Psychiatric Disorders

Question 1

What antidepressants increases bleed risk?

Answer 1

TCA, SSRI, SNRIs via pharmacodynamic interactions

Fluoxetine and fluvoxamine via CYP2C9 via pharmacokinetic interactions

Question 2

T/F: Some antidepressants can lower the analgesia affects of pain meds through CYP2D6 interaction

Answer 2

True. fluoxetine, paroxetine, duloxetine, buproprion

Question 3

T/F duloxetine, paroxetine, buproprion are CYP2D6 inhibitors

Answer 3

True

Question 4

If a patient is on an acetylcholinesterase inhibitor and are not responding, check if they are on a potent inhibitor of CYP2D6 like duloxetine, paroxetine, buproprion.

Answer 4

Will negate effects and decrease tolerability of drug

Question 5

T/F: good idea to check interactions when patient is on pain meds that are substrate for 2d6 like codeine, tramadol, hydrocodone etc.

Answer 5

T: hard to reach analgesia dose as it is for older patients, wanna make sure no other medication is not dec its affects like strong 2D6 inhibitors like fluoxetine, paroxetine, duloxetine, and buproprion

Question 6

What is the best medication for panic disorder in the older patients?

Answer 6

Venlafaxine XR

Question 7

What are the medications used to treat schizophrenia?

Answer 7

Atypicals: aripiprazole, asenapine (saphris), cariprazine (Vraylar), clozapine, lurasidone (Latuda), olanzapine, quetiapine, risperidone, ziprasidone, paliperidone, iloperidone

Question 8

Which atypicals are most and least likely to cause EPS?

Answer 8

Most: risperidone, paliperidone, lurasidone (Latuda)
least: quetiapine, clozapine, pimavenserin (Nuplazid, only for parkinsons psychosis)

Question 9

Which atypicals are most and least likely to cause metabolic syndrome?

Answer 9

most: olanzapine, clozapine
least: aripiprazole, lurasidone, ziprasidone

Question 10

Which atypical is most likely to cause qtc prolongation?

Answer 10

most: ziprasidone

Question 11

Which atypical is most and least likely to cause prolactinemia?

Answer 11

Most: risperidone, paliperidone
least: aripiprazole, lurasidone

Question 12

Which atypicals are the most sedating?

Answer 12

quetiapine, clozapine

Question 13

Which medications are used for bipolar disorder?

Answer 13

Mood stabilizers with or without antipsychotics and antidepressants

mood: lithium, valproic acid, lamotrigine, carbamazepine
ap: seroquel most evidence for older adults

Question 14

Which two mood stabilizers can interact with each other?

Answer 14

Valproic acid and lamotrigine, can cause rash, likely need to reduce lamotrigine

Question 15

What is lithium used for?

Answer 15

Bipolar disorder, monitor tsh and kidney function

Question 16

What common drugs does lithium interact with?

Answer 16

nsaids, acei, arbs, thiazide diuretics (ie hctz)

Question 17

What are side effects of lithium? toxic signs?

Answer 17

SE: cns, ataxia, GI, tremors, hypothyroid, reduced kidney function
toxicity: nausea, vomitting, sedation, uncoordinated movements, tremor

coma seizure at very high levels (normal target 0.5-1.2)

Question 18

What is valproic acid used for?

Answer 18

bipolar, seizures, migraines

Question 19

What are some AE of valproic acid?

Answer 19

cns sedation, GI upset
unique: reduced platelets, elevated ammonia, hair loss, LFT elevation

Question 20

T/F: penem antibiotics reduce the concentration of VPA?

Answer 20

True

Question 21

T/F: valproic acid can cause weight gain

Answer 21

True

Question 22

What is the target level of lithium?VPA?carbamazepine?

Answer 22

0.5-1.2
50-100
4-12

Question 23

What are some AE of carbamazepine?

Answer 23

CNS, GI, elevated LFTs, alterations in WBC, hyponatremia

Monitor CBC, LFTS, Na

Question 24

What allele is important in using carbamazepine?

Answer 24

HLA-B*1502 higher risk for SJS, higher in asian descent

Question 25

What are some assessment tests for depression?

Answer 25

PHQ-9, HAM-D —> higher the number the worse the disorder

Question 26

T/F: velafaxine has the sig potential for withdrawal if abrupt dc?

Answer 26

True

Question 27

Which SNRI has highest potential or raising BP?

Answer 27

Venlafaxine