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Psychiatry > Psychiatric Drugs > Flashcards

Psychiatric Drugs Flashcards

1
Q

What are the HAM side effects?

A

antiHistamine-sedation, weight gain
antiAdrenergic-hypotension
antiMuscarinic-dry mouth, blurred vision, urinary retention

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2
Q

Where are the HAM side effects found?

A

Low potency antipsychotics

TCAs

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3
Q

CYP Inhibitors?

A

Increase drug levels

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4
Q

CYP inhibitors and their corresponding CYP?

A 
Fluvoxamine (1A2, 206, 3A4)
Fluoxetine (2C19, 2C9, 2D6)
Paroxetine (2D6)
Duloxetine (2D6) 
Sertraline(2C19)
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5
Q

CYP Inducers and their corresponding CYP?

A

Smoking (1A2)
Carbamazepine (1A2, 2C9, 3A4)
Barbiturates(2C9)
St. John’s wort (2C19, 3A4)

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6
Q

Most antidepressants require a trial of at least?

A

3-4 weeks for effect

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7
Q

A patient with antidepressants has dizziness, headaches, nausea, insomnia, and malaise. What is this called?

A

Withdrawal phenomenon.

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8
Q

SSRIs are the most commonly prescribed because?

A

Little side effects
No food restrictions
Much safer in overdose

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9
Q

Fluoxetine (Prozac) F’s?

A

Fullest half-life

safe in Full term babies

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10
Q

Sertraline (Zoloft) Main side effect?

A

Certainly GI effects

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11
Q

Paroxetine (Paxil) P’s?

A

Protein bound=> several drug interactions
Puny half-life
More anticholingeric problems=>sedation..

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12
Q

Fluvoxamine (Luvox) is for?

A

OCD

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13
Q

Citalopram (Celexa):

A

cita-LOW-pram

Fewest drug-drug interactions

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14
Q

SSRI AE? (think Blood, Brain, Bowel)

A

Sexual Stopper
GI disturbances
Headache, Seizures, Restlessness
Serotonin Syndrome

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15
Q

What is Serotonin Syndrome?

A

too much serotonin in the brain

Symptoms: fever, diaphoresis, tachycardia, delirium=>death

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16
Q

SSRls should not be used for at least _________ before or after use of an MAOI.

A

2 weeks

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17
Q

Venlafaxine (Effexor) Side effects?

A

Increases BP (Flexes BP)

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18
Q

Duloxetine (Cyrnbalta) use?

A

It DULLs your pain and brain

Neuropathic pain and depression

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19
Q

Bupropion{Wellbutrin) MOA? Use? AE?

A

MOA: NE, D reuptake inhibitor
Use: Less Sexual Side Effects (makes your sexual side effects well)
AE: BUT makes your head RINg (seizures)

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20
Q

Wellbutrin should be decreased in patients who have?

A

Eating Disorder and epilepsy

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21
Q

Trazodone AE?

A

AE: priapism and sedation

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22
Q

Nefazodone AE?

A

Nefarious to Liver

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23
Q

Mirtazapine, Trazodone and Nefazodone are used for?

A

Refractory MDD

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24
Q

Why is Remeron (Mirtazapine) used in the elderly?

A

Remeron helps Sleep (sedation) and appetite (weight gain)

Sleep ON
Weight ON

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25
Q

Tertiary Amines vs Secondary Amines?

A

highly anticholinergic, more sedating, greater lethality in overdose in Tertiary Amines

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26
Q

What are the four tertiary amines?

A

Amitriptyline, lmipramine (Tofranil), Doxepin, Clomipramine

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27
Q

What is Clomipramine used for and why?

A

Clomipramine (Anafranil):

Most serotonin specific, useful in treatment of OCD.

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28
Q

Secondary Amines

A

Nortriptyline
Desipramine

2ND

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29
Q

TCA overdose, Tx?

A

IV sodium bicarb

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30
Q

TCAs side effects?

A

3 C’s
Cardiotoxicity
Convulsions
Coma

31
Q

MAOIs MOA?

A

irreversibly inhibiting the enzymes MAO-A and -B, MAOis increase the number of neurotransmitters available in synapses.

32
Q

MAOa deactivate?

A

ASS

maoA deactivate Serotonin

33
Q

Which MAO does not require dietary restriction?

A

Selegiline

34
Q

For refractory depression, which drugs are effective?

A

MAOIs; for refractory depression-MAO is the best
Phenelzine (Nardil)
Tranylcypromine (Pamate)
Isocarboxazid (Marplan)

35
Q

MAOIs w/SSRI?

A

Serotonin Syndrome

36
Q

MAOIs w/Tyramine

A

Hypertensive Crisis

37
Q

TCAs are 1st line for?

A

imipramine in Enuresis

38
Q

Atypical antipsychotics increase in all causes of?

A

mortality and stroke

39
Q

Both Typical and atypical treat?

A

Positive symptoms

40
Q

Atypical antipsychotics treat?

A

Negative symptoms like flat affect

41
Q

High potency antipsychotics are?

A

High potency: Trifluoperazine, Fluphenazine, Haloperidol (Try to Fly High)

42
Q

Low vs High potency means?

A

low or high on dopamine receptors

43
Q

High Potency more likely?

A

EPS symptoms

44
Q

Low Potency more likely?

A

Non neurologic symptoms

45
Q

Low Potency are?

A

(Cheating Thieves are low)

Chlorpromazine, Thioridazine

46
Q

Low Potency symptoms are?

A

Alpha block: orthostatic hypotension

Bluish skin

47
Q

Thioridazine leads to?

A

reTinal deposits

48
Q

Positive symptoms are due to?

A

Mesolimbic; “hallucinating that I am limping”

49
Q

Negative symptoms are due to?

A

Mesocortical

50
Q

Tx of EPS?

A

Reduce Antipsychotic+Benztropine

51
Q

Symptoms of NMS?

A 
FALTERED
Fever
Autonomic
Leukocytosis
Tremor
Elevated CPK
Rigidity 
Excessive sweating
Delirium
52
Q

Tx of NMS?

A

Supportive+ Dantrolene

53
Q

Clozapine is the only antipsychotic shown to

Lithium is the only mood stabilizer shown to

A

decrease the risk of suicide

54
Q

Clozapine has two AE? What should you watch out for?

A
  1. agranulocytosis
  2. seizures

ANC

55
Q

Risperidone AE?

A

Increased prolactin

56
Q

Atypicals in general have what kind of side effects?

A

Metabolic syndrome and weight gain

57
Q

Therapeutic dose, lethal and toxic dose of lithium?

A
  1. 0.6-1.2
  2. Toxic >1.5
  3. Toxic >2.0
58
Q

NSAIDs do what to lithium?

A

NSAIDs decrease lithium levels (everything else increase)

59
Q

Carbamazepine AE?

A
  1. SJS
  2. aplastic anemia
  3. SIADH
60
Q

Lamotrigine AE?

A

SJS

61
Q

Lamotrigine effective in?

A

Bipolar depression

62
Q

Topomax Benefit vs Risk

A

Benefit: Weight loss (To lose max weight)
Risk: Cognitive slowing

63
Q

Depakote AE?

A

Hepatotoxicity

Hepakote

64
Q

In patients with liver disease and alcoholics, there are a LOT of them to use?

A

Lorazepam
Oxazepam
Temazepam

65
Q

Diazepam (valium) used for?

A

Alcohol detoxification

66
Q

Clonozepam (klonopin)

A

Anxiety

67
Q

D/C the long acting drugs!

A

Diazepam, Clonozepam

68
Q

ALOT of intermediate drugs!

A

Alprazolam
Lorazepam
Oxazepam
Temazepam

69
Q

Zolpidem (Ambien)/zaleplon(Sonata)/eszopiclone (Lunesta): work on BZ?

A

BZ1

70
Q

Ramelteon (Rozerem) works on

A

Selective melatonin MTI and MT2 agonist

71
Q

Buspirone MOA?

A

5HT-1A receptor (partial agonist) for anxiety

72
Q

ECT is treatment of choice in?

A

Patients who are pregos
NMS
Catatonic Schizos
Refractory mania

73
Q

ECT is effective based on?

A

postictal suppression: magnitude drop in EEG at the end.

74
Q

ECT side effect?

A

Amnesia

Psychiatry (10 decks)

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