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Child Board Review > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

Side effects of chlorpromazine in IM form?

A

Hypotension –> monitor BP

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2
Q

Chlorpromazine has an FDA approval for?

A

Treatment of several behavioral problems (combativeness and explosive, hyperexcitable behavior) in children 6 months and older

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3
Q

How is lithium excreted?

A

Unchanged through the kidney (lithium is not metabolized by the body)

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4
Q

How does the volume of distribution of lithium in children differ from adults?

A

In children with NORMAL renal function, lithium has about a 20% greater volume of distribution

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5
Q

When should lithium levels be drawn?

A

10-12 hours after an oral dose

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6
Q

Mechanism of lithium

A

Inositol second messenger system

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7
Q

Time to peak plasma concentration of IR melatonin

A

30 to 120 min

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8
Q

Half life of oral melatonin

A

30-50 min, hence only useful for those with problems regarding sleep onset

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9
Q

What age is atomoxetine approved for?

A

6 years or older

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10
Q

Contraindications to atomoxetine? (3)

A

1) Concurrent use of MAO-Is
2) Glaucoma
3) Pheochromocytoma

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11
Q

How long does it take atomoxetine to reach steady state?

A

2-4 weeks

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12
Q

What agents are FDA approved to treat bipolar disorder in youth?

A

Aripiprazole, quetiapine, lithium, olanzapine (10-17), olanzapine/fluoxetine (10-17), risperidone, asenapine

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13
Q

What is the mechanism of action of lamotrigine?

A

Inhibition of glutamate and voltage-gated sodium channels

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14
Q

What antipsychotic side (both 1st and 2nd gen) effect occurs at higher rate in children than adults?

A

EPS

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15
Q

Contraindications to propranolol (2)

A

Asthma, cardiac co-morbidity

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16
Q

How does IR guanfacine differ from IR clonidine?

A

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)

17
Q

What did the Multimodal Treatment of ADHD (MTA) study conclude about growth differences between stimulant and non-stimulant groups?

A

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)

18
Q

Main conclusion of the MTA study

A

Carefully monitored medication management (monthly) is more effective than intensive behavioral treatment alone

19
Q

What are the three mechanisms of action of aripiprazole?

A

1) D2 partial agonist
2) 5-HT1A partial agonist
3) 5-HT2A antagonist

20
Q

In treatment of irritability associated with ASD, what ages are aripiprazole and risperidone approved for?

A

Aripiprazole (6-17 yo)
Risperidone (5-16 yo)

21
Q

How does tardive dyskinesia (TD) from risperidone compare to other atypical antipsychotics?

A

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

22
Q

Mechanism of propranolol

A

Non-selective beta-1 and beta-2 adrenergic antagonist

23
Q

What antipsychotic has the highest risk of hyperprolactinemia?

A

Risperidone

24
Q

What are the psychiatric FDA indications for propranolol? What are the off label uses?

A

NONE, off label it is used for performance anxiety (10-40 mg one hour before), aggression (ASD), and akathisia

25
Q

What has been shown to be the most efficacious treatment for nocturnal enuresis?

A

Bell pad treatment (classical conditioning)

26
Q

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?

A

1) 60-70%
2) More than 1 wet night per month after a period of dryness
3) Slowly taper medication rather than stop abruptly

27
Q

According to AACAP practice parameters, psychiatrists should consider alternative therapies if a QTc is what?

A

460 and above

28
Q

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?

A

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.

29
Q

What effect does carbamazepine have on cardiac conduction?

A

Slows conduction (avoid in patients with sick sinus syndrome or AV blocks)

30
Q

What is the mechanism of lamotrigine?

A

Inhibits glutamate and voltage-gated sodium channels

31
Q

What is the gap between stopping an MAO-I and starting another anti-depressant? What is the exception??

A

2 week gap / 5 weeks for fluoxetine

32
Q

Carbamazepine is an inducer of which two (2) P450 enzymes?

A
  • 3A4 (autoinducer)
  • 1A2
33
Q

Fluvoxamine is a potent inhibitor of which two (2) P450 enzymes?

A
  • 1A2
  • 3A4

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