Psych Pharm Flashcards
Beno toxicity (side effects)
1st trimester teratogen, sedative effects, additive with alcohol.
special population to be careful of when prescribing benzodiazepines and why.
Pregnancy: teratogen in 1st trimester
problem with extended benzo use?
dependency. Use for >2-3 weeks increases chance.
what happens with rapid discontinued use of alprazolam?
Withdrawal: seizures, delirium.
risk of using >4mg of alprazolam for panic disorder?
increased frequency and severity of withdrawal.
Describe the demonstrated efficacy of long term Chlordiazepoxide?
use longer than 4 months has NOT been established.
Primary indication for midazolam and 2 routes of admin?
Pre-op sedation, anxiety, anterograde amnesia. Routes: IM or IV, orally in peds.
Advantage of buspirone for anxiety?
relief for 2-4 weeks, no potential for abuse or withdrawal, maintain cognitive/psychomotor skills, can be used with ETOH.
Disadvantage of buspirone for anxiety?
less effective in recent benzo users, slow onset (2-4 weeks), NOT effective for panic disorders.
Buspirone MOA?
5-HT1A receptor (modulates serotonin)
Indication for efficacy of buspirone?
mostly in outpatient settings for general anxiety for periods of 1 month to 1 year.
Common adverse effect in regular Zolpidem?
nervous system and GI
Common adverse effect in extended release Zolpidem?
nervous system
3 sleep related behaviors associated with Zolpidem?
risk of complex sleep behaviors: sleep driving, making phone calls, making/eating food while asleep.
What class of drug is Alprazolam?
benzo
Alprazolam use?
anxiety, panic disorders
What food causes increase in Alprazolam bio availability?
grapefruit juice
What has additive effects on Alprazolam?
other benzos and alcohol.
How is Alprazolam metabolized?
CYP-450, 3A(so anything that affects that will affect how the drug acts).
what group is Chlordiazepoxide?
benzo
Chlordiazepoxide: use?
anxiety, pre-op sedative, ETOH withdrawal. Has also been used to treat IBS and peptic ulcers.
Midazolam: group?
benzo
Midazolam: use?
Pre-op sedation, anxiety, anterograde amnesia.
Buspirone: use?
anxiety
Buspirone: length of effect?
2-4 weeks
Buspirone: advantage
retain cognitive skills and motor skills. Can use alcohol.
Buspirone: disadvantage
2-4 weeks for effect
Buspirone: AE
dizzy, light headed, CNS depression.
Zolpidem: use
hypnotic (sleep agent) for insomnia.
Advantage of SSRI over other anti-depressanta (AD)
others had anti-histamine (sleepy), anti-muscarinic, and alpha receptor blocking actions.
Fluoxetine metabolite? Half life?
Metabolite = nor-fluoxetine, T 1/2 = 7-9 days
Rate of pts having remission in the STAR*D trials after failing to respond to SSRI?
25%
Citalopram: serious side effect? How do you handle this?
cardio funcion: prolonged QT. Handle by screening patients.
Seratonin Syndrome symptoms:
hyperthermia, muscle regidity, myoclonus, rapid changes in vital signs.
Seratonin syndrome: drugs that are contra-indicated with SSRI?
MAOI. Will cause spike in seratonin.
What is the only SSRI approved for peds?
Prozac
What needs to be monitored in peds taking Prozac?
worsening depression, suicidal thinking, changes in behavior.
Safety advantages of bupropion?
few drug-drug interactions, treats co-morbid conditions (nicotine, ADHD): improves attention and concentration.
Tolerability advantage of bupropion?
no sexual dysfunction (? Not sure on these)
What should be done to Imipramine (and other TCAs) once symptoms are controlled?
dose gradually reduced to the lowest level that will maintain symptom relief.
Indication for Clomipramine?
OCD
Lithium: use
mood stabalizer: mania and depression. It is used prophylactically.
advantage of using Lithium for treating bipolar in an alcoholic?
Lithium reduces drinking as well as treating bipolar.
How is Lithium metabolized?
it distributes in body water and it not metabolized. OD just use dialysis. It gets excreted by the kidneys.
what 3 things need to be monitored in older pts taking Lithium?
blood count, urinalysis, ECG.
Precautions in prescribing Valproic acid in child bearing age females?
Teratogen, should NOT be given to pregnant or nursing pts.
Use of adjunctive agents with mood stabalizers?
in acute maia, Lithium is often used with an anti-psychotic or anti-convulsive drug (ie: carbamazepine or valproic acid)
Advantage of SSRI over other AD?
have fewer side effects, pt compliance is higher.
Which SSRI is dosed differently than other AD?
Fluoxetine start with 20mg/day and maintain for several weeks until you can gague pts response.
Dosing regimine for TCA
start low and increase by 25 mg every 2-3 weeks. Inpatient start at 100 mg, Outpatient start at 10-75 mg
How to prevent TCA overdose?
prescirbe <1.25 g ro 50 dose untis at 25 mg no refills. Entrust meds to a relative.
5 D’s of AD treatment?
Diagnosis, Drug, Dose, Duration, Different treatment
3 adjunctive meds to Anti-depressants?
Lithium, thyroid hormones, atypical anti-psychotics.
2 metabolic steps in the arachidonic acid cycle inhibitied by Lithium?
IP3, DAG. Lithium blocks conversion of IP2 to IP1 and IP1 to inositol which depletes PIP2
where do benzos bind on GABA?
GABA-A subunit
Benzo have no effect on the GABA channel without what else?
GABA neurotransmitter. From this site the action of GABA in opening chlorine ion channels is increased, but no effect without GABA.
Alprazolam use?
panic disorders
Lorazapam use?
general anxiety disorder
Meprobamate use?
short-term anxity and sedative.
Procedure for weaning a pt off of Benzos?
taper 25% per week to 50% of the dose, the 1/8 dose every 4-7 days.
Who should not get Meprobamate?
pregnant females.
where do azapirones (Buspirone) act vs Benzos?
Azapirone acts on 5HT to inhibit release, Benzo on GABA.
Advantate of Buspirone over Benzos?
less motor disruption
Z-hypnotic vs Benzo action?
Z-hypnotics are non-benzos used for sedative, act on GABA-A, very selective, less anti-convulsant effect.
