Psychopharmacological Therapy & Dantrolene

Question 1

SSRI (fluoxetine, sertraline, paroxetine) SE

Answer 1

-HA
-N/D
-sex dysfx
-agitation
-insomnia
Taper d/c to avoid: dizziness, paresthesia, myalgias, irritability insomnia

Question 2

SSRI (fluoxetine, sertraline, paroxetine) Interactions

Answer 2

-may inhibit CP450 enzymes
-serotonin syndrome

Question 3

Tricyclic antidepressants MOA

Answer 3

block presynaptic uptake/reuptake of serotonin and/or NE

Question 4

Tricyclic (trimipramine, nortriptyline, amitriptyline) antidepressants SE

Answer 4

-anticholinergic
-antiadrenergic (alpha blockade)
-antihistamine
-ortho HoTN
-tachycardia
-sedation
-weakness
-fatigue
-fine tremor

Structurally similar to phenothiazines and LA

Question 5

Tricyclic antidepressants Interactions

Answer 5

-Interfere w/ sympathomimetics, inhaled anesthetics, anticholinergics, antihypertensives, opioids
-highly protein bound

Question 6

MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline) SE

Answer 6

-ortho HoTN
-impotence
-weight gain
-paresthesias
-hepatitis (rare

Question 7

MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline) interactions

Answer 7

-serotonin syndrome
-avoid tyramine (cheese, liver, fava beans, avocados, chianti wine)

Question 8

MAOI overdose

Answer 8

-SNS stim
-tx w/ gastric lavage
-dantrolene for muscle rigidity

Question 9

Prohibited drugs with MAOI (phenelzine, tranylcypromine, isocarboxazid, selegiline)

Answer 9

-cyclic antidepressants
-fluoxetine
-cold/allergy meds
-nasal decongestants
-indirect-acting sympathomimetics
-opioids (esp meperidine)

Question 10

Anesthesia management w/ MAOI

Answer 10

-Ok to continue meds
-Avoid certian drugs: meperidine, indirect-acting sympathomimetics

Question 11

Lithium MOA

Answer 11

inhibits 2nd messenger system = dampened signal transmission in hyperactive neurons

Question 12

Lithium SE

Answer 12

-hypothyroid
T wave flat/inverted
-cardiac conduction
-acne
-psoriasis
-memory impairment
-hand tremor
-sedation
-polyuria
-polydipsia

Question 13

Lithium interactions

Answer 13

-serotonin syndrome
-prolong NMBs
-↓MAC
-↓tubular response to ADH (↓ or ↑Na)
-impairs PTH release (↓Ca)
-thiazides ↑lithium reabsorption
-NSAIDs & ACEIs ↑lithium toxicity

Question 14

Lithium and Na

Answer 14

-0% protein bound
-Reabsorbed in PCT (competes there w/ Na
-lithium lvls inverse of Na lvls (↓Na = ↑lithium)

Question 15

Lithium therapeutic levels

Answer 15

0.8-1.2 mEq/L
>2 = AV block, HoTN, dysrhythmias, sz

Question 16

Malignant Hyperthermia
Onset
Causes
Key features
Tx

Answer 16

Onset: within min
Causes: halogenated anes, succ
Key features: Hypercarbia, tachycardia, myoglobinuria, acidosis, muscle rigidity
Tx: dantrolene, support

Question 17

Serotonin syndrome
Onset
Causes
Key features
Tx

Answer 17

Onset: up to 12 hr
Causes: SSRI, SNRI, MAOI, MDMA, + methylene blue or meperidine or fentanyl
Key features: Akathisia, mydriasis, tremor, altered mental status, clonus, muscle rigidity
Tx: cyproheptadine, supportive

Question 18

Antipsychotic (Neuroleptic) Drugs

Answer 18

-Phenothiazines (promethazine, chlorpromazine)
-Thioxanthenes (thiothixene, chlorprothixine)
-Butyrophenones (droperidol, haloperidol)

Question 19

Antipsychotic Drug Interactions

Answer 19

Opioids:
-exaggerated ventilatory depressant effects
- ↑ miotic & sedative effects
-potentiated analgesic effects
ETHO: effects enhanced
Interfere w/exogenously administration dopamine