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Pharmacology > Pyschiatry > Flashcards

Pyschiatry Flashcards

1
Q

Examples of SSRIs

A
  1. Fluoxetine / Prozac
  2. Sertraline / Zoloft
  3. Citalopram / Celexa
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2
Q

SSRI Indications

A
  1. First-line defense for anxiety disorder and depression
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3
Q

Who is sertraline good for?

A

postpartum moms who are breastfeeding

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4
Q

Who is escitalopram good for?

A

If celexa was helpful but there are many side effects b/c it is a metabolite of celexa

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5
Q

What is Fluoxetine commonly written for?

A

OCD symptoms along with mood disorder

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6
Q

Which SSRI has the longest half life?

A

fluoxetine - greater than 100 hours

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7
Q

paroxetine/paxil has a little impact similar to what other class of drugs?

A

SNRIs

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8
Q

SSRI MOA

A

bind to reuptake transporters on the presynapse for serotonin and prevent removal of serotonin from the synaptic cleft –> increased serotonin available to bind postsynaptic receptors

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9
Q

How long does it take for SSRIs to work?

A

up to 6-8 weeks to see full impact of drug

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10
Q

typical SSRI half life and what does this mean?

A

24 hours or more –> once a day administration

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11
Q

Patient education for starting SSRI

A

may start to feel side effects of drug before they start to feel the pharmacologic effects

start at lose dose and titrate up, will reevaluate at 8-12 weeks

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12
Q

Which SSRI is good for noncompliant pateints?

A

Fluoxetine because it has such a long half life

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13
Q

SSRI Indications

A
  1. Major depressive disorder
  2. Obsessive Compulsive Disorder
  3. Generalized Anxiety Disorder
  4. Panic Disorder
  5. Bulimia nervosa
  6. off-label for IBS-D, post traumatic head injury
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14
Q

SSRI absolute CIs and why

A
  • MAOIs used w/in 2-3 weeks
  • Can cause serotonin syndrome which can be fatal
  • washout period is 2-3 weeks
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15
Q

SSRI General S/E

A
  1. sexual dysfunction (MC)
  2. GI distress (N/V, constipation) - nausea initially but transient, usually lasts 1-2 weeks
  3. agitation (fluoxetine)
  4. tremor
  5. insomnia
  6. serotonin syndrome
  7. bleeding
  8. suicide
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16
Q

What do you do if patient has sexual dysfunction on SSRI?

A
  1. try different SSRIs

2. if still not helpful, then add a little bit of Wellbutrin

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17
Q

Specific side effects of fluoxetine / prozac

A
  1. tremor

2. insomnia

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18
Q

Specific side effects of paroxetine / paxil

A
  1. excessive sedation
  2. weight gain

dose at bedtime

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19
Q

Specific side effects of sertraline / zoloft and citalopram / celexa

A
  1. often well tolerated

2. both less stimulating than Prozac

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20
Q

Specific side effects of citalopram / celexa

A
  1. prolonged QT interval!!

- -> don’t exceed 40 mg/day

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21
Q

What is serotonin syndrome?

A
  1. hyperthermia
  2. muscle rigidity
  3. myoclonus
  4. rapid fluctuations in vital signs
  5. rapid fluctuations in mental status
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22
Q

Do you need to stop SSRIs prior to surgery?

A

no

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23
Q

who is at increased risk for suicide with SSRIs

A

patients under 24 years (more motivation than feel good initially)

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24
Q

Lifestyle modifications to suggest when giving SSRI

A

CBT, relaxation, meditation, therapy

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25
Q

What does SNRI stand for

A

serotonin noradrenaline reuptake inhibitors

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26
Q

SNRI examples

A
  1. venlafaxine / effexor

2. duloxetine / cymbalta

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27
Q

SNRI MOA

A

inhibit reuptake and increase concentration of both serotonin and noradrenaline in synaptic cleft

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28
Q

When do you try SNRIs

A

if failed multiple SSRIs

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29
Q

lower doses (<150 mg) of effexor also affect which neurotransmitter

A

serotonin reuptake

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30
Q

what is duloxetine uniquely indicated for?

A

neuropathy

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31
Q

is cymbalta/duloxetine or effexor/venlafaxine stronger? What does this mean?

A

duloxetine/cymbalta more potently blocks serotonin and NE –> higher risk of increased HR, BP

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32
Q

half life of SNRIs compared to SSRIs

A

shorter

should take at same time every day so do not have withdrawal

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33
Q

Who should you not give SNRIs to?

A

noncompliant patients (can get withdrawal)

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34
Q

symptoms of SNRI withdrawal

A
  1. aches
  2. flu-like symptoms
  3. nausea
  4. brain zaps
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35
Q

who is effexor good for?

A

perimenopausal women because good for headaches, symptoms of menopause

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36
Q

SNRIs Indications

A
  1. depression
  2. generalized anxiety disorder
  3. social anxiety disorder
  4. panic disorder
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37
Q

SNRIs Absolute CIs and why

A

MAOIs –> can cause serotonin syndrome and hypertensive crisis
allow for 2 week wash period

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38
Q

SNRIs S/E

A
  1. Nausea, constipation
  2. dizziness (unique from SSRI)
  3. somnolence (initially)
  4. insomnia
  5. sexual dysfunction
  6. sweating
  7. increased intraocular pressure
  8. tremor
  9. dry mouth
  10. sustained HTN
  11. suicidal thoughts/behavior
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39
Q

What do you need to be cautious of with SNRIs

A

Need to gradually taper off b/c withdrawal response - nausea, flu-like symptoms, brain zaps, aggression, agitation, convulsions

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40
Q

What does NDRI stand for?

A

Noradrenaline and Dopamine Reuptake Inhibitor

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41
Q

NDRI example

A

Bupropion / Wellbutrin

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42
Q

Bupropion MOA

A

inhibits presynaptic reuptake of both dopamine and noradrenaline –> increased levels of both of these in synaptic cleft

43
Q

Who is wellbutrin good for?

A

patient only depressed, no anxiety, no panic

44
Q

buproprion as smoking cessation drug MOA

A

nicotinic receptor antagonist –> prevents exogenously administered nicotine from binding to this receptor –> decreases reward that smokers gets from nicotine

45
Q

NDRI Indications

A
  1. depression

2. smoking cessation

46
Q

NDRI Contraindications

A
  1. seizures - lowers seizure threshold
  2. MAOIs - HTN crisis
  3. thioridazine - increased risk of ventricular arrhythmia
47
Q

NDRI S/E

A
  1. dry mouth
  2. nausea
  3. insomnia
  4. seizures (rare)
48
Q

benefit of buproprion

A

no sexual side effects

49
Q

Tricyclic Antidepressant Examples

A
  1. amitriptyline / Elavil

2. nortriptyline / Pamelor

50
Q

benefit of amitriptyline

A

helps with neuropathic pain

51
Q

off label uses for TCAs

A
  1. post traumatic head injuries
  2. IBS-D
  3. sleep
52
Q

TCA MOA

A
  1. serotonin, NE reuptake inhibitors

2. block H1-histamine and alpha-adrenergic receptors

53
Q

who should not used TCAs

A

the elderly –> orthostatic hypotension, cardiac problems

young athletes with low BP

54
Q

TCA S/E

A
  1. sedation
  2. dry mouth
  3. constipation
55
Q

TCA overdose

A
  1. cardiac arrhythmias
  2. hypotension
  3. CNS involvement
56
Q

TCA indications

A
  1. depression
  2. OCD
  3. panic disorder
  4. neuropathic pain (amitriptyline)
57
Q

TCA Contraindications

A
  1. MAOIs
  2. recovery phase of MI
  3. doxepin in glaucoma or urinary retention
58
Q

TCA S/E

A
  1. dry mouth (MC)
  2. confusion
  3. urinary retention
  4. constipation (MC)
  5. blurred vision
  6. increase intraocular pressure
  7. photosensitivity
  8. neurologic - confusion, delusions, hallucinations, aggressiveness, mania, sedation
  9. arrhythmias if high dose
  10. orthostatic hypotension
59
Q

what do you have to consider when prescribing TCA

A

wide range of potential drug interactions

think about liver metabolism issues w/ other drugs

60
Q

MAOI indications

A

depression

61
Q

MAOI MOA

A

irreversible, nonselective inhibitors of monoamine oxidase in CNS –> increased levels of epi, NE, serotonin, and dopamine

62
Q

how quickly do MAOIs work

A

relief of symptoms in days up to 2 weeks

63
Q

MAOI contraindications

A
  1. drug interactions
  2. sympathomimetics (ie. ritalin, methyldopa)
  3. SSRIs
  4. TCAs
  5. foods with tyramine (pickles, pepperoni, vinegar, wine, cheese)
  6. alcohol
64
Q

MAOI S/E

A
  1. sleep disorders - insomnia, reduction in REM sleep
  2. weight gain
  3. postural hypotension
  4. sexual disturbances
  5. serotonin syndrome!
  6. hypertensive crisis!
65
Q

Atypical antidepressant examples

A
  1. trazadone / desyrel

2. mirtazapine / remeron

66
Q

what is trazadone good vs. not good for

A

terrible for depression, doesn’t work at all

good for sleep !

67
Q

what class is mirtazepine

A

tetracyclic antidepressant

68
Q

Mirtazepine MOA

A
  1. antagonist at presynaptic alpha receptors –> increases synaptic NE and serotonin
  2. potent antihistamine blocking response
  3. inhibits serotonin 5HT2 and 5HT3
69
Q

who is mirtazepine good for

A

elderly people - b/c increases appetite
cancer patients
people for whom tricyclic is effective but not tolerated

70
Q

mirtazepine indication

A

depression

71
Q

dosing considerations for mirtazepine

A
  1. dose reduction in patients with liver or kidney disease
72
Q

trintellix indication

A

major depressive disorder

73
Q

trintellix CI

A
  1. MAOIs
74
Q

trintellix MOA

A

enhances serotinergic activity in CNS through inhibition of reuptake of serotonin

75
Q

trintellix S/E

A
  1. N/V, constipation
  2. suicide risk
  3. serotonin syndrome
  4. abnormal bleeding
  5. activation of mania/hypomania
  6. hyponatremia
76
Q

Lithium indications`

A
  1. bipolar disorder - prophylaxis and treatment of manic phase
  2. refractory depression
77
Q

lithium CIs

A
  1. use w/ extreme caution in patients w/ significant renal or cardiovascular disease
  2. use w/ extreme caution in patients w/ severe dehydration or sodium depletion
78
Q

What do you need to check with giving lithium

A

follow BMP, BUN and creatinine especially
Lithium levels b/c narrow therapeutic index
TSH, T4 (risk of hypothyroidism w/ long term use - yearly)

79
Q

lithium MOA

A

inhibits dopamine neurotransmission

80
Q

Lithium serious S/E

A

acute lithium toxicity

  1. N/V/D
  2. renal failure
  3. ataxia, tremor, confusion, delirium, seizures
81
Q

Lithium S/E

A
  1. arrhythmias
  2. hypotension
  3. goiter
  4. hypothyroidism
  5. nephrotoxicity
  6. weight gain
  7. Nausea, GI irritation
  8. memory disturbances, cognitive dulling
82
Q

Lithium drug interactions

A
  1. NSAIDs
  2. Diuretics
  3. ACE inhibitors
  4. Fluoxetine decreases efficacy of lithium
    many more
83
Q

First Generation Antipsychoitc examples

A
  1. chlorpromazine / thorazine
  2. Prochlorperazine / compazine
  3. haloperidol / Haldol
84
Q

compazine uses

A
  1. excellent antiemetic
85
Q

uses of haldol and thorazine

A
  1. agitation acutely in ER

2. intractable hiccups

86
Q

First Gen Antipyschotic indications

A
  1. psychosis
  2. acute agitation, delirium, mania (haloperidol)
  3. N/V (chlorpromazine)
  4. Tourette’s syndrome (haldol)
  5. intractable hiccups (haldol, chlorpromazine)
87
Q

FGAs MOA

A

antagonist at dopamine D2 receptors

also antagonists at adrenergic, cholinergic, histamine H1 receptors

88
Q

FGA half-life

A

12-24 hours

89
Q

FGA CI

A

severe CNS depression

avoid if decreased consciousness

90
Q

FGA S/E

A
  1. anticholinergic - dry mouth, constipation, difficulty urinating
  2. alpha antagonism - orthostatic hypotension, ejaculatory failure
  3. sedation
  4. extrapyramidal syndrome!!
  5. tardive dyskinesia
  6. akathisia - inability to sit still
  7. dystonia - muscles spasms of face, tongue, back, neck
91
Q

what is extrapyramidal syndrome

A

blockage of dopamine receptors in basal ganglia –> Parkinson-like symptoms (slow movements, stiffness, tremor)

92
Q

what is tardive dyskinesia

A

repetitive involuntary movements of face, arms, trunk

rhythmic tongue protrusion, puffing out cheeks, puckering of mouth

93
Q

FGA rare but serious side effects

A
  1. neuroleptic malignant syndrome (NMS) - hyperthermia accompanied by extrapyramidal and autonomic disturbances that may be fatal
  2. agranulocytosis - severe reduction in # of leukocytes –> neutropenia
  3. cardiac conduction abnormalities, long QT
94
Q

Second Generation (Atypical) Antipsychotics examples

A
  1. olanzapine / zyprex
  2. risperidone / risperdal
  3. quetiapine / seroquel
95
Q

what else is olanzapine used for

A

sleep

96
Q

2nd gen antipsychotic indications

A
  1. disorders of thought
  2. depression or mania w/ psychotic features
  3. bipolar disorder
  4. severe agitation and delusions in pts w/ dementia
97
Q

2nd gen antipsychotic CIs

A

hx of neuroleptic malignant syndrome

98
Q

2nd gen antipsychotic MOA

A
  1. antagonize dopamine and serotonin receptors primarily
  2. D2 receptor antagonists
  3. potent antagonists of 5 HT2 receptors
  4. also antagonize adrenergic, cholinergic, histamine H1 receptors
99
Q

2nd gen antipsychotic metabolism

A

liver

100
Q

2nd gen antipsychotic serious S/E

A
  1. increased mortality in elderly patients
  2. endocrine - exacerbation of diabetes, hyperglycemia, dyslipidemia, hyperprolactinemia
  3. Neuroleptic malignant syndrome
  4. extrapyramidal symptoms
101
Q

what should you screen for when giving 2nd gen antipsychotic

A

CMP, lipid panel, A1c, weight gain

102
Q

2nd gen antipsychotic common S/E

A
  1. orthostatic hypotension
  2. sedation
  3. anticholinergic
  4. N/V
103
Q

switching from 2nd gen antipsychotic

A

cross-titrate rather than wash out

104
Q

Natural antidepressants

A
  1. exercise
  2. exposure to light
  3. supplements

Pharmacology (27 decks)

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