Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Psychiatry - Pharm > Flashcards

Psychiatry - Pharm Flashcards

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tx Dysthymia

A

SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx social phobia

A

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

Benzo or beta blocker if infrequent occurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx IBS

A

SSRI

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx Enuresis

A

TCA –> imipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx neuropathic pain

A

TCA

  • amitriptyline
  • nortriptyline

duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx migraine HA

A

TCA
SSRI
Bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx smoking cessation

A

Bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tx autism

A

SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tx Pmenstrual dysphoric disorder

A

SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx Depressive phase of manic depression

A

SSRI

Bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx insominia

A

Mirtazapine
TCA

1st line for primary insomnia = benzos!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tricyclic Antidepressant MoA

Names?

A

—| reuptake of norepi + serotonin

Names (Didnt AC):
Doxepin
Imipramine
Desipramine
Nortriptyline
Triamipramine

Amitriptyline
Clomipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

TCA least likely to cause orthostatic hypotension

A

Nortriptyline (secondary amine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

TCA least sedating

A

Desipramine (secondary amine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TCA least anticholinergic effects

A

Desipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hallmark of TCA toxicity

A

Widened QRS (>100msec)

Used as thershold to tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx TCA overdose

A

IV sodium bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MAO-A preferentially deactivates

A

Serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MAO-B preferentially deactivates

A

Norepinephine

Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is MAOI very useful for?

A

Certain types of refractory depression + refractory panic d/o

Atypical depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MAOI side effects

A 
Orthostatic hypotension (#1)
Drowsiness
Wt gain
Sex dysfunction
Dry mouth
Sleep dysfunction

Serotonin syndrome
Hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does serotonin syndrome happen?

Sx?

How to avoid?

How to tx?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hypertensive crisis happens…

A

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!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Selective serotonin reuptake inhibitors (SSRIs) MoA

Names

A

—| PREsynaptic serotonin pumps

Names:
FLashbacks PARalyze SEnior CITezens ESCargo
Fluoxetine, Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

SSRI w/ Longest 1/2 life w/ active metabolites

A

Fluoxetine

- don’t need to taper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SSRI w/ highest risk GI distrubances

A

Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SSRI most serotonin specific, most activating

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Only SSRI for OCD

A

Fluvoxamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

SSRI Side effects

A 
Sex dysfunction
GI disturbances
Insomnia
HA
Anorexia, wt loss

Serotonin syndrome w/ MAOIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

SNRI

  • names
  • uses
A

Venlafaxine

  • depression
  • GAD
  • ADHD

Duloxetine

  • Depression
  • neuropathic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

S/E SNRI

A

Like SSRI

Increase BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Bupropion uses

A

Smoking cessation
Seasonal affective disorder
ADHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Bupropion S/E

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Trazadone uses

A

refractory major depression
major depression w/ anxiety
insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Trazadone S/E

A 
Nausea
dizziness
orthostatic hypotension
cardiac arrhythmias
SEDATION
PRIAPISM

Black box warning - rare but serious liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Mirtazapine

  • mech
  • uses
A

a2 presynaptic neuron antagonist
5-HT2 and 5-HT3 receptor blocker
H1 receptor blocker

Tx refractory major depression, esp if need wt gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Mirtazapine Side effects

A 
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Difference between typical and atypical antipsychoatics

A

typical = block dopamine receptors

atypical = blcok dopamine and serotonin receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Low potency typical antipsychotics

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

High potency typical antipsychotics

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Typical antipsychoatics S/E

A

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

  1. wt gain
  2. HIGH LIVER enzymes —> jaundice
  3. Ophtho issues –> retinal pigmentation w/ Thioridazine, lens + corneal deposits w/ chlorpromazine
  4. Skin issues –> rash, blue-gray skin color w/ chlorpromazine
  5. Sizures
  6. Tardive dyskinesia (have to use > 6 mo)
  7. Neuroleptic malignant syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Reason for tardive dyskinesia

A

Increase # of dopamine receptors causing lower levels of ACH

Choreathetoid muscle mvms, usually of mouth and tongue

After YEARS of antipsychotic use (> 6 mo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Neuroleptic malignant syndrome

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Atypical antipsychotics

  • MoA
  • names
A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Atypical antipsychotics s/e

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which atypical antipsychotics approved for mania?

A 
Quetiapine
Ziprasidone
olanzapine
aripiprazole
Risperidone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Mood stabilizers

A

Lithium
Carbamazepine
Valproic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Lithium uses, MoA

A

Tx acute mania

Ppx manic and depressive episodes in bipolar

MoA:

  • inhibit inositol-1-phosphatase in neurons
  • metabolized by kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Factors affecting Li levels

A

Decreasing:
- NSAIDs

Increasing:

  • dehydration
  • salt deprivation
  • impaired renal fxn

diuretics
ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Lithium S/E

A 
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Carbamazepine uses as mood stabilizer

A

Good for:
mixed episodes
rapid-cyclinc bipolar

Trigeminal neuralgia

Blocks Na channels and inhibits A/P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Carbamazepine S/E

A

Leukopenia
Hyponatremia
Aplastic anemia
Agranulocytosis

inc LFTs
NOT ok for preggers (neural tube defects)

Autoinducer

Toxicity:
stupor
confusion
ataxia
tremor
nystagmus
vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Valproate uses as mood stabilizer

A

Mixed manic epi

rapid cycling bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Valproate S/E

A

Hepatotoxicity
Thrombocytopenia

Neural tube defects in preggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Benzodiazepine MoA

A

Potentiating effects of GABA - increase action on GABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Long acting benzos

  • names
  • uses
A

Chlordiazepoxide

  • EtOH detox
  • presurgery anxiety

Diazepam

  • anxiety
  • seizure control

Clonazepam

  • panic attacks
  • anxiety
  • not ok for renal dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Immediate acting benzos

  • names
  • uses
A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Short acting benzos

  • names
  • uses
A

Triazolam
- insomnia

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Benzo S/E

A

Drowsiness
Falls / reduced motor coordination

Toxicity: respiratory depression w/ OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Zolpidem
Zaleplon
Eszopiclone

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Buspirone

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Propanolol can be used to tx…

A

Autonomic effects of panic attacks (palps, diaphoresis, tachy)

Akathisia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Meds causing psychosis

A 
Sympathomimetics
analgesics
abx (INH)
anticholinergic
anticonvulsants
antihistamines
corticosteroids
anti-parkinson drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Meds causing agitation/confusion/delirium

A

May be caused by antipsychotics, antidepressants, antiarrhythmics, antineoplastics,
corticosteroids, cardiac glycosides, NSAIDs, antiasthmatics, antibiotics,
antihypertensives, antiparkinsonian agents, and thyroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Meds causing depression

A

antihypertensives, antiparkinsonian agents, corticosteroids,

calcium channel blockers, NSAIDs, antibiotics, and peptic ulcer drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Meds causing anxiety

A

sympathomimetics, antiasthmatics, antiparkinsonian

agents, hypoglycemics, NSAIDs, and thyroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Meds causing sedation/ poor ocncentration

A

antianxiety agents/hypnotics, anticholinergics, antibiotics,

and antihistamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Antipsychotic with highest cardio toxicity

A

IV haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Non reversible vs reversible MAOIs

A

Non reversible
Isocarboxazide
Phenelzine
Tranylcypromine

Reversible:
Selegiline

76
Q

When use clozapine for schizophrenia?

A

When pt fails both typical and atypical antipsychotics

77
Q

If develop metabolic syndrome from atypical antipsychotic, what do you do?

A

Switch to 1st gen antipsychotic

Switch to 2nd gen weight neutral (aripiprazole or ziprasidone)

78
Q

Tx tardive dyskinesia

A

Stop meds

Clozapine to tx if can’t stop meds

Maybe: Benzos, beta blockers, cholinomimetics short term

79
Q

Antipsychotic class + EPS risk

A

Risk related to degree of D2 blockade

High potency typicals > low-potency typical antipsychotics

Typical antipsychotics > atypical antipsychotics

80
Q

Tx acute stress disorder

A

CBT

Short term benzo for severe distress (<2 wks only)

81
Q

Tx Generalized anxiety disorder

A

CBT + pharm most effective

SSRIs, buspirone, venlafaxine

Benzos (clonazepam, diazepam) should be tapered off when possible to avoid dependence

82
Q

Tx SPECIFIC phobia

A

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
Q

ECT S/E

A

Amnesia (retro and anterograde - anterograde resolves more rapidly)

Prolonged seizures

delirium

HA

Nausea

Skin burns

84
Q

Tx alzheimer’s disease

A

Acetylcholinesterase inhibitors

  • donepezil
  • rivastigmine
  • galantamine
  • tacrine

Memantine (NMDA antagonist)
- for moderate to severe dementia

85
Q

Which antipsychotics have most s/e of weight gain?

A

Olanzapine

Clozapine

86
Q

How long do you have to wait for SSRI to start working?

A

4-6 weeks

87
Q

Tx hoarding disorder

A

SSRI

CBT

88
Q

most likely atypical to cause EPS

A

risperidone

89
Q

S/E methylphenidate

A 
Nervousness
Loss of appetite
Nausea
ab pain
INsomnia
Tachy

Long term:
Mild growth retardation
Wt loss

DO NOT USE in children < 6 yo

90
Q

What’s approved to tx depressive episodes in bipolar alone or with lithium or valproate?

A

Lurasidone (Latuda)

91
Q

What can you give schizophrenics that are not compliant with oral meds?

A

Depot antipsychotics

Only ones are:
Haloperidol
Fluphenazine
Risperidone
Paliperidone
92
Q

Antipsychotic causing most QT prolongation

A

Ziprasidone

93
Q

Antipsychotic causing hyperprolactinemia

A

1st gen antipsychotics

Risperidone

94
Q

Tx narcolepsy

A

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
Q

Tx tourette’s syndrome

A

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
Q

Most activating of SSRIs?

Most sedating of SSRIs?

A

Activating = fluoxetine

Sedating = paroxetine

97
Q

DDAVP used to tx

A

enuresis

S/E: mild hyponatremia

98
Q

S/E fluoxetine

A

GI sx
Insomnia
Agitation
HA

99
Q

Tx enuresis

A

Behavior modification

DDAVP

TCAs (imipramine)

100
Q

S/E clonidine

A

Sedation

Contraindicated w/ mirtazapine as antagonistic effects

101
Q

antipsychotic EPS s/e

A

Acute dystonic reaction
Akathisia
Drug induced parkinsonism

102
Q

Acute dystonic rxn

  • sx
  • tx
A

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
Q

Akathisia

  • sx
  • tx
A

Subjective restlessness, inability to sit still

Tx:
Beta blocker - propanolol

104
Q

Drug induced parkinsonsm

  • sx
  • tx
A

Gradual onset
Tremor, rigidity, bradykinesia, masked facies

Tx:
Anticholinergic
Amantadine (D agonist)

105
Q

Who usually ca’t tolerate side effects of antidepressant medications?

A

Elderly

Pregnancy women

106
Q

ECT uses

A

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
Q

What are carbamazepine or valproic acid best for as mood stabilizers?

A

Rapid cycling bipolar DO

Mixed episodes

HAVE INCREASED RISK OF SUICIDE

108
Q

Tx adjustment disorder

A

Supportive psychotherapy most effective

Group therapy

Pharm for associated sx (insomnia, anxiety, depression)

109
Q

Flumazenil

A

Short acting BDZ antagonist

Use to tx BDZ OD

CAUTION! Can precipitate seizures

110
Q

Methadone

A

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
Q

Buprenorphine

A

Partial opioid receptor agonist

Pros:

  • sublingual
  • safer than methadone –> effects reach plateau and OD unlikely

Cons:
- only via prescrip from office based docs

112
Q

Naltrexone

A

Competitive opioid antagonist precipitates WD if used within 7d heroin use

Pros:
- good for highly motivated pts

Cons:
- compliance issue

113
Q

Tx lewy body dementia

A

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
Q

Tx pick disease

A

Anticholinergic meds

Antidepressants

Improve behavior but not cognition

115
Q

Tx pseudodementia

A

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
Q

What can you use to help with sleep in elderly?

A

Hydroxyzine

Trazodone

117
Q

Tx encopresis

A

Inital bowel catharsis, then stool softeners if etiology is constipation

118
Q

Tx intermittent explosive disoder

A

SSRI
Anticonvulsants
Lithium
Propanolol

Individual psychotherapy usually not helpful

Group therapy may be helpful to create plans to help manage episodes

119
Q

Tx trichotillomania

A
  • SSRIs
  • antipsychotics
  • lithium
  • behavioral interventions
120
Q

Tx anorexia

A

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
Q

Tx bulimia

A

Cognitive behavioral therapy (#1)

Nutritional rehab

SSRI antidepressants 1st line med
- fluoxetine

Avoid buproprion b/c lower seizure threshold

122
Q

Tx binge eating disorder

A
  • 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
Q

Pharm tx sexual dysfunciton

A

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
Q

HAM side effects

A

antiHistamine - sedation, wt gain

antiAdrenergic - hypotension

antiMuscarinic - dry mouth, blurred vision, urinary retention

Found in TCAs and low potency antipsychotics

125
Q 
Comparison of kinesias:
Tardive dyskinesia
Acute dystonia
Akathisia
Bradykinesia
A

Tardive dyskinesia - grimacing + tongue protrusion

Acute dystonia - twisting + abnormal postures

Akathisia - inability to sit still

Bradykinesia - decreased or slow body mvmt

126
Q

CYP 450 inhibitors

A 
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertaline
127
Q

Withdral phenom of antidepressants

A 
Dizziness
HA
Nausea
Insomnia 
Malaise
128
Q

SSRI ok for preggers

A

Fluoxetine

129
Q

SSRI s/e sleep changes and anxiety

A

Fluoxetine

Sertraline

130
Q

SSRI more anticholinergic effects

A

Paroxetine

131
Q

SSRI short half life leading to WD phenomenon if not taken regularly

A

Paroxetin

132
Q

SSRI fewest drug interactions

A

Citalopram

133
Q

Amitriptyline uses

A

Chronic pain
Migraines
Insomnia

134
Q

Imipramine uses

A

Enuresis

panic disorder

135
Q

Clomipramine uses

A

OCD

136
Q

Doxepin uses

A

Chronic pain

Sleep aid in low dosese

137
Q

Tetracycline antidepressants

A

Amoxapine
- metabolite of antipsychotic loxapine –> can cause EPS

Maprotiline
- higher rates of seizure, arrhythmia, fatality on OD

138
Q

Antipsychotics with IM forms (decanoate)

A

Haloperidol

Fluphenazine

139
Q

only antipsychotic shown to decrease risk of suicide

A

Clozapine

140
Q

only mood stabilizer shown to decrease suicidality

A

Lithium

141
Q

Check blood levels of…

A

lithium
Valproate
carbamazzpine
Clozapine

142
Q

Lamotrigine

A

Good for bipolar depression but not mania

Works on Na channels modulating glutamate and aspartate

SE: dizziness, sedation, HA, ataxia, SJS

143
Q

Effect of lamotrigine and valproate on each other’s levels

A

Lamotrigine –> dec valproate levels

Valproate –> increase lamotrigine levels

144
Q

Gabapentin

A

Helps with anxiety, sleep

Trigeminal neuralgia + neuropathic pain

Little efficacy in bipolar but can use

145
Q

Pregabalin

A

Used in GAD and fibromyalgia

Little use in bipolar

146
Q

Tigabine

A

Helps with anxiety

147
Q

Topiramate

A

Helps with impulse control disorder and anxiety

SE:

  • wt loss
  • cognitive slowing
148
Q

Benzos OK for liver dz

A

LOT

Lorazepam
Oxazepam
Temazepam

149
Q

Diphenhydramine

A

Non-benzo hypnotic

antihistamine

SE: 
sedation
dry mouth
constipation
urinary retention
blurry vision
150
Q

Chloral hydrate

A

NOn-benzo hypnotic

tolerance and dependence risk

Lethal in OD –> hepatic AND liver failure

151
Q

Ramelteon

A

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
Q

Hydroxyzine

A

Non-benzo anxiolytic

Antihistamine

SE: 
sedation
dry mouth
constipation
urinary retention
blurry vision

Quick acting
Short term

153
Q

Barbituates

A

Non-benzo anxiolytic

Rarely used b/c of lethality of OD

154
Q

Watch out in:
dextroamphetamine
Methylphenidate

A

Dextroamphetamine - BP, wt loss, insomnia

Methylphenidate - leukopenia, anemia, LFTs, BP, wt loss, insomnia

155
Q

Meds causing psych sx:

  • procainamide, quinidine
  • albuterol
  • INH
  • tetracyclines
  • nifedipine, verapamil
  • cimetidine
  • steroids
A
  • procainamide, quinidine = confusion, delirium
  • albuterol = anxiety, confusion
  • INH = Psychosis
  • tetracyclines = depression
  • nifedipine, verapamil = depression
  • cimetidine = depression, psychosis
  • steroids = agitation, hypomania, anxiety, psychosis
156
Q

What is effectiveness of ECT based on?

A

Length of postictal suppression

NOT on seizure duration

157
Q

Uses of ECT

A

Depression (esp with psychotic features)

Acute mania

Catatonia

–> stop after symptomatic improvement
maintenance ECT to prevent relapse of sx

158
Q

ECT contraindications

A

Recent MI

Increased ICP

Aneurysms

Bleeding disorders

Any condition disrupting blood brain barrier

159
Q

Tx aggression or impulsivity

A

SSRI

160
Q

Med delaying ejaculation

A

Fluoxetine - also decreases sex drive

Perphenazine

161
Q

Meds causing impotence

A

Propanolol

162
Q

Modafinil

A

For:

  • narcolepsy
  • cataplexy
  • OSA
  • shift work sleep DO

Increases release of monoamines and elevates hypothalamic histamine levels

Pts can develop tolerance to drug

163
Q

Tx nightmare disorder

A

Imagery rehearsal therapy (IRT)

  • very good for recurrent nightmares in PTSD
  • use of mental imagery to modify outcome of recurrent nightmare

Prazosin

164
Q

Tx acute dystonia

A

Benztropine IM

Diphenhydramine IM

Anticholinergics!!!

165
Q

Rabbit syndrome vs tardive dyskinesia

A

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
Q

Tx MAOI OD induced delirium

A

IV benzos

Lorazepam

167
Q

What SSRI can increase carbamazepine levels?

A

fluoxetine

168
Q

Lithium EKG changes

A

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
Q

Meds increasing lithium levels

A 
Thiazides
Diuretics
Spironolactone
NSAIDs (but not ASA and sulindac)
Metronidazole
Tetracyclines
ACEi
170
Q

Which TCA has relativelu less a-1 blocking activity?

A

Nortriptyline

some clinicians prefer it over other tricyclics in
the elderly.

171
Q

Med to decrease cravings for EtOH

A

Naltrexone

172
Q

1st attempt at opioid detox..what do you use?

A

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
Q

Mood stabilizer with increased risk pancreatitis

A

Valproate

174
Q

Which SSRI can produce significant withdrawal syndrome in a few days

A

Paroxetine!

It has a very short half life

175
Q

Tx depression and diabetic neuropathy

A

duloxetine

176
Q

Antidepressants without sexual dysfuction

A

Mirtazapine
Bupropion
Nefazodone

177
Q

GABA-A vs GABA-B

A

GABA-A
- EtOH and benzos potentiate

GABA-B
- site of action of baclofen (muscle relaxant)

178
Q

Antipsychotic with least weight gain

A

aripiprazole

ziprasidone

179
Q

Risk of mortality with 2nd gen antipsychotics in elderly - what is cause of death?

A

Strokes

180
Q

Antipsychotic least likely to cause EPS

A

Clozapine

Quetiapine

181
Q

Antipsychotic most likely to cause akathesia

A

Aripiprazole

182
Q

2nd generation antipsychotic at risk of causing lens deposits (cataracts)

A

Quetiapine

183
Q

Tx ADHD

A

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
Q

Tx catatonic depression or schizophrenia

A

Benzodiazepines

ECT if doesn’t work

185
Q

Side effect of SSRI that is shared by sx of depression

A

Insomnia

Psychiatry (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions