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Pharmacology > Chapter 15: psych > Flashcards

Chapter 15: psych Flashcards

1
Q

which receptors are blocked by antipsychotics

A

cholinergic

muscarinic

histamine

dopamine

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2
Q

antipsychotic action

A

comes from blocking of CNS dopamine receptors in the mesocorttical/mesolimbal systems in the brain

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3
Q

EPS is the result of

A

dopamine blocking in other parts of the body

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4
Q

EPS

A

parkinson-like syndrome usually occuring with both classes of antipsychotics as a result of years of exposure

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5
Q

symptoms of EPS

A

dystonia usually occurs within first 5-30 days

tardive dyskkinesia after 6 months (can be reversible)

rhythmic tongue protrusion, puffing cheeks, puckering of mouth

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6
Q

neuroleptic malignant syndrome (NMS)

A

life-threatening

starts months after therapy begins but rapidly progresses

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7
Q

treatment of NS

A

rapid d/cof agent and administration of dantrolene to relax muscles

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8
Q

how should antipsychotic therapy be discontinued

A

slowly reduce dose over 2-3 weeks

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9
Q

first generation antipsychotics (typical)

A

phenothiazines

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10
Q

examples of phenothiazines

A

haloperidol (Haldol)

trifluoperazine (Stelazine)

chlorpromazine (Thorazine)

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11
Q

second generation antipsychotics (atypicals)

A

aripiprazole (Abilify)

risperidone (Risperdal)

Olanzapine (Zyprexa)

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12
Q

largest group of psychotropic agents

A

phenothiazines

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13
Q

phenothiazine mechanism of action

A

unknown

theorized that it is a result of dopamine blockage in certain areas of CNS

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14
Q

effects of long term phenothiazine usage

A

cardiac arrythmia

hyperlexia (life-threatening)

HTN

rigidity

tardive dyskinesia

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15
Q

clinical uses of phenothiazines

A

acute, idiopathic psychotic illness marked by agitation

manic phase of bipolar disorder

schizophrenia

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16
Q

phenothiazines interactions

A
  • alcohol (CNS depression)
  • anticholinergics (increased anticholinergic effects)
  • amphetamines (decrease antipsychotic effect)
  • antiparkinson drugs (antagonize antipsychotic effect)
  • hypoglycemics (weaken control of diabetes)
  • lithium (decreases antisychotic effect)
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17
Q

phenothiazines contraindications

A

parkinsonism

blood dyscrasia

severe liver impairment, cardiac disease, or CNS depression

Reye’s syndrome

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18
Q

overdose of phenothiazines

A

fairly common but not fatal

symptoms: worsening CNS depression, hypotension, worsening of EPS

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19
Q

why are atypical antipsychotics considered atypical

A

hey do not cause EPS, tardive dyskinesia, or elevate prolactin levels

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20
Q

what is the only atypical antipsychotic with clear evidence of efficacy in treatment-resistant schizophrenia

A

clozapine (Clozaril)

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21
Q

black box warning for all antipsychotics

A

may increase mortality in elderly with dementia-related psychosis

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22
Q

Clozaril places at increased risk for

A

agranulocytosis, aeizures, and myocarditis

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23
Q

clinical uses for atypical antipsychotics

A

psychosis in patients with schizophrenia

depression or mania with psychotic features

bipolar disorder

severe agitation and delusions in dementia patients

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24
Q

when are antipsychotic medications used

A

psychotic episodes when tranquilizing effect is needed

Tourette’s (pimozide)

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25
Q

examples of atypical antipsychotics

A
  • aripiprazole (Abilify)
  • asenapine (Sapris)
  • clozapine (Clozaril)
  • iloperidone (Fanapt)
  • lurasidone (Latuda)
  • olanzpine (Zyprexa)
  • olanzapine/fluoxetine (Symbyax)
  • palpiperidone (Invega)
  • quetiapine (Seroquel)
  • risperidone (risperdal)
  • ziprasidone (Geodon)
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26
Q

atypical antipsychotic interactions

A

any drug requiring liver metabolism (including alcohol)

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27
Q

atypical antipsychotic contraindications

A

liver impairment

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28
Q

drug classes used for depression

A

MAOIs (Monoamine oxidase inhibitors)

TCAs (tricyclic antidepressants)

SSRIs (selective serotonin reuptake inhibitors)

non-TCA Antidepressants

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29
Q

examples of third line MAOIs

A

tranylcypromine (parnate)

selegiline (Emsam)

phenylamine (Nardil)

RARELY USED ANYMORE

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30
Q

MAOI mechanism of action

A

irreversible, non-selective inhibitors of MAO in its CNS storage sites

depression relief immediately or within 1 week

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31
Q

HTN crisis with MAOIs can be precipitated by

A

foods rich in tyramine (alcohol, aged cheese)

sympathomimetic drugs (cough meds containing ephedrin)

tricyclic antidepressants

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32
Q

what herb can cause life-threatening serotonin syndrome when taken with MAOI

A

St. John’s wort

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33
Q

MAOI contraindication

A

liver impairment

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34
Q

wash out period when witching from MAOI to SSRI

A

2 weeks

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35
Q

foods high in tyramine

A

aged cheese, beer, wine, pickled products, liver, raisins, bananas, figs, avocados, chocolate, yogurt, meat tenderizer

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36
Q

second line tricyclic antidepressants (TCAs)

mechanism of action

A

blocks neuronal reuptake of norepinephrine and serotonin at presynaptic terminus

has anticholinergic properties

ability to increase mood poorly understood as they do not stimulate the CNS

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37
Q

how long to clinical effect of TCAs

A

2-8 weeks

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38
Q

clinical uses of TCAs

A

endogenous depression

reactive depression

depression r/t alcohol/cocaine withdrawal, anxiety, neuropathic pain, enuresis, OCD

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39
Q

examples of TCAs

A
  • amitriptyline (Elavil)
  • clomipramine (Anafril)
  • doxepine (Silenor)
  • imipramine (Tofranil)
  • trimipramine (Surmontil)
  • amoxapine (Asendin)
  • desipramine (Norpramin)
  • nortriptyline (Pamelor)
  • protriptyline (Vivactil)
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40
Q

TCA interactions

A

any anticholinergic or barbituate, chlorpropamide, cimetidine, clinodine, epinephrine, ethanol, fluoxetine, neuroleptics, norepinephrine, propoxyphene, quinidine, and SSRIs

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41
Q

TCA contraindications

A

MAOI use

recovery phase of MI

doxepine is contraindicated with glaucoma or urinary retention

42
Q

TCAs are most effective in which population

A

severe depression, especially with greater disturbances and melancholia

43
Q

advantages of SSRI

A

act quicker and more reliabily than other antidepressants and have fewer side effects

44
Q

SSRI mechanism of action

A

selectively inhibits 5-HT neuronal reuptake at selected nerve terminals in the CNS and inhibit CYP450

45
Q

SSRI effect on norepinephrine and dopamine reuptake

A

little to no effect

46
Q

clinical uses of SSRIs

A

major depression

depression in patients with comorbidities

panic disorder

47
Q

examples of SSRIs

A

citalopram (Celexa)

fluoxetine (Prozac)

fluvoxamine (Luvox)

paroxetine (Paxil)

sertraline (Zoloft)

escitaloprma (Lexapro

48
Q

how long does it take SSRIs to relieve depression

A

up to 6 weeks

49
Q

Luvox (SSRI) is used only for

A

OCD

(produces no anticholinergic effects)

50
Q

which SSRIs should be taken in the morning and why

A

Prozac, Paxil, Zoloft because they can induce insomnia

51
Q

SSRIs and NSAIDs

A

concurrent use can increase GI bleeding risk

52
Q

SSRI interactions

A

buspirone

diazepam

lithium

MAOIs

neuroleptics

tricyclics

53
Q

SSRI contraindications

A

MAOI use within 14 days

pregnancy and lactation

54
Q

Prozac dosage with liver problems

A

must be reduced because Prozac is a strong inhibitor of the CYP450 system

55
Q

Prozac elevates the levels of which drugs

A

antiarrhythmics, other antidepressants, phenothiazine, risperidone, theophylline

56
Q

antidepressant for a patient that presents with a flat affect and fatigue

A

Prozac because it one of the more stimulating SSRIs

57
Q

most sedating SSRI

A

Paxil

58
Q

depressed patient that presents with anxiety, agitation and severe insomnia

A

Paxil

59
Q

which SSRI has a higher incidence of weight gain and side effects, requiring frequent monitoring

A

Paxil

60
Q

symptom of abrupt d/c of Paxil

A

flu-like syndrome

61
Q

middle of the road SSRI

A

Zoloft

62
Q

newer SSRI that is highly bound to plasma protein

A

Celexa

63
Q

SSRi with the most favorable drug-drug interaction profile

A

Celexa because it has the least effect on the CYP450 system

64
Q

when did non-TCA antidepressants enter the market

A

1990’s

65
Q

classes of non-TCAs

A

SNRI (serotonin and norepinephrine reuptake inhibitors)

NDRIs (norepinephrine and dopamine reuptake inhibitors)

SRIs (serotonin reuptake inhibitors)

TeCa (tetracycline antidepressant)

66
Q

examples of SNRIs

A

Ymbalta

Pristiq

Effexor

67
Q

aside from depression, SNRIs are approved to treat

A

anxiety

panic disorder

OCD

bulimia

68
Q

common off label uses for SNRIs

A

insomnia

chronic pain (diabetic neuropathy)

69
Q

SNRI contraindications

A

MAOI use within 14 days

70
Q

example of NDRIs

A

bupropion (Wellbutrin)

71
Q

wellbutrin adverse reactions

A
  • CV: tachycardia
  • DERM: photosensitivity
  • ENDO: hyperglycemia, hypoglycemia
  • GI: anorexia, weight loss, nausea, constipation, dry mouth
  • META: weight loss
  • NEURO: tremors/seizures if not taken correctly (dose dependent)
72
Q

wellbutrin interactions

A

common are phenobarbital and tegretal because they all undergo first pass metabolism

73
Q

wellbutrin contraindications

A

history of seizure, anorexia, bulimia

MAOI use within 14 days

74
Q

example of SRI

A

trazadone (Desyrel)

75
Q

clinical uses of trazadone

A

depression with insomnia, anxiety, and chronic pain

76
Q

off label uses of trazadone

A

sedative, panic attacks, agoraphobia, cocaine withdrawal, aggressive behavior

77
Q

trazadone interactions

A

digoxin and coumadin

(take in divided doses)

78
Q

trazadone contraindications

A

hypersensitivity

79
Q

example of tetracyclic antidepressant (TeCA)

A

mirtazipine (Remeron)

80
Q

clinical uses of remeron

A

depression

PTSD

81
Q

remeron interactions

A
  • MAOIs (HTN, seizures, death from serotonin syndrome)
  • CNS depressants (increased CNS depression)
  • any drug affecting CYP450
82
Q

remeron contraindications

A

hypersensitivity

83
Q

agents used to treat bipolar mania

A

lithium

valproates

carbamazepine

84
Q

itium mechanism of action

A

unknown

85
Q

clinical uses of lithium

A

bipolar disorder

with other antidepressants for major depression

with antipsychotics for schizophrenia

86
Q

what are lithium side effects related to

A

serum level

87
Q

signs of lithium toxicity and serum levels at which they occur

A

2.0-2.5 mEq/L or greater

  • CV: severe hypotension, ARRYTHMIAS, ECG changes, circulatory failure
  • NEURO: ataxia, blurred vision, giddiness, tinnitus, SEIZURES
  • GU: oliguria, nephrogenic diabetes insipidus
88
Q

lithium contraindications

A

significant renal impairment

significant cardiovascular disease

significant thyroid disease

diabetes

severe dehydration

sodium depletion

pregnancy

89
Q

how often should lithium levels be drawn

A

biweekly until stable and then every 2-3 months

90
Q

what can happen with abrupt withdrawal of depakote

A

status epilepticus

91
Q

valproaes mechanism of action and uses

A

mechanism of action is unknown

acts as an anticonvulsant, anti-manic, and antimigraine

92
Q

Benzo pharmacokinetics

A

page 288

93
Q

benzo interactions

A

alcohol, CNS depressants, opiod analgesics, anesthetics, TCAs can cause enhanced CNS depression

94
Q

benzo contraindications

A

comotose

uncontrolled severe pain

severe hypotension

angle-closure glaucoma

sleep apnea

95
Q

specific contraindications for Halcion and Xanax

A

taking ketoconazole and itraconazole

96
Q

schedule of benzodiazepines

A

IV

97
Q

Meprobamate (Equanil, Miltown)

A

schedule IV drug that is a carbamate derivative

use today is almost non-existant

98
Q

meprobamate

mechanism of action

A

affects thalamus and limbic systems as well as inhibits multi-neuronal spinal reflexes

99
Q

clinical use of meprobamate

A

relieve pain of muscle spasms and rigidity

100
Q

implications for special populations

A

pages 289-290

Pharmacology (28 decks)

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