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Psychotherapeutics Flashcards

1
Q

Do first or second generation antipsychotics work better in the treatment of schizophrenia?

A

They work the same

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2
Q

Pros and cons of first gen antipsychotics

A

Pros = cheaper
Cons = EPS

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3
Q

Pros and cons of second gen antipsychotics

A

Pros = no EPS
cons = more expensive, metabolic effects that put the patient at risk for CV events and death

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4
Q

Which receptors do 1st gen antipsychotics work on?

A

D2

Also can interact with ACh, histamine, and NE receptors

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5
Q

Which receptors do 2nd gen antipsychotics work on?

A

D1, D2, D4, 5-HT

Also can interact with a1, histamine, and M receptors

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6
Q

How long does it take for schizophrenia symptom improvement upon initiation of pharmacological therapy?

A

2-4 weeks
Full effect: months

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7
Q

Adverse effects of FGAs

A

EPS!!!
neuroleptic malignant syndrome
Anti cholinergic effects
Orthostatic hypotension
Hyperprolactinemia
Seizures
Sexual dysfunction
Dysrhythmias

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8
Q

What are EPS?

A

Movement disorders due to drug effects on the extrapyramidal motor system

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9
Q

List 4 types of EPS

A

pseudoparkinsonism
Acute dystopia
Akathisia
Tardive dyskinesia

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10
Q

Which category of EPS does not have a treatment?

A

Tardive dyskinesias

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11
Q

How are 3/4 of EPS treated?

A

Anticholinergics
Amantadine
Beta blockers
Benzodiazepines

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12
Q

Mechanism of neuroleptic malignant syndrome?

A

DA receptor blockade from antipsychotic medications

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13
Q

S/s neuroleptic malignant syndrome

A

Rigidity
Sudden high fever
Sweating
ANS instability —> BP changes/dysrhythmias
Seizures, coma

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14
Q

Treatment for neuroleptic malignant syndrome

A

Withdraw antipsychotic med
Possibly switch to SGA
Supportive care (resp, hemodynamics)

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15
Q

What can NMS also look like?

A

Serotonin syndrome (from drugs that increase 5-HT)

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16
Q

Major adverse of haloperidol?

A

Earlier EPS
QT prolongation

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17
Q

What is the potency of haloperidol?

A

High

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18
Q

What are the major adverse effects of phenothiazine?

A

Sedation
Orthostatic hypotension
Anticholinergic effects
QT prolongation
Lower incidence of EPS

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19
Q

What are the three metabolic adverse effects of SGA that can result in CV events?

A

DM
Weight gain
HLD

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20
Q

Schizophrenia relapse while on pharmacological therapy is most likely to occur because of ______.

A

Nonadherence

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21
Q

How long is the pharmacological treatment of schizophrenia?

A

Indefinite

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22
Q

Neurotransmitters hypothesized to be involved in depression?

A

Norepi
Serotonin

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23
Q

When initiating antidepressant therapy, how long until drug effects are at plateau?

A

Up to 3m

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24
Q

Pharmacological antidepressant therapy should be combined with:

A

Psychotherapy

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25
Antidepressants have a black box warning because:
Early in treatment, depression/suicidal ideation can increase
26
List 4 classes of antidepressants
SSRIs SNRIs TCAs MAOIs
27
Mechanism of SSRIs
Inhibit reputake of 5-HT = increased concentration in neuronal synapse
28
Which is the safest antidepressant class?
SSRIs
29
List some SSRIs
Fluoxetine Citalopram Escitalopram Paroxetine Sertaline (Others)
30
Adverse effects of SSRIs
Nausea Agitation/insomnia Sexual dysfunction Weight gain Serotonin syndrome
31
Major drug interactions with SSRIs
Other drugs that increase serotonin (MAOIs, SNRIs, TCAs, analgesics, triptans) = serotonin syndrome Other drugs that inhibit platelet aggregation (antiplatelets) = increased bleeding risk
32
Mechanism of SNRIs
Inhibit reuptake of 5-HT and NE = increased concentration on neuronal synapse
33
Adverse effects of SNRIs
Same as SSRIs + HTN
34
List some SNRIs
Venlafaxine Duloxetine (Others)
35
Mechanism of TCAs:
As an antidepressant, they inhibit 5-HT and NE reuptake = increased concentration in neuronal synapse Not selective tho, so also impact H, M, and various other receptors
36
List some TCAs
Amitriptyline Clomioramine (Others)
37
Adverse effects of TCAs
Commonly due to H & M receptor interaction - orthostatic hypotension - anticholinergic effects - sedation - cardiac toxicity (dyrhythmias, HB) - seizures - SI
38
Major reasons for drug interactions with TCAS:
1. HTN risk (MAOIs, sympathomimetics) 2. CNS depression (additive with other agents)
39
Mechanism of MAOIs
Inhibit monoamine oxidase = decreased metabolism of NE, 5-HT, DA, tyramine Antidepressant = increased NE and 5-HT availability
40
Duration of effect of MAOIs
2 weeks (Since irreversible inhibition of MAO)
41
List some MAOI inhibitors used for depression
Isocarboxazid Phenelzine Tranycypromine
42
Are nonselective MAOI or MAO-B inhibitors used for treatment of depression?
Nonselective
43
Adverse effects of MAOIs
CNS stim Orthostatic hypotension Others same as SSRIs
44
Major causes of drug interactions with MAOIs
1. Severe HTN with any other drug that increases NE or causes hypertension 2. Serotonin syndrome risk with any other drug that increases 5-HT
45
Food element that should be avoided while on MAOIs
Tyramine
46
What is the risk with tyramine when on a MAOI
Excessive NE release = HTN, HA, tachycardia/MI Can be deadly
47
List some tyramine containing foods
Aged cheeses Cured meats Processed meats Fermented or pickled foods Some sauces (soy sauce) Fava beans Alcoholic beverages (Others)
48
List some atypical antidepressants
Bupropion Mirtazapine Esketamine (Others)
49
List mood stabilizers used in the treatment of bipolar disorder
Lithium Valproate Carbamazepine
50
Which antipsychotics are used in bipolar disorder
Second gen
51
Specific PK considerations with lithium
- rapid 1/2 life = multiple doses per day - narrow therapeutic index = drug levels must be monitored
52
S/s mild lithium toxicity (to educate patients)
Fine tremor GI disturbances Polyuria & polydipsia Agitation Confusion/delirium
53
S/s severe lithium toxicity
Tremors Delirium Seizures QT prolongation Renal failure Coma Death
54
Goal range in lithium treatment
0.4-1mEq/L
55
Mechanism of action of benzodiazepines
Potentiation of GABA (I.e. utilizes the GABA that the body has)
56
Why does ceiling effect occur with benzodiazepines?
Because they potentiate endogenous GABA, they don’t agonize the receptor on their own
57
Adverse effects of benzodiazepines
CNS depression Anterograde amnesia Teratogenic
58
Mechanism of action of benzodiazepine like drugs
Agonize GABA receptor
59
List some benzodiazepine like drugs
Zolpidem Zaleplon Eszipiclone
60
What is the difference between zalpeplon and zolpidem
Zaleplon has a rapid onset but short duration, so only helpful for falling asleep Zolpidem has a longer duration so helpful also for staying asleep
61
How does ramelteon work
Agonizes melatonin receptor (15x more potent than melatonin itself)
62
Which sleep aid isn’t a controlled substance
Ramelteon (melatonin agonist)
63
How does suvorexant work?
Antagonizes the effects of orexin, resulting in decreased wakefulness
64
Major difference between barbiturates and benzodiazepines
Barbiturates agonize GABA receptor directly, thus there is no ceiling effect to CNS and respiratory depression
65
Adverse effects of barbiturates
Severe resp depression (death) Sedation (can be used as a general anesthetic) CYP450 induction Tolerance & physical dependence
66
Drugs used in anxiety
SSRIs SNRIs Buspirone Benzodiazepines
67
Mechanism of action of buspirone
Not we’ll known, but likely binds 5-HT receptors
68
Adverse effects of buspirone
Minimal Dizziness Nausea HA
69
First line drugs for ADHD
CNS stimulants
70
Adverse effect of all CNS stimulants
Seizures
71
Types of CNS stimulants
Amphetamines Methylphenidate/dexmethylphenidate Methylxanthines Modafinil
72
Mechanism of action of amphetamines
Stimulate release of NE & DA, inhibit some of their reuptake
73
Adverse effects of amphetamines
Insomnia, restlessness, euphoria Appetite suppression Tachycardia, vasocontriction (can lead to dysrhythmias, HTN)
74
How do methylxanthines work
Block adenosine receptor = cAMP accumulation
75
Which schedule drug is methylphenidate
II
76
Adverse effects of methylxanthines
Decreased fatigue Tremors, insomnia Cardiac stimulation CNS vasoconstriction Bronchodilation
77
How does modafinil work
Unclear Influences sleep/wake cycles
78
Adverse effects of modafinil
Minimal, just avoid in pregnancy

Pharm (27 decks)

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