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Adult boards > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

Haloperidol and ____ used in combo in some patients can cause an encephalopathic syndrome resembling NMS as well as prolong QT interval

A

Lithium

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2
Q

Fluoxetine and paroxetine inhibit __________

A

CPY2D6

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3
Q

_____ has evidence in tx of trichotillomania

A

N-acetylcysteine

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4
Q

Ramelteon MOA is ______, with significant binding to _____. FDA approved for insomnia

A

melatonin receptor agonist; MT1 and MT2

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5
Q

____, a salt of gamma hydroxybutyrate, is thought to improve daytime alertness in narcolepsy

A

Sodium oxybate

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6
Q

___, used for tx of hepatitis C, can induce depressive disorder in 10% to 40% of pts; can also induce mania/hypomania

A

Interferon

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7
Q

Lorazepam, oxazepam and temazepam are primarily metabolized by ___, a capacity maintained even with severe hepatic compromise

A

glucuronidation (phase 2 metabolism)

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8
Q

Alprazolam, clonazepam, diazepam, and triazolam require microsomal oxidation via ___, and are thus subject to metabolism in competition with other substrates and to reduced elimination in the presence of liver disease

A

the cytochrome P450 enzyme system

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9
Q

Concurrent use of ___ can result in lithium toxicity is inhibition of prostaglandin synthesis resulting in vasoconstriction and decreased lithium excretion

A

NSAID’s (ibuprofen)

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10
Q

Valproic acid ___ levels of lamotrigene by ___

A

Increases; inhibition of glucuronidation pathway (3a4)

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11
Q

Cochrane Systematic Review found evidence supporting the use of ___ and ___ for prolonging abstinence from cocaine among cocaine dependent users

A

bupropion and dextroamphetamine

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12
Q

only FDA-approved medication for treatment of psychosis in Parkinson’s disease

A

Pimavanserin

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13
Q

Atomoxetine carries an FDA black box warning in the package insert for increasing risk of which one of the following conditions

A

Suicidal ideation

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14
Q

The manufacturers’ package inserts for clozapine, paliperidone, risperidone, and lurasidone have recommended dosage adjustments based on ___

A

Renal function

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15
Q

Low dose ____ has been shown helpful to improve cancer-related fatigue

A

Methylphenidate

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16
Q

Itraconazole antifungals inhibit hepatic oxidative metabolism via ____

A

CYP 3A4

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17
Q

Fluvoxamine is both a potent inhibitor of the ___ isoform and a substrate for it

A

CYP 1A2

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18
Q

Anti-epileptic medication most often associated with hyponatremia

A

Oxcarbazepine

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19
Q

__ and __ are first-line treatments for Restless Leg Syndrome

A

Dopamine agonists (e.g., pramipexole,) and calcium channel alpha-2-delta antagonists (e.g., gabapentin)

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20
Q

Which combo of meds has the best evidence for maintenance treatment to prevent relapse of MDD following a course of ECT?

A

Nortriptyline and lithium

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21
Q

___ associated photopigmentation/photosensitivity occurs due to an unknown mechanism. It is known to bind to melanin-containing tissues and toxic accumulation over time may lead to photosensitivity

A

Lamotrigene

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22
Q

The risk of developing ___ (of which hirsutism is a common symptom) is increased during treatment with valproic acid

A

polycystic ovary syndrome

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23
Q

Fluoxetine and Paroxetine are strong ___ in comparison to other SSRIs and can inhibit the metabolism of commonly used cardiovascular medications (e.g., S-metoprolol)

A

2D6 inhibitors

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24
Q

___ is the only mediction listed that is FDA approved for sleep initiation and maintenance, having a half life of about 6 hours

A

Eszopiclone (Lunesta)

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25
Q

___ are the only neuroleptic agents in this list that are FDA approved for treatment of Tourette syndrome

A

Pimozide and haloperidol

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26
Q

Mechanism of action of memantine is ___

A

N-methyl-D-aspartate (NMDA) receptor antagonism

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27
Q

Mechanism of action of atomoxetine (Strattera) is ___

A

Selective norepinephrine reuptake inhibitor

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28
Q

Patients with a history of asthma or COPD potentially can experience increased airway reactivity following use of what medications?

A

Cholinesterase inhibitors (donepezil, galantamine, Rivastygmine)

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29
Q

Minimum duration of methadone maintenance treatment should be what length of time?

A

12 months

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30
Q

Treatment for hepatic encephalopathy

A

Lactulose

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31
Q

The exact MOA of valbenazine in the treatment of tardive dyskinesia is not known, but is may be mediated through ___

A

Reversible inhibition of vesicular monoamine transporter 2 (VMAT2)

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32
Q

___, an oxazolidinone antibiotic, has antidepressant effects through mild reversible nonselective inhibition of monoamine oxidase inhibitors. In combo w/ SSRI, there is a documented risk for serotonin syndrome

A

Linezolid

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33
Q

___ is FDA approved for the treatment of narcolepsy with excessive daytime sleepiness and cataplexy. MOA is ___

A

sodium oxybate, a salt of GHB; agonist at GABA-B

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34
Q

NSAIDs act by inhibiting ___, an essential enzyme in the formation of prostaglandins. For individuals with congestive heart failure, ascites, hypovolemia, or chronic renal diseaseconditions which often occur in the elderlyNSAIDs can adversely affect renal blood flow and glomerular filtration rate:

A

cyclooxygenase (COX)

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35
Q

Clozapine metabolism is typically ___ by tobacco smoke causing levels after cessation to be relatively ___

A

induced; increased

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36
Q

The two TCAs with the lowest anticholinergic activity are ___

A

nortriptyline and desipramine

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37
Q

A pregnant female is requesting detoxification from heroin. Assuming good adherence, which treatment for opioid use disorder would be most likely to result in the best maternal outcome and the lowest risk of neonatal abstinence syndrome for the newborn?

A

buprenorphine

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38
Q

Most common adverse effects of naltrexone?

A

nausea (10%), headache (7%)

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39
Q

The dose of acamprosate should be reduced in patients with ___

A

moderate renal impairment

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40
Q

Methadone withdrawal begins ___ after the last dose, and ends in 10 to 14 days. Buprenorphine withdrawal has been observed to peak at about ___ after the last dose and is generally mild, although symptoms may persist for weeks.

A

1-3 days ; 5 days

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41
Q

___, a non-specific 5HT1A and 5HT2A serotonin antagonist, is an FDA-recognized antidote for serotonin syndrome

A

Cyproheptadine

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42
Q

___ is the commonest drug causing hypernatraemia; serum sodium levels as high as 196 mmol/L have been reported

A

Lithium (Li)

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43
Q

Isoenzyme ___ is induced by smoking

A

CYP1A2

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44
Q

___ is an FDA-approved drug for the treatment of delusions and hallucinations associated with Parkinson’s disease psychosis (PDP). It has antagonistic actions at serotonin 5HT2A receptors with a weaker antagonist/inverse agonist actions at 5HT2C receptors

A

Pimvanserin

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45
Q

___ is the first drug approved in the US for the treatment of adults with tardive dyskinesia (TD), and its MOA is ___

A

Valbenazine; reversible vesicular monoamine transporter 2 (VMAT2) inhibitor

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46
Q

Which antipsychotics do not appear to cause consistent, congenital harm to the fetus in pregnant women?

A

Olanzapine

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47
Q

A 23 y/o F is brought to the ED for overdosing on tricyclic antidepressants and is minimally responsive to painful stimuli with seizures and is hypotension. What is the best way to manage this patient?

A

IV sodium bicarbonate, lipid emulsion, and plasmapheresis

48
Q

cytochrome P450 ___ metabolizes about 95% of the caffeine ingested. This enzyme is ___ by fluvoxamine

A

1A2; inhibited

49
Q

___ is the most widely studied drug indicated for cannabis abstinence in adolescents. The drug has shown to reduce cravings and promote abstinence

A

N-acetylcysteine

50
Q

A 79 y.o. female nursing home resident is found unresponsive. Her nephew, who visited that day, is called and admits to giving the patient some ‘generic Benadryl’ for her allergies. Which medication is most likely to reverse the patient’s delirium

A

Physostigmine

51
Q

The mainstay of treatment of lithium-induced nephrogenic diabetes insipidus (polyuria, polydipsia in the setting of low osmolarity urine despite increased plasma osmolality, and a low urine specific gravity) is ___

A

amiloride, a potassium-sparing diuretic

52
Q

What anti-emetic is used to treat post-operative delirium and what is its MOA?

A

Ondansetron - selective serotonin type-receptor 5HT3 antagonist (acts via inhibition of vagal nerves)

53
Q

Which acetylcholinesterase inhibitor is FDA-approved for treatment of anticholinergic delirium?

A

Physostigmine

54
Q

Giving ___ is contraindicated when a person is on an MAOI

A

meperidine

55
Q

MAO of memantine is ___

A

antagonist at NMDA receptors

56
Q

Sumatriptan MOA is ___; Contraindicated in patients with ___

A

serotonin 5-HT1A and 5HT-1B agonist; uncontrolled HTN or coronary ischemic heart disease

57
Q

Benzo’s that are safe for patients with compromised liver functioon (no active metabolites, no need for oxidation by liver)

A

“Lorazepam, Oxazepam, Temazepam (““LOT””)”

58
Q

What two psychotropic medication classes increase TCA levels through interaction with the cytochrome P450 system?

A

Antipsychotics + methylphenidate

59
Q

Psychotropic drug that decreases TCA levels

A

Lithium

60
Q

Adverse effects for this medication include hirsutism in women, facial dysmorphism, and gingival hypertrophy

A

Phenytoin

61
Q

Psychotropic medications contraindicated with levodopa/carbidopa repletion there as they are postsynaptic enzymatic metabolizers of dopamine

A

MAO-A type inhibitors

62
Q

Valproate is a classic inhibitor of ___, which causes inhibition of enzymatic clearance of lamotrigene

A

cytochrome P450 3A4

63
Q

MOA of Ropinirole, used to treat restless legs syndrome

A

Dopamine agonist

64
Q

What antipsychotic inhibits serotonin (5-HT 1A) and norepinephrine reuptake

A

Ziprasidone

65
Q

Treatment of choice for Wilson’s disease

A

Penicillamine

66
Q

Reserpine interferes with Mg and ATP-dependent uptake of biogenic amines, which results in ___. In this way, it can relieve sx of dystonia and also causes depression, sedation, and a Parkinson’s like syndrome

A

depletion of DA, NE, serotonin neurotransmitters

67
Q

Medications that should be stopped prior to ECT

A

Lithium (–> postictal delirium), Clozapine, Bupropion

68
Q

Carbamazepine is an inducer of what CYP450 enzymes?

A

2C19 and 3A4 (auto inducer)

69
Q

MOA for Buspirone

A

full agonist on the serotonin 1A (5HT1A) autoreceptor and as a partial agonist on the postsynaptic 5-HT1A receptor.

70
Q

Tricyclic antidepressants that are secondary amines:

A

Desipramine, Nortriptyline, Protriptyline

71
Q

Tricyclic antidepressants that are tertiary amines:

A

Doxepin, Imipramine, Amitriptyine, Clomipramine, Trimipramine

72
Q

Tricyclic antidepressants are metabolized by ___?

A

CYP 2D6

73
Q

Tricyclic antidepressant used to treat childhood enuresis

A

Imipramine - not v effective

74
Q

___ block peripheral degradation of peripheral levodopa and central degradation of I-DOPA and dopamine, thereby increasing I-DOPA and dopamine levels centrally. Given concomitant with each dose of carbidopa-levodopa throughout the day to improve parkinsonian symptoms

A

Entacapone (Comtan) and Tolcapone (Tasmar) = catechol-O-methyltransferance (COMT) inhibitors

75
Q

___ can be used to treat lithium-induced neprogenic diabetes insipidus

A

Amiloride

76
Q

Drugs that can increase lithium levels

A

ibuprofen, naproxen, ACE inhibitors, thiazide diuretics

77
Q

MOA for Atomoxatine is ___. Useful when trying to treat both tics and ADHD, as it does not worsen the tic condition

A

norepinephrine reuptake inhibition

78
Q

Clonidine’s MOA is ___, reducing the amount of norepinpehrine that is released from the synaptic bouton. THis effect decreases sympathetic tone and bodily arousal and activation

A

presynaptic a2-receptor agonist

79
Q

MOA for sildenafil, vardenafil, and tadalafil

A

phosphodiesterase 5 (PDE5) inhibiton

80
Q

Tricyclic antidepressant that has a metabolite with dopamine-blocking actiity (can possibly cause parkinsonian symptoms)

A

Amoxapine

81
Q

Lithium toxicity occurs at levels above ___. IF the level is above ___, or the patient shows serious signs of toxicity (nephrotoxicity, convulsions, coma), patient must have hemodialysis

A

2.5 mEq/L; 4 mEq/L

82
Q

Meperidine (Demerol) can never be given with ___

A

an MAOI

83
Q

MOA of Bromocriptine, used to treat Parkinson’s

A

mixed dopamine agonist-antagonist

84
Q

Zaleplon (Sonata) has MOA of ___ and half life of ___

A

benzodiazepine receptor agonist; half life 1 hr

85
Q

Of sleeping agents, ___ as half life of about 6 hours, making it most likely to cause next-day drowsiness

A

Eszopiclone (Lunesta)

86
Q

The least anticholinergic of the tricyclic antidepressants

A

Desipramine

87
Q

___ has been shown to be helpful in some cases of Exhibitionistic D/O and can be useful in any sexual disorder in which the patients are extremely hypersexual to the point of being out of control or dangerous

A

Medroxyprogesterone acetate

88
Q

MOA for Gabapentin ___

A

GABA-modulating agent

89
Q

___ is a selective GABA reuptake inhibitor, FDA-approved as an adjunctive treatment for partial complex seizures

A

Tiagabine (Gabitril)

90
Q

MOA for Memantine is ___, used to treat ___

A

NMDA antagonist; moderate to severe Alzheimer’s dementia

91
Q

Benzodiazapines bind to ___ receptors, which is a chloride ion channel

A

GABA-A

92
Q

MOA of Naltrexone

A

opioid antagonist

93
Q

MOA of Methadone

A

opioid agonist

94
Q

MOA of buprenorphine

A

mixed opioid agonist/antagonist mixed opioid agonist/antagonist

95
Q

___ can be used to treat urinary hesitancy or retention in patients having anticholinergic side effects from psychotropics

A

Bethanechol

96
Q

What antibiotic, when given with carbamazepine, causes carbamazepine levels to increase?

A

Erythromycin

97
Q

MOA of triptans (abortive agents for migraines)

A

Agonists at 5-HT 1B and 5-HT 1D receptors

98
Q

FDA approved for treatment of chorea in Huntington’s Disease

A

Tetrabenazine

99
Q

FDA approved for postherpetic neuralgia

A

Gabapentin

100
Q

Liothyronin (Cytomel) can be used as augmenting agent for depressive d/o. It should not be taken by patients with ___

A

cardiac disease, angina, or HTN

101
Q

MOA for Ramelteon (Rozerem)

A

melatonin agonist

102
Q

Differences in metabolism of Risperidone vs Paliperidone

A

Risperdal is hepatically cleared; Paliperidone is 80% metabolized through kidney

103
Q

MOA of Varenicline (Chantix)

A

partial nicotine agonist 4alpha2

104
Q

Treatment for organophosphate insectivide exposure and poisoning

A

IV pralidoxime (accelerates reactivation of inhibited acetylcholinesterase) with atropine (counteracts muscarinic effects)

105
Q

Thiazide diuretic increases ___

A

lithium level

106
Q

MOA of Botulinism toxin

A

blocks release of acetylcholine at neuromuscular junction

107
Q

What benzodiazepines are metabolized via hepativ glucoronidation rather hepatic oxidation?

A

“Lorazepam, Oxazepam, Temazepam (““LOT””)”

108
Q

Carbamazepine has autoinduction of its own metabolism via hepatic ___ enzymes

A

CYP 3A4

109
Q

Most common side effects of donepezil

A

nausea, abdominal cramping

110
Q

___, can be used to treat hypertensive emergencies, most notably due to pheochromocytoma as well as hypertensive crisis 2/2 MAOI. Mechanism of action is ___

A

Phenoxybenzamine, Alpha-blocker

111
Q

For pt on clozapine who develops ANC between ___, the correct action is to stop the clozapine

A

500-999

112
Q

For a pt whose ANC on clozapine is between 1000-1499, you can ___

A

switch to 3x weekly monitoring until it is back above 1500

113
Q

Phenelzine has less _______ than tranylcypromine because tranylcyprome has significant inhibitory effects on the uptake of norepinephrine, dopamine, and serotonin. Phenelzine is more sedating due to the following reasons: It does not stimulate release of norepinephrine and dopamine, it increases levels of GABA, and it has greater H1 antihistaminergic properties.

A

activation

114
Q

_____ of patients treated with lamotrigine develop a benign rash that is non-confluent, non-tender, and spotty, and usually resolves in 10 to 14 days.

A

8-10%

115
Q

Cimetidine has what effect on CYP enzymes?

A

Inhibits CYP 2D6 (leads to higher levels of substrate)

Also inhibits 1A4, 2C19

116
Q

MOA of ondansetron

A

potent 5-HT3 antagonist

117
Q

MOA of metaclopromide

A

D2 antagonist

Adult boards (6 decks)

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