole, Quetiapine.
Which antipsychotic is considered the most effective for treatment-resistant schizophrenia?
Clozapine.
Which antipsychotics are FDA-approved for bipolar disorder (BPD)?
Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone, Lurasidone.
Which SGAs are approved for MDD augmentation?
Aripiprazole, Quetiapine (ER), Olanzapine (with Fluoxetine).
Which SGAs are used off-label for PTSD in military veterans?
Risperidone, Quetiapine.
What is the mechanism of action (MOA) of SGAs?
Block dopamine D2 and serotonin 5-HT2A receptors.
Which SGAs have the highest risk of metabolic side effects?
Clozapine, Olanzapine.
Which SGAs are associated with the lowest risk of metabolic side effects?
Ziprasidone, Lurasidone.
What are the most common side effects of SGAs?
Weight gain, sedation, diabetes, hyperlipidemia, QT prolongation.
Which SGA has the highest risk of seizures?
Clozapine, especially at doses >600 mg/day.
Which antipsychotics have the highest risk of QT prolongation?
Thioridazine, Ziprasidone.
Which SGA decreases prolactin levels?
Aripiprazole.
Which SGAs are FDA-approved for schizophrenia in children?
Aripiprazole, Risperidone, Quetiapine, Paliperidone, Ziprasidone.
Which SGAs are FDA-approved for pediatric BPD?
Aripiprazole, Quetiapine, Risperidone.
What is the first-line treatment for schizophrenia?
SGAs due to lower EPS risk compared to FGAs. (Aripiprazole, Asenapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone)
What is the treatment for neuroleptic malignant syndrome (NMS)?
Discontinue antipsychotic, supportive care, Dantrolene or Bromocriptine.
Which SGA is approved for hallucinations in Parkinson’s disease?
Pimavanserin (Nuplazid).
What are common adverse effects of Clozapine?
Agranulocytosis, weight gain, sedation, seizures, myocarditis.
What is required for Clozapine monitoring?
CBC monitoring for agranulocytosis (weekly initially).
Which SGAs are available in long-acting injectable (LAI) formulations?
Aripiprazole, Paliperidone, Risperidone, Olanzapine.
Which FGA has the highest risk of weight gain?
Chlorpromazine.
Which SGAs have the highest risk of sedation?
Clozapine, Olanzapine, Quetiapine.
Which SGA has the lowest risk of sedation?
Aripiprazole.
Which FGA is commonly used for Tourette’s syndrome?
Pimozide.
Which SGA is preferred for patients with schizophrenia and metabolic concerns?
Ziprasidone or Lurasidone.
What is the recommended monitoring for metabolic effects of SGAs?
BMI, glucose, lipids, blood pressure at baseline and regularly thereafter.
Which SGA is most effective for schizoaffective disorder?
Paliperidone.
What is the primary risk of using Iloperidone?
QT prolongation and dizziness.
Which SGA must be taken with food to enhance absorption?
Lurasidone.
Theophylline
Methylxanthine for COPD/Asthma. Phosphodiesterase inhibitor. ADE: tachycarida, GI distress
Nicotine
Stimulant, smoking cessation, nicotinic receptor agonist. ADE: HTN, addiction
Varenicline (Chantix)
Partial nicotinic agonist, smoking cessation. ADE: mood changes, SI, nightmares
Methylphenidate (Ritalin)
Stimulant, ADHD, narcolepsy. Dopamine and NE reuptake inhibitor. Insomnia, weight loss, dependence.
Modafinil (Provigil)
Stimulant, Narcolepsy. Unclear MOA, adrenergic and dopaminergic systems. ADE: HA, nausea, nervousness
Armodafinil (Nuvigil)
Stimulant, narcolepsy. Unclear MOA, adrenergic and dopaminergic systems. ADE: Insomina, abuse potential
Lisdexamfetamine (Vyvanse)
Stimulant, ADHD, prodrug of dexroamphetamine. ADE: HTN, appetite loss.
Atomoxetine (Strattera)
Non-stimulant (not controlled), ADHD, selective NE reuptake inhibitor. ADE: HTN, insomnia.
Phentermine (Adipex)
Stimulant, Obesity, sympathomimetic amine. ADE: palpitations, dry mouth, insomnia
Diethylpropion (Tenuate)
Stimulant, obesity, sympathomimetic amine. ADE: HTN, arrhythmias, dependency
Chlordiazepoxide
Librium, benzo. For anxiety, ETOH withdrawal. MOA: enhances GABA effects. ADE: confusion ataxia
Flumazenil
Romazicon. Benzo antagnoins/reversal agent. GABA receptor antagonist. ADE: seizures, dizziness
Buspirone
Anoxiolytic. Chronic anxiety. MOA: 5-HT1a receptor agonist. ADE: dizziness and nausea
Barbiturates
ie Phenobarbital. Sedative. Seizures, insomnia, Enhances GABA. ADE: respiratory depression, addiction
