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psych- not in EH's cards Flashcards

1
Q

failure to taper down antidepressants will result in this syndrome

A

withdrawal syndrome w FINISH sx

flu like sx, insomnia, nausea, imbalance, sensory changes, hyperarousal

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2
Q

which two SSRIs have dual MOAs

A

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
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3
Q

sx of serotonin syndrome

A

sweating, hyperreflexia, myoclonus, shivering/tremors

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4
Q

SSRIs w LEAST cyp450 interaction

A

escitalopram

vortioxetine

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5
Q

describe receptor sensitivity of different types of SNRIs

A

NON-TCA= 5HT > NE
3 amines= mostly equal (except A+C act like non-TCA)
2 amines= NE> 5HT

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6
Q

AEs of trazodone

A

= SARA
sedation and orthostatic hypotension
priapism

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7
Q

AEs of mirtazapine

A

sedation and weight gain

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8
Q

bupropion

A

nicotine withdrawal
antidepressant
trx ADHD sx (inattentiveness)

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9
Q

MOA of MAO-I

A

MAO breaks down NE, 5HT, DA so we stop that

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10
Q

what are the MAO inhibitors

A

isocarboxazid
phenelizine
selegiline
tranylcypromine

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11
Q

what is the only indication for fluoxemine

A

OCD

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12
Q

imipramine special indication

A

enuresis = bed wetting

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13
Q

which two antidepressants work with DA

A

amoxipine and bupropion

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14
Q

MOA of nefazodone and trazodone

A

antagonize SERT presynpatically

postsynaptically antagonize a1 (on NE neurons) and 5HT2

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15
Q

MOA of mirtazepan

A

presynaptic block a2, postsynaptic 5HT2

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16
Q

MOA of bupripion

A

block NET and D2 receptors
agonist VMAT2
=an NDRI

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17
Q

pharmokinetics +dynamics of MAO inhibitors

A 
=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

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18
Q

how to prevent serotonin syndrome w MAO inhibitors

A

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)

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19
Q

esketamine indication

A

treatment resistant depression, give nasally
highly addictive,
observe for 2 hours after you give it, by checking BP

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20
Q

Brexanolone

MOA and indication and how is it delivered

A

GABA(A) receptor modulator

used for postpartum depression

60 hour IV admission, lasts for 30 days

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21
Q

what mood stabilizer is considered neuroprotective

and in what part of the pbrain

A

lithium

hippocampus, anterior cingulate cortex, superior temporal gyrus, ventral prefrontal cortex

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22
Q

explain the effect of lithium function at different receptors

A 
inhib D2 (Gs and Gi) --> trx mania
inhibit NMDA receptor--> glutamate modulation

promote GABA R–> GABA release

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23
Q

MOA of benzos

A

allosteric modification of GABA A receptors–> increased Cl influx–> CNS inhibition

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24
Q

indication for benzos

A

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

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25
Q

AEs of benzos

A

tolerance (down-regulation of GABA A)
physical dependence
dose related CNS depression and decreased memory
central ataxia and confusion in elderly

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26
Q

general indication for barbiturates

+MOA

A

sedation for critically ill patients and occasionally for refractory seizures

modulate GABA-A receptors to keep it open–> CNS depression

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27
Q

which barbiutate only lasts 5-10 minutes because it is redistributed quickly to sk M and fat

A

thiopental

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28
Q

AEs of thiopental

A 
myocardial depression
arrhythmia
somnolence
cough/sneeze
bronchospasm/laryngospasm
shivering
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29
Q

indication and contraindication for secobarbital

A 
ind= insomnia and pre-anesthetic
contra= respiratory ds, porphyria (dark urine, AMS, skin photophobia)
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30
Q

contraindications for phenobarbital

A

porphyria (dark urine, skin photophobia, AMS)

relative contra= mental depression, suicidal tendencies, hx of drug abuse

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31
Q

describe the metabolism of barbituates

A

= cyp450 inducers

hepatic metabolism, renal excretion

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32
Q

describe MOA of zolpidem, zaleplon, and eszopidone

A 
zolpidem= GABA A1 receptor modulator
zaleplon= GABA A1
eszopidone= GABA A1

–> CNS depression

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33
Q

describe use of zolpidem/zaleplon/eszopidone in elderly populations

A

have a higher half life in elderly so overdose can lead to cognitive impairment, delerium, impaired balance and increased falls

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34
Q

describe metabolism of zolpidem, zaleplon, and eszopidone

A

cyp450 inducer

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35
Q

flumazenil is an antidote for what substances

A

benzos, barbs, zolpidem, zaleplon, eszopidone

36
Q

ramelteon MOA, use, metabolism

A

= 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

37
Q

indication for buspirone

metabolism

A

= a hypnotic used for trx of GAD (NO sedation or M relax)

CYP3A4

38
Q

what hypnotic can be used for short acting anxiety relief

A

meprobomate

39
Q

indications for chloral hydrate

A

short term sedative

sleep, alc withdrawal or anxiety secondary to withdrawal

40
Q

describe the dopamine pathways associated with sxhizophrenia

A

increased activity of the mesolimbic pathway (VTA–>NA) is associated with the (+) sx

abn mesocorticol pathway (VTA–>cortex) is associated with (-) sx

41
Q

what NT is associated with schizophrenia

A

DA

42
Q

AEs associated w first generation antipsychotics

A

dry mouth, urinary retention, constipation, orthostatic hypotension, dizzy, syncope, sedation, QTC prolongation, seizure EPS+TD+prolactinemia

43
Q

indication for primavanserine

A

parkinson and psychosis

44
Q

contraindication to second generation antipsychotics

A

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
45
Q

which second gen antipsychotic is associated with agranulocytosis and metabolic changes

A

clozapine–> monitor WBCs before starting trx and enroll in REMS program

46
Q

which second generation antipsychotic is associated with DRESS Syndrome and metabolic changes

A

olanzapine
(fatal hypersensitivity 2-8 weeks after exposure)
sx of skin&blood and lymphadenopathies

47
Q

what is neuroleptic malignant syndrome and how is it treated

A

=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

48
Q

antipsychotic trx for multidrug resistant patients and psychotic patients with suicidal ideation

A

clozapine

49
Q

first generation antipsychotics with ZERO anticholinergic AEs or orthostatic hypotension

A

fluphenazine

haloperidol

50
Q

first generation antipsychotics with A LOT OF anticholinergic AEs or orthostatic hypotension

A

thioridazine

chlorpromazine

51
Q

second generation antipsychotics with least amount of AEs

all of which have NO qtc prolongation, PRL change, or antichol

A

aripriprazole
cariprazine
lurasidone

52
Q

which second generation antipsychotic is especially associated with QTC prolongation

A

ziprasidone

53
Q

DA in what brain area leads to EPS and TD

in what area leads to increase PRL, decreased libido

A
  1. nigrostriatal path

2. tuberinfundibular

54
Q

trx for psychotic depression

A

olanzapine and fluoxetine combo

55
Q

trx for mania+psychosis

A

lithium and anticonvulsants combo

56
Q

benzos metabolism

A

cyp3a4, renal excretion

57
Q

alprazolam indication and contra

A

short term anxiety,

contra a acute narrow angle glaucoma and antifungal

58
Q

chlordiazepoxide

indication and contra

A

for alcohol withdrawal and management of anxiety and preop anxiety

no use w opioids

59
Q

trx for anxiety

A 
alprazolam
diazepam
clonazepam
lorazepam
buspirone
meprobamate
60
Q

contra against lorazepam

A

no give to delusional old people

61
Q

triazolam indication and contra

A

insomnia drugs

no give w opioids

62
Q

diazepam contraindication

A

myasthenia gravis
sleep apnea
narrow angle glaucoma

63
Q

benzos vs barbiturates

which is more sedative, which is more hypnotic

A 
benzos= sedative
barbituates= hypnotic
64
Q

trx for tension HA

A

barb + acetaminophen+ caffeine

65
Q

AE of eszopiclone

A 
bad taste
HA
resp/viral infection
dizzy
rash
hallucination
dry mouth
66
Q

indication of zaleplon

A

short term trx of insomnia

67
Q

indication of zolpidem

A

trx of insomnia specifically w sleep initiation

68
Q

trx of insomnia

A 
secobarbitol
chloral hydrate
eszopiclone
zolpidem
zaleplon
rameltion
69
Q

what AEs of opioids will develop only minimal tolerance

A

constipation
convulsions
miosis

70
Q

opioids + antidepressants –>

A

serotonin syndrome

71
Q

opioids + sedative hypnotics

A

increased CNS depression

72
Q

opioids + antipsychotics

A

increased sedation and CV effects

73
Q

opioids + MAO inhibitors

A

hyperpyrexic coma (hypertensive…)

74
Q

metabolism of atomexatine

AEs

A

(NE reuptake inhibitor, for ADHD)

CYP2D6
AE= fatigue, dry mouth, dizzy, nervous

75
Q

MOA of cannabis

A

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

76
Q

dronabinol

MOA
indication

A

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
77
Q

CANNABIS
conditions w proved efficacy
conditions w/o proved efficacy

A

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

78
Q

contra to cannabis

A

hx of psychosis, substance abuse, CV ds, resp ds

79
Q

nabilone- who he?

A

THC capsule, for N/V secondary to chemo

80
Q

missouri regulations for cannabis

A

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

81
Q

CBD pharmacokinetics??

A

poor aqueous solubility, builds up in fat
oral bioavail= 6%, more if inhaled
rapid distribution
CYP3A4, CYP2C19

82
Q

CBD actions at different receptors

A

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

83
Q

cannabis is indicated in decreasing seizures in what two seizure syndromes

A

Dravet Syndrome (seizures associated w warm baths)

Lennox-Gastite Syndrome (seizures associated w REM sleep, start 3-5 yo but persist into adulthood)

84
Q

what are the indications for CBD specifically

A

alzheimers, N/V, pain, fragile x syndrome, unwanted skin growth, CA, anxiety and depression

85
Q

describe drug schedules

A

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

86
Q

meds for agitation in autsim

A

aripriprazole

risperidone

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