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Psychiatry 200 > Therapeutic Drugs > Flashcards

Therapeutic Drugs Flashcards

1
Q

Imipramine (tofranil)

A

TCA; standard tx of enuresis

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2
Q

Buspiron (Buspar)

A

Partial 5HT1A antagonist

Not effective for panic disorder

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3
Q

Paroxetine

A

Paxil; short half life, bad withdrawal

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4
Q

Tranylcypromine

A

nonselective MOAI

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5
Q

MAOI intoxication tx

A

Treat delirium with IV benzos like lorazepam (short half life)

Don’t use neuroleptics-hypotension

Ventricular arrythmias: lidocaine

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6
Q

Bretylium

A

Antiarrythmic that blocks sympathetics

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7
Q

Best treatment for atypical depression?

A

MAOIs such as phenelzine

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8
Q

Atypical depressive symptoms?

A

Weight gain, hypersomnia, mood reactivity

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9
Q

How long to see if an antidepressant is workin?

A

6 weeks

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10
Q

Which benzos undergo glucuronidation?

A

Lorazepam and oxazepam…good for compromised liver

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11
Q

Which benzos are metabolized extensively by the liver?

A

Chlordiazepoxide and diazepam

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12
Q

Low-potency antipsychotics and seizure threshold?

A

Lower the threshold, like thorazine

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13
Q

Treatment for akathisia

A
  1. Lower dose
  2. Beta blocker
  3. Benzo?? the answer says not helpful
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14
Q

Bupropion for panic disorder

A

Can’t use it, must act on serotonin

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15
Q

Propranolol for panic disorders

A

Does NOT prevent the attack, only attenuates it

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16
Q

Benzo equivalency doses

A 
Lorazepam: 1 mg
Clonazepam (Klonopin): 0.25
Triazolam: 0.25
Alprazolam: 0.5
diazepam: 5 mg
clorazepate: 7.5 mg
chlordiazepoxide: 10 mg
Flurazepam: 30 mg
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17
Q

What to check before lithium tx?

A

Renal function: Cr, BUN, elec., thyroid function, UA

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18
Q

Lithium side effects

A

Benign leukocytosis…..

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19
Q

Tests before Depakote?

A

LFTs

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20
Q

NSAIDs and Lithium

A

Increase lithium levels, use aspirin or sulindac

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21
Q

Treatments for Tourettes

A

D2 antagonism: greatest relief

alpha2-agonist (NOT antagonist): not as effective as D2 blocking

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22
Q

Clonidine MOA

A

alpha2-agonist

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23
Q

Borderline Pharmacotherapy

A

SSRIs: fluoxetine: reduces impulsiveness and affective instability, better than TCAs

Antipsychotics: impulsiveness and psychotic thinking

Anticonvulsants: modulate intense affective fluctuations

NO STIMULANTS

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24
Q

Seizures and SSRIs

A

Fluoxetine increases Tegretol levels

Paroxetine is a fine choice for use with antiepileptics

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25
Q

SSRIs or TCAs

A

Generally better to use SSRIs because of cardiotoxicity from TCAs

Use TCAs for special indications:

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26
Q

Lithium ECG findings

A

T-wave flattening or inversion, usually not clinically significant

Lithium toxicity can cause sinoatrial block, AV block, AV dissociation, bradyarrhythmias, ventricular tachycardia, and ventricular fibrillation.

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27
Q

Drugs that increase lithium levels

A

Thiazides, other diuretics including spironolactone, triamterene, NSAIDs except aspirin and sulindac, metronidazole and tetracycline, and ACE inhibitors

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28
Q

Clomipramine use

A

OCD from potent 5HT reuptake inhibition

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29
Q

Mirtazapine MOA

A

central alpha2-antagonist: leads to increased NE and 5HT release

antagonist of 5HT2 and 5HT3 and H1: Increased appetite, weight gain, and sedation

Higher doses lead to less sedation!

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30
Q

OCD

A

SSRis or Clomipramine

Generally not neuroleptics

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31
Q

Fluvoxamine drug class

A

SSRI…used for OCD

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32
Q

Buspirone and OCD

A

doesn’t work!

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33
Q

Clozapine and treatment Resistant SCZ

A

Better than typicals at reducing positive and negative sxs.

Also improves cognitive deficits

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34
Q

Geodon MOA

A

5HT2a and D2

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35
Q

Clozapine MOA

A

D4>D2 blockade

5HT2

36
Q

TCA and Orthostasis

A

alpha1 blockade

37
Q

TCA for geezers

A

Nortriptyline

38
Q

Trazodone and Orthostatis

A

has alpha1 blockade, causes it!

39
Q

Mood-stabilizer for pregnancy

A

All of the common ones except Clonazepam (Klonopin)

40
Q

Lithium and Pregnancy

A

During first trimester: Ebstein anomaly to 7.7%

Can be used in 2nd and 3rd trimesters but stop peripartum due to changes in GFR

41
Q

Carbamazepine and Pregnancy

A

Neural tube defects

42
Q

Depakote and Pregnancy

A

Intrauterine growth retardation and neural tube defects

43
Q

Delirium treatments

A

Low dose atypicals like risperdal to reduce agitation

44
Q

Low-potency typicals

A

Chlorpromazine (Thorazine)

Thioridazine

45
Q

ECG and typicals

A

Low-potency has greater QT prolongation?

46
Q

AChEIs

A

Donepezil and Tacrine for Alzheimer’s

47
Q

Pemoline drug type

A

Stimulant

48
Q

Hypoglycemic Alcoholic with LOC

A

Prevent Wernicke-Korsakoff’s by giving thiamine before glucose

49
Q

Heroin detox

A

Clonidine (alpha2-agonist) > methadone detox

clonidine is good for sympathetic response

50
Q

Neuropathic and Chronic pain tx

A

Try SSRIs before using nortriptyline or amitriptyline

51
Q

Gabapentin uses

A

Anticonvulsant used in BAD and neuropathic pain, not approved for BAD tho

52
Q

Risperdone MOA

A

potent 5HT2a blocker and D2 and alpha1blocker

No significant anticholinergic effects

53
Q

Risperdone and EPS

A

Highest propensity of the atypicals…is it the most typical atypical?

54
Q

Molindone is a…

A

antipsychotic

55
Q

Yohimbine can help…

A

get yo dick up

56
Q

Yohimbine vs Clonidine

A

Clonidine is alpha2agonist, Yohimbine is alpha2antagonist

57
Q

First line for insomnia

A

Benzos

Temazepam is short acting and doesn’t leave people drowsy

58
Q

Panic disorder antidepressant treatments

A

SSRIs, TCAs, MAOIs, just can’t use bupropion or MAO-b inhibitor deprenyl

59
Q

Sertaline drug-drug interactions

A

Fewest of all the SSRIs

60
Q

Benzos and pregnancy

A

Increased risk for oral clefts after first-trimester exposure

61
Q

ECT and pregnancy

A

It works!

62
Q

Sedative-Hypnotic withdrawal symptoms

A

Autonomic hyperactivity, orthostatic hypotension, muscle weakness, tremor, insomnia, nausea, vomiting, AVH, agitation, anxiety

Most serious is grand mal seziures on 2nd or 3rd day

Delirium develops between 3-8 day

63
Q

Which antipsychotics make you the fattest?

A

Olanzapine and Clozapine

64
Q

If you can use an atypical or typical, which do you choose?

A

Atypical, it has better side effects

65
Q

How long to treat a first episode of unipolar depression?

A

At least 6 months, but usually 8-12 months

66
Q

Clomipramine and sexual dysfunction

A

High because it has strong serotonin reuptake inhibition

67
Q

Propylthiouracil MOA

A

anticholinergic that is good for sialorrhea

68
Q

Amantadine Use

A

Parkinsonian symptoms

69
Q

NMS symptoms

A

Hyperthermia, change in mental status, and increased muscle tone.

Can lead to renal failure following dehydration and a rise in muscle breakdown products (creatine kinase levels go up), pulmonary complications, and death

70
Q

Neurovegetative symptoms

A

SIGECAPS

71
Q

What symptoms of depression respond first to tx?

A

Neurovegetative=SIGECAPS symptoms

72
Q

Least likely atypicals to cause weight gain?

A

Aripiprazole and Ziprasidone»risperidone and quetiapine»olanzapine and clozapine

73
Q

Atypicals vs. Anticonvulsants for mania monotherapy

A

Can’t use atypicals!!! You must use anticonvulsants if you’re going to use a monotherapy

74
Q

Contraindcations for ECT

A

Recent MI in past 6 months, clinically significant intracranial space-occupying lesion because of the risk of brain stem hernation

75
Q

Lamotrigine dangerous side effect

A

SJS/TEN

76
Q

Tegretol dangerous side effect

A

Aplastic anemia

77
Q

Duloxetine special purpose

A

Diabetic neuropathy

78
Q

Antidepressants with no dick problems

A

Mirtazapine, bupropion, and nefazodone

79
Q

When to use ECT for depression

A

When there is refusal to eat/drink, severe suicidality, catatonia

80
Q

Rabbit syndrome

A

Rapid movement of the lips from dopaminergic system

81
Q

Agranulocytosis causes

A

Clozapine and Chlorpromazine

82
Q

Obstructive Jaundice cause

A

Chlorpromazine

83
Q

Pigmented Retinopathy

A

High dose thioridazine

84
Q

Double depression

A

MDD superimposed on dysthymic disorder, bad prognosis

85
Q

Delirium tremens onset

A

Within 96 hrs, 5 days

Psychiatry 200 (5 decks)

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