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Psych Pharm Flashcards

1
Q

Beno toxicity (side effects)

A

1st trimester teratogen, sedative effects, additive with alcohol.

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2
Q

special population to be careful of when prescribing benzodiazepines and why.

A

Pregnancy: teratogen in 1st trimester

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3
Q

problem with extended benzo use?

A

dependency. Use for >2-3 weeks increases chance.

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4
Q

what happens with rapid discontinued use of alprazolam?

A

Withdrawal: seizures, delirium.

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5
Q

risk of using >4mg of alprazolam for panic disorder?

A

increased frequency and severity of withdrawal.

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6
Q

Describe the demonstrated efficacy of long term Chlordiazepoxide?

A

use longer than 4 months has NOT been established.

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7
Q

Primary indication for midazolam and 2 routes of admin?

A

Pre-op sedation, anxiety, anterograde amnesia. Routes: IM or IV, orally in peds.

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8
Q

Advantage of buspirone for anxiety?

A

relief for 2-4 weeks, no potential for abuse or withdrawal, maintain cognitive/psychomotor skills, can be used with ETOH.

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9
Q

Disadvantage of buspirone for anxiety?

A

less effective in recent benzo users, slow onset (2-4 weeks), NOT effective for panic disorders.

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10
Q

Buspirone MOA?

A

5-HT1A receptor (modulates serotonin)

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11
Q

Indication for efficacy of buspirone?

A

mostly in outpatient settings for general anxiety for periods of 1 month to 1 year.

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12
Q

Common adverse effect in regular Zolpidem?

A

nervous system and GI

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13
Q

Common adverse effect in extended release Zolpidem?

A

nervous system

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14
Q

3 sleep related behaviors associated with Zolpidem?

A

risk of complex sleep behaviors: sleep driving, making phone calls, making/eating food while asleep.

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15
Q

What class of drug is Alprazolam?

A

benzo

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16
Q

Alprazolam use?

A

anxiety, panic disorders

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17
Q

What food causes increase in Alprazolam bio availability?

A

grapefruit juice

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18
Q

What has additive effects on Alprazolam?

A

other benzos and alcohol.

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19
Q

How is Alprazolam metabolized?

A

CYP-450, 3A(so anything that affects that will affect how the drug acts).

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20
Q

what group is Chlordiazepoxide?

A

benzo

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21
Q

Chlordiazepoxide: use?

A

anxiety, pre-op sedative, ETOH withdrawal. Has also been used to treat IBS and peptic ulcers.

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22
Q

Midazolam: group?

A

benzo

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23
Q

Midazolam: use?

A

Pre-op sedation, anxiety, anterograde amnesia.

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24
Q

Buspirone: use?

A

anxiety

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25
Q

Buspirone: length of effect?

A

2-4 weeks

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26
Q

Buspirone: advantage

A

retain cognitive skills and motor skills. Can use alcohol.

27
Q

Buspirone: disadvantage

A

2-4 weeks for effect

28
Q

Buspirone: AE

A

dizzy, light headed, CNS depression.

29
Q

Zolpidem: use

A

hypnotic (sleep agent) for insomnia.

30
Q

Advantage of SSRI over other anti-depressanta (AD)

A

others had anti-histamine (sleepy), anti-muscarinic, and alpha receptor blocking actions.

31
Q

Fluoxetine metabolite? Half life?

A

Metabolite = nor-fluoxetine, T 1/2 = 7-9 days

32
Q

Rate of pts having remission in the STAR*D trials after failing to respond to SSRI?

A

25%

33
Q

Citalopram: serious side effect? How do you handle this?

A

cardio funcion: prolonged QT. Handle by screening patients.

34
Q

Seratonin Syndrome symptoms:

A

hyperthermia, muscle regidity, myoclonus, rapid changes in vital signs.

35
Q

Seratonin syndrome: drugs that are contra-indicated with SSRI?

A

MAOI. Will cause spike in seratonin.

36
Q

What is the only SSRI approved for peds?

A

Prozac

37
Q

What needs to be monitored in peds taking Prozac?

A

worsening depression, suicidal thinking, changes in behavior.

38
Q

Safety advantages of bupropion?

A

few drug-drug interactions, treats co-morbid conditions (nicotine, ADHD): improves attention and concentration.

39
Q

Tolerability advantage of bupropion?

A

no sexual dysfunction (? Not sure on these)

40
Q

What should be done to Imipramine (and other TCAs) once symptoms are controlled?

A

dose gradually reduced to the lowest level that will maintain symptom relief.

41
Q

Indication for Clomipramine?

A

OCD

42
Q

Lithium: use

A

mood stabalizer: mania and depression. It is used prophylactically.

43
Q

advantage of using Lithium for treating bipolar in an alcoholic?

A

Lithium reduces drinking as well as treating bipolar.

44
Q

How is Lithium metabolized?

A

it distributes in body water and it not metabolized. OD just use dialysis. It gets excreted by the kidneys.

45
Q

what 3 things need to be monitored in older pts taking Lithium?

A

blood count, urinalysis, ECG.

46
Q

Precautions in prescribing Valproic acid in child bearing age females?

A

Teratogen, should NOT be given to pregnant or nursing pts.

47
Q

Use of adjunctive agents with mood stabalizers?

A

in acute maia, Lithium is often used with an anti-psychotic or anti-convulsive drug (ie: carbamazepine or valproic acid)

48
Q

Advantage of SSRI over other AD?

A

have fewer side effects, pt compliance is higher.

49
Q

Which SSRI is dosed differently than other AD?

A

Fluoxetine start with 20mg/day and maintain for several weeks until you can gague pts response.

50
Q

Dosing regimine for TCA

A

start low and increase by 25 mg every 2-3 weeks. Inpatient start at 100 mg, Outpatient start at 10-75 mg

51
Q

How to prevent TCA overdose?

A

prescirbe <1.25 g ro 50 dose untis at 25 mg no refills. Entrust meds to a relative.

52
Q

5 D’s of AD treatment?

A

Diagnosis, Drug, Dose, Duration, Different treatment

53
Q

3 adjunctive meds to Anti-depressants?

A

Lithium, thyroid hormones, atypical anti-psychotics.

54
Q

2 metabolic steps in the arachidonic acid cycle inhibitied by Lithium?

A

IP3, DAG. Lithium blocks conversion of IP2 to IP1 and IP1 to inositol which depletes PIP2

55
Q

where do benzos bind on GABA?

A

GABA-A subunit

56
Q

Benzo have no effect on the GABA channel without what else?

A

GABA neurotransmitter. From this site the action of GABA in opening chlorine ion channels is increased, but no effect without GABA.

57
Q

Alprazolam use?

A

panic disorders

58
Q

Lorazapam use?

A

general anxiety disorder

59
Q

Meprobamate use?

A

short-term anxity and sedative.

60
Q

Procedure for weaning a pt off of Benzos?

A

taper 25% per week to 50% of the dose, the 1/8 dose every 4-7 days.

61
Q

Who should not get Meprobamate?

A

pregnant females.

62
Q

where do azapirones (Buspirone) act vs Benzos?

A

Azapirone acts on 5HT to inhibit release, Benzo on GABA.

63
Q

Advantate of Buspirone over Benzos?

A

less motor disruption

64
Q

Z-hypnotic vs Benzo action?

A

Z-hypnotics are non-benzos used for sedative, act on GABA-A, very selective, less anti-convulsant effect.

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