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Psychiatry Pharmacology > Psych Pharm > Flashcards

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
Q

Side Effects of Hydroxyzine

A

Sedation, dry mouth, tremor
Convulsions in high doses
Bronchodilation, respiratory depression

26
Q

Use of hydroxyzine

A

Anxiety and tension

27
Q

Treatment of Choice for Depression

A

CBT + Anti-depressants (SSRIs)

28
Q

MOA of SSRI

A

Selective inhibition of 5-HT reubtake by Serotonin reuptake transporter (SERT)
SERT 300x&raquo_space;> NERT

29
Q

Do SSRIs have action at A, H1 or M receptors?

A

Little to NO ACTION!

30
Q

5-HT1 receptor activity

A

Anti-depresssant

Anxiety

31
Q

5-HT2 receptor activity

A

Insomnia
Anxiety
Agitation
Sexual Dysfunction

32
Q

5-HT3 receptor activity

A

Nausea, GI effects

33
Q

Common side effects

A

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
Q

Most significant side effect due to combining SSRIs or with MAOIs due to elevated 5-HT

A

Serotonin Syndrome

35
Q

Serotonin Syndrome symptoms

A

Myclonus, agitation, GI cramping, HTN

36
Q

Extrapyramidal symptoms

A

Akathesia, Dystonia

37
Q

Discontinuation Syndrome

A

Dysphoria, agitation, seizures, paranoia

38
Q

Why should you not combine SSRIs with Tramadol?

A

Increased risk of seizures

39
Q

Fluoxetine (What is Trade name?)

A

Prozac (what is generic?)

40
Q

Fluoxetine (Prozac) Use

A

Major Depression Disorder (drug of choice)

OCD, atypical depression, anxiety, panic disorder, bulimia nervosa, binge eating

41
Q

Which anti-depressant has less anorgasmia effects?

A

Fluoxetine (Prozac)

42
Q

Escitalopram (what is the trade name?)

A

Lexapro (what is generic?)

43
Q

Escitalopram (Lexapro) Use

A

MDD, GAD

*Preferred in patients with anxiety and depression

44
Q

Difference between Escitalopram (Lexapro) and Citalopram (Celexa)

A

Escitalopram (Lexapro) is more activating and 2x more potent than celexa

45
Q

Sertraline (what is trade name?)

A

Zoloft (what is generic name?)

46
Q

Sertraline (Zoloft) Use

A

MDD, OCD, Panic, Anxiety, PTSD, ETOH dependence, premenstrual dsyphoric disorder

47
Q

Why is Zoloft often used frequently?

A

4-5x more potent and selective than Prozac, often works better, well tolerated with less side effects (more selective)

48
Q

Paroxetine (what is trade name?)

A

Paxil (what is generic name?)

49
Q

Paroxetine (Paxil) Use

A

MDD, OCD, Panic, Social and GAD, PTSD, vasomotor symptoms

50
Q

Which is the most potent SSRI?

A

Paxil

51
Q

Which SSRI is more sedating but it is usually transient?

A

Paxil

52
Q

Which SSRI is used first line for OCD?

A

Fluvoxamine (Luvox)

53
Q

MOA of SNRI

A

Inhibition of SERT and NERT (Norepinephrine reuptake transporter)
SERT 5x > NERT
No action at alpha, H1 or muscarininc

54
Q

Side Effects of SNRI

A

N/V/D, decreased appetite, dry mouth, constipation
Insomnia, sedation, dizziness
Sexual dysfunction
increased BP

55
Q

Which Side Effect of SNRIs is not seen in SSRIs?

A

Elevated BP, urinary retention

56
Q

Venlafazine (what is the trade name?)

A

Effexor (what is generic name?)

57
Q

Venlafazine use

A

MDD, GAD, Social anxiety, panic

58
Q

What is a consideration with using Venlafazine (Effexor)?

A

Overdose can be lethal

59
Q

Side effect of Venlafazine (Effexor)?

A

Diastolic HTN

60
Q

Duloxetine

A

Cymbalta

61
Q

Which SNRI can be used for Diabetic Peripheral Neuropathy, Fibromyalgia, Chronic Pain?

A

Duloxetine (Cymbalta)

Psychiatry Pharmacology (1 decks)

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