Psychopharm Flashcards
Which 2 psych drug classes cause the most HAM ADEs?
TCAs
Low-potency antipsychotics
DOC for neuroleptic-induced EPS?
Benzotropine
Classic drug combo leading to serotonin syndrome?
SSRI + MAO-1
What presents w/ fever, tachycardia, very elevated CPK, and lead pipe rigidity?
NMS
How does carbamazepine affect CYPs?
Induces 1A2, 2C9, 3A4
Mortality rate of NMS?
20%
Which neurologic disease is classically worsened by anti-cholinergics?
Alzheimers dz
What % of pts w/ major depression will respond to anti-depressants? What % of the above is placebo effect?
70% respond. 30% of that is placebo
How long do most anti-depressants require for effect?
3-4 weeks
What time/dose constitutes an adequate trial of an anti-depressant (which is required before changing meds)?
Full dose for 1-2 months
Describe the correlation btwn plasma levels of SSRIs and efficacy or ADEs.
No correlation
How often are most SSRIs dosed? What’s the exception to this?
Daily. Fluoxetine also has a weekly dosing form.
Which SSRI has the longest half-life and thus doesn’t need to be tapered?
Fluoxetine
What’s the levo-enantiomer of citalopram?
Escitalopram
Which SSRI has the fewest DDIs?
Citalopram
Which SSRI is only approved for OCD? What is its major problem?
Fluvoxamine; lots of DDIs
Which SSRI is safe in pregnancy and in kids?
Fluoxetine
Which SSRI has a short half-life, increasing the risk of withdrawl?
Paroxetine
Which SSRI is highly protein bound, inhibits cyp2D6, and has relatively more anti-cholinergic ADEs?
Paroxetine
How can fluoxetine change levels of neuroleptics?
It inhibits cyp 1A2, 2D6, and 3A4, which can increase levels.
Which SSRI has the highest risk for GI disturbance but very few DDIs?
Sertraline
Person on high-dose antidepressants takes OTC cough meds. What potentially fatal complication could you expect?
Serotonin syndrome: some OTC anti-cough drugs can boost 5HT levels.
What’s the BBW for SSRIs?
Increased suicidal thinking and behavior (MC in kids and teens)
Which category of SSRI ADEs doesn’t typically resolve w/in a few weeks?
Sexual dysfxn
Name the 3 major advantages of SSRIs over other antidepressants
Fewer ADEs
No food restrictions
Much safer in OD
How , long should you wait btwn giving SSRI and MAO-I?
2 wks
What syndrome presents w/ fever, sweating, shivering, HTN, hyperreflexia, “electric jolt” limb movements, etc?
Serotonin syndrome
What monitoring might you have to do when starting a warfarin pt on an SSRI?
Increase monitoring of warfarin bc SSRIs can incr warfarin levels
Name the 3 SNRIs
Venlafaxine
Duloxetine
Desvenlafaxine
What are the 3 main indications for venlafaxine?
Depression
Anxiety
ADHD
Venlafaxine has an ADE profile similar to SSRIs. Which ADE is different?
It increases BP
What drug is the expensive active form of venlafaxine?
Desvenlafaxine
What drug would be useful in someone with depression + neuropathic pain?
Duloxetine
Which SNRI can be used to treat fibromyalgia?
Duloxetine
Name the unique and worrisome ADE of duloxetine (compared to other SNRIs)
Hepatotox
What’s the MOA of bupropion?
NE-DA reuptake inhibitor
What’s the major upside of using bupropion vs other antidepressants? What groups of people can’t take bupropion?
Lack of sexual ADEs
Eating disorders and seizure patients
Name the 3 major indications for trazodone or nefazodone
Refractory major depression
Major depression w/ anxiety
Insomnia
BBW for nefazodone?
Liver failure
3 major ADEs of trazodone?
Arrhythmia
Sedation
Priapism
Rx refractory major depression in LOL who can’t sleep and needs to gain weight?
Mirtazapine
Mirtazapine MOA?
Alpha2 antagonist
Scariest ADE of mirtazapine?
Agranulocytosis
MOA of TCAs?
Inhibit reuptake of NE and 5HT
How much TCA is required to kill yourself?
As little as 1-2 g
Rx of TCA OD?
IV sodium bicarb
Which TCA is the most serotonin-specific?
Clomipramine
What do (other than depression) is clomipramine used for?
OCD
Which type of TCA is more anticholinergic/sedating/lethal in OD: tertiary or secondary amines?
Tertiary amines
Which 4 TCAs are tertiary amines?
Amitriptyline
Imipramine
Clomipramine
Doxepin
Which 2 TCAs are secondary amines?
Nortriptyline
Desipramine
Which TCA has useful therapeutic blood levels?
Nortriptyline
Which TCA has an IM form and can be used for enuresis or panic do?
Imipramine
What’s the least anticholinergic TCA?
Desipramine
Name the 2 tetracyclic antidepressants
Amoxapine
Maprotinine
Which tetracyclic has the highest rates of seizure, arrhythmia, and fatality?
Maprotiline
Amoxapine has a similar ADE profile to what drug class?
Typical antipsychotics
