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Psychology Pharm Flashcards

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1
Q

What is the MOA of Benzodiazepines

A

GABA-A allosteric site agonists (increasing Chloride channel opening frequency) leading to CNS depression

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2
Q

What drug is used in the treatment of Benzodiazepine overdose

A

Flumazenil, competitive GABA-A antagonist (inhibitor)

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3
Q

How to differentiate between Benzo and Opioid overdose (physical sign)

A

Opioid overdose presents with pupillary constriction (miosis).

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4
Q

What benzodiazepines are used to treat EtOH withdraw

A

Long acting Benzo: Diazepam (Valium) and Chlordiazepoxide. Both have long acting active metabolites created in the liver.

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5
Q

What is the treatment for EtOH withdraw in a patient with Liver Disease

A

Short Acting Benzo: Lorazepam IV (Ativan)

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6
Q

IV Benzodiazepines used for Tx of status epilepticus

A

Diazepam (Valium) or Lorazepam (Ativan)

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7
Q

What is the MOA of SSRI

A

Inhibit Serotonin 5-HT transporter, inhibiting re-uptake of serotonin and Increasing serotonin concentration at the synapse.

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8
Q

What SSRI has long acting metabolites, and therefore doesn’t cause discontinuation syndrome

A

Fluoxetine (Prozac)

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9
Q

What SSRI is contraindicated in pregnancy

A

Paroxitine (Paxil)

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10
Q

What SSRI is recommended in pregnancy

A

Sertraline (Zoloft)

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11
Q

SSRIs approved for treatment of OCD

A

Fluvoxamine (Luvox), Sertraline (Zoloft), Fluoxetine (Prozac)

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12
Q

What is the most serious adverse effect of SSRI

A

SIADH: Increased ADH secretion leading to Increased water retention resulting in Hyponatremia (Hypoosmolar serum) and Hyperosmolar urine)

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13
Q

What is the normal range for urine specific gravity

A

(hypoosmolar)1.005 to 1.030 (hyperosmolar)
“If its high, you’re dry!”

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14
Q

What is the differentiating physical sign seen in Serotonin Syndrome compared to Neuroleptic Malignant Syndrome (NMS)

A

Hyperreflexia (ankle clonus)

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15
Q

What is the treatment for Serotonin Syndrome

A

1st line: Diazepam (Valium) or Lorazepam (Ativan) to reduce agitation and stabilize vital signs.

2nd line: Cyproheptadine (5HT-2 Antagonist)

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16
Q

What is the MOA for SNRI

A

Inhibit pre-synaptic reuptake of Norepinephrine & Serotonin (monoamines)

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17
Q

What SNRI is use for the treatment of Fibromyalgia and Osteoarthritis

A

Duloxetine (Cymbalta)

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18
Q

Which antidepressant can cause hypertension

A

SNRI: Venlafaxine (Efexor)

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19
Q

MOA of Bupropion (Welbutrin)

A

Weak NDRI: Norepinephrine and Dopamine reuptake inhibitor (blocks NET/DAT transporters)

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20
Q

Contraindications for Bupropion (Wellbutrin) use

A

Hx of seizure, Hx of eating disorder, Hx of EtOH abuse, Conditions leading to electrolyte imbalance.

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21
Q

MOA of Mirtazapine (Remeron)

A

alpha2 antagonist (Increased Secretion of
Norepinephrine)

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22
Q

MOA of Trazodone (Molipaxin)

A

Serotonin Modulator: SSRI activity + various serotonin receptor binding.

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23
Q

What are the MAOIs and what do they increase

A

Isocarboxazid
Phenelzine
Tranylcypromine

Increase catecholamine and dopamine levels

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24
Q

What are the TCAs

A

secondary amines: better tolerated
Nortriptyline
Desipramine

tertiary amines:
Amitryptyline
Imipramine

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25
MOA of tricyclic antidepressants
Serotonin & Norepinephrine reuptake inhibition. Anti-H1, A1, Muscarinic blockade (Anti-HAM)
26
Selegiline MOA
MAO-B Inhibitor, leading to Increased levels of Dopamine.
27
What are the C's of TCA Toxicity
Convulsions *Seizure* Coma Cardiotoxicity Anti-Cholinergic side effects
28
Method of Lithium reabsorption in the kidney
Mostly resorbed in the PCT via sodium channels. Reabsorption into the Collecting Duct Principal Cells by the ENAC channel leads to Lithium accumulation in the principal cells and reduces or desensitizes the kidney's ability to respond to ADH, leading to Diabetes Insipidus (unable to resorb water) leading to Hyperosmolar serum and Hypoosmolar (dilute) urine. *Urine Specific Gravity will be <1.005
29
Adverse effects of the mood stabilizer Valproate (Depakote)
Teratogen (Spina bifida) Pancreatitis High Aminotransferases (Liver) Low Platelets (Thrombocytopenia) *Agranulocytosis (a more severe neutropenia) Low Neutrophils (ANC) in <100 cells per microlitre.
30
What are the Mood Stabilizers used to treat Bipolar Disorder I
1st Line: Lithium Valproate (Depakote) 2nd Line: Quetiapine (Atypical) Lamotrigine *depressive type* (Inactivates Na+ channels) 3rd Line: Carbamazepine ( binds to Na+ channels in extend inactivated phase, blocking sustained high frequency neuron firing ) (reduces release of glutamate)
31
Treatment of ACTUE MANIA
Lithium or Valproate + Quetiapine
32
What are the HIGH potency antipsychotics
Haloperidol (TdP, EKG for QT interval) Fluphenazine Trifluoperazine
33
What are the LOW potency antipsychotics
Chlorpromazine (Cornea/skin deposits, Cholestatic Jaundice) Thioridazine (retina deposits)
34
What antipsychotic is the most effective, and has least EPS
Clozapine This drug is a last resort and required failure of 2 or more antipsychotic trials. Requires regular monitoring of ANC due to *Agranulocytosis (a more severe neutropenia) Low Neutrophils (ANC) in <100 cells per microlitre.
35
DOC for Anorexia Nervosa
Olanzapine
36
DOC for Escalating Agitation in Acute Mania
IM injection of Olanzapine
37
Atypical with the most EPS
Risperidone
38
Atypical with QT elongation
Ziprasidone
39
MOA of Buspirone
Partial Serotonin Agonist (anxiolytic)
40
Serotonin modulators MOA (example: Vortioxetine, Trazodone )
SSRI + various serotonin receptor binding
41
Pt who fails trial of 2 SSRIs can be trialed on what alternate 1st line medications
Bupropion (NDRI) Mirtazapine SNRI Serotonin Modulators ( Trazodone, Vortioxetine )
42
Signs of Acute Lithium Toxicity
N/V/D > Neurological signs
43
Signs of Chronic Lithium Toxicity
Lethargy/Confusion/Agitation Ataxia Tremor Fasciculation Seizure
44
Conditions that precipitate Lithium toxicity
Hypovolemic states Activation of RAAS *Diuretics/NSAIDS/ACE-Inhibitors* Impaired Kidney Function Impaired excretion
45
Treatment for Lithium Toxicity
IV Hydration, Dialysis if severe.
46
Treatment of RLS
Mild-Intermittent: Carbidopa-Levodopa Mild-Daily: Gabapentin (Ca2+ channel Ligand)
47
MOA of Carbidopa-Levodopa
* Increased CNS dopamine levels* Carbidopa (prevents peripheral conversion of levodopa to dopamine) Levodopa (dopamine precursor)
48
Treatment for Stimulant Intoxication
Benzo: Lorazepam To blunt the effects of increased catecholamine release
49
Treatment for Dystonia
Diphenhydramine Benztropine
50
Non-pharmacological treatment for BPD (Borderline Personality Disorder)
Dialectical Behavior Therapy
51
What SSRI is a best choice for cardiac patients
Sertraline
52
What SSRIs have the fewest drug-drug interactions
Escitalopram (Lexapro) Citalopram (Celexa) Do NOT inhibit CYP- 450
53
What are the Adverse Effects of Clozapine
Agranulocytosis (ANC<100) Myocarditis Hyperlipidemia Seizures
54
Organophosphate Poisoning causes inhibition of what
Acetylcholinesterase leading to HIGH levels of AcH in the synapse and over activation of PNS.
55
What is the treatment for Organophosphate Poisoning
Atropine (Completive binding at muscarinic inhibitors) to reverse binding of AcH
56
Next Steps with Psychosis in setting of Carbidopa-Levodopa
1st: cautious dose reduction 2nd: quetiapine
57
Treatment for Public Speaking Anxiety
Beta Blockers (nonselective) Propranolol Atenolol Nadolol
58
Treatment for Specific Phobia
CBT: Desensitization (gradual exposure) or Flooding (Immediate exposure)
59
Treatment for Acute Bipolar Depression
Atypical: quetiapine or lurasidone or Lamotrigine
60
Treatment for Bipolar 2
Atypical: quetiapine or lurasidone
61
How long is the "Continuation-phase Treatment"
6 months after resolution of symptoms (which usually takes 8 weeks). * If remission is maintained for 6 months, taper and gradually discontinue.
62
Effects of Lithium on Thyroid
Hyperparathyroidism (>10.2 Serum Ca2+) Hypothyroid (Increased TSH above 5.0)
63
Treatment for Tourette Disorder
Antipsychotics: Haldol/Risperidone Tetrabenazine alpha-2 Agonists: Guanfacine/ Clonidine
64
Treatment for Tardive Dyskinesia (like lip smacking or tongue thrusting)
Valbenazine Deutetrabenazine *Vmat inhibitors prevent release of neurotransmitters in vesicles)
65
Treatment for TCS Overdose
Sodium Bicarbonate
66
What is the MOA of Sodium Bicarb in treatment of TCA Toxicity
Increase extracellular Na+ to overcome the Sodium Channel Blockade.
67
When should Sodium Bicarb be given in TCA Overdose
A QRS duration >100 ms is an indication for bicarbonate therapy in the setting of TCA overdose
68
1st line treatment of ADHD
Stimulants: Methylphenidate(net/dat re-uptake inhibitor) Amphetamines
69
Methylphenidate MOA
non-competitively blocks the reuptake of dopamine and noradrenaline into the terminal by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT)
70
ADHD treatment alternatives
Atomoxetine: Norepinephrine RI Guanfacine/ Clonidine: alpha-2 Agonists
71
Treatment for Acute Stress Disorder
CBT +/- meds for Insomnia or Anxiety
72
1st line treatment for PTSD
SSRI (Sertraline/Paroxetine/Fluoxetine) or SNRI (Venlafaxine)
73
PTSD w/ Agitation treatment
alpha2 agonist: Guanfacine/ Clonidine
74
PTSD w/ nightmares / insomnia
alpha1 antagonist: prazosin
75
Treatment for Akathisia (subjective restlessness)
Beta Blocker: Propranolol Benzo: Lorazepam Benztropine
76
Treatment for Parkinsonism seen as an effect of antipsychotic medications
Benztropine: AcH Blocker (antimuscarinic) Amantadine: weak antagonist of the NMDA-type glutamate receptor, increases dopamine release, and blocks dopamine reuptake.
77
What causes Tardive Dyskinesia
Chronic D2 blockade leads to: D2 receptor upregulation and Increased Sensitivity *appear at dose reduction or discontinuation
78
Pt on Haloperidol has Tardive Dyskinesia, what is Next Best Step
Stope Haloperidol & Start Atypical
79
What eye pathology is seen in use of Quitiepine
80
What short acting Benzos are metabolized by glucuronidation
Lorazepam Oxazepam Temazepam (give these 3 in liver dysfunction)
81
Pt with HTN, Tachypnea, Tachycardia, Mydriasis, "Bugs crawling on skin", What is the overdose and how is it treated
Cocaine. Benzodiazepine or phenoxybenzamine/phentolamine (alpha blockers) or Carvedilol/Labetalol (alpha/beta blockers).
82
What mood stabilizer has skin findings that can escalate to SJS
Lamotrigine (binds & inhibits Na+ channels)
83
What is the treatment for Narcolepsy
Scheduled Naps > Modafinil (indirectly activates Orexin secretion)
84
What medications can cause TdP
TCAs SSRI Methadone Ondansetron Macrolides/Fluoroquinolones
85
Antibiotic associated with Serotonin Syndrome
Linezolid
86
Anticholinergic Toxicity 1st Step and Treatment
EKG: looking for widened QRS, or prolonged QT interval Physostigmine: (Acetylcholinesterase Inhibitor) > more AcH in the synapse. Benzo: for Agitation/Seizure: Lorazepam/Diazepam
87
What are the signs of Anticholinergic Toxicity
remember that anti-cholinergic=anti parasympathetic. Therefore, activation of SNS: Mydriasis (dilated pupils) Urinary retention Reduced bowel sounds Dry/Flushed skin Tachycardia Hyperthermia Agitation/Hallucinations
88
Organophosphate toxicity = Too Much AcH =Acetylcholinesterase Inhibitor Overdose What are the signs and order of treatment
Increased saliva and tear production, diarrhea, nausea, vomiting, small pupils, sweating, muscle tremors, and confusion. 1st Atropine 2nd Pralidoxime Injection which re-activates cholinesterase=decreases AcH levels by breaking it down
89
What is the intoxicant Agitation Pin-Point pupils that don't respond to light Nystagmus
Phencyclidine (PCP)
90
What is the intoxicant Confusion FLANKPAIN Hematuria AGMA (Gap Acidosis) *Calcium Oxalate urine crystals
Ethylene Glycol Sodium Bicarb Ethanol Hemodialysis Ethanol: Competitively blocks the formation of toxic metabolites in toxic alcohol ingestion by having a higher affinity for the enzyme Alcohol Dehydrogenase (ADH).
91
What is the intoxicant Confusion Blurred Vision AGMA (Gap Acidosis) History of alcohol use
Methanol
92
What class of drugs are used to treat the symptoms of Alzheimer's (Dementia)
** Central Acting ** Acetylcholinesterase Inhibitors > resulting in less breakdown of ACh > Increased ACh at the synapse.
93
What are the three Acetylcholinesterase Inhibitors used to treat Alzheimer's Dementia
Rivastigmine Donepezil Galantamine
94
What non-psych drug can improve appetite in hospice patients
Megestrol Acetate (a progesterone analog that spruces the appetite).
95
What SSRIs cause dose dependent QT prolongation
Citalopram and escitalopram cause dose dependent QT interval prolongation which can cause life threatening cardiac arrhythmias (especially in the face of hypokalemia and hypomagnesemia) * Should not be prescribed at doses greater than 40 mg for citalopram and 20 mg for escitalopram per day
96
Pharmacological therapy for Lewy Body Dementia
Acetylcholinesterase (AChE) inhibitors donepezil (Aricept), rivastigmine (Exelon) galantamine (Reminyl)
97
What drugs (MOA) are use for treatment of Alzheimer's Dementia
Acetylcholinesterase (AChE) inhibitors donepezil (Aricept), rivastigmine (Exelon) galantamine (Reminyl)

Psychology Shelf (2 decks)

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