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MS3 Rotations > Psychopharmacology & Somatic Therapies > Flashcards

Psychopharmacology & Somatic Therapies Flashcards

1
Q

Patient is tachycardic, diaphoretic, mydriatic, has hyperthermia and clonus. They have AIDS and are taking a protease inhibitor and fluoxetine. What is the cause of their symptoms, and what is the mechanism?

A

Serotonin Syndrome from the fluoxetine.

Mechanism: the protease inhibitor is metabolized by P450 as well, which increases the circulating levels of psychotropic drugs

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2
Q

Which labs need to be checked q6 months when taking lithium?

A

TSH for hypothyroidism

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3
Q

Which antidepressant class is best tolerated by the elderly, and why?

A

SSRIs such as fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram. This is because they are less sedating and have less anticholinergic properties than TCAs. MAOIs have the main side effect of hypotension, and are therefore not tolerated in the elderly.

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4
Q

What is the main side effect of MAOIs, which lead them to be less well tolerated in the elderly?

A

Hypotension

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5
Q

What are effective medications for OCD?

A

Clomipramine is a TCA that is effective in OCD for both children and adults.

SSRIs are also effective for OCD

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6
Q

Mainstays of treatment for ADHD

A

CNS stimulants:

Detroamphetamine, methylphenidate, pemoline

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7
Q

Pemoline

A

Dopaminergic stimulant that is used for ADHD and narcolepsy

MAOIs are contraindicated with pemoline.

Cause hepatotoxicity - perform liver tests regularly

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8
Q

Clozapine causes what blood cell disorder?

A

Agranulocytosis

If s/s of infection, discontinue and get more frequent CBCs:

  • 2000-3000 = daily CBC
  • 3000-3500 = 2x/week
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9
Q

Lithium toxicity treatment

A

<3 meq/L = supportive with IV saline and frequent levels

> 3meq/L = dialysis

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10
Q

Best medication to treat depression without weight gain

A

Sertraline

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11
Q

Valproic acid, Lithium, Chlorpromazine, Haloperidol, Fluoxetine - which is highest risk for fetus?

A

Valproic acid

then lithium

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12
Q

Bipolar disorder with fever, chills, bleeding gums, extreme fatigue, pallor after starting carbamazepine = what is pt experiencing?

A

Acute aplastic anemia

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13
Q

Bipolar disorder with fever, chills, bleeding gums, extreme fatigue, pallor after starting carbamazepine = what is pt experiencing?

A

Acute aplastic anemia

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14
Q

What levels should you monitor closely with NMS?

A

Creatine Phosphokinase (CPK)

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15
Q

“Stiffness and twisting” of neck and jaw. On lithium and trifluophenazine. What should you do first?

A

Benztropine IM or diphenhydramine IM to stop dystonia

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16
Q

What property do phenothiazines, TCAs, and antiparkinsonian agents share?

A

Anticholinergic

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17
Q

What should you do first when you notice tardive dyskinesia?

A

D/C antipsychotics. If you cannot, then add clozapine

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18
Q

Which sleep drugs can cause sleepwalking, binge-eating, aggressive outbursts, and night driving without the patient being aware?

A

Zolpidem and Zaleplon

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19
Q

Akathisisa

A

Feeling or restlessness coupled with the need to move.

Best to stop the offending drug, but may also try propanalol

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20
Q

If you have a serious suicide attempt + a lack of desire to eat or drink, what should you do with pt?

A

ECT! They are high risk for suicide again

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21
Q

What drug should you give before ECT?

A

Methohexital - lower cardiac risk than other barbiturates, with duration of action of 5-7 minutes.

22
Q

Urinary retention, blurred vision, constipation, dry mouth = what kind of symptoms? Associated with what kinds of antidepressant drugs? Which is the worst in this class?

A

Anticholinergic.

Associated with TCAs.

Amitriptylene is the most anticholinergic.

23
Q

Best drug for hypoactive sexual desire disorder + stopping smoking?

A

Bupropion

24
Q

What should you advise a parent regarding Ritalin administration?

A

Do not give it after noon because it is known to cause insomnia

25
Q

Disulfiram + alcohol = what kinds of reaction?

A

Facial flushing, tachycardia, vomiting, nausea.

Even with over-the-counter cough and cold medications.

26
Q

Pharm Tx for narcolepsy

A

Stimulants such as methylphenidate, pemoline, and amphetamine.

Modafinil as well to decrease # of sleep attacks

27
Q

72 y/o with Parkinson’s is convinced that someone is plotting against him. Thought disorder at evening and night. What antipsychotic do you give this patient?

A

Clozapine - relative sparing of nigrostriatal dopaminergic system.

Typical antipsychotics aggravate the extrapyramidal symptoms

28
Q

Erythromycin, theophylline, and cisplatin effects on carbamazepine levels?

A

Erythromycin = increased cbm level

Theophylline and cisplatin = decreased cbm level

29
Q

How long does it take for lithium to reach equilibrium?

A

4-5 half lives.

Half life = 20 hrs; equilibrium achieved in 5-7 days of regular intake

30
Q

If you treat akasthisia with propanalol, what other condition will you worsen?

A

Asthma, because beta-blockade causes bronchospasm

31
Q

What hormone do you generally give when treating depression? Why?

A

Levothyroxine - because hypothyroidism is frequently occuring at the same time.

32
Q

Seizure on clozapine - what do you do?

A

Stop clozapine and begin phenobarbital. You can restart clozapine at 50% of original dose and gradually raise it back.

33
Q

Seasonal affective disorder benefit from what non-pharma treatment?

A

Phototherapy

34
Q

Best drugs for PTSD?

A

Clonidine and beta-blockers. Inhibit adrenergic activity, which reduces the symptoms of hyperarousal.

35
Q

Which neuroleptics are preferred in elderly patients with cardiovascular problems and prostatic hypertrophy?

A

Haloperidol and fluphenazine

Less likely to cause postural hypotension

36
Q

SSRI withdrawal symptoms

A

Dizziness, nausea, vomiting, lethargy, flu-like symptoms, sleep disturbances.

Irritability, anxiety and crying spells.

Usually have symptoms in 1-3 days after the last dose.

37
Q

Which receptors do BZDs act upon?

A

GABA receptors

These represent the main cortical and thalamic inhibitory system.

38
Q

Which medications can cause a hypertensive crisis in patients on MAOIs?

A

Sympathomimetic containing drugs such as pseudoephedrine.

39
Q

Aged vs. non-aged cheeses cause more of a problem with MAOIs?

A

Aged

40
Q

Which medications can be used to reduce and delay REM sleep?

A

SSRIs, TCAs, MAOIs

Desipramine

41
Q

Features of NMS

A

Hyperthermia, muscular rigidity, autonomic instability, changes in mental status.

42
Q

Lab findings of NMS

A

Increased CPK, liver transaminase activity, leukocytes, myoglobinuria

43
Q

Pharma Tx of NMS

A

Bromocriptine and / or dantrolene

44
Q

Pharma for nocturnal enuresis + anxiety or tics

A

Imipramine

Can be helpful if pt doesnt tolerate stimulants or has past substance abuse

45
Q

Most important side effect of sildenafil

A

Myocardial infarction due to stress placed on the heart by sexual activity.

NAION is possible but is rare.

46
Q

Biggest cardiac side effect of TCAs

A

Slow cardiac conduction

Have a quinidine-like antiarrhythmic effect

47
Q

Lithium tremor

A

Benign, high-frequency, fine tremor that worsens during activities with fine motor control.

48
Q

Neuroleptic-induced dystonia

A

intermittent or sustained muscle spasms, usually involving the head and neck. Can have an oculogyric crisis (forced upward gaze)

49
Q

Coarse pill-rolling nonintentional tremor that improves with intentional movement

A

Parkinsonian tremor

50
Q

Rabbit syndrome

A

Extrapyramidal neuroleptic-induced syndrome. Rapid chewing movements without involvement of other parts of the body, including the tongue (no rapid tongue darting).

MS3 Rotations (3 decks)

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