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Pharmacology > Q2 PSYCHOPharm > Flashcards

Q2 PSYCHOPharm Flashcards

1
Q

What are the benefits BEYOND symptom control of psychopharm meds?

A

Neuroprotective
Reverses neurodegenerative process
Improves memory
Stimulates Neuro genesis and new synapses.

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2
Q

Examples of Monoamine NTs

A

NE, 5HT (serotonin), DA (dopamine), histamine, melatonin

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3
Q

Examples of amino acid NTs

A

Glutamate (celebrate! Excitatory)
GABA (inhibitory)

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4
Q

Meds that take longer to reach therapeutic levels have _____ issues with dependency and developing tolerance.

A

LESS.

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5
Q

What do psychotropic meds have that makes it possible for them to so readily cross the BBB?

A

Lipophilicity.
Highly protein bound - if patients are malnourished or deficient in protein/albumin the meds could not work as hoped.

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6
Q

If another medication is an INDUCER, it _________ the breakdown and makes the substrates _____ available, so you might need to _____ the dose of the psychotropic med.

If another medication is an INHIBITOR, it _________ the breakdown and makes the substrates _____ available, so you might need to _____ the dose of the psychotropic med.

A

Inducer - increases, less, increase
Inhibitor - slows, more, decrease

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7
Q

If a psychotropic med is being taken along with another medication that is a known inducer, what response to the psychotropic med may you expect to see?

A

The other medication induces, so it increases the breakdown of the psychotropic med making the substrates less available to the body, so you may need to increase the dosage to get the same desired effect.

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8
Q

Phenytoin and rifampin are well known ________ and work against CYP _____ substrates. A dose ______ may be needed

A

Inducers
3A4, 2C9, 2C19 and 1A2
Increase.

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9
Q

Benzos, hypnotics, opioids and some other miscellaneous (buspar, Tazo done, ziprasidone) are CYP ____ substrates.

A

3A4

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10
Q

“If i could create a magic pill for you, what would it do and what would it not do?”

A
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11
Q

1/3 of psych medications target ______
1/3 target ________
And 10% target_______
The rest target _______

A

NTs
GPCR
Enzymes
Ion channels

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12
Q

Classes of Psych Meds:

A

“4 SAAAAMI!”
Sleep Meds
Antidepressants
Antipsychotics
Anxiolytics
ADHD meds
Mood stabilizers
Impulsivity, compulsively and addiction

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13
Q

Classes of meds used as Antidepressants:

A

SSRI, SNRI, NDRI, SPARI(serotonin partial agonist reuptake inhibitor), Alpha2agonists, NRIs, SARIs, TCAs, MAOIs, NMDA

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14
Q

SSRIs characteristics
Selective Serotonin Reuptake Inhibitor

A

-etine
-opram
-odone
CYP1A2,2D6,3A4, GI upset, sexual side effects, serotonin syndrome. Can interfere with clotting. Metabolized in liver

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15
Q

SSRI common SEs and serious SEs

A

GI upset (90% of serotonin made in gut so take with food!)
Sexual side effects, HA, dry mouth
Serious: Serotonin Syndrome and increased SI.

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16
Q

Safety plan: “is there someone you can ask to let you know if you act down or can take you to the ER in the middle of the night if you start having SI?”

A
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17
Q

If a patient has a lot of baseline GI issues, which antidepressant class would NOT be the best choice?

A

SSRIs - 90% serotonin made in gut so frequent GI upset with SSRIs

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18
Q

What is Citalopram FDA approved for?
Clinical considerations?
SEs
Notes:

A

SSRI - MDD in adults only.
Weak histamine so give at night
NA, nausea, sexual dysfunction, sweating, prolonged QT
Favorable in elderly

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19
Q

Which med is the worst offender for causing mania?how can we prevent this?

A

Paroxetine (Paxil)
Make absolutely certain that the depression you are treating is NOT a depressive episode of someone who is bipolar. If so, you’ll just send them straight into a manic episode.

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20
Q

Difference between remission and response?

A

Remission = resolution of ALL symptoms
Response = 50% decrease in symptoms.

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21
Q

When should you switch within a class?

A

Not very often…. 50% of patients who fail to respond to one SSRI will fail another SSRI
70% of patients who could not tolerate one SSRI cannot tolerate another.

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22
Q

Instead of switching from SSRI to TCA, try

A

SSRI AND TCA

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23
Q

*some of the indications for antidepressants overlap with personality disorder and depression phase of bipolar - if you use antidepressants, it won’t treat the whole of PD or the whole of bipolar and may actually send them into a manic phase.

A
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24
Q

Your psych patient has been having issues with isolation and social withdrawal and communication skills. You prescribe a medication adjunct to help with social anxiety.

A

WRONG. These are symptoms they can be working on in therapy and should not be medically treated for. In addition to self esteem, and lack of coping mechanisms.

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25
Q

the first line of treatment for GAD are ________

A

Antidepressants. But often innefective by itself - needs an augmenting agent.

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26
Q

What is the chicken before the egg scenario in GAD?

A

Sometimes depression can cause anxiety and sometimes anxiety can cause depression

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27
Q

First line therapy for PTSD are _____ and NOT _______

A

SSRIs. NOT BENZOs. Benzos harm the brain’s way of processing trauma.

28
Q

What is a signal “event”?

A

Something a person will or will not be doing if their symptoms are getting worse or improving. “The more depressed i am, the more i dress up”

29
Q

What is an “anxious responder” and how do you treat?

A

Someone with depression who has remission of depressive symptoms, but continued anxiety/tension/worry.

Switch to SSRI plus NRI (SNRI) or augment with benzo, buspar, Mirtazapine or Gabapentin/Pregabalin.

30
Q

What is an apathetic responder and how do you treat?

A

Remission of depressive symptoms but remains not motivated, no zest, decreased concentration, or interest.
Augment or switch (131) Bupropion, Zoloft, Lamictal, Strattera???

31
Q

How long should you treat depression?

A

Treat to remission, and then at least 4-9 months past that.

32
Q

What happens if someone has a recurrence of depression?

A

Recurrence happens after remission. Usually lifetime therapy is needed after the 2nd or 3rd recurrence.

33
Q

Patients who present with fatigue or lack of energy as main symptom, have pain as a primary concern, have a lot of concentration of attention problems and may have fibromyalgia it’s best to start with ________

A

An SNRI.

34
Q

Augment when_______
Switch when ________

A

Adequate dose and duration, good tolerance but only response and not remission
Switch when inadequate response and intolerable SEs.

35
Q

Non-pharmacological augmentation

A

EXERCISE!!!!!
CBT/other therapy.

36
Q

Exercise increases availability of _____ and ______

A

Serotonin and NE

37
Q

Use Lithium to augment when:

A

Mood lability. Enhances seratonergic Neuro transmission.

38
Q

Use Buspar to augment when:

A

Effects of SSRIs
Residual anxiety
Sexual side effects.

39
Q

Use Modafinil (provigil) to augment when:

A

Low concentration
Fatigue
Sleepiness

40
Q

Use atypical antipsychotics to augment when:

A

SSRI or SNRI inadequate response

41
Q

Use benzos to augment when:

A

Patient needs to bridge the gab between now and when their mainstay meds start working
They need to be able to concentrate and actively participate in therapy
SHORT TERM
Reduces anxiety and insomnia

42
Q

Most addictive benzo

A

Xanax - shortest 1/2 life.

43
Q

Augment with thyroid hormones when:

A

2-4 weeks only
Cytomel
Use in depression while waiting for mainstay med (TCAs) to take effect.

44
Q

MOA of thyroid hormones?

A

Boosts Monoamine NTs, synapse formation

45
Q

Augment with anticonvulsants when:

A

Continued labile mood, anxiety and borderline patients. Pain.
Lamictal and Tegretol (inhibits glutamate release)

46
Q

Augment with Anticonvulsants when:

A

Continued anxiety, neuropathic pain, fibromyalgia,
Pregabalin, Gabapentin and Depakote.

47
Q

Augment with psychostimulants when:

A

Concentration, fatigue, memory and lack of energy problems.
Schedule II - highly addictive
Augment SSRI, SNRI, TCA and MAOI

48
Q

Why is folate so important?

A

Needed. For synthesis of NE, serotonin and DA.
Better absorbs antidepressants

49
Q

Why is Deplin a good option for folate supplementation?

A

Because it is already broken down, so those who lack the enzymes needed to break folate down, this is already done for them

50
Q

What’s a good daily dose for Omega-3 fatty acid?

A

1-3G daily.

51
Q

Supplement Vit D if below

A

50

52
Q

What does NAC help with?

A

Bipolar and OCD.
Amino acid derivative that supports the antioxidant system.

53
Q

What works well to treat tremor?

A

Clonidine, propanolol and Gabapentin

54
Q

What works well to augment for fatigue/sleepiness/sedation and improving concentration?

A

Modafinil, Bupropion, Atomoxetine, Methylfolate and thyroid augmentation.

55
Q

Which antidepressants are Non-sedating?

A

Bupropion, escitalopram, fluoxetine, selegiline, sertraline, vilazodone, vortioxetine.

56
Q

These two meds are usually the primary culprit in having residual anxiety, jitteriness and insomnia.

A

Fluoxetine and sertraline.

57
Q

Nausea? What meds may be better?

A

Bupropion: does not increase synaptic serotonin
Mirtazapine/vortioxetine: blocks serotonin receptors.

58
Q

HA - how treat?

A

OTC pain relievers, however caution with SSRIs - since they increase the risk of bleeding it’s not good to take them with NSAIDS which also increase bleeding risk.

59
Q

Dealing with the SE of sexual dysfxn?

A

Switch to serotonin antidepressant with 5HT2 antagonism
Citalopram, Maprotiline, Mirtazapine, Moclobemide, Selegiline, Trazodone, Vilazodone, Vortioxetine
Bupropion, estrogen cream for women or tadalafil, sildenafil or vardenafil for men.

60
Q

Dealing with urinary retention or hesitancy as a SE?

A

If culprit is SNRI - lower dose
If culprit is TCA, Bethanicol
Culprit is NRI (Atomoxetine)? Lower dose.

61
Q

If a patient presents with irritability instead of euphoria,they may be having

A

Hypomania symptoms.

62
Q

If you suspect bipolar, do NOT treat with a(n)

A

Antidepressant.

63
Q

1st line for PMDD

A

SSRIs - Prozac, Zoloft, Paxil

64
Q

When treating PMDD, you should start on day ___ of cycle for 2 weeks - the ______ phase.
What part does serotonin play in PMDD/

A

14
Luteal.
Serotonin mediates estrogen.

65
Q

Safest psych meds during pregnancy? Which med should you NOT give during pregnancy?

A

SSRIs. Zoloft specifically is the safest.
NOT Paxil.

Pharmacology (20 decks)

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