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Psych Meds Flashcards

1
Q

What drug class is phenelzine?

A

MAOI

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2
Q

What is a differentiating factor of serotonin syndrome vs neuroleptic malignant syndrome?

A

myoclonus

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3
Q

What is the antidote for narcotic overdose?

A

naloxone

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4
Q

What is the antidote for cholingeric overdose (organophosphate)?

A

atropine

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5
Q

How long does it take to develop DTs?

What is the management?

A

> 48hrs no alcohol

benzos

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6
Q

How do benzos work?

A

Enhance GABA activity

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7
Q

What happens in neuroleptic malignant syndrome?

A

Complete dopamine blockade with fever, rigidity, autonomic instability (from antipsychotics)

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8
Q

How do you treat neuroleptic malignant syndrome?

A

Supportive care
Dantrolene (hydration derivative use as muscle relaxant)
Bromocriptine (DA agonist)

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9
Q

19 year old presents with: violent behaviour, slurred speech and muscular rigidity

A

Phencyclidine (PCP, angel dust)

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10
Q

What is a side effect of trazadone?

A

Priaprism

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11
Q

What does buspirone work?

A

Serotonin receptor partial agonist

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12
Q

What following tricyclic antidepressants can be used to treat enuresis?

A

Imipramine

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13
Q

What is the most common side effect of haloperidol in the acute setting?

A

Painful paralysis of the ocular muscles (dystonia)

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14
Q

What medication do you use to treat narcolepsy?

A

Methylphenidate

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15
Q

What drug classes can cause serotonin syndrome?

A

any drug that increases 5-HT (e.g MAOIs, SSRIs, SNRIs, TCAs, tramadol, ondansetron, triptans, linezolid, MDMA, Dextromethrorphan)

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16
Q

What are the 3 As of serotonin syndrome?

A

1) neuromuscular hyperActivity(clonus, hyperreflexia, hypertonia, tremor, seizure)
2) Autonomic stimulation(hyperthermia, diaphoresis, diarrhea)
3) Agitation Treatment: cyproheptadine (5-HT2 receptor antagonist)

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17
Q

How do you treat serotonin syndrome?

A

cyproheptadine (5-HT2 receptor antagonist)

supportive care

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18
Q

What is discontinuation syndrome?

A

patients who are treated with an antidepressant for at least several (eg, three to five) weeks, and are stopping the drug without switching to another antidepressant

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19
Q

What is the approach to prevent for discontinuation syndrome?

A

Long term: progressively taper (reduce) the dose by a fixed amount or percent for at least two to four weeks
One to three weeks: the drug can be tapered over one to two weeks
Seven days or less: the drug can be abruptly stopped

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20
Q

What are the pharmacological options to treat gambling?

A

Pramipexoleis the dopamine agonist implicated
Antidepressants
Opioid antagonist(naltrexone)
(+ psychotherapy)

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21
Q

What is chlordiazepoxide?

A

Benzo (can be used in alcohol withdrawal)

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22
Q

What is clomipramine?

A

TCA (can be used for OCD)

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23
Q

What drug class is used for ADHD?

A

Stimulants (methylphenidate, amphetamines)

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24
Q 
What class of drugs are there:
Haloperidol
Trifluoperazine
Fluphazine
Chlorpromazine
A

Antipsychotics (neuroleptics)

Haloperidol + -azines

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25
How do typical antipsychotics work?
Block dopamine D2 receptors (increase cAMP concentration)
26
What are the high potency antipsychotics?
``` "Try to Fly High" TRIfluoperazine Fluphenazine Haloperidol (extrapyramidal side effects) ```
27
What are the low potency antipsychotics?
Cheating Thieves are Low Chlorpromazine Thioridazine (non-neurologic side effects anticholinergic, antihistamine, alpha blockade)
28
What are the side effects of typical antipsychotic?
1. Extrapyramidal 2. Anticholinergic (dry mouth, constipation) 3. Antihistamine 4. Alpha 1 blockage effects (pure vasoconstrictor - therefore vasodilator, can develop hypotension)
29
Adverse effects timeline with typical antipsychotics?
Onset: "ADAPT" Hours to days: Acute Dystonia Days to months: Akathisia, Parkinsonism Months to years: Tardive dyskinesia
30
What symptoms present with NMS?
``` "FEVER" Fever Encephalopathy Vitals unstable Enzymes increase Rigidity of muscles ```
31
Adverse effects timeline with typical antipsychotics?
Onset: "ADAPT" Hours to days: Acute Dystonia (muscle spasm, stiffness, oculogyric crisis) Days to months: Akathisia (restlessness), Parkinsonism (bradykinesia) Months to years: Tardive dyskinesia
32
What is the treatment for NMS?
Dantrolene, D2 agonist (bromocriptine)
33
What symptoms present with NMS?
``` "FARM" Fever Autonomic changes (increased HR,BP, sweating) Rigidity of muscles Mental status changes ``` *note: these can also appear to SS, but no GI symptoms with NMS
34
How do you treat dystonia (axtropyrimidal side effect of antipsychotic)
Benztropine (Congentin) can also use Diphenhydramine (Benadryl)
35
What endocrine side effects can an antipsychotic cause?
Dopamine receptor antagonism - hyperprolectinemia - galactorrhea, oligomenorrhea, gynecomastia
36
What is the treatment for NMS?
Dantrolene + D2 agonist (bromocriptine)
37
How do atypical antipsychotics work?
most are D2 antagonists (except abilify), various effects on 5-HT2, dopamine, alpha and H1 receptors
38
What is the mechanism of action of aripiprazole (abilify)?
Partial D2 AGONIST
39
What are the side effects of atypical antipsychotics?
METABOLIC SYNDROME Prolonged QT interval Fewer EPS and anticholinergic effects
40
What is the side effect of clozapine?
Agranulocytosis (CBC weekly to monitor WBC)
41
When do you try clozapine?
Failed 2-3 atypical antipsychotics, try clozapine
42
How does lithium work?
Not established, possibly related to inhibition of phosphoinositol cascade
43
What are the side effects of lithium?
``` LMNOP Lithium side effects: Movement (tremor) Nephrogenic diabetes insipidus HypOthyroidism Pregnancy problems ```
44
What pregnancy side effect occurs with lithium?
Epstein anomaly
45
What is Buspirone?
Drug used for GAD Stimulates 5-HT1A receptors I'm always anxious if the BUS will be ON time, so I take BUSpirONe.
46
How does lithium work?
Not established, possibly related to inhibition of phosphoinositol cascade Mood stabilizer
47
How do you monitor your patient's lithium levels?
Always wait 12 hrs after dose for serum levels | Then monitor biweekly or monthly until steady state is reached, then q2 month
48
What other blood test do you do on someone taking lithium?
Thyroid function q6months Creatinine q6months Urinalysis q1year
49
What do you monitor in patients on Divalproex (Epival)? Mood stabilizer
LFTs weekly x 1 month, then monthly
50
When do you switch SSRIs in depression txt?
NO response at 8 weeks (try another SSRI, or SNRI)
51
How do MAO work?
Blocks reuptake of NE
52
``` What class of drugs are these meds: Fluoxetine Paroxetine Sertraline Citalopram ```
SSRIs "Flashbacks paralyze senior citizens"
53
How do SSRIs work?
5-HT specific reuptake inhibitors
54
What are the side effects of SSRIs?
SIADH Sexual dysfunction GI distress
55
What class of drugs are these meds: Venlafaxine Desvenlafaxine Duloxetine
SNRIs
56
How do SNRIs work?
Inhibit 5-HT and NE reuptake
57
What are the side effects of SNRIs?
Increased BP (HTN)
58
What are discontinuation symptoms with abrupt cessation of anti-depressants?
``` FINISH Flu-like Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (anxiety/agitation) ```
59
TCA that can be used in OCD?
clomipramine
60
What can TCAs be used for?
MDD, OCD, peripheral neuropathy, chronic pain, migraine prophylaxis
61
Adverse effects of TCAS?
Tri-Cs Convulsions Coma Cardiotoxicity (arrhythmia due to Na+ channel inhibition)
62
What investigation do you need to order in someone who overdoes on TCA (ex: amitriptyline)?
ECG !!!!! | prolonged QT interval
63
How do you treat someone who overdosed to TCA (ex: amitriptyline)
Sodium Bicarb
64
``` What class are these drugs: Tranylcypromine Phenelzineu Isocarboxazid Selegiline ```
Monoamine Oxidase Inhibitor | MAO Takes Pride in Shanghai
65
How do MOAs work?
Nonselective MOA inhibition increase levels of amine neurotransmitters - norepi, 5-HT, dopamine
66
What is the adverse effect of MAO?
HTN crisis (most notably with ingestion of tyramine - found in aged cheese and wine)
67
What are MAOs contraindicated with?
``` SSRIs TCAs St. John's wort Meperidine Dextromethorphan ```
68
What are MAOs contraindicated with?
``` SSRIs TCAs St. John's wort Meperidine Dextromethorphan ``` (Wait at least 2 weeks after stoping MAO before starting SSRI)
69
``` What class are these drugs: Bupropion Mirtazapine Trazadone Varenicline ```
Atypical antidepressants
70
What conditions are contraindication to use Bupropion?
Hx of seizures Anorexia nervosa Bulimia nervosa
71
What are the benefits of Bupropion?
No sexual side effects | Can be used for smoking cessation
72
What atypical antidepressant causes weight gain?
Mirtazapine (can be used in elderly or anorexia if want weight gain)
73
What is a side effect of Trazodone?
Sleep Priapism TraZZZoBONE
74
How many treatments are in an initial course of ECT?
6-12 treatments, 2-3/week
75
What are the indications for ECT?
Depression refractory to adequate pharmacological trial High suicide risk Medical risk in addition to depression (dehydration, pregnancy) Pre good response to ECT/ fam response to ECT Elderly Catatonic features Marked vegetative features Acute schizo (unresp) Acute mania (unresp) OCD (refract)
76
What are the side effects of ECT?
Memory loss (retro and anteroom) Headaches Myalgia
77
What are the contraindications to ECT?
``` Increased ICP Recent MI (<2 weeks) ```
78
What medication do you use to treat schizophrenia?
Antipsychotics (haloperidol, risperiode) | +/- mood stabilizers
79
How long do you treat schizophrenia?
1-2 years after 1st episode 5 years after multiple episodes *not nec lifetime
80
Can you treat acute cocaine toxicity with chest pain with b-blockers?
NO | Contraindicated
81
Can you treat acute cocaine toxicity (presenting with chest pain) with b-blockers?
NO | Contraindicated
82
What meds do you avoid in treating panic disorders?
Bupropion or TCAs due to simulating effects (exacerbate anxious symptoms)
83
When can you use beta-blockers in phobic disorders?
In acute situations (i.e. public speaking)
84
What meds can be used to treat Dementia?
Cholinesterase inhibitors (Donepezil = Aricept) for mild to severe disease NMDA receptor antagonist (memantine) for moderate to severe disease Low dose neuroleptics (risperidone, quetiapine) for behavioural/emotional symptoms * reassess q 3months
85
What blood tests should you order prior to starting lithium?
CBC, urinalysis, TSH, BUN, Cr, Lytes | ECG if >45 yr or CV risk
86
What is the drug of choice in the treatment of a tremor secondary to lithium therapy
Propranolol
87
Drug of choice for narcolepsy
Modafinil Second line: stimulants

CB Psychiatry (3 decks)

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