psychopharmacology Flashcards
1
Q
HAM side effects
A
anti H istamine: sedation, weight gain
anti A drenergic: hypotension
anti M uscarinic: dry mouth, blurred vision, urinary retention
found in TCAs and low potency antipsychotics
2
Q
serotonin syndrome
A
confusion flushing diaphoresis tremor myoclonic jerks hyperthermia hypertonicity rhabdomyolysis renal failure death
3
Q
EPS side effects
A
Parkinsonism (masklike face, cogwheel rigidity, pillrolling tremor)
akathisia: restlessness, agitation
dystonia: sustained contraction of muscles of neck, tongue, eyes, diaphragm
4
Q
EPS side effects result from which meds
A
high potency traditional antipsychotics
5
Q
when do EPS side effects occur
A
within days of starting med
6
Q
hyperprolactinemia occurs with what meds
A
high potency traditional antipsychotics and risperidone
7
Q
tardive dyskinesia
A
choreoathetoid muscle movements, usually of mouth and tongue
8
Q
when does tardive dyskinesia occur
A
after YEARS of antipsychotic use (particularly high potency typical antipsychotics)
9
Q
tardive dyskinesia can be irreversible: true or false
A
true
10
Q
neuroleptic malignant syndrome signs
A
fever tachycardia hypertension tremor elevated CPK lead pipe rigidity
11
Q
neuroleptic malignant syndrome caused by what meds
A
all antipsychotics after short or long time (increase with high potency traditional antipsychotics)
12
Q
important CYP450 inducers include
A
smoking
carbamazepine
barbiturates
St Johns wort
13
Q
choice of drug to tx the EPS produced by neuroleptics
A
benzotropine
14
Q
tardive dyskinesia characterized by
A
grimacing and tongue protrusion
15
Q
acute dystonia characterized by
A
twisting and abnormal postures
16
Q
akathisia characterized by
A
inability to sit still
17
Q
important CYP450 inhibitors
A
fluvoxamine (SSRI, and alpha 1 agonist) fluoxetine paroxetine duloxetine sertraline
18
Q
most antidepressants have a withdrawal phenomenon characterized by
A
dizziness, HAs, nausea, insomnia, malaise
19
Q
side effects of SSRIs mostly resolve with time: true or false
A
true
20
Q
SSRIs have advantage of
A
low incidence of side effects
no food restrictions
much safer in overdose
21
Q
side effects of SSRIs
A
sexual dysfxn (typically do not resolve in a few wks) GI distrubance (giving w food can help) insomnia/vivid dreams (often resolves) HA anorexia, weight loss restlessness seizures
22
Q
drugs that increase serotonin may be found in what OTC meds
A
cold remedies (cough medicine for ex)
23
Q
sexual side effects of SSRIs can be treated by
A
augmenting regimen w buproprion
changing to non SSRI
adding medications like sildenafil for men
24
Q
advantages of fluoxetine
A
longest half life with active metabolites so no need to taper
safe in preg, approved for children
25
cons of fluoxetine
can elevate levels of neuroleptics leading to increased side effects
26
advantages of citalopram
possibly fewer sexual side effects
| fewest drug drug interactions
27
uses of venlafaxine
depression, anxiety
| may have some use in ADHD
28
side effect of venlafaxine
similar to SSRIs
| can increase BP
29
duloxetine-used for
depression and neuropathic pain or in fibromyalgia
30
SNRIs-list them
venlafaxine
| duloxetine
31
bupropion MOA
NE and dopamine reuptake inhibitor
32
benefits of bupropion
relative lack of sexual side effects compared to SSRIs
| some efficacy in tx of adult ADHD
33
bupropion is contraindicated in
pts with seizures or actving eating disorders, those currently on an MAOI
34
for depression, serotonin receptor antagonists and agnoists-list them
trazodone and nefazodone
35
what are serotonin receptor antagnoists and agnoists useful for?
tx of refractory major depression, major depression w anxiety, and INSOMNIA
36
side effects of trazodone and nefazodone
```
nausea
dizziness
orthostatic hypotension
cardiac arrhythmias
SEDATION
PRIAPISM
```
nefazodone has black box warning for rare liver failure
37
for depression, list the alpha 2 adrenergic receptor antagonists
mirtazapine
38
what is mirtazapine useful for
tx of refractory major depression, esp in pts who need to gain weight
39
MOA of TCAs
inhibit reuptake of NE and serotonin
40
TCAs can be lethal in overdose: true or false
true
41
tertiary amines of TCAs-list them
amitriptyline, imipramine, clomipramine, doxepin
42
properties of tertiary amines of TCAs
highly anitcholinergic, more sedating, greater lethality in overdose
43
amitriptyline is useful for
chronic pain, migraines, insomnia
44
imipramine is useful for
enuresis, panic disorder
45
clomipramine is useful for
OCD (bc it's most serotonin specific of tertiary amines of TCAs)
46
doxepin is useful for
chronic pain
| sleep aid in low doses
47
secondary amines of TCAs-list them
nortriptyline, desipramine
48
nortriptyline is useful for
chronic pain
49
desipramine pros
least sedating, least anticholinergic
50
why is mirtazapine (remeron) good for depression in elderly?
helps with sleep and appetite
51
tx for TCA overdose
IV sodium bicarbonate
52
TCA side effects
antihistaminic-sedation
antiadrenergic (CV SIDE EFFECTS)-orthostatic hypotension, dizziness, reflex tachycardia, arrhythmias, EKG changes
antimuscarinic effects-dry mouth, constipation, urinary retention, blurred vision, tachycardia, exacerbation of narrow angle glaucoma
weight gain
LETHAL in overdose
seizures
serotonergic effects-ertectile/ejaculatory dysfxn, anaorgasmia in females
53
list MAOIs
phenelzine
tranylcypromine
isocarboxazid
54
major complications of TCAs-3 Cs
cardiotoxicity
convulsions
coma
55
MOAIs are more effective in
atypical depression
56
when suspect serotonin syndrome, what should you do
first d/c med
can also try ca ch blockers (oral nifedipine). if carefully monitored, can try chlorpormazine (low potency antipsy) or phentolamine (alpha adrenergic antag)
57
HTN crisis signs
```
elevated BP
HA
sweating
n/v
photophobia
autonomic instability
chest pain
arrhythmias
death
```
58
side effects of MAOIs
```
risk of HTN crisis
orthostatic hypotension
drowsiness
weight gain
sexual dysfxn
dry mouth
sleep dyxfxn
rarely liver toxicity, seizures, edema
```
start low and go slow
59
OCD-meds
SSRIs (high dose)
| TCAs (clomipramine)
60
panic disorder-meds
SSRIs
TCAs (imipramine)
MAOIs
61
atypical antipsychotics MOA
block both dopamine and serotonin receptors
62
warning about atypical antipsychotics
althought used to tx symptoms of delirium and dementia, increased risk of all cause mortality and stroke when using these agents in elderly
63
all typical antipsychotics have similar what but different what?
efficacy but different potency
64
fluoxetine doesn't require tapering-why?
has long half life (2-4 days) as well as an active metabolite w very long half life of 7-15 days
65
SSRI discontinuation syndrome-what to do?
restart and then taper (for paroxetine)
66
concurrent use of lamotrigine with what med can affect levels of both meds?
oral contraceptives
67
trazodone MOA
weak reuptake inhibition
antagonist activity of 5HT1a, 5HT1c, 5HT2 receptors
alpha adrenergic blockade (sedative effect)
modest histamine blockade
68
lithium causes what EKG changes
most commonly T wave depression, usu not clinically significant
69
what meds can increase lithium levels
```
thiazides
ethacrynic acid
spironolactone
triameterene
NSAIDs(except aspirin and sulindac)
metronidazole, tetracycline
```
70
clozapine acts at which dopamine receptor
D4
71
low potency antipsychotics have lower incidence of
EPS and neurolpetic malignant syndrome
72
low potency antipsychotics have more lethality in overdose due to
QT prolongation and potential for heart block and ventricular tachycardia
73
low potency antipsychotics have a higher or lower seizure risk than higher potency antipsy
higher
74
chlorpromazine commonly cuases
orthostatic hypotension
75
thioridazine is associated w
retinitis pigmentosa
76
list high potency typical antipsyc
haloperidol
fluphenazine
pimozide
77
EPS symptoms occur through what pathway
nigrostriatum pathways
78
increased prolactin with antipsychotics is related to dopamine action in
tuberoinfundibular area
79
dystonia
sustained painful contrac of muscles of neck, tongue, eyes (oculogyric crisis). life threatening if airway or diaphragm involved
80
symptoms of hyperprolactinemia
```
decreased libido
galactorrhea
gynecomastia
impotence
amenorrhea
osteoporosis
```
81
anti adrenergic effects
orthostatic hypotension
cardiac abnormalities
sexual dysfxn
82
neurolpetic malig syndrome mnemonic
FALTERED
```
fever
autonomic instability
leukocytosis
tremor
elevated CPK
rigidity
excessive sweating
delirium
```
83
tx of EPS includes
reducing dose of antipsy and administer:
anticholiner such as benztropine
antihistaminergic med such as diphenhydramine
anti parkinsonian med such as amantadine
84
blue gray skin discoloration occurs w
chrlopromazine
85
antipsychotics lower
seizure thresholds
| more likely with low potency
86
which atypical antipsychotics are less assoc w weight gain
ziprasidone
| airpiprazole
87
atypical antipsychotics are also used to tx
acute mania
bipolar disorder
adjunctive meds in unipolar depression
sometimes personality disorders and certain psych disorders in childhood
88
clozapine
more anticholinergic side effects than other atypical or high potency typicals
myocarditis can develop. assoc w tachycardia and hypersalivation
1-2% incidence agranulocytosis, 2-5% incidence seizures
89
stop clozapine if
absolute neutrophil count decreases below 1500/microliter
90
only antipsychotic shown to decrease the risk of suicide
clozapine
91
risperidone
can cause increase in prolactin
some orthostatic hypotension, reflex tachycar
has long acting injectable form
92
quetiapine side effects
common sedation and orthostatic hypotension
93
aripirazole has unique MOA
partial D2 agonism
| can be more activating (akathisia) and less sedating
94
side effects of atypical antipsy
```
metabolic syndrome
some anti-HAM effects
wegith gain
hyperlipidemia
hypgerglycemia
liver fxn-monitor yearly
QT prolongation
```
95
mood stabilizers are used for
acute mania
prevent relapses of manic episode
schizoaffective disorder
less commonly:
- potentiation of antidepressants in pts w MDD refractory to monotherapy
- potentiation of antipsy in pts w schizophrenia
- enhancement of abstinence in tx of alcoholism
- tx of aggression and impulsivity (dementia, intoxication, mental retardation, personality disorders)
96
drug of choice in acute mania
lithium
97
lithium's use
acute mania
prophylaxis for both manic and depressive sym in bipolar and schizoaffective d/os
cyclothymia, unipolar depression
98
prior to initiating lithium, what do you need to check
```
EKG
basic chemistries
thyroid fxn
CBC
pregnancy test
```
99
onset of action of lithium
5-7 days
100
after starting lithium, what should you check
blood levels of lithium every 2-3 days until therapeutic
blood levels regularly
thyroid function (TSH)
kidney fxn
101
side effects of lithium
toxic levels (over 1.5) can cause AMS, coarse tremors, convulsions, death
fine tremor
```
nephrogenic diabetes insipidus
GI disturbance
weight gain
sedation
thyroid enlargement, hypothyroi
EKG changes
benign leukocytosis
Ebstein's anomaly
```
102
blood levels are useful for
lithium
valpro acid
carbamazapine
clozapine
103
think twice before prescribing what to pt on lithium
ibuprofen
104
factors that affect lithium levels
```
NSAIDs
aspirin
dehydration
salt deprivation
sweating (salt loss)
impaired renal fxn
diuretics, esp thiazides
```
105
carbamazepine MOA
blocks Na ch and inhibits APs
106
onset of action of carbamazepine
5-7 days
107
side effects of carbamazepine
GI and CNS (drowsiness, ataxia, sedation, confusion) most common
possible skin rash (SJS)
leukopenia, hyponatremia, aplastic anemia, thrmbocytopenia, agrnulocytosis
elevated liver enzymes, causing hepatitis
neural tube defects
drug interac w drugs metabolized by cytochrome P450 pathway
108
valproic acid is useful for
mixed episodes of bipolar disorder as well as rapid cycling
109
when on valproic acid, should check
LFTs, CBC
110
when on carbamazepine, should check
CBC, LFTs
111
lamotrigine use ful for
BIPOLAR DEPRESSION. little efficacy for acute mania or prevention of mania
112
side effects of lamotrigine
dizziness, sedation, HA, ataxia most common
most serious is SJS
valproic acid increases lamotrigine levels, lamotrigine decreases valproic acid levels
113
gabapentin used for
adjunctively to help with anxiety, sleep
114
pregabalin used for
GAD, fibromyalgia
115
topiramate used for
impulse control d/o
anxiety
beneficial side effect of weight loss
116
valproic acid side effects
```
GI
weight gain
sedation
alopecia
pancreatitis
HEPATOTOXIC, or benign amniotransferase elev
increase ammonia
thrombocytopenia
neural tube defects
```
117
common indications for anxiolytics/hypnotics (bnezos, barbi, buspirone)
```
anxiety disorders
muscle spasm
seizures
sleep d/o
alcohol withdrawal
anesthesia induc
```
118
long acting benzos-list them
diazepam, clonazepam
119
in chronic alcoholics or liver dis pts, use which benzos
LOT
lorazepam
oxazepam
temazepam
120
non-benzo hypnotics
zolpidem (ambien)/zaleplon/eszopiclone (lunesta) for short term tx of insomnia
diphenhydramine
chloral hydrate
ramelteon
121
MOA of zolpidem
selective receptor binding to benzodiazepine receptor 1, which is responsible for sedation
122
non benzo anxiolytics
buspirone
hydroxyzine
barbiturates
propranolol
123
efficacy of buspirone
not as effec as other options so it is often used in combo w another agent (SSRI for ex) for tx of anxiety
124
hydroxyzine MOA
antihistamine
125
uses for hydroxyzine
for quick acting, short term med
126
propranolol can be used to tx what in addition to panic attacks and perform anxiety
akathisia
127
when are psychostimulants used
ADHD, refractory depression
128
modafinil is what kind of drug and used for what
psychostimulant, used for narcolepsy
129
how long should antidepressants be used for after initiation at least before stopping?
at least 6 months
130
propranolol is used for
akathisia
131
EKG changes for clozapine
persistent sinus tachycardia that does not require cessation of tx
usu resolves but if persist may be treated w beta antagonist propranolol
132
lamotrigine use
for tx of bipolar DEPRESSION and MAINTENANCE tx-NOT useful for acute mania
133
what tx is appropriate for middle insomnia (freq awakenings at night)
zaleplon
