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Psychopharm > Psychopharm > Flashcards

Psychopharm Flashcards

0
Q

Dopamine pathways

A

Mesolimbic (+ symptoms)
Mesocortical (- symptoms)
Tuberoinfundibular (dopamine suppresses prolactin production)
Nigrostiatal (movement)

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1
Q

HAM side effects

A 
H = weight gain and sedation 
A = orthostasis 
M = can't pee, see, poo, think clearly
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2
Q

Akethesia

A

Subjective sense of restlessness. Treat with beta blocker or benzo.

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3
Q

Acute dystonia

A

Usually involves oral/buccal/facial. Treat with benztropine, Benadryl, or aromatidine.

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4
Q

Parkinsonism

A

Cogwheel rigidity, shuffling gait, resting tremor. Can treat by changing meds, may ultimately need to change to clozaril.

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5
Q

TD

A

Late in onset, insidious, oral/buccal choreathoid movements. Treat by discontinuing medications to prevent this from becoming permanent

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6
Q

Low potency typical antipsychotics

A

Chlorpromazine, thioridazine.

More likely to have HAM side effects than EPS.

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7
Q

NMS

A

Autonomic instability (high fever, tachy, sweating, HTN), muscle rigidity, dystonia, agitation. Treat by discontinuing agent and giving dantrolene

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8
Q

Side effects of thioridazine

A

Retinitis pigmentosa

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9
Q

High potency typical antipsychotics

A

Haldol, prolexin, pimozide

More likely to have EPS, less likely to have HAM side effects

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10
Q

Possible side effects of all antipsychotics

A

EPS, HAM, raise QTC, lower seized threshold

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11
Q

Mechanism of atypicals

A

Block D2 and 5HT2

Will commonly see metabolic syndrome as side effect

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12
Q

Mechanism and side effects of abilify

A

Partial agonist at dopamine and serotonin 1a receptor and antagonist at post synaptic serotonin 2a receptors

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13
Q

Side effects of clozaril

A 
Agranulocytosis 
Anticholinergic 
Weight gain and sedation
NMS 
cardiomyopathy
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14
Q

Actions of various serotonin receptors

A

5HT1a – decrease depression and anxiety
5HT2a/c – headaches and jitteriness, decreased libido long term
5HT3/4 – gi disturbances

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15
Q

MoA of TCAs

A

Increase levels of norepi and serotonin in synapse

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16
Q

Highly cholinergic TCAs

A

Amitryptiline, doxepin, imipramine, clomipramine trimipramine

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17
Q

TCA used to treat OCD

A

Clomipramine

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18
Q

Less anticholinergic TCAs

A

Desipramine, nortriptyline, protryptiline, amoxapine

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19
Q

Preventing serotonin syndrome

A

2 week washout period for SSRIs, but 5 weeks for Prozac because of long half life

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20
Q

SSRI with shortest half life

A

Paroxetine (Paxil)

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21
Q

Buspirone

A

Partial 5HT1a agonist

Used to treat GAD

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22
Q

Mirtazapine

A

Alpha 2 antagonist – leads to increased norepi and serotonin by blocking feedback inhibition.
No interference with sexual function.
Can cause sedation and weight gain

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24
Q

Bupropion

A

Norepi and dopamine reuptake inhibitor
Lowers seizure threshold
Used for smoking cessation

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25
Q

Nefazadone and trazadone

A

serotonin antagonist and reputake inhibitor
often used as sleep aid
Trazadone can cause priapism

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26
Q

Lithium dosing range

A

0.8 - 1.0

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27
Q

Carbamazepine dosing range

A

8-12

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28
Q

Valproic acid dosing range

A

80-120

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29
Q

Lithium side effects

A

neurotoxicity, hypothyroid, diabetes insipidus, leukocytosis

can cause Ebsteins anomaly

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30
Q

Carbamazepine side effects

A

autoinducer at liver, S/J rash, CBC anomalies
can cause hepatitis
can cause craniofacial and neural tube defects

31
Q

Valproic acid side effects

A

hepatitis, CBC abnormalities, sedation, weight gain

can cause neural tube and defects

32
Q

Lamictal

A

good for preventing depression

causes serious S/J rash

33
Q

shortest acting benzo

A

Alprazolam (xanaz) – quick onset and short half life, so high risk for abuse

34
Q

mid acting benzo

A

lorazepam (ativan) – longer to onset and moderate risk of abuse

35
Q

Longest acting benzo

A

Clonazepam (klonopin) – long to onset and long half life, so lowest risk of abuse

36
Q

Patient with cirrhosis needs to go on benzo taper for etoh withdrawal. what do you use?

A

LOT – Lorezapam, oxazepam, and tomezapm (?) are only glucuronidated, so they spare the liver unlike other benzos

37
Q

How is benzo overdose reversed?

A

use Flumazenil. But watch out because it can theoretically lower sz threshold.

38
Q

What receptor do Benzos and Etoh act on?

A

GABA-a

39
Q

Uses of lithium

A

acute mania, prophylaxis for manic and depressive episodes in bipolar and schizoaffective d/o.

40
Q

Testing needed to initiate lithium treatment

A

ECG, basic chemistries, thyroid function tests, CBC, pregnancy test.
Need to check lithium blood levels five days after starting therapy

41
Q

Factors that influence lithium levels

A

Decrease - NSAIDS

Increase = dehydration, salt deprivation, sweating, impaired renal function, diuretics

42
Q

Carbamazepine (tegretol) uses

A

treating mixed episodes and rapid cycling BD.

not as effective in depressed phase

43
Q

tests needed when starting tegretol

A

CBC and LFTs

44
Q

Depakote uses

A

treating mixed episodes and rapid cycling

45
Q

what is the interaction between lamictal and depakote?

A

Valproate will increase lamictal levels, and lamictal will decrease valproate levels.
D is delicious, so it gets eaten first when paired with other drugs.

46
Q

Dextroamphetamine and amphetamine side effects

A

weight loss and insomnia

47
Q

MoA of psychostimulants

A

increase dopmane and norepi

48
Q

atomoxetine (strattera) MoA. What is special about it?

A

presynaptic norepi transport inhibitor
Unlike other stimulants this is less likely to cause tics
has a more gradual onset of action.

49
Q

Watch out for what with ritalin?

A

Leukopenia, anemia, increased LFTs

may cause weight loss and insomnia

50
Q

Donepezil

A

Acetylcholinesterase inhibitor – dementia

51
Q

Galantamine

A

Acetylcholinesterase inhibitor – dementia

52
Q

Rivastigmine

A

Acetylcholinesterase inhibitor – dementia

53
Q

Tacrine

A

Acetylcholinesterase inhibitor – dementia

54
Q

Memantine

A

NMDA receptor antagonist – dementia (augments therapy)

55
Q

order of atypicals in terms of metabolic syndrome (worst to least)

A

olanzapine – risperidone – quetiapine – ziprasidone – aripiprazole

56
Q

What is so typical about risperdal?

A

It causes the most EPS side effects of the atypicals

57
Q

Why were we giving out so much seroquel on spruce 6?

A

Because it’s extremely sedating (and it can also cause orthostatis (anti adrenergic effect)

58
Q

What is the FALTERED pneumonic for NMS?

A 
F = fever
A = autonomic instability 
L = leukocytosis 
T = tremor
E = elevated CPK
R = rigidity 
E = excessive sweating
D = delirium
59
Q

how is a hypertensive crisis mediated by MAOIs treated?

A

Give an alpha adrenergic blocker – like phentolamine

60
Q

What is the initial presentation of serotonin syndrome?

A

lethargy, restlessness, confusion, flushing, diaphoresis, tremor, mycolonic jerks.

61
Q

What does the end stage of serotonin syndrome look like?

A

Hyperthermia, hypertonicity, rhabdo, renal failure, convulsions, coma, and death.

62
Q

treatment of cateplexy

A

use sodium oxygate – agonizes GABA b receptor

63
Q

What are the FDA approved pharm agents for treating acute mania?

A

Li, VPA, Carb, SGA’s and thorazine.

NOTE: lamictal is not approved to treat mania

64
Q

What are the FDA approved pharm treatments for bipolar depression?

A

Olanzapine + fluoxetine, Seroquel, Latuda.

Lithium and lamictal don’t have FDA approval but are still used.

65
Q

What are the best agents for preventing mania in the maintenance phase?

A

Antipsychotics > Li&raquo_space;» LMT

66
Q

What are the best agents for preventing bipolar depression in maintenance phase?

A

LMT>Li

67
Q

What are the common side effects of lithium?

A

Acne, tremor, N/V/D, sedation

68
Q

Who is most susceptible to SJS with carb?

A

Asians!

69
Q

What does VPA do to the blood?

A

decreases platelet levels

70
Q

What does carb do to the blood?

A

Decreases WBC count (watch out for aplastic anemia)

71
Q

Why do carb levels fall over time, even if the patient is compliant?

A

Carb is an autoinducer of its own metabolism by the P450 system, so its level will gradually decrease over time before reaching a new steady state.

72
Q

side effects of nefazadone

A

hepatitis and liver failure

73
Q

lithium toxicity syndrome

A

dysarthria, ataxia, coarse tremor, and ab pain seen early.

later see seizures, neuromuscular irritabilty, impaired consicousness.

Psychopharm (1 decks)

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