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Psych Clerkship > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

Which 2 psych drug classes cause the most HAM ADEs?

A

TCAs

Low-potency antipsychotics

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2
Q

DOC for neuroleptic-induced EPS?

A

Benzotropine

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3
Q

Classic drug combo leading to serotonin syndrome?

A

SSRI + MAO-1

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4
Q

What presents w/ fever, tachycardia, very elevated CPK, and lead pipe rigidity?

A

NMS

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5
Q

How does carbamazepine affect CYPs?

A

Induces 1A2, 2C9, 3A4

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6
Q

Mortality rate of NMS?

A

20%

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7
Q

Which neurologic disease is classically worsened by anti-cholinergics?

A

Alzheimers dz

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8
Q

What % of pts w/ major depression will respond to anti-depressants? What % of the above is placebo effect?

A

70% respond. 30% of that is placebo

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9
Q

How long do most anti-depressants require for effect?

A

3-4 weeks

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10
Q

What time/dose constitutes an adequate trial of an anti-depressant (which is required before changing meds)?

A

Full dose for 1-2 months

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11
Q

Describe the correlation btwn plasma levels of SSRIs and efficacy or ADEs.

A

No correlation

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12
Q

How often are most SSRIs dosed? What’s the exception to this?

A

Daily. Fluoxetine also has a weekly dosing form.

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13
Q

Which SSRI has the longest half-life and thus doesn’t need to be tapered?

A

Fluoxetine

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14
Q

What’s the levo-enantiomer of citalopram?

A

Escitalopram

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15
Q

Which SSRI has the fewest DDIs?

A

Citalopram

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16
Q

Which SSRI is only approved for OCD? What is its major problem?

A

Fluvoxamine; lots of DDIs

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17
Q

Which SSRI is safe in pregnancy and in kids?

A

Fluoxetine

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18
Q

Which SSRI has a short half-life, increasing the risk of withdrawl?

A

Paroxetine

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19
Q

Which SSRI is highly protein bound, inhibits cyp2D6, and has relatively more anti-cholinergic ADEs?

A

Paroxetine

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20
Q

How can fluoxetine change levels of neuroleptics?

A

It inhibits cyp 1A2, 2D6, and 3A4, which can increase levels.

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21
Q

Which SSRI has the highest risk for GI disturbance but very few DDIs?

A

Sertraline

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22
Q

Person on high-dose antidepressants takes OTC cough meds. What potentially fatal complication could you expect?

A

Serotonin syndrome: some OTC anti-cough drugs can boost 5HT levels.

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23
Q

What’s the BBW for SSRIs?

A

Increased suicidal thinking and behavior (MC in kids and teens)

24
Q

Which category of SSRI ADEs doesn’t typically resolve w/in a few weeks?

A

Sexual dysfxn

25
Q

Name the 3 major advantages of SSRIs over other antidepressants

A

Fewer ADEs
No food restrictions
Much safer in OD

26
Q

How , long should you wait btwn giving SSRI and MAO-I?

A

2 wks

27
Q

What syndrome presents w/ fever, sweating, shivering, HTN, hyperreflexia, “electric jolt” limb movements, etc?

A

Serotonin syndrome

28
Q

What monitoring might you have to do when starting a warfarin pt on an SSRI?

A

Increase monitoring of warfarin bc SSRIs can incr warfarin levels

29
Q

Name the 3 SNRIs

A

Venlafaxine
Duloxetine
Desvenlafaxine

30
Q

What are the 3 main indications for venlafaxine?

A

Depression
Anxiety
ADHD

31
Q

Venlafaxine has an ADE profile similar to SSRIs. Which ADE is different?

A

It increases BP

32
Q

What drug is the expensive active form of venlafaxine?

A

Desvenlafaxine

33
Q

What drug would be useful in someone with depression + neuropathic pain?

A

Duloxetine

34
Q

Which SNRI can be used to treat fibromyalgia?

A

Duloxetine

35
Q

Name the unique and worrisome ADE of duloxetine (compared to other SNRIs)

A

Hepatotox

36
Q

What’s the MOA of bupropion?

A

NE-DA reuptake inhibitor

37
Q

What’s the major upside of using bupropion vs other antidepressants? What groups of people can’t take bupropion?

A

Lack of sexual ADEs

Eating disorders and seizure patients

38
Q

Name the 3 major indications for trazodone or nefazodone

A

Refractory major depression
Major depression w/ anxiety
Insomnia

39
Q

BBW for nefazodone?

A

Liver failure

40
Q

3 major ADEs of trazodone?

A

Arrhythmia
Sedation
Priapism

41
Q

Rx refractory major depression in LOL who can’t sleep and needs to gain weight?

A

Mirtazapine

42
Q

Mirtazapine MOA?

A

Alpha2 antagonist

43
Q

Scariest ADE of mirtazapine?

A

Agranulocytosis

44
Q

MOA of TCAs?

A

Inhibit reuptake of NE and 5HT

45
Q

How much TCA is required to kill yourself?

A

As little as 1-2 g

46
Q

Rx of TCA OD?

A

IV sodium bicarb

47
Q

Which TCA is the most serotonin-specific?

A

Clomipramine

48
Q

What do (other than depression) is clomipramine used for?

A

OCD

49
Q

Which type of TCA is more anticholinergic/sedating/lethal in OD: tertiary or secondary amines?

A

Tertiary amines

50
Q

Which 4 TCAs are tertiary amines?

A

Amitriptyline
Imipramine
Clomipramine
Doxepin

51
Q

Which 2 TCAs are secondary amines?

A

Nortriptyline

Desipramine

52
Q

Which TCA has useful therapeutic blood levels?

A

Nortriptyline

53
Q

Which TCA has an IM form and can be used for enuresis or panic do?

A

Imipramine

54
Q

What’s the least anticholinergic TCA?

A

Desipramine

55
Q

Name the 2 tetracyclic antidepressants

A

Amoxapine

Maprotinine

56
Q

Which tetracyclic has the highest rates of seizure, arrhythmia, and fatality?

A

Maprotiline

57
Q

Amoxapine has a similar ADE profile to what drug class?

A

Typical antipsychotics

Psych Clerkship (3 decks)

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