Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring Pharm > PyschPharm > Flashcards

PyschPharm Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

of identifiable neurotransmitters

A

21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2nd generation typical anti-psychotic

SE

A

2nd generation typical anti-psychotic

SE

  1. droperidol is a vasoconstrictor,
    • decrease CBF but not CMRO2
  2. Decrease in systemic in BP from alpha blockade - minimal
  3. Antidysrthymic!
    • protects against epinephrine induced dysrthymia
    • large doses decrease conduction along accessory pathways
  4. Prolonged QT interval
  5. R/F Torsade’s de Pont.
    • must have EKG before
    • must be monitored 2-3 hours after
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute dystonia associated with anti-psychotics responds well to

A

diphenhydramine, 25-50 mg IV.

Also helps EPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

current antidepressants primarily act on either

A

NE or serotonin by affecting metabolism, reuptake, or selective receptor antagonism

exception: ketamine

  • is an NMDA receptor antagonist. MOA for anti-depression unclear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

all sodium channel blockers are

A

usually more associated with stevens-johnson syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

All TCAs have

A

All TCAs have

active metabolites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alprazolam can depress

A

cortisol secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Amantadine (“Symmetrel”)

class:

MOA:

uses:

A

Amantadine (“Symmetrel”)

class:

anti-viral

MOA:

unknown

enhances dopamine release and delay re-uptake

uses:

symptomatic improvement of parkinsonian symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

amine hypothesis:

A

Depression is a functional decrease in amine (NE, serotonin, dopamine) transmissio.

Incidental disocvery r/t use of reserpine (depletes vesciles of NE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anesthesia notes on MAO-Is

A

Anesthesia notes on MAO-Is

Minimize possility of a sympathetic nervous stimulation or drug induced hypotension - get a nice hydrated patient to sleep.

Avoid need for sympathomimetic in anyway.

May need higher MAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anesthesia with pts on Lithium

A

Anesthesia with pts on Lithium

  1. Pre-Op labs:
    • ECG, Mag, Na+
  2. Anesthetic Requirements may be decreased
    • titrate very slowly, esp CNS depressants
    • Additive effects with sedation / cognitive slowing
  3. Actions of NMB may be prolonged
    • use agent that can be reversed with sugammadex
    • must have PNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anti-Cholinergics for Parkinson’s

SE

A

Anti-Cholinergics for Parkinson’s

  1. Trihexyphenidyl (Artane)
  2. Benzotripine (Cogentin)

SE

  1. hallucinations
  2. confusion
  3. urinary rention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anti-Depressant Discontinuation Syndrome

A

Anti-Depressant Discontinuation Syndrome

  • Dizziness
  • myalgias
  • Parathesias
  • Irratbility
  • Insomnia
  • Visual Distburances
  • Tremors
  • Lethargy
  • N/V/D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anti-Epileptics:

CYP450 inhibitors

A

Anti-Epileptics:

CYP450 inhibitors

Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anti-Epileptics

CYP450 inducers:

A

Anti-Epileptics

CYP450 inducers:

phenytoin

phenobarbital

carbamezapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Atypical Anti-Psychotic

MOA:

Agent:

A

Atypical Anti-Psychotic

MOA:

Multi-receptor antagonists

  • Less potent dopamine blocker than typical agents
  • Potent serotonin receptor antagonist
  • Also blocks alpha, histamine, cholinergic
    • like TCA and typical anti-psychotics

Prototype drug: Clozapine (“Clozaril”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Atypical Anti-Psychotics prematurely age

A

the CV system.

“can be at risk for MI or stroke”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Atypical Anti-Psychotic

SE:

A

Atypical Anti-Psychotic

SE:

  1. Weight Gain
  2. DM II
  3. Dyslipidemia
  4. Myocarditis/pericarditis
  5. tonic-clonic seizures 3%
  6. Alpha Antagonism
    • Orthostatic Hypotension
  7. Histamine Antagnosim
    • Sedation
  8. Cholinergic Antagonism
    • Anticholinergic SE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Atypical Anti-Pyschotics are used to treat:

A

Bipolar

Schizophrenia, esp with suicide risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Buspirone (“Buspar”)

Class:

MOA:

Uses:

E1/2T:

A

Buspirone (“Buspar”)

Class:

not a BZD

MOA:

partial agonist at serotonin receptor

Uses:

used for tx of generalized anxiety disorder, but not panic disorder

E1/2T:

2- 11 hours

“No direct effect on GABA so no cross reactivity with benzos, barbs, ETOH…”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Carbamezepine (“Tegretol”)

MOA:

SE:

A

Carbamezepine (“Tegretol”)

MOA:

blocks sodium channels

SE:

minimal cognitive impiarment; mild CNS effects can occur

Rash: mild to steven-johnson’s syndrome

Hematological Effects: Aplastic Anemia, thrombocytopenia, anemia, leukopenia

SIADH -> hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Carbemezapine (“Tegretol”)

interactions

A

Carbemezapine (“Tegretol”)

interactions

CYP450 inducer!!

Accelerates metabolism of: warfarin, oral contraceptives, other anti-seizures, NDNMB, phenytoin, phenobarb.

Grapefruit juice

increases levels of drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cardiac Concerns/Testing with droperidol

A

Droperidol has a black box warning for QT prolongation, r/f torsade’s de pont, ventricular fibrillation.

  • Must have EKG before.
  • Must be monitored prior to admin and continued 2-3 hours after.
  • Caution with pts at risk for developing QT syndrome
  • Avoid giving with other drugs that prolong QT (erythromycin, amiodarone, quindine, TCAs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cholinesterase Inhibitors for AD:

Agents:

SE:

A

Cholinesterase Inhibitors for AD:

Donazepil (Aricept)

Rivastigmine (Exelon)

Galantamine (Razadyne)

SE:

Nausea

diarrhea

head ache

bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clozapine (“Clozaril”) specific SE

A

agranulocytosis

Fatal infections (1:5000)

contra-indicated with WBC <3500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clozaril is contraindicated with

A

WBC <3,500

fatal infections with clozaril = 1:5000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Direct Dopamine Agonists:

A

Direct Dopamine Agonists:

  1. pramipexole “mirapex”
  2. bromocriptine
  3. pergolide
  4. ropinirole (requip)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

eldepryl

A

selegiline * selective for MAO-I B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Entacapone

class:

MOA:

Uses:

SE:

A

Entacapone

class:

COMT-inhibitor

MOA:

prevents breakdown of dopamine and other catecholamines.

End result: increase the amount of dopamine available to CNS

Uses:

Prolongs half life of dopamine 50-75%, used with sinemet to prolong half-life of dopamine

SE:

Similar to sinemet

orange urine

hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Fosphenytoin (“Cerebryx” is a

A

prodrug of phenytoin (Dilantin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Fosphenytoin (“Cerebryx”)

MOA:

Dose:

A

Fosphenytoin (“Cerebryx”)

MOA:

blocks Na+ channel

Dose:

10-20mg/kg IV dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Lamotrigine (“Lamictal”)

MOA:

SE:

A

Lamotrigine (“Lamictal”)

MOA:

blocks Na+ channel,

SE:

major concern: steven-johnson’s sndrome

CNS: sedation, visual disturbances, HA, N/V, depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Levetiracetam (“Keppra”)

MOA:

SE:

A

Levetiracetam (“Keppra”)

MOA:

Unknown.

Not known to affect GABA

May have affects on voltage gated ion channels

SE:

Adverse effects are much less significant cmopared to other anti-epileptics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Levodopa/Carbidopa (“Sinemet”)

interactions

A

Levodopa/Carbidopa (“Sinemet”)

interactions

Butyrophenones, Phenothiazines:

  • antagonist effects - dopamine antagonists)

Metoclopramide

  • also a dopamine antagonist

Droperidol*

  • especially can cause skeletal muscle rigidity and pulmonary edema d/t sudden antaognism of dopamine

MAO-I

  • Interferes with inactivation of catecholamines inculding dopamine , can be beneficial

Anti-Cholinergics:

  • act synergistically with levodopa to improve tremor.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Levodopa/Carbidopa (“Sinmet”)

MOA:

SE:

A

Levodopa/Carbidopa (“Sinmet”)

MOA:

Is a dopamine precursor and decarboxylase inhibitor. Increase dopamine in brain.

SE:

  1. N/V -> dopamine at CRTZ
  2. Transient flushing of skin, ST, PACs, PVCs, orthostatic hypotension r/t higher plasma dopamine levels
  3. Abnormal involuntary morvements devleop in 50% of pts after 1-4 onths
  4. Psychiatric disturbances
  5. Increase liver enzymes
  6. transient increase in bUN
  7. urinary metabolites can cause false positive for ketoacidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lithium Interactions:

A

Lithium Interactions:

Diuretics:

Increase lithium levels and r/f lithium toxicity r/t lowering of sodium

NSAIDs:

Increase lithium levels by ~60%

ACE-inhibitors:

Increase lithium levels

Anticholinergics:

urinary retention!

Painful with high volume of urine.

Amiloride:

(potassium sparing diuretic)

decreases urine volume !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Lithium is contraindicated in patients with

A

SA node dsyfunction:

Sick-sinus syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Lithium range for acute mania:

A

1 - 1.2 mEq/L for acute mania

very narrow

40
Q

Low dose typical anti-psychotics can be used anti-emetics because

A

they block dopamine at chemo trigger zone

[dopamine antagonism]

41
Q

MAO-Inhibitor A

increases

A

serotonin,

epinephrine,

norepinephrine

42
Q

MAO-Inhibitor B increases

A

phenylethylamine

dopamine

43
Q

MAO-I:

SE:

A

MAO-I:

SE:

Orthostatic hypotension

Weight Gain

anticholinergic effects

Impotance/Anorgasmy :(

Sedation OR mild stimulant effects

MAO-A enzyme is present in liver, GI tract, kidneys, lungs -> metabolizes dietary tyramine.

44
Q

MAO-I

MOA:

A

MAO-I

MOA:

MAO-Is form a stable irreversible complex monoamine oxidase, increasing the availability of these neurotransmitters in the CNS and peripheral autonomic nervous system.

45
Q

MAO-I

C/I

A

MAO-I

C/I

  • Dietary tyramine + MAO-I = massive release of endogenous catecholamines/serotonin -> HTN crisis or sertonnin syndrome, r/f CVA
  • SSRIs, TCAs - r/f sertonin syndrome
  • Meperidine - r/f serotonin syndrome
  • Ephedrine - can be fatal
  • Decrease dose of phenylephrine to 1/3
  • Cold/Allergy drugs may have some sympathomimetics
  • Nasal Decongestants
46
Q

marplan

A

isocarboxazid

47
Q

Mild Lithium Toxicity

A

>1.2 mEq/L

  • Sedation,
  • nausea,
  • skeletal muscle weakness,
  • wide QRS,
  • AV heart block,
  • hypotension,
  • dysrthymia,
  • seizure
48
Q

Mirtazapine (“Remeron”)

SE

A

Mirtazapine (“Remeron”)

SE

“more pronounced effect on co-morbid anxiety” - decreases anxiety

Sedation > 50%

Constipation

Increased Appetite

Weight Gain

Increased Cholesterol

Less sexual SE, less GI effects

49
Q

Mirtazapine (“Remeron”)

Class:

MOA:

Notable Uses:

A

Mirtazapine (“Remeron”)

Class:

atypical anti-depressant

MOA:

Unique: presynaptic a2 - antagonist, blocks negative feedback mechanism and increases release of NE serotonin. Is also a serotonin antagonist?

Notable Uses:

In addition to normal anti-depressant reasons, specifically can be used in CA patient to help with insomnia and appetite.

50
Q

Mirtazpine (“Remeron”)

C/I

A

Mirtazpine (“Remeron”)

C/I

With MAO-Is -> r/f serotonin syndrome

Caution with CNS depressants r/t sedation

51
Q

Mood Stabilizer:

Lithium

MOA:

Uses:

A

Mood Stabilizer:

Lithium

MOA:

  • Unknown!
  • Theories:
  • Alterated glutamine signaling, serotonin receptor blockade.
  • Lithium is a positively charged inorganic ion.

Uses:

  • Tx for bipolar, gold standard!
  • Especially good for manic phase.
52
Q

Mood Stabilizer: Lithium

SE:

A

Mood Stabilizer: Lithium

SE:

  • Polydipsia/Polyuria - 3L/urine per day
  • Impaired renal concentrating ability
  • ECG: T wave changes
    • clinically irrelevant and reversible
  • Heart Block (rare)
    • C/i in pts with SA node dysfunction
  • Hypothyroidism
    • more common in females
  • New onset Psoriasis
  • Fine tremor
  • Sedation
  • Memory Disturbances
  • Cognitive Slowing
53
Q

Nardil

A

phenelzine

54
Q

Neurolepetic Malignant Syndrome

A

Neurolepetic Malignant Syndrome

  • develops over 24 - 72 hours
  • more common in young men
  • hyperthermia
  • hypertonicity of skeletal muscles
  • myoglobinuria
  • instability of autonomic NS
  • fluctuating lOC
  • 4%mortality with early intervention
  • 30% mortality with delayed intervention r/t respiratory failure, CV collapse, dysrthymias

Tx is supportive and inlcuds dantrolene and dopamine agonists.

55
Q

Memantine (“Namdena”)

Class

MOA:

Uses:

SE:

A

Memantine (“Namdena”)

Class:

NMDA antagonist

MOA:

blocking the leacky NMDA channels that allow excess calcium into neurons.

Chronic glutamate release depolarzies NMDA.

Uses:

Alzheimer’s, very modest benefits.

SE:

Dizziness

HA

fatigue

sedationn

Hypertension

Rash

Diarrhea

Weight gain

urinary frequnecy

anemia

56
Q

Notable SE of citalopram

A

QT prolongation

57
Q

parnate

A

tranylcypromine

58
Q

Phenobarbital

MOA:

SE:

A

Phenobarbital

MOA:

Modulation of post-synaptic ations of GABA and glutamate.

Prolong duration of cholride channel opening, limiting spread of seizure

SE

cognitive and behavior side effects limit usefulness

Adults: sedation

Children; paradoxical excitation

Elderly: confusion

Induces CYP450

59
Q

Phenytoin (“Dilantin”)

Administration:

A

Phenytoin (“Dilantin”)

Administration:

infusion no faster than 50mcg/min in adults.

1-3 mg/kg/min in peds or 50 mcg/min, whichevr is slower! To avoid hypotension and dysrthymias.

60
Q

Phenytoin (“Dilantin”)

interactions

A

Phenytoin (“Dilantin”)

interactions

Phenytoin is a CYP450 inducer

increases metabolism of other anti-epiletptics, OC, warfarin, corticosteroids, NDNMB

Topiramate:

can increase levels of phenytoin

61
Q

Phenytoin (“Dilantin”)

MOA:

A

Phenytoin (“Dilantin”)

MOA:

Regulates Na+ and Ca++ ion transport across the neuronal membrane to decrease excitability.

62
Q

Phenytoin (“Dilantin”)

Pk

A

Phenytoin (“Dilantin”)

Pk

Atypical Pharmokinetics:

Non-linear pharmacokinetics; metabolism is saturable.

1st order kinetics until higher dose than 0 order kinetics.

63
Q

Phenytoin

SE:

A

Phenytoin

SE:

Dose Related:

ataxia, nystagmus, diplopia, vertigo, peripheral neuropathy, drowsiness, cognitive impairment

NON-Dose Related:

Steven-Johnson’s syndrome, gingival hyerplasia, hepatotoxicity, purple glove syndrome

64
Q

Pramipexole (“mirapex”)

class:

MOA:

Uses:

SE:

A

Pramipexole (“mirapex”)

class:

direct dopamine agonst

MOA:

selectively binds to D2, D3

delayed onset! 2-3 weeks

Uses:

Used as 1st line monotherapy then combined with levodopa as diseas progresses

SE:

  • N/V
  • postural hypotension
  • hallucinations
  • vivid dreams
  • sleepiness
  • dyskinesias (less than with levodopa)
  • Impulse high risk behaviors
65
Q

Sertonin Syndrome

A

Sertonin Syndrome

  • MAO-I + any other drug that increases serotonin can cause SS
    • meperidine
    • SSRI
    • SNRI
    • tyramine containing foods

Symptoms:

Hyperthermia

Diaphoresis

muscle rigidity

rapid flucations in VS/mental status

confusion

agitation

hallucinations

Excitatory Response (Type I):

agitation, skeletal muscle rigidty, hyperprexia

Depressive Response (Type II)

Hypotension, respiratory depression, coma

Serotonin Syndrome is rare but fatal

66
Q

Significant Lithium Toxicity

A

Significant Lithium Toxicity

>2.5 mEq/L

more significant symptoms!

Life threatening dysrthymias.

Medical Emergency!

Sedation,

nausea,

skeletal muscle weakness,

wide QRS,

AV heart block,

hypotension,

dysrthymia,

seizure

67
Q

SNRI

SE

A

SNRI

SE

GI distress

sexual dysfunction

diastolic blood pressure increases 5-7%

Pupil dilation (caution in glaucoma)

insomnia

withdrawl syndroms if stopped abruptly

neonatal withdrawl syndrome

68
Q

Sodium depletion can cause

A

increase plasma concentratino of lithium by 50%

69
Q

SSRIs + pregnancy

A

SSRIs + pregnancy

Most are category C:

Late pregnancy use = small risk to fetus. But infant withdrawl symptoms and pumlonary HTN can happen.

When you increase serotonin in really high concentratoins it can promote pulmonary HTN.

70
Q

SSRIs inhibit

A

CYP450-2D6

will increase levels of warfarin, TCAs, and lithium

71
Q

SSRI

interactions

A

SSRI

interactions

MAO-I: r/f serotonin syndrome, absolute contraindications.

Drugs that impair coagulation/platelets

SSRIs inhibit CYP450-2D6 (potentiate warfarin, TCA, lithium)

SRRI + wellbutrin = increase r/f seizure

St John’s Wart, TCAs = increase serotonin

72
Q

SSRI

SE

A

SSRI

SE

Sexual dysfunction

Suppretion of plt aggregation

Orthostatic Hypotension

Hyponatremia (esp c diuretics)

Withdrawl if stopped abruptly

CNS excitation (agitation, insomnia)

GI distress

Sleepiness, light headedness

Bruxism

Rash

Short term weight loss/long term weight gain

Prolonged QT (citalopram)

r/f serotonin syndrome

Black box warning - r/f suicide, esp in first few months

73
Q

Tardive Dyskinesia with Typical Anti-Psychotics:

A

is usually not reversible, diagnosed 6 months after chronic use.

74
Q

TCA also acts on receptors

A

TCA receptor activated:

  1. Alpha Adrenergic Antagonism
  2. Histamine Antagonist
  3. Cholinergic Antagonism
75
Q

TCA

side effects

A

TCA

side effects

1. Alpha-Adrenergic Antagonism

  • hypotension, orthostatic hypotension, can lead to mild tachycardia r/t blocking of alpha2

2. Histamine Antagonism:

  • sedation, weakness, fatigue

3. Cholinergic Antagonism

  • tachycardia
  • dry mouth
  • urinary retention
  • constipation
  • ileus
  • slow gastric emptying

4. Cardiac Conduction Abnormalities:

  • QT prolongation, arrthymias via vagal and bundle-of-his conduction (inhibition). -> promotes tachycardia.

5. Lowers seizure threshhold

  • only for pts who have seizure d/o

6. Hypomania

7. Must be weaned to prevent withdrawl symptoms

76
Q

TCA

overdoses;

A

TCA

overdoses;

are often fatal.

So they are only given 1 week supply at a time.

77
Q

TCAs are prone to drug interactions because

A
  1. they are metabolized by CYP450
  2. and bc they have affects at so many receptors (cholinergic, hisatmine, alpha)
78
Q

TCAs are structurally simliar to

A

TCAs are structurally simliar to

Dopamine Antagonists (typical anti-psychotics)

  • phenothiazines
  • thioxanthenes
  • butyrphenones
    • haloperidol
    • droperidol
79
Q

TCAs are used for neuropathic pain:

A
  1. at low doses
  2. because they resemble LA
  3. potentiate enodgenous opioids
  4. inhibit overactive inflammatory response system
80
Q

TCAs

uses

A

TCAs

uses

depression

bipolar (depssive episodes)

chronic pain syndrome - low doses

81
Q

TCAs

C/I

A

TCAs

C/I

MAO-Is: strict contraindication

Direct & Indirect Acting Sympathomimetic: use extreme caution

Avoid Ephedrine

Avoid anti-cholinergic drugs

Avoid droperidol, erythromycin -> prolong QT

Caution with

  • sedating drugs, etoh, barbs, anti-histamines, opioids, inhaled agents, IV induction agents
  • liver diseae, renal diease ->active metabolites
82
Q

TCAs

PB:

A

TCAs

PB: high!

Acidosis may increase unbound drug leading to more SE and dysrthymias, important because drug has a narrow therapuetic window.

83
Q

To prevent QT prolongation, avoid anti-pyschotics concurrent use with

A

TCA

erythromycins

quinidine

amiodarone

84
Q

Topiramate (“Topomax”)

interactions:

A

Topiramate (“Topomax”)

interactions:

  1. when given with valproate: can lead to ammonia accumulation, CNS toxicity
  2. Can increase levels of phenytoin,
  3. Can increase levels of cabramezapine
85
Q

Topiramate (“Topomax”)

MOA:

SE:

A

Topiramate (“Topomax”)

MOA:

Blocks Na+ channels

Enhances gaba

Blocks Ca++ channels

Glutamate Antagonist

Produces GABA release

NMDA antagonist

SE:

Drowsiness, impaired cognition

ataxia

weight loss

Psychomotor slowing

renal stones

metabolic acidosis

glaucoma

86
Q

Tricyclic Anti-Depressants:

MOAs:

A

Tricyclic Anti-Depressants:

MOAs:

Blocks reuptake of serotonin and/or NE

tertiary amines:

  • inhibit sertonin and NE reuptake
  • Amitryptilline (Elavil)
  • Imipramine (Tofranil)
  • Clomipramine (anafranil)

secondary amines:

  • inhibit NE reuptake
  • desipramine (norpramin)
  • nortriptyline (pamelor)
87
Q

Tx for Lithium Toxicity

A
  1. Hemodiaysis
  2. Osmotic Diuresis with NaBicarb
88
Q

Typical Anti-Psychotics

SE

A

Typical Anti-Psychotics

SE

Histamine Antagonism

  • sedation

Cholinergic Antagonism:

  • dry mouth, constipation, urinary retention

Alpha Adrenergic Antagonism

  • hypotension, orthostatic hypotension

Parkinsonianism

  • bradykinesia,
  • tremor,
  • rigidity,
  • akinesia

Dyskinesia

spasms of muscle groups

Acute Dystonia:

Acute skeletal muscle rigidity and cramping of muscles of eyes, tongue, face, larynx, r/f laryngospasm, neck, back - can be so severe that jaw discloates, acute respiratory distress from laryngeal dyskinesea

Tardive Dyskinesia

Not reversible, usually diagnosed after 6 months of chronic use

Severe dysrthymias and QT prolongation

direct cardiac depression

droperidol has blackbock warning

Decreased BP

Agranulocytosis

Sedation

d/t histamine antagonism, tolerance to sedation with chronic therapy

Seizure threshhold is reduced

89
Q

Typical Anti-Psychotics are similar to

A

TCAs

they both act as:

  1. histamine antagonists
  2. cholinergic antagonists
  3. alpha adrenergic antagonist

in addition to their MOA/effect

90
Q

Typical Anti-Pyschotics:

Agents:

MOA:

Generations:

A

Typical Anti-Pyschotics:

Agents:

Phenonthiazines (1st)

Thioxanthenes (1st)

Butyrophenones (2nd)

MOA:

Dopamine antagonists at D2 receptors in the basal ganglia and limbic portions of the forebrain.

Generations:

First generation

Second generation = more potent, so less side effects

91
Q

Valproate (“Depakote”)

+ CYP450

A

Valproate (“Depakote”)

not metabolized by CYP450 but does induce CYP450

92
Q

Valproate (“Depakote”)

MOA:

SE:

C/I”

A

Valproate (“Depakote”)

MOA:

Blocks Na+ channels

Blocks T-Type VGCC

Promotes synthesis of GABA

SE:

N/V

weight gain

alopecia

thrombocytopenia

fatal hepatotoxicity (1:40,000)

fatal pancreatitis

C/I:

pregnancy

93
Q

Valproate (“Depakote”)

SE:

A

Valproate (“Depakote”)

SE:

N/V

weight gain

alopecia

thrombocytopenia

fatal hepatotoxicity

  • 1:40,000 = adults
  • 1:500 = pediatrics less than 2y/o

CYP450 inhibitor

94
Q

Vaproate (“Depakote”)

+ topiramate

A

Vaproate (“Depakote”)

+ topiramate

high levels of ammonia can accumulate and cause CNS toxicity

95
Q

Wellbutrin

Class:

MOA:

Uses:

A

Wellbutrin

Class:

atypical anti-depressant

MOA:

primarily an inhibitor of dopamine and NE reuptake

Uses:

  • prevent seasonal affective disorder
  • smoking cessation aid
  • pt’s not tolerating other SSRIs
  • Hypoactive sexual desire disorder

Off label:

  • neuropathic pain
  • ADHD
96
Q

Wellbutrin

C/I

A

Wellbutrin

C/I

Dopamine and NE reuptake inhibitors.

MAO-Is

Avoid:

drugs that inhibit cyp450-CYP2D6 ( SSRIs )

increase seizure risk

97
Q

Wellbutrin

SE

A

Wellbutrin

SE

  • Nervousness
  • HA
  • insomnia
  • N/V/constipation
  • Dry Mouth
  • Tremor
  • Weight Loss
  • Small risk of psychotic symptoms r/t dopamine
  • Increased r/f seizures (0.4%)

Spring Pharm (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions