psychopharmacology Flashcards
1
Q
the first line treatment for EPS caused by antipsychotics is
A
benztropine (cogentin)
2
Q
characterized by grimacing and tongue protrusion
A
tardive dyskinesia
3
Q
characterized by twisting and abnormal postures
A
acute dystonia
4
Q
characterized by the inability to sit still
A
akathisia
5
Q
characterized by decreased or slow body movement
A
bradykinesia
6
Q
HAM side effects
** found in TCAs and low potency antipsychotics
A
H- antihistamine– sedation, weight gain
A- antiadrenergic–hypotension
M- antimmuscarinic– dry mouth, blurred vision, urinary retention, constipation
7
Q
treatment for serotonin syndrome
A
stop medications, supportive care
8
Q
SE:
confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperhtermia, hypertonicity, rhabdomyolysis, renal failure and death
A
serotonin syndrome
9
Q
caused by a buildup of stored catecholamines; caused by the combination of MAOIs with tyramine rich foods or with sympathomimetics
A
hypertensive crisis
10
Q
EPS side effects reversible?
A
yep
11
Q
When does EPS occurs?
A
within hours to days of starting medications or icnreasing doses
12
Q
hyperprolactinemia occurs in which medication?
A
high potency, typical first generation antipsychotics and risperidone
13
Q
mental status changes, fever, tachycardia, hypertension, tremor, elevated CPK “lead pipe” rigidity
A
neuroleptic malignant syndrome
14
Q
CYP450 inducers (4)
A
- tobacci
- carbamazepine
- barbituates
- St. John’s wort
15
Q
CYP450 inhibitors(5)
A
- fluvoxamine
- fluoxetine
- paroxetine
- Duloxetine
- sertraline
16
Q
common side effect of anticholinergic medications
A
consitpation
17
Q
anticholinergic medications exaerbate
A
neurocognitive disorders–dementia
18
Q
all antidepressants have similar response rates in treating major depression
A
yep
19
Q
taper for antidepressants?
A
yep– depending on the dose and half-life
20
Q
drugs that increase serotoning ma ybe found in ________________ that can possibly lead to serotonin syndrome
A
over-the-counter cold remedies such as dextromethorphan
21
Q
what s the MOA thatmight explain the delay to onset of antidepressant effect
A
downstream effects that causes increased brain plasticity
22
Q
SSRIs:
- longest half-life with active metabolites–no need to taper
- safe in pregnancy and approved in children and adolescense
- common se: insomnia, anxiety, sexual dysfunction
- can elevate levels of antipsychotics, leading to increased SE
A
Fluoxetine – PRozac
23
Q
SSRIs:
- higher risk for GI disturbances
- very few drug interactions
- other common side effects: insomnia, anxiety, sexual dysfunction
A
sertraline– Zoloft
24
Q
SSRIs:
- highly protein bound, leading to several drug interactions
- common SE: anticholinergi effects and sexual dysfunction
- short half-life leading to withdrawal phenomena if not taken consistently
A
Paroxetine– Paxil
25
SSRIs:
1. currently approved only for use in obsessive-compulsive disorder (OCD)
2. common-SE: nausea/vomiting
3. multiple drug interactions due to CYP inhibition
fluvoxamine--luvox
26
SSRIs:
1. fewest drug-drug interaction
2. dose dependent QTc prolongation
Citalopram-- Celexa
27
SSRIs:
1. levo-enantiomer of citalopram: similar efficacy, possibly fewer side effects
2. dose dependent QTc prolongation
Escitalopram
28
Black box warning of SSRIs
potentially increasing "suicidal thinking and behavior" this warning applies sto children and young adults to age 25 but may be accurate for adults as well
29
1. often used for depression, anxiety disorders like GAD and neuropathic pain
2. low drug interaction potential
3. extended release allows for once-daily dosing
4. SE: increases BP in higher doses
venlafaxine--effexor
30
is the active metabolite of venlafaxine; it is expensive do not use in patients with untreated or labile BP
desvenlafaxine--pristiq
31
1. often used for people with depression, neuropathic pain and in fibromyalgia
2. SE are similar to SSRIs but more dry mouth and constipation
3. hepatoxicity in pts. with liver diseasr or alcohol diesease
4. expensive
duloxetine-- cymbalta
32
SSRIs can ______ levels of warfarin requiring monitoring when starting and stopping these medications
increase
33
1. relative lack of sexual SE compared to SSRI
2. some efficacy in treatment of adult ADHD
3. effective for smoking cessation
4. SE include increased anxiety as well as increased risk of seizures and psychosis at high doses
5. CI in pt. with seizure or active eating disorders
Nupropion-- wellbutrin
34
_________ for treating MDD in the elderly-- helps with sleep and appetite
remeron
35
1. useful in treating MDD, anxiety and insomnia
2. do not have sexual SE and no REM effct
3. SE: nausea, dizziness, orthostatic ypotension, cardiac arrhythmias, sedation and priapism
4. not used as antidepressant due to orthostatic hypotension
Trazodone-- Desyrel
36
Black box warning of nefazodone (serzone)
liver failure
37
1. useful in treating MDD, especially in pt. who have significant weight loss and/or insomnia
2. SE: sedation, weight gain, dizziness, tremor, dry mouth, contipation and agranulocytosis
3. fewer SE comapred to SSRIs and few drug interactions
alpha-2 Adrenergic Receptor antagonists
38
TCAs inhibits the
reuptake of NE and serotonin thus increases availibility of monoamines in the synapse
39
TCAs have long or short half lives?
long that is why most are dosed once daily
40
treatment for TCA overdose is
IV sodium bicarbonate
41
TCAS:
useful in chronic pain, migraines and insomnia
amitriptyline--elavil
42
TCAS:
1. has intramuscular form
2. useful in enuresis and panic disorder
imipramine-- tofranil
43
TCAS:
most serotonin specific, therefor useful in the treatment of OCD
clomipramine--anafranil
44
TCAS:
1. useful in treating chronic pain
2. emergin use as a sleep aid in low doses
doxepin--sinequan
45
TCAS:
1. least likely to cause orthostatic hypotension
2. useful therapuetic blood levels
3. useful in treatig chronis pain
nortriptyline--pameliot/aventyl
46
TCAS:
1. more activating/ lest sedating
2. least anticholineergic
desipramine norpramin
47
TCAS:
1. metabolite of antipsychotic loxapine
2. may cause EPS and has a similar side-effect profile to typical antipsychotics
amoxapine--asendin
48
major complications of TCAS (3)
3 Cs
- cardiotoxicity
- convulsions
- Coma
49
MAOIS or TCAS are considered more effective in depression with atypical features, characterized dby hypersomnia, increased appetite, heavy feeling in extremities, and increased sensitivity to interpersonal rejection
MAOIs
50
TCAS are __________ protein bound and lipid _______, and therefore can interact with other medications of the same characterisitcs
highly protein bound and lipid soluble
51
the side effects of TCAS are mostly due to
lack of specificity and interaction with other receptors
52
MAOIs:
is used to treatdepression that does not require following the dietary restrictions when used in low dosages
Selegiline
53
why are MAOIs not used as first line treatment agents?
b/c of the increased safety and tolerability of newer agents
54
when are MAOIs are used? Name 3
used for certain types of recfractory depression and in refractory anxiety disorders:
1. phenelzine--nardil
2. tranylcypromine-- parnate
3. isocarboxazid-- marplan
55
what do when you first suspect serotonin syndrome?
discontinue the medication, provide cupportive care and benzo.
56
serotonin antagonist that can be used in serotonin syndrome
cyproheptadine
57
hypertensive crisis when taking MAOIs occur when
you ea tyramine-rich foods or sympathomimetics
58
what to use in OCD?
SSRIs (in high doses)
and TCAs (clomipramine)
59
what to use in Panic disorder
SSRIs, TCAs and MAOIs
60
what to use in eating disorder
SSRIs (in high doses) and TCAs
61
what to use in persistent depressive disorder (dysthymia)
SSRIs, SNRIs
62
what to use in social anxiety disorder (social phobia)
SSRIs, SNRIs and MAOIs
63
what to use in GAD
SSRIs, SNRIs, TCAs
64
what to use in posttraumatic stress disorder
SSRIs
65
what to use iwhat to use in irritable bowel syndrome
SSRIs and TCAs
66
what to use in enuresis
TCAs (imipramine)
67
what to use in neuropathic pain
TCAs (amitriptyline and nortriptyline and SNRIs
68
what to use in chronic pain
SNRIs and TCAs
69
what to use in fibromyalgia
SNRIs
70
what to use in migraine headaches
TCAs-- amitriptyline
71
what to use in smoking cessation
bupropion
72
what to use in premenstrual dysphoric disorder
SSRIs
73
what to use in insomnia
mirtazapine and trazodone and TCAs--doxepin
74
low potency, typical antipsychotics
1. chlorpromazinr (thorazine)
| 2. thioridazine
75
midpotency, typical antipsychotics
1. loxapine (loxitane)
2. thiothixene (navane)
3. molindone (moban)
4. perphenazine (trilafon)
76
High potency, typical antipsychotics
1. haloperidol (haldol)
2. fluphenazine (prolixin)
3. trifluoperazine (stelazine)
4. pimozide (orap)
77
greater affinity for dopamine receptors; therefore a relatively low dose is needed to achieve effect-- less sedation, orthostatic hypotension, and anticholinergic effects; greater risk for EPS
high potency, typical antipsychotics
78
lower affinity for dopamine receptors and therefore higher does is required.--higher incidence of antiadrenergic, anticholinergic and antihistaminince effects' lower incidence of EPS, increased lethality in overdose due to QTc prolongation
low potency, typical antipsychotics
79
typical antipsychotics associated with retinitis pigmentosa
thioridazine
80
typical antipsychotics associated with corneal deposition
chlorpromazine
81
antidpoaminergic effects of typical antipsychotics
1. EPS
| 2. hyperprolactinemia
82
EPS (3)
1. parkinsonism
2. akathisia
3. dystonia
83
bradykinesia, maslike face, cogwheel rigidity, pill-rolling tremor
parkinsonism
84
subjective anxiety and restlessness, objective fidgetiness. Patients may report a sensation of inability to sit still. Best treated with B-blockers or benzo
akathisia
85
sustained painful contraction of musclecs of neck (torticollis), tongue, eyes (oculogyric crisis)-- it may be life threatening if it involves the airway or diaphragm
dystonia
86
antihistaminic effects
results in sedation and weight gain
87
anti-a1-adrenergic effects
results in orthostatic hypotension, cardiac abnormalities and sexual dysfunction
88
antimuscarinic effects
anticholinergic effects, resulting in dry mouth, tachycardia, urinary retention, blurry vision, cosntipation, and precipitation of narrow-angle glaucoma
89
choreoathetoid (writhing) movements of mouth and tongue that may occur in patients who have used neuroleptics for >6 months
tardive dyskinesia
90
treatment for tarduve dyskinesia
discontinuation
91
which atypical antipsychotic is less likely to cause tardive dyskinesia
clozapine
92
though rare it occurs more often in young males in early treatment with high potency of typical antipsyhoctics:
Fever, autonomic instability, leukocytosis, tremor, elevated CK, rigidity, excessive sweating, delirium
neuroleptic malignant syndrome
93
onset of antipsychotic side effects:
1. NMS
2. Acute dystonia
3. parkinsonism/akathisisa
4. TD
1. NMS-- any time but usually early in treatment
2. Acute dystonia-- hours to days
3. parkinsonism/akathisisa-- days to weeks
4. TD-- months to years
94
thirty percent of patients wiht treatment-resistant psychosis will respond to
clozapine
95
onlyantipsychotic shown to decrease the risk of suicide
clozapine
96
second generation antipsychotic:
- unique mechanism of partial D2 agonism
- can be more activating (akathisia) and less sedating
- less potential for weight gain
aripiprazole (abilify)
97
________ are often prescribed as monotherapy in the acute or maintenance treatment of bipolar disorder
atypical antipsychotics
98
the only moos stabilizer shown to decrease suicidality
Lithium
99
lithiums is metablozed by the ____
kidney
100
blood levels are useful for (4)
1. lithium
2. valproic acid
3. carbamazapine
4. clozapine
101
especially useful in treating mania with mixed features and rapid-cycling bipolar disorder; less effective for the depressed phase
carbamazepine--tegretol
102
efficacy for bipolar depression, through little efficacy for aute mania or prevention of mania
lamotrigine--lamictal
103
MOA of carbamezapine
acts by blocking sodium channels and inhibiting action potentials
104
MOA of Valpric acid
blocks sodium channels and increases GABA concenrtation in the brain
105
MOA of lamotrigine
sodium channels that modulate glutamate and aspartate
106
as effective in mood disorders as carbamazepine but better tolerated
oxcarbazepine--trileptal
107
often used adjunctively to help with anxiety, sleep, neuropathic pain but little efficacy in bipolar disorder
Gabapentin-- neurontin
108
used in GAD and fribormyalgia but little efficacy in bipolar disorder
pregabalin--Lyrica
109
In chronic alcoholics or liver disease, use of benzo that are not metabolized by the liver are: (3)
1. Lorazepam
2. Oxazepam
3. Tremazepam
110
Benzo can be lethal when mized with _____-- respiratory depression may cause death
alcohol
111
for benzo overdose ______ is used to reverse the effects
flumazenil
112
MOA of benzo
work by potentiating the effects of gamma-aminobutyric acid (GABA)
113
long acting with half-life of >20 hr Benzo (2)
1. diazepam--valium
| 2. clonazepam--klonopin
114
Intermediate acting and half-life of 6-20 hr benzo (4)
1. alprazolam--Xanaz
2. Lorazepam--Ativan
3. Oxazepam-- Serax
4. Temazepam--Restoril
115
Short acting and half-life of <6 hrs Benzo (2)
1. triazolam--Halcion
| 2. Midazolam--Versed
116
selective melatonin MT agonist
ramelteon--rozerem
117
MOA of Zolpidem (ambien)/ zaleplon (sonata)/ eszopiclone (Lunesta)
work by selctive receptor binding to the oemga-1 receptor on the GABA-A receptor, which is responsible for sedation
118
Zolpidem (ambien)/ zaleplon (sonata)/ eszopiclone (Lunesta) used ofr?
short term treatmetn of insomnia
119
buspirone used for
GAD
120
useful for patients who want a quick-acting, short term medications, but who cannot take BDZs for various reasons
Hydroxyzzine--atarax
121
Used in ADHD and in treatment of refractory depression
Dextroamphetamine and amphetamines (Dexedrine, adderall)
122
Modafinil (provigil) is used in
narcolepsy
123
inhibits presynaptic NE reuptake, resulting in increased synaptic NE and dopamine but is less effective than amphetamines for ADHD
atomoxetine---strattera
124
acetylcholinesterae inhibitors used in dementia (3)
1. Donepezil--aricept
2. galantamine--razadyne
3. rivastigmine--exelon
125
used in moderate to severe neurocognitive disorders-- dementia and has fewer side effects than cholinestrease inhibitors
Memantine-- Namenda
126
Effects of procainamide/quinidine
confusion and delirium
127
effects of albuterol
anxiety and confusion
128
effects on isoniazid
psychosis
129
effects of tetracycline
depression
130
effects of nifedipine and verapamil
depression
131
effects of cimetidine
depression, confusion and psychosis
132
effects of steroids
aggressiveness/agitation, mania, depression, anxiety, psychosis
133
ECT is the most effective treatment for (3)
MDD with psyhcotic features, mania and catatonia
134
surgical treatment involving the implantation of a medical device that sends electrical impulses to specific parts of the brain
Deep brain stimulation
135
noninvasive method to excite neurons in the brain
repetitive transcranial magnetic stimulation
** less efficacy than ECT and more harmful SE
136
exposure to daylight or to specific wavelengths of light using lasers, light emitting diodes for MDD w/ a seasonal pattern
light therapy
