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Pharm Final > Psych > Flashcards

Psych Flashcards

1
Q

Antidepressant categories, which is 1st line?

A

SSRI (First line)
SNRI
TCA
MAOI

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2
Q

Why are SSRI first line for depression?

A

Low SE profile, low OD risk

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3
Q

Fluoxetine dose

A

20 - 80mg Qday

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4
Q

When should you take Fluoxetine

A

morning, can increase energy

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5
Q

Fluoxetine SE

A
  • Insomnia
  • HA
  • Nervousness (!)
  • Decrease libido
  • Somnolence
  • N/D
  • Anorexia
  • Dry mouth
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6
Q

Fluoxetine uses

A
  • OCD
  • Bulimia
  • Panic DO
  • Premenstrual dysphoric DO
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7
Q

Symbyax MOA

A

combo fluoxetine + olanzapine (zyprexa)

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8
Q

Symbyax use

A

depression associated with bipolar

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9
Q

How should most all psych drugs be discontinued?

A

Gradual taper - rebound depression is common because they bottom out the receptors

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10
Q

Sertraline (Zoloft) dose

A

50 - 200 mg Qday

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11
Q

Sertraline (Zoloft) uses

A
  • OCD
  • Panic DO
  • PTSD
  • Social anxiety
  • Nocturnal eating (!)
  • Premestrual dysphoric DO
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12
Q

Parozetine (Paxil) dose

A

20 - 60 mg Qday

- CR 12.5 - 7 mg/d

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13
Q

Sertraline, Parozetine, Duloxetine SE

A
  • Insomnia
  • HA
  • Dizziness (!)
  • Fatigue (!)
  • Decrease libido
  • Somnolence
  • N/D
  • Anorexia
  • Dry mouth
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14
Q

SSRIs

A
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Parozetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
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15
Q

Parozetine (Paxil) uses

A
  • Panic DO
  • OCD
  • GAD
  • PTSD
  • Social anxiety DO
  • Premenstrual dysphoric DO
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16
Q

Parozetine (Paxil) special SE

A

associated with more wt gain than other SSRI

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17
Q

What SSRI is best for depression with anxiety?

A

Parozetine (Paxil)

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18
Q

Citalopram (Celexa) dose

A

20 - 40 mg Qday

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19
Q

Escitalopram (Lexapro) dose

A

10 - 20 mg Qday

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20
Q

Escitalopram (Lexapro) SE

A
  • Insomnia
  • Somnolence
  • HA
  • N
  • Ejaculator DO
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21
Q

Escitalopram (Lexapro) uses

A
  • GAD
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22
Q

SNRIs

A
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Duloxetine (Cymbalta)
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23
Q

Venlafaxine (Effexor) dose

A
  • Immediate and XR

- 37.5 - 225 mg Qday

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24
Q

Venlafaxine (Effexor), Desvenlafaxine (Pristiq) SE

A
  • Diaphoresis (!)
  • Increase BP (!)
  • Insomnia
  • Somnolence
  • HA
  • Nervousness
  • Dizziness
  • N/D/C
  • Anorexia
  • Dry mouth
  • Abn ejaculation/orgasm
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25
Q

How should you take Venlafaxine (Effexor)?

A

with food

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26
Q

Desvenlafaxine (Pristiq) dose

A

50 mg Qday

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27
Q

Duloxetine (Cymbalta) dose

A

40 - 60 mg Qday

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28
Q

Drug used for pain associated with DM neuropathy and fibromyalgia

A

Duloxetine (Cymbalta)

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29
Q

Duloxetine (Cymbalta) CI

A

Liver dz

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30
Q

Buproprion (Wellbutrin) MOA

A

Dopamine re-uptake inhibitor

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31
Q

Buproprion (Wellbutrin) dose

A
  • 100 mg TID
  • 150 - 200mg BID
  • 150 - 450 mg Qday
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32
Q

How do you start Buproprion (Wellbutrin)?

A

with extended release dose

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33
Q

Buproprion (Wellbutrin) SE

A
  • Insomnia
  • HA
  • Wt loss (!)
  • Tachycardia (!)
  • dry mouth
  • dizziness
  • HA
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34
Q

Which drug is associated with less sexual SE?

A
  • Buproprion (Wellbutrin)

- Mirtazapine (Remeron)

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35
Q

Which drug should be avoided by people with seizure d/o or anorexia?

A

Buproprion (Wellbutrin)

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36
Q

Interesting uses of Buproprion (Wellbutrin)

A
  • SAD
  • Smoking cessation (Zyban)
  • Decrease drug cravings
37
Q

Mirtazapine (Remeron) MOA

A

Alpha-2 Antagonist

- Enhances noradrenergic and serotonergic transmission

38
Q

Mirtazapine (Remeron) dose

A

7.5 - 45 mg

39
Q

Mirtazapine (Remeron) SE

A
  • Increase appetite (!)
  • Wt gain (!)
  • Increase cholesterol (!)
  • Constipation
  • Dry mouth
40
Q

Which drug is used in elderly pts to help with depression, sleep and or appetite/wt?

A

Mirtazapine (Remeron)

41
Q

How long does it take most antidepressants to work?

A

2 - 8 weeks

42
Q

What adjunct should be recommended in depression?

A

Group therapy

43
Q

When do SE tend to resolve?

A

Usually resolve after 1 week

44
Q

What may happen if pt does not complete a full course of therapy?

A

Relapse

45
Q

What should you advise pts about d/c’ing meds?

A

Do not stop antidepressant before discussing it with clinician first

46
Q

What is the most appropriate follow up after starting antidepressant?

A

1 - 2 weeks

47
Q

What should you watch out for when starting med?

A
  • Suicide (esp in first 1 - 2 months)

- Mania due to bipolar

48
Q

Recommended length of tx

A

4 - 9 months after determining therapeutic dose

49
Q

How long should pts at risk for recurrence be on meds?

A

1 - 3 yrs of maintenance

50
Q

Who is recommended to be on indefinite tx?

A
  • pts with hx of multiple episodes (> 3)

- Comorbid psychiatric or general med DO

51
Q

When d/cing antidepressant, do so over ________.

A

2 - 4 weeks

52
Q

Who should be hospitalized?

A
  • Suicidal or homicidal ideations
  • Severe psychomotor retardation or agitation
  • Associated psychosis
53
Q

Nociceptive pain

A

Tissue damage/injury

  • Somatic - muscle, bones, joints
  • Visceral - internal organs
54
Q

How do you treat nociceptive pain? Acute vs Chronic

A
  • Acute: NSAIDs up to short-acting opioids

- Chronic: long-acting + SSRI/SNRIs

55
Q

Neuropathic pain

A
  • Nerve damage or inflammation
56
Q

How do you tx neuropathic pain?

A
  • Neurontin
  • NSAIDs
  • Opioids

Central: Clonidine/Baclofen
Peripheral: Lidocaine, SSRI/SNRI, long-acting opioids

57
Q

Mild pain

A
  • ASA
  • Acetaminophen
  • NSAIDs
  • with adjuvants
58
Q

Moderate pain

A
  • Acet/Codeine
  • Acet/Hydrocodone
  • Acet/Oxycodone
  • Acet/Dihydrocodeine
  • Tramadol
  • with adjuvants
59
Q

What moderate pain med lowers seizure threshold?

A

Tramadol

60
Q

Severe pain

A
  • Morphine
  • Hydromorphone
  • Methadone
  • Fentanyl
  • Oxycodone
  • with adjuvants
61
Q

Acetaminophen dose

A

1000 mg Q 8 hrs

62
Q

Acetaminophen SE

A

Hepatotoxicity

63
Q

Acetaminophen, max dose

A

3 g/day

64
Q

NSAIDs SE

A
  • GI bleeding, use with PPI

- Nephrotoxic

65
Q

MOA

A

SSRI

66
Q

How long can you use Ketorolac (Toradol)?

A
67
Q

Ibuprofen, max dose

A

600 mg Q 6 hrs

68
Q

NSAIDs

A
  • Ketorolac (Toradol)

- Ibuprofen

69
Q

Codeine dose

A

15 - 60 mg Q 4 hrs

70
Q

Hydrocodone dose

A

5 - 7.5 mg Q 4-6 hrs

71
Q

Oxycodone dose

A

5 mg Q 4-6hrs

72
Q

Caution with codeine preparations

A
  • May contain acetaminophen
  • 325-1000mg per pill
  • Hepatotoxicity
  • Do not exceed 3g/day
73
Q

Tramadol (Ultram) MOA

A

opioid

74
Q

Tramadol SE

A
  • Decreases seizure threshold

- Addictive

75
Q

Long acting severe pain meds, used in

A

Acute and chronic pain

76
Q

Short acting severe pain meds, used in

A

break through pain

77
Q

Morphine dose

A

10 mg Q 4 hrs

78
Q

Hydromorphone dose

A

4mg Q 4 hrs

79
Q

Major SE of severe pain meds,

A
  • N/V
  • Constipation (Rx laxative with potent opioids)
  • Dry mouth
  • AMS
  • Respiratory distress (this is what kills people)
  • Tolerance ( dose for pain relief, not for dose to cause miosis or constipation, use least effective oral dose)
  • Dependence
80
Q

Dependence ______ addiction

A

does NOT equal

81
Q

With DEA cert and SP approval, how many days worth can PA rx Schedule II and III?

A

30 days

82
Q

Without DEA cert, how many days can PA rx?

A
  • 72 hrs max, except if “dealing with potential loss of life or limb or major acute traumatic pain”
83
Q

Max ___ rx in 6 months for CIV an CV

A

5

84
Q

A primary neurobio dz characterized by impaired control over drug use, craving, compulsive use, and continued use despite harm

A

Addiction

85
Q

Behaviors that appear to indicate addiction, but actually reflect untreated pain

A

Pseudoaddiction

86
Q

A state of adaptation to a drug class that results in withdrawl signs and symptoms if the drug is abruptly stopped or the dose decreased significantly

A

Physical dependence

87
Q

A physiologic state resulting from regular use of a drug in which an increased dose is needed to produce a specific effect, or a reduced effect is observed with a constant dose over time

A

Tolerance

88
Q

Typical drug seeking behaviors

A
  • Overreporting symptoms
  • Vague, multiple symtoms
  • Insist on specific meds
  • Convenient allergies
  • Demand brand name
  • High tolerance
  • First visit req
  • Veiled or overt threats
  • Flattery followed by req
  • Early refill req
  • Doctor shopping
89
Q

Solutions and boundaries

A
  • Screen for chemical dependency
  • Document meds
  • ID common sense
  • Communicate with pharmacy
  • Write careful rx
  • Use alternatives if possible
  • Get pharmacy and med hx
  • Don’t be cynical!

Pharm Final (5 decks)

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