Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PPC3 Exam 3 > Psychopharmacology 2 > Flashcards

Psychopharmacology 2 Flashcards

1
Q

SNRI Mechanism of Action (3)

A
  1. Prevents serotonin and norepinephrine from being taken back into the pre‐synaptic cell
  2. More serotonin and norepinephrine stays in the synaptic cleft
  3. More serotonin and norepinephrine binds to post‐synaptic receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SNRI Duloxetine (Cymbalta) (4)

A
  1. Serotonin and norepinephrine reuptake inhibitor
  2. Multicenter study with 7‐17 year olds with GAD
  3. Followed for 10 weeks
  4. Significant improvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Selective Serotonin Reuptake Inhibitors (5)

A
  1. May take several weeks to see full effect – Titrate slowly (every 2‐3 weeks)
  2. If one medication does not work when titrated to maximum dose, switch to another medication
  3. Use associated with increased risk of suicide
  4. Especially in adolescent age group
  5. CAUTION with heart rhythm abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSRI Adverse Effects (13)

A

CNS

  1. Agitation
  2. Insomnia
  3. Sedation
  4. Tremor
  5. Apathy
  6. Headache

GI

  1. Weight gain or weight loss
  2. Appetite changes
  3. Nausea
  4. Diarrhea
  5. Stomach upset
  6. Dose related anorgasmia (Sexual dysfunction)
  7. Serotonin syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SSRI Side Effect Profile Expanded (4)

A
  1. Uncommon side effects include: Increased risk of bleeding, serotonin syndrome, abnormal heart rhythm
  2. Hyponatremia
  3. Suicidal ideations
  4. Rate of suicide is lower in countries where there is an increased use of SSRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Side Effects of SSRI: Serotonin Syndrome Clinical Presentation (9)

A
  1. Tachycardia
  2. Tremors
  3. Agitation, restlessness, confusion, disorientation – Fever
  4. Hypertension and hemodynamic instability – Salivation
  5. Loss of coordination
  6. Twitching of muscles, ataxia,
  7. Nausea, vomiting and diarrhea.
  8. Can mimic the presentation of influenza type illness
  9. Can occur due to patient taking herbal medication with SSRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Serotonin Syndrome Concerns (4)

A
  1. Induction of hypomaniac or manic episode if used in pediatric patients with bipolar disorder
  2. Signs of withdrawal can occur SSRIs are abruptly discontinued or taken inconsistently.
  3. Symptoms can include nausea and vomiting, dizziness, vertigo, sleep disruption, flu‐like symptoms or sensory disturbances such as paresthesias.
  4. Fewer withdrawal symptoms with fluoxetine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Serotonin Syndrome: Increased Risk (6)

A
  1. Increased risk when a medication is introduced, when a dose is increased, or when a second agent known to potentiate serotonin release is added to the drug regime
  2. Drugs that have an additive effect includes: – Triptans
  3. Opioid analgesics, central nervous system depressants Linezolid and macrolide antibiotics
  4. Vitamin E, omega‐3acidethylesters
  5. Alcohol
  6. Herbal preparations including St. John’s Wort – Run your drug programs!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Serotonin syndrome: treatment (4)

A
  1. Benzodiazepines such as Diazepam (Valium) or Lorazepam (Ativan) to decrease agitation, seizure‐like movements, and muscle stiffness
  2. Cyproheptadine (Periactin), a drug that blocks serotonin production
  3. Fluids by IV
  4. Withdrawal of medicines that caused the syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Serotonin Syndrome: Response to Tx (10)

A

Acute phase

  1. Look for response and some remission
  2. Partial response after six weeks – Assess compliance
  3. Consider dose increase

Maintenance

  1. 4 to 12 months; Generally a year
  2. If stable then wean off

Discontinuation

  1. Possible if no previous history of depression and stable for 9 to 12 months
  2. Low stress time for weaning
  3. 25% decrease in week long intervals
  4. If previous depressive episode, wait full year
  5. If more than one episode, high risk of recurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of SSRI Side Effects (9)

A
  1. Antidepressants
  2. Cardiotoxicity of Citalopram
  3. Mechanism is due to metabolite didesmethylcitalopram causing inhibition of K+ and Ca2++ channel
  4. Changes in QTc interval fluoxetine, sertraline, paroxetine, bupropion, venlafaxine
  5. Patients with long QT syndrome, heart failure, brayarrhythmias or predisposition to hypomagnesemia or hypokalemia need ECG if treated with citalopram
  6. Suicidality
  7. Third leading cause of death in youth – Evaluate for suicide using a tool
  8. Common somatic side effect
  9. Headache, GI distress, nausea, and weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the best treatment for adolescent depression? (4)

A
  1. Discussion of the underlying conflict of the depression
  2. SSRI only
  3. Referral to a therapist trained in cognitive behavioral therapy
  4. SSRI with cognitive behavioral therapy*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PTSD Tx (4)

A
  1. No medication has FDA approval
  2. Propanolol
  3. No controlled studies
  4. Dearth of data on PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antihistamines: MOA (2), Agents (3)

A

Mechanism of Action

  1. Competes with histamine on H1‐receptors
  2. Adverse event: sedation

Agents
1. Diphenhydramine (Benadryl): PO or IV (onset 30-60 min, duration 5-10 hours)

  1. Hydoxyzine (Vistaril): PO/IM (onset 15-30 min, duration 6-12 hours)
  2. Promethazine (Phenergan) – DO NOT USE IT!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antihistamines ADEs (9)

A
  1. Sedation
  2. Dry mouth
  3. Blurred vision
  4. Hang‐over effect
  5. Mechanism of Action for anxiety is actually via the adverse effect of sedation
  6. Hydroxyzine has FDA approved anxiety treatment in children
  7. Diphenhydramine is not
  8. Promethazine only approved in children > 2 year old but not be used due dystonia – Favorable side effect profile
  9. Associated drowsiness may make it difficult to tolerate antihistamines in social situations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hydroxyzine Side Effects (10)

A

Stop using hydroxyzine and call your doctor at once if you have a serious side effect such as:

  1. Restless muscle movements in your eyes, tongue, jaw, or neck
  2. Tremor (uncontrolled shaking)
  3. Confusion
  4. Seizure (convulsions).

Less serious hydroxyzine side effects may include:

  1. Dizziness
  2. Drowsiness;
  3. Blurred vision
  4. Dry mouth
  5. Headache.
  6. Anti-histamine type side effects
17
Q

Group 2 Drugs (7)

A
  1. Monitored in primary care
  2. Generally prescribed by specialists
  3. Child psychiatrists, PMHNPs
  4. Developmental behavioral peds
  5. Specialist of neurodevelopmental disabilities or adolescent medicine
  6. Pediatric Neurologist
  7. Adult psychiatrist
18
Q

Second generation antipsychotics (7)

A
  1. Aripiprazole (Abilify)
  2. Olanzapine (Zyprexa)
  3. Quetiapine (Seroquel)
  4. Risperidone (Risperdal)
  5. Paliperidone (Invega)
    * All approved for psychosis in schizophrenia
    * All except paliperidone approved for mania in bipolar
    * Risperidone and aripiprazole for irritability in autism – Used off label to treat aggression

Mood stabilizer

  1. Lithium
  2. Acute mania in bipolar
19
Q

Antipsychotics: General (3)

A
  1. Antipsychotic effects for hallucination, delusions and disorganized thinking
  2. Mood stabilizing effects for mania, irritability and mood instability
  3. Possible organizing or calming effects for agitation and aggressive behaviors
20
Q

Bipolar Disease: Manic and mixed state tx (3)

A
  1. Lithium (12 and up) FDA approved
  2. Aripaprazole (Abilify) and respirodone 10‐17 years
  3. Atypical antipsychotics are more effective than placebo in treating manic or mixed states)
21
Q

Bipolar disease: anticonvulsant tx (4)

A

a. Divalproic acid
b. Carbamazepine (Tegretol)
c. Oxcarbazepine (trileptal)
d. Lamotrigine(Lamictal)

22
Q

Disruptive Behavior Disorders (4)

A
  1. Treatment of the aggression of Oppositional defiant disorders and conduct disorders
  2. Mood stabilizers: Lithium and divalproic acid formulations
  3. Atypical antipsychotics (most commonly used)
    a. Risperidone*
    b. Seroqual (Quetiapine)
    c. Zyprexa (olanzapine)
    d. Abilify (Aripiprazole)
  4. May see polypharmacy or single atypical antipsychotics
    a. Used to treat the aggression associated with ODD/CD rather than actually treating the disorder
23
Q

Lithium (2)

A
  1. This is an uncommon drug for primary care providers to RX as it requires therapeutic drug level monitoring.
  2. Following these patient, it is important to recognize that poor response to lithium in pediatric bipolar disease is seen in patients with comorbid psychiatric diseases
    a. Personality disorder
    b. conduct disorder
    c. ADHD
    d. Substance abuse
    e. Children with a prepubertal onset of bipolar disease.
24
Q

What you need to know about lithium (4)

A
  1. Levels need to done preferably 12 hours after a dose and 5 days after a dose change.
  2. Starting dose is 300 mg per day
  3. Narrow therapeutic window
  4. Toxicity can easily occurs especially in overdoses
25
Q

Lithium side effects (6)

A
  1. Dermatological changes acne
  2. Hypothyroidism
  3. Tremor
  4. Benign leukocytosis,
  5. Reversible conduction delays
  6. Diabetes insipidus with polyuria and polydipsia
26
Q

Four common mood stabilizers (4)

A

a. Lithium
b. Valproic acid
c. Carbamazepine (Tegretol)
d. Oxcarbazepine (Trileptal).

27
Q

Mood stabilizer: general info (3)

A
  1. Only Lithium is approved for the treatment of bipolar disorder in children 12 or older.
  2. Valproic acid, Carbamazepine Tegretol and Oxcarbazepine (Trileptal) only have approved for seizure disorders but not bipolar disease.
  3. Use of these drugs are falling out of favor due to monitoring
28
Q

Carbemazepine (3)

A
  1. The evidence for the use and safety of carbamazepine as a mood stabilizer in adolescents and pre‐adolescents is limited.
  2. Case reports have pointed to the effectiveness in adolescents resistant to lithium.
  3. Carbamazepine is a hepatic P450 enzyme inducer and therefore there is a greater risk of drug to drug interactions and can induce rapid metabolism of itself and other drugs.
29
Q

Vaproate Products (4)

A
  1. Divalproex sodium (Depakote)
  2. Valproic acid (Depakene and generic formulation)
  3. Valproate sodium (Depacon)
  4. Approved for seizure treatment and migraine headache prevention
30
Q

Valproate Products: ADEs (4)

A
  1. U.S. Boxed Warning regarding teratogenicity and congenital malformations cardiac and neurological defects
    * Highest risk with patients on higher doses
  2. Weight gain is common and occurs more often in females
  3. Polycystic ovarian syndrome (PCOS) risk is likely higher
  4. Estrogen containing birth control causes lowering of valproic acid levels.
    * Progestin only birth control is suggested.

PPC3 Exam 3 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions