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Psychiatry > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

What are the HAM side effects? What classes have them (2)?

A

H- antiHistamine- sedation weight gain
A- antiAdrenergic- hypotension
M-antiMuscarinic- dry mouth, blurred vision, urinary retention
Classes- TCAs (imipramine, amitriptyline, doxepin, etc) and low potency antipsychotics (clozapine, olanzapine, risperidone, quetiapine, etc)

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2
Q

What is serotonin syndrome? What are some drugs that cause it?

A

Too much serotonin causing neuromuscular (clonus, hyperreflexia), autonomic instability (increased BP, HR, temp), cognitive (AMS), and and GI distress
SSRIs and one of the following- MAOIs, tramadol, triptans, MDMA, cocaine, etc)

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3
Q

What is the treatment for extrapyramidal side effects of neuroleptics?

A

Benzotropine- anticholinergic

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4
Q

What are the extrapyramidal side effects? What drugs cause them? How long until they can be seen?

A

Parkinson like symptoms, akthisia (treat with propanolol), dystonia
Occurs with typical antipsychotics (haloperidol, fluphenazine, chlorpromazine, etc)
Can occur within days

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5
Q

What lass of drugs can cause hyperprolactinemia?

A

Typical antipsychotics AND risperidone

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6
Q

What is Neuroleptic malignant syndrome? Treatment?

A

Looks like serotonin syndrome without GI distress
Autonomic instability, “lead pipe” rigidity, AMS
Check CPK levels
Treat with cooling blankets and dantrolene

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7
Q

What disorders are only treated by SSRIs? (6)

A 
OCD
Pre-menstrual dysphoric disorder
PTSD
Social Anxiety long term
Premature Ejaculation
Hot Flashes (specifically Paroxetine)
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8
Q

What typically causes “brain zaps”, anxiety, irritability, dizziness, and headaches?

A

Serotonin rapid discontinuation

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9
Q

What class of drugs can treat fibromyalgia, chronic back pain due to OA, and neuropathic pain

A

SNRIs, specifically duloxetine

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10
Q

What % of patients will respond to antidepressants?

A

30-40%

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11
Q

What is the black box warning for SSRIs?

A

Increased suicidal thinking and behavior

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12
Q 
What makes the following SSRIs special?
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine
Citalopram
Escitalopram
A

Fluoxetine- longest half life no need to taper
Sertraline- highest risk for GI side effects
Paroxetine- short half life, more anticholinergic side effects (sedation, constipation)
Fluvoxamine- only approved for OCD
Citalopram- no CYP effects
Escitalopram- no CYP effects

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13
Q

Pneumonic for SSRI side effects?

A

Sex
Stomach
Restlessness
Insomnia

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14
Q 
What is special about the following SNRIs?
Duloxetine
Venlafaxine
Desvenlafaxine
Savella
A

Duloxetine- used for fibromyalgia or neuropathic pain, contraindicated in liver disease
Venlafaxine- can increase BP
Desvenlafaxine- metabolite of venlafaxine
Savella- none, used for fibromyalgia

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15
Q

What is buproprion MOA, uses, side effects, special facts?

A

MOA- NE and dopa reuptake inhibitors
Uses- depression, smoking cessation, ADHD and obesity (causes weight LOSS) are off label
Side effects- lowers seizure threshold, headache, insomnia
Contraindicated in people with eating disorders
NO SEXUAL side effects

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16
Q

What is vilazodone MOA, uses, side effects?

A

SSRI and partial serotonin 1a agonist
Used for depression
Side effects similar to SSRIs- diarrhea and nausea are common

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17
Q

What is trazodone and nefazodone MOA, uses, side effects?

A

MOA- serotonin antagonist and reuptake inhibitor
Uses- refractory depression and insomina
Side effects- dizziness, orthostatics, sedation, and priapism

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18
Q

What is the black box warning for nefazodone?

A

Liver failure

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19
Q

What is mirtazapine MOA, uses, side effects?

A

MOA- alpha 2 agonist, SNRI, and serotonin antagonist
Uses- refractory depression, good for elderly as helps with sleep or patients who need to gain weight
Side effects- WEIGHT GAIN, sedation, dizziness, constipation

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20
Q

What is the treatment of TCA overdose?

A

Sodium Bicarbonate

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21
Q

What are the side effects of TCAs (7)? Which of these can be used as advantages (4)?

A

Anti-histamine
Anti-adrenergic
Anti-muscarinic
Cardiotoxicity- get EKG!
Convulsions
Coma
LETHAL IN OVERDOSE- assess suicide risk
Urinary retention- use imipramine to treat enuresis
Sedation- doxepin used to treat insomnia
Anti-histamine- doxepin used to treat itching
IBS, neuropathic pain, migraines- use amytriptyline to treat

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22
Q 
What makes these TCAs special? MOA of TCAs?
Amitriptyline
Imipramine
Clomipramine
Doxepin
Nortriptyline
Desipramine
Amoxapine
Trimipramine
Protryptiline
A 
MOA- inhibits reuptake of 5HT and NE
Amitriptyline- used for IBS, migraines
Imipramine- used in enuresis, IM form
Clomipramine- used in OCD
Doxepin- used for insomnia and itching
Nortriptyline- less orthostatics
Desipramine- least anticholinergic, less sedation
Amoxapine- similar side effects of antipsychotics
Trimipramine- none
Protryptiline- none
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23
Q

What are the dosing and treatment strategies for antidepressants?

A

Start low and titrate as tolerated
At least 6 weeks at maximum dose if no side effects seen
Then switch to other classes
Then augmentation

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24
Q

Phenelzine, Tranylcypromne, Isocarboxazid, selegiline- MOA, uses, side effects, anything special?

A

MAOIs- prevent the break down of NE, 5HT, dopa, and tyramine
Used for atypical or refractory depression
Major side effect profile- serotonin syndrome with SSRIs, hypertensive crisis and many more
Selegiline has a patch that can avoid hypertensive crisis via certain foods- does not affect MAO in the gut

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25
Q

What are three things to monitor when prescribing lithium?

A

Creatinine, lithium and thyroid levels

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26
Q

What does potency mean when discussing antipsychotics?

A

Action on dopamine receptors

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27
Q

Which typical antipsychotics are considered low potency and how are they special (3)?

A

Chlorpromazine, mesoridazine, and Thioridazine
Have lower affinity for dopamine, more anticholinergic and antihistaminic side effects, less EPS side effects
Chlorpromazine- photosensitivity, can treat hiccups
Thioridazine- associated with retinitis pgimentosa
Mesoridazine

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28
Q

What are the midpotency typical antipsychotics and how are they special (4)?

A

Loxapine, Thiothixene, trifluoperazine, perphenazine
Have midrange properties for affinity and side effects
Loxapine- high risk of seizure
Thiothixene- can cause ocular pigment changes
Trifluoperazine- can reduce anxiety
Perphenazine- can treat nausea and vomiting in pregnant women

29
Q

Other typical antipsychotics to know and why (1)?

A

Molindone- described as both typical and atypical, causes weight loss

30
Q

What are the high potency typical antipsychotics and how are they special (3)?

A

Haloperidol, Fluphenazine, Pimozide
Highest affinity for dopamine receptors, more EPS side effects, greatest risk for tardive dyskinesia, less anticholinergic and antihistaminic effects

31
Q

What two drugs have been shown to decrease risk of suicide?

A

Lithium and clozapine

32
Q

What class of drugs cause metabolic syndrome?

A

Atypical antipsychotics

33
Q

Which atypical antipsychotics are FDA approved for Depression?

A

Quetiapine

34
Q

Which atypical antipsychotics are FDA approved for maintenance of bipolar disorder?

A

Quetiapine, olanzapine, aripiprazole, ziprasidone

35
Q

Which atypical antipsychotics are FDA approved depression as augmentation with at least one other drug?

A

Aripiprazole

36
Q

Which brain pathway is responsible for positive schizophrenia symptoms?

A

Mesolimbic

37
Q

Which brain pathway is responsible for negative schizophrenia symptoms?

A

Mesocortical

38
Q 
What makes the following atypical antipsychotics special? MOA of atypicals?
Clozapine
Risperidone
Quetiapine
Olanzapine
Ziprasidone
Aripiprazole
Paliperidone
Asenapine
Iloperidone
Lurasidone
A

MOA- 5HT2A and D2 receptors blockade
Clozapine- more efficacious than any other antipsychotic, can cause agranulocytosis or myocarditis, orthostatics
Risperidone- hyperprolactinemia, has long acting indictable form
Quetiapine- less EPS side effects, more sedation, lots of FDA approvals
Olanzapine- lowest discontinuation, weight gain is common
Ziprasidone- less weight gain
Aripiprazole- less sedating, can be used as adjunct treatment for depression
Paliperidone- metabolite of risperidone, long acting forms
Asenapine- none
Iloperidone- none
Lurasidone- none

39
Q

What stimulants are used in narcolepsy, OSA?

A

Modafanil, Armodafinil

40
Q

What are the stimulants used in ADHD and refractory depression (5)? MOA? Biggest side effect?

A

Dextroamphetamine, Amphetamine salts, Lis-Dextroamphetamine, Methamphetamine, Methylphenidate
Inhibit reuptake of dopamine and NE
Major potential for abuse
Weight loss, insomnia, and hypertension are other side effects

41
Q

What is the MOA of amphetamines?

A

Taken up by VMAT causing release of dopamine, NE, and 5HT

42
Q

What are some side effects of Methylphenidate?

A

Leukopenia, anemia, increased LFTs, weight loss, insomnia

Stimulant used for AHDHD

43
Q

What is atomoxetine MOA, uses, side effects?

A

Presynaptic NE transporter inhibitor
Used for ADHD
Side effects- LESS appetite suppression and insomnia

44
Q

What is Guanfacine and C ionidine MOA, uses, side effects?

A

MOA- alpha 2 agonist, located in prefrontal cortex leading to increased attention
Uses- ADHD, HTN, anxiety, Tics, withdrawal of alcohol, opioids
Side effects- abdominal pain, constipation, dry mouth, headaches

45
Q

What is the difference between methadone and buprenorphine?

A

Methadone is just an agonist while buprenorphine is an agonist and antagonist
Buprenorphine is more efficacious- has longer duration of action

46
Q

What is acamprosate MOA, uses, side effects?

A

MOA- reduces excitatory glutamate and increases GABA
Used for alcohol dependance
GI side effects common
Can be used in liver failure as not hepatically metabolized

47
Q

What is Naltrexone MOA, uses, and side effects?

A

MOA- blocks mu opioid receptor preventing alcohol from binding
Uses- alcohol dependance
Side effects- n/v, eosinophilic PNA, hepatocellular injury

48
Q

What is disulfiram MOA, uses?

A

MOA- inhibits aldehyde dehydrogenase that causes nausea, vomiting, diaphoresis, flushing, and dyspnea when alcohol is consumed
Used for alcohol dependance

49
Q

What alpha 2 agonist can be used for ADHD?

A

Clonidine

50
Q

What mood stabilizer typically causes SJS? (2)

A

Lamotrigine is most common

Also Carbamazepine

51
Q

What are the side effects of carbamazepine (6)?

A

SJS, GI distress, CNS effects, HYPONATREMIA, Hepatitis, Teratogenic

52
Q

What should be monitored when giving a patient Valproic Acid/ Depakote?

A

LFTs!!

53
Q

What mood stabilizer causes fine tremor?

A

LITHIUM

54
Q

Lithium uses, side effects (7)? Special considerations (2)

A

Used for acute mania and maintenance of bipolar disorder, also schizoaffective disorder
Side effects- Tremor, AMS, diabetes insipidus, ECG changes, weight gain, hypothyroid, Ebstein’s anomaly (teratogen)
MONITOR BLOOD LEVELS and kidney function, avoid NSAIDs

55
Q

Carbamazepine MOA, uses

A

Blocks Na channels inhibiting action potentials

Used for mixed episodes and rapid cycling bipolar disorder

56
Q

What are two advantages of oxcarbazepine vs carbamazepine?

A

Better tolerated

Less risk of rash and hepatic toxicity

57
Q

Two uses for gabapentin other than anticonvulsant?

A

Anxiety, insomnia

58
Q

Two uses for pregabalin other than anticonvulsant?

A

GAD, fibromyalgia

59
Q

Topiramate uses, side effects (4)

A

Used for anxiety and impulse control

Side effects- Weight loss is advantage, metabolic acidosis, kidney stones, COGNITIVE SLOWING

60
Q

Long acting BZDs? (4)

A

Diazepam, Clonazepam, Flurazepam, Clorazepate,

61
Q

Intermediate acting BZDs? (5)

A

Alprazolam, Lorazepam, Oxazepam, Temazepam, Chlordiazepoxide

62
Q

Short acting BZDs?

A

Triazolam, Midazolam

63
Q

Side effects of BZDs (5)

A

Drowsiness, Amnesia, Decreased coordination, Withdrawal, Respiratory depression

64
Q

Buspirone MOA, uses, side effects?

A

MOA- 5HT-1A receptor partial agonist
Used for GAD
Few side effects, low potential for abuse

65
Q

Hydroxyzine MOA, uses, side effects

A

MOA- antihistamine
Uses- Anxiety- quick acting
Side effects- sedation, dry mouth, constipation, urinary retension

66
Q

Propanolol uses (2)

A

Performance anxiety, Akathisia

67
Q

Clonidine MOA, uses (2), side effects (3)?

A

MOA- alpha 2 agonist
Uses- ADHD, anxiety,
Side effects- dizziness, orthostatic hypotension, somnolence

68
Q

Zolpidem, Zalelpon, Eszopiclone MOA, uses, side effects (4)

A

MOA- BZD receptor 1 agonist
Uses- insomnia
Side effects- GI distress, amnesia, hallucinations, sleepwalking

69
Q

Ramelteon MOA

A

Melatonin receptor agonist

Psychiatry (2 decks)

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