Psychiatric Disorders Flashcards
What antidepressants increases bleed risk?
TCA, SSRI, SNRIs via pharmacodynamic interactions
Fluoxetine and fluvoxamine via CYP2C9 via pharmacokinetic interactions
T/F: Some antidepressants can lower the analgesia affects of pain meds through CYP2D6 interaction
True. fluoxetine, paroxetine, duloxetine, buproprion
T/F duloxetine, paroxetine, buproprion are CYP2D6 inhibitors
True
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.
Will negate effects and decrease tolerability of drug
T/F: good idea to check interactions when patient is on pain meds that are substrate for 2d6 like codeine, tramadol, hydrocodone etc.
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
What is the best medication for panic disorder in the older patients?
Venlafaxine XR
What are the medications used to treat schizophrenia?
Atypicals: aripiprazole, asenapine (saphris), cariprazine (Vraylar), clozapine, lurasidone (Latuda), olanzapine, quetiapine, risperidone, ziprasidone, paliperidone, iloperidone
Which atypicals are most and least likely to cause EPS?
Most: risperidone, paliperidone, lurasidone (Latuda)
least: quetiapine, clozapine, pimavenserin (Nuplazid, only for parkinsons psychosis)
Which atypicals are most and least likely to cause metabolic syndrome?
most: olanzapine, clozapine
least: aripiprazole, lurasidone, ziprasidone
Which atypical is most likely to cause qtc prolongation?
most: ziprasidone
Which atypical is most and least likely to cause prolactinemia?
Most: risperidone, paliperidone
least: aripiprazole, lurasidone
Which atypicals are the most sedating?
quetiapine, clozapine
Which medications are used for bipolar disorder?
Mood stabilizers with or without antipsychotics and antidepressants
mood: lithium, valproic acid, lamotrigine, carbamazepine
ap: seroquel most evidence for older adults
Which two mood stabilizers can interact with each other?
Valproic acid and lamotrigine, can cause rash, likely need to reduce lamotrigine
What is lithium used for?
Bipolar disorder, monitor tsh and kidney function
What common drugs does lithium interact with?
nsaids, acei, arbs, thiazide diuretics (ie hctz)
What are side effects of lithium? toxic signs?
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)
What is valproic acid used for?
bipolar, seizures, migraines
What are some AE of valproic acid?
cns sedation, GI upset
unique: reduced platelets, elevated ammonia, hair loss, LFT elevation
T/F: penem antibiotics reduce the concentration of VPA?
True
T/F: valproic acid can cause weight gain
True
What is the target level of lithium?VPA?carbamazepine?
0.5-1.2
50-100
4-12
What are some AE of carbamazepine?
CNS, GI, elevated LFTs, alterations in WBC, hyponatremia
Monitor CBC, LFTS, Na
What allele is important in using carbamazepine?
HLA-B*1502 higher risk for SJS, higher in asian descent
What are some assessment tests for depression?
PHQ-9, HAM-D —> higher the number the worse the disorder
T/F: velafaxine has the sig potential for withdrawal if abrupt dc?
True
Which SNRI has highest potential or raising BP?
Venlafaxine
