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Elaina: Psych > Psych Pharm > Flashcards

Psych Pharm Flashcards

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1
Q

which drug is indicated for not only depression, but also PTSD?

A

sertraline (zoloft)

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2
Q

which drug for depression carries the biggest risk of QT prolongation?

A

citalopram (celexa)

get EKG before!

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3
Q

do SSRIs or SNERIs carry less risk for sexual side effects?

A

SNERIs

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4
Q

what drug should we consider for depression if our patient is worried about sexual dysfunction?

A

venlofaxine (effexor); its a SNERI

or buproprion!

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5
Q

which drug indicated for depression can also be used for chronic pain or fibromyalgia?

A

duloxetine (cymbalta)

SNERI

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6
Q

which atypical antidepressant is indicated for smoking cessation? what side effect are we most worried about?

A

buproprion

lowers seizure threshold

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7
Q

which populations should we avoid buproprion in?

A

alcoholics, bulimics, SDO

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8
Q

what is the main benefit of treating someone’s patient with burproprion?

A

less sexual side effects

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9
Q

which drug is a poor antidepressant but a great sleep aide?

A

trazodone

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10
Q

which drug carries the side effect of priaprism?

A

trazodone

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11
Q

what are the main side effects of trazadone?

A

sleepiness and othostatic hypotension

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12
Q

which antipsychotic has the greatest risk of weight gain?

A

olanzeprine (zyprexa)

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13
Q

which special indications does fluoxetine (prozac) carry?

A

OCD and eating disorders

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14
Q

which of our antidepressants is very activating? which is sedating?

A

prozac (fluoxetine) very activating

paxil (paroxetine) very sedating

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15
Q

if someone is very tired and depressed what drug should you avoid giving?

A

paroxetine (paxil); has anticholinergic side effects

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16
Q

with which antidepressant do we worry about withdrawal symptoms?

A

paroxetine (paxil)

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17
Q

what drug do we use for stage fright?

A

propranalol

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18
Q

which antipsychotic does not increase prolactin levels, therefore being a good choice if patient is worried about infertility?

A

quetiapine (seroquel)

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19
Q

which drug is not a good choice if you have a non-functioning psychotic, as it is more of a mild anti-psychotic?

A

quetiapine (seroquel)

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20
Q

if a patient with parkinson’s has psychosis symptoms, which drug should you start them on? why?

A

quetiapine (seroquel)

works more on serotonin, less on dopamine

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21
Q

which antipsychotic drug should we avoid if we are worried about weight gain?

A

olanzapine (zyprexa)

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22
Q

most common side effects of haloperidol?

A

EPS, TD

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23
Q

which movement disorder show up most often only with long-term use of antipsychotics, but may be irreversible?

A

tardive dyskinesia

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24
Q

which SE are we most worried about when prescribing 2nd generation antipsychotics, such as risperidone (risperdal)?

A

T2DM, lipids, BP, weight gain

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25
Q

what unpleasant side effects might cause patients on antipsychotics to stop medication?

A

galactorrhea, gynecomastia, infertility in women

dopamine normally inhibits prolactin; when we inhibit dopamine prolactin is free to flow

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26
Q

which of our mood stabilizers is teratogenic? which of the mood stabilizers may cause spina bifida in babies?

A

teratogenic = lithium

spina bifida = valproate

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27
Q

what do we need to monitor if our patient is on a 2nd generation antipsychotic (like risperidone)?

A

A1C, lipids, BP every 6 months

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28
Q

what side effects do we worry about with lithium?

A

diabetes insipidus

muscle stiffness

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29
Q

if a patient with parkinson’s begins showing signs of psychosis, what should the first move be?

A

reduce dose of levodopa/carbidopa

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30
Q

are antidepressants alone sufficient when a patient’s unipolar depression becomes developing mixed features?

A

no!

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31
Q

if your previously unipolar patient develops mania, what do you treat with? what if they develop delusions?

A

mania = lithium

delusions = quetiapine (seroquel)

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32
Q

which second generation antipsychotic carries the greatest risk of agranulocytosis?

A

clozapine (clozaril)

no longer prescribed by PCP

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33
Q

what can be used for acute relief of tardive dyskinesia?

A

benadryl

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34
Q

what is anhedonia?

A

caused by lack of dopamine; an extreme displeasure in doing life stuff, no pleasure

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35
Q

how do we treat anhedonia in a parkinsons patient?

A

benztropine (anti-cholinergic)

will help balance between acetylcholine and dopamine

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36
Q

which drug, not on our drug table, has the propensity to cause serotonin syndrome in the elderly?

A

tramadol

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37
Q

which drug do we use to treat parkinson’s dementia? what do we worry about?

A

aricept; may worsen parkinson’s symptoms :( poop

38
Q

what is the short term treatment for acute panic disorder? what is used long-term?

A

short term: benzodiazepines

long term: venlofaxine (effexor)-SNERI

39
Q

what is the max amount of time that we use benzodiazepines for?

A

4 weeks

40
Q

which drug is our go to if a patient has depression and sexual dysfunction worries?

A

cymbalta (effexor)

or buproprion

41
Q

which drug do we use for postpartum depression?

A

sertraline (zoloft)

lowest concentration for breast feeding

42
Q

which second generation anti-psychotic is PG category B?

A

lurasideone (latuda)

43
Q

if your patient has generalized anxiety disorder and PTSD, what drug should you use?

A

sertraline (zoloft)

44
Q

which of our SSRIS is most likely to cause insomnia?

A

fluoxetine (prozac)

45
Q

when should we expect to see the full impact of anti-depressants in adults vs. elderly?

A

adults: 6-8 weeks
elderly: 10-12 weeks

46
Q

when should we expect to begin to see an improvement of symptoms when treating depression?

A

2-4 weeks

47
Q

if our patient has generalized anxiety disorder with insomnia, what should we treat them with? what drug class is it?

A

mirtazapine (remeron); VERY sedating (blocks H1)

tetracycline

48
Q

what drug is used for refractory depressive disorder, unresponsive to all other treatment?

A

phenelzine (nardil)

49
Q

what drug must you avoid tyramine-rich foods, such as cheese and wine, while taking?

A

phenelzine (nardil)

50
Q

which drug do we use to treat seasonal affective disorder?

A

paroxetine (paxil)

51
Q

which antidepressant works much quicker than 6 weeks to give the patient relief?

A

vortioxetine (britellux)

52
Q

which two drugs are partial serotonin agonists / antagonists?

A

vortioxetine (britellux) and vilazodone (viibryd)

53
Q

what side effects do we worry about with viladazone (viibryd) and vortioxetine (britellux)?

A

increased bleeding; impaired platelet functioning

way less likely to cause other major side effects! we have some agonizing and antagonizing activity

54
Q

when should we follow up with patients once we initiate treatment with an SSRI? why?

A

2 weeks to evaluate for suicidal ideation

55
Q

what percentage of people will not fill their RX for their antidepressant?

A

one third

56
Q

what do we use to monitor for TD in patients? how often do we do it?

A

AIMS

every 6 months

57
Q

how long must we wait after stopping fluoxetine (prozac) to prescribe an MAOI like phenelzine (nardil)? how about the other SSRIs/tricyclics?

A

5 weeks for fluoxetine (prozac)

2 weeks for da rest

58
Q

which SSRI has the longest half life?

A

fluoxetine (prozac)

59
Q

why do we see so many side effects in tricyclic antidepressants, such as nortriptyline (pamelor)?

A

blocks many neurotransmitters

(M1, H1, alpha 1, voltage gated Na channels) on top of serotonin, norepinephrine

60
Q

what side effects can we expect if we block the following?

1) M1
2) H1
3) Alpha 1
4) Dopamine
5) voltage gated Na channels

A

1) M1: dry mouth, urinary retention, constipation (anti-cholinergics)
2) H1: sedation, weight gain
3) Alpha1: orthostatic hypotension, dizziness
4) Dopamine: galactorrhea, gynecomastia, infertility
5) seizures, arrhythmias

61
Q

which 2nd generation antipsychotic carries a lower risk for metabolic problems (DM, weight gain) than the others?

A

ziprasidone (geodon)

62
Q

your patient is coping with the loss of his dog, he is depressed and having trouble sleeping, what should you RX?

A

trazadone

great for situational depression

63
Q

which is the only SSRI that will self down-titrate? why?

A

fluoxetine (prozac)

long half life

64
Q

which drug (not on our drug tables) has the propensity to cause serotonin syndrome in the elderly?

A

tramadol

65
Q

what is our DOC for post-partum depression? why?

A

sertraline (zoloft)

lowest concentration in breast milk

66
Q

all of our SSRIS are which pregnancy category? which is the only exception?

A

C!

paxil is PG category D – definitely avoid

67
Q

if your patient on fluoxetine (prozac) is experiencing insomnia, anxiety, agitation, what should we switch them to?

A

escitalopram (lexapro)

less excitatory but not as sedative as paxil

68
Q

signs of withdrawal from paxil?

A

insomnia, dizziness, parasthesisas

69
Q

which drug class indicated to calm a patient may have a paradoxical effect when given to patients with psychosis? what is the mechanism behind this?

A

benzodiazepines

work in the pre-frontal cortex and remove patient’s self control; they may get more violent

70
Q

what is the longest time period that we should use clonazepam (klonopin)? why?

A

4 weeks

can cause addiction because of dopamine flash (very short half life = very addicting)

71
Q

which drug should be avoided in patients with anxiety and insomnia, especially females? why?

A

suvorexant (belsomra)

increases suicidal thoughts

72
Q

restlessness, need to get up and go all the time

A

akathesia

73
Q

involuntary contraction of major muscle groups (ie. torticollis)

A

dystonia

74
Q

primarily issue of the face: grimacing, lip smacking, tongue protrusion, lateral jaw movements

A

tardive dyskinesia

75
Q

what is unique to serotonin and norepinephrine pathways vs. dopamine pathways? what is the added benefit?

A

S + NE both have descending pathways and help with pain (why we can use SNERIS in pain and neuropathy)

76
Q

neurotransmitters are associated with movement, pleasure, reward, cognition, psychosis, arousal, sleep

A

dopamine

77
Q

neurotransmitters associated with mood, arousal, cognition, pain

A

norepinephrine

78
Q

neurotransmitters associated with mood, anxiety, sleep, pain

A

serotonin

79
Q

how long must a patient be sober before you can RX disulfram to aid in alcohol recovery?

A

12 hours

80
Q

at what age do we begin to prescribe medication for children with ADHD?

A

6 years old

therapy before then

81
Q

prior to prescribing ADHD meds, what must you be sure to do?

A

do full assessment with big emphasis on cardiovascular system – these drugs can cause sudden death if any CVD issues

82
Q

what do you want to be sure to monitor throughout a child’s treatment with methylphenidate?

A

growth!

it can inhibit growth

83
Q

what are the contraindications for methadone (as a drug for chronic pain control)?

A

respiratory problems! (COPD)

cardiovascular problems like a fib! (can cause QT prolongation)

84
Q

are opioids or methadone better for chronic pain control in a patient with respiratory disease?

A

opioids

85
Q

what was the common cause of opioid overdose deaths we talked about in class? why does this occur so frequently?

A

methadone (one third of opioid overdose deaths)

long half life (5 days); when we are trying to titrate a dose we get into a place where we are suppressing respirations but don’t have pain control yet. we just keep up-titrating.

86
Q

bipolar patient comes in with frequent urination, polydipsia, and a 5 lb weight gain. whats up? how should you proceed?

A

diabetes insipidus

downtitrate lithium while uptitrating quetiapine (seroquel)

87
Q

again, which 3 drugs used to treat anxiety and/or depression are very sedating?

A

mirtazapine

trazadone

paxil

88
Q

what drug is given as an opioid antagonist?

A

naloxone

89
Q

what is the main side effect we worry about with belsomra?

A

weird REM sleep phenomenon; they can literally just lose all muscle tone in the middle of the day

90
Q

why might a patient who needs to be alive awake alert enthusiastic first thing in the morning dislike belsomra?

A

half life of 12 hours!

morning hangovers

Elaina: Psych (7 decks)

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