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
What is the generic name for Fetzima?
Levomilnacipran
What type of antidepressant is venlafaxine (Effexor)?
SNRI
What type of antidepressant is desvenlafaxine (Pristiq)?
SNRI
What type of antidepressant is duloxetine (Cymbalta)?
SNRI
What type of antidepressant is levomilnacipran (Fetzima)?
SNRI
Are SNRIs or SSRIs better at treating depression?
SNRIs, but they have more side effects than SSRIs
What is the brand name for atomoxetine?
Strattera
What is the generic name for Strattera?
Atomoxetine
What type of drug is atomoxetine (Strattera)?
NRI (norepinephrine reuptake inhibitor)
What is the brand name for reboxetine?
Vestra
What is the generic name for Vestra?
Reboxetine
What type of antidepressant is reboxetine (Vestra)?
NRI (norepinephrine reuptake inhibitor)
What is the brand name for nefazodone?
Serzone
What is the generic name for Serzone?
Nefazodone
What type of antidepressant is nefazodone (Serzone)?
Atypical
What is the spelled-out version of SNRI?
Serotonin and norepinephrine reuptake inhibitor
What should nefazodone (Serzone) never be used with?
Xanax
What is the brand name for buspirone?
BuSpar
What is the generic name for BuSpar?
Buspirone
What does buspirone (BuSpar) treat, and what is its dosage?
Anxiety, 10-40mg/day
What is the brand name for vilazodone?
Viibryd
What is the generic name for Viibryd?
Vilazodone
What type of antidepressant is vilazodone (Viibryd)?
Atypical
What is the brand name for vortioxetine?
Trintellix
What is the generic name for Trintellix?
Vortioxetine
What type of antidepressant is vortioxetine (Trintellix)?
Atypical
What food interactions increase the risk of a hypertensive crisis with MAOIs?
Foods high in tyramine, like fish, sausage, Italian meats, bananas, beef bouillon, and sauerkraut
What is the riskiest side effect of MAOIs?
Hypertensive crisis
What drug interactions increase the risk of a hypertensive crisis with MAOIs?
Stimulants, including decongestants and psychostimulants
What is the brand name for phenelzine?
Nardil
What is the generic name for Nardil?
Phenelzine
What is the brand name for tranylcypromine?
Parnate
What is the generic name for Parnate?
Tranylcypromine
What type of antidepressant is tranylcypromine (Parnate)?
MAOI
What type of antidepressant is phenelzine (Nardil)?
MAOI
What are the brand names for selegiline?
Deprenyl and Ensam (patch)
What is the generic name for Deprenyl and Ensam?
Selegiline
What comorbid physical and psychological conditions does selegiline (Deprenyl and Ensam) treat?
Parkinson’s and depression
What type of antidepressant is selegiline (Deprenyl and Ensam)?
MAOI
What type of antidepressant is meclobemide?
MAOI
What is the brand name for troamphetamine?
Dexedrine
What is the generic name for Dexedrine?
Troamphetamine
What is the brand name for methylphenidate?
Ritalin
What is the generic name for Ritalin?
Methylphenidate
What type of drug is troamphetamine (Dexedrine)?
Stimulant
What type of drug is methylphenidate (Ritalin)?
Stimulant
What are stimulants like methylphenidate (Ritalin) and troamphetamine (Dexedrine) sometimes used to treat and why?
Depression, because they promote the release of catecholamines
Do people need to be on antidepressants for life?
Not usually, unless they have another episode of depression after the first course of treatment, then yes.
How long does it normally take for someone to develop physiological tolerance to antidepressant side effects?
1-2 weeks
What is the standard dose for the antidepressant amitriptyline (Elavil)?
75-300mg/day
What is the standard dose for the antidepressant clomipramine (Anafranil)?
75-200mg/day
What is the standard dose for the antidepressant desipramine (Norpramin)?
75-300mg/day
What is the standard dose for the antidepressant imipramine (Tofranil)?
75-300mg/day
What is the standard dose for the antidepressant nortriptyline (Pamelor and Aventyl)?
50-150mg/day
What is the standard dose for trazodone (Oleptro) when treating depression?
150-400mg/day
What is the standard dose for the antidepressant citalopram (Celexa)?
10-40mg/day
What is the standard dose for the antidepressant escitalopram (Lexapro)?
5-20mg/day
What is the standard dose for the antidepressant fluoxetine (Prozac)?
20-80mg/day
What is the standard dose for the antidepressant fluvomaxine (Luvox)?
50-300mg/day
What is the standard dose for the antidepressant paroxetine (Paxil)?
20-60mg/day
What is the standard dose for the antidepressant sertraline (Zoloft)?
50-200mg/day
What is the standard dose for the antidepressant atomoxetine (Strattera)?
60-120mg/day
What is the standard dose for the antidepressant bupropion (Wellbutrin)?
150-400mg/day
What is the standard dose for the antidepressant desvenlafaxine (Pristiq)?
50-400mg/day
What is the standard dose for the antidepressant duloxetine (Cymbalta)?
20-100mg/day
What is the standard dose for the antidepressant levomilnacipran (Fetzima)?
40-120mg/day
What is the standard dose for the antidepressant mirtazapine (Remeron)?
15-45mg/day
What is the standard dose for the antidepressant nefazodone (Serzone)?
100-600mg/day
What is the standard dose for the antidepressant venlafaxine (Effexor)?
75-350mg/day
What is the standard dose for the antidepressant vilazodone (Viibryd)?
10-40mg/day
What is the standard dose for the antidepressant vortioxetine (Trintellix)?
10-20mg/day
What is the standard dose for the antidepressant phenelzine (Nardil)?
30-90mg/day
What is the standard dose for the antidepressant selegiline (Ensam)?
6-12mg/day
What is the standard dose for the antidepressant tranylcypromine (Parnate)?
20-60mg/day
Why is family psychopharmacology relevant when it comes to medication selection?
If a family member responded to the medication, it’s more likely this patient will, too.
True or false: people need to continue antidepressants for 9-12 months, even after symptoms go away, to ensure complete remission.
True
In terms of antidepressant side effects, what is activation?
Anxiety symptoms that occur within the first few hours of starting an antidepressant or increasing dosage
In terms of antidepressant side effects, what is switching?
A manic state, usually one that occurs a few weeks after starting an antidepressant or increasing dosage
What is a common misconception about taking medications that must be overcome to ensure compliance?
Considering the need for medications a “moral weakness” (meaning they weren’t strong enough to overcome mental illness on their own)
What does St. John’s wart treat, and what is its dosage?
Depression, 900-1800mg/day
What prescription drugs should St. John’s wart not be taken with?
Any, including other antidepressants
What is the spelled-out name for the drug SAM-e?
S-adenosyl-methionine
What is SAM-e used to treat, and what is its dosage?
Depression, 400-1600mg/day
What mental illness can omega-3 fatty acids be used to treat, and at what dose?
Depression, 1-9g/day
True or false: it is safe to mix MAOIs and other types of antidepressants.
False.
How long does it take to see symptom reduction in bipolar disorder with lithium?
5-14 days, with full stabilization taking months
What does it mean when people say that lithium has as narrow therapeutic window?
The difference in dosage between the therapeutic dose and the toxic dose is very small.
What is the lithium dosage for someone in an acute manic state with bipolar disorder?
1200-1400mg/day
What is the maintenance lithium dose for someone with bipolar disorder?
600-1800mg/day
What organ’s impairment is most likely to lead to toxic lithium buildup?
Kidneys (renal system)
What are 6 signs of lithium toxicity?
GI symptoms
Worsening of tremors
Confusion
Stupor
Slurred speech
Seizure
What are the brand names for carbamazepine?
Tegretol and Equetro
What is the generic name for Tegretol?
Carbamazepine
What is the brand name for divalproex?
Depakote
What is the generic name for Depakote?
Divalproex
What is the brand name for lamotrigine?
Lamictal
What is the generic name for Lamictal?
Lamotrigine
What is the generic name for Equetro?
Carbamazepine
What type of drug is carbamazepine (Equetro and Tegretol)?
Anticonvulsant
What type of drug is divalproex (Depakote)?
Anticonvulsant
What type of drug is lamotrigine (Lamictal)?
Anticonvulsant
What does carbamazepine (Tegretol and Equetro) treat, and what is its dosage?
Bipolar disorder, 600-1600mg/day
What does lamotrigine (Lamictal) treat, and what is its dosage?
Bipolar disorder, 50-300mg/day
What does divalproex (Depakote) treat, and what is its dosage?
Bipolar disorder, 750-1500mg/day
What two symptoms are indicative of carbamazepine (Equetro and Tegretol) toxicity?
Neurological and cardiac malfunctions
What two symptoms are indicative of divalproex (Depakote) toxicity?
Somnolence and coma
What symptom is indicative of lamotrigine (Lamictal) toxicity?
Rashes, including Stevens-Johnson syndrome (red, hive-y rash)
What is the brand name for oxcarbazepine?
Trileptal
What is the generic name for Trileptal?
Oxcarbazepine
What does oxcarbazepine (Trileptal) treat, and what type of drug is it?
It is an anticonvulsant that treats bipolar disorder.
What are the 2 concerns with giving a bipolar patient an antidepressant?
Inducing a manic episode and increasing the speed of cycling
Which 2 classes of antidepressants are preferred for bipolar patients?
SSRIs and bupropion (Wellbutrin)
How long do bipolar patients need to stay on their medication?
For life
What is the brand name for diazepam?
Valium
What is the brand name for chlorodiazepoxide?
Librium
What is the brand name for clonazepam?
Klonopin
What is the brand name for lorazepam?
Ativan
What is the brand name for alprazolam?
Xanax
What is the brand name for midazolam?
Versed
What is the generic name for Valium?
Diazepam
What is the generic name for Librium?
Chlorodiazepoxide
What is the generic name for Klonopin?
Clonazepam
What is the generic name for Ativan?
Lorazepam
What is the generic name for Xanax?
Alprazolam
What is the generic name for Versed?
Midazolam
What type of drug is diazepam (Valium)?
Benzodiazepine
What type of drug is chlorodiazepoxide (Librium)?
Benzodiazepine
What type of drug is clonazepam (Klonopin)?
Benzodiazepine
What type of drug is temazepam (Restoril)?
Benzodiazepine
What type of drug is lorazepam (Ativan)?
Benzodiazepine
What type of drug is alprazolam (Xanax)?
Benzodiazepine
What type of drug is triazolam (Halcion)?
Benzodiazepine
What type of drug is midazolam (Versed)?
Benzodiazepine
What does diazepam (Valium) treat, and what is its dosage?
Anxiety, 4-40mg/day
What does chlorodiazepoxide (Librium) treat, and what is its dosage?
Anxiety, 15-100mg/day
What does clonazepam (Klonopin)treat, and what is its dosage?
Anxiety, 1-8mg/day
What does temazepam (Restoril) treat, and what is its dosage?
Anxiety, 15-60mg/day
What does lorazepam (Ativan) treat, and what is its dosage?
Anxiety, 1.5-6mg/day
What does alprazolam (Xanax) treat, and what is its dosage?
Anxiety, 0.5-6mg/day
What does triazolam (Halciun) treat, and what is its dosage?
Anxiety, 0.125-0.5mg/day
What does midazolam (Versed) treat, and how is it delivered?
Anxiety, pre-measured injectable
What are the brand names for hydroxyzine?
Atarax and Vistaril
What is the generic name for Atarax and Vistaril?
Hydroxyzine
What does hydroxyzine (Atarax and Vistaril) treat, and what is its dosage?
Anxiety, 30-200mg/day
In addition to insomnia, what does diphenhydramine (Benadryl) treat, and what is its dosage?
Anxiety, 75-200mg/day (3-8 pills)
What is the brand name for propranolol?
Inderal
What is the generic name for Inderal?
Propranolol
What does propranolol (Inderal) treat, and what is its dosage?
Anxiety, 20-160mg/day
What is the brand name for atenolol?
Tenormin
What is the generic name for Tenormin?
Atenolol
What type of drug is atenolol (Tenormin)?
Beta blocker
What does atenolol (Tenormin) treat, and what is its dosage?
Anxiety, 25-100mg/day
What are the brand names for clonidine?
Kapvay and Catapres
What is the generic name for Kapvay and Catapres?
Clonidine
When used to treat anxiety, what is the dosage for clonidine (Kapvay and Catapres)?
0.2-0.9mg/day
When used to treat ADHD, what is the dosage for clonidine (Kapvay and Catapres)?
0.15-0.4mg/day
When used to treat anxiety, what is the dosage of doxepin (Silenor)?
3-25mg/day
What is the brand name for prazosin?
Minipress
What is the generic name for Minipress?
Prazosin
What does prazosin (Minipress) treat, and what is its dosage?
Anxiety and PTSD, 10-20mg/day
Can someone die from benzodiazepine withdrawal?
Yes
How long does it take to safely wean someone off benzodiazepines without encountering withdrawal symptoms?
A very long time. Don’t decrease dosage by more than 5-10% per week.
What is the risk of combining alcohol and anxiety medications, especially benzodiazepines?
They can have an additive depressive effect (they’re both downers), and therefore people can have respiratory depression or even become comatose.
What are neuroleptics?
First-generation antipsychotics
What two antipsychotic medications are most likely to cause sedation?
Chlorpromazine (Thorazine) and clozapine (Clozaril)
What three antipsychotic medications are most likely to cause extrapyramidal effects?
Fluphenazine (Prolixin), haloperidol (Haldol), and pimozide (Orap)
What two antipsychotic medications are most likely to cause anticholinergic effects?
Chlorpromazine (Thorazine) and clozapine (Clozaril)
Do first- or second-generation antipsychotics have more side effects?
First-generation antipsychotics
What two antipsychotic medications are most likely to cause metabolic effects?
Clozapine (Clozaril) and olanzapine (Zyprexa)
What is rapid neuroleptization?
The use of high doses of antipsychotic medications
Do most patients with schizophrenia need to be treated for life?
No. They can discontinue medications 1 year after symptom remission.
What is the brand name for chlorpromazine?
Thorazine
What is the brand name for fluphenazine?
Prolixin
What is the brand name for haloperidol?
Haldol
What is the brand name for loxapine?
Loxitane
What is the brand name for perphenazine?
Trilafon
What is the brand name for pimozide?
Orap
What is the brand name for aripiprazole?
Abilify
What is the brand name for asenapine?
Saphris
What is the brand name for brexpiprazole?
Rexulti
What is the brand name for cariprazine?
Vraylar
What is the brand name for clozapine?
Clozaril
What is the brand name for iloperidone?
Fanapt
What is the brand name for lurasidone?
Latuda
What is the brand name for olanzapine?
Zyprexa
What is the brand name for paliperidone?
Invega
What is the brand name for risperidone?
Risperidal
What is the brand name for ziprasidone?
Geodon
What is the generic name for Thorazine?
Chlorpromazine
What is the generic name for Prolixin?
Fluphenazine
What is the generic name for Haldol?
Haloperidol
What is the generic name for Loxitane?
Loxapine
What is the generic name for Trilafon?
Perphenazine
What is the generic name for Orap?
Pimozide
What is the generic name for Ability?
Aripiprazole
What is the generic name for Saphris?
Asenapine
What is the generic name for Rexulti?
Brexpiprazole
What is the generic name for Vraylar?
Cariprazine
What is the generic name for Clozaril?
Clozapine
What is the generic name for Fanapt?
Iloperidone
What is the generic name for Latuda?
Lurasidone
What is the generic name for Zyprexa?
Olanzapine
What is the generic name for Invega?
Paliperidone
What is the generic name for Risperdal?
Risperidone
What is the generic name for Geodon?
Ziprasidone
What type of medication is chlorpromazine (Thorazine)?
First-generation antipsychotic
What type of medication is fluphenazine (Prolixin)?
First-generation antipsychotic
What type of medication is loxapine (Loxitane)?
First-generation antipsychotic
What type of medication is perphenazine (Trilafon)?
First-generation antipsychotic
What type of medication is pimozide (Orap)?
First-generation antipsychotic
What type of medication is aripiprazole (Abilify)?
Second-generation antipsychotic
What type of medication is asenapine (Saphris)?
Second-generation antipsychotic
What type of medication is brexpiprazole (Rexulti)?
Second-generation antipsychotic
What type of medication is cariprazine (Vraylar)?
Second-generation antipsychotic
What type of medication is clozapine (Clozaril)?
Second-generation antipsychotic
What type of medication is iloperidone (Fanapt)?
Second-generation antipsychotic
What type of medication is lurasidone (Latuda)?
Second-generation antipsychotic
What type of medication is olanzapine (Zyprexa)?
Second-generation antipsychotic
What type of medication is paliperidone (Invega)?
Second-generation antipsychotic
What type of medication is quetiapine (Seroquel)?
Second-generation antipsychotic
What type of medication is risperidone (Risperdal)?
Second-generation antipsychotic
What type of medication is ziprasidone (Geodon)?
Second-generation antipsychotic
What is the appropriate dosage for chlorpromazine (Thorazine)?
50-1500mg/day
What is the appropriate dosage for fluphenazine (Prolixin)?
3-45mg/day
What is the appropriate dosage for haloperidol (Haldol)?
2-40mg/day
What is the appropriate dosage for perphenazine (Trilafon)?
8-60mg/day
What is the appropriate dosage for loxapine (Loxitane)?
50-250mg/day
What is the appropriate dosage for pimozide (Orap)?
1-10mg/day
What is the appropriate dosage for aripiprazole (Abilify)?
10-30mg/day
What is the appropriate dosage for asenapine (Saphris)?
5-20mg/day
What is the appropriate dosage for brexpiprazole (Rexulti)?
0.5-4mg/day
What is the appropriate dosage for cariprazine (Vraylar)?
1.5-6mg/day
What is the appropriate dosage for clozapine (Clozaril)?
300-900mg/day
What is the appropriate dosage for iloperidone (Fanapt)?
12-24mg/day
What is the appropriate dosage for lurasidone (Latuda)?
40-80mg/day
What is the appropriate dosage for olanzapine (Zyprexa)?
5-20mg/day
What is the appropriate dosage for paliperidone (Invega)?
3-12mg/day
What is the appropriate dosage for quetiapine (Seroquel)?
300-750mg/day
What is the appropriate dosage for risperidone (Risperdal)?
4-16mg/day
What is the appropriate dosage for ziprasidone (Geodon)?
40-160mg/day
True or false: there are medications that can be taken to reduce the Parkinson’s-like and anticholinergic side effects of antipsychotic medications?
True.
What is the brand name for thioridazine?
Mellaril
What is the generic name for Mellaril?
Thioridazine
What type of medication is thioridazine (Mellaril)?
First-generation antipsychotic
What is the appropriate dosage for thioridazine (Mellaril)?
150-800mg/day
What is the brand name for trifluoperazine?
Stelazine
What is the generic name for Stelazine?
Trifluoperazine
What type of medication is trifluoperazine (Stelazine)?
First-generation antipsychotic
What is the appropriate dosage for trifluoperazine (Stelazine)?
10-40mg/day
What is folic acid used to treat, and what is its dosage?
Mood disorders, 400-500mg/day
What is ginkgo biloba used to treat, and what is its dosage?
Cognitive impairment (like memory loss), 30-240mg/day
What is yohimbine used to treat, and what adverse psychological effects might it cause?
It is used to treat erectile dysfunction, but it causes anxiety.
What is kava kava used to treat?
Anxiety
What form of ketamine is FDA-approved for the treatment of treatment-resistant depression?
Esketamine (injectable)
What is the chemical name for MDMA?
3,4-methylenedioxymethamphetamine
How can you mitigate the discontinuation side effects from psychiatric medications?
Slowly decrease the dose over multiple months instead of going cold turkey
What is the only common psychiatric disorder that usually requires lifelong medication?
Bipolar disorder
How does dosing in pre-pubescent children relate to adult dosing, and why?
It’s generally the same because young children have a very high drug metabolism rate.
Why might children who are stable on a medication experience increased side effects when they enter puberty?
In puberty, children’s drug metabolism slows down significantly, so side effects may increase.
What is an off-label drug?
A drug that is not approved by the FDA
What 3 types of stimulants are used to treat ADHD?
Methyphenidates, dextroamphetamines, and amphetamines
What is the brand name for dextroamphetamine?
Dexedrine
What is the generic name for Dexedrine?
Dextroamphetamine
What type of drug is dextroamphetamine (Dexedrine)?
Stimulant
What does dextroamphetamine (Dexedrine) treat, and what is its dosage?
ADHD, 5-40mg/day
When used to treat ADHD, what is the appropriate dosage for lisdexamphetamine (Vyvanse)?
30-70mg/day
What is the brand name for dexmethylphenidate?
Focalin
What is the generic name for Focalin?
Dexmethylphenidate
What does dexmethylphenidate (Focalin) treat, and what is its dosage?
ADHD, 5-20mg/day
What class of stimulant is Adderall?
Amphetamine
What does Adderall treat, and what is its dosage?
ADHD, 5-40mg/day
What class of stimulant is Ritalin?
Methylphenidate
What does Ritalin treat, and what is its dosage?
ADHD, 10-60mg/day
Metadate and Methylin are brand names for what drug?
Methylphenidates
Metadate and Methylin treat what, and what is their dosage?
ADHD, 10-60mg/day
What are the brand names for guanfacine?
Tenex and Intuniv
What is the generic name for Intuniv and Tenex?
Guanfacine
What does guanfacine (Intuniv and Tenex) treat, and what is its dosage?
ADHD, 0.25-1mg/day
What two antidepressants can be used to treat ADHD?
Bupropion (Wellbutrin) and atomoxetine (Strattera)
Is sadness or irritability more common in youth with depression?
Irritability
Do antidepressants increase suicidality in youth?
They increase suicidal ideation and actions, but not actual suicides.
True or false: most children with bipolar mania can be treated with one mood stabilizer.
False. Most need two.
What is a notable negative drug interaction for female patients on carbamazepine (Tegretol and Equetro) or oxazepine?
Carbamazepine and oxazepine reduce the body’s ability to process birth control pills and can render them ineffective.
What class of drugs is best for OCD treatment in youth?
SSRIs
What is drug bioavailability?
The amount of the drug that actually reaches systemic circulation (represented as a %)
What risks might a patient run if they switch from a brand medication to a generic medication?
A decrease in bioavailability, even at the same dose, because of differences in manufacturing practices
What does it mean if a drug has an enteral route of administration?
It involves the GI system (oral and rectal)
What does it mean if a drug has a parenteral route of administration?
It does not involve the GI system (IV, IM, inhalation, transdermal, and through the mucous membranes)
True or false: most psychiatric drugs do not cross the placenta and affect the fetus.
False. Most drugs do cross the placenta.
True or false: some psychiatric medications can cause teratogenesis in fetuses.
True.
What is important to consider in geriatric psychopharmacology?
They’re often on a lot of drugs, so make sure to be aware of drug-drug interactions and whether psych symptoms are a result of side effects from other drugs or are their own individual diagnosis.
Which three benzodiazepines are safest to use in elderly patients?
Oxazepam (Serax), lorazepam (Ativan), and temazepam (Restoril)
Which three benzodiazepines are riskiest to use in elderly patients?
Diazepam (Valium), chlordiazepoxide (Librium), and flurazepam (Dalmane)
Dosage of elderly patients is often at what percentage of dosage in younger patients?
30-50% that of younger patients
What three diagnoses is gabapentin empirically supported to treat?
Social anxiety disorder, panic disorder, and alcohol use disorder
What % THC is hemp and CBD?
Less than 0.3%
What % THC is hemp and CBD?
Less than 0.3%
What % THC is low-dose cannabis (the only type that has been studied for medicinal benefits)?
0.5-3%
What % THC is low-dose cannabis (the only type that has been studied for medicinal benefits)?
0.5-3%
What % THC can you get in OTC cannabis?
Up to 90%
What % THC can you get in OTC cannabis?
Up to 90%
What catecholemine does cannabis release?
Dopamine
True or false: people do not experience withdrawal symptoms when stopping cannabis use.
False
What two forms of cannabis ingestion are more likely to lead to psychosis, and why?
Dabs and vape pens because of how concentrated they are
What two forms of cannabis ingestion are more likely to lead to psychosis, and why?
Dabs and vape pens because of how concentrated they are
True or false: people with psychotic disorders will often use cannabis to reduce positive symptoms and/or medication side effects, which makes their psychosis worse.
True
True or false: people with psychotic disorders will often use cannabis to reduce positive symptoms and/or medication side effects, which makes their psychosis worse.
True
What are wax, butter, and shatter?
Cannabis dabs that have up to 99% THC
True or false: using high-% THC products leads to tolerance and makes low-% THC products ineffective.
True
What is Delta 8, and is it legal?
A psychoactive CBD-derivative
It is federally legal and unregulated (different in some states), as opposed to marijuana which is still federally illegal, because of the 2018 farm bill that legalized hemp.
What illegal drug is associated with an increase in early-onset dementia?
Cocaine
How long does it take for the effects of cocaine to wear off?
1-2 hours
How long does it take for the effects of alcohol to wear off?
1-2 hours
How long does it take for the effects of marijuana to wear off?
1-6 hours
How long does it take for the effects of ecstasy to wear off?
2-4 hours
How long does it take for the effects of meth to wear off?
4-12 hours
How long does it take for the effects of LSD/PCP/acid to wear off?
12 hours
