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Psych Pharm Flashcards

1
Q

What receptors do Benzodiazepines interact with?

A

GABA-A

Bind between alpha and gamma subunits

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2
Q

Effect of BZDs at the receptor

A

Binds when GABA is bound, resulting in increase in Cl- causing hyperpolarization and decreased action potentials = CNS Depression

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3
Q

Short acting BZDs

A

Alprazolam (Xanax)
Midazolam (Versed)
Triazolam (Halcion)
Oxazepamn (Serax)

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4
Q

Intermediate acting BZDs

A

Lorazepam (Ativan)

Temazepam (Restoril)

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5
Q

Long acting BZDs

A

Diazepam (Valium)
Flurazepam (Dalmane)
Clonazepam (Klonipin)
Chlordiazepoxide (Librium)

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6
Q

Side Effects of BZDs

A 
Drowsiness
Sedation
Ataxia/Impaired motor function
Confusion, anterograde amnesia (caution in elderly)
Tolerance + Withdrawal
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7
Q

BZD effect on Pediatrics

A

Paradoxical Effects - hyperactivity and aggression

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8
Q

BZD Toxicity

A

Occurs when taken with more benzos, ETOH or CNS depressants

Results in severe drowsiness, ataxia

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9
Q

Which BZDs are not metabolized by the liver CYP enzymes?

A

Lorazepam (Ativan)

Temazepam (Restoril)

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10
Q

Which BZD is used also as a muscle relaxant and for Status Epilepticus?

A

Diazepam (Valium)

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11
Q

What med is used in BZD overdose?

A

Flumazenil

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12
Q

Flumazenil MOA

A

Competitive antagonist at BZD site at GABA-A

Blocks effects of BZDs and related drugs

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13
Q

Considerations with Flumazenil in treating BZD OD

A

Requires multiple doses to prevent recurrence/sedation due to short half life
Need to still establish an airway

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14
Q

Barbituates MOA

A

Non-selective GABA-A agonist and increases the duration of the Cl- channel opening

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15
Q

What is so dangerous about barbituates?

A

Non-selective GABA-A action results in all levels of CNS depression and central respiratory arrest
At toxic doses can also bind in absence of GABA and suppress activation of Glutamate NMDA

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16
Q

Side Effects of Barbituates

A

CNS and respiratory depression
Alkalinization of urine
Tolerance + Physical Dependence

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17
Q

Tolerance considerations w/ Barbituates

A

Increased metabolic clearance results in tolerance
BUT DOES NOT with respiratory depression - can be fatal!!!
DOES NOT occur with anti-seizure effects

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18
Q

Barbituates withdrawal s/s

A

8-12 hr: anxiety, tremors, restlessness, weakness, N/V, insomnia
2 days: increased SNS activity, delirium, seizures, death

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19
Q

Medication used to treat Epileptic Seizures

A

Phenobarbital

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20
Q

MOA of Buspirone (Buspar)

A

Partial 5-HT1A, 5-HT2 receptor

No interaction with GABAn

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21
Q

Use of Buspirone (Buspar)

A

Generalized Anxiety Disorder

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22
Q

Advantage of Buspar

A

Little abuse potential
Can be combined with CNS depressants, no sedative effects
No rebound anxiety or withdrawal

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23
Q

Side Effects of Buspar

A

Restlessness, dizziness, tachycardia, palpitations

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24
Q

Hydroxyzine MOA

A

Antagonist of H1 receptor (similar to benadryl)

Results in sedation/calmnness

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25
Side Effects of Hydroxyzine
Sedation, dry mouth, tremor Convulsions in high doses Bronchodilation, respiratory depression
26
Use of hydroxyzine
Anxiety and tension
27
Treatment of Choice for Depression
CBT + Anti-depressants (SSRIs)
28
MOA of SSRI
Selective inhibition of 5-HT reubtake by Serotonin reuptake transporter (SERT) SERT 300x >>> NERT
29
Do SSRIs have action at A, H1 or M receptors?
Little to NO ACTION!
30
5-HT1 receptor activity
Anti-depresssant | Anxiety
31
5-HT2 receptor activity
Insomnia Anxiety Agitation Sexual Dysfunction
32
5-HT3 receptor activity
Nausea, GI effects
33
Common side effects
Nausea, GI distress, diarrhea Sexual side effects (decreased libido, delayed orgasm) Anxiety, panic attacks, insomnia, agitation Others SEs: Cardiac: QT prolongation, bleeding risks (impaired PLT aggregation) Bone Fractures Nocturnal bruxism
34
Most significant side effect due to combining SSRIs or with MAOIs due to elevated 5-HT
Serotonin Syndrome
35
Serotonin Syndrome symptoms
Myclonus, agitation, GI cramping, HTN
36
Extrapyramidal symptoms
Akathesia, Dystonia
37
Discontinuation Syndrome
Dysphoria, agitation, seizures, paranoia
38
Why should you not combine SSRIs with Tramadol?
Increased risk of seizures
39
Fluoxetine (What is Trade name?)
Prozac (what is generic?)
40
Fluoxetine (Prozac) Use
Major Depression Disorder (drug of choice) | OCD, atypical depression, anxiety, panic disorder, bulimia nervosa, binge eating
41
Which anti-depressant has less anorgasmia effects?
Fluoxetine (Prozac)
42
Escitalopram (what is the trade name?)
Lexapro (what is generic?)
43
Escitalopram (Lexapro) Use
MDD, GAD | *Preferred in patients with anxiety and depression
44
Difference between Escitalopram (Lexapro) and Citalopram (Celexa)
Escitalopram (Lexapro) is more activating and 2x more potent than celexa
45
Sertraline (what is trade name?)
Zoloft (what is generic name?)
46
Sertraline (Zoloft) Use
MDD, OCD, Panic, Anxiety, PTSD, ETOH dependence, premenstrual dsyphoric disorder
47
Why is Zoloft often used frequently?
4-5x more potent and selective than Prozac, often works better, well tolerated with less side effects (more selective)
48
Paroxetine (what is trade name?)
Paxil (what is generic name?)
49
Paroxetine (Paxil) Use
MDD, OCD, Panic, Social and GAD, PTSD, vasomotor symptoms
50
Which is the most potent SSRI?
Paxil
51
Which SSRI is more sedating but it is usually transient?
Paxil
52
Which SSRI is used first line for OCD?
Fluvoxamine (Luvox)
53
MOA of SNRI
Inhibition of SERT and NERT (Norepinephrine reuptake transporter) SERT 5x > NERT No action at alpha, H1 or muscarininc
54
Side Effects of SNRI
N/V/D, decreased appetite, dry mouth, constipation Insomnia, sedation, dizziness Sexual dysfunction increased BP
55
Which Side Effect of SNRIs is not seen in SSRIs?
Elevated BP, urinary retention
56
Venlafazine (what is the trade name?)
Effexor (what is generic name?)
57
Venlafazine use
MDD, GAD, Social anxiety, panic
58
What is a consideration with using Venlafazine (Effexor)?
Overdose can be lethal
59
Side effect of Venlafazine (Effexor)?
Diastolic HTN
60
Duloxetine
Cymbalta
61
Which SNRI can be used for Diabetic Peripheral Neuropathy, Fibromyalgia, Chronic Pain?
Duloxetine (Cymbalta)

Psychiatry Pharmacology (1 decks)

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