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psychopharm Flashcards

1
Q

antipsychotic of choice in hx EPS

A

zyprexa

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2
Q

what % D2 blockade assoc w EPS vs clinical effect

A

80% vs 60-70

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3
Q

carbamazepine cardiac affect, conditions to avoid

A

slows conduction > avoid in AV block, sick sinus synd

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4
Q

carbamazepine effect on Na

A

SIADH –> hypoNa

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5
Q

atypical w highest risk EPS

A

risperdal

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6
Q

ALL antipsychotics block what receptors (to some degree)

A 
HAM (+ D)
histamine
alpha1
muscarinic
dopa
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7
Q

antipsychotic side effects from histamine blockade

A

sedation, wt gain

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8
Q

antipsychotic side effects from alpha1 blockade

A

sedation, dizziness, orthostatic hypotension

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9
Q

antipsychotic side effects from muscarinic blockade

A

sedation, dry mouth, constipation (anticholinergic)

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10
Q

antipsychotic side effects from dopa blockade

A

motor/EPS

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11
Q

amphetamine MoAs on DA (3)

A

1 competitively inhib DA presynaptic uptake by transporter
2 facilitates DA release from vesicles into cytoplasm & presynaptic neuron
3 promotes transporter-med reverse-transport of DA into cleft, indep of action-potential-ind vesicular release
–> inc extracell DA + longer DA rec signaling @striatum

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12
Q

class of mirtazapine

A

tetracyclic, NaSSA (noradrenergic & specific serotonergic antidepressant)

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13
Q

mirtazapine MoA

A

blocks presynaptic alpha2 rec –> 5HT1a activation & inc DA release

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14
Q

how does amiloride help w Li side effects

A

blocks Li entry thru Na channel of kidney –> reduces nephrogenic DI (polyuria 2/2 dec fluid resorption @distal tubules)

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15
Q

hypnotic to take in middle of night

A

zaleplon (shortest t1/2 1-2h)

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16
Q

ginkgo biloba indication + CI med

A

cognition/memory, warfarin

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17
Q

by what age is absorption & transportation of drugs same as adult

A

4mo

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18
Q

by what age are GFR & CYP metab same as adult

A

1yo

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19
Q

which CYP present at birth, last to develop

A

3A7 @birth (undetectable in adults), 1A2 last

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20
Q

CYP that metabolizes most drugs

A

3A4 (40-50%)

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21
Q

race most commonly affected by abnormal 2D6 metab & %

A

5-10% caucasians > AA > azns

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22
Q

galantamine MoA

A

reversible competitve inhib AChE + allosteric modulator of nicotinic AChRs

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23
Q

memantine MoA

A

glutamatergic NMDAR antag

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24
Q

effect of NSAIDs on Li

A

renal a constr –> dec Li clearance via renal excr –> inc serum lvl

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25
sertraline CYP effect
>100 inhib
26
MAOI MoA
inhib oxidative deamination of serotonin, NE, DA
27
MAOI HTN crisis mechanism
inhib tyramine metab @GI
28
t1/2 of Z drugs from shortest to longest
zaleplon 1-2h zolpidem 2-3 eszopiclone 6 (ramelteon 1-3, temazepam 10-20, diazepam 40h)
29
Li lvl requiring HD in otherwise healthy pt
4-6
30
which SSRI would be most problemsatic with clozaril?
fluVOXamine (1a2 inhib)
31
initial side effects of high or low potency typical antipsychotics are similar to TCAs?
LOW (including wt gain) | EPS = HIGH potency!
32
rate of TD occurance in typical antipsychotics?
5% annually
33
what mechanisms contribute to sexual side effects of antipsychotics?
a1 rec, anticholinergic, antidopaminergic
34
increased risk of CV malformations with paxil vs other SSRIs
1.5-2x
35
what can be used to treat poor appetite as result of stimulant use?
cyproheptadine
36
how can cbz & vpa cause bleeding
thrombocytopenia/bone marrow suppression
37
which amphetamine isomer is most rapidly eliminated from body?
dextro-isomer in acidified urine
38
CBZ MoA
inhib voltgated & presynaptic Na channels > inhib glutamate release
39
topamax MoA
inhib Na channels, enhances GABAa rec, antag kainate @AMPA rec
40
VPA effect on GABA
INC
41
meds assoc w serotonin synd:
- antidepr/mood stab incl SSRIs, SNRIs, MAOIs, buspar, Li, CBZ, VPA - amphetamines ie ecstasy - analgesics ie flexeril, fentanyl, demerol, tramadol - other: reglan, zofran, ergots, triptans, dexromethorphan, linezolid
42
most serious side effect of mirtazapine
agranulocytosis (1/1000), reversible can also cause hypoNa, hypotension, neutropenia, urinary freq
43
Li effect on Na + how to correct vs CBZ/VPA effect on Na
competes w ADH rec @kidney > inc water output (nephrogenic DI) > hyperNa amiloride > blocks Li entry CBZ/VPA > hypoNa
44
is Li like insulin or glucagon
insulin (lower bG > inc appetite > wt gain)
45
meds to tx NMS? benzo OD? opioid OD?
NMS: dantrolene benzo: flumazenil opioid: naloxone, naltrexone
46
indication/MoA for phentolamine
a1 blocker for extravasation of NE & HTN from pheo
47
buspar acts on what rec
5HT1a selective ptl agonist postsyn @raphe,cortex,hippocampus,ceruleus + inhib D2 presyn
48
topamax MoA for alcohol use do
in etoh use, GABA firing decd > disinhib/incd DA release from accumbens >> reinforcing etoh...disinhib GABA neurons @VTA mean its "hyperexcitable" TPX incs GABA tone @accumbens > inhib GABA @VTA & antag glutamate > suppr etoh-ind DA release @ accumbens
49
meds assoc w inc risk depression: CV, repro, neuro, psych
CV: clonidine, hydralazine repr: OCPs neuro: amantadine, reserpine, levodopa psych: benzos
50
ways to treat hypotension from MAOI
support hose, hydrate, salt, fludrocortisone, stimulants
51
serotonin synd sxs, cause, & resolution time
sensory change/paresthesias, sleep/vivid dreams, anxiety, agitation, flu like sxs, disequilib dec synaptic serotonin 2w or 24h if restarted SSRI
52
clozapine OD
delirium, lethargy, hypotension, tachy, resp failure a1 block (dizzy, sedation, hypotension), D2 block, M1 block (dry mouth, constip, sed), H1 block (sed, wt gain)
53
% pts who hypersalivate w clozaril
33%
54
prevalence of ebsteins anomaly w Li during pregn
1/1000 (compared to 1/20000)
55
trazodone MoA
active metab is agonist @5HT2A > ptl @2C, ptl @1A. it's metabolized by CYP2D6 (actually blocked by traz @5HT2A/C) + selective inhib serotonin reuptake by brain presynaptosomes
56
benzo chemical structure determines what
t1/2 in body/metab 2keto: long t1/2 bc oxidation @liver slow 3hydroxy: shorter t1/2 bc conjug w glucuronide radical triazolo: shorter t1/2 bc oxidized but ltd active metab
57
topamax MoA
inhib Na channels, enhances GABAa rec, antag subtype glutamate rec (kainate & AMPA)
58
VPA MoA
inc GABA
59
lamictal MoA
inhib volt gated Na channels & inhib glutamate
60
CBZ MoA
inhib volt gated & presyn Na channels
61
buspar MoA
5HT1A ptl agonist @postsyn hippocampus & cortex + full @presyn, D2/3/4 mild-mod ptl antag @presyn, a1 ptl ag
62
memantine MoA
NMDA rec antag (blocks glutamate overstim which can cause cytotoxicity & neuron death)
63
mirtazapine drug class
tetracyclic
64
doxepin drug class
TCA
65
is nicotine spray or inhaler faster to reach peak? lozenge or gum? how long does cigarette take?
SPRAY LOZENGE <1min (fastest)

board vitals psychiatry (10 decks)

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