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board vitals psychiatry > psychopharm > Flashcards

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
Q

sertraline CYP effect

A

> 100 inhib

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26
Q

MAOI MoA

A

inhib oxidative deamination of serotonin, NE, DA

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27
Q

MAOI HTN crisis mechanism

A

inhib tyramine metab @GI

28
Q

t1/2 of Z drugs from shortest to longest

A

zaleplon 1-2h
zolpidem 2-3
eszopiclone 6

(ramelteon 1-3, temazepam 10-20, diazepam 40h)

29
Q

Li lvl requiring HD in otherwise healthy pt

A

4-6

30
Q

which SSRI would be most problemsatic with clozaril?

A

fluVOXamine (1a2 inhib)

31
Q

initial side effects of high or low potency typical antipsychotics are similar to TCAs?

A

LOW (including wt gain)

EPS = HIGH potency!

32
Q

rate of TD occurance in typical antipsychotics?

A

5% annually

33
Q

what mechanisms contribute to sexual side effects of antipsychotics?

A

a1 rec, anticholinergic, antidopaminergic

34
Q

increased risk of CV malformations with paxil vs other SSRIs

A

1.5-2x

35
Q

what can be used to treat poor appetite as result of stimulant use?

A

cyproheptadine

36
Q

how can cbz & vpa cause bleeding

A

thrombocytopenia/bone marrow suppression

37
Q

which amphetamine isomer is most rapidly eliminated from body?

A

dextro-isomer in acidified urine

38
Q

CBZ MoA

A

inhib voltgated & presynaptic Na channels > inhib glutamate release

39
Q

topamax MoA

A

inhib Na channels, enhances GABAa rec, antag kainate @AMPA rec

40
Q

VPA effect on GABA

A

INC

41
Q

meds assoc w serotonin synd:

A
  • 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
Q

most serious side effect of mirtazapine

A

agranulocytosis (1/1000), reversible

can also cause hypoNa, hypotension, neutropenia, urinary freq

43
Q

Li effect on Na + how to correct

vs CBZ/VPA effect on Na

A

competes w ADH rec @kidney > inc water output (nephrogenic DI) > hyperNa

amiloride > blocks Li entry

CBZ/VPA > hypoNa

44
Q

is Li like insulin or glucagon

A

insulin (lower bG > inc appetite > wt gain)

45
Q

meds to tx NMS? benzo OD? opioid OD?

A

NMS: dantrolene

benzo: flumazenil
opioid: naloxone, naltrexone

46
Q

indication/MoA for phentolamine

A

a1 blocker for extravasation of NE & HTN from pheo

47
Q

buspar acts on what rec

A

5HT1a selective ptl agonist postsyn @raphe,cortex,hippocampus,ceruleus + inhib D2 presyn

48
Q

topamax MoA for alcohol use do

A

in etoh use, GABA firing decd > disinhib/incd DA release from accumbens&raquo_space; 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
Q

meds assoc w inc risk depression: CV, repro, neuro, psych

A

CV: clonidine, hydralazine

repr: OCPs
neuro: amantadine, reserpine, levodopa
psych: benzos

50
Q

ways to treat hypotension from MAOI

A

support hose, hydrate, salt, fludrocortisone, stimulants

51
Q

serotonin synd sxs, cause, & resolution time

A

sensory change/paresthesias, sleep/vivid dreams, anxiety, agitation, flu like sxs, disequilib

dec synaptic serotonin

2w or 24h if restarted SSRI

52
Q

clozapine OD

A

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
Q

% pts who hypersalivate w clozaril

A

33%

54
Q

prevalence of ebsteins anomaly w Li during pregn

A

1/1000 (compared to 1/20000)

55
Q

trazodone MoA

A

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
Q

benzo chemical structure determines what

A

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
Q

topamax MoA

A

inhib Na channels, enhances GABAa rec, antag subtype glutamate rec (kainate & AMPA)

58
Q

VPA MoA

A

inc GABA

59
Q

lamictal MoA

A

inhib volt gated Na channels & inhib glutamate

60
Q

CBZ MoA

A

inhib volt gated & presyn Na channels

61
Q

buspar MoA

A

5HT1A ptl agonist @postsyn hippocampus & cortex + full @presyn, D2/3/4 mild-mod ptl antag @presyn, a1 ptl ag

62
Q

memantine MoA

A

NMDA rec antag (blocks glutamate overstim which can cause cytotoxicity & neuron death)

63
Q

mirtazapine drug class

A

tetracyclic

64
Q

doxepin drug class

A

TCA

65
Q

is nicotine spray or inhaler faster to reach peak?

lozenge or gum?

how long does cigarette take?

A

SPRAY

LOZENGE

<1min (fastest)

board vitals psychiatry (10 decks)

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