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Clin Pharm > Psychiatric > Flashcards

Psychiatric Flashcards

1
Q

What % of pts who receive tx for depression will improve

A

80%

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2
Q

Depression:∙
Rx tx can take __-__ wks to become fully effective, but improvement is often experienced w/in __ wk(s)

A

4-6wks
1wk

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3
Q

Are antidepressants habit forming?

A

nope

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4
Q

Tx time for antidepressants after full remission?

A

4-9mo

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5
Q

T/F: you can do graded discontinuance for antidepressants in recurrent depression

A

nope
continuous rx indefinitely

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6
Q

6 indications for antidepressant use

A

∙Depression
∙Anxiety
∙Chronic Pain
∙Premenstrual dysphoric disorder (PMDD)
can be just around menses, 1wk
∙Smoking cessation (Welbutrin)
∙Eating disorders

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7
Q

How to chose an antidepressant (5)

A

∙Indication
∙Cost
∙Availability
∙Drug interactions
always run interactions in epocrates prior to start
∙Patient age and gender

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8
Q

First line Rx classes for depression?

A

SSRI & SNRI

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9
Q

5 reasons why TCA & MAOI are not 1st line for depression?

A

potential lethal OD
need titration
serious DDI
adverse effects
narrow therapeutic window
TCA’s are bad…

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10
Q

Can you use St John’s Wort or SAMe in patients currently taking a serotonergic agent?

A

HELL NO

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11
Q

T/F: St John’s wort has lots of DDIs

A

Yes
Its a potent inducer of CYP450

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12
Q

SSRI MOA and 5 common ones

A

Selective serotonin reuptake inhibitors
“zo pro pro, PaCe”
Zoloft
Prozac
Lexapro
Paxil
Celexa

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13
Q

SNRI MOA and 3 common ones

A

Serotonin-NE reuptake inhibitors
“Pristine Cymbal Effects”
Pristiq
Cymbalta
Effexor

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14
Q

SSRI or SNRI:
Anxiety?

A

Both

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15
Q

SSRI or SNRI:
Depression tx

A

SNRI>SSRI.
SSRI still good

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16
Q

SSRI or SNRI:
More s/e?

A

SNRI

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17
Q

Tx for Melancholic Depression

A

TCA:Amitriptyline
these pts are also at higher risk of SI

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18
Q

Tetracyclic Rx for depression

A

Welbutrin

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19
Q

T/F: Welbutrin can be first line for depression?

A

yes

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20
Q

MOA of Welbutrin?

A

NE-D2 receptor antagonist

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21
Q

2 Tx for Depression with Insomnia/Anxiety?

A

Mirtazapine (Remeron)
Trazodone (Desyrel)

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22
Q

2 Tx for Resistant Depression

A

“Able to see the light”
Aripiprazole (Abilify) and Quetiapine (Seroquel)

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23
Q

Why should seroquel NEVER be 1st line for depression?

A

Can develop acute psychosis

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24
Q

MAOI MOA and 2 Rx

A

Monoamine oxidase inhibitor
Isocarbozid (Marplan), Penelzine (Nardil)

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25
Q

Can Marplan or Nardil ever be 1st line depression Rx?

A

Nope

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26
Q

SSRI:
What are 5 serotonic activity effects?

A

weight gain
Nausea
Diarrhea
GI upset
Diminished sexual function
HA

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27
Q

SSRI:
What are the 2 s/e of Discontinuation syndrome?

A

sudden discontinuation
→ dizziness and paresthesia

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28
Q

Will discontinuation syndrome in SSRI/SNRI cause deadly w/d?

A

nope

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29
Q

What are the 2 groupings of adverse effects from SNRIs?

A

Serotonergic adverse effects
Noradrenergic effects:
HTN
Tachy
CNS activation: insomnia, anxiety, agitation

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30
Q

What is the D/Csyndrome like for SNRI & TCA (2)?

A

Cholinergic rebound
FLS

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31
Q

TCA: Adverse effects

A

Anticholinergic:
dry mouth
constipation
urinary retention
blurred vision
confusion

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32
Q

MAOI: Adverse effects (2)
Higher effects of what?

A

Orthostatic hypotension
wt gain

higher rates of sexual effects

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33
Q

D/C syndrome of TCA?

A

cholinergic rebound
FLS

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34
Q

Are suicide attempts common in depression?

A

yes

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35
Q

What is the MCC of SI in depression?

A

OD (esp TCA)

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36
Q

___ dose of ___ (<__days) is lethal

A

1500mg
Amitriptyline
<7d

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37
Q

Managing S/E:
GI Distress?

A

Take after meals

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38
Q

Managing S/E:
Sedation?

A

Take at HS, most SSRIs are less sedating (Prozac)

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39
Q

Managing S/E:
Agitation and Insomnia:

A

“Causes Rapid Eye”
Switch to a more sedating options (Remeron, Celexa, Effexor)

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40
Q

Managing S/E:
Sexual Dysfunction:

A

Less with Wellbutrin, Remeron, consider a PDE-5 (Sildenafil)

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41
Q

Managing S/E:
Anxiety/Panic:
Avoid what drug class?

A

“Treat Every Panic Real”
Paxil, Remeron, Effexor, TCAs
(try to avoid BDZs)

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42
Q

Managing S/E:
Orthostatic HYPOTN:

A

hydrate, educate on mvt

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43
Q

Managing S/E:
Wt gain:

A

“Prevents weight change”
cymbalta, Prozac, Welbutrin

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44
Q

D/C
Is the w/d bad?
taper? how?

A

No
WD typically mild
taper is recommended
↓ over 4wks– slower if symptomatic

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45
Q

D/C Taper for SNRI?

A

do a slower taper with the SNRI
(↓ Q2wks, plan to be done in 6-8wks)
could also crossover to another Drug

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46
Q

Best combo for MDD tx?

A

Medication therapy + Psychotherapy (CBT)

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47
Q

Is it common for schizophreniato be diagnosed in a person younger than 12 or older than 40.

A

Nope

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48
Q

Can schizophrenia be treated?

A

yes

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49
Q

1/2 of schizophrenia pts can be fully independent with what 2 things?

A

aggressive tx & compliance

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50
Q

Antiphsychotics do what 3 things for schizophrenia?

A

↑ mood
↓ anxiety
↓ sleep disorders

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51
Q

When are FGA best used?

A

acute
short-term symptom control

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52
Q

Wy are FGA not 1st line for schizo (3)?

A

EPS
TD
cognitive impairment

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53
Q

3 drug classes of FGA

A

Phenothiazines – Chlorpromazine (Thorazine)
Thioxanthenes – Thiothixene (Navane)
Butyrophenones – Haloperidol/droperidol (Haldol)

54
Q

Which FGA class has wt gain, sedation & TD?

A

Phenothiazines – Chlorpromazine (Thorazine)

55
Q

Which FGA class has high potency, medium EPS, medium sedative & hypotension?

A

Thioxanthenes – Thiothixene (Navane)

56
Q

Which FGA class has high levels of EPS & high potency & is widely used?

A

Butyrophenones – Haloperidol/droperidol (Haldol)

57
Q

EPS:
Dystonia-

A

continuous spasm and muscle contractions

58
Q

EPS:
Akathisia-

A

motor restlessness

59
Q

EPS:
Parkinsonism-

A

irregular, jerky movements

60
Q

EPS:
Tardive dyskinesia-

A

involuntary muscle movements in lower and distal extremities

61
Q

EPS:
Bradykinesia-

A

Slow movements
Tremors

62
Q

What drug class is 1st line tx for Schizophrenia?Why?

A

SGA
lower risk EPS
minima risk TD
lower incidence of cognitive impairment

63
Q

7 drugs choices for SGA?

A

Quetiapine – (Seroquel & Seroquel XR)
Risperidone (Resperdal)
Ziprasidone (Geodon)
Paliperidone (Invega)
Aripiprazole (Abilify)

Clozapin
Olanzapine (Zyprexa)

64
Q

SGA:
Which 2 rx causes wt gain?

A

Seroquel
Risperdal

65
Q

SGA:
Which rx causes EPS with an increase in dosage?

A

Rsiperdal

66
Q

SGA:
Which rx is an active metabolite of risperdal?

A

Invega

67
Q

SGA:
Which rx is inexpensive, comes in long & sort acting options?

A

Risperdal

68
Q

SGA:
Which Rx is FDA approved monotherapy or adjunctive tx of acute manic or mixed episodes assoc w/ bipolar I disorder, and irritability associated with autistic disorder.

A

Risperdal

69
Q

SGA:
Which Rx should be used with caution in CVD and prolonged QTc

A

Geodon

70
Q

SGA:
Which 2 rx cause less wt gain?

A

Geodon & Abilify

71
Q

Why do we only use clozapin for refractory pts?

A

severe risk of neutropenia

72
Q

SGA:
Which rx is NOT recommended as 1st line?

A

Zyprexa

73
Q

3 things to consider with schizo drug choice

A

Adverse effects/efficacy
comorbids
cost

74
Q

What dose works for schizophrenia?

A

lowest possible effective dose

75
Q

Are divided daily doses hard for this pop? (schizo)?

A

yes

76
Q

Schizo:
___ = compliance

A

Simplification

77
Q

3 acute options for schizo

A

Zyprexa – IM/ODT
Haldol – IV
Benzo’s

78
Q

SGA should be given an adequate trial for at least__-__weeks at a therapeutic dose.

A

6–8 weeks at a therapeutic dose.
**6-8wks after you get pt to right dose

79
Q

7 SE we need to know for SGA?

A

wt gain
hyperglycemia
DM
HLD
DKA
Coma
Death

80
Q

Schizo:
Must distinguish b/w __ and _

A

drug-induced psychosis and schizophrenia

81
Q

Schizo:
to dx, must see ____ when they are not under _____.

A

new psychotic features
Haldol or other drugs.

82
Q

MDD:
Differentiate b/w ___ or ____ Depression

A

Chronic
Situational

83
Q

Short term ETOH w/d goals (5)
Most important goal?

A

*Control acute symptoms of alcohol withdrawal
**Prevent progression to delirium tremens
*Prevent future ETOH WD Sz
*Correct electrolyte imbalances (K+ and Mg2+)
*Start THIAMINE prophylaxis to prevent Wernicke’s encephalopathy

84
Q

T/F: If a pt has a ETOH WD Sz, will prob sz again in future

A

true

85
Q

DT sx and onset:

A

Delirium & tremors! & AMS
onset 3-5 (10) days post, lasts 2-3 days

86
Q

Long term goals of ETOH WD (4)

A

*Enroll patient in a program to help him stop drinking
-followed by long-term abstinence control
*W/U for liver dz (LFTs)→ prevent further progress
*Treat and manage other comorbidities

87
Q

Prophylaxis Tx for Wernickes encephalopathy

A

THIAMINE

88
Q

What is the TOC for ETOH & WD sz?
& 2 reasons why?

A

Barbituates

Less risk of respiratory depression
longer half-life

89
Q

What is the DOC for ETOH & WD sz?
Why?

A

Phenobarbitol
does not cause a high

90
Q

__ are DOC if your ETOH pt is actively seizing

A

Benzos

91
Q

T/F: All benzodiazepines seem equally efficacious in reducing signs and symptoms of ETOH withdrawal

A

true

92
Q

Which Benzo class needs clinical monitoring?

A

Long acting
(Diazepam (valium) & Chloradiazepoxide (Librium))

93
Q

Which Benzo class prevents w/d sz and sx control?

A

Long acting
diazepam (valium) & chloradiazepoxide (Librium)

94
Q

Which benzo class has increased toxicity risk (liver metabolism)

A

Long acting
diazepam (valium) & chloradiazepoxide (Librium)

95
Q

Which benzo class has less affected by liver dysfunction & ↓ sedative effects

A

Short acting (lorazepam and oxazepam)

96
Q

Which benzo can be used outpt?

A

Librium (long acting)

97
Q

Which 2 ETOH wd Rx do not cause a high?

A

Phenobarbitol
Librium

98
Q

Benzos:
3 Rx for WD

A

Lorazepam 2–4 mg PO/IV Q 4–6 H
Valium 5mg PO Q6hrs
Librium 50-100mg

99
Q

Benzos:
2 Rx for Sz

A

Lorazepam 4 mg IV may repeat
Valium 5-10mg IV q 10min 30mg total

100
Q

Clonidine? for ETOH w/d?

A

Alpha – Agonists can be safely added. ↓ sx
In the short term, ↓BP & HR

101
Q

What 2 necessary tx are added to ETOH WD Tx?

A

THIAMINE
FOLATE

102
Q

When is sz risk highest?

A

6-72hrs

103
Q

T/F: Librium can be done at home

A

true
all other benzos at home-risky

104
Q

Disulfram (Antabuse)
Can you use w/an intoicated pt?

A

NEVER GIVE TO SOMEONE WHO IS INTOXICATED
only works if pt is motivated to stay sober

105
Q

What to do with ETOH W?D pt w/hx of Sz & high risk? (might have had sz)?

A

Admit this patient, barb load, correct (e-)
if necessary, give thiamine and folate
Home – hemodynamically stable, definitive f/u plan and resources

106
Q

When can admitted etoh wd pt go home?

A

hemodynamically stable, definitive f/u plan and resources

107
Q

T/F: It is safer for patients to continue drinking that stop without a definitive plan

A

true

108
Q

What are the e- imbalances of ETOH misuse?

A

K+
Mg2+

109
Q

Meds assoc w/Insomnia:
CNS stimulants

A

D-amphetamine
Methylphenidine

110
Q

Meds assoc w/Insomnia:
BP drugs

A

alpha & BB

111
Q

Meds assoc w/Insomnia:
Resp rx

A

Albuterol
Theophylline

112
Q

Meds assoc w/Insomnia:
Decongestants

A

Phenylephrine
Pseudoephedrine

113
Q

Meds assoc w/Insomnia:
Hormones

A

Corticosteroids

114
Q

Meds assoc w/Insomnia:
Others substances

A

Alcohol
Narcotics
Cocaine

115
Q

Approach to insomnia (4)

A

∙ Lifestyle
∙ Stimulus Control → avoid alcohol, caffeine
∙ Environment→ dark room, quiet, decrease pre-sleep activity
∙ Behavioral therapy→ sleep hygiene, sleep restriction therapy, relaxation, CBT

116
Q

Dietary Supplements for insomnia

A

Valerian Root
Kava-Kava
Melatonin
Passion flower
Skullcap
Lavender
Hops
Tryptophan

117
Q

T/F: Dietary supplements for insomnia are FDA regulated

A

false

118
Q

T/F: Many OTC rx for insomnia are antihistamine or anticholinergic

A

true

119
Q

5 OTC Rx for insomnia

A

Benadryl
Tylenol PM
Sleep-Eze
doxylamine (Unisom)
Hydroxazine

120
Q

2 undesirable effects from OTC rx for insomnia

A

vivid dreams
hangover

121
Q

2 rx classes that act on ___ to promote sleep

A

GABA
Antidepressants
Benzos

122
Q

Is a benzo a good idea for sleep?

A

hell no

123
Q

Antidepressants for sleep?

A

Doxepin
Trazodone

124
Q

T/F:Doxepin, Trazodone & benzos are category x

A

truee

125
Q

Non benzo rx for insomnia
do they work well?

A

Ambien
Lunesta
YES

126
Q

predominate inhibitory neurotransmitter for sleep

A

GAB

127
Q

Insomnia:
Everyone should do __ & ___

A

lifestyle change ad sleep hygiene

128
Q

max timeline for benzos for insomnia

A

2wks

129
Q

T/F: when chosing insomnia rx, you can use an antidepressant for co-morbid depression, anxiety, mania

A

True

130
Q

Is it reasonable to start insomnia tx with melatonin?

A

yes!

Clin Pharm (6 decks)

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