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Summary Notes Royal College > Psychopharm > Flashcards

Psychopharm Flashcards

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1
Q

Which of the following antidepressants has minimal norepinephrine selectivity?

A
  • citalopram and escitalopram most selective serotonin and very little inhibition of NE and dopamine

NE activitity of SSRIs (highest to lowest): Paroxetine (somewhat significant) Fluoxetine (somewhat significant) Sertraline FluvoxamineCitalopram (very minimal) Escitalopram

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2
Q

Which TCA has most norepinephrine sensitivity?

A
  1. Desimipramine

2. Nortryptilline

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3
Q

Serotonin Syndrome?

A

Lab abnormalities: metabolic acidosis, rhabdomylosis, elevated serum AAT, creatiine, DIC*
hypERthermia, agitation, tremor, akithesia, deep tendon hypERreflexia, spontaenous CLONUS, DILATED PUPILS

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4
Q

Drugs associated with serotonin syndrome?

A

SSRI
Trazodone, Nefazodone, Clomipramine, Buspirone, Venlafaxine
MAOi - phenelzine, moclobemide, clorgiline,
Anticonvulsants - valproate
Analgesics - meperidine, fentanyl, pentazocine
Antiemetics - ondansetron, graniesteron, metclopramide
Antibiotics - linezolid
Lithium

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5
Q

MAOI side effects

A 
OWEIS
O- Orthostasis
W - Weight gain
E - edema/peripheral
I - Insomnia
S - sexual dysfunction
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6
Q

Pharmacokinetics w/aging

A

no change to conjucation and glucornidation
decreased hydroxylation and demethylation
decreased oxidation/decreased reduction

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7
Q

What don’t you use with clozapine?

A

Carbamezapine - increases agranulocytosis - BM suppression

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8
Q

Clozapine toxcitiy?

A

hypotension NOT hypERtension

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9
Q

Clonidine- pharm actions?

A

works on presynaptic - 2 adrenergic receptors- agonist
opp of heroin withdrawal
dry mouth, constipation, dizziness, hypotension

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10
Q

CYP1A2

A
  1. Fluvoxamine
  2. Fluoxetine

Minimal

  • Bupropion
  • Mirtazapine
  • Paroxetine
  • Sertraline
  • Venlafaxine
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11
Q

CYP2D6

A
  1. Bupropion, Fluoxetine, Paroxetine

Mod - Citalopram, Escitalopram, Sertraline

Low - 
Fluvoxamine
Mirtazapine
Nefazodone
Venlafaxine
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12
Q

CYP3A4/CYT p450

A

High:
Fluvoxamine
Nefazodone
Tricyclics

Fluoxetine
Sertraline

Low:
citralopram
escitalopram
mirtazapine
paroxetine
venlafaxine
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13
Q

Largest risk for TD ?

A

elderly female

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14
Q

SSRI - side effects

A

platelet aggregation

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15
Q

What is least histaminergenic/ach?

A

desimpramine

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16
Q

Most common side effect of Trazodone?

A

Headache

2A & C reuptake inhibitor

17
Q

NMS

A 
Hyperthermia
Mental status change
CK elevation
Blood pressure elevation
Diaphoresis
Urinary incontience
18
Q

Lamotrogine - MOA

A

blockade of voltage gated Na channels

modulates release of glutumate and aspartate

19
Q

Buspirone - MOA

A 
affinity 5HT1A
moderate affinity D2
no effect on GABA
in GAD.
Buspirone does not cause weight gain, sexual dysfunction, discontinuation symptoms, or significant sleep disturbance. It does not produce sedation or cognitive and psychomotor impairment. The most common adverse effects of buspirone are headache, nausea, dizziness, and (rarely) insomnia.
20
Q

Tetrabenzine

A

Depression

VMAT

21
Q

Carbamezapine

A 
rash
mild hematopoetic suppression
sedation
H- Headache
A - Ataxia
R - Rash
D - Dizziness
S - Sexual Dysfunction
A - Anemia/Agranulocytosis
N - Nausea
D - Diplopia
22
Q

Lithium induced tremor - tx

A

Propanolol

23
Q

Anticholinergic toxcitiy

A 
BLIND AS A BAT, MAD AS A HATTER
blurred vision - mydriasis
fever
dry mouth
tachycardia
urinary retention
ileus
hypotension
24
Q

Worst SSRI - sexual dysfunction

A

paroxetine
stimulation of 5Ht2
worse because it impairs NOS

25
Q

Desimipramine

A

no SRI activity

all NRI*

26
Q

MOA - Mirtazapine

A

alpha-2 antagonist, 5HT2A/C antagonist, H1 antagonist

27
Q

Psychostimulants - key interactions

A

Psychostimulants may increase the level of phenytoin, carbamazepine, and phenobarbital.

At the same time, these antiepileptics may lower the psychostimulant level as they act as universal enzyme inducers.

Psychostimulants increase the level of MAO inhibitor and TCAs. Possible increase in SSRI level.
Psychostimulants may increase the effect of warfarin.

Valproic acid – increased concentrations of valproic acid: consider monitoring serum valproic acid concentrations.

Heart rate-lowering drugs: concomitant use not recommended.

28
Q

Contraindications to psychostimulants

A

Treatment with MAO inhibitors and for up to 14 days
Pre-existing severe gastrointestinal narrowing after discontinuation
Advanced arteriosclerosis
Glaucoma
Known hypersensitivity or allergy to the products
Untreated hyperthyroidism
Moderate to severe hypertension

Summary Notes Royal College (16 decks)

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