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PHARM SHELF AND BOARDS > PSYCHIATRY > Flashcards

PSYCHIATRY Flashcards

1
Q

General drugs for alcohol withdrawal

A

Benzodiazepines

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1
Q

What level of potency do trifluoperazine, fluphenazine, and haloperidol have as typical antipsychotics?

A

high

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1
Q

A schizophrenic pt that has weekly CBC monitoring is most likely taking what drug?

A

clozapine because it causes agranulocytosis

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1
Q

Which SNRI can be used to treat the neuropathic pain of diabetic neuropathy?

A

Duloxetine

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1
Q

Which TCA can be used to Tx bedwetting?

A

Imipramine

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1
Q

Which TCA can be used to Tx OCD?

A

Clomipramine

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1
Q

Name 4 MAOI antidepressants

A

Tranylcypromine, Isocarboxazid, Selegiline, and Phenelzine

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2
Q

Name 5 typical antipsychotics

A

Haloperidol, trifluoperazine, fluphenazine, thioridazine, and chlorpromazine (haloperidol and the zines)

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2
Q

Which drug is known to cause the Ebstein anomaly?

A

lithium

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2
Q

What is the Tx for serotonin syndrome? MOA?

A

Cyproheptadine (5HT2 antagonist)

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3
Q

Which drugs are best for Tourette’s syndrome?

A

antipsychotics (haloperidol and risperidone)

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3
Q

In general, which generation of antipscyhotics is known to 1) Cause EPS and tardive dyskinesia 2) cause weight gain?

A

1) typicals (1st gen) 2) atypicals (2nd gen)

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4
Q

What is the MOA of the typical antipsychotics?

A

Blocks D2 and therefore increases cAMP

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4
Q

Clozapine and Olanzapine are atypical antipsychotics most notorious for causing ______-

A

weight gain (clozapine also causes agranulocytosis)

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4
Q

NaHCO3 is the antidote to OD of which antidepressant?

A

TCA’s–esp to prevent cardiotoxicity

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4
Q

What kind of drug is tranylcypromine?

A

MAO-I antidepressant

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5
Q

What are the major AE of trazodone (4)

A

PRIAPISM (trazoBONE), sedation, nausea, and postural hypotension

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7
Q

2 types of drugs for ADHD

A

amphetamines and methylphenidate

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8
Q

What is the primary endocrine AE of typical antipsychotics?

A

galactorrhea because they block DA and DA is aka prolactin-inhibiting factor

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9
Q

Which drug is a selective MAOB inhibitor?

A

Selegiline

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9
Q

Which drug is an alpha-2 antagonist, and 5HT2 and 5HT3 antagonist?

A

mirtazapine

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10
Q

What is the Tx for TCA overdose?

A

NaHCO3 (alkalinize urine)

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11
Q

What drugs are best for PTSD?

A

SSRIs

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11
Q

What kind of drug is ziprasidone? Major AE?

A

Atypical antipsychotic, QT prolongation

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11
Q

Where can you find tyramine? With which class of drug is it an issue? What happens?

A

Wine and cheese; MAOI’s; HTN crisis

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13
Q

High potency typical antipsychotics primarily have what AE?

A

neurological AE (i.e. EPS and tardive dyskinesia)

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13
Q

What is buspirone used to Tx?

A

Generalized anxiety disorder

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14
Q

Which population is most at risk for seizure on bupropion?

A

Bulimics

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15
Q

What may provoke a HTN crisis in a patient on an MAOI?

A

Tyramine

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16
Q

Which class of drugs can cause HTN crisis if taken with tyramine containing foods?

A

MAOIs

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18
Q

What other indication does bupropion have aside from depression?

A

smoking cessation

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19
Q

What sexual AE are present in bupropion?

A

NONE

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20
Q

Name 2 SNRI’s

A

venlafaxine, duloxetine

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20
Q

Which atypical antidepressant is an alpha-2 antagonist?

A

mirtazapine

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20
Q

Why is mirtazapine preferrable in depressed pts with insomnia?

A

one of its AE is sedation

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21
Q

What is the major AE of clozapine (2)

A

agranulocytosis (weekly CBC monitoring) and weight gain

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23
Q

What atypical antidepressant primarily inhibits serotonin reuptake and is used for insomnia?

A

Trazodone

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24
Q

What is the Tx of neuroleptic malignant syndrome (2)

A

Bromocriptine and Dantrolene

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24
Q

What is the MOA of mirtazapine?

A

Atypical antidepressant that is an alpha-2 antagonist that increases release of NE and serotonin; it also inhibits 5HT2 and 5HT3

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26
Q

What kind of drugs are sertraline and citalopram?

A

SSRIs

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27
Q

What class of drug has a similar MOA to tricyclic antidepressants?

A

SNRI’s, both block reuptake of serotonin and NE

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29
Q

Dantrolene and Bromocriptine are important for the Tx of what?

A

Neuroleptic malignant syndrome (dantrolene for muscle rigidity, and bromocriptine to agonize the antagonized D2 receptors)

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30
Q

MOA of lithium

A

unknown but likely affects the phosphoinositol cascade

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31
Q

Which drugs are best for OCD? (2)

A

SSRI and clomipramine (a TCA)

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31
Q

7 indications for SSRI’s

A

Depression, Generalized Anxiety Disorder, Panic Disorder, OCD, bulimia, social phobias, and PTSD

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32
Q

DOC class for bulimia

A

SSRI

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32
Q

What are 4 AE of mirtazapine?

A

sedation (good for insomnia), increase appetite, wieght gain (good for anorexia), and dry mouth

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34
Q

Which drugs MOA are not completely understood but block 5HT2, D2, and alpha 1 and H1?

A

atypical antipsychotics (2nd Gen)

35
Q

Why do typical antipsychotics take so long to leave the body?

A

They are highly fat soluble

36
Q

Which drugs are best for social phobias?

A

SSRIs

37
Q

What is the MOA of the CNS stimulants: methylphenidate, dextroamphetamine, and methamphetamine?

A

increase catecholamines at the synaptic cleft (NE and DA, in particular)

39
Q

What is the MOA of MAOI’s?

A

Block monoamine oxidase so increase concentration of amine neurotransmitters (NE, DA, and 5HT)

40
Q

What is the MOA of maprotiline?

A

blocks NE reuptake

41
Q

What kind of drugs are olanzapine, clozapine, quetiapine, risperidone, aripiprazole, and ziparasidone?

A

atypical antipsychotics

42
Q

What kind of drugs are fluoxetine, paroxetine, sertraline, and citalopram?

A

SSRIs

43
Q

Which typical antipsychotic causes corneal deposits? Retinal deposits?

A

Chlorpromazine, thioridazine

45
Q

What 5 drugs are CI with MAOIs as it may provoke serotonin syndrome?

A

Meperidine, Dextromethorphan, SSRI, TCA, and St. John’s Wort

46
Q

What 3 disorders can be Tx’d by methylphenidate, dextroamphetamine

A

Narcolepsy, ADHD, and appetite control

47
Q

What atypical antipsychotic causes weight gain and agranulocytosis which requires weekly CBC monitoring?

A

clozapine

49
Q

Which atypical antidepressant increases NE and DA via an unknown mechanism and may cause seizures in bulimics?

A

Buproprion

50
Q

Why do TCAs sometimes cause postural hypotension?

A

alpha-1 blockade

52
Q

Which anxiolytic does NOT interact with alcohol?

A

Buspirone because it is not GABAergic, rather it stimulates 5HT-1A

52
Q

What kind of drug is phenelzine?

A

MAOI antidepressant

53
Q

Which atypical antipsychotic is most likely to cause QT prolongation?

A

Ziprasidone

54
Q

Which sexual dysfunctions may arise with SSRI’s?

A

Anorgasmia and decreased libido

56
Q

What SNRI is also approved for Tx of generalized anxiety and panic disorder?

A

Venlafaxine

58
Q

What is the MOA of the SNRI’s?

A

Block reuptake of BOTH serotonin and norepi

59
Q

What kind of drugs are duloxetine and venlafaxine?

A

SNRI’s

60
Q

What is the MOA of 1) Buspirone and 2) Bupropion

A

1) anxiolytic that stimulates 5HT-1A 2) Atypical antidepressant that increases NE and DA via unknown mechanism

62
Q

Which AE of typical antipsychotics is typically irreversible?

A

Tardive dyskinesia

63
Q

What level potency typical antipsychotics generally have non-neurologic side effects? i.e. anticholinergic, antihistaminergic, and alpha-1 blockade?

A

low potency typical antipsychotics (i.e. chlorpromazine and thioridazine)

65
Q

Name 7 TCA’s

A

Amitryptaline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, and Amoxapine

66
Q

What are the Tri-C’s of TCA toxicity?

A

Convulsions, Comas, and Cardiotoxicity

67
Q

What is the least sedating TCA with the highest seizure threshold?

A

Desipramine

68
Q

What are the low potency typical antipsychotics?

A

Chlorpromazine and thioridazine

69
Q

Which 2 MAOI’s do NOT end in iptyaline or impramine?

A

Doxepin and Amoxapine

70
Q

What kind of drug is selegiline?

A

MAOI antidepressant; also used for Parkinsons (it is a SELECTIVE MAO-B INHIBITOR)

71
Q

How long does it take for antidepressants to have an effect?

A

4-8 weeks

73
Q

What is the caution for using bupropion in bulimics?

A

Can cause seizure; in general it lowers seizure threshold

75
Q

How long does buspirone take to take effect?

A

1-2 weeks (would not use for panic disorder)

76
Q

What are the special uses of the TCA’s: 1) Imipramine and 2) Clomipramine

A

1) Bedwetting (anticholinergic effect) 2) OCD

77
Q

Which psychiatric med has an unestablished MOA but likely affects the phosphoinositol cascade?

A

lithium

78
Q

Which antipsychotics can Tx both positive and negative Sx of schizophrenia

A

2nd gen

79
Q

What receptors do typical antipsychotics block to cause 1) dry mouth and constipation 2) drowsiness 3) hypotension

A

1) muscarinic 2) histaminergic (H1) and 3) alpha 1

81
Q

Which drugs block the D2 receptors (only) and increase cAMP?

A

typical antipsychotics (neuroleptics)

82
Q

Which typical antipsychotic causes corneal deposits?

A

Chlorpromazine

83
Q

MOA of atypical antipsychotics

A

not completely understood but affect 5HT-2, DA, and alpha and H1 receptors

84
Q

Which SNRI has the greatest effect on NE?

A

Duloxetine

85
Q

What kind of drug is isocarboxazid? Isoniazid?

A

MAOI antidepressant; anti-TB drug that blocks mycolic acid synthesis

86
Q

What other indication aside from depression is duloxetine used for?

A

Diabetic peripheral neuropathy (neuropathic pain)

87
Q

Why would you want an EKG for 1 )Lithium 2) Ziprasidone

A

1) Causes heart block (CI in sick sinus syndrome) 2) causes QT prolongation

88
Q

What drugs are indicated for atypical depression, anxiety, and hypochondriasis

A

MAOI

89
Q

Name 4 SSRIs

A

Fluoxetine, paroxetine, sertraline, and citalopram

90
Q

4 signs and symptoms of neuroleptic malignant syndrome

A

rigidity, autonomic instability, hyperpyrexia, and myoglobinuria

91
Q

What fetal cardiac defects are associated with maternal use of lithium when pregnant?

A

Ebstein anomaly and great vessel defects

92
Q

Which drug is best for depression with insomnia?

A

mirtazapine

94
Q

What level of potency do chlorpromazine and thioridazine have as typical antipsychotics?

A

low

96
Q

Which 2 atypical antipsychotics are most likely to cause weight gain?

A

clozapine (and agranulocytosis) and olanzapine

97
Q

What is the most severe AE of SSRI’s?

A

serotonin syndrome

99
Q

Which level of potency typical antipsychotics display primarily neurologic AE?

A

High potency (trifluoperazine, fluphenazine, and haloperidol)

100
Q

Which type of drug causes neuroleptic malignant syndrome?

A

Typical antipsychotics

101
Q

What kind of drugs are tranylcypromine, phenelzine, selegiline, and isocarboxazid?

A

MAOI antidepressants

102
Q

Which atypical antidepressant can cause priapism?

A

trazodone (recall from Rohrbach, the one thing he actually taught us)

103
Q

Which typical antipsychotic causes retinal deposits?

A

Thioridazine

104
Q

With which opioids (2) are MAOI’s contraindicated because it may lead to serotonin syndrome?

A

Meperidine and dextromethorphan

105
Q

What is the major psych use of cyproheptadine?

A

To treat serotonin syndrome

107
Q

What syndrome involves hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea and seizures?

A

Serotonin syndrome

108
Q

What can imipramine be used to Tx aside from major depression?

A

Nocturnal enuresis due to anticholinergic effect

109
Q

What else can clomipramine be used to Tx aside from major depression?

A

OCD

110
Q

Indications for MAOI’s (3)

A

Atypical depression, anxiety, and hypochondriasis

111
Q

What is the most common AE of SNRI’s? Most severe?

A

HTN; serotonin syndrome

112
Q

What are the most common AE of SSRI’s? Most severe?

A

GI distress and Sexual dysfunction (anorgasmia and decreased libido); Serotonin syndrome

113
Q

What is the Tx for neuroleptic malignant syndrome? Serotonin syndrome?

A

NMS = Bromocriptine and Dantrolne; SS = Cyproheptadine

114
Q

What are 4 major AE of lithium?

A

Hypothyroidism, Nephrogenic DI, teratogenic (ebstein anomaly), tremor, and heart block (sick sinus syndrome)

115
Q

Where in the kidney is lithium reabsorbed?

A

PCT (follows Na)

116
Q

Name 6 atypical antipsychotics

A

Quetiapine, olanzapine, clozapine, risperidone, aripiprazole (ablify), ziprasidone

117
Q

What are the AE of TCA’s?

A

Antimuscarinic, Anticholinergic, and Antihistaminergic (Convulsions, Coma, and Cardiotoxicity (Tri-C’s))

118
Q

Which drug, approved for generalized anxiety disorder stimulates 5HT-1A receptors?

A

Buspirone

119
Q

What non-psychiatric condition can lithium be used to Tx?

A

SIADH (because it causes nephrogenic DI)

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