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Neurology Boards > Psych Meds > Flashcards

Psych Meds Flashcards

1
Q 
1. Mechanism of action of:
Fluoxetine
Sertraline
Citalopram
Paroxetine
Fluvoxamine
Escitalopram
A

SSRI

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2
Q

List 5 common side effects of SSRI’s.

What psych disorder can SSRI’s make worse?

A 
Nausea, diarrhea
Sexual dysfunction
Headache
Anxiety
Bleeding risk- dysfunction of platelets

Can worsen mania

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3
Q

Fluoxetine

  1. Half-life (long or short)
  2. Inducer or Inhibitor
A
  1. Longest- therefore less discontinuation syndrome and need more time (3-4 weeks) before starting MAOi
  2. Inhibitor (increases TCA’s, warfarin, CBZ, PHT, thioridazine, buproprion
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4
Q

Fluvoxamine

  1. Inducer or Inhibitor
  2. Marketed for what disorder specifically
  3. Half-life (long or short)
A
  1. Inhibitor (increases warfarin levels)
  2. OCD
  3. Short (higher risk of serotonin synd)
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5
Q

Paroxetine

  1. Inducer or Inhibitor
  2. Half-life (long or short)
A
  1. Inhibitor (increases warfarin levels)

2. Short (higher risk of serotonin synd)

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6
Q

Sertraline

  1. Inducer or Inhibitor
  2. Can cause what false positive on drug tox screen?
  3. What is an additional mechanism of action?
A
  1. Inhibitor (sometimes inhibits warfarin metabolism)
  2. Benzo’s
  3. DA transporter inhibitor
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7
Q

Citalopram

  1. Specific side effect warning at high doses?
A
  1. QT prolongation- irregular cardiac rhythms
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8
Q

Serotonin syndrome:

  1. List the electrolyte and lab abnormalities.
  2. List the clinical symptoms (different from NMS).
  3. What if a person has repeated episodes of serotonin-like syndromes?
A 
1. Hyponatremia
hypocalcemia
hypomagnesium 
elevated LFTs
elevated CK (rhabdo)- most serious complication
leukocytosis
  1. Shivering, myoclonus
  2. Order CT Chest- may be lung cancer.
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9
Q
  1. Mechanism of action of:
    Venlafaxine
    Desvenlafaxine
    Duloxetine
A

SNRI’s (5HT reuptake inhib and NE reuptake inhib)

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10
Q

Venlafaxine

  1. Can cause what false positive on drug tox screen?
  2. Most common side effect?
A
  1. PCP

2. HTN- do not use with anticoagulation or acute angle glaucoma

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11
Q

Trazodone

  1. Can cause what false positive on drug tox screen?
  2. Mechanism of action
A
  1. Amphetamine
  2. 5HT reuptake inhib
    Presynaptic 5HT antagonist
    Postsynaptic 5HT agonist at high dose
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12
Q

Buproprion

  1. Mechanism of action
  2. Also used for what?
  3. Major side effect concern
  4. What side effect does it NOT cause that other anti-depressants do?
A
  1. Increases NE and DA
  2. Smoking cessation
  3. Lowers seizure threshold (especially with eating disorder)
  4. Sexual dysfunction
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13
Q

Mirtazapine

  1. Mechanism of action
A
  1. Increases 5HT and NE
    Post-synaptic 5HT1 agonist
    Presynaptic 5HT 2 and 3 antagonist
    Presynaptic alpha antagonist
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14
Q

List 3 major psych meds (1 med and 2 categories) that cause weight gain.

A

Mirtazapine
TCA’s
MAOi’s

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15
Q

Side effects of ECT?

A

Temporary anterograde and retrograde amnesia

Anethesia risks

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16
Q

Lithium

  1. List side effects
  2. List 2 additional side effects with toxic doses
A 
1. Tremor
Ataxia
Acne
Weight gain
Polyjria
Hypokalemia
Hyperparathyroidism and hypercalcemia
  1. QT prolong
    Renal failure- May need dialysis
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17
Q

Which 2 antipsychotics are lowest risk of worsening PD?

A

Clozapine and quetiapine

18
Q

1a. List typical antipsychotics- low potency
1b. Mechanism of action.

2a. List typical antipsychotics- high potency
2b. Mechanism of action

A

1a. chlorpromazine and thioridazine
1b. DA blockade, anti-ACh, anti-NE, and anti-H1 (more side effects but less EPS)

2a. Haloperidol, thiothixene, fluphenazine
2b. Mainly DA blockade

19
Q

Typical antipsychotics

  1. Which one safest in pregnancy?
  2. Which one least risk of metabolic syndrome?
  3. What is the black box warning?
A
  1. Haloperidol
  2. Haloperidol
  3. Increased mortality in elderly with dementia related psychosis
20
Q
  1. List atypical antipsychotics

2. Mechanism of action

A 
1. Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
Aripiprazole
Paliperidone
Lurasidone
  1. 5HT>DA blockade and D4>D2 blockade
21
Q

Clozapine

  1. Category of drug
  2. Side effects
  3. What condition does it specifically decreases suicide attempts?
  4. What side effects does it NOT have?
A
  1. Atypical antipsychotic
2. Greatest risk of seizures
Agranulocytosis
Neutropenia
Severe anti-ACh and Anti-H1 side effects- sedation and drooling (most common)
Eosinophilic colitis
  1. Schizophrenia
  2. EPS and tardive dyskinesia
22
Q

Olanzapine

  1. Category of drug
  2. Side effects
A
  1. Atypical antipsychotic
  2. Massive weight gain
    Sedation
23
Q

Quetiapine

  1. Category of drug
  2. Side effects
A
  1. Atypical antipsychotic

2. Weight gain, sedation (anti-H1), hypotension (alpha blockade)

24
Q

Risperidone

  1. Category of drug
  2. Mechanism- how is it different from other atypicals?
  3. Side effects
A
  1. Atypical antipsychotic
  2. Highest D2/ 5HT blockade ratio
  3. Dose related EPS
    Hyperprolactinemia- gynecomastia
    Decreased libido
    Ortho hypotension
25
Q

Aripiprazole

  1. Category of drug
  2. Mechanism
A
  1. Atypical antipsychotic

2. partial agonist, high affinity at D2 and 5HT receptor

26
Q

Ziprasidone

  1. Category of drug
  2. Side effects
A
  1. Atypical antipsychotic
  2. Prolong QT the most
    EPS
27
Q

Lurasidone

  1. Category of drug
  2. Mechanism
  3. List 3 meds that increase Lurasidone.
A
  1. Atypical antipsychotic
  2. Antagonist at D2 and 5HT
    Partial agonist at 5HT1A
  3. Ketoconazole, rifampin, and diltiazem
28
Q

What do you use to treat EPS: acute dystonia?

A

Benadryl or benztropine

29
Q

What do you use to treat EPS: akathisia?

A

Propranolol, benzo, or anticholinergic

30
Q

What do you use to treat EPS: parkinsonism?

A

Reduce antipsychotic
Add anticholinergic
Switch to more “atypical” drug

31
Q

NMS

  1. Mechanism of pathology
  2. Symptoms
  3. Treatment
A
  1. DA blockade- temp is reset in hypothalamus and EPS
2. AMS
Rigid
Fever
Tremor
Autonomic instability
Leukocytosis
Elevated CK
  1. Stop antipsychotic, cooling and hydration, bromocriptine, dantrolene
32
Q

Bromocriptine mechanism

A

DA agonist

33
Q

Dantrolene mechanism

A

Blocks Ca release (muscle relaxant)

34
Q

Buspirone mechanism of action

A

Partial agonist at 5HT1A

35
Q

Benzo mechanism of action

A

GABA-A agonist

36
Q

Barbituate mechanism of action

A

GABA-A agonist

37
Q

Flumazenil

  1. Mechanism
  2. What is it used for
A
  1. Benzo antagonist

2. Benzo overdose

38
Q

Naloxone

  1. Mechanism
  2. What is it used for
A
  1. Opioid antagonist

2. Opioid overdose

39
Q

Naltrexone

  1. Mechanism
  2. What is it used for
A
  1. Competative antagonist at opioid receptor

2. maintain drug-free state in opioid dependence

40
Q

Methadone

  1. Mechanism
  2. What is it used for
A
  1. Opioid agonist

2. Replace Heroin

41
Q

Buprenorphine

  1. Mechanism
  2. What is it used for
A
  1. Partial mu-opioid agonist

2. Alternative to methadone

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