psych- not in EH's cards Flashcards
failure to taper down antidepressants will result in this syndrome
withdrawal syndrome w FINISH sx
flu like sx, insomnia, nausea, imbalance, sensory changes, hyperarousal
which two SSRIs have dual MOAs
V for 2
Vilazodone= SSRI and partial agonist of 5HT1A Vortioxetine= SSRI and partial agonist of 5HT1B and full antagonist of 5HT1A,D,3-7
sx of serotonin syndrome
sweating, hyperreflexia, myoclonus, shivering/tremors
SSRIs w LEAST cyp450 interaction
escitalopram
vortioxetine
describe receptor sensitivity of different types of SNRIs
NON-TCA= 5HT > NE
3 amines= mostly equal (except A+C act like non-TCA)
2 amines= NE> 5HT
AEs of trazodone
= SARA
sedation and orthostatic hypotension
priapism
AEs of mirtazapine
sedation and weight gain
bupropion
nicotine withdrawal
antidepressant
trx ADHD sx (inattentiveness)
MOA of MAO-I
MAO breaks down NE, 5HT, DA so we stop that
what are the MAO inhibitors
isocarboxazid
phenelizine
selegiline
tranylcypromine
what is the only indication for fluoxemine
OCD
imipramine special indication
enuresis = bed wetting
which two antidepressants work with DA
amoxipine and bupropion
MOA of nefazodone and trazodone
antagonize SERT presynpatically
postsynaptically antagonize a1 (on NE neurons) and 5HT2
MOA of mirtazepan
presynaptic block a2, postsynaptic 5HT2
MOA of bupripion
block NET and D2 receptors
agonist VMAT2
=an NDRI
pharmokinetics +dynamics of MAO inhibitors
=nonselective except selegilline (MAO-B selective, is a patch so least sideeffects bc not systemically absorbed)
oral agents are irreversible, takes 14 days for MAO to regenerate
how to prevent serotonin syndrome w MAO inhibitors
titrate off MAO inhibitors before starting other serotonin syndrome
for 2 weeks
4 weeks for fluoxetine
due to MAO-A making tyramine, so less risk for sergelline
dont eat foods w high tyramine (picked and cheeses)
esketamine indication
treatment resistant depression, give nasally
highly addictive,
observe for 2 hours after you give it, by checking BP
Brexanolone
MOA and indication and how is it delivered
GABA(A) receptor modulator
used for postpartum depression
60 hour IV admission, lasts for 30 days
what mood stabilizer is considered neuroprotective
and in what part of the pbrain
lithium
hippocampus, anterior cingulate cortex, superior temporal gyrus, ventral prefrontal cortex
explain the effect of lithium function at different receptors
inhib D2 (Gs and Gi) --> trx mania inhibit NMDA receptor--> glutamate modulation
promote GABA R–> GABA release
MOA of benzos
allosteric modification of GABA A receptors–> increased Cl influx–> CNS inhibition
indication for benzos
short term insomnia (tho associated w lots of AEs+dependence)
parasomnias in children (sleepwalking/night terrors)
sk M relaxation
IV administration for status epilepticus, seizures, sedation and anesthesia
withdrawal from alc/drugs
AEs of benzos
tolerance (down-regulation of GABA A)
physical dependence
dose related CNS depression and decreased memory
central ataxia and confusion in elderly
general indication for barbiturates
+MOA
sedation for critically ill patients and occasionally for refractory seizures
modulate GABA-A receptors to keep it open–> CNS depression
which barbiutate only lasts 5-10 minutes because it is redistributed quickly to sk M and fat
thiopental
AEs of thiopental
myocardial depression arrhythmia somnolence cough/sneeze bronchospasm/laryngospasm shivering
indication and contraindication for secobarbital
ind= insomnia and pre-anesthetic contra= respiratory ds, porphyria (dark urine, AMS, skin photophobia)
contraindications for phenobarbital
porphyria (dark urine, skin photophobia, AMS)
relative contra= mental depression, suicidal tendencies, hx of drug abuse
describe the metabolism of barbituates
= cyp450 inducers
hepatic metabolism, renal excretion
describe MOA of zolpidem, zaleplon, and eszopidone
zolpidem= GABA A1 receptor modulator zaleplon= GABA A1 eszopidone= GABA A1
–> CNS depression
describe use of zolpidem/zaleplon/eszopidone in elderly populations
have a higher half life in elderly so overdose can lead to cognitive impairment, delerium, impaired balance and increased falls
describe metabolism of zolpidem, zaleplon, and eszopidone
cyp450 inducer
flumazenil is an antidote for what substances
benzos, barbs, zolpidem, zaleplon, eszopidone
ramelteon MOA, use, metabolism
= melatonin receptor modulator in superchiasmatic nucleus of hypthalamus
a hypnotic that is proven to be safe in elderly patients
CYP1A2 , v big first pass
AE= dizzy, fatigue, incr PRL, dec T
indication for buspirone
metabolism
= a hypnotic used for trx of GAD (NO sedation or M relax)
CYP3A4
what hypnotic can be used for short acting anxiety relief
meprobomate
indications for chloral hydrate
short term sedative
sleep, alc withdrawal or anxiety secondary to withdrawal
describe the dopamine pathways associated with sxhizophrenia
increased activity of the mesolimbic pathway (VTA–>NA) is associated with the (+) sx
abn mesocorticol pathway (VTA–>cortex) is associated with (-) sx
what NT is associated with schizophrenia
DA
AEs associated w first generation antipsychotics
dry mouth, urinary retention, constipation, orthostatic hypotension, dizzy, syncope, sedation, QTC prolongation, seizure EPS+TD+prolactinemia
indication for primavanserine
parkinson and psychosis
contraindication to second generation antipsychotics
pts w heart ds, on statins or antiangina meds, high BMI
- elderly w dementia –>hx of stroke
- increased risk of QtC prolongation in women, elderly and those w hx of arrhythmias
which second gen antipsychotic is associated with agranulocytosis and metabolic changes
clozapine–> monitor WBCs before starting trx and enroll in REMS program
which second generation antipsychotic is associated with DRESS Syndrome and metabolic changes
olanzapine
(fatal hypersensitivity 2-8 weeks after exposure)
sx of skin&blood and lymphadenopathies
what is neuroleptic malignant syndrome and how is it treated
=severe parkinsonian like syndrome that can occur in response to antipsychotic meds
starts w just AMS, progresses to rhabdomyolysis–> circulatory collapse and death
trx= dantrolene (ANTIDOTE) : works at ryanodine receptor to induce peripheral M relaxation
antipsychotic trx for multidrug resistant patients and psychotic patients with suicidal ideation
clozapine
first generation antipsychotics with ZERO anticholinergic AEs or orthostatic hypotension
fluphenazine
haloperidol
first generation antipsychotics with A LOT OF anticholinergic AEs or orthostatic hypotension
thioridazine
chlorpromazine
second generation antipsychotics with least amount of AEs
all of which have NO qtc prolongation, PRL change, or antichol
aripriprazole
cariprazine
lurasidone
which second generation antipsychotic is especially associated with QTC prolongation
ziprasidone
DA in what brain area leads to EPS and TD
in what area leads to increase PRL, decreased libido
- nigrostriatal path
2. tuberinfundibular
trx for psychotic depression
olanzapine and fluoxetine combo
trx for mania+psychosis
lithium and anticonvulsants combo
benzos metabolism
cyp3a4, renal excretion
alprazolam indication and contra
short term anxiety,
contra a acute narrow angle glaucoma and antifungal
chlordiazepoxide
indication and contra
for alcohol withdrawal and management of anxiety and preop anxiety
no use w opioids
trx for anxiety
alprazolam diazepam clonazepam lorazepam buspirone meprobamate
contra against lorazepam
no give to delusional old people
triazolam indication and contra
insomnia drugs
no give w opioids
diazepam contraindication
myasthenia gravis
sleep apnea
narrow angle glaucoma
benzos vs barbiturates
which is more sedative, which is more hypnotic
benzos= sedative barbituates= hypnotic
trx for tension HA
barb + acetaminophen+ caffeine
AE of eszopiclone
bad taste HA resp/viral infection dizzy rash hallucination dry mouth
indication of zaleplon
short term trx of insomnia
indication of zolpidem
trx of insomnia specifically w sleep initiation
trx of insomnia
secobarbitol chloral hydrate eszopiclone zolpidem zaleplon rameltion
what AEs of opioids will develop only minimal tolerance
constipation
convulsions
miosis
opioids + antidepressants –>
serotonin syndrome
opioids + sedative hypnotics
increased CNS depression
opioids + antipsychotics
increased sedation and CV effects
opioids + MAO inhibitors
hyperpyrexic coma (hypertensive…)
metabolism of atomexatine
AEs
(NE reuptake inhibitor, for ADHD)
CYP2D6
AE= fatigue, dry mouth, dizzy, nervous
MOA of cannabis
stimulus–> increase intracellular CA post synaptic–> activate DAG lipase –> increased endocannaboid made by post-synaptic neuron –> CB1 on pre-synpatic –> anandamide (partial agonist) degraded by FAAH post synapse
+ 2-AG (full agonist) degraded by MAG lipase presynapse
dronabinol
MOA
indication
synthetic THC
oral administration, peak effect in 2-4 hours
equal affinity for CB1+CB2, less efficacious of CB2
indications= anorexia in AIDS pts, chemo induced N/V off-label= obstructive apnea
CANNABIS
conditions w proved efficacy
conditions w/o proved efficacy
w proved efficacy= chronic pain (RA, fibromyalgia, CA, co-admin w opioids)
mild N/V
MS: spasticity, pain and bladder function
w/o proved efficacy= ACUTE pain, tremor of Ms, huntingtons glaucoma, schizo, depression, slowing of CA growth
contra to cannabis
hx of psychosis, substance abuse, CV ds, resp ds
nabilone- who he?
THC capsule, for N/V secondary to chemo
missouri regulations for cannabis
need an ID card, costs $25
qualifying conditions= CA, epilepsy, glaucoma, intractable migraines, chronic pain/spasm, HIV/AIDs
can grow but no more than 6 at any stages
CBD pharmacokinetics??
poor aqueous solubility, builds up in fat
oral bioavail= 6%, more if inhaled
rapid distribution
CYP3A4, CYP2C19
CBD actions at different receptors
agonist of PPARy –> antiinflammatory neuroprotection
agonist TRPV –> neuroprotection
agonist of 5HT in the dorsal raphe nucleus
inverse agonist of CB1 and CB2
agonist of GPR55
cannabis is indicated in decreasing seizures in what two seizure syndromes
Dravet Syndrome (seizures associated w warm baths)
Lennox-Gastite Syndrome (seizures associated w REM sleep, start 3-5 yo but persist into adulthood)
what are the indications for CBD specifically
alzheimers, N/V, pain, fragile x syndrome, unwanted skin growth, CA, anxiety and depression
describe drug schedules
schedule 1= no med use, high addiction potential
schedule 2= med use, high addiction potential
schedule 3= med use, mod addiction potential
schedule 4= med use, low addiction potential
meds for agitation in autsim
aripriprazole
risperidone
