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CB Psychiatry > Psych Meds > Flashcards

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
Q

How do typical antipsychotics work?

A

Block dopamine D2 receptors (increase cAMP concentration)

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26
Q

What are the high potency antipsychotics?

A 
"Try to Fly High"
TRIfluoperazine
Fluphenazine
Haloperidol 
(extrapyramidal side effects)
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27
Q

What are the low potency antipsychotics?

A

Cheating Thieves are Low
Chlorpromazine
Thioridazine
(non-neurologic side effects anticholinergic, antihistamine, alpha blockade)

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28
Q

What are the side effects of typical antipsychotic?

A
  1. Extrapyramidal
  2. Anticholinergic (dry mouth, constipation)
  3. Antihistamine
  4. Alpha 1 blockage effects (pure vasoconstrictor - therefore vasodilator, can develop hypotension)
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29
Q

Adverse effects timeline with typical antipsychotics?

A

Onset: “ADAPT”
Hours to days: Acute Dystonia
Days to months: Akathisia, Parkinsonism
Months to years: Tardive dyskinesia

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30
Q

What symptoms present with NMS?

A 
"FEVER"
Fever
Encephalopathy 
Vitals unstable
Enzymes increase
Rigidity of muscles
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31
Q

Adverse effects timeline with typical antipsychotics?

A

Onset: “ADAPT”
Hours to days: Acute Dystonia (muscle spasm, stiffness, oculogyric crisis)
Days to months: Akathisia (restlessness), Parkinsonism (bradykinesia)
Months to years: Tardive dyskinesia

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32
Q

What is the treatment for NMS?

A

Dantrolene, D2 agonist (bromocriptine)

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33
Q

What symptoms present with NMS?

A 
"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

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34
Q

How do you treat dystonia (axtropyrimidal side effect of antipsychotic)

A

Benztropine (Congentin)

can also use Diphenhydramine (Benadryl)

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35
Q

What endocrine side effects can an antipsychotic cause?

A

Dopamine receptor antagonism - hyperprolectinemia - galactorrhea, oligomenorrhea, gynecomastia

36
Q

What is the treatment for NMS?

A

Dantrolene + D2 agonist (bromocriptine)

37
Q

How do atypical antipsychotics work?

A

most are D2 antagonists (except abilify), various effects on 5-HT2, dopamine, alpha and H1 receptors

38
Q

What is the mechanism of action of aripiprazole (abilify)?

A

Partial D2 AGONIST

39
Q

What are the side effects of atypical antipsychotics?

A

METABOLIC SYNDROME
Prolonged QT interval
Fewer EPS and anticholinergic effects

40
Q

What is the side effect of clozapine?

A

Agranulocytosis (CBC weekly to monitor WBC)

41
Q

When do you try clozapine?

A

Failed 2-3 atypical antipsychotics, try clozapine

42
Q

How does lithium work?

A

Not established, possibly related to inhibition of phosphoinositol cascade

43
Q

What are the side effects of lithium?

A 
LMNOP
Lithium side effects:
Movement (tremor)
Nephrogenic diabetes insipidus
HypOthyroidism 
Pregnancy problems
44
Q

What pregnancy side effect occurs with lithium?

A

Epstein anomaly

45
Q

What is Buspirone?

A

Drug used for GAD
Stimulates 5-HT1A receptors

I’m always anxious if the BUS will be ON time, so I take BUSpirONe.

46
Q

How does lithium work?

A

Not established, possibly related to inhibition of phosphoinositol cascade

Mood stabilizer

47
Q

How do you monitor your patient’s lithium levels?

A

Always wait 12 hrs after dose for serum levels

Then monitor biweekly or monthly until steady state is reached, then q2 month

48
Q

What other blood test do you do on someone taking lithium?

A

Thyroid function q6months
Creatinine q6months
Urinalysis q1year

49
Q

What do you monitor in patients on Divalproex (Epival)?

Mood stabilizer

A

LFTs weekly x 1 month, then monthly

50
Q

When do you switch SSRIs in depression txt?

A

NO response at 8 weeks (try another SSRI, or SNRI)

51
Q

How do MAO work?

A

Blocks reuptake of NE

52
Q 
What class of drugs are these meds:
Fluoxetine
Paroxetine
Sertraline
Citalopram
A

SSRIs

“Flashbacks paralyze senior citizens”

53
Q

How do SSRIs work?

A

5-HT specific reuptake inhibitors

54
Q

What are the side effects of SSRIs?

A

SIADH
Sexual dysfunction
GI distress

55
Q

What class of drugs are these meds:
Venlafaxine
Desvenlafaxine
Duloxetine

A

SNRIs

56
Q

How do SNRIs work?

A

Inhibit 5-HT and NE reuptake

57
Q

What are the side effects of SNRIs?

A

Increased BP (HTN)

58
Q

What are discontinuation symptoms with abrupt cessation of anti-depressants?

A 
FINISH
Flu-like
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal (anxiety/agitation)
59
Q

TCA that can be used in OCD?

A

clomipramine

60
Q

What can TCAs be used for?

A

MDD, OCD, peripheral neuropathy, chronic pain, migraine prophylaxis

61
Q

Adverse effects of TCAS?

A

Tri-Cs
Convulsions
Coma
Cardiotoxicity (arrhythmia due to Na+ channel inhibition)

62
Q

What investigation do you need to order in someone who overdoes on TCA (ex: amitriptyline)?

A

ECG !!!!!

prolonged QT interval

63
Q

How do you treat someone who overdosed to TCA (ex: amitriptyline)

A

Sodium Bicarb

64
Q 
What class are these drugs:
Tranylcypromine
Phenelzineu
Isocarboxazid
Selegiline
A

Monoamine Oxidase Inhibitor

MAO Takes Pride in Shanghai

65
Q

How do MOAs work?

A

Nonselective MOA inhibition increase levels of amine neurotransmitters - norepi, 5-HT, dopamine

66
Q

What is the adverse effect of MAO?

A

HTN crisis (most notably with ingestion of tyramine - found in aged cheese and wine)

67
Q

What are MAOs contraindicated with?

A 
SSRIs
TCAs
St. John's wort
Meperidine
Dextromethorphan
68
Q

What are MAOs contraindicated with?

A 
SSRIs
TCAs
St. John's wort
Meperidine
Dextromethorphan

(Wait at least 2 weeks after stoping MAO before starting SSRI)

69
Q 
What class are these drugs:
Bupropion
Mirtazapine
Trazadone
Varenicline
A

Atypical antidepressants

70
Q

What conditions are contraindication to use Bupropion?

A

Hx of seizures
Anorexia nervosa
Bulimia nervosa

71
Q

What are the benefits of Bupropion?

A

No sexual side effects

Can be used for smoking cessation

72
Q

What atypical antidepressant causes weight gain?

A

Mirtazapine (can be used in elderly or anorexia if want weight gain)

73
Q

What is a side effect of Trazodone?

A

Sleep
Priapism

TraZZZoBONE

74
Q

How many treatments are in an initial course of ECT?

A

6-12 treatments, 2-3/week

75
Q

What are the indications for ECT?

A

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
Q

What are the side effects of ECT?

A

Memory loss (retro and anteroom)
Headaches
Myalgia

77
Q

What are the contraindications to ECT?

A 
Increased ICP
Recent MI (<2 weeks)
78
Q

What medication do you use to treat schizophrenia?

A

Antipsychotics (haloperidol, risperiode)

+/- mood stabilizers

79
Q

How long do you treat schizophrenia?

A

1-2 years after 1st episode

5 years after multiple episodes

*not nec lifetime

80
Q

Can you treat acute cocaine toxicity with chest pain with b-blockers?

A

NO

Contraindicated

81
Q

Can you treat acute cocaine toxicity (presenting with chest pain) with b-blockers?

A

NO

Contraindicated

82
Q

What meds do you avoid in treating panic disorders?

A

Bupropion or TCAs due to simulating effects (exacerbate anxious symptoms)

83
Q

When can you use beta-blockers in phobic disorders?

A

In acute situations (i.e. public speaking)

84
Q

What meds can be used to treat Dementia?

A

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
Q

What blood tests should you order prior to starting lithium?

A

CBC, urinalysis, TSH, BUN, Cr, Lytes

ECG if >45 yr or CV risk

86
Q

What is the drug of choice in the treatment of a tremor secondary to lithium therapy

A

Propranolol

87
Q

Drug of choice for narcolepsy

A

Modafinil

Second line: stimulants

CB Psychiatry (3 decks)

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