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Psychiatry / Addiction Medicine > Psych Meds > Flashcards

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
Q

Other anti-depressants other intended effects?

A

Sleep

Weight gain
mirtazapine (Remeron)

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26
Q

SNRIs rare but severe side effects?

A

Serotonin syndrome

At very high doses or when used in combination with other meds effecting serotonin system

MDMA, (PMA), amphetamines, fentanyl, tramadol, cocaine, LSD

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27
Q

Anti-epileptic drugs examples?

A

Lamotragine (Lamictal),

divalproex (Depakote),

topiramate (Topamax),

carbamazepine (Tegretol),

oxcarbazapine (Trileptal)

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28
Q

Anti-epileptic drugs causing cognitive slowing an d brain fog?

A

Esp topirimate (Topamax)

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29
Q

TCAs rare but severe side effects?

A

Acute anti-cholinergic syndrome (delirium)

Heart rhythm effects including death

Death in overdose

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30
Q

SSRI rare but severe side effects?

A

Serotonin syndrome

31
Q

Benzodiazepines other intended effects?

A

Decrease “agitation” in any condition

Treat alcohol withdrawal

Treat intoxication due to stimulants

Amnesia

32
Q

Older anti-psychotics 1st generation common side effects?

A

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
Q

Medications for Psychosis: Older ( 1st Generation) examples?

A

chlorpromazine (Thorazine),

haloperidol (Haldol),

thioridazine (Melloril)

**B52 -
50 benadryl, 2 ativant, 5 haldol **

34
Q

Serotonin syndrome combonitation drugs that cause it ?

A

fentanyl
tramadol

MDMA

(PMA)

amphetamines

cocaine

LSD

**both are narcotics, Fentanyl - elephant tranquilizer, short quick and easy to reverse **

35
Q

Basic Pharmacology?

A

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
Q

Basic Pharmacology questions?

A

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
Q

Tricyclic Anti-Depressant examples?

A

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
Q

Placebo main intended effects?

A

Anti-depressant

Anti-anxiety

???

39
Q

Other anti-depressants common side effects?

A

Sedation

Weight gain
Mirtazapine (Remeron)

Over-activation
Bupropion (Wellbutrin)

40
Q

Medications for Psychosis: Atypical anti-psychotic 2nd generation examples?

A

olanzapine (Zyprexa),

quetiapine (Seroquel),

risperidone (Risperdal),

aripiprazole (Abilify),

ziprasadone (Geodon),

paliperidone (Invega),

clozapine (Clozaril)

41
Q

Anti-epileptic drugs main intended effects?

A

Mood stabilizer

prevent seizures

42
Q

Lithium other intended effects?

A

Anti-depressant

43
Q

Lithium rare but severe side effects?

A

Toxic levels can be fatal

Can occur quickly in overdose or if at normal dose patient becomes dehydrated

Kidney failure

44
Q

SNRIs examples?

A

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
Q

Atypical anti-psychotics common side effects?

A

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
Q

Medications effects?

A

change how they act,

how long or short they act,

how toxic they are

Effective dose

47
Q

Other anti-depressants main intended effects?

A

Anti-depressant

Anti-anxiety
Not bupropion (Wellbutrin)
48
Q

Older anti-psychotics 1st generation main intended effects?

A

Anti-psychotic

Anti-mania

49
Q

Medications for Anxiety?

A

SSRis
Benzodiazepines
Other

50
Q

Atypical antipsychotic main intended effect?

A

Anti-psychotic

Anti-mania

Mood stabilizer

51
Q

Anti-epileptic drugs common side effects?

A 
Cognitive slowing / brain fog
Esp topirimate (Topamax)

GI effects
Abdominal pain, nausea and vomiting

Sedation

Weight gain

Weight loss
topiramate (Topamax)

dizziness

52
Q

Medications can act _______________ in causing adverse effects including risk of overdose

A

synergistically

53
Q

Serotonin syndrome occurs when?

A

At very high doses or when used in combination with other meds effecting serotonin system

54
Q

Atypical anti-psychotics Rare but Severe Side Effects

?

A

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
Q

Benzodiazepines main intended effects?

A

Anti-anxiety

Anti-panic attack

Sleep

56
Q

SNRIs common side effects?

A

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
Q

Other anti-depressants rare but severe side effects: Trazadone?

A

Priapism - erection that won’t go away

58
Q

Basic Pharmacology cont..?

A

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
Q

Anti-epileptic drugs causing weight loss as side effect?

A

topiramate (Topamax)

60
Q

Older anti-psychotics 1st generation rare but severe side effects?

A

Neuroleptic malignant syndrome

Irreversible tardive dyskinesia

61
Q

Benzodiazepines Rare but Severe Side Effects?

A

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
Q

Benzodiazepines examples?

A

Diazapam (Valium) - highest addictive potential ,

lorazapam (Ativan),

alprazolam (Xanax),

clonazapam (Klonapin) - long acting and can be dosed like twice daily

63
Q

Medications for Anxiety: Other examples?

A

Buspirone (Buspar)

Atypical anti-psychotics, anti-psychotics (major tranquilizers)

64
Q

Older anti-psychotics 1st generation other intended effects ?

A

Decrease any kind of agitation

65
Q

SNRIs other intended effects?

A

Sleep

Activation / energy

66
Q

`Placebo (Nocebo) common side effects?

A

Expected adverse effects are more likely to occur

Often interfere with effective treatment

67
Q

SSRIs common side effects?

A

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
Q

SNRIs main intended effects?

A

Anti-depressant

Anti-anxiety

Anti-OCD

Neuropathic pain

Fibromyalgia

69
Q

Anti-epileptic drugs rare but severe side effects: severe skin rash?

A

Esp. lamotrigine (Lamictal)

70
Q

Anti-epileptic drugs rare but severe side effects: confusion, ataxia, delirium?

A

Esp. at high doses or overdose

71
Q

Other anti-depressants ?

A

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
Q

TCAs common side effects?

A

Anti-cholinergic
Dry mouth, sedation, urinary retention,

Sedation

73
Q

Benzodiazepines common side effects?

A

Sedation

Interferes with memory and learning

Unpleasant withdrawal when stopped abruptly

Psychiatry / Addiction Medicine (11 decks)

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