Psychiatry / psychology Flashcards
Antipsychotic most likely to cause weight gain and hyperglycemia
antidepressant most likely to cause weight gain
Olanzapine
Mirtazapine
Define Neurasthenia
remember “FOG”
Fatigue after mental effort
Overlaps with Chronic fatigue syndrome, depression, and anxiety disorders
General symptoms (dizziness, headache, irritability, insomnia)
SNRI’s
Name 4 and what is unique about them
Sven, Du you mind asking milly to Se_ND_ a Fax about how well these work at high doses
Venlefaxine
Desvenlafaxine
Duloxetine
Milnacipran
Low dose: Serotonin
medium dose: Serotonin + norepeniephrine
High dose: Serotonin + norepinephrine + dopamine
Depressed patient complains of sexual side effects on his prozac.
Whad do you screen for, and what class of drug would you prescribe
Norepinephrine Dopamine Reuptake inhibitors (buproprion)
Lower seizure threshold, so screen for hx of sz
Name the tricyclic antidepressants (TCA)’s
People with rhythm abnormalities CANT DIP into TCA’s due to risk of fatal arrythmias at high doses
Clomipramine
Amitryptiline
Nortriptyline
Trimipramine
Desipramine and Doxepin
Imipramine
Protriptyline
2nd and 3rd generation antipsychotics
“Zip up the tent and cloze your LIPs or Risper quietly, Or you’ll be killed by…._A Rip_per!
Ziprasidone
Clozapine
Lurazidone
Iloperidone
Paliperidone
Risperidone
Quetiapine
Olanzapine
Aripirazole (3rd gen)
Low versus high potentency antipsychotics
“Dr. Thio Promised (3 times) to Rid us of our psychosis, but when things got too Thix, he Dropped his halo and flu away”
Low Potency
- ThioRIDazine
- Chlorphromaxine
- Prochlorpromazine
- Promethazine
High potency
- Thiothixine
- Droperidol
- Haloperidol
- Fluphenazine
Side effects of high potency versus low-potency antipsychotics
Low potency
- Less likely to have
- EPS
- MORE likely to have
- Muscarinic (dry mouth)
- Adrenergic (orthostasis)
- Histaminergic (sedation
High potency
- LESS likely to Musarinic / adrenergic / histaminergic effects
- MORE likely to have EPS
Mnemonic for antipsychotic adverse effects
Does anyone really Think about Psychotic Rabbits?
- Dystonia
- Akinesia
- Rigidity
- Tremors
- Akasthesia
- Pisa Syndrome
- (Twisting of head and neck to one side + tonic trunk flexion to lean like the tower of Pisa)
- Rabbit syndrome
- EPS side effect syndrome by involuntary, fine, rhythmic perioral ~5 Hz tremor (think of a gnawing bunny rabbit)
- NO tongue envolvement
Key points on antipsychotics:
- Most likely to increase prolactin (1)
- Most likely to cause weight gain (2)
- Most likely to prolong QTC (3)
- Most likely to cause orthostatic symptoms (3)
- Must take with food (1)
- most EPS symptoms (2)
- Most likely to increase prolactin
- risperidone
- Most likely to cause weight gain
- Olanzapine
- Clozapine
- Most likely to prolong QTC
- All 1st generation
- Ziprazidone
- Iloperidone
- Most likely to cause orthostatic symptoms
- Chlorpromazine
- Clozapine
- Quetiapine
- Must take with food
- Ziprazidone (if not will decrease bioavailability)
- most EPS symptoms
- high-potency 1st gen
- Risperidol
Patient with treatment resistant depression asks what else can be done about it
What are 3 drugs that are FDA approved and 3 drugs that are NOT for augmentation in depression
FDA approved
Quetiapine
Aripiprazole
Brexpiprazole
NOT FDA approved
Lithium
t3 (liothyroxine)
methylphenadate
Patients with depression have increased metabolism in ___ but decreased meabolism in _____
Hypermetabolism in Orbitofrontal cortex
Hypometabolic: dorsolateral prefrontal complex
You are starting a patient on Lithium
What drugs should you tell them to avoid because it can increase their levels?
think LIthium
DIuretics
Ace Inhibitors
NSAIDs
Angiotencin II inhibitors
Things to keep in mind when starting antidepressants in Patient’s with:
Hypertension (3)
- Hypertension: avoid
- venlafaxine
- buproprion
- maoi’s (if consuming tyramine containing compounds)
Mechanism of action: Selegiline
Inhibition of MAO-B isoform
Note: majority of serotonin is metabolized through MAO-A isoform
Patient with Depression and Gastric ulcers develops anemia
What is likely causing it?
What would change if patient was on warfarin?
SSRI’s (decreased platelet activation and aggregation due to reduction of serotonin in platelets
Fluvoxamine (also an SSRI) can incraese levels of Warfarin and lead to increased bleeding risk
How do neurotransmitter levels change in delirium?
Dopamine
Acetylcholine
Glutamate
Gaba
Serotonin
Melatonin
- Dopamine = Increases nearly 500 fold
- Acetylcholine = Decreased
- Glutamate = increased (less compared to dopamine)
- Gaba increased (only roughly 5 fold)
- Serotonin increased (less compared to dopamine)
- Melatonin: Decreases
Patient prescribes disulfram stopps taking the medicaiton.
What is the half-life of the drug and how long before patient will not have a reaction from drinking?
Half-life 60-120 hours
Time before safe to drink: roughly 2 weeks
Patient with depression is being prescribed pain medication after surgery.
What medications do you want to screen for, and what would it increase risk for?
SSRI’s (combo with Tramadol can result in decreased seizure threshold and increased risk of serotonin syndrome)
Patient with early parkinons disease comes to you because he failed a drug test.
What was he on?
Selegiline (can give false-positive result for methanephetamine)
Depressed patient presents to ED with small laceration needing stitches, ultimately goes into hypertensive crisis
What happened?
What medication was he on?
what other drugs should he avoid (4)
Hypertensive crisis from interaction with MAO-I’s
Avoid:
Meperedine
epinepherine
Local anesthetics (with sympathomimetics; I.e. lidocaine with epi)
Decongestants
how do you treat a constipated patient with anorexia nervosa?
Surfactants (such as docusate)
Stool sofeners
AVOID:
Laxatives, osmotic agents