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Psych Meds Flashcards

1
Q

Acute anti-cholinergic syndrome (delirium) rom TCAs mosts occurs because?

A

High dose or combination of anticholinergics

promethazine (phenergan)

Homeopathic medicines- datura, brugmansia

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2
Q

Anti-epileptic drugs that cause craving and release in alcoholism?

A

topiramate (topamax)

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3
Q

Anti-epileptic drugs other intended effects?

A

Decrease impulsivity and aggressiveness

Adjunct to pain control

Decrease craving and relapse in alcoholism
topiramate (topamax)

Prevent migraine
Divalproex (Depakote),topiramate (topamax)

Many other possible effects being studied

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4
Q

Other anti-depressants rare but severe side effects: MAO inhibitors?

A

Potentially fatal interactions with food and other medications

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5
Q

Medications for Depression?

A

SSRI

SNRI

MAOI - monoamine oxidase inhibitor

TCAs

Atypical anti-psychotics

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6
Q

Anti-epileptic drugs to prevent migraines?

A

Divalproex (Depakote)

topiramate (topamax)

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7
Q

MAO Inhibitor examples?

A

Phenalzine (Nardil),

tranylcypromine (Parnate)

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8
Q

Antidepressants (and other meds) and suicide?

A

Overall medications appear to reduce suicide attempts and completed suicides

increased suicide risk in children

when 1st starting medications

This may also be true in adults

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9
Q

Medications for Psychosis: Atypical anti-psychotic Injectable long lasting atypical examples?

A

risperdal consta,

Invega Sustenna

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10
Q

Placebo (Nocebo) rare but severe side effects?

A

???

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11
Q

Medications for Bipolar Disorders?

A

Lithium

Anti-epileptic drugs

Atypical anti-psychotics

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12
Q

TCAs other intended effects?

A

Sleep

Pain relief

Anti-itching
Doxepin

Anti-anxiety

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13
Q

Placebo Other Intended Effects?

A

Eliminate “side effects

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14
Q

Medications interaction?

A

Other prescriptions or OTC meds

some foods

street drugs

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15
Q

Other anti-depressants rare but severe side effects: Bupropion (Wellbutrin)?

A

Seizures

this is not a good choice if they have hx of seizures

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16
Q

Anti-epileptic drugs rare but severe side effects: blood and liver problems?

A

Esp. carbamazepine (Tegretol)

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17
Q

Lithium main intended effects?

A

Anti-manic

Mood stabilizer

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18
Q

SSRI main intended effects?

A

Anti-depressant

Anti-anxiety

Anti-OCD

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19
Q

SSRIs examples?

A

fluoxetine (Prozac)

sertraline (Zoloft),

paroxetine (Paxil),

citalopram (Celexa),

escitalopram (Lexapro)

In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability

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20
Q

Atypical antipsychotic Other Intended Effects ?

A

Anti-depressant

Decrease agitation due to any cause

Anti-anxiety

Sleep

Practically anything anybody can think of

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21
Q

SSRI other intended effects?

A

Sleep

Activation / energy

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22
Q

Lithium common side effects?

A

Tremor

Diarrhea, nausea

Weight gain

Inability to concentrate urine

Increased urination

Increased need to drink water

Easy tendency to dehydration

Thyroid dysfunction
hypothyroidism

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23
Q

TCAs main intended effects?

A

Anti-depressant

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24
Q

How to Reduces Risks when Prescribed Drugs

A

Rationale for Using the Medication

Informed Consent
True informed consent not the fake kind

Follow Up
Is it working? Could it be working better? Make changes when needed

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25
Other anti-depressants other intended effects?
Sleep Weight gain mirtazapine (Remeron)
26
SNRIs rare but severe side effects?
Serotonin syndrome At very high doses or when used in combination with other meds effecting serotonin system MDMA, (PMA), amphetamines, fentanyl, tramadol, cocaine, LSD
27
Anti-epileptic drugs examples?
Lamotragine (Lamictal), divalproex (Depakote), topiramate (Topamax), carbamazepine (Tegretol), oxcarbazapine (Trileptal)
28
Anti-epileptic drugs causing cognitive slowing an d brain fog?
Esp topirimate (Topamax)
29
TCAs rare but severe side effects?
Acute anti-cholinergic syndrome (delirium) Heart rhythm effects including death Death in overdose
30
SSRI rare but severe side effects?
Serotonin syndrome
31
Benzodiazepines other intended effects?
Decrease “agitation” in any condition Treat alcohol withdrawal Treat intoxication due to stimulants Amnesia
32
Older anti-psychotics 1st generation common side effects?
Movement disorders Extrapyramidal Symptoms (continuous spasms and muscle contractions, rigidity) Tardive Dyskinesia (irregular, jerky movements) Akathisia (motor restlessness), Sexual side effects Sedation Weight gain
33
Medications for Psychosis: Older ( 1st Generation) examples?
chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Melloril) **B52 - 50 benadryl, 2 ativant, 5 haldol **
34
Serotonin syndrome combonitation drugs that cause it ?
fentanyl tramadol MDMA (PMA) amphetamines cocaine LSD **both are narcotics, Fentanyl - elephant tranquilizer, short quick and easy to reverse **
35
Basic Pharmacology?
Medications receive FDA approval for specific indications but are also very commonly used for other indications (off label) Any substance can have adverse effects if used in the wrong way at the wrong time Even water can kill you Any drug can cause an allergy and if severe it (and closely related drugs) should not be used Many drugs can have idiosyncratic (unpredictable) liver, kidney, or other toxicity Some side effects are relatively mild but so common that they are important Some side effects are rare but so severe that they are important
36
Basic Pharmacology questions?
What is a “psych med”? Why do or don’t medical providers prescribe psych meds? Why do or don’t people take psych meds? Harm reduction vs. harm production Are psych meds part of harm reduction? Can psych meds produce harm? **When is it a med and when is it a drug. Why is it a med when you prescribe it but a drug when the cops bust me for it? Biological component of bio-psycho-social-spiritual spectrum but we are biological beings.**
37
Tricyclic Anti-Depressant examples?
Amitryptaline (Elavil), Nortryptaline (Pamelor), Desipramine (Norpramin), Doxepin (Sinequan), derm for itching **In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability**
38
Placebo main intended effects?
Anti-depressant Anti-anxiety ???
39
Other anti-depressants common side effects?
Sedation Weight gain Mirtazapine (Remeron) Over-activation Bupropion (Wellbutrin)
40
Medications for Psychosis: Atypical anti-psychotic 2nd generation examples?
olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), ziprasadone (Geodon), paliperidone (Invega), clozapine (Clozaril)
41
Anti-epileptic drugs main intended effects?
Mood stabilizer | prevent seizures
42
Lithium other intended effects?
Anti-depressant
43
Lithium rare but severe side effects?
Toxic levels can be fatal Can occur quickly in overdose or if at normal dose patient becomes dehydrated Kidney failure
44
SNRIs examples?
venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq) levomilnacipran (Fetzima) milnacipran (Savella) **In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability**
45
Atypical anti-psychotics common side effects?
Weight gain Diabetes Abnormal lipids (cholesterol, LDL, etc) Sedation Sexual side effects Movement disorders Akathisia, tremor, dystonic reactions, repetitive movements Less common than older antipsychotics
46
Medications effects?
change how they act, how long or short they act, how toxic they are Effective dose
47
Other anti-depressants main intended effects?
Anti-depressant ``` Anti-anxiety Not bupropion (Wellbutrin) ```
48
Older anti-psychotics 1st generation main intended effects?
Anti-psychotic Anti-mania
49
Medications for Anxiety?
SSRis Benzodiazepines Other
50
Atypical antipsychotic main intended effect?
Anti-psychotic Anti-mania Mood stabilizer
51
Anti-epileptic drugs common side effects?
``` Cognitive slowing / brain fog Esp topirimate (Topamax) ``` GI effects Abdominal pain, nausea and vomiting Sedation Weight gain Weight loss topiramate (Topamax) dizziness
52
Medications can act _______________ in causing adverse effects including risk of overdose
synergistically
53
Serotonin syndrome occurs when?
At very high doses or when used in combination with other meds effecting serotonin system
54
Atypical anti-psychotics Rare but Severe Side Effects | ?
Prolong QT interval causing fatal heart arrhythmias when combined with other QT prolonginn medications (e.g. methadone, zofran) Depersonalization / feeling like a zombie Tardive dyskinesia Neuroleptic malignant syndrome Excess prolactin production Increased risk of stroke and death in elderly
55
Benzodiazepines main intended effects?
Anti-anxiety Anti-panic attack Sleep
56
SNRIs common side effects?
Sexual side effects Orgasm delay or anorgasmia Low libido, ED Stomach discomfort, jitteriness in 1st 1-2 weeks Mild sedation Dizziness, dry mouth Difficulty urinating Insomnia Headache Emotional Blunting
57
Other anti-depressants rare but severe side effects: Trazadone?
Priapism - erection that won’t go away
58
Basic Pharmacology cont..?
medication should be started at the lowest possible dose gradually increased to the lowest effective dose In some urgent situations higher doses must be used right away Many adverse effects are dose dependent Some medications require monitoring of blood levels for effective levels and to prevent toxic levels when stopping a medication, slowly decreasing the dose decreases the risk of discontinuation symptoms In some cases of adverse reactions medications must be stopped immediately
59
Anti-epileptic drugs causing weight loss as side effect?
topiramate (Topamax)
60
Older anti-psychotics 1st generation rare but severe side effects?
Neuroleptic malignant syndrome Irreversible tardive dyskinesia
61
Benzodiazepines Rare but Severe Side Effects?
Addiction especially in people with other addictive disorders Fatal overdose when mixed with alcohol or other sedatives or opioids Severe withdrawal including seizures and delirium Falls and fractures esp. in elderly
62
Benzodiazepines examples?
Diazapam (Valium) - highest addictive potential , lorazapam (Ativan), alprazolam (Xanax), clonazapam (Klonapin) - long acting and can be dosed like twice daily
63
Medications for Anxiety: Other examples?
Buspirone (Buspar) Atypical anti-psychotics, anti-psychotics (major tranquilizers)
64
Older anti-psychotics 1st generation other intended effects ?
Decrease any kind of agitation
65
SNRIs other intended effects?
Sleep Activation / energy
66
`Placebo (Nocebo) common side effects?
Expected adverse effects are more likely to occur Often interfere with effective treatment
67
SSRIs common side effects?
Sexual side effects Orgasm delay or anorgasmia Low libido, ED Stomach discomfort, jitteriness in 1st 1-2 weeks Mild sedation Insomnia Uncomfortable effects when abruptly stopped Esp. paroxetine (Paxil) Emotional Blunting **receptors are also in the gut so we can have abd pain you can also get jitteriness , constipation med that is serotonin based **
68
SNRIs main intended effects?
Anti-depressant Anti-anxiety Anti-OCD Neuropathic pain Fibromyalgia
69
Anti-epileptic drugs rare but severe side effects: severe skin rash?
Esp. lamotrigine (Lamictal)
70
Anti-epileptic drugs rare but severe side effects: confusion, ataxia, delirium?
Esp. at high doses or overdose
71
Other anti-depressants ?
MAO Inhibitor Bupropion (Wellbutrin) Mirtazapine (Remeron) - causes weight gain Trazadone - for sleep ( side effect is pripraism) **In the short term most medications work about equally effectively (probably including placebo). Differences are in “other intended effects, side effects, long term efficacy and tolerability**
72
TCAs common side effects?
Anti-cholinergic Dry mouth, sedation, urinary retention, Sedation
73
Benzodiazepines common side effects?
Sedation Interferes with memory and learning Unpleasant withdrawal when stopped abruptly

Psychiatry / Addiction Medicine (11 decks)

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