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psychopharmacology Flashcards

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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

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2
Q

serotonin syndrome

A 
confusion
flushing
diaphoresis
tremor
myoclonic jerks
hyperthermia
hypertonicity
rhabdomyolysis
renal failure
death
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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

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4
Q

EPS side effects result from which meds

A

high potency traditional antipsychotics

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5
Q

when do EPS side effects occur

A

within days of starting med

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6
Q

hyperprolactinemia occurs with what meds

A

high potency traditional antipsychotics and risperidone

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7
Q

tardive dyskinesia

A

choreoathetoid muscle movements, usually of mouth and tongue

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8
Q

when does tardive dyskinesia occur

A

after YEARS of antipsychotic use (particularly high potency typical antipsychotics)

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9
Q

tardive dyskinesia can be irreversible: true or false

A

true

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10
Q

neuroleptic malignant syndrome signs

A 
fever
tachycardia 
hypertension
tremor
elevated CPK
lead pipe rigidity
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11
Q

neuroleptic malignant syndrome caused by what meds

A

all antipsychotics after short or long time (increase with high potency traditional antipsychotics)

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12
Q

important CYP450 inducers include

A

smoking
carbamazepine
barbiturates
St Johns wort

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13
Q

choice of drug to tx the EPS produced by neuroleptics

A

benzotropine

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14
Q

tardive dyskinesia characterized by

A

grimacing and tongue protrusion

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15
Q

acute dystonia characterized by

A

twisting and abnormal postures

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16
Q

akathisia characterized by

A

inability to sit still

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17
Q

important CYP450 inhibitors

A 
fluvoxamine (SSRI, and alpha 1 agonist)
fluoxetine
paroxetine
duloxetine
sertraline
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18
Q

most antidepressants have a withdrawal phenomenon characterized by

A

dizziness, HAs, nausea, insomnia, malaise

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19
Q

side effects of SSRIs mostly resolve with time: true or false

A

true

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20
Q

SSRIs have advantage of

A

low incidence of side effects
no food restrictions
much safer in overdose

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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
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22
Q

drugs that increase serotonin may be found in what OTC meds

A

cold remedies (cough medicine for ex)

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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

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24
Q

advantages of fluoxetine

A

longest half life with active metabolites so no need to taper

safe in preg, approved for children

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25
Q

cons of fluoxetine

A

can elevate levels of neuroleptics leading to increased side effects

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26
Q

advantages of citalopram

A

possibly fewer sexual side effects

fewest drug drug interactions

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27
Q

uses of venlafaxine

A

depression, anxiety

may have some use in ADHD

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28
Q

side effect of venlafaxine

A

similar to SSRIs

can increase BP

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29
Q

duloxetine-used for

A

depression and neuropathic pain or in fibromyalgia

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30
Q

SNRIs-list them

A

venlafaxine

duloxetine

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31
Q

bupropion MOA

A

NE and dopamine reuptake inhibitor

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32
Q

benefits of bupropion

A

relative lack of sexual side effects compared to SSRIs

some efficacy in tx of adult ADHD

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33
Q

bupropion is contraindicated in

A

pts with seizures or actving eating disorders, those currently on an MAOI

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34
Q

for depression, serotonin receptor antagonists and agnoists-list them

A

trazodone and nefazodone

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35
Q

what are serotonin receptor antagnoists and agnoists useful for?

A

tx of refractory major depression, major depression w anxiety, and INSOMNIA

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36
Q

side effects of trazodone and nefazodone

A 
nausea
dizziness
orthostatic hypotension
cardiac arrhythmias
SEDATION
PRIAPISM

nefazodone has black box warning for rare liver failure

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37
Q

for depression, list the alpha 2 adrenergic receptor antagonists

A

mirtazapine

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38
Q

what is mirtazapine useful for

A

tx of refractory major depression, esp in pts who need to gain weight

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39
Q

MOA of TCAs

A

inhibit reuptake of NE and serotonin

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40
Q

TCAs can be lethal in overdose: true or false

A

true

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41
Q

tertiary amines of TCAs-list them

A

amitriptyline, imipramine, clomipramine, doxepin

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42
Q

properties of tertiary amines of TCAs

A

highly anitcholinergic, more sedating, greater lethality in overdose

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43
Q

amitriptyline is useful for

A

chronic pain, migraines, insomnia

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44
Q

imipramine is useful for

A

enuresis, panic disorder

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45
Q

clomipramine is useful for

A

OCD (bc it’s most serotonin specific of tertiary amines of TCAs)

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46
Q

doxepin is useful for

A

chronic pain

sleep aid in low doses

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47
Q

secondary amines of TCAs-list them

A

nortriptyline, desipramine

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48
Q

nortriptyline is useful for

A

chronic pain

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49
Q

desipramine pros

A

least sedating, least anticholinergic

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50
Q

why is mirtazapine (remeron) good for depression in elderly?

A

helps with sleep and appetite

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51
Q

tx for TCA overdose

A

IV sodium bicarbonate

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52
Q

TCA side effects

A

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

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53
Q

list MAOIs

A

phenelzine
tranylcypromine
isocarboxazid

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54
Q

major complications of TCAs-3 Cs

A

cardiotoxicity
convulsions
coma

55
Q

MOAIs are more effective in

A

atypical depression

56
Q

when suspect serotonin syndrome, what should you do

A

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
Q

HTN crisis signs

A 
elevated BP
HA
sweating
n/v
photophobia
autonomic instability
chest pain
arrhythmias
death
58
Q

side effects of MAOIs

A 
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
Q

OCD-meds

A

SSRIs (high dose)

TCAs (clomipramine)

60
Q

panic disorder-meds

A

SSRIs
TCAs (imipramine)
MAOIs

61
Q

atypical antipsychotics MOA

A

block both dopamine and serotonin receptors

62
Q

warning about atypical antipsychotics

A

althought used to tx symptoms of delirium and dementia, increased risk of all cause mortality and stroke when using these agents in elderly

63
Q

all typical antipsychotics have similar what but different what?

A

efficacy but different potency

64
Q

fluoxetine doesn’t require tapering-why?

A

has long half life (2-4 days) as well as an active metabolite w very long half life of 7-15 days

65
Q

SSRI discontinuation syndrome-what to do?

A

restart and then taper (for paroxetine)

66
Q

concurrent use of lamotrigine with what med can affect levels of both meds?

A

oral contraceptives

67
Q

trazodone MOA

A

weak reuptake inhibition
antagonist activity of 5HT1a, 5HT1c, 5HT2 receptors
alpha adrenergic blockade (sedative effect)
modest histamine blockade

68
Q

lithium causes what EKG changes

A

most commonly T wave depression, usu not clinically significant

69
Q

what meds can increase lithium levels

A 
thiazides
ethacrynic acid
spironolactone
triameterene
NSAIDs(except aspirin and sulindac)
metronidazole, tetracycline
70
Q

clozapine acts at which dopamine receptor

A

D4

71
Q

low potency antipsychotics have lower incidence of

A

EPS and neurolpetic malignant syndrome

72
Q

low potency antipsychotics have more lethality in overdose due to

A

QT prolongation and potential for heart block and ventricular tachycardia

73
Q

low potency antipsychotics have a higher or lower seizure risk than higher potency antipsy

A

higher

74
Q

chlorpromazine commonly cuases

A

orthostatic hypotension

75
Q

thioridazine is associated w

A

retinitis pigmentosa

76
Q

list high potency typical antipsyc

A

haloperidol
fluphenazine
pimozide

77
Q

EPS symptoms occur through what pathway

A

nigrostriatum pathways

78
Q

increased prolactin with antipsychotics is related to dopamine action in

A

tuberoinfundibular area

79
Q

dystonia

A

sustained painful contrac of muscles of neck, tongue, eyes (oculogyric crisis). life threatening if airway or diaphragm involved

80
Q

symptoms of hyperprolactinemia

A 
decreased libido
galactorrhea
gynecomastia
impotence
amenorrhea
osteoporosis
81
Q

anti adrenergic effects

A

orthostatic hypotension
cardiac abnormalities
sexual dysfxn

82
Q

neurolpetic malig syndrome mnemonic

A

FALTERED

fever
autonomic instability
leukocytosis
tremor
elevated CPK
rigidity
excessive sweating
delirium
83
Q

tx of EPS includes

A

reducing dose of antipsy and administer:

anticholiner such as benztropine
antihistaminergic med such as diphenhydramine
anti parkinsonian med such as amantadine

84
Q

blue gray skin discoloration occurs w

A

chrlopromazine

85
Q

antipsychotics lower

A

seizure thresholds

more likely with low potency

86
Q

which atypical antipsychotics are less assoc w weight gain

A

ziprasidone

airpiprazole

87
Q

atypical antipsychotics are also used to tx

A

acute mania
bipolar disorder
adjunctive meds in unipolar depression
sometimes personality disorders and certain psych disorders in childhood

88
Q

clozapine

A

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
Q

stop clozapine if

A

absolute neutrophil count decreases below 1500/microliter

90
Q

only antipsychotic shown to decrease the risk of suicide

A

clozapine

91
Q

risperidone

A

can cause increase in prolactin
some orthostatic hypotension, reflex tachycar
has long acting injectable form

92
Q

quetiapine side effects

A

common sedation and orthostatic hypotension

93
Q

aripirazole has unique MOA

A

partial D2 agonism

can be more activating (akathisia) and less sedating

94
Q

side effects of atypical antipsy

A 
metabolic syndrome
some anti-HAM effects
wegith gain
hyperlipidemia
hypgerglycemia 
liver fxn-monitor yearly
QT prolongation
95
Q

mood stabilizers are used for

A

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
Q

drug of choice in acute mania

A

lithium

97
Q

lithium’s use

A

acute mania
prophylaxis for both manic and depressive sym in bipolar and schizoaffective d/os

cyclothymia, unipolar depression

98
Q

prior to initiating lithium, what do you need to check

A 
EKG 
basic chemistries
thyroid fxn
CBC
pregnancy test
99
Q

onset of action of lithium

A

5-7 days

100
Q

after starting lithium, what should you check

A

blood levels of lithium every 2-3 days until therapeutic

blood levels regularly
thyroid function (TSH)
kidney fxn

101
Q

side effects of lithium

A

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
Q

blood levels are useful for

A

lithium
valpro acid
carbamazapine
clozapine

103
Q

think twice before prescribing what to pt on lithium

A

ibuprofen

104
Q

factors that affect lithium levels

A 
NSAIDs
aspirin
dehydration
salt deprivation
sweating (salt loss)
impaired renal fxn
diuretics, esp thiazides
105
Q

carbamazepine MOA

A

blocks Na ch and inhibits APs

106
Q

onset of action of carbamazepine

A

5-7 days

107
Q

side effects of carbamazepine

A

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
Q

valproic acid is useful for

A

mixed episodes of bipolar disorder as well as rapid cycling

109
Q

when on valproic acid, should check

A

LFTs, CBC

110
Q

when on carbamazepine, should check

A

CBC, LFTs

111
Q

lamotrigine use ful for

A

BIPOLAR DEPRESSION. little efficacy for acute mania or prevention of mania

112
Q

side effects of lamotrigine

A

dizziness, sedation, HA, ataxia most common
most serious is SJS

valproic acid increases lamotrigine levels, lamotrigine decreases valproic acid levels

113
Q

gabapentin used for

A

adjunctively to help with anxiety, sleep

114
Q

pregabalin used for

A

GAD, fibromyalgia

115
Q

topiramate used for

A

impulse control d/o
anxiety

beneficial side effect of weight loss

116
Q

valproic acid side effects

A 
GI 
weight gain
sedation
alopecia
pancreatitis
HEPATOTOXIC, or benign amniotransferase elev
increase ammonia
thrombocytopenia
neural tube defects
117
Q

common indications for anxiolytics/hypnotics (bnezos, barbi, buspirone)

A 
anxiety disorders
muscle spasm
seizures
sleep d/o
alcohol withdrawal
anesthesia induc
118
Q

long acting benzos-list them

A

diazepam, clonazepam

119
Q

in chronic alcoholics or liver dis pts, use which benzos

A

LOT

lorazepam
oxazepam
temazepam

120
Q

non-benzo hypnotics

A

zolpidem (ambien)/zaleplon/eszopiclone (lunesta) for short term tx of insomnia

diphenhydramine

chloral hydrate

ramelteon

121
Q

MOA of zolpidem

A

selective receptor binding to benzodiazepine receptor 1, which is responsible for sedation

122
Q

non benzo anxiolytics

A

buspirone

hydroxyzine

barbiturates

propranolol

123
Q

efficacy of buspirone

A

not as effec as other options so it is often used in combo w another agent (SSRI for ex) for tx of anxiety

124
Q

hydroxyzine MOA

A

antihistamine

125
Q

uses for hydroxyzine

A

for quick acting, short term med

126
Q

propranolol can be used to tx what in addition to panic attacks and perform anxiety

A

akathisia

127
Q

when are psychostimulants used

A

ADHD, refractory depression

128
Q

modafinil is what kind of drug and used for what

A

psychostimulant, used for narcolepsy

129
Q

how long should antidepressants be used for after initiation at least before stopping?

A

at least 6 months

130
Q

propranolol is used for

A

akathisia

131
Q

EKG changes for clozapine

A

persistent sinus tachycardia that does not require cessation of tx

usu resolves but if persist may be treated w beta antagonist propranolol

132
Q

lamotrigine use

A

for tx of bipolar DEPRESSION and MAINTENANCE tx-NOT useful for acute mania

133
Q

what tx is appropriate for middle insomnia (freq awakenings at night)

A

zaleplon

Psych (20 decks)

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