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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
Q

MOA of tricyclic antidepressants

A

Serotonin & Norepinephrine reuptake inhibition. Anti-H1, A1, Muscarinic blockade (Anti-HAM)

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26
Q

Selegiline MOA

A

MAO-B Inhibitor, leading to Increased levels of Dopamine.

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27
Q

What are the C’s of TCA Toxicity

A

Convulsions Seizure
Coma
Cardiotoxicity
Anti-Cholinergic side effects

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28
Q

Method of Lithium reabsorption in the kidney

A

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

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29
Q

Adverse effects of the mood stabilizer Valproate (Depakote)

A

Teratogen (Spina bifida)
Pancreatitis
High Aminotransferases (Liver)
Low Platelets (Thrombocytopenia)
*Agranulocytosis (a more severe neutropenia)
Low Neutrophils (ANC) in <100 cells per microlitre.

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30
Q

What are the Mood Stabilizers used to treat Bipolar Disorder I

A

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)

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31
Q

Treatment of ACTUE MANIA

A

Lithium or Valproate + Quetiapine

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32
Q

What are the HIGH potency antipsychotics

A

Haloperidol (TdP, EKG for QT interval)
Fluphenazine
Trifluoperazine

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33
Q

What are the LOW potency antipsychotics

A

Chlorpromazine (Cornea/skin deposits, Cholestatic Jaundice)

Thioridazine (retina deposits)

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34
Q

What antipsychotic is the most effective, and has least EPS

A

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.

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35
Q

DOC for Anorexia Nervosa

A

Olanzapine

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36
Q

DOC for Escalating Agitation in Acute Mania

A

IM injection of Olanzapine

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37
Q

Atypical with the most EPS

A

Risperidone

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38
Q

Atypical with QT elongation

A

Ziprasidone

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39
Q

MOA of Buspirone

A

Partial Serotonin Agonist (anxiolytic)

40
Q

Serotonin modulators MOA (example: Vortioxetine, Trazodone )

A

SSRI + various serotonin receptor binding

41
Q

Pt who fails trial of 2 SSRIs can be trialed on what alternate 1st line medications

A

Bupropion (NDRI)
Mirtazapine
SNRI
Serotonin Modulators ( Trazodone, Vortioxetine )

42
Q

Signs of Acute Lithium Toxicity

A

N/V/D > Neurological signs

43
Q

Signs of Chronic Lithium Toxicity

A

Lethargy/Confusion/Agitation
Ataxia
Tremor
Fasciculation
Seizure

44
Q

Conditions that precipitate Lithium toxicity

A

Hypovolemic states
Activation of RAAS
Diuretics/NSAIDS/ACE-Inhibitors
Impaired Kidney Function
Impaired excretion

45
Q

Treatment for Lithium Toxicity

A

IV Hydration, Dialysis if severe.

46
Q

Treatment of RLS

A

Mild-Intermittent: Carbidopa-Levodopa
Mild-Daily: Gabapentin (Ca2+ channel Ligand)

47
Q

MOA of Carbidopa-Levodopa

A
  • Increased CNS dopamine levels*
    Carbidopa (prevents peripheral conversion of levodopa to dopamine)
    Levodopa (dopamine precursor)
48
Q

Treatment for Stimulant Intoxication

A

Benzo: Lorazepam
To blunt the effects of increased catecholamine release

49
Q

Treatment for Dystonia

A

Diphenhydramine
Benztropine

50
Q

Non-pharmacological treatment for BPD (Borderline Personality Disorder)

A

Dialectical Behavior Therapy

51
Q

What SSRI is a best choice for cardiac patients

A

Sertraline

52
Q

What SSRIs have the fewest drug-drug interactions

A

Escitalopram (Lexapro) Citalopram (Celexa)
Do NOT inhibit CYP- 450

53
Q

What are the Adverse Effects of Clozapine

A

Agranulocytosis (ANC<100)
Myocarditis
Hyperlipidemia
Seizures

54
Q

Organophosphate Poisoning causes inhibition of what

A

Acetylcholinesterase leading to HIGH levels of AcH in the synapse and over activation of PNS.

55
Q

What is the treatment for Organophosphate Poisoning

A

Atropine (Completive binding at muscarinic inhibitors) to reverse binding of AcH

56
Q

Next Steps with Psychosis in setting of Carbidopa-Levodopa

A

1st: cautious dose reduction
2nd: quetiapine

57
Q

Treatment for Public Speaking Anxiety

A

Beta Blockers (nonselective)
Propranolol
Atenolol
Nadolol

58
Q

Treatment for Specific Phobia

A

CBT: Desensitization (gradual exposure) or Flooding (Immediate exposure)

59
Q

Treatment for Acute Bipolar Depression

A

Atypical: quetiapine or lurasidone
or
Lamotrigine

60
Q

Treatment for Bipolar 2

A

Atypical: quetiapine or lurasidone

61
Q

How long is the “Continuation-phase Treatment”

A

6 months after resolution of symptoms (which usually takes 8 weeks).

  • If remission is maintained for 6 months, taper and gradually discontinue.
62
Q

Effects of Lithium on Thyroid

A

Hyperparathyroidism (>10.2 Serum Ca2+)
Hypothyroid (Increased TSH above 5.0)

63
Q

Treatment for Tourette Disorder

A

Antipsychotics: Haldol/Risperidone
Tetrabenazine
alpha-2 Agonists: Guanfacine/ Clonidine

64
Q

Treatment for Tardive Dyskinesia (like lip smacking or tongue thrusting)

A

Valbenazine
Deutetrabenazine
*Vmat inhibitors prevent release of neurotransmitters in vesicles)

65
Q

Treatment for TCS Overdose

A

Sodium Bicarbonate

66
Q

What is the MOA of Sodium Bicarb in treatment of TCA Toxicity

A

Increase extracellular Na+ to overcome the Sodium Channel Blockade.

67
Q

When should Sodium Bicarb be given in TCA Overdose

A

A QRS duration >100 ms is an indication for bicarbonate therapy in the setting of TCA overdose

68
Q

1st line treatment of ADHD

A

Stimulants:
Methylphenidate(net/dat re-uptake inhibitor)
Amphetamines

69
Q

Methylphenidate MOA

A

non-competitively blocks the reuptake of dopamine and noradrenaline into the terminal by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT)

70
Q

ADHD treatment alternatives

A

Atomoxetine: Norepinephrine RI

Guanfacine/ Clonidine: alpha-2 Agonists

71
Q

Treatment for Acute Stress Disorder

A

CBT
+/- meds for Insomnia or Anxiety

72
Q

1st line treatment for PTSD

A

SSRI (Sertraline/Paroxetine/Fluoxetine)
or
SNRI (Venlafaxine)

73
Q

PTSD w/ Agitation treatment

A

alpha2 agonist: Guanfacine/ Clonidine

74
Q

PTSD w/ nightmares / insomnia

A

alpha1 antagonist: prazosin

75
Q

Treatment for Akathisia (subjective restlessness)

A

Beta Blocker: Propranolol
Benzo: Lorazepam
Benztropine

76
Q

Treatment for Parkinsonism seen as an effect of antipsychotic medications

A

Benztropine: AcH Blocker (antimuscarinic)

Amantadine: weak antagonist of the NMDA-type glutamate receptor, increases dopamine release, and blocks dopamine reuptake.

77
Q

What causes Tardive Dyskinesia

A

Chronic D2 blockade leads to:
D2 receptor upregulation
and Increased Sensitivity

*appear at dose reduction or discontinuation

78
Q

Pt on Haloperidol has Tardive Dyskinesia, what is Next Best Step

A

Stope Haloperidol & Start Atypical

79
Q

What eye pathology is seen in use of Quitiepine

A
80
Q

What short acting Benzos are metabolized by glucuronidation

A

Lorazepam
Oxazepam
Temazepam
(give these 3 in liver dysfunction)

81
Q

Pt with HTN, Tachypnea, Tachycardia, Mydriasis, “Bugs crawling on skin”, What is the overdose and how is it treated

A

Cocaine.
Benzodiazepine
or
phenoxybenzamine/phentolamine (alpha blockers)
or
Carvedilol/Labetalol
(alpha/beta blockers).

82
Q

What mood stabilizer has skin findings that can escalate to SJS

A

Lamotrigine (binds & inhibits Na+ channels)

83
Q

What is the treatment for Narcolepsy

A

Scheduled Naps > Modafinil (indirectly activates Orexin secretion)

84
Q

What medications can cause TdP

A

TCAs
SSRI
Methadone
Ondansetron
Macrolides/Fluoroquinolones

85
Q

Antibiotic associated with Serotonin Syndrome

A

Linezolid

86
Q

Anticholinergic Toxicity 1st Step and Treatment

A

EKG: looking for widened QRS, or prolonged QT interval

Physostigmine: (Acetylcholinesterase Inhibitor) > more AcH in the synapse.

Benzo: for Agitation/Seizure: Lorazepam/Diazepam

87
Q

What are the signs of Anticholinergic Toxicity

A

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
Q

Organophosphate toxicity
= Too Much AcH
=Acetylcholinesterase Inhibitor Overdose

What are the signs and order of treatment

A

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
Q

What is the intoxicant

Agitation
Pin-Point pupils that don’t respond to light
Nystagmus

A

Phencyclidine (PCP)

90
Q

What is the intoxicant

Confusion
FLANKPAIN
Hematuria
AGMA (Gap Acidosis)
*Calcium Oxalate urine crystals

A

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
Q

What is the intoxicant

Confusion
Blurred Vision
AGMA (Gap Acidosis)
History of alcohol use

A

Methanol

92
Q

What class of drugs are used to treat the symptoms of Alzheimer’s (Dementia)

A

** Central Acting **
Acetylcholinesterase Inhibitors > resulting in less breakdown of ACh > Increased ACh at the synapse.

93
Q

What are the three Acetylcholinesterase Inhibitors used to treat Alzheimer’s Dementia

A

Rivastigmine
Donepezil
Galantamine

94
Q

What non-psych drug can improve appetite in hospice patients

A

Megestrol Acetate (a progesterone analog
that spruces the appetite).

95
Q

What SSRIs cause dose dependent QT prolongation

A

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
Q

Pharmacological therapy for Lewy Body Dementia

A

Acetylcholinesterase (AChE) inhibitors

donepezil (Aricept), rivastigmine (Exelon) galantamine (Reminyl)

97
Q

What drugs (MOA)
are use for treatment of Alzheimer’s Dementia

A

Acetylcholinesterase (AChE) inhibitors

donepezil (Aricept), rivastigmine (Exelon) galantamine (Reminyl)

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