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Psychiatry > Psychopharm Nuggets > Flashcards

Psychopharm Nuggets Flashcards

1
Q

Medications approved for OCD

A 
fluvoxamine 
paroxetine
sertraline
fluoxeteine
clomipraine (look for anticholinergic side effects and sedation)
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2
Q

TCA’s used for insomnia

A

Amitrityline

Doxepin

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3
Q

Common side effects associated with anticholinergics

A

dry mouth, constipation, tachycardia

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4
Q

Off label uses for wellbutrin other than the standard depression

A

ADHD, bipolar depression, and sexual dysfunction caused by SSRI

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5
Q

Target dose for wellbutrin for managing depression

A

300 mg total

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6
Q

Difference in how you dose wellbutrin when prescribing SR,IR,or ER

A

SR and IR need BID dosing (separate at least 6-8 hrs to decrease risk of seizures)- there is a higher risk for seizures with larger doses of wellbutrin in SR and IR versions

ER is once a day

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7
Q

Ways that seizure risk is increased with wellbutrin

A

SR/IR at high doses (>450)

Crushing and snorting it, chewing it, dividing it

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8
Q

Receptors that wellbutrin acts on

A

DA and NE reuptake inhibitors

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9
Q

Common side effects of wellbutrin

A

Agitation, insomnia, headache, nausea, vomiting, tremor, tachycardia, dry mouth, weight loss.

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10
Q

Ideal depressed patients that would benefit from wellbutrin

A

Those with poor concentration and fatigue and concerned about weight gain

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11
Q

Factors to base SSRI decision on

A

side effects, cost, and drug interactions

All of the SSRI’s are technically of the same efficacy

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12
Q

Which SSRI is associated with a prolonged QTc

A

Citalopram (studies noted that when given doses greater than 40 mg daily, QTc prolonged)

This is not seen with escitalopram

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13
Q

Which SSRI has the least drug interactions

A

Escitalopram, racemic version of citalopram

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14
Q

Which SSRI is most associated with anxiety, insomnia, and decreased appetite

A

fluoxeteine/prozac

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15
Q

What disorder is fluvoxamine often used for

A

OCD

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16
Q

Con’s with prescribing fluvoxamine

A

BID dosing and risk for drug interactions

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17
Q

What sexual dysfuntion is an SSRI helpful for

A

premature ejaculation

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18
Q

Which benzo is a good one to start with for anxiety if needed

A

clonazepam because of it’s long half life and has a gradual onset and offset

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19
Q

Time frame regimen for rx ssri + benzo

A

start patient on ssri and benzo, but then tell them the plan to stop the benzo in 2 weeks because they will no longer need it because the SSRI would have started to kick in by then

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20
Q

When is propranolol useful in anxiety

A

when the patient is experiencing somatic symptoms like heart pounding and shortness of breath and shaking/tremors

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21
Q

Why is prescribing benzos and opiates a no-no

A

increased risk of profound sedation, respiratory depression, coma, and death

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22
Q

Mechanism of propranolol

A

non-selective beta 1 and beta 2 antagonists

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23
Q

Dosage range for propranolol

A

10mg -40 mg BID

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24
Q

When would you want to use propranolol with lithium

A

if there is a lithium induced tremor

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25
Q

Metabolism of propranolol

A

CYP2D6

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26
Q

How long until you see some effect when starting an antidepressant

A

It is actually 1-2 weeks the patient should see some impovement (2-4 weeks is actually a myth according to maudsley)

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27
Q

When should you consider switching an antidepressant

A

if there is NO response at all by 3-4 weeks (if they experience some relief then don’t switch, they may get a full response in a few more weeks)

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28
Q

What side effects are associated with paxil

A

weight gain and sexual dysfunction

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29
Q

What SSRI is associated with diarrhea the most

A

zoloft

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30
Q

Cardiac side effects associated with TCA’s

A

prolonged QTc, tachycardia, hypotension

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31
Q

When is suicide risk the highest with antidepressants

A

when first starting the medication and when discontinuing it

(still good to place people on SSRI beccause treating depression is the best way to prevent suicide and SSRI’s is one of the best treatments for now that we have)

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32
Q

How long should a patient be on an antidepressant

A

6-9 months for single episodes

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33
Q

do SSRI’s treat the cause of depression

A

NO, they only help to relieve the symptoms

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34
Q

At what point should you assess to see if a patient is experiencing benefit from SSRI

A

2 weeks! switch to another agent

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35
Q

An indication to use IR buproprion

A

Pt’s with bariatric surgery, concerns about how it is absorbed

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36
Q

Alternative medication combo with fluoxeteine for treatment resistant depression

A

combine with olanzapine, typically is related to bipolar depression

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37
Q

Meds often used as adjucnt to SSRI when treatment resistant depressione

A

lithium, quetiapine (150-300 mg), abilify (2-10 mg), buproprion (up to 400 mg), or mirtazipine (can do combo of venlafaxine also, but in general with adding mirtazipine, there is a theoretical risk of serotonin syndrome)

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38
Q

What are the cons associated with ketamine treatment in resistant depression (Pro is rapid response)

A

has to be done in the hospital if IV and need multiple sessions

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39
Q

What dose of T3 is needed for adjunct in resistant depression

A

20-50 micrograms

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40
Q

Dose of omega 3 for depression adjunts

A

1-2 grams daily

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41
Q

Best treatment for depression with psychotic features

A

combination of SSRI + antipsychotic OR TCA (imipramine) alone

Also consider ECT, effective and thought to be protective against relapsing into it again

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42
Q

With ECT, meds that decrease the duration of the seizure (meds you want to hold)

A

Benzos, AED’s, barbituates.

Some recommend holding lithium because it increases the risk of confusion- actually increases length of seizure possibly

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43
Q

What population should TCA’s be avoided in

A

those with cardiac issues and elderly patients, Go for SSRI’s

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44
Q

Benefits of stimulants in depression

A

euphoria, wakefulness, and improved fatigue (although modafanil does not provide euphoria but don’t have to worry about dependence or tolerance like the other ones)

Not really recommended to use stimulants in depression though

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45
Q

When might using stimulants in depression be a good idea

A

for patients on hospice who are not expected to live for much longer

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46
Q

Which antidepressants have been studied the most and found to be the most tolerable and effective in post-stroke

A

zoloft, prozac, celexa, and nortriptyline

Nortriptyline is not associated with increased bleeding risk if stroke was hemorrhagic or the patient is on an anticoagulant

Celexa does not affect the enzymes related to anticoagulants as well

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47
Q

Risks associated with SSRI’s in elderly

A
  • increased risk of bleeding (if on NSAIDS, warfarin, or steroids)
  • more likely to develop hyponatremia from it
  • hypotension
  • falls
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48
Q

SSRI’s that are more likely to have drug-drug interactions

A

fluvoxamine, fluoxetine, and paroxetine because they are potent CYP inhibitors

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49
Q

SSRI’s that are least likely to have drug- drug interactions

A

sertraline, citalopram, escitalopram, and vortioxetine

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50
Q

Which SNRI/SSRI is the most toxic in the case of overdose

A

venlafaxine

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51
Q

Adverse effects seen in TCA’s

A

can lead to anticholinergic effects (urinary retention, dry mouth, blurry vision), seizures, cardiac arrythmias

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52
Q

what increases the risk of reccurence of depressive episodes?

A

Having multiple episodes, the more episodes you have the more likely you are to have another episode in comparison to someone who has only had 1 episode

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53
Q

When continuing antidepressant therapy and their symptoms have improved, should you adjust their dose?

A

No, keep it at the same treatment dose. There is no benefit in decreasing it

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54
Q

Discontinuation syndrome vs withdawal

A

discontinuation = symptoms that you experience when you stop a drug that is not a drug of dependence

withdrawal = symptoms associated with drugs of dependence

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55
Q

Types of symptoms experienced in discontiuation syndrome

A

GI, affective, neuro (parastheisas or increased dreaming)

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56
Q

Which psych meds increases the risk of discontinuation syndrome

A

ones with short half lifes (paxil and effexor)

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57
Q

Common symptoms assosicated with SSRI discontinuation syndrome

A 
Flu like symptoms
Shock like sensations 
dizziness worse with movement
insomnia
vivd dreaming 
irritability 
crying spells

(Paxil and venlafaxine)

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58
Q

Common discontinuation syndrome symptoms with TCA’s

A

Flu like
insomnia
excessibe dreaming

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59
Q

Common discontinuation syndrome symptoms with MAOI

A 
agitation
irritability
ataxia
vivid dreams
slowed/pressured speech
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60
Q

The time frame you should take to discontinue an antidepressant

A

4 weeks (especially for one’s that have a shorter half life)

If discontinuation symptoms are bad, may do it slower or introduce one with a longer half life and taper

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61
Q

How long do you have to take an antidepressant to experience discontinuation syndrome

A

6 weeks

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62
Q

When is it appropriate to discontinue an antidepressant abruptly

A

severe adverese events, like cardiac arrythmias

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63
Q

Pharmacodynamic effects of TCA’s

A
  • H1 blockers- sedating (be mindful of combining with other sedating meds/substance because it can lead to resp depression)
  • Anticholinergic (mindful of combining with antihistamines or antipsychotics)
  • a1 blockers (hypotension, espically if getting other a1 blockers)
  • arrythmogenic (mindful of electrolyte disturbances or if they are on diuretics)
  • lowers seizure threshold (if have epilepsy, may need higher dose of AED)
  • some are serotenergic (look out for serotonin syndrome when combined with certain meds)
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64
Q

Which TCA’s are serotonergic

A

imipramine, comipramine, amitriptyline

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65
Q

Pharmacology risks associated with SSRI

A
  • increased risk of bleeding 2/2 to inhibiting platelet aggregation (esp when patient takes NSAID and aspirin)
  • increased risk of hyponatremia
  • may cause osteopenia
  • serotonin syndrome when combined with other serotonergic medications
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66
Q

Risk with MAOI’s

A

hypertensive crisis 2/2 to overload of monoamines because MAOI’s prevent the destruction of monoamines

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67
Q

antidepressants that are associated with arrythmias (either at normal doses or when OD)

A

TCA
Trazodone (some case reports)
MAOIs
citalopram

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68
Q

Antidepressants associated with prolonging QTc

A

citalopram, duloxeteine, trazodone, and TCA’s

Other than TCA’s the prolonged Qt is seen in overdose and from studies there aren’t many clinical correlates with it)

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69
Q

Safest antidepressant post MI

A

zoloft! (has the least cardaic effects and may help improve cardiovascular risk factors)

Mirtazipine is good as well, as well as fluoxeteine

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70
Q

Antidepressants associated with postural hypotension

A

TCA
Trazodone
MAOI’s

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71
Q

With benzos, which populations are more likely to get a paradoxical reaction

A

children/elderly and TBI patients

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72
Q

Max dose of buspar you can give in a day

A

60 mg total (typically want to split it up)

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73
Q

What receptor does buspar work on?

A

5ht1a, partial agonsit

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74
Q

What diagnosis is buspar most effective for

A

GAD (not panic or the other anxiety disorders)

Good alternative for those who cannot have benzos (but probably won’t give as robust a response)

May also help potentiate SSRI antidepressant effects

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75
Q

why does valium act so quickly?

A

has the highest lipid solubility of all the benzos and thus gets into the CNS the quickest- leading to the rush that people like to abuse

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76
Q

Target dose for prazosin

A

1-5 mg

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77
Q

Efficacy of prazosin on nightmares

A

Mixed, some studies have found that it is not more helpful than placebo but you might as well see if it helps with the PTSD nightmares

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78
Q

Dose of vitamin D for depression

A

1000 -5000 IU

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79
Q

Why do TCA’s induce arrythmias

A

because they inhibit sodium and calcium channels leading to prolonged PR, QRS, and QT

ECG is a better measure of toxicity than even levels

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80
Q

The cardiotoxicity of antidepressants, especially TCA’s is dependent on what

A

dose! The higher the dose, the more toxic

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81
Q

Which antidepressants are most associated with hyponatremia

A

SSRI and SNRI

TCA are medium risk

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82
Q

Risk factors for developing hyponatremia on an SSRI

A 
older age***the most important one
female
surgery
hx of hyponatremia
use of other drugs associated with hyponatremia (diuretics, nsaids, antipsych, carbamazapine, laxatives)
medical comorbidities
low body weight
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83
Q

Time frame to monitor hyponatremia in pt’s on antidepressants

A

baseline then 3 month

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84
Q

Treatment of hyponatremia from SSRI (likely caused by SIADH)

A
  • can try fluid restriction but if severe, discontinue it!
85
Q

Conditions associated with hyponatremia

A

COPD, CHF, hypothyroidism, diabetes, TBI, CVA, HTN

86
Q

Signs of hyponatremia

A

HA, nausea, vomiting, muscle cramps, restlessness, lethargy, confusion, and disorientation

87
Q

At what sodium level is there a risk for seizures

A

<125! they need a specialist and admission to the hospital. Discontinue that shit!

88
Q

What to do if someone’s sodium is low but above 125?

A

Will need daily monitoring until better (lol at this point, may need to be admitted to the hospital for all that lol)

89
Q

Can you restart someone on an SSRI if they were hyponatremic?

A

Better to start them on an agent in a different class (nortriptyline, mirtazapine, MAOI, etc. or even ECT)

90
Q

What anti-seizure med is commonly associated with hyponatremia

A

carbamazapine

91
Q

How does vraylar/carpirazine work?

A

D2, D3, and 5HT1a receptor partial agonists

5ht2A antagonist

92
Q

What was vraylar specifically created to address

A

Is similar to abilify with it’s partial agonisim of D2

Hopeful to address negative symptoms in schizo and bipolar (can still help with mania)

93
Q

Side effects associated with vraylar

A

akathisia, EPS, weight gain

94
Q

which antidepressant is associated with flase positive PCP

A

venlafaxine

95
Q

Common side effects with effexor

A

anorexia, constipation, dry mouth, nausea, nervousness, sexual side effects, headaches

96
Q

at what doses is effexor like an ssri vs snri

A

ssri @ 75 mg/day
snri @ 150-225 mg/day
affects all monoamines @ 225 mg

97
Q

at what dose of effexor will you see some improvement with severely depressed patients

A

some may need 350 mg

98
Q

why ppl choose effexor over other meds

A

may be slightly more effective than other ssri’s, but has a lot of side effects

99
Q

at what doses do you see an increase in bp with effexor

A

225+

100
Q

What effect do SSRI’s have on diabetes

A

Can actually help improve glycemic control modestly in DM II

101
Q

Effect of TCAs on diabetes

A

TCA are associated with weight gain and hyperglycemia, so may want to avoid in those with diabetes

102
Q

What antidepressants are the least associated with sexual dysfunction

A

Buproprion and mirtazipine

103
Q

What sexual disorders can ssri’s be used for

A

premature ejaulation, can use clomipramine or an SSRI

104
Q

At what doses is buproprion helpful for sexual dysfunction

A

higher doses, like 300 mg

105
Q

The risks and benefits of drug holidays for sexual dysfunction

A

pt skips 1-2 doses prior to sex so that they don’t experience the sexual dysfunction, but increases their risk of discontinuation syndrome

106
Q

SSRI’s that inhibit reuptake more potently and are more likely to be associated with bleeding

A

sertraline, paroxetine, fluoxetine, duloxetine, and clomipamine

mirtazipine and nortriptyline are the more common and less/non-potent reuptake inhibitors

107
Q

Which medications should you be mindful of prescribing SSRI’s that places the patient at an increased risk of bleeding

A

aspirin, NSAIDS, anticoagulants like warfarin

108
Q

What types of bleeds are patients on antidepressants at risk for

A

Upper GI bleeds and ICH

Can give a PPI to help

109
Q

The other name for st johns worts

A

Hypericum perforatum

110
Q

Side effects to warn patients about if they chose to take saint john’s worts

A

photosensitivity, may increase their risk of bleeding, can induce mania in a bipolar patient

Serotonin syndrome is possible when taken with other serotonergic medications

111
Q

Mechanism of st john wort

A

unclear, may work on 5ht, MAOI, NE, etc.

112
Q

Why not to prescribe st john for depression

A

We do not know enough about it or how it works, not a licensed medication
It is helpful for mild to moderate depression

113
Q

What drugs does St John’s commonly interact with

A

*interaction happen because it is a potent inducer of CYP enzymes in intestines and liver and affects the plasma concentrations of the drugs

Warfarin, OCP, digoxin, indinavir, clozapine, statins, just to name a few (makes anticoagulant and birth control less effective)

114
Q

Preferred SSRI for management of anxiety

A

Zoloft and Prozac

Prozac most effective

Zoloft the most well tolerated

115
Q

What is the negative associated with BuSpar

A

It takes a long time to feel the effects, about six weeks

116
Q

What does a propranolol is ideal for management of anxiety

A

40 to 120 mg per day divided throughout the day

117
Q

What are the FDA first line drug options for treatment of anxiety

A

SSRI, SNRI, Lyrica

118
Q

What tricyclics are recommended for treatment of anxiety

A

Imipramine and clomipramine

119
Q

When is the ideal time to use benzodiazepines for management of anxiety

A

With severe and distressing anxiety, try to avoid using it due to dependence and potential withdrawal symptoms

120
Q

First line treatment for panic disorder

A

SSRI or venlafaxine

121
Q

What should you be cautious about when starting a medication in a patient with anxiety or panic disorder

A

There’s symptoms may get worse when you’re starting the medication therefore informed the patient and also start at a low-dose

122
Q

Preferred SSRI for management of PTSD

A

Paxil, Zoloft, Prozac

Venlafaxine as well

123
Q

When were an antipsychotic be helpful in PTSD

A

When they are having intrusive symptoms like flashbacks and nightmares, not helpful with avoidance and hyper arousal

124
Q

Which antipsychotic has been studied the most and PTSD

A

Risperidone at low doses

125
Q

What are the first line drugs used to treat OCD

A

Any SSRI or clomipramine, start with an SSRI due to there being less tolerance for clomipramine

126
Q

What medication can you add to an SSRI while treating OCD but not getting a good response

A

Can I add an antipsychotic to the SSRI at a low to moderate dose. Most studies have looked at Abilify and Risperidone

My one patient is on Zyprexa and is doing well it’s a combination

127
Q

What are the second line medication is used for OCD treatment

A

And AC or and anti-epileptic medication like Topamax or Lamictal

128
Q

For benzos, which population of patients do you want to avoid Giving this medication to

A

Patients with substance use disorder

129
Q

Other than propranolol for management of anxiety, what other beta blocker can you use

A

Atenolol, 25 to 100 mg a day

130
Q

First line treatment for social phobia

A

Any SSRI or venlafaxine

131
Q

Why is it so important to treat GAD

A

Prevents the development of major depression

132
Q

Initial treatment for body dysmorphic disorder

A

CBT, can add an SSRI if not improving or is moderate to severe

133
Q

First line treatment for social anxiety

A

CBT

134
Q

What should you monitor and all patients treated with an SSRI

A

Akathisia, increase anxiety, increase and suicidal ideation

135
Q

What anti-seizure medication is similar to benzodiazepine in terms of treatment for anxiety

A

Lyrica, has a comparable speed of onset of action to a benzo. Starting dose of 150 mg they can be increased to a maximum of 600 mg dust 2 to 3 times throughout the day

136
Q

Why is it important to not stop Lyrica abruptly

A

Stopping Lyrica Abruptly may lead to seizures, taper it off

137
Q

What is the longest amount of time you should use a benzo when treating anxiety disorder

A

2 to 4 weeks while waiting for the effect of an SSRI to kick in

138
Q

What phase of sleep is inhibited with the use of benzos

A

REM sleep

139
Q

Common side effects of benzodiazepines

A

Headaches, confusion, ataxia, dysarthria, blurred vision, gastrointestinal disturbances, jaundice, paradoxical excitement, it is sometimes linked with aggressive behavior

140
Q

When is respiratory depression more likely with the use of benzos

A

When given IV, it is more rare with oral therapy

141
Q

What is the benzodiazepine antagonist that can be used if someone uses too much benzos

A

Flumazenil

Has a shorter lifespan Valium, wash the patient for several hours after administering

142
Q

Who is at risk for paradoxical reactions with benzo use

A

Young/old, cns damage, those with learning disabilities or impulse control issues

143
Q

What are the Brand names for guanfacine

A

Intuniv, the long acting version and tenex, The immediate release version

144
Q

What is guanfacine typically used for

A

Mono therapy for ADHD, not the most effective and it’s only approved for monotherapy and children, or as an adjunct to stimulant therapy therapy

Off label it is used for conduct disorder, Tourette’s and text, opioid withdrawal, migraine prophylaxis

145
Q

What is the minimal and the maximal dose for Intuniv

A

1 mg to 4 mg

146
Q

What is the mechanism of action for intuniv

A

Selective alpha-2 adrenergic agonist

147
Q

What is the benefit of guanfacine over clonidine

A

Guanfacine times to be less sedating then clonidine

148
Q

Common side effects associated with guanfacine

A

Dry mouth, somnolence, dizziness, constipation, fatigue, headache, hypotension, syncope, orthostasis

149
Q

What is the patient at risk for if they abruptly stop guanfacine

A

They are at risk for a nervousness, anxiety, potential rebound hypertension. It is important to taper off this medication 1 mg per day

150
Q

How long does it take to see the effects of guanfacine

A

About 2 to 4 weeks

151
Q

Which version of guanfacine is used More frequently

A

Intuniv the extended release version

152
Q

What is a good stimulant option for patients who abuse drugs

A

Atomoxeteine, start with this one.

If They struggle with depression and tobacco use then you can consider bupropion

If they struggle with insomnia then you can try clonidine or guanfacine (although more commonly used in children)

153
Q

Why is methylphenidate preferred over Amphetamines

A

Amphetamines have more side effects and are more likely to be abused or diverted

154
Q

For switching from amphetamine to amphetamine, what is the conversion

A

They are all equivalent, no extra conversion is needed

Vyvanse is the main amphetamine that works need to be doubled because it’s formation only has about 30% amphetamine

155
Q

When changing from one methylphenidate to another what is the conversion

A

All her equipment except for Concerta and Focalin

Focalin is a dextro isomer of methylphenidate that is twice as potent, so you will need half a dose of Focalin

Concerta has 83% off Methylphenidate, so 18 mg of Concerta is equivalent to 15 mg of methylphenidate

156
Q

What is the conversion from methylphenidate to amphetamine

A

Methylphenidate is half as potent as amphetamine

I 10 mg of Ridellan it’s like the equivalent of 5 mg of taxes are in

157
Q

Do you need to cross taper when switching from one Stimulant to another

A

No, just have the patient take the last dose of the stimulus and start the new similar on the next day

It is helpful to start a new stimulant at a slightly lower dose

158
Q

What are the major side effects associated with all stimulants

A

They can potentially call psychosis or aggression, this has to be related to dose

Can worsen Tourette’s or tics

Increases the risk of seizures because it lowers the seizure threshold, patients with seizures can be on this medication just need to monitor seizure disorders closely

Can inhibit Grove and children was long-term use

Associated with weight loss due to appetite suppression

Increased risk of cardiovascular events, try to avoid Amphetamines and Patients with cardiovascular disease

It is a controlled substance, schedule two needs to be a new prescription every month

159
Q

What are the non-stimulant options for ADHD

A

Guanfacine, clonidine, modafinil, atomoxetein, wellbutrin

160
Q

The different options for amphetamines

A

Dexedrine/dextroamphetamine

Desoxyn/methamphetamine

Eveko/amphetamine

Adderall / miser amphetamine salts

Adderall XR

Vyvanse/ lysdexamphetamine

Mydayis

161
Q

The different options for methylphenidate

A

Focalin/dextromethylphenodate

Ritalin

Concerta

Contempla

Focalin XR

162
Q

How does straterra work

A

It is a selective norepinephrine reuptake inhibitor

Metabolized by the liver, CYP2D6

163
Q

What antidepressants do you want to avoid using with straterra or use with caution

A

Maois

Prozac, Paxil, and quinodine because they are cyp2d6 inhibitors and thus will increase the levels of strattera. Use with caution and slower titration

164
Q

Side effects associated with Strattera

A

In children I can leave the headaches and stomach pain decreased appetite nausea vomiting. There is also a warning for suicidal ideation and children and teens

An adult that can lead to G.I. upset, dry mouth, decreased appetite, insomnia, erectile dysfunction, urinary hesitation

For a side effect includes severe hepatic injury demonstrated by elevated LFTs and jaundice, they can also experience elevated blood pressure and heart rate

165
Q

In terms of ADHD symptoms, what is Strattera most helpful for

A

Improving attention it does not help significantly with hyperactivity

166
Q

What laughs do you need to monitor the patient is on Strattera

A

Liver function test

167
Q

How long does it take for the effects of Strattera to be seen

A

2 to 4 weeks

168
Q

What is the generic name for Focalin

A

Dexmethylphenidate

169
Q

What are common side effects seen with Focalin

A

Decreased appetite, insomnia, anxiety, G.I. upset, tics, Tachycardia, hypertension, dry mouth

170
Q

What is the mechanism of Focalin

A

It inhibits the reuptake of Dopamine and norepinephrine

171
Q

What is the strength of Oakland compared to methylphenidate

A

It is two times more potent, it is the D isomer of methylphenidate

172
Q

What is unique about the Focalin XR capsules

A

They contain two types of beets, how far immediate release pizza and the other half are delayed release beats

Therefore these capsules cannot be split but the beads can be sprinkled on their food and they have to eat all the food

173
Q

How can you decrease the risk of G.I. upset when taking Focalin

A

Take it with food

174
Q

What is the generic name for Dexedrine

A

Dextroamphetamine

175
Q

How is the potency if Dexedrine compared to amphetamine

A

It is the d isomer and is more potent but has less peripheral effects

176
Q

What are the uses for Dexedrine

A

ADHD in children less than 3 and narcolepsy

Also can be used for obesity and treatment resistant depression

177
Q

What are the indications for Vyvanse

A

ADHD and binge eating disorder

178
Q

What is unique about Vyvanse

A

Is dextroamphetamine with a lysing attached to it that makes it an active until G.I. enzymes clear off the lysing and converted to the active dextroamphetamine. It’s made this way so drug abusers can’t get high by snorting or injecting it

179
Q

What effect does food have on Vyvanse

A

Sometimes taking it with food can decrease the effect of it and delay the peak of the medication. If the patient is not feeling the effects fast enough tell them to take it on an empty stomach

180
Q

What is the mechanism of action of Vyvanse

A

Is it a stimulant that will Hibbetts three uptake of dopamine in norepinephrine, it was metabolized by the liver not using CYP and signs

181
Q

What are the common side effects with Vyvanse

A

Headache, insomnia, anorexia, G.I. upset, increased heart rate, anxiety, irritability or agitation

182
Q

What a relationship is seeing between Vyvanse and blood pressure medication

A

Vyvanse can sometimes make blood pressure medication less effective

183
Q

Which stimulant is the most addicting

A

Desoxyn, also known as methamphetamine

It is the same as the abuse streets drug meth just the pharmaceutical grade. It is generally not recommended

184
Q

What are common side effects of Desoxyn

A

Anorexia, tachycardia, insomnia, restlessness, headache, constipation, dental complications like poor dental hygiene and cavities and tooth where, and there is an increased risk of abuse

185
Q

What is the generic name for Ritalin

A

methylphenidate

186
Q

What are common side effects of Ritalin

A

Insomnia, headache, abdominal pain, nausea vomiting, anorexia, affect lability

187
Q

What are some benefits of Ridellan compared to amphetamines

A

Less side effects and lower abuse potential and patient reports feeling less wired

188
Q

In general with stimulants, what over-the-counter medication is the best avoided when using it

A

Antacids

189
Q

What are the extended release versions of methylphenidate

A

Concerta and Ritalin SR & LA

Typically the capsules are composed of beads that I am extra of immediate release an extended release

190
Q

What is the generic of Adderall

A

It is mixed amphetamine salts

Composed of dextro and levo isomers of amphetamine, mostly dextro

191
Q

What is the benefit of Adderall over the methylphenidate

A

I will provide more of a kick and tends to be more potent

192
Q

Unique property of abilify

A

Partial agonist of D2 and 5HT1A

5HT2 receptor antagonist

193
Q

Common side effects associated with abilify

A

akathisia, anxiety, insomnia, sedation

Rare: pathological gambling and impulse control issues (reversible with discontinuation)

194
Q

Why is abilify helpful with hyperprolactinemia 2/2 to antipsychotic use

A

it’s partial D2 agonism helps counter the antagonism caused by other antipsychotics

195
Q

What is the max dose of abilify for adults and children

A

30 mg/day

goal should be about 10 mg or when symptoms start to improve

196
Q

What new antipsychotic acts very similarly to abilify

A

brexipiprazole/rexulit

D2 partial agonist and 5HT1A partial agonist and 5HT2 receptor antagonist

Used for schizophrenia and as an adjunct for depression

Very expensive, so might as well stick with abilify

197
Q

Which antipsychotics are reported to be the most “efficacious”

A

clozapine and olanzapine, but both have a lot of side effects with the major concerns being metabolic syndrome/weight gain

Clozapine also has other crappy side effects and extenisive monitoring is required

198
Q

Which stimulant is approved for children that are three years old and up

A

Adderall IR

They have to be six years and older for extended release

199
Q

What do you SSR eyes specifically block in their mechanism of action

A

The SERT transporter

200
Q

What role does 5HT1a have on neurons that releases serotonin

A

They are a type of autoreceptor that is responsible for decreasing the amount of serotonin that is released when there is serotonin present and binding to it

201
Q

What happens to the amount of 5HT1A Receptors when a patient has started on an SSRI

A

The amount of these receptors is down regulated once they are started on an SSRI because the SSRI leads to an increase amount of serotonin that eventually leads to the amounts of those receptors decreasing.

This results in the neuron now being disinhibited enable to fire and release more serotonin which is what we want

Remember that this receptor is responsible originally for decreasing the amount of serotonin that’s released

202
Q

What is the hypothesis for depression that involves BDNF

A

The hypothesis states that there are decreased levels of BDNF Impatience with depression and that when the patient was started on an antidepressant it can help increase his levels and help improve the Neuronalplasticity of these patients

Brain derived neurotrophic factor

203
Q

Why is the location of serotonin 1a receptors important

A

The presynaptic receptors are responsible for inhibiting the releases serotonin whereas the receptors that are postsynaptic (in the hippocampus,amygdala, and the cortex) have different functions - My controlling mood cognition and memory

204
Q

How does BuSpar work

A

It is a serotonin 1a partial agonist and also antagonist

205
Q

What is the proposed mechanism as to why fluoxetine is so activating

A

It’s inhibition of 5htc receptor

206
Q

What is one of the more activating ssri’s

A

Prozac

So be cautious when rx to patients with increased anxiety or insomnia

207
Q

What ssri is approved for bulimia?

A

Prozac!

208
Q

Max dose for wellbutrin so that we decrease the risk for seizures

A

450 mg, the target dose is 300 mg, but once you get to 450 mg + that is when the seizure risk increases 10 +

If using IR, no single dose should be above 150 mg

Psychiatry (5 decks)

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