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MD Psychiatry > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

Atomoxetine s/e

A

GI, weight loss
Headache, dizziness, fatigue, irritability
Priapism, suicidal thinking, mood changes

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2
Q

Pre-clozapine workup

A

CBC
Chem-7
LFTs
HbA1C and Lipid profile
ECG if >40 or risk factors
Weight and vital signs
Pancreatic profile
Prolactin
CK and ESR?

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3
Q

Pre-lithium workup

A

CBC
Chem-10
TSH
Weight and vital signs
HbA1C and lipid profile
b-hCG
ECG if >40 or risk factors

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4
Q

Pre-Epival workup (5ish)

A

CBC
LFTs
HbA1C and lipid profile
Weight and vital signs
b-hCG

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5
Q

Meds with no baseline workup

A

Antidepressants?
Lamotrigine
Benzos

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6
Q

Mirtazapine mechanism of action

A

incr. NE/5HT release via decreased inhibition (blockade of central presynaptic a2 receptors on NE and 5HT2 neurons)
5HT2/3 and H1 antagonist (similar MoA as Mianserin, which is used in Europe)

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7
Q

Trazodone mechanism of action

A

Weak SRI
5HT2A/a1>H1 antagonist

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8
Q

TCAs - the secondary amines

A

Nortriptyline
Desipramine

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9
Q

MAOI safety issues

A

Serotonin syndrome (wait 2 weeks)
Hypertensive crisis (drug-food or drug-drug intxn)
Overdose (only phenelzine, tranylcypromine and isocarboxazid)

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10
Q

Moclobemide mechanism of action

A

Reversible inhibitor of MAO-A (RIMA)

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11
Q

Predictors of good lithium response in mania (7)

A

FHx of lithium response or BAD
Mania-Depr-Euthymia course
No SUD or psychosis or neurological deficits
Minimal comorbidity
Few past episodes
Classic, euphoric mania
Previous lithium response

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12
Q

Predictors of good Epival response in mania (6)

A

Mixed features
Rapid cycling
Multiple previous episodes
Secondary mania
Head trauma
SUD

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13
Q

Predictors of good AAP response in mania (4)

A

Mixed features
Rapid cycling
Young age
Agitation

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14
Q

Psychopharm Tx of FTD

A

NOT AChEI
Trazodone (irritability)
Paroxetine (SSRI in general for impulsivity)

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15
Q

Psychopharm Tx of LBD

A

Rivastigmine (decrease BPSD including hallucinations)
Avoid antipsychotics, but if must, quetiapine or clozapine

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16
Q

Psychopharm for Parkinson’s dementia

A

If no response to AChEI or quetiapine, try clozapine (gold standard)

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17
Q

Psychopharm for vascular dementia

A

No evidence for AChEI, but if must, try Donepezil or Reminyl (galantamine)
DGV

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18
Q

Psychopharm for Alzheimer’s

A

AChEI for mild-mod (donepezil, rivastigmine, galantamine)
Memantine (Ebixa) for mod-sev

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19
Q

Adequate trial of clozapine (3)

A

At least 8, preferably 12 weeks
Dose at least 400mg/d
Trough levels at least 1100 nmol/L (DIE dosing)

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20
Q

5HT precursor

A

Tryptophan

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21
Q

Dopamine precursors (2)

A

Phenylalanine
Tyrosine

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22
Q

Rate-limiting enzyme in 5HT synthesis

A

Tryptophan hydroxylase

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23
Q

Rate-limiting enzyme in DA synthesis

A

Tyrosine hydroxylase

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24
Q

Carbamazepine adverse reactions (7)

A

Rare aplastic anemia
Rare agranulocytosis
Rare SJS/TEN (esp. Asian if HLA-B*1502)
Liver and heart toxicity
SIADH/hyponatremia
Decreased OCP efficacy

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25
Q

Pharm Tx of Serotonin syndrome (3)

A

Cyproheptadine (5HT antagonist)
Dantrolene
BZD

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26
Q

Pharm Tx ish of NMS (5)

A

Bromocriptine (DA agonist)
Dantrolene (muscle relaxant)
Amantadine
BZD
ECT

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27
Q

Foods to avoid while on MAOIs

A

Aged or fermented cheese
Aged or cured meats
Overripe or spoiled foods
Fermented foods
Beer

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28
Q

1A2 substrates (5)

A

Agomelatine
Clozapine
Duloxetine
Olanzapine
Warfarin

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29
Q

2C19 substrates (3)

A

Diazepam
Propranolol
Warfarin

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30
Q

2D6 substrates (7)

A

Abilify
Olanzapine
Risperidone
Tamoxifen
TCAs
Vortioxetine
Venlafaxine (to Pristiq)

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31
Q

3A4 substrates (9)

A

Abilify
Haldol
Levomilnacipran
Lurasidone
Methadone
Mirtazapine
Quetiapine
Risperidone
Vilazodone

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32
Q

Preferred pharmacoTx in HIV + MDD (2)

A

Celexa
Cipralex

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33
Q

Preferred pharmacoTx in MDD with anxious distress

A

GAD treatments (Level 4)
No diff between SSRI/SNRI/Bupropion

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34
Q

Preferred pharmacoTx in MDD with catatonia

A

BZD

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35
Q

Preferred pharmacoTx in MDD with atypical features

A

Old studies: MAOI > TCA

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36
Q

Preferred pharmacoTx in MDD with mixed features (2)

A

Lurasidone (level 2)
Ziprasidone (level 3)

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37
Q

Preferred pharmacoTx in MDD with cognitive dysfunction (3)

A

Vortioxetine (level 1)
Bupropion, duloxetine, SSRI (level 2)
Moclobemide (level 3)

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38
Q

Preferred pharmacoTx in MDD with sleep problems (4)

A

Agomelatine (level 1)
Mirtazapine, quetiapine, Trazodone (level 2)

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39
Q

Preferred pharmacoTx(ish) in MDD and menopause

A

1st line = desvenlafaxine, CBT
2nd line = transdermal estradiol > Citalopram, duloxetine, escitalopram, Mirtazapine, venlafaxine XR, quetiapine XR

40
Q

Preferred pharmacoTx in MDD with AUD (3)

A

1st line =
Mirtazapine
Naltrexone
Naltrexone + Sertraline

41
Q

Preferred pharmacoTx in MDD with ADHD

A

1st line =
Bupropion
AD + long-acting stimulant
AD + CBT

42
Q

Varenicline binding profile

A

a7 full agonist
a4b2, a3b4, a6b2 partial agonist

43
Q

Risk factors for CKD on lithium (6)

A

Higher plasma Li levels
Multiple daily doses
Concurrent meds (NSAIDs, ARBs, ACEis, diuretics)
Somatic illnesses (HTN, DM, CAD)
Older age
Lithium toxicity

44
Q

Heart-safe antipsychotics (2)

A

Lurasidone
Aripiprazole

45
Q

Symptoms of hyperammonemic encephalopathy (3)

A

Confusion
Lethargy
Vomiting

46
Q

Psychopharm(ish) of MDD in pedopsy

A

1st line = CBT or IPT (OR iCBT)
2nd line = Flx (level 1), Celexa and Cipralex and Zoloft (level 2)
3rd line = Effexor or TCAs (if > age 12)

47
Q

1st line for mania in elderly BAD (2)

A

Lithium
DVP

48
Q

1st line for depression in elderly BAD (4)

A

Quetiapine or Lurasidone
Lithium or Lamotrigine

49
Q

Maintenance in elderly BAD (3)

A

Lithium or Lamotrigine (level 2)
DVP (level 3)

50
Q

Pharm Tx for late-life depression (5)

A

Duloxetine (level 1)
Mirtazapine, Sertraline, Venlafaxine, Vortioxetine (level 2)

51
Q

Melatonin precursors (2)

A

Tryptophan
Serotonin

52
Q

Pregabalin binding

A

Binds the alpha-2-delta subunit of voltage-gated Ca channels in the CNS

53
Q

2nd line for mania + mixed features (4)

A

Asenapine
Cariprazine
DVP
Abilify
NOT FGA

54
Q

2nd line for depression + mixed features (2)

A

Cariprazine
Lurasidone
NOT AD

55
Q

Adderall XR duration of action

A

12h

56
Q

Vyvanse duration of action

A

13-14h

57
Q

Biphentin duration of action

A

10-12h

58
Q

Concerta duration of action

A

12h

59
Q

Foquest duration of action

A

13-16h

60
Q

HC-approved meds for insomnia (8)

A

Temazepam, triazolam
Zopiclone, zolpidem, eszopiclone
Doxepin
Lemborexant (orexin receptor antagonist)
Ramelteon (melatonin agonist)

61
Q

Carbamazepine in Mania (5)

A

TBI
Anxiety
Substance use
Schizoaffective (mood-incong del.)
No FHx in 1st-degree relatives

62
Q

When you can safely reduce dose of meds in euthymic BAD

A

6 months

63
Q

Phase 1 metabolism

A

Redox and hydrolysis
CYP450 enzymes

64
Q

Disulfiram MoA

A

Aldehyde dehydrogenase inhibitor
Leads to accumulation of acetaldehyde

65
Q

Universal inducers (3)

A

Carbamazepine
Phenytoin
Rifampin

66
Q

2nd-line adjuncts for OCD (3)

A

Quetiapine
Topiramate
Memantine

67
Q

Phase 2 reactions (3)

A

Conjugation!! Including:
Glucuronidation
Sulfation
Glutathione conjugation

68
Q

Atomoxetine dosing

A

Initial: 0.5mg/kg/day, then 1.2
Max: 1.4mg/kg/day
Doses: 10, 18, 25, 40, 60, 80, 100mg

69
Q

Oculogyric crisis

A

Irregular prolonged deviations of the eyes, usually up and lateral
Lack rhythmicity and slow phases
Most frequently encountered with phenothiazine intoxication

70
Q

Mesolimbic pathway

A

VTA (midbrain) to Limbic system (NAcc)

71
Q

Major 5HT metabolite

A

5-HIAA

72
Q

When to stop a ChEI (5)

A
  1. Clinically meaningful NCD worsening (not due to medical or env’tal)
  2. NO BENEFIT at any time during Tx
  3. Intolerable side effects
  4. Severe or end-stage NCD
  5. Poor adherence (not safe, can’t assess effectiveness)
73
Q

ChEI side effects (5)

A

GI
Sleep
Neuromuscular (cramps + weakness)
Cardiac (Brady, syncope)
Uro (incontinence)

74
Q

Methylphenidate MoA

A

Blocks DA and NE reuptake

75
Q

Amphetamine MoA

A

DA and NE release (also 5HT)
Blocks DA reuptake

76
Q

SCZ relapse risk without meds

A

Doubles within 1-10 days
5x increase after >30 days

77
Q

Theophylline substrate of

A

1A2

78
Q

1st choice of antidepressant in CAD/ACS

A

Sertraline

79
Q

2-OH-estradiol substrate of (2)

A

1A2
3A4

80
Q

Renal failure extends half-life of these psychotropics (9)

A

Venlafaxine XR (and Pristiq)
Mirtazapine
Paroxetine
Bupropion (metabolites)
Risperidone/Paliperidone
Topiramate
Zolpidem

81
Q

Contraindicated in TCA toxicity (2)

A

Physostigmine (ass’d with cardiac arrest)
Flumazenil (lowers seizure threshold)

82
Q

Caffeine in ECT

A

Increased seizure duration

83
Q

Short half-life benzos ass’d with (3)

A

Interdose withdrawal
Rebound anxiety btwn doses
Anterograde amnesia

84
Q

St John’s Wort interactions (2)

A

3A4 inducer
Induces cyclosporine

85
Q

1st line CAM Tx in MDD (3)

A

Exercise (mild-mod) as mono
Light therapy (seasonal) as mono
St. John’s Wort (mild-mod) as mono

86
Q

Best adjuncts in late-life depression (3)

A

Abilify (level 1)
Methylphenidate (level 2)
Lithium (level 3)

87
Q

Citalopram in elderly

A

Max dose of 20mg if age>65

88
Q

PTSD 2nd line (6)

A

Mono: fluvoxamine, phenelzine, mirtazapine
Adjunct: Risperidone, Olanzapine, eszopiclone

89
Q

Vortioxetine mechanism of action

A

SRI
Agonist at 5HT1A
Partial agonist at 5HT1B
Antagonist at 5HT1D, 5HT3A, 5HT7

90
Q

Cholinergic rebound when stopping clozapine (5)

A

Diarrhea
Nausea/Vomiting
Headache
Sweating

91
Q

HIV med causing depressive sxs and SI

A

Efavirenz

92
Q

Augmenting agent in PTSD exposure Tx

A

D-cycloserine

93
Q

Bad anticonvulsant in alcohol w/d

A

Phenytoin

94
Q

Clozapine code yellow

A

WBC < 3.5
or
ANC < 2.0

95
Q

Erythromycin metabolism effects (2)

A

3A4 substrate
3A4 inhibitor

96
Q

Hemodialysis and lithium levels (2)

A

> 2.5 if chronic
4.0 if acute
Or lower if neuro sxs

97
Q

Depression and suicidality with which ASMs?

A

GABAergic ones

MD Psychiatry (5 decks)

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