Psychopharm/Meds/Studies Flashcards
Fluoxetine (Prozac) is FDA approved for what disorders and age groups?
KIDS
MDD (ages 8+)
OCD (ages 7+)
ADULTS
panic disorder
bulimia
PMDD
What medication can cause the following side effects: hypothyroidism, hypercalcemia, diabetes insipidus, leukocytosis, nausea, tremors, acne, psoriasis
Lithium
Mnemonic: CLMNOP
The meta-analysis by Bridge ET al 2007, compared placebo vs SSRI response rates. What was the placebo response rate vs the SSRI response rate? most effective being Prozac
What was the NNT?
Placebo = 50%
SSRIs= 61%
NNT= 10
What are the 2 main concerns when someone OD’s on Topamax (topiramate)?
Liver failure & metabolic acidosis
If a patient is taking Valproic acid and is started on Carbamezapine (Tegretol), what drug interaction would you be concerned with?
It would increase the valproic acid levels and decrease carbamezapine
What effect can oxcarbazapine have on thyroid levels?
Oxcarbazapine can cause Low T4
Match MOA with drug.
Lamictal
Carbamezapine
Depakote
Topiramate
1.increases GABA in the brain
2.inhibits glutamate and VG-sodium channels
3.inhibits sodium channels, enhances GABA-a receptors and antagonizes kainate at AMPA receptor
4.inhibits voltage dependent sodium channels and pre-synaptic sodium channels
1.increases GABA in the brain: DEPAKOTE
2.inhibits glutamate and VG-sodium channels: LAMICTAL
3.inhibits sodium channels, enhances GABA-a receptors and antagonizes kainate at AMPA receptor: TOPIRAMATE
- inhibits voltage dependent sodium channels and pre-synaptic sodium channels: CARBAMEZAPINE
Which medication has most common AE of n/v/d, hyponatremia, rash and fluid retention. And has less common AE of leukopenia, thrombocytopenia and hypo-osmolality?
Carbamazepine
What anti-depressant increases the following drug levels?
TCAs and Thioridazine (increased cardiac risk)
Benzodiazepines (increased sedation)
Carbamezapine & Phenytoin & warfarin (increased toxicity)
Bupropion (increased seizure risk)
Prozac —it is a CYP3A4 inhibitor
When taken with food, what SSRI’s peak plasma concentration is increased by 25%?
Sertraline (Zoloft)
Ventricular arrhythmia and seizures are seen with _______ overdoses.
A) SSRI
B) SNRI
C) TCA
D) Antipsychotics
E) Welbutrin
TCAs
Cardiac conduction defects are most common with which TCA?
Desipramine
T/F: Carbamazepine slows cardiac conduction and should be avoided in patients with high-grade AV block and sick sinus syndrome.
True
T/F: Most rashes associated with carbamazepine use are benign.
True
only if rash is widespread + includes mucous membrane involvement should SJS be considered
What heart condition is contraindicated in lithium use?
sick sinus syndrome
What drugs are cyp450 inducers?
SCRAP GP
Sulfonylureas, Smoking, St. Johns worts
Carbamazepine, Corticosteroids
Rifamycins (Rifampicin, Rifabutin)
Alcohol (Chronic)
Phenytoin
Griseofulvin
Phenobarbital
What drugs are CYP450 inhibitors?
SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol, Amiodarone&
Grapefruit Juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
What is the MOA of Mirtazapine?
antagonist of alpha-2 inhibitory autoreceptors
What is the change in effect on serotonin receptors with Trazodone at low vs high doses?
low doses: serotonin antagonist
high doses: serotonin agonist
T/F: Clonidine can cause or worsen depression?
True
What is a side effect that is rare but qualifies as a medical emergency one can experience from atomoxetine (STRATTERA)?
Priapism
Match MOA with drug.
Modafinil
Clonidine
Buproprion
Mirtazapine(Remeron)
- alpha-2 blocker
- alpha-2 agonist
- DA and NE reuptake inhibitor
- exploit the hypocretin/orexin pathway
- alpha-2 blocker: Mirtazapine
- alpha-2 agonist: Clonidine
- DA and NE reuptake inhibitor: Buproprion
- exploit the hypocretin/orexin pathway: Modafinil
What 2 drugs are FDA approved for treatment of aggression and irritability in youth with Autism?
- Risperidone
- Abilify
MODAFINIL showed efficacy in reducing ADHD symptoms in kids but is not FDA approved due to what possible AE?
SJS
What are symptoms of Serotonin syndrome?
HARMED
Hyperthermia and hyperreflexia
Autonomic instability
Rigidity
Myoclonus
Encephalopathy
Diarrhea
What mood stabilizer is associated with increased risk of developing PCOS?
Depakote
Which gene is the target of stimulant meds for ADHD?
DAT1
-codes for the dopamine transporter that is involved in the reuptake of dopamine from the synapse back into the presynaptic neuron. The dopamine transporter is one of the major gene products implicated in the pathophysiology of ADHD. Stimulant drugs act by inhibiting DAT1 and the reuptake of dopamine which leads to an increase in the levels of dopamine at the synapse.
What is the treatment for NMS?
Hydration
Stop offending drug
+/- bromocriptine or dantrolene
follow renal fxn to r/o rhabdo
What is difference between pharmacodynamic and pharmacokinetic DDI?
pharmacodynamic DDI : two drugs have additive activity when given together, more like how there individual results affect one another
pharmacokinetic DDI: talking about ADME effects (absorption, distribution, metabolism, excretion), affects concentration (up or down) of victim drug at its site of action, movement of the drug through the body
What is the difference in the proportion of total body water and fat in children vs adults?
Children: more total body water, less fat
adults: more total body fat, less water
Given the proportions how does it affect VOD?
Children: more total body water, less fat
adults: more total body fat, less water
Children: Increased VOD of water soluble drugs
(ie lower serum lithium levels because lithium is drawn into cells as it is water soluble)
Adults: increased VOD of lipid soluble drugs
Carbamezapine induces what enzyme?
CYP3A4
Cigarette SMOKE induces which enzyme which can lead to pharmacokinetic or metabolic DDI?
CYP 1A2 enzyme
What are the 4 drugs that go directly to Phase 2 metabolism?
BENZOS: LOT (lorazepam, oxazepam, temazepam)
Lamictal
GABA and Glycine are ____NT which hyperpolarize the cell.
Inhibitory
Glutamate and aspartate are _____ NT which depolarize the cell.
Excitatory
What is the MOA of Buproprion?
DNRI (dopamine and NE reuptake inhibitor)
What is the MOA of Mirtazapine?
5H2 &3: lower GI and sexual side effects
Histamine: sedating effects
Alpha-1 : orthostatic hypotension
Alpha-2: continued release of NT
What is the MOA of Buprenorphine?
- antagonist at kappa receptor
- partial agonist at mu receptor
kappa statistic is employed in assessing level of agreement across raters.
T/F
True
If a mom continues Carbamezapine during pregnancy (despite its high risk) what vitamin should we supplement with?
Vitamin K
What type of study design entails a single group of individuals being studied periodically before and after an intervention? It’s a quasi-experimental design.
Time Series Design
Name disorder that matches animal study for genetic risk.
1) SAPAP3 (SAP90/PSD-95-associated protein 3) synaptic protein mutant mouse OR Slitrk5 (SLIT and NTRK-like family
2) Pten mutant mouse
3) MeCP2 mutant mouse
4) Fibroblast growth factor mutant mice
1) OCD
2) autism
3) Rett
4) depression and anxiety
Fetal hydantoin syndrome is correct as it is caused if the fetus is exposed to _________drug during pregnancy. It is characterized by abnormalities in limbs, central nervous system abnormalities, cleft lip and palate, and ocular defects present in this baby.
Phenytoin has teratogenic effects and causes various defects in the developing fetus.
anti-epileptics
Carbamazepine _____ the metabolism of lamotrigine, resulting in a 40% reduction in serum levels at a given dose. Therefore, lamotrigine is usually initiated at twice the usual recommended dose in patients on carbamazepine.
induces
