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Psychiatry - Pharm Flashcards

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1
Q

Major categories of antidepressants

How often does it work?

Abuse? Mood changes?

A

Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Atypical antidepressants

About 70% of patients with major depression will respond to antidepressant medication.

Antidepressants have no abuse potential and do not elevate mood.

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2
Q

Tx OCD

A

Behavioral tx + Meds
- Exposure and response prevention (ERP)

SSRIs (need higher doses than in depression)
- fluvoxamine**

TCAs
- Clomipramine

Can use amitriptyline if have corresponding pain sydnrome

ECT is last resort

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3
Q

Tx Panic disorder

A
  • SSRIs: paroxetine, sertraline
  • –> need 2-4 weeks for effective, need higher doses than for depression
  • imipramine
  • TCAs, benzos, MAOIs

Tx should last for 8-12 mo at least as relapse common

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4
Q

Tx Dysthymia

A

SSRI

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5
Q

Tx social phobia

A

CBT or SSRI/SNRI (paroxetine) if generalized (frequent) form

Benzo or beta blocker if infrequent occurrence

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6
Q

Tx PTSD

A

SSRIs - help decrease numbing sx
TCA (imipraine, doxepin)
MAOI

Prazosin for nightmares

CBT, support groups, eye mvmt desensitization

AVOID addictive meds (eg benzos) because of high rate of substance abuse in these pts

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7
Q

Tx IBS

A

SSRI

TCA

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8
Q

Tx Enuresis

A

TCA –> imipramine

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9
Q

Tx neuropathic pain

A

TCA

  • amitriptyline
  • nortriptyline

duloxetine

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10
Q

Tx migraine HA

A

TCA
SSRI
Bupropion

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11
Q

Tx smoking cessation

A

Bupropion

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12
Q

Tx autism

A

SSRI

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13
Q

Tx Pmenstrual dysphoric disorder

A

SSRI

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14
Q

Tx Depressive phase of manic depression

A

SSRI

Bupropion

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15
Q

Tx insominia

A

Mirtazapine
TCA

1st line for primary insomnia = benzos!

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16
Q

Tricyclic Antidepressant MoA

Names?

A

—| reuptake of norepi + serotonin

Names (Didnt AC):
Doxepin
Imipramine
Desipramine
Nortriptyline
Triamipramine

Amitriptyline
Clomipramine

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17
Q

TCA least likely to cause orthostatic hypotension

A

Nortriptyline (secondary amine)

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18
Q

TCA least sedating

A

Desipramine (secondary amine)

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19
Q

TCA least anticholinergic effects

A

Desipramine

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20
Q

Hallmark of TCA toxicity

A

Widened QRS (>100msec)

Used as thershold to tx

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21
Q

Tx TCA overdose

A

IV sodium bicarbonate

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22
Q

TCA side effects

A

Anti-HAM (histamine, adrenergic, muscarinic)

Anti histamine:
- Sedation

Anti-adrenergic:

  • Orthostatic hypotension
  • tachycardia
  • arrhythmias

Anti-muscarinic:

  • Dry mouth
  • constipation
  • urinary retention
  • blurred vision
  • tachy
  • Wt gain

Major complications: 3 C’s

  • convulsions
  • coma
  • cardiotoxicity
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23
Q

Monoamine Oxidase Inhibitor MoA

Names?

A

Prevent inactivation of biogenic amines such as norepinephrine, serotonin, dopamine, and tyramine by inhibiting MAOI

Irreversible MAO-A and MAO-B inhibition

Names (PIT):
Phenelzine
Isocarboxazid
Tranylcypromine

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24
Q

MAO-A preferentially deactivates

A

Serotonin

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25
MAO-B preferentially deactivates
Norepinephine | Epinephrine
26
What is MAOI very useful for?
Certain types of refractory depression + refractory panic d/o Atypical depression
27
MAOI side effects
``` Orthostatic hypotension (#1) Drowsiness Wt gain Sex dysfunction Dry mouth Sleep dysfunction ``` Serotonin syndrome Hypertensive crisis
28
How does serotonin syndrome happen? Sx? How to avoid? How to tx?
SSRI + MAOI taken together ``` Sx: Autonomic instability Hyperthermia Seizures Myoclonic jerks ``` ``` Can progress to: Hyperthermia Hypertonicity Rhabdo Renal failure Convulsions Coma Death ``` Avoid: wait 2 weeks before switching from SSRI to MAOI Tx: d/c meds
29
Hypertensive crisis happens...
MAOI + tyramine-rich foods or sympathomimetics Don't have to follow diet restrictions with selegiline patch if low doses but serotonergic drugs must still be avoided ``` Foods w/ tyramine: Red chianti wine Cheese chicken liver fava beans cured meats ``` Sympathomimetics in OTC cold meds! be careful!
30
Selective serotonin reuptake inhibitors (SSRIs) MoA Names
---| PREsynaptic serotonin pumps ``` Names: FLashbacks PARalyze SEnior CITezens ESCargo Fluoxetine, Fluvoxamine Paroxetine Sertraline Citalopram Escitalopram ```
31
SSRI w/ Longest 1/2 life w/ active metabolites
Fluoxetine | - don't need to taper
32
SSRI w/ highest risk GI distrubances
Sertraline
33
SSRI most serotonin specific, most activating
Paroxetine
34
Only SSRI for OCD
Fluvoxamine
35
SSRI Side effects
``` Sex dysfunction GI disturbances Insomnia HA Anorexia, wt loss ``` Serotonin syndrome w/ MAOIs
36
SNRI - names - uses
Venlafaxine - depression - GAD - ADHD Duloxetine - Depression - neuropathic pain
37
S/E SNRI
Like SSRI | Increase BP
38
Bupropion uses
Smoking cessation Seasonal affective disorder ADHD
39
Bupropion S/E
LACK sexual SE Dopaminergic effect in higher doses can exacerbate psychosis Lower seizure threshold NOT OK for: lots of anxiety seizure d/o active eating d/o (b/c electrolyte disturbances make you at risk for seizures)
40
Trazadone uses
refractory major depression major depression w/ anxiety insomnia
41
Trazadone S/E
``` Nausea dizziness orthostatic hypotension cardiac arrhythmias SEDATION PRIAPISM ``` Black box warning - rare but serious liver failure
42
Mirtazapine - mech - uses
a2 presynaptic neuron antagonist 5-HT2 and 5-HT3 receptor blocker H1 receptor blocker Tx refractory major depression, esp if need wt gain
43
Mirtazapine Side effects
``` Sedation Wt gain Dizziness Somnolence Tremor Agranulocytosis ``` It becomes less sedative as you increase dose! This is because it increases Norepi uptake with higher doses
44
Difference between typical and atypical antipsychoatics
typical = block dopamine receptors atypical = blcok dopamine and serotonin receptors
45
Low potency typical antipsychotics
Lower affinity for dopamine receptors - need higher dose Mostly antagonize D2 receptors Have higher incidence of antiCh and antihistamine S/E than high potency Lower incidencey extrapyramidal s/e Chlorpromazine (tx intractable hiccups; SE: orthostatic hypotension, skin discoloration (blue), photosensitivity) Thioridazine
46
High potency typical antipsychotics
Greater affinity for D receptors - lower dose needed Mostly antagonize D2 receptors Higher incidence EPSE and neuroleptic malignant syndrome Lower incidence antiCh and antihistamine s/e (orthostatic hypotension, sedation) Better for negative symptoms of psychosis (eg flattened affect, social W/D) ``` Trifluoperazine Fluphenazine Haloperidol Perphenazine Pimozide (cardiac effects) ```
47
Typical antipsychoatics S/E
1) Anti-dopamine effects - Extrapyramidal s/e (blepharospasm, opisthotomos, torticolis) - happens within days of starting meds; can be life threatening - Parkinsonism (mask-face, cogwheel rigidity, pill rolling tremor) - Akathisia (restlessness) - Dystonia - hyperprolactinemia (decreased libido, impotence) - -> usually with typicals and risperidone 2) Anti-HAM (histamine, adrenergic, muscarinic) effects - sedation - orthostatic hypoTN, cardiac abnormalities, sex dysfunction - dry mouth, tachy, urinary retention, blurry vision, constipation 3. wt gain 4. HIGH LIVER enzymes ---> jaundice 5. Ophtho issues --> retinal pigmentation w/ Thioridazine, lens + corneal deposits w/ chlorpromazine 6. Skin issues --> rash, blue-gray skin color w/ chlorpromazine 7. Sizures 8. Tardive dyskinesia (have to use > 6 mo) 9. Neuroleptic malignant syndrome
48
Reason for tardive dyskinesia
Increase # of dopamine receptors causing lower levels of ACH Choreathetoid muscle mvms, usually of mouth and tongue After YEARS of antipsychotic use (> 6 mo)
49
Neuroleptic malignant syndrome
FALTERED ``` Fever Autonomic instability (tachy, labile HTN, diaphoresis) Leukocytosis Tremor Elevated CPK Rigidity (lead pipe) Excessive sweating Delirium ``` This is a med emergency! 20% mortality Tx: - d/c meds, - supportive care; - dantrolene, bromocriptine, amantadine This is not allergic reaction and is not prevented from restarting same neuroleptic at later time
50
Atypical antipsychotics - MoA - names
Antagonize serotonin (5-HT2) and dopamine receptors Aripiprazole is PARTIAL D2 agonist Should take meds for 4 weeks before efficacy determined ``` Clozapine Risperidone Quetiapine Olanzapine Ziprasidone ```
51
Atypical antipsychotics s/e
Clozapine - agranulocytosis, seizures, tachy, hypersalivation, myocarditis Olanzapine - HLD, glucose intolerance, wt gain, LFT increase (metabolic syndrome!) Quetiapine - cataracts (maybe), sedation, orthostatic hypotension CHECK FOR METABOLIC SYNDROME! Risk of mortality and stroke in elderly (black box warning)
52
Which atypical antipsychotics approved for mania?
``` Quetiapine Ziprasidone olanzapine aripiprazole Risperidone ```
53
Mood stabilizers
Lithium Carbamazepine Valproic acid
54
Lithium uses, MoA
Tx acute mania Ppx manic and depressive episodes in bipolar MoA: - inhibit inositol-1-phosphatase in neurons - metabolized by kidney
55
Factors affecting Li levels
Decreasing: - NSAIDs Increasing: - dehydration - salt deprivation - impaired renal fxn diuretics ASA
56
Lithium S/E
``` Fine tremor sedation ataxia thirst metallic taste polyuria wt gain cardiac arrhythmias alopecia ``` HYPOTHYROIDISM Nephrogenic DI nephrotoxicity Can cause Ebstein's anomaly in 1st trimester
57
Carbamazepine uses as mood stabilizer
Good for: mixed episodes rapid-cyclinc bipolar Trigeminal neuralgia Blocks Na channels and inhibits A/P
58
Carbamazepine S/E
Leukopenia Hyponatremia Aplastic anemia Agranulocytosis inc LFTs NOT ok for preggers (neural tube defects) Autoinducer ``` Toxicity: stupor confusion ataxia tremor nystagmus vomiting ```
59
Valproate uses as mood stabilizer
Mixed manic epi | rapid cycling bipolar
60
Valproate S/E
Hepatotoxicity Thrombocytopenia Neural tube defects in preggers
61
Benzodiazepine MoA
Potentiating effects of GABA - increase action on GABA
62
Long acting benzos - names - uses
Chlordiazepoxide - EtOH detox - presurgery anxiety Diazepam - anxiety - seizure control Clonazepam - panic attacks - anxiety - not ok for renal dysfunction
63
Immediate acting benzos - names - uses
Alprazolam - panic attacks - SHORT onset of action Lorazepam - panic attacks - alcohol w/d - ok for liver dz Oxazepam - EtOH and sedative detox - ok for liver dz Temazepam - insomnia
64
Short acting benzos - names - uses
Triazolam - insomnia Midazolam
65
Benzo S/E
Drowsiness Falls / reduced motor coordination Toxicity: respiratory depression w/ OD
66
Zolpidem Zaleplon Eszopiclone
NOn-benzo hypnotic - short term use for insomnia - bind to benzo 1 site on GABA receptor - no anticonvulsant or muscle relax properties - no w/d - minimal rebound insomnia - little tolerance/dependence SE: anterograde amnesia, hallucinations, sleepwalking
67
Buspirone
Non-benzo anxiolytic Acts at 5HT-1A receptor (partial agonist) slower onset action than benzos For generalized anxiety d/o Low potential for abuse Doesn't potentiate CNS depressino of alcohol
68
Propanolol can be used to tx...
Autonomic effects of panic attacks (palps, diaphoresis, tachy) Akathisia
69
Meds causing psychosis
``` Sympathomimetics analgesics abx (INH) anticholinergic anticonvulsants antihistamines corticosteroids anti-parkinson drugs ```
70
Meds causing agitation/confusion/delirium
May be caused by antipsychotics, antidepressants, antiarrhythmics, antineoplastics, corticosteroids, cardiac glycosides, NSAIDs, antiasthmatics, antibiotics, antihypertensives, antiparkinsonian agents, and thyroid hormones
71
Meds causing depression
antihypertensives, antiparkinsonian agents, corticosteroids, | calcium channel blockers, NSAIDs, antibiotics, and peptic ulcer drugs
72
Meds causing anxiety
sympathomimetics, antiasthmatics, antiparkinsonian | agents, hypoglycemics, NSAIDs, and thyroid hormones
73
Meds causing sedation/ poor ocncentration
antianxiety agents/hypnotics, anticholinergics, antibiotics, | and antihistamines
74
Antipsychotic with highest cardio toxicity
IV haloperidol
75
Non reversible vs reversible MAOIs
Non reversible Isocarboxazide Phenelzine Tranylcypromine Reversible: Selegiline
76
When use clozapine for schizophrenia?
When pt fails both typical and atypical antipsychotics
77
If develop metabolic syndrome from atypical antipsychotic, what do you do?
Switch to 1st gen antipsychotic Switch to 2nd gen weight neutral (aripiprazole or ziprasidone)
78
Tx tardive dyskinesia
Stop meds Clozapine to tx if can't stop meds Maybe: Benzos, beta blockers, cholinomimetics short term
79
Antipsychotic class + EPS risk
Risk related to degree of D2 blockade High potency typicals > low-potency typical antipsychotics Typical antipsychotics > atypical antipsychotics
80
Tx acute stress disorder
CBT Short term benzo for severe distress (<2 wks only)
81
Tx Generalized anxiety disorder
CBT + pharm most effective SSRIs, buspirone, venlafaxine Benzos (clonazepam, diazepam) should be tapered off when possible to avoid dependence
82
Tx SPECIFIC phobia
Pharm NOT effetive Best: Behavior therapy - systemic desensitization is common = gradual exposure of pt to feared object or situation SSRI/SNRI - if freq exposure to stimulus + CBT not available Benzo - if not frequent exposure to stimulus + CBT not available
83
ECT S/E
Amnesia (retro and anterograde - anterograde resolves more rapidly) Prolonged seizures delirium HA Nausea Skin burns
84
Tx alzheimer's disease
Acetylcholinesterase inhibitors - donepezil - rivastigmine - galantamine - tacrine Memantine (NMDA antagonist) - for moderate to severe dementia
85
Which antipsychotics have most s/e of weight gain?
Olanzapine Clozapine
86
How long do you have to wait for SSRI to start working?
4-6 weeks
87
Tx hoarding disorder
SSRI CBT
88
most likely atypical to cause EPS
risperidone
89
S/E methylphenidate
``` Nervousness Loss of appetite Nausea ab pain INsomnia Tachy ``` Long term: Mild growth retardation Wt loss DO NOT USE in children < 6 yo
90
What's approved to tx depressive episodes in bipolar alone or with lithium or valproate?
Lurasidone (Latuda)
91
What can you give schizophrenics that are not compliant with oral meds?
Depot antipsychotics ``` Only ones are: Haloperidol Fluphenazine Risperidone Paliperidone ```
92
Antipsychotic causing most QT prolongation
Ziprasidone
93
Antipsychotic causing hyperprolactinemia
1st gen antipsychotics Risperidone
94
Tx narcolepsy
sleep hygiene schedule daytime naps avoidance of shift work For daytime sleepiness: - amphetamines - methylphenidate - modafinil (#1) - Na oxybate Cataplexy: - Sodium oxybate (#1) - TCAs - imipramine, protriptyline, clomipramine - SSRIs - fluoxetine, fluvoxamine, venlafaxine
95
Tx tourette's syndrome
Education + supporive interventions Pharm if tics impair life: - atypical neuroleptics (risperidone) - alpha 2 agonists (clonidine = #1, guanfacine) - typical neuroleptics for severe Stimulants can exacerbate tics
96
Most activating of SSRIs? Most sedating of SSRIs?
Activating = fluoxetine Sedating = paroxetine
97
DDAVP used to tx
enuresis S/E: mild hyponatremia
98
S/E fluoxetine
GI sx Insomnia Agitation HA
99
Tx enuresis
Behavior modification DDAVP TCAs (imipramine)
100
S/E clonidine
Sedation Contraindicated w/ mirtazapine as antagonistic effects
101
antipsychotic EPS s/e
Acute dystonic reaction Akathisia Drug induced parkinsonism
102
Acute dystonic rxn - sx - tx
Sudden onset sustained contraction of neck, mouth, tongue, eye muscles Greater risk w/ rapid or high dose escalation Tx: Anticholinergic (benztropine) Antihistamine (diphenhydramine) Amantadine
103
Akathisia - sx - tx
Subjective restlessness, inability to sit still Tx: Beta blocker - propanolol
104
Drug induced parkinsonsm - sx - tx
Gradual onset Tremor, rigidity, bradykinesia, masked facies Tx: Anticholinergic Amantadine (D agonist)
105
Who usually ca't tolerate side effects of antidepressant medications?
Elderly Pregnancy women
106
ECT uses
MDD if unresponse to pharmacotherapy, can't tolerate pharm (eg preggers), or if suicide risk - Usually significantly improved after 1st tx Bipolar in preggers and refractory mania
107
What are carbamazepine or valproic acid best for as mood stabilizers?
Rapid cycling bipolar DO Mixed episodes HAVE INCREASED RISK OF SUICIDE
108
Tx adjustment disorder
Supportive psychotherapy most effective Group therapy Pharm for associated sx (insomnia, anxiety, depression)
109
Flumazenil
Short acting BDZ antagonist Use to tx BDZ OD CAUTION! Can precipitate seizures
110
Methadone
Long acting opioid receptor Pros: - 1x / day - gold std for preggers - reduce mortality Cons: - only in substance abuse programs - can cause QTc interval prolongation
111
Buprenorphine
Partial opioid receptor agonist Pros: - sublingual - safer than methadone --> effects reach plateau and OD unlikely Cons: - only via prescrip from office based docs
112
Naltrexone
Competitive opioid antagonist precipitates WD if used within 7d heroin use Pros: - good for highly motivated pts Cons: - compliance issue
113
Tx lewy body dementia
Cholinesterase inhibitors for visual hallucinations Levadopa/carbidopa, dopamine agonists for cognition, apathy, motor sx Atypical neuroleptics to stop delusions and agitation Clonazepam for REM sleep behavior disorder
114
Tx pick disease
Anticholinergic meds Antidepressants Improve behavior but not cognition
115
Tx pseudodementia
Psychotherapy Involve in senior groups Low dose SSRI If need to use TCA --> nortriptyline b/c least amt of antiCh SE Mirtazapine Methylphenidate for psychomotor retardation ECT
116
What can you use to help with sleep in elderly?
Hydroxyzine | Trazodone
117
Tx encopresis
Inital bowel catharsis, then stool softeners if etiology is constipation
118
Tx intermittent explosive disoder
SSRI Anticonvulsants Lithium Propanolol Individual psychotherapy usually not helpful Group therapy may be helpful to create plans to help manage episodes
119
Tx trichotillomania
- SSRIs - antipsychotics - lithium - behavioral interventions
120
Tx anorexia
Outpatient unless: - > 20% below ideal body wt - Hospitalization if dehydration, electrolyte disturbances, or bradycardia Cognitive behavioral therapy Family therapy Nutritional rehab Pharm: - SSRIs - Olanzapine - if no response to above - Benzos before meals to relive anxiety
121
Tx bulimia
Cognitive behavioral therapy (#1) Nutritional rehab SSRI antidepressants 1st line med - fluoxetine Avoid buproprion b/c lower seizure threshold
122
Tx binge eating disorder
- individual psychotherapy + CBT + strict diet and exercise - stimulants to suppress appetite - Orlistat (---| pancreatic lipase --> dec amt of fat absorbed from GI) - Sibutramine ( --| reuptake of norepi, serotonin, dopamine)
123
Pharm tx sexual dysfunciton
Erectile dysfunction - PDE5 inhibitors (sildenafil orally or alprostadil injection) Premature ejaculation - SSRI - TCA Hypoactive sexual desire disorder - Testosterone replacement men + women - estrogen replacement in women
124
HAM side effects
antiHistamine - sedation, wt gain antiAdrenergic - hypotension antiMuscarinic - dry mouth, blurred vision, urinary retention Found in TCAs and low potency antipsychotics
125
``` Comparison of kinesias: Tardive dyskinesia Acute dystonia Akathisia Bradykinesia ```
Tardive dyskinesia - grimacing + tongue protrusion Acute dystonia - twisting + abnormal postures Akathisia - inability to sit still Bradykinesia - decreased or slow body mvmt
126
CYP 450 inhibitors
``` Fluvoxamine Fluoxetine Paroxetine Duloxetine Sertaline ```
127
Withdral phenom of antidepressants
``` Dizziness HA Nausea Insomnia Malaise ```
128
SSRI ok for preggers
Fluoxetine
129
SSRI s/e sleep changes and anxiety
Fluoxetine | Sertraline
130
SSRI more anticholinergic effects
Paroxetine
131
SSRI short half life leading to WD phenomenon if not taken regularly
Paroxetin
132
SSRI fewest drug interactions
Citalopram
133
Amitriptyline uses
Chronic pain Migraines Insomnia
134
Imipramine uses
Enuresis | panic disorder
135
Clomipramine uses
OCD
136
Doxepin uses
Chronic pain | Sleep aid in low dosese
137
Tetracycline antidepressants
Amoxapine - metabolite of antipsychotic loxapine --> can cause EPS Maprotiline - higher rates of seizure, arrhythmia, fatality on OD
138
Antipsychotics with IM forms (decanoate)
Haloperidol | Fluphenazine
139
only antipsychotic shown to decrease risk of suicide
Clozapine
140
only mood stabilizer shown to decrease suicidality
Lithium
141
Check blood levels of...
lithium Valproate carbamazzpine Clozapine
142
Lamotrigine
Good for bipolar depression but not mania Works on Na channels modulating glutamate and aspartate SE: dizziness, sedation, HA, ataxia, SJS
143
Effect of lamotrigine and valproate on each other's levels
Lamotrigine --> dec valproate levels Valproate --> increase lamotrigine levels
144
Gabapentin
Helps with anxiety, sleep Trigeminal neuralgia + neuropathic pain Little efficacy in bipolar but can use
145
Pregabalin
Used in GAD and fibromyalgia Little use in bipolar
146
Tigabine
Helps with anxiety
147
Topiramate
Helps with impulse control disorder and anxiety SE: - wt loss - cognitive slowing
148
Benzos OK for liver dz
LOT Lorazepam Oxazepam Temazepam
149
Diphenhydramine
Non-benzo hypnotic antihistamine ``` SE: sedation dry mouth constipation urinary retention blurry vision ```
150
Chloral hydrate
NOn-benzo hypnotic tolerance and dependence risk Lethal in OD --> hepatic AND liver failure
151
Ramelteon
NOn-benzo hypnotic Selective melatonin MT1 and MT2 agonist No tolerance or dependence Excellent for insomnia - is restorative for sleep SE: Headache NOT OK for - hepatic impairment - severe sleep apnea - severe COPD
152
Hydroxyzine
Non-benzo anxiolytic Antihistamine ``` SE: sedation dry mouth constipation urinary retention blurry vision ``` Quick acting Short term
153
Barbituates
Non-benzo anxiolytic Rarely used b/c of lethality of OD
154
Watch out in: dextroamphetamine Methylphenidate
Dextroamphetamine - BP, wt loss, insomnia Methylphenidate - leukopenia, anemia, LFTs, BP, wt loss, insomnia
155
Meds causing psych sx: - procainamide, quinidine - albuterol - INH - tetracyclines - nifedipine, verapamil - cimetidine - steroids
- procainamide, quinidine = confusion, delirium - albuterol = anxiety, confusion - INH = Psychosis - tetracyclines = depression - nifedipine, verapamil = depression - cimetidine = depression, psychosis - steroids = agitation, hypomania, anxiety, psychosis
156
What is effectiveness of ECT based on?
Length of postictal suppression NOT on seizure duration
157
Uses of ECT
Depression (esp with psychotic features) Acute mania Catatonia --> stop after symptomatic improvement maintenance ECT to prevent relapse of sx
158
ECT contraindications
Recent MI Increased ICP Aneurysms Bleeding disorders Any condition disrupting blood brain barrier
159
Tx aggression or impulsivity
SSRI
160
Med delaying ejaculation
Fluoxetine - also decreases sex drive Perphenazine
161
Meds causing impotence
Propanolol
162
Modafinil
For: - narcolepsy - cataplexy - OSA - shift work sleep DO Increases release of monoamines and elevates hypothalamic histamine levels Pts can develop tolerance to drug
163
Tx nightmare disorder
Imagery rehearsal therapy (IRT) - very good for recurrent nightmares in PTSD - use of mental imagery to modify outcome of recurrent nightmare Prazosin
164
Tx acute dystonia
Benztropine IM Diphenhydramine IM Anticholinergics!!!
165
Rabbit syndrome vs tardive dyskinesia
Rabbit syndrome is an uncommon extrapyramidal neurolepticinduced syndrome often confused with tardive dyskinesia. In this syndrome, the chewing movements are much more rapid and regular than the orofacial choreoathetoid movements typical of tardive dyskinesia. Furthermore, the tongue and other parts of the body are not involved.
166
Tx MAOI OD induced delirium
IV benzos Lorazepam
167
What SSRI can increase carbamazepine levels?
fluoxetine
168
Lithium EKG changes
Lithium often causes T-wave flattening or inversion on ECG, but the changes are usually not clinically significant. Lithium toxicity can cause sinoatrial block, AV block, AV dissociation, bradyarrhythmias, ventricular tachycardia, and ventricular fibrillation.
169
Meds increasing lithium levels
``` Thiazides Diuretics Spironolactone NSAIDs (but not ASA and sulindac) Metronidazole Tetracyclines ACEi ```
170
Which TCA has relativelu less a-1 blocking activity?
Nortriptyline some clinicians prefer it over other tricyclics in the elderly.
171
Med to decrease cravings for EtOH
Naltrexone
172
1st attempt at opioid detox..what do you use?
Clonidine Some centers use methadone for heroin withdrawal but some authors advise against methadone for detoxification in patients who have never detoxified before because of the success of clonidine detoxification.
173
Mood stabilizer with increased risk pancreatitis
Valproate
174
Which SSRI can produce significant withdrawal syndrome in a few days
Paroxetine! It has a very short half life
175
Tx depression and diabetic neuropathy
duloxetine
176
Antidepressants without sexual dysfuction
Mirtazapine Bupropion Nefazodone
177
GABA-A vs GABA-B
GABA-A - EtOH and benzos potentiate GABA-B - site of action of baclofen (muscle relaxant)
178
Antipsychotic with least weight gain
aripiprazole | ziprasidone
179
Risk of mortality with 2nd gen antipsychotics in elderly - what is cause of death?
Strokes
180
Antipsychotic least likely to cause EPS
Clozapine | Quetiapine
181
Antipsychotic most likely to cause akathesia
Aripiprazole
182
2nd generation antipsychotic at risk of causing lens deposits (cataracts)
Quetiapine
183
Tx ADHD
CNS stimulants 1st line - methylphenidate (ritalin, concerta) - dextroamphetamine amphetamine esalts (adderal) Atomoxetine = presynpatic selective NE reuptake ---| Alpha 2 agonists (clonidine, guanfacine) Non-pharm: - family, individual, group psychotherapy - edu interventions can unmask tic disorders but still use even if have tic
184
Tx catatonic depression or schizophrenia
Benzodiazepines ECT if doesn't work
185
Side effect of SSRI that is shared by sx of depression
Insomnia

Psychiatry (9 decks)

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