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Psychiatry Terms > Psychopharm Concepts > Flashcards

Psychopharm Concepts Flashcards

1
Q

Efficacy vs Effectiveness

A

Efficacy is controlled setting. Effectiveness is real world with missed doses.

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2
Q

When antacid pops up in the vignette?

A

They are trying to cue you in that something is impairing/changing the absorption.

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3
Q

Do children have more or less total body water than adults?

A

More total body water, less fat. They will have increased volume of distribution for water soluble drugs .

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4
Q

What is Phase I metabolism?

A

Adding a ‘handle’ on the drug mostly through CYP450. This means oxidation, reduction, or hydrolysis.

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5
Q

3A4 inhibitors?

A

Ketoconazole, grapefruit juice, erythyromycin , cimetidine, nifedipine, verapamil

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6
Q

What all drugs will carbamazepine induce?

A

depakote, haldol, OCP, protease inhibitors, midazolam, vincristine.

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7
Q

What enzyme does smoking induced

A

1A2 (the 1 looks like a cigarette). This will impact imipramine, clomipramine, luvox, trazdoone, thiothixine, haldol, fluphenazine, olanzapine, xanax, valium

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8
Q

Phase II Metabolism

A

Conjugation of drug with endogenous substrates (glucuronic acid, glutathione, sulfate, acettie.

  • Glucuronides are excreted into bile while all others go into urine.
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9
Q

What does ‘Out the Liver Mean?’

A

Drugs that go directly to Phase II metabolism. (Oxazepam, temaepam, lorazepam, Lamictal).

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10
Q

How does remeron get its antidepressant effects?

A

Via alpha 2 antagonism which is a negative feedback loop. Ultimately increases level of monoamines.

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11
Q

What is an example of an inverse agonist?

A

Pimavanserin (nuplazid)

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12
Q

How are remeron and clonidine/guanfacine opposites?

A

Remeron is alpha 1 and alpha 2 antagonism

Clonidine is alpha 2 agonism.

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13
Q

How do the triptans work?

A

Constrict cranial arteries. Mechanism is that they are 5-HT1D agonists.

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14
Q

What makes aripiprazole unique?

A

It is an antipsychotic that is a partial agonist at 5HT2a and D2.

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15
Q

What are the 3 subgroups of monoamines?

A

1) Catecholamines (catechol group: NE, E, D)
2) Tryptamines (serotonin, melatonin)
3) Histamines

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16
Q

What cardiac problems can lithium cause?

A

Supraventricular arrythmias suh as sick sinus syndrome and tachy-brady syndrome. Can prolong PR interval.

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17
Q

Which med may SHORTEN QTc?

A

bupropion

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18
Q

Which 3 antipsychotics are the most likely to cause hypotension/falls?

A

Clozapine, seroquel, and chlorpromazine

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19
Q

Two main drugs to avoid in renal disease?

A

Lithium and duloxetine

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20
Q

In addition to the NTD, what other defects can depakote cause to baby?

A

Neurobehavioral teratogenicity: lower IQ, possible ID, and linked to autism. Can also have withdrawal sx, liver toicity, and hypoglycemia.

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21
Q

BZD and risk to baby

A

Cleft abnormalities can happen along with floppy baby syndrome if given right before birth.

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22
Q

Is doxepin safe for lactation?

A

No, it is the worst. L5 category.

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23
Q

What should you counsel anyone when giving luvox?

A

Caution on caffeine consumption. Luvox inhibits CYP1A2 metabolism of caffeine. Pt can develop caffeine intoxication including palpitations, anxiety, insomnia, dyspepsia, and loose stools.

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24
Q

Which carbamazepine interactions should one be aware of?

A
  • erythrymocyin leads to carbamazepine toxicity
  • Lowers valproate
  • Lowers OCP, increased risk of pregnancy.
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25
Q

Common luvox interactions

A
  • Warfarin toxicity
  • Theophylline toxicity
  • Clozapine toxicity
  • Caffeine toxicity
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26
Q

Linezolid interactions

A

Antibiotic with MAOI activity, can lead to serotonin syndrome.

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27
Q

Methylene blue

A

Can lead to serotonin syndrome.

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28
Q

What is significant about ST. John’s Wort?

A

3A4 inducer which can decrease the plasma levels of OCP, increasing risk of pregnancy. Pharmacodynamically, it can combine with fluoxetine to cause serotonin syndrome.

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29
Q

What does grapefruit inhibit?

A

3A4 inhibitor. Separating ingestion of grapefruit from drug does not work bc cell neds 24 hours to replace 50% of inactivated 3A4 enzyme.

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30
Q

Buspar and grapefruit

A

Grapefruit can have 9x increase area under curve of buspar, vastly increased concentrations.

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31
Q

Cannabidiol and CYP

A

3A4 inhibitor which could increase bzd and opioid levels

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32
Q

PPI interactions

A

PPI’s cause 2C19 inhibition which increases levels of citalopram, escitalopram, and diazepam.

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33
Q

Cimetidine interactions

A

3A4 inhibitor that can increase chlordiazepoxide, dizepam, some tca, and citalopram.

34
Q

Amphetamines and GERD meds

A

Increased pH leads to increased meth absorption. ADHD meds would get increased too

35
Q

Does volume of distribution go up or down in the elderly?

A

Up if it is a lipid soluble drug.

36
Q

OCP and caffeine

A

OCPs reduce the elimination of caffeine

37
Q

Main reasons for noncompliance

A

Cost of medications are too high
Psychiatric symptoms interfere with treatment
Instructions are poorly given

38
Q

In addition to NTD, what other things happen if uterus is exposed to VPA?

A

increased risk of autism

39
Q

What percentage of white people are poor CYP2D6 metabolizers?

A

6% to 10% , lower in Asians (2%).

40
Q

chlorpromazine associated with high or low EPS?

A

Low

41
Q

MOA of bzd on GABA receptor

A

MODULATOR

42
Q

Black box warning for carbamazepine?

A

Derm rxn

43
Q

LSD mechanism of action?

A

5-hydroxytryptamine receptor agonism. strong serotonergic effects

44
Q

Which 2 vitamins have evidence for tardive?

A

Vitamin E and Vitamin B6 (pyridoxine)

45
Q

What electrolyte abnormality does oxcarbazepine cause?

A

Hyponatremia like SSRI’s.

46
Q

Which meds can lead to diabetic ketoacidosis?

A

atypical antipsychotics because they disrupt metabolism

47
Q

Which 2 TCA’s have the lowest anticholinergic profile?

A

nortriptyline and desipramine.

48
Q

VPA can lead to what in females?

A

PCOS

49
Q

Paralytic ileus is seen in what?

A

clozapine toxicity

50
Q

Narrow angle glaucoma, be careful about which med?

A

Benztropine

51
Q

What receptor does buspar work on?

A

5HT1A receptor

52
Q

What antipsychotic should be avoided in breastfeeding?

A

Clozapine. Agranulocytosis

53
Q

What is the amino acid precursor of all the catecholamine neurotransmitters including dopamine, norepinephrine, and epinephrine.

A

Tyrosine

54
Q

What medicine, when combined with haldol, can cause a syndrome that looks like NMS?

A

Lithium

55
Q

How do you treat lithium induced NDI?

A

lithium-induced NDI is amiloride, a potassium-sparing diuretic that reduces lithium uptake in the cells of the collecting duct improving responsiveness to ADH-stimulated translocation of AQP2 to the membrane of the principal cells.

56
Q

Common 1A2

A

fluvoxamine, haldol, theophylline

57
Q

Psychogenic polydipsia more common in typical or atypical antipsychotics?

A

typical. Switch them to an atypical .

58
Q

What should one worry about with wellbutrin and drug interactions?

A

2D6 inhibitor. Gonna crank up things like nortriptyline.

59
Q

Which 4 antipsychotics require renal adjustment?

A

clozapine, paliperidone, risperidone, and lurasidone

60
Q

What are platelet serotonin levels doing during the headache phase of a migraine? Urine platelet serotonin levels?

A

Drop dramatically during the headache phase of migraine, while levels in the urine increase

61
Q

What types of molecules can go through the blood brain barrier?

A

the blood-brain barrier (BBB) allows lipophilic molecules to cross easily by passive diffusion, which is the reason for the acute effects of CNS depression after solvent inhalation.

62
Q

Other than trazodone, what other drugs can cause priapism?

A

Antipsychotics

63
Q

First line treatment for predatory aggression?

A

antipsychotics

64
Q

What drugs are used for myoclonus?

A

Clonazepam and valproic acid are most commonly used for myoclonus, though often with limited efficacy.

65
Q

What dietary counseling should you tell pt’s regarding Z drugs?

A

No fatty meals.

66
Q

Caffeine intoxication causing heart problems, what do you do?

A

hemodialysis

67
Q

Safest antipsychotic for pregnancy?

A

Olanzapine

68
Q

Which 2 drugs can help reduce bedwetting?

A

desmopressin and imipramine.

69
Q

Dutasteride have what teratogenic effect?

A

Birth defects in male fetuses

70
Q

Which neurotransmitter does MAO B have a higher affinity for?

A

Dopamine , causing its degredation

71
Q

If lymphadenopathy is present after a lamictal rash, is it benign or not benign?

A

Not benign.

72
Q

Bupropion MOA

A

Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that inhibits the reuptake of dopamine and , to a lesser degree, norepinephrine, leading to an increased level of these chemicals in the synapse.

73
Q

Drugs to treat the 4 types of aggression:

affective, organic, predatory, and ictal

A

The drug of choice for organic-like aggression is imipramine, which is a tricyclic antidepressant. Anticonvulsants are a valid alternative. Selective serotonin reuptake inhibitors may have some clinical utility as well. Lithium is a drug of choice for affective aggression. Haloperidol might be an acceptable choice for predatory aggression, however second-generation antipsychotics are less neurotoxic and should be considered first.

74
Q

Which antiepileptic causes aplastic anemia and liver failure , therefore is a last resort?

A

Felbamate

75
Q

Which NT abnormality is associated with episodic violence?

A

An increased norepinephrine receptor sensitivity is associated with hyperactivity to the environment which may increase the likelihood of aggression.

76
Q

False Positive for amphetamines and methamphetamines

A

bupropion

77
Q

Excitatory NTs?

Inhibitory NTS?

A

Glutamate and aspartate are the amino acids that serve as excitatory neurotransmitters and activate the N-methyl-d-aspartate (NMDA) receptors which have been implicated in learning, memory and mood changes.

78
Q

What is amoxapine used to treat?

A

Depression

79
Q

Who is most susceptible to acute dystonic reactions?

A

Young, antipsychotic-naive males are more prone to acute dystonic reactions.

80
Q

What do you give for lithium induced NDI?

A

Amiloride

Psychiatry Terms (33 decks)

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