Psychopharm Flashcards
What are the two forms of lithium, and what are they the first-line treatment for?
Lithium carbonate and lithium citrate are the front-line treatment for bipolar disorder.
Clinically, why is it important to ask about ALL medications and changes in medications, not just psychiatric medications?
Because some medications, like hypertension and rheumatoid arthritis medications, can have psychological side effects.
What does sodium pentothal cause?
Unconsciousness
What is the risk of metabolism impairment when it comes to psychopharm?
Drug toxicity (poisoning due to high levels of the drug in the body because it can’t be metabolized correctly) and/or severe side effects
What does Greek descent have to do with psychopharm?
Some people of Greek descent metabolize drugs very quickly, which means they’d see minimal symptom improvement at very high doses.
What are five drugs that contain significant levels of caffeine, and why is that relevant?
Excedrin (pain reliever), Midol (pain reliever), Cafergot (migraines), Fiorinal (tension headaches), Fioricet (tension headaches).
These mimic symptoms of anxiety and panic disorders.
What drug do you need to inquire about in someone with acne and depression/suicidal ideation?
Isotretinoin (Accutane) - can cause depression and SI
What are the two types of drugs used to treat seasonal affective disorder?
SSRIs and MAO inhibitors
How long do most antidepressants take to work?
2-4 weeks
What are 7 drugs that can induce mania?
Amphetamines
Tricyclic antidepressants
SAM-e (osteoarthritis meds and OTC depression meds)
Antihypertensives
Prednisone (corticosteroid)
Anticholinergics (benztropine and trihexyphenidyl)
Levothyroxine (thyroid medication)
If you’re treating bipolar disorder with an antidepressant, what else do you need to do?
Pair it with a mood stabilizing drug (antipsychotic) to avoid inducing mania
Does bipolar disorder respond better to therapy or medication?
Medication, by a lot
What is the one specific phobia that responds well to medication therapy, and why?
Social phobias, due to medications’ ability to mediate parts of our brain that activate to avoid rejection and abandonment
What are 4 non-obvious drugs that can cause anxiety?
Steroids, asthma medications, nasal decongestants, and appetite suppressants
Why is the locus coeruleus relevant for medication treatment for anxiety disorders?
Dysregulation here is thought to be a primary biological cause of anxiety disorders
Why do some people with anxiety disorders self-medicate with opiates?
Opiates bind to the inhibitory receptors on the locus coeruleus, which acts as a natural brake and prevents the locus coeruleus from firing activation signals to the limbic system
What two conditions is gabapentin used to treat?
Seizure disorders and anxiety disorders
If propranolol (Inderal) is taken before a stressful event like a speech, what is its dosage?
10-80mg
What type of drug is propranolol?
Beta blocker
What do beta blockers do?
Prevent increased cardiac action (like a rapid heartrate) and reduce blood pressure
Are benzodiazepines addictive?
Yes, if used for more than a few weeks.
Why is medication treatment contraindicated in neurotic anxiety?
Medication can further block awareness of the underlying psychological conflict
What percentage of patients have a relapse of panic disorder symptoms if they stop medication?
70%
What are the two classes of medications used to treat panic disorder?
Benzodiazepines and antidepressants (specifically MAOIs)
What is the one antidepressant that should never be used to treat panic disorder and why?
Bupropion (Zyban and Wellbutrin), because it has been shown to exacerbate panic attacks
What is the symptom relapse rate for OCD if clients stop taking their medication?
95%
What is the only psychotherapy effective at treating OCD?
Exposure therapy (75-80% success rate after 25 sessions)
What is the % difference in dosing rate for OCD compared to depression?
OCD dosing rates are 50-100% higher - meaning they need more to see an effect
What drugs are most effective at treating OCD?
Antidepressants
What do 5-HT antidepressants do?
Increase the level of serotonin in the brain
What is the relapse rate for schizophrenia symptoms, with and without medication treatment?
70% relapse if they stop meds, 30-40% relapse even on meds
True or false: patients who have been psychotic longer prior to medication treatment have a poorer treatment response.
True
Why are Parkinson’s medications sometimes used for schizophrenia?
To treat the extrapyramidal (movement-based) symptoms of schizophrenia
True or false: beta blockers are sometimes used for schizophrenia because they reduce akathisia.
True.
(Akathisia is an inability to sit still, and it is a common side effect of antipsychotics)
How long is the minimum recommended course of treatment for antipsychotics?
6 months
What drugs are best suited to treat hyperarousal in PTSD patients and why?
Antidepressants because they can inhibit hypersensitive norepinephrine receptors that cause hyperarousal
True or false: treatment with clonidine (Catapres and Kapvay) and beta-blockers immediately following a traumatic event may prevent brain damage from excessive adrenaline levels.
False. They may prevent brain damage due to excessive cortisol and glutamate levels.
What is the recommended antidepressant treatment length for PTSD?
9-12 months
What is the problem with treating PTSD with high doses of benzodiazepines and antipsychotics?
They may chemically induce a state similar to dissociation and prevent the person from accessing and working through the underlying trauma.
Are benzodiazepines an appropriate treatment for borderline personality disorder and why/why not?
No, because borderline patients are at high risk for dependency and abuse.
Should the antidepressant bupropion (Zyban and Wellbutrin) be used in borderline personality disordered patients and why/why not?
No, because bupropion is a dopamine agonist and may exacerbate psychotic symptoms.
Which types of antidepressants are at high risk for toxicity in overdose?
Tricyclic antidepressants and MAO inhibitors
What is the street name for phencyclidine?
PCP (stimulant)
What is the one commonly abused drug type that does not cause withdrawal symptoms or persisting symptoms following cessation of use?
Hallucinogens, specifically PCP
What commonly abused drug does not cause anxiety?
Opioids
What are the only two commonly abused drugs that cause dementia and amensia?
Alcohol and sedative-hypnotics (like benzos)
What is the brand name for disulfiram?
Antabuse
What is the generic name for Antabuse?
Disulfiram
What does disulfiram (Antabuse) do, and what is the appropriate dosing for it?
Encourages alcohol abstinence by causing nausea and vomiting when the person drinks alcohol. Dosage is 250-500mg daily.
What two drugs can reduce alcohol cravings post-detox?
Naltrexone and acamprosate (Campral)
What is the generic name for Campral?
Acamprosate
What is the brand name for acamprosate?
Campral
What can you give someone to reduce their alcohol intoxication?
Multivitamins, specifically those with thiamine and folate
What neurotransmitter system is highly activated during stimulant intoxication?
Dopamine
(Therefore, antipsychotics can reduce acute intoxication)
What is the brand name for propoxyphene?
Darvon
What is the generic name for Darvon?
Propoxyphene
What type of drug is propoxyphene (Darvon)?
Opioid
What is the brand name for meperidine?
Demerol
What is the generic name for Demerol?
Meperidine
What type of drug is meperidine (Demerol)?
Opioid
What is the brand name for pentazocine?
Talwin
What is the generic name for Talwin?
Pentazocine
What type of drug is pentazocine (Talwin)?
Opioid
What is the brand name for hydromorphone?
Dilaudid
What is the generic name for Dilaudid?
Hydromorphone
What type of drug is hydromorphone (Dilaudid)?
Opioid
What are the 2 brand names for oxycodone?
Percodan and Oxycontin
What is the generic name for Percodan and Oxycontin?
Oxycodone
What type of drug is oxycodone (Percodan and Oxycontin)?
Opioid
What are the 2 brand names for hydrocodone?
Vicodin and Damason-P
What is the generic name for Vicodin and Damason-P?
Hydrocodone
What type of drug is hydrocodone (Vicodin and Damason-P)?
Opioid
What is the chemical name for lysergic acid diethylamide?
LSD (hallucinogen)
What type of drug is mescaline?
Hallucinogen
How long does it usually take for the body to flush itself of hallucinogens?
12-24 hours
What substance addiction can bupropion (Zyban and Wellbutrin) be used to treat?
Nicotine addiction
What are the brand names for bupropion?
Zyban and Wellbutrin
What is the generic name for Zyban?
Bupropion
What is the brand name for varenidine?
Chantix
What is the generic name for Chantix?
Varenidine
What is varenidine (Chantix) used to treat?
Nicotine addiction
True or false: tranquilizers like Xanax, Ativan, and Valium, as well as sleeping pills, improve sleep.
False. They lead to poor sleep because they reduce the amount of time in deep sleep.i
Do decongestants improve or hinder sleep, and why?
Hinder, because many contain pseudoepinepherine
What type of medications are Sonata, Lunesta, Rozerem, and Ambien?
Sleeping pills (the good ones that don’t reduce deep sleep)
What type of medication is Atarax?
Antihistamine
What is the brand name for zolpidem?
Ambien
What is the generic name for Ambien?
Zolpidem
What is the brand name for zaleplon?
Sonata
What is the generic name for Sonata?
Zaleplon
What is the brand name for eszopiclone?
Lunesta
What is the generic name for Lunesta?
Eszopiclone
What is the brand name for ramelteon?
Rozerem
What is the generic name for Rozerem?
Ramelteon
What is a common side effect of sleeping pills?
Amnesia/doing things you don’t remember
What is the brand name for triazolam?
Halcion
What is the generic name for Halcion?
Triazolam
What two sleeping pills are most associated with amnesia?
Triazolam (Halcion) and zolpidem (Ambien)
What is the only sleeping pill that is not habit-forming?
Ramelteon (Rozerem)
What are the brand names for trazodone?
Desyrel and Oleptro
What is the generic name for Desyrel?
Trazodone
What is the brand name for quetiapine?
Seroquel
What is the generic name for Seroquel?
Quetiapine
What is the brand name for mirtazapine?
Remeron
What is the generic name for Remeron?
Mirtazapine
What type of drug is mirtazapine (Remeron)?
Sedating antidepressant (SNRI)
What does mirtazapine (Remeron) treat, and what is its dosage?
Depression and insomnia, 7.5-15mg for insomnia
What is the brand name for flurazepam?
Dalmane
What is the generic name for Dalmane?
Flurazepam
What does flurazepam (Dalmane) treat, and what is its dosage?
Insomnia, 15-60mg/day
What is the brand name for temazepam?
Restoril
What is the generic name for Restoril?
Temazepam
When temazepam (Restoril) is used to treat insomnia, what is its dosage?
15-30mg/day
When triazolam (Halcion) is used to treat insomnia, what is its dosage?
Insomnia, 0.25-0.5mg/day
What is the brand name for estazolam?
Prosom
What is the generic name for Prosom?
Estazolam
What does estazolam (Prosom) treat, and what is its dosage?
Insomnia and anxiety, 1-2mg/day
What is the brand name for quazepam?
Doral
What is the generic name for Doral?
Quazepam
What does quazepam (Doral) treat, and what is its dosage?
Insomnia, 7.5-15mg/day
What does zolpidem (Ambien) treat, and what is its dosage?
Insomnia and anxiety, 5-12.5mg/day
What does zaleplon (Sonata) treat, and what is its dosage?
Insomnia and anxiety, 5-10mg/day
What does eszopiclone (Lunesta) treat, and what is its dosage?
Insomnia and anxiety, 1-3mg/day
What does ramelteon (Rozerem) treat, and what is its dosage?
Initial insomnia, 4-16mg/day
What is the brand name for survorexant?
Belsomra
What is the generic name for Belsomra?
Survorexant
What does survorexant (Belsomra) treat, and what is its dosage?
Insomnia and anxiety, 10-20mg/day
What dosage of melatonin is appropriate to treat insomnia?
0.5mg/day
What dosage of diphenhydramine (Benadryl) is appropriate to treat insomnia?
25-100mg/day (1-4 pills)
When used to treat insomnia, what is the dosage for trazodone (Desyrel)?
25-100mg/day
What is the brand name for doxepin?
Silenor
What is the generic name for Silenor?
Doxepin
When used to treat insomnia, what is the dosage of doxepin (Silenor)?
3-6mg/day
Is sleep hygiene or medication most effective at treating insomnia?
Sleep hygiene
What three types of drugs can treat restless leg syndrome?
Dopamine agonists, benzodiazepines, and anticonvulsants
What two types of drugs can exacerbate restless leg syndrome?
Antihistamines and serotonergic antidepressants
What do haloperidol and pimozide treat?
Tourette Syndrome
What is the one and only drug that might help treat anorexia, and why?
Naltrexone (opiate agonist), because it mimics the endorphin high that results from fasting
What is the generic name for Wellbutrin?
Bupropion
Whar type of medication best treats bulimia?
SSRI antidepressants
Should bupropion (Zyban and Wellbutrin) be used to treat eating disorders, and why/why not?
No, because it increases risk of convulsions.
What is the brand name for topiramtate?
Topamax
What is the generic name for Topamax?
Topiramate
What type of drug is topiramate (Topamax), and what is it sometimes used to treat?
It is an anticonvulsant sometimes used to treat bulimia.
What is the street name for anoretic agents?
Diet pills
What is the brand name for lisdexamfetamine?
Vyvanse
What is the generic name for Vyvanse?
Lisdexamfetamine
What type of drug is lisdexamfetamine (Vyvanse), and what is it used to treat?
It is a psychostimulant that treats binge-eating disorder and ADHD.
What are 4 common side effects of lisdexamfetamine (Vyvanse)?
Dry mouth, insomnia, reduced appetite, and increased heart rate
What class of drug is used to treat dementia?
Acetylcholinesterase inhibitors
As the brain ages, there is a reduction in the level of the neurotransmitter acetylcholine, and this drug prevents the catalyzation of acetylcholine.
What are 3 examples of acetylcholinesterase inhibitors?
Rivastigmine, donepezil, and galantamine
What are brand names for phentermine?
Fastin and Ionamin
What is the generic name for Fastin and Ionamin?
Phentermine
What is phentermine (Fastin and Ionamin) used to treat?
Obesity
What should phentermine (Fastin and Ionamin) never be taken with?
SSRI antidepressants
What is the brand name for sibutramine?
Meridia
What is the generic name for Meridia?
Sibutramine
What does sibutramine (Meridia) treat?
Obesity
What do Orlistat, Contrave, and Qsymia treat?
Obesity
What is the brand name for lorcaserin?
Belviq
What is the generic name for Belviq?
Lorcaserin
What does lorcaserin (Belviq) treat?
Obesity
What class of medication is best for treating chronic pain?
Cyclic antidepressants
Dopamine, norepinephrine, and serotonin are examples of what?
Catecholamines
How does a monoamine oxidase inhibitor work?
Stops the function of monoamine oxidase, which breaks down catecholamines like dopamine and serotonin
What is the brand name for amitriptyline?
Elavil
What is the generic name for Elavil?
Amitriptyline
What is the brand name for clomipramine?
Anafranil
What is the generic name for Anafranil?
Clomipramine
What is the brand name for desipramine?
Norpramin
What is the generic name for Norpramin?
Desipramine
What is the brand name for imipramine?
Tofranil
What is the generic name for Tofranil?
Imipramine
What are the brand names for nortriptyline?
Pamelor and Aventyl
What is the generic name for Pamelor and Aventyl?
Nortriptyline
What are the three categories of side effects for tricyclic antidepressants?
Anticholinergic (things dry out), adrenergic (sweating, orthostatic hypotension, and sexual dysfunction), and antihistaminic (sedation and weight gain)
True or false: tricyclic antidepressants are difficult to overdose on.
False. They are very toxic.
Which two tricyclic antidepressants generally have the worst side effects?
Amitriptyline (Elavil) and doxepin (Silenor)
What is the brand name for fluoxetine?
Prozac
What is the generic name for Prozac?
Fluoxetine
What is the brand name for citalopram?
Celexa
What is the generic name for Celexa?
Citalopram
What is the brand name for escitalopram?
Lexapro
What is the generic name for Lexapro?
Escitalopram
What is the brand name for fluvoxamine?
Luvox
What is the generic name for Luvox?
Fluvoxamine
What is the brand name for paroxetine?
Paxil
What is the generic name for Paxil?
Paroxetine
What is the brand name for sertraline?
Zoloft
What is the generic name for Zoloft?
Sertraline
What type of antidepressant is amitriptyline (Elavil)?
Tricyclic
What type of antidepressant is clomipramine (Anafranil)?
Tricyclic
What type of antidepressant is despiramine (Norpramin)?
Tricyclic
What type of antidepressant is doxepin (Silenor)?
Tricyclic
What type of antidepressant is imipramine (Tofranil)?
Tricyclic
What type of antidepressant is nortriptyline (Pamelor and Aventyl)?
Tricyclic
What type of antidepressant is trazodone (Oleptro)?
Tricyclic
What type of antidepressant is fluoxetine (Prozac)?
SSRI
What type of antidepressant is citalopram (Celexa)?
SSRI
What type of antidepressant is escitalopram (Lexapro)?
SSRI
What type of antidepressant is fluvoxamine (Luvox)?
SSRI
What type of antidepressant is paroxetine (Paxil)?
SSRI
What type of antidepressant is sertaline (Zoloft)?
SSRI
Do tricyclic antidepressants or SSRIs have more side effects?
Tricyclics
What might happen after a few months of treatment with SSRIs, and what do you do about it?
Patients may develop a syndrome that mimics depression. They should add bupropion (Wellbutrin) or a stimulant.
What is the brand name for venlafaxine?
Effexor
What is the generic name for Effexor?
Venlafaxine
What is the brand name for desvenlafaxine?
Pristiq
What is the generic name for Pristiq?
Desvenlafaxine
What is the brand name for duloxetine?
Cymbalta
What is the generic name for Cymbalta?
Duloxetine
What is the brand name for levomilnacipran?
Fetzima