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Psychiatry Clerkship > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Indications for supportive psychotherapy

A
  1. Adjustment disorders
  2. Acute emotional crises
  3. When a long-lasting “cure” is not expected, but improved functioning is hoped for (as in chronic schizophrenia, for example)
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2
Q

Indications for insight-oritented psychotherapy

A
  1. Treatment of anxiety and depression in all of their forms
  2. Somatoform and dissociative disorders
  3. Personality disorders
  4. Neuroses
  5. Chronic effects of psychosocial trauma
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3
Q

Goal of supportive psychotherapy

A

To form a close therapeutic alliance with the patient and help to define current problems, consider and implement possible solutions

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4
Q

Goal of insight psychotherapy

A

Recognize transference/countertransference feelings as they occur, uncover unconscious wishes and defenses that may have caused the patient to behave in a maladaptive manner

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5
Q

Substitution therapy

A

Form of behavioral modification therapy that is aimed at replacing an undesirable behavior with a desirable one

Ex, replace smoking with chewing gum

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6
Q

Types of “talk therapy”

A

Individual psychotherapy

Behavior modification therapy

Cognitive therapy

Social therapy (therapy as a group of similar patients, family, couple, etc)

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7
Q

Indications for ECT

A
  1. Depression that is unresponsive to medication
  2. Depression that is severe and acutely life-threatening (unrelenting, serious suicidal ideation, patient will not eat/drink, etc)
  3. Severe, unrelenting mania (less common)
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8
Q

What is the single most effective treatment for severe major depressive disorder?

A

ECT

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9
Q

Side effects of ECT

A
  • Postictal state (brief)
  • Possible retrograde memory loss
  • Headache, nausea
  • Muscle stiffness
  • Very small to nonexistent risk of long-term cognitive impairment
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10
Q

Contraindications to ECT

A
  • Elevated ICP
  • Space-occupying lesion in the brain
  • Recent MI (< 3 months since event)
  • Severe arterial hypertension

Note that pregnancy is NOT a contraindication to ECT.

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11
Q

Transcranial magnetic stimulation

A

Similar idea to ECT, but not inducing a seizure

Must be used repetitively (generally daily, 5x/week, 4-6 weeks). For this reason it is usually called “repetitive” TMS, or rTMS.

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12
Q

Side effects of rTMS

A
  • Syncope
  • Twitching/tingling of facial musculature
  • Scalp discomfort at site of treatment
  • Headache
  • Rarely, hearing loss, seizure
  • Rarely may induce a manic episode in those with bipolar disorder
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13
Q

Tricyclic antidepressants

A
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14
Q

SSRIs and SNRIs

A
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15
Q

MAOis

A
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16
Q

Miscellaneous antidepressants

A
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17
Q

Mood stabilizers

A
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18
Q

1st generation antipsychotics

A
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19
Q

2nd generation antipsychotics

A
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20
Q

Nonbenzodiazepines

A
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21
Q

Stimulants

A
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22
Q

Treating antipsychotic-induced dystonias

A

Anticholinergics (or 1st generation antihistamines with anticholinergic properties) are used for this indication:

Bantropine, biperiden, diphenylhydramine, trihexyphenidyl

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23
Q

Treating antipsychotic-induced akithisias

A

Remember, akithisias = motor restlessness

Propranolol or benzodiazepines are useful for this indication

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24
Q

Medications used to treat parkinsonian side effects of antipsychotics

A

Amantadine and/or levodopa are typically used

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25
Q

Important side effect of chronic quetiapine use

A

Cataracts may develop

Slit-lamp exam when starting chronic use and q6 month are recommended

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26
Q

Possible acute side effect of trazodone

A

Priapism

Treat with intra-corporal injection of epinephrine. This is a medical emergency.

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27
Q

What is the single most imporant side effect of buproprion?

A

Lowering the seizure threshold

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28
Q

Important side effects of clozapine

A

Agranulocytosis – frequent monitoring of leukocyte count is necessary

Anticholinergic effects

Like all antipsychotics, possibility of NMS

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29
Q

Treatment for life-threatening lithium toxicity

A

Dialysis

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30
Q

Treatment of benzodiazepine overdose

A

Flumenazil

A benzodiazepine antagonist

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31
Q

Treatment for excessive daytime sleepiness in shift workers

A

Modafinil

Just like narcolepsy!

32
Q

Amoxapine - loxapine relationship

A

The tricyclic antidepressant amoxapine also happens to be a metabolite of the antipsychotic loxapine

Due to their structural similarity, amoxapine can also cause some extrapyramidal symptoms, making it unique among the tricyclics

33
Q

Serotonin syndrome symptoms in order of appearance

A
  • Diarrhea
  • Restlessness
  • Extreme agitation
  • Hyperreflexia and autonomic instability
  • Myoclonus, seizure, hyperthermia, rigidity, delirium
  • Coma, death
34
Q

Most common side effects of SSRIs

A

Sexual dysfunction

GI disturbance

35
Q

Foods containing tyramine

A

Red wine

Aged cheese

Liver

Smoked foods

36
Q

Use buproprion in patients with ___

Avoid buproprion in patients with ___

A

Use buproprion in patients with smoking history

Avoid buproprion in patients with eating disorders, seizures

37
Q

Who can’t use valproate as a mood stabilizer?

A

Women of child-bearing age

38
Q

Benzo withdrawal looks a lot like ___

A

Benzo withdrawal looks a lot like alcohol withdrawal

Which makes sense. Both GABA antagonists.

39
Q

ehat is ths crap?

A

i dunno

40
Q

Main drug specific side effect of olanzapine

A

Atypical antipsychotic (serotonin-dopamine antagonist)

Somnolence

41
Q

All tricyclics end with:

A
  • -yline
  • -amine

Exception: amoxapine

42
Q

Notable side effects of all tricyclics

A
  • Anticholinergic effects
  • Orthostatic hypotension and/or tachycardia
  • QT prolongation
  • Weight gain
43
Q

Side effects of venlafaxine

A

“Activating SNRI” that may worsen anxiety

Poor choice for insomnia.

Increases BP at high doses – poor choice for hypertension

Great for patients who need an activating antidepressant

44
Q

How long of a window should there be between stopping an SSRI/SNRI and starting a MAOi

A

5 weeks

To prevent serotonin syndrome

45
Q

Side effects of all SSRIs or SNRIs

A

Akathisia, anxiety, agitation

Diarrhea/GI upset

Sexual dysfunction

Risk of serotonin syndrome

May increase suicidal thoughts/behaviors

46
Q

Main drug specific side effect of these SSRIs:

Sertraline

Paroxetine

Fluvoxamine

Citalopram

A
  • Sertraline: Diarrhea
  • Paroxetine: Anticholinergic effects
  • Fluvoxamine: Nausea/vomiting
  • Citalopram: Less sexual side effects than other SSRIs
47
Q

Mood stabilizers with high risk of neural tube defect in pregnant patients

A
  • Valproate
  • Divalproex
48
Q

Drug specific side effect of Thioridazine

A

Retinitis pigmentosa

A form of degenerative retinopathy. Characterized by “pigment clumps” in the retina. Images shown.

Technically all antipsythotics can cause this, but it is usually associated with this one

49
Q

Main drug specific side effect of Ziprasidone

A

QT prolongation

An atypical antipsycbotic

50
Q

Only four MAOis you need to know

A

Phenelzine

Isocarboxazid

Selegiline

Trancylcypromine

51
Q

If it ends in any of these, it is either a 1st or 2nd generation antipsychotic:

A
  • -zine / -azine
  • -apine
  • -done / -idone
52
Q

Why might a TCA be a poor therapeutic choice for a patient with MDD with suicidality?

A

Because you can OD on it!

TCA toxicity causes potentially fatal cardiac arrhythmias

53
Q

Buproprion side effect profile

A
  • Reduced seizure threshold
  • Tachycardia w/ possible arrhythmias
  • Insomnia
  • Activating side effects like jitteriness
  • Also helps with smoking cessation!
  • Weight loss
54
Q

Effects of mirtazapine

A
  • Effective in treating both depression and anxiety
  • Encourages appetite
  • Helps induce sleep/to treat insomnia
55
Q

Best SNRI for the purpose of treating neuropathic pain

A

Duloxetine

56
Q

Only two atypical antipsychotics that can be used in an acute setting (fast acting)

A

Olanzapine

Ziprazidone

57
Q

Final active metabolite of benzodiazepines

A

Oxazepam

58
Q

If someone is delirious, you cannot . . .

A

. . . comment on psychosis or mood

You have to treat the delirium before you can evaluate these.

59
Q

Benzos at a low dose can induce ___ rather than ___

A

Benzos at a low dose can induce disinhibition rather than sedation

60
Q

Antidepressant rule of 6’s

A
  • It takes 6 weeks to see efficacy
  • Stay on it for 6 months at an effective dose before trialing off
  • If changing medications, allow for a 6 week washout period
61
Q

Most common SSRIs

A

(Es)citalopram

Sertraline

Fluoxetine

Paroxetine

62
Q

Most common SNRIs

A

(Des)venlafaxine

Duloxetine

63
Q

Buproprion cannot be used in ___

A

Buproprion cannot be used in bulimia

Since they are high risk for seizures

64
Q

Serotonin modulators

A

Mirtazepine (SE: orexogenic)

Trazodone (SE: sleep aid, may cause priapism)

More used for their side effects than as primary antidepressants.

65
Q

TCA’s that don’t end in “-tryptyline”

A

Imipramine

Doxepin

66
Q

3 C’s of the TCAs

A
  • Convulsions (increased risk of seizure)
  • Cardiotoxicity (predispose to arrhythmias, prolong QT interval)
  • Coma (altered mental status)
67
Q

Patient with a history of depression has a hypertensive crisis after attending a wine and cheese party. What antidepressant are they taking?

A

One of the MAOis, either phenylzine or selegiline.

68
Q

Lines of therapy for bipolar

A

1st line: Li or valproate

2nd line: Quetiapine or Li/valproate + quetiapine or lamotrigine

3rd line / almost never: Carbamazepine

69
Q

Only FDA approved medication for pediatric depression

A

Fluoxetine

70
Q

SSRI with the most cardiac effects

A

(Es)citalopram

QTc prolongation

71
Q

What SSRI is contraindicated in pregnancy?

A

Paroxetine

72
Q

Lithium toxicity

A

Lithium toxicity results in an altered mental status, dysarthria, decreased muscle strength, and a coarse tremor.

It happens in the case of overdose OR dehydration.

Treat w/ hemodialysis.

73
Q

Fluphenazine

A

1st generation antipsychotic belonging to the Phenothiazine subgroup

Fluphenazine in particular can cause impaired thermoregulation (hyper or hypothermia)

Patients on fluphenazine who are likely to be exposed to extreme temperatures should be monitored

74
Q

If a patient who smokes is already willing and motivated to quit. . .

A

. . . there is no additional benefit to motivational interviewing

Start buproprion if there is no contraindication. Otherwise, start varenicline.

75
Q

Antidepressant discontinuation syndrome

A

Caused by abrupt cessation of antidepressant drugs without appropriate tapering

Onsets in 1-4 days

Sx include: headache, depressed mood, fatigue, insomnia, nausea, sensory disturbances, irritability, ataxia, tremor, and myalgia

Paroxetine discontinuation has an increased risk of antidepressant discontinuation syndrome.

Psychiatry Clerkship (53 decks)

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