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Therapeutics > Psychiatric Disorders > Flashcards

Psychiatric Disorders Flashcards

Schizophrenia, Depression, Bipolar, Anxiety Disorders

1
Q

What ANC would require D/C of clozapine?

A

< 1000/mm^3

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2
Q

What agent is associated with paradoxical disinhibition?

Who is at highest risk?

What happens after it occurs?

A

Benzos

elderly & pt w/ developmental disorders

NEVER USE BENZO AGAIN

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3
Q

What is the dosing schedule & need for oral overlap for Perseris?

Generic?

A

every 4 weeks

N/A

risperidone

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4
Q

Which SSRI does not have discontinuation syndrome?

A

fluoxetine (Prozac)

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5
Q

Which serotonin modulator is anticholinergic & has a bleeding risk? (less than SSRI)

A

trazodone (Desyrel)

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6
Q

How does smoking effect clozapine levels?

A

decreases serum concentration by induction of CYP1A2

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7
Q

What agent can be added to treat tremors due to mood stabilizer agents?

A

beta blockers (can be PRN in some cases)

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8
Q

What mood stabilizer(s) need serum electrolyte monitoring?

A

lithium & carbamazepine

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9
Q

What mood stabilizers have risk of hypothyroidism?

How is this addressed?

A

lithium & carbemazepine

supp w/ levothyroxine

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10
Q

Which TCA is not indicated for MDD? What is it used for?

A

clomipramine (Anafranil)

OCD

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11
Q

What mood stabilizers have risk of SJS/TEN?

A

lamotrigine & carbamazepine

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12
Q

Which 2nd gen antipsychotics are NOT indicated for schizophrenia?

A

pimavanserin (Nuplazid)

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13
Q

What action is taken if hypoxia occurs while administering brexanolone (Zulresso)?

A

D/C and DO NOT reinitiate

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14
Q

What bipolar episodes is lumateperone (Caplyta) FDA approved for?

A

mixed, depression

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15
Q

(4) List the SNRIs:

A
  1. venlafaxine (Effexor)
  2. desvenlafaxine (Pristiq/Khedezla)
  3. duloxetine (Cymbalta)
  4. levomilnacipran (Fetzima)
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16
Q

What mood stabilizer has a significant anti-suicide effect?

A

lithium

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17
Q

What is the dosing schedule & need for oral overlap for Risvan?

Generic?

A

every 4 weeks

N/A

risperidone

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18
Q

What bipolar episodes is lurasidone (Latuda) FDA approved for?

A

mixed, depression

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19
Q

What bipolar episodes is olanzapine (Zyprexa) FDA approved for?

A

mania, mixed, maintenance

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20
Q

Pseudoparkinsonism:
1. presentation/onset
2. factors increasing risk
3. treatment

think about the onset!!

A
  1. within 1-2 weeks
  2. high potency/dose 1st gens and older age females
  3. anticholinergic (can do PO), dec dose or D/C agent
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21
Q

Which six 2nd gen antipsychotics also have a BBW for suicidality up to 24 yo?

A
  1. aripiprazole (Abilify)
  2. brexipiprazole (Rexulti)
  3. cariprazine (Vraylar)
  4. lumateperone (Caplyta)
  5. lurasidone (Latuda)
  6. quetiapine (Seroquel)
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22
Q

What are the BBWs on esketamine (Spravato)?

A

sedation, dissociation, abuse/misuse

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23
Q

What anxiety/related disorders is sertraline (Zoloft) FDA approved for?

A

OCD, panic, PTSD, PMDD, SAD

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24
Q

What mood stabilizer has a risk of a benign hand tremor?

What other mood stabilizers have risk of tremor?

A

lithium

lamotrigine & valproate

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25
Q

What is the BBW for ALL antidepressants?

A

suicidality up to 24 yo

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26
Q

(8) List the TCAs:

A
  1. amitriptyline (Elavil)
  2. amoxapine (Asendin)
  3. clomipramine (Anafranil)
  4. desipramine (Norpramin)
  5. doxepin (Sinequan)
  6. imipramine (Tofranil)
  7. nortriptyline (Pamelor)
  8. maprotilline (Ludiomil)
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27
Q

What is the effect of MAO A inhibition?

A

antidepressant effect

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28
Q

What anxiety/related disorders is fluvoxamine (Luvox) FDA approved for?

A

OCD

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29
Q

Which two 1st gen antipsychotics have the highest risk of QT prolongation?

A

thioridazine (Mellaril) & chlorpromazine (Thorazine)

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30
Q

(6) List the SSRIs:

A
  1. citalopram (Celexa)
  2. escitalopram (Lexapro)
  3. fluvoxamine (Luvox)
  4. fluoxetine (Prozac)
  5. paroxetine (Paxil)
  6. sertraline (Zoloft)
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31
Q

Which SNRI is associated with hyperlipidemia?

A

desvenlafaxine (Pristiq/Khedezla)

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32
Q

Which serotonin modulator has a BBW for hepatic failure?

A

nefazodone (Serzone)

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33
Q

What are BBW for 2nd gen antipsychotics in bipolar/MDD augmentation?

A

sucidality up to 24 yo & mortality in dementia related psychosis

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34
Q

What agents/procedures increase lithium neurotoxicity?

A

CCBs, ECT

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35
Q

What anxiety/related disorders is venlafaxine (Effexor) FDA approved for?

A

GAD, panic, SAD

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36
Q

What is the BBW for all antipsychotics?

A

mortality in dementia related psychosis

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37
Q

What is the dosing schedule & need for oral overlap for Zyprexa Relprevv?

Generic?

A

every 2-4 weeks

N/A

olanzapine

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38
Q

Why is a tyramine restriction needed for patients on MAOI?

A

to prevent risk of life threatening hypertensive crisis

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39
Q

What is the dosing schedule & need for oral overlap for Abilify Maintena?

Generic?

A

every 4 weeks

14 day overlap

aripiprazole

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40
Q

Which Benzo indicated for anxiety is long acting & high potency?

A

clonazepam

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41
Q

Which three 2nd gen antipsychotics have the highest metabolic risk?

A

clozapine (Clozaril), olanzapine (Zyprexa), & quetiapine (Seroquel)

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42
Q

(3) List the MAOIs with indication for MDD:

A
  1. phenelzine (Nardil)
  2. tranylcypromine (Pamate)
  3. selegiline PATCH (Ensom)
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43
Q

Which 2nd gen antipsychotic should be avoided with Benzos? Why?

A

olanzapine (Zyprexa) due to risk of severe respiratory depression

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44
Q

What mood stabilizer(s) need drug concentration monitoring?

A

Lithium, valproate, carbamazepine

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45
Q

Which two 1st gen antipsychotics have the highest risk of anticholinergic effects, sedation & orthostatic hypotension?

A

thioridazine (Mellaril) & chlorpromazine (Thorazine)

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46
Q

Which SNRI has the least insomnia?

A

duloxetine (Cymbalta)

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47
Q

What mood stabilizer is completely renally eliminated?

A

lithium

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48
Q

Which SNRIs weakly effect dopamine?

A

venlafaxine (Effexor) & desvenlafaxine (Pristiq/Khedezla)

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49
Q

What are the BBWs for Benzos?

A
  1. use w/ opiate
  2. risk of abuse, misuse, addiction
  3. physical dependence with continued use
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50
Q

What is samidorphan and its purpose when in combination with olanzapine?

A

WHAT: opioid modulator, similar to naltrexone & prevents opiate effects

WHY: its used to decrease the metabolic effects of olanzapine

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51
Q

What anxiety disorder can pregabalin be used in?

What risk is associated with its use?

A

SAD

rhabdo

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52
Q

What bipolar episodes is lithium FDA approved for?

A

mania, maintenance

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53
Q

Which 2nd gen antipsychotic requires 1st dose monitoring for anaphylaxis?

A

asenapine (Saphris)

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54
Q

Which antidepressant class is LETHAL in overdose? Why?

A

TCAs due to their cardiac effects of ventricular tachycardia and heart block

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55
Q

What mood stabilizer is contraindicated in severe renal or cardiac disease, and nursing mothers?

A

lithium

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56
Q

What anxiety/related disorders is fluoxetine (Prozac) FDA approved for?

A

OCD, panic, PMDD, bulimia

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57
Q

What bipolar episodes is quetiapine (Seroquel) FDA approved for?

A

ALL!!
mania, mixed, maintenance, depression

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58
Q

What is pimavanserin (Nuplazid) indicated for?

A

Parkinson’s psychosis

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59
Q

Which miscellaneous antidepressant can also be used for SAD?

A

bupropion (Wellbutrin)

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60
Q

When can clozapine be considered for non-refractory schizophrenia?

A

patients with suicide risk

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61
Q

What mood stabilizer has a risk of severe acne?

A

lithium

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62
Q

What is the dosing schedule & need for oral overlap for Uzedy?

Generic?

A

every month or 2 mo

N/A

risperidone

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63
Q

Which miscellaneous antidepressant is contraindicated with a Hx of intracranial hemorrhage, or aneurysmal vascular disease?

A

esketamine (Spravato)

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64
Q

What are general class ADR for SNRIs? List 5!

A
  1. increased bleeding risk due to platelet dysfunction
  2. increased BP
  3. hyponatremia
  4. serotonin syndrome
  5. discontinuation syndrome
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65
Q

What antidepressants are more likely to exacerbate mania?

A

TCAs & SNRIs

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66
Q

What is the dosing schedule & need for oral overlap for Aristada?

Generic?

A

every 4, 6 or 8 weeks

21 days or one time Aristada Initio w/ PO dose

aripiprazole

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67
Q

How is zuranolone (Zurzuvae) administered?

A

PO 14 day course taken w/ fat containing food

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68
Q

What is 1st line therapy for PTSD?

A

psychotherapy

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69
Q

Which postpartum depression agent has a BBW for driving impairment due to CNS depression up to 12 hours after admin?

A

zuranolone (Zurzuvae)

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70
Q

What mood stabilizer has cardiac adverse effects & ideally should have a baseline cardiac function before starting?

A

lithium

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71
Q

What 2nd gen antipsychotics are indicated for bipolar (11)?

A
  1. aripiprazole (Abilify)
  2. asenapine (Saphris)
  3. cariprazine (Vraylar)
  4. iloperiodone (Fanapt)
  5. lumateperone (Caplyta)
  6. lurasidone (Latuda)
  7. olanzapine (Zyprexa)
  8. olanzapine + samidorphan (Lybalvi)
  9. quetiapine (Seroquel)
  10. risperidone
  11. ziprasidone
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72
Q

What mood stabilizers are teratogenic?

What would you use in a pregnant patient if you had to?

A

ALL -> lithium, lamotrigine, valproate, carbamazepine

lamotrigine would be lowest risk

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73
Q

What anxiety/related disorders is escitalopram (Lexapro) FDA approved for?

A

GAD

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74
Q

Which Benzo indicated for anxiety is a prodrug?

What does it need for activation?

A

chlorazepate

requires acid in GI for activation

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75
Q

What agent is indicated for acute agitation in adults with schizophrenia & bipolar?

What else can be used for agitation treatment?

A

dexmedetomidine (Igalmi)

IM lorazepam, IM olanzapine

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76
Q

Which four 2nd gen antipsychotics have an indication for MDD augmentation?

A
  1. aripiprazole (Abilify)
  2. brexipiprazole (Rexulti)
  3. olanzapine (Zyprexa) WITH fluoxetine
  4. quetiapine (Seroquel)
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77
Q

What bipolar episodes is risperidone (Risperdal) FDA approved for?

A

mania, maintenance

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78
Q

Which miscellaneous antidepressant increases seizure risk?

A

bupropion (Wellbutrin)

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79
Q

How is brexanolone (Zulresso) administered?

A

continuous IV infusion over 60 hours

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80
Q

What is buspirone FDA approved for?

How should it be used?

A

GAD

NOT a PRN therapy

81
Q

What is the dosing schedule & need for oral overlap for Invega Sustenna?

Generic?

A

every 4 weeks

N/A

paliperidone

82
Q

What is the dosing schedule & need for oral overlap for Invega Hafyera?

Generic?

A

every 6 mo

Need to be on Sustenna or Trinza 1st

paliperidone

83
Q

What mood stabilizers have a risk of weight gain?

A

lithium & valproate

84
Q

What should be done when an acute bipolar episode is under control?

A

D/C adjunct agents ASAP

85
Q

Which antidepressant class is preferred in pregnancy?

86
Q

How long is the washout needed from other antidepressants before starting a MAOI?

Any exceptions?

A

2 weeks

fluoxetine = 5 weeks
vortioxetine = 3 weeks

87
Q

What agents/classes have increase bleeding risk due to platelet dysfunction?

A

SSRI & SNRI

88
Q

Which serotonin modulators are beneficial in anxiety reduction?

A

vortioxetine (Trintellix) & gepirone (Exxua)

89
Q

Which SSRI is favored in eating disorders due to not promoting weight gain?

A

fluoxetine (Prozac)

90
Q

What is the minimum ANC to start clozapine?

91
Q

What does withdrawal syndrome from TCAs look like?

A

cholinergic rebound
- insomnia
- sweating
- abdominal pain
- diarrhea
- myalgias
- nausea

92
Q

Treatment guidelines for mixed episodes:

A

olanzapine +/- fluoxetine

Benzos as short term adjunct

93
Q

Which two 1st gen antipsychotics have the highest risk of EPS?

A

fluphenazine (Prolixin) & haloperidol (Haldol)

94
Q

Which 1st gen antipsychotics are available as LAI?

A

fluphenazine & haloperidol

!!decanoate!!

95
Q

Which AED mood stabilizer has the least sedation/cognitive impairment?

A

lamotrigine

96
Q

What anxiety/related disorders is paroxetine (Paxil) FDA approved for?

A

GAD, OCD, panic, PTSD, PMDD, SAD

97
Q

What mood stabilizer(s) need TSH monitoring?

A

lithium & carbamazepine

98
Q

What mood stabilizer has risk of DRESS?

A

lamotrigine

99
Q

Which SNRI should be avoided in hepatic/renal impairment?

A

duloxetine (Cymbalta)

100
Q

What mood stabilizers only have FDA indication for mania?

A

valproate & carbamazepine

101
Q

Which SSRI is available as a concentrate?

A

sertraline (Zoloft)

102
Q

List the postpartum depression agents:

A
  1. zuranolone (Zurzuvae)
  2. brexanolone (Zulresso)
103
Q

Which serotonin modulator may decrease sexual ADR & weight gain?

A

gepirone (Exxua)

104
Q

What agents/procedures decrease lithium levels?

A

mannitol, caffeine

105
Q

What mood stabilizer has a risk of bone marrow suppression?

A

carbamazepine

106
Q

What are the BBWs for valproate?

A

hepatotoxicity

pancreatitis

teratogenicity

mitochondrial diseases (urea disorders)

107
Q

When is tyramine dietary restriction not necessary for a MAOI?

A

when on initial dose of 6mg for selegiline patch, at higher doses restriction is needed

108
Q

What is the dosing schedule & need for oral overlap for Abilify Asimtufii?

Generic?

A

every 8 weeks

14 day overlap or not needed if on Maintena first

aripiprazole

109
Q

What mood stabilizer(s) need LFT monitoring?

A

lamotrigine, valproate, carbamazepine

110
Q

Which SNRI has an increased risk of BP changes with high doses?

A

venlafaxine (Effexor)

111
Q

What TCA is FDA approved for OCD?

A

clomipramine

112
Q

Which Benzo indicated for anxiety is also used in panic disorder?

A

alprazolam

113
Q

T or F: Mood stabilizers can be used for bipolar depression

A

FALSE none can be used for depression

114
Q

Which 2nd gen antipsychotics are contraindicated in severe hepatic disease?

A

asenapine (Saphris)

115
Q

What mood stabilizer has a risk of hyponatremia?

A

carbamazepine

116
Q

What needs to happen if a patient is on lithium and is receiving ECT?

A

lithium needs to be D/C 2 days before and after ECT

117
Q

What bipolar episodes is olanzapine + fluoxetine (Symvax) FDA approved for?

A

depression

118
Q

Which Benzo indicated for anxiety is long acting and has a risk of misuse due to its euphoric effects?

119
Q

What agent cannot be used concurrently with psychotherapy or CBT?

120
Q

What is the effect of MAO B inhibition?

A

risk of malignant hypertension

121
Q

What bipolar episodes is cariprazine (Vraylar) FDA approved for?

A

mania, mixed, depression

122
Q

What mood stabilizer has a risk of hyperammonemia?

123
Q

Which SNRIs are associated with urinary retention?

A

duloxetine (Cymbalta) & levomilnacipran (Fetzima)

124
Q

What bipolar episodes is asenapine (Saphris) FDA approved for?

A

mania, mixed, maintenance

125
Q

Which SSRI should NOT be used in pregnancy?

A

paroxetine (Paxil)

126
Q

What is the interaction between estrogen contraceptives & lamotrigine?

A

estrogen contraceptives DECREASE lamotrigine levels by 50%

127
Q

What is the dosing schedule & need for oral overlap for Risperidal Contra?

Generic?

A

every 2 weeks

21 day overlap

risperidone

128
Q

What agents/classes have increase bleeding risk due to platelet depletion (thrombocytopenia)?

129
Q

Which four 1st gen antipsychotics have the highest risk of hyperprolactinemia?

A

thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin) & haloperidol (Haldol)

130
Q

Which antipsychotic agent has a BBW for post injection delirium/sedation syndrome?

What monitoring is needed for this agent?

A

olanzapine LAI

3hr post injection w/ access to emergency life support

131
Q

Which postpartum depression agent has a BBW for excessive sedation that requires monitoring & pulse ox?

A

brexanolone (Zulresso)

132
Q

What mood stabilizer has risk of polydipsia & polyuria +/- nephrogenic diabetes insipidus?

133
Q

Which SNRI needs a dose reduction in mild-mod hepatic/renal impairment?

A

venlafaxine (Effexor)

134
Q

What bipolar episodes is ziprasidone (Geodon) FDA approved for?

A

mania, mixed

maintenance WITH Li/VPA

135
Q

Which SNRI is associated with hypotension?

A

duloxetine (Cymbalta)

136
Q

What agents can MASK tardive dyskinesia symptoms?

A

anticholinergics

137
Q

Akathisia:
1. presentation/onset
2. factors increasing risk
3. treatment

think about onset!!! & risk factors :,)

A
  1. restlessness, purposeless movement within hours to days
  2. high potency/dose 1st gens and aripiprazole, risperidone
  3. beta blockers, dec dose or D/C agent
138
Q

Can antidepressants be used as monotherapy in bipolar?

Why or why not?

A

NO can precipitate a manic/mixed episode

139
Q

What are contraindications for Benzos? (6)

A
  1. substance abuse Hx
  2. myasthenia gravis
  3. severe hepatic disease (use OTL)
  4. respiratory disorders
  5. pregnancy/lactation
  6. narrow angle glaucoma
140
Q

Which SSRI has a QT prolongation warning?

A

citalopram (Celexa)

141
Q

What mood stabilizer only has FDA indication for maintenance?

A

lamotrigine

142
Q

What agents are used for autonomic symptoms in SAD?

How should they be used?

A

beta blocker (propranolol, atenolol)

PRN 0.5-1 hr before event

143
Q

Which miscellaneous antidepressant is contraindicated in seizure disorders?

A

bupropion (Wellbutrin)

144
Q

Acute dystonia:
1. presentation/onset
2. factors increasing risk
3. treatment

A
  1. painful prolonged muscle contractions within 24-96 hours
  2. high potency/dose 1st gens and younger men
  3. injectable anticholinergics, IM Benzos, dec dose or D/C agent
145
Q

What is the BBW for lamotrigine?

A

SJS/TEN increased risk w/ valproate or rapid dose escalation

146
Q

Which 2nd gen antipsychotics have an LAI formulation available?

A

aripiprazole, olanzapine, paliperidone, risperidone

147
Q

T or F: desvenlafaxine brands Pristiq and Khedezla are interchangeable.

148
Q

Which 2nd gen antipsychotics are associated with DRESS? What about SJS/TEN?

A

DRESS: olanzapine (Zyrexa) & ziprasidone (Geodon)

SJS/TEN: ziprasidone (Geodon)

149
Q

Which Benzo indicated for anxiety has a long duration and PKPD to oxazepam?

A

chlordiazepoxide

150
Q

(5) List the serotonin modulators indicated for MDD:

A
  1. nefazodone (Serzone)
  2. trazodone (Desyrel)
  3. vilazodone (Viibryd)
  4. vortioxetine (Trintellix)
  5. gepirone (Exxua)
151
Q

Neuroleptic Malignant Syndrome
1. presentation/onset
2. factors increasing risk
3. treatment

A
  1. confusion, increased muscle tone/rigidity, INC CPK!, rapid over 24-72 hours
  2. high potency drugs esp 1st gen LAI, dehydration or other organic brain disorders
  3. D/C agent, rechallenge w/ different agent (clozapine has few reports of NMS)
152
Q

Which serotonin modulator has increased absorption with high fat meals? (keep meals consistent)

A

gepirone (Exxua)

153
Q

What mood stabilizer(s) need CBC w/ diff monitoring?

A

Lithium, lamotrigine, valproate, carbamazepine

154
Q

What is the dosing schedule & need for oral overlap for Rykindo?

Generic?

A

every 2 weeks

7 day overlap

risperidone

155
Q

Serotonin Syndrome presentation:

A

mental status changes, autonomic instability, neuromuscular abnormality, GI symptoms

156
Q

What are the ANC monitoring requirements for clozapine?

A

QW x 6 mo, q2w x 6 mo, then QM after

157
Q

What is the dosing schedule & need for oral overlap for Invega Trinza?

Generic?

A

every 3 mo

Need to be on Sustenna 1st

paliperidone

158
Q

Which Benzo indicated for anxiety can be used in hepatic dysfunction but is slow onset and has a short duration?

A

lorazepam (OTL)

159
Q

What is the indication for esketamine (Spravato)/when can it be used?

A

treatment resistant depression in combo w/ an antidepressant

need to fail 2 other drugs

160
Q

A patient taking lithium has sudden onset of GI ADR, what does this mean?

A

need to check lithium levels could be toxicity

161
Q

(3) List the miscellaneous antidepressant agents:

A
  1. bupropion (Wellbutrin)
  2. mirtazapine (Remeron)
  3. esketamine (Spravato)
162
Q

What mood stabilizers have dose related GI effects?

A

lithium & valproate

163
Q

Treatment guidelines for bipolar maintenance:

A

MONOTHERAPY!!

Lithium, lamotrigine, valproate

2nd gen antipsychotic

COMBO only if needed

164
Q

Which two 2nd gen antipsychotics have the highest risk of hyperprolactinemia?

A

paliperidone (Invega) & risperidone (Risperdal)

165
Q

Tardive Dyskinesia:
1. presentation/onset
2. factors increasing risk
3. treatment

A
  1. tongue thrusting, chewing, lip smacking, grimacing, limb twisting, rocking within months to years (LATE)
  2. high potency/dose 1st gens and older age females
  3. PREVENTION, D/C agent!, benazines used as maintenance therapy but not curative
166
Q

What agents/procedures increase lithium levels?

A

NSAIDs, ACE/ARB, thiazide diuretics

167
Q

Which 2nd gen antipsychotics have a risk of misuse due to euphoric effects?

A

quetiapine (Seroquel)

168
Q

What are general class ADR for SSRIs? List 7!

A
  1. discontinuation syndrome
  2. hyponatremia & SIADH
  3. sexual dysfunction
  4. weight gain
  5. QT prolongation
  6. increased bleeding risk due to platelet dysfunction
  7. serotonin syndrome
169
Q

Which Benzo indicated for anxiety is high potency, has a fast onset and long duration?

A

alprazolam

170
Q

Which Benzos are used short term in bipolar episodes?

A

clonazepam or lorazepam (OTL-good in hepatic dysfunction)

171
Q

What agent is indicated for nightmare treatment in PTSD?

172
Q

Which SNRI is associated with hepatotoxicity?

A

duloxetine (Cymbalta)

173
Q

What is the dosing schedule & need for oral overlap for Erzofri?

Generic?

A

every 4 weeks

N/A

paliperidone

174
Q

Which miscellaneous antidepressant is sedating, stimulates appetite, increases cholesterol and LFTs?

A

mirtazapine (Remeron)

175
Q

Which SSRIs are very anticholinergic & sedating?

A

paroxetine (Paxil)

fluvoxamine (Luvox)

176
Q

What are the BBWs for carbamazepine?

A

SJS/TEN increased risk w/ HLA B 1502

agranulocytosis

177
Q

If a patient is taking lamotrigine and valproate what adjustment is needed?

A

1/2 dose of lamotrigine

178
Q

What SNRIs are FDA approved for GAD?

A

duloxetine (Cymbalta) & venlafaxine (Effexor)

179
Q

Which SSRI is NOT indicated for MDD?

A

fluvoxamine (Luvox)

180
Q

What mood stabilizer has metabolic risk?

181
Q

What mood stabilizer(s) need ECG monitoring?

A

lithium & carbemazepine

182
Q

Which LAI antipsychotics can be used in bipolar? (generic & brands)

A
  1. aripiprazole (Abilify Maintena & Abilfiy Asimtufii)
  2. risperidone (Risperdal Contra & Rykindo)
183
Q

How does lithium effect ANC levels in a patient on clozapine?

A

increases ANC

ANC will drop when lithium is D/C

184
Q

Which 2nd gen antipsychotic has the highest risk of EPS?

A

risperidone (Risperdal)

185
Q

What patients are not ideal for bipolar treatment with lithium?

A

rapid cyclers & mixed states

non-adherent patients

186
Q

Which serotonin modulator needs a dose reduction in poor CYP2D6 metabolizers?

A

vortioxetine (Trintellix)

187
Q

What agent may unmask Brugada syndrome (cardiac malformation)?

188
Q

List the 1st gen antipsychotics (9):

A
  1. thioridazine (Mellaril)
  2. chlorpromazine (Thorazine)
  3. loxapine (Loxitane)
  4. molidone (Moban)
  5. perphenazine (Trifalon)
  6. trifluoperazine (Stelazine)
  7. thiothixene (Navane)
  8. fluphenazine (Prolixin)
  9. haloperidol (Haldol)
189
Q

Which 2nd gen antipsychotics are available as a patch?

A

asenapine (Saphris)

190
Q

What is 1st line therapy for specific phobias?

What happens if 1st line fails?

A

CBT

try paroxetine & Benzos

191
Q

T or F: Benzos relieve both physical and psychiatric symptoms of anxiety

A

FALSE Benzos only improve physical symptoms

192
Q

What mood stabilizer has a risk of alopecia?

193
Q

Treatment guidelines for acute manic & mixed episodes:

A
  1. Li or VPA
  2. 2nd gen antipsychotic
  3. COMBO Li/VPA & 2nd gen

D/C antidepressants if possible

194
Q

What bipolar episodes is aripiprazole (Abilify) FDA approved for?

A

mania, maintenance

195
Q

What mood stabilizer(s) need renal fxn monitoring?

A

Lithium, lamotrigine, valproate, carbamazepine

196
Q

What LAI can be given subQ?

A

Perseris & Uzedy

197
Q

(3) Buspirone pearls:

A
  1. less sedating than Benzos
  2. low potential for abuse
  3. takes 2-4 weeks for full effect
198
Q

Which mood stabilizer is best for bipolar disorder characterized by mixed states and rapid cycling?

Therapeutics (17 decks)

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