Psychopharm Flashcards
Side effects of chlorpromazine in IM form?
Hypotension –> monitor BP
Chlorpromazine has an FDA approval for?
Treatment of several behavioral problems (combativeness and explosive, hyperexcitable behavior) in children 6 months and older
How is lithium excreted?
Unchanged through the kidney (lithium is not metabolized by the body)
How does the volume of distribution of lithium in children differ from adults?
In children with NORMAL renal function, lithium has about a 20% greater volume of distribution
When should lithium levels be drawn?
10-12 hours after an oral dose
Mechanism of lithium
Inositol second messenger system
Time to peak plasma concentration of IR melatonin
30 to 120 min
Half life of oral melatonin
30-50 min, hence only useful for those with problems regarding sleep onset
What age is atomoxetine approved for?
6 years or older
Contraindications to atomoxetine? (3)
1) Concurrent use of MAO-Is
2) Glaucoma
3) Pheochromocytoma
How long does it take atomoxetine to reach steady state?
2-4 weeks
What agents are FDA approved to treat bipolar disorder in youth?
Aripiprazole, quetiapine, lithium, olanzapine (10-17), olanzapine/fluoxetine (10-17), risperidone, asenapine
What is the mechanism of action of lamotrigine?
Inhibition of glutamate and voltage-gated sodium channels
What antipsychotic side (both 1st and 2nd gen) effect occurs at higher rate in children than adults?
EPS
Contraindications to propranolol (2)
Asthma, cardiac co-morbidity
How does IR guanfacine differ from IR clonidine?
IR guanfacine has a shorter half life (12-14 hrs, dosed 2-3 times/day) vs clonidine (8-12 hrs, dosed 3-4 times/day, but behavioral effects last 3-6 hrs)
What did the Multimodal Treatment of ADHD (MTA) study conclude about growth differences between stimulant and non-stimulant groups?
1) While they still grew, children receiving stimulants grew on average 2 cm shorter (over 14 months)
2) Weighed less (gained approx 3 kg less)
Main conclusion of the MTA study
Carefully monitored medication management (monthly) is more effective than intensive behavioral treatment alone
What are the three mechanisms of action of aripiprazole?
1) D2 partial agonist
2) 5-HT1A partial agonist
3) 5-HT2A antagonist
In treatment of irritability associated with ASD, what ages are aripiprazole and risperidone approved for?
Aripiprazole (6-17 yo)
Risperidone (5-16 yo)
How does tardive dyskinesia (TD) from risperidone compare to other atypical antipsychotics?
While the rate is still lower when compared to TYPICAL antipsychotics, risperidone has a higher rate of TD when HIGH-DOSES are used compared to other atypical antipsychotics
Mechanism of propranolol
Non-selective beta-1 and beta-2 adrenergic antagonist
What antipsychotic has the highest risk of hyperprolactinemia?
Risperidone
What are the psychiatric FDA indications for propranolol? What are the off label uses?
NONE, off label it is used for performance anxiety (10-40 mg one hour before), aggression (ASD), and akathisia
What has been shown to be the most efficacious treatment for nocturnal enuresis?
Bell pad treatment (classical conditioning)
1) What is the approximate relapse rate in children with nocturnal enuresis after discontinuation of desmopressin (DDAVPP)? 2) How do you define relapse? 3) What is a step to take to prevent relapse?
1) 60-70%
2) More than 1 wet night per month after a period of dryness
3) Slowly taper medication rather than stop abruptly
According to AACAP practice parameters, psychiatrists should consider alternative therapies if a QTc is what?
460 and above
1) What is clomipramine FDA approved for in children?
2) What P540 enzyme is it metabolized by?
3) What are the life threatening side effects?
1) OCD in children 10 and older
2) 3A4
3) Seizure, arrhythmia (C/I in Qtc of 500), QTc prolongation, sudden death, hematological issues (neutropenia, agranulocytosis, thrombocytopenia), syncope.
What effect does carbamazepine have on cardiac conduction?
Slows conduction (avoid in patients with sick sinus syndrome or AV blocks)
What is the mechanism of lamotrigine?
Inhibits glutamate and voltage-gated sodium channels
What is the gap between stopping an MAO-I and starting another anti-depressant? What is the exception??
2 week gap / 5 weeks for fluoxetine
Carbamazepine is an inducer of which two (2) P450 enzymes?
- 3A4 (autoinducer)
- 1A2
Fluvoxamine is a potent inhibitor of which two (2) P450 enzymes?
- 1A2
- 3A4
