Psych meds Flashcards

1
Q

What are the antidepressant categories?

A

SSRIs, SNRIs, MAOIs, TCAs, and atypical

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2
Q

How long does it take to start seeing some improvement of symptoms when patients are started on an antidepressant?

A

1-3 weeks

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3
Q

How long does it take for optimal results to peak when patients are started on an antidepressant?

A

12 weeks

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4
Q

When should we begin to titrate/reassess for need for titration when starting a patient on an antidepressant?

A

1 month

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5
Q

What are the 1st line antidepressants?

A

SSRIs, SNRIs, Buproprion, Mirtazapine

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6
Q

What is the black box warning that ALL antidepressants carry?

A

They may increase suicidal thoughts or actions, increased suicide risk

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7
Q

What patient population is at highest risk to the BBW for suicide risk?

A

Patients less then 25 y/o

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8
Q

What is the mechanism of action of the SSRIs?

A

They inhibit the reuptake of serotonin, thus allowing for more in the synaptic space

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9
Q

What are the adverse effects of the SSRIs?

A

nausea, headache, sexual dysfunction, CNS stimulation, weight gain, serotonin syndrome

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10
Q

What are the patient education points for SSRIs?

A

Avoid use with alcohol, avoid OTC medications that can cause CNS depression

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11
Q

What is the pregnancy category for SSRIs?

A

Category C

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12
Q

What are the therapeutic uses for SSRIs?

A

Depression, bipolar disorder, panic disorder, OCD, bulemia

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13
Q

What are the symptoms of serotonin syndrome?

A

shivering, sweating, tachycardia, mydriasis, AMS, delirium, tremors, hyperreflexia, HTN, hyperthermia

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14
Q

What are the two most common SSRIs?

A

Sertaline (Zoloft) and Fluoxetine (Paxil)

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15
Q

What is the mechanism of action of the SNRIs?

A

Inhibit the reuptake of norepinephrine and serotonin, leaving more in the synaptic spaces

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16
Q

What are the adverse effects of the SNRIs?

A

headache, somnelence, dizziness, insomnia, fatigue, dry mouth, orthostatic hypotension, can increase blood glucose levels, anorexia

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17
Q

What are the therapeutic uses for the SNRIs?

A

depression, generalized anxiety disorder, panic disorder, social anxiety

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18
Q

What are the common SNRIs?

A

Duloxetine (Cymbalta) and Venlafaxine (Effexor)

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19
Q

What medications should be avoided with use with the SNRIs?

A

Fluoroquinolones, MAOIs, OTC medications as they can have many interactions depending on the medication

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20
Q

What is the mechanism of action of the TCAs?

A

They act on many neurotransmitters to prevent reuptake

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21
Q

What are the adverse effects of the TCAs?

A

anticholinergic effects (dry mouth, weight gain, dizziness, ortho hypotension, etc), sedation, hypotension, diaphoresis, QT prolongation

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22
Q

What are the TCA’s most commonly used today?

A

Amitryptyline, Nortryptyline, Imipramine

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23
Q

Who are TCAs contraindicated in?

A

Patients with heart disease due to risk of QT prolongation

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24
Q

Why are TCAs falling out of favor?

A

The development of SSRIs and SNRIs

They are easy to overdose on (lethal dose is only 8 times the therapeutic dose)

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25
Q

How should TCAs be stopped?

A

Need a taper dose, don’t abruptly stop

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26
Q

What are the therapeutic uses for TCAs?

A

2nd line treatment normally

depression, bipolar disorder, neuropathy, insomnia, ADD/ADHD, panic disorder, OCD

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27
Q

What is the mechanism of action of the MAOIs?

A

Irreversibly inhibit MAO to prevent norepinephrine, serotonin, and dopamine reuptake

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28
Q

What are the adverse effects of the MAOIs?

A

HTN crisis (very large risk), orthostatic hypotension, insomnia, diarrhea

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29
Q

What foods must be avoided with MAOIs?

A

Tyramine high foods (smoked meats, aged cheese, pickled food, dried fruits, avocados)

30
Q

What are the MAOIs medications?

A

Phenelzine (Nardil), Marplan, Parnate, Selegline (MAO-B only, dopamine)

31
Q

What are the therapeutic uses of the MAOIs?

A

Last line

depression (normally atypical depression), panic disorders, Parkinsons (Selegline for dopamine)

32
Q

What is the most commonly used atypical antidepressant?

A

Bupropion (Wellbutrin)

33
Q

What is the mechanism of action of Bupropion?

A

It’s a stimulant, may block NE and/or dopamine receptors to promote more in the synapses

34
Q

What are the adverse effects of Bupropion?

A

agitation, headache, constipation, weight loss (off label use), GI upset, tremor, insomnia, blurred vision, tachycardia

35
Q

What are the therapeutic uses of Bupropion?

A

depression, smoking cessation, weight loss

36
Q

What are the 1st line treatments for GAD?

A

SSRI, SNRI, Buspar

37
Q

What is the 2nd line treatment for GAD?

A

Benzos

38
Q

What is the 1st line treatment for panic disorders?

A

SSRIs

39
Q

What is the 2nd line treatment for panic disorders?

A

Benzos, SNRIs, TCAs, MAOIs (last line)

40
Q

What is the 1st line treatment for OCD?

A

SSRIs

41
Q

What is the 2nd line treatment for OCD?

A

TCAs

42
Q

What is the 1st line treatment for social anxiety?

A

SSRIs

43
Q

What is the 2nd line treatment for social anxiety?

A

Benzos, propanolol (low dose)

44
Q

What is the drug therapy for PTSD?

A

SSRI or SNRI

45
Q

What is the mechanism of action of Buspar?

A

relieves anxiety by reducing triggers without working on the CNS

46
Q

What are the adverse effects of Buspar?

A

dizziness, headache, nausea, nervousness, sedation, light-headedness, excitement

47
Q

What is the mechanism of action of the benzos? (-lam or -pam)

A

potentiate the action of GABA to inhibit the excitatory ability of the neurons to reduce anxiety and resolve insomnia

48
Q

What are the anxiety dose side effects of benzos?

A

insomnia, excitations, euphoria, heightened anxiety, rage

49
Q

What are the insomnia dose side effects of benzos?

A

drowsiness, light-headedness, incoordination, amnesia, sleep-behaviors

50
Q

What is the pregnancy category for benzos?

A

Category D, cannot give in pregnancy

51
Q

What are the fast acting benzos?

A

Diazepam (Valium) and Temazapam (Restoril)

52
Q

What are the intermediate acting benzos?

A

Xanax and Ativan

53
Q

What are the long acting benzos?

A

Clonazepam and Oxazepam

54
Q

What medications are used to treat ADD/ADHD?

A

CNS stimulants

55
Q

What is the mechanism of action of the amphetamines?

A

promote the release of NE and dopamine to help promote wakefulness and alertness

56
Q

What are adverse effects of the amphetamines?

A

euphoria, restlessness, insomnia (prescribe in AM if possible), weight less, tachycardia, HTN, dysrhythmias, paranoia, psychosis

57
Q

What is a concern with the amphetamines?

A

They are highly abused, often used for illicit use, they chemically change the wiring of the brain, have high physical dependence

58
Q

What are the amphetamine medications?

A

Vyvanse, Adderall

59
Q

What is the medication trend leaning towards with prescribing for ADD/ADHD treatment?

A

Moving away from amphetamine use and towards methylphenidate (less addictive)

60
Q

What is the mechanism of action of the methylphenidates?

A

Promotes NE and dopamine release and prevents reuptake

61
Q

What are the adverse effects of methyphenidate?

A

insomnia, anorexia, weight loss, emotional lability

62
Q

What the the methylphenidate medications?

A

Ritalin, focalin, Concerta

63
Q

What are the risks of methylphenidate?

A

They also carry a high illicit drug use risk, they cause physical dependence

64
Q

What is the scheduling class of amphetamines and mehtyphenidates?

A

Class 2 controlled substances

65
Q

How can the abuse potential be combated/lowered?

A

ER tablets, prodrugs (Vyvanse), patches instead of pills

66
Q

What is the medication that is a CNS stimulant, but not amphetamine based?

A

Strattera

67
Q

What is the mechanism of action of Strattera?

A

Selectively inhibits NE reuptake to increase NE in the synapses

68
Q

What are the adverse effects of Strattera?

A

GI upset, anorexia, weight loss, somnolence, growth delay in children, SI in children, mood swings, insomnia, sexual dysfunction, liver failure, HTN, syncope

69
Q

What other non-stimulants are approved for ADD/ADHD treatment?

A

Guanfacine and Clonidine

70
Q

What adverse effects do Guanfacine and Clonidine carry?

A

sedation, hypotension, fatigue

71
Q

What is the mechanism of action of the antipsychotic medications?

A

They block the dopamine receptors to help stabilize mood

72
Q

What is the adverse effects of the antipsychotics?

A

EPS symptoms (most common in typicals), anticholinergic effects