Psych Pharm Flashcards
which drug is indicated for not only depression, but also PTSD?
sertraline (zoloft)
which drug for depression carries the biggest risk of QT prolongation?
citalopram (celexa)
get EKG before!
do SSRIs or SNERIs carry less risk for sexual side effects?
SNERIs
what drug should we consider for depression if our patient is worried about sexual dysfunction?
venlofaxine (effexor); its a SNERI
or buproprion!
which drug indicated for depression can also be used for chronic pain or fibromyalgia?
duloxetine (cymbalta)
SNERI
which atypical antidepressant is indicated for smoking cessation? what side effect are we most worried about?
buproprion
lowers seizure threshold
which populations should we avoid buproprion in?
alcoholics, bulimics, SDO
what is the main benefit of treating someone’s patient with burproprion?
less sexual side effects
which drug is a poor antidepressant but a great sleep aide?
trazodone
which drug carries the side effect of priaprism?
trazodone
what are the main side effects of trazadone?
sleepiness and othostatic hypotension
which antipsychotic has the greatest risk of weight gain?
olanzeprine (zyprexa)
which special indications does fluoxetine (prozac) carry?
OCD and eating disorders
which of our antidepressants is very activating? which is sedating?
prozac (fluoxetine) very activating
paxil (paroxetine) very sedating
if someone is very tired and depressed what drug should you avoid giving?
paroxetine (paxil); has anticholinergic side effects
with which antidepressant do we worry about withdrawal symptoms?
paroxetine (paxil)
what drug do we use for stage fright?
propranalol
which antipsychotic does not increase prolactin levels, therefore being a good choice if patient is worried about infertility?
quetiapine (seroquel)
which drug is not a good choice if you have a non-functioning psychotic, as it is more of a mild anti-psychotic?
quetiapine (seroquel)
if a patient with parkinson’s has psychosis symptoms, which drug should you start them on? why?
quetiapine (seroquel)
works more on serotonin, less on dopamine
which antipsychotic drug should we avoid if we are worried about weight gain?
olanzapine (zyprexa)
most common side effects of haloperidol?
EPS, TD
which movement disorder show up most often only with long-term use of antipsychotics, but may be irreversible?
tardive dyskinesia
which SE are we most worried about when prescribing 2nd generation antipsychotics, such as risperidone (risperdal)?
T2DM, lipids, BP, weight gain
what unpleasant side effects might cause patients on antipsychotics to stop medication?
galactorrhea, gynecomastia, infertility in women
dopamine normally inhibits prolactin; when we inhibit dopamine prolactin is free to flow
which of our mood stabilizers is teratogenic? which of the mood stabilizers may cause spina bifida in babies?
teratogenic = lithium
spina bifida = valproate
what do we need to monitor if our patient is on a 2nd generation antipsychotic (like risperidone)?
A1C, lipids, BP every 6 months
what side effects do we worry about with lithium?
diabetes insipidus
muscle stiffness
if a patient with parkinson’s begins showing signs of psychosis, what should the first move be?
reduce dose of levodopa/carbidopa
are antidepressants alone sufficient when a patient’s unipolar depression becomes developing mixed features?
no!
if your previously unipolar patient develops mania, what do you treat with? what if they develop delusions?
mania = lithium
delusions = quetiapine (seroquel)
which second generation antipsychotic carries the greatest risk of agranulocytosis?
clozapine (clozaril)
no longer prescribed by PCP
what can be used for acute relief of tardive dyskinesia?
benadryl
what is anhedonia?
caused by lack of dopamine; an extreme displeasure in doing life stuff, no pleasure
how do we treat anhedonia in a parkinsons patient?
benztropine (anti-cholinergic)
will help balance between acetylcholine and dopamine
which drug, not on our drug table, has the propensity to cause serotonin syndrome in the elderly?
tramadol
which drug do we use to treat parkinson’s dementia? what do we worry about?
aricept; may worsen parkinson’s symptoms :( poop
what is the short term treatment for acute panic disorder? what is used long-term?
short term: benzodiazepines
long term: venlofaxine (effexor)-SNERI
what is the max amount of time that we use benzodiazepines for?
4 weeks
which drug is our go to if a patient has depression and sexual dysfunction worries?
cymbalta (effexor)
or buproprion
which drug do we use for postpartum depression?
sertraline (zoloft)
lowest concentration for breast feeding
which second generation anti-psychotic is PG category B?
lurasideone (latuda)
if your patient has generalized anxiety disorder and PTSD, what drug should you use?
sertraline (zoloft)
which of our SSRIS is most likely to cause insomnia?
fluoxetine (prozac)
when should we expect to see the full impact of anti-depressants in adults vs. elderly?
adults: 6-8 weeks
elderly: 10-12 weeks
when should we expect to begin to see an improvement of symptoms when treating depression?
2-4 weeks
if our patient has generalized anxiety disorder with insomnia, what should we treat them with? what drug class is it?
mirtazapine (remeron); VERY sedating (blocks H1)
tetracycline
what drug is used for refractory depressive disorder, unresponsive to all other treatment?
phenelzine (nardil)
what drug must you avoid tyramine-rich foods, such as cheese and wine, while taking?
phenelzine (nardil)
which drug do we use to treat seasonal affective disorder?
paroxetine (paxil)
which antidepressant works much quicker than 6 weeks to give the patient relief?
vortioxetine (britellux)
which two drugs are partial serotonin agonists / antagonists?
vortioxetine (britellux) and vilazodone (viibryd)
what side effects do we worry about with viladazone (viibryd) and vortioxetine (britellux)?
increased bleeding; impaired platelet functioning
way less likely to cause other major side effects! we have some agonizing and antagonizing activity
when should we follow up with patients once we initiate treatment with an SSRI? why?
2 weeks to evaluate for suicidal ideation
what percentage of people will not fill their RX for their antidepressant?
one third
what do we use to monitor for TD in patients? how often do we do it?
AIMS
every 6 months
how long must we wait after stopping fluoxetine (prozac) to prescribe an MAOI like phenelzine (nardil)? how about the other SSRIs/tricyclics?
5 weeks for fluoxetine (prozac)
2 weeks for da rest
which SSRI has the longest half life?
fluoxetine (prozac)
why do we see so many side effects in tricyclic antidepressants, such as nortriptyline (pamelor)?
blocks many neurotransmitters
(M1, H1, alpha 1, voltage gated Na channels) on top of serotonin, norepinephrine
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
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
which 2nd generation antipsychotic carries a lower risk for metabolic problems (DM, weight gain) than the others?
ziprasidone (geodon)
your patient is coping with the loss of his dog, he is depressed and having trouble sleeping, what should you RX?
trazadone
great for situational depression
which is the only SSRI that will self down-titrate? why?
fluoxetine (prozac)
long half life
which drug (not on our drug tables) has the propensity to cause serotonin syndrome in the elderly?
tramadol
what is our DOC for post-partum depression? why?
sertraline (zoloft)
lowest concentration in breast milk
all of our SSRIS are which pregnancy category? which is the only exception?
C!
paxil is PG category D – definitely avoid
if your patient on fluoxetine (prozac) is experiencing insomnia, anxiety, agitation, what should we switch them to?
escitalopram (lexapro)
less excitatory but not as sedative as paxil
signs of withdrawal from paxil?
insomnia, dizziness, parasthesisas
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?
benzodiazepines
work in the pre-frontal cortex and remove patient’s self control; they may get more violent
what is the longest time period that we should use clonazepam (klonopin)? why?
4 weeks
can cause addiction because of dopamine flash (very short half life = very addicting)
which drug should be avoided in patients with anxiety and insomnia, especially females? why?
suvorexant (belsomra)
increases suicidal thoughts
restlessness, need to get up and go all the time
akathesia
involuntary contraction of major muscle groups (ie. torticollis)
dystonia
primarily issue of the face: grimacing, lip smacking, tongue protrusion, lateral jaw movements
tardive dyskinesia
what is unique to serotonin and norepinephrine pathways vs. dopamine pathways? what is the added benefit?
S + NE both have descending pathways and help with pain (why we can use SNERIS in pain and neuropathy)
neurotransmitters are associated with movement, pleasure, reward, cognition, psychosis, arousal, sleep
dopamine
neurotransmitters associated with mood, arousal, cognition, pain
norepinephrine
neurotransmitters associated with mood, anxiety, sleep, pain
serotonin
how long must a patient be sober before you can RX disulfram to aid in alcohol recovery?
12 hours
at what age do we begin to prescribe medication for children with ADHD?
6 years old
therapy before then
prior to prescribing ADHD meds, what must you be sure to do?
do full assessment with big emphasis on cardiovascular system – these drugs can cause sudden death if any CVD issues
what do you want to be sure to monitor throughout a child’s treatment with methylphenidate?
growth!
it can inhibit growth
what are the contraindications for methadone (as a drug for chronic pain control)?
respiratory problems! (COPD)
cardiovascular problems like a fib! (can cause QT prolongation)
are opioids or methadone better for chronic pain control in a patient with respiratory disease?
opioids
what was the common cause of opioid overdose deaths we talked about in class? why does this occur so frequently?
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.
bipolar patient comes in with frequent urination, polydipsia, and a 5 lb weight gain. whats up? how should you proceed?
diabetes insipidus
downtitrate lithium while uptitrating quetiapine (seroquel)
again, which 3 drugs used to treat anxiety and/or depression are very sedating?
mirtazapine
trazadone
paxil
what drug is given as an opioid antagonist?
naloxone
what is the main side effect we worry about with belsomra?
weird REM sleep phenomenon; they can literally just lose all muscle tone in the middle of the day
why might a patient who needs to be alive awake alert enthusiastic first thing in the morning dislike belsomra?
half life of 12 hours!
morning hangovers
