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PsyShelf > Psych Meds > Flashcards

Psych Meds Flashcards

1
Q

TCAs MOA:

A

Increase Norepinephrine

-Tx for Depression/Anxiety, relieve Chronic Pain

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2
Q

SSRIs MOA:

A

Increase Serotonin

-Tx for Depression, Anxiety Disorders (Panic DO, GAD, Social Anxiety DO, PTSD) - 1st line, OCD

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3
Q

MAOIs MOA:

A
  • FILL IN

- Not used much b/c cause hypertensive crisis with tyramine exposure

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4
Q

Nefazodone (Serzone)

A
  • Increase Serotonin BOTH pre- and post-synaptically

- Tx for Depression and ???

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5
Q

Venlafaxine (Effexor)

A
  • Mixed Serotonin/Norepinephrine agent

- Tx for Depression and ???

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6
Q

Buproprion (Wellbutrin)

A

-Acts on Dopamine receptors

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7
Q

Chlorpromazine (Thorazine)

A

Antipsychotic that blocks dopamine receptors

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8
Q

Thioridazine (Mellaril)

A

Antipsychotic that blocks dopamine receptors

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9
Q

Haloperidol (Haldol)

A

Antipsychotic that blocks dopamine receptors

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10
Q

Clozapine (Clozaril)

A

Atypical antipsychotic
1. Tx: Tx-resistant schizophrenia & schizoaffective DO (pt who failed 2+ antipsychotics)

  1. SEs:
    - Leukopenia (Neutropenia) - Agranulocytosis
    * *Must monitor WBCs & Abs Neutrophil Ct
    - Eosinophilia is possible
    - Wt gain, metabolic syndrome, seizures, ileus, myocarditis, hypotension
    - LEAST LIKELY to cause EPS
    - DOES NOT CAUSE tardive dyskinesia
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11
Q

Risperidone (Risperdal)

A

Atypical antipsychotic

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12
Q

Olanzapine (Zyprexa)

A

Antypical antipsychotic

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13
Q

Benzodiazepines

A

Sedative hypnotics

  • Affect GABA neurotransmitter system & relieve anxiety
  • SEs: Sedation, reduced reflexes, tolerance, potential for addiction
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14
Q

Atypical antipsychotics with risk of orthostatic hypotension:

A

HIGH RISK:

  1. Quetiapine
  2. Clozapine
  3. Respiridone

LOW RISK:

  1. Aripiprazole
  2. Olanzapine
  3. Ziprasidone
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15
Q

Atypical antipsychotics with risk of metabolic syndrome:

A

HIGH RISK: Clozapine, Olanzapine

MEDIUM RISK: Quetiapine, Respiridone

LOW RISK: Aripiprazole, Ziprasidone

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16
Q

Atypical antispychotics with risk of anticholinergic side effects:

A

HIGH RISK:

  1. Clozapine
  2. Olanzapine
  3. Quetiapine

LOW RISK:

  1. Aripiprazole
  2. Respiridone
  3. Ziprasadone
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17
Q

Short-acting injectible atypical antipsychotics:

A
  1. Olanzipine

2. Ziprasidone

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18
Q

Long-acting/Depot form injectible atypical antipsychotics:

A
  1. Aripiprazole (dangerous) (Abilify mantenna)
  2. Olanzapine
  3. Respiridone (Resperdal consta) or Paliperidone (Invega sustenna)
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19
Q

Lithium indications:

A
  • Tx for acute mania and maintenance therapy in Bipolar Disorder
  • Has narrow therapeutic index, so can cause toxicity easily –> monitor drug levels every 6-12 months and 5-7 days after dose change or starting other meds that could interact.
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20
Q

Lithium side effects:

A

Acute:

  • Tremor, ataxia, weakness
  • Polyuria, polydipsia
  • Vomiting, diarrhea
  • Cognitive impairment
  • Wt gain

Chronic:

  • Nephrogrenic diabetes insipidus
  • Thyroid dysfunction
  • Hyperparathyroidism w/hypercalcemia

Pregnancy:

  • Exposure in 1st trimester causes cardiac malformations (septal defects & Ebstein’s anomoly –> atrialization of rt ventricle)
  • Exposure in 2nd/3rd trimesters causes goiter and transient neonatal neuromuscular dysfunction.
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21
Q

Lithium contraindications:

A

Don’t use lithium in pts with:

  1. Heart disease (HD)
  2. Chronic kidney disease (CKD)
  3. Hyponatremia or Diuretic use
  4. Pregnancy - Litihium should be avoided or dose adjusted b/c it can cause complications in 1st trimester (Ebstein’s anomoly) and later stages (Polyhydramnios, DI, Floppy Baby)
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22
Q

Baseline studies required before Lithium use:

A
  1. BUN, Cr, Calcium, Urinalysis
  2. Thyroid Fxtn Tests
  3. ECG in pts w/coronary/CAD risk factors (HTN, DM, smoking)
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23
Q

Drugs that affect Lithium levels:

A

INCREASE Lithium in body:

  1. Thiazide diuretics
  2. NSAIDs (except ASA)
  3. ACE-Is, ARBs
  4. Abx (ie. Tetracycline, Metro.)

DECREASE Lithium in body:

  1. K-sparing diuretics
  2. Theophylline

INCREASE or DECREASE Lithium in body:

  1. Loop diuretics
  2. Ca-channel blockers
24
Q

Tx for Delusional Disorder

A

-Antipsychotics and/or CBT

25
Q

Neuroleptic Malignant Syndrome (NMS):

A

Key Sx:

  1. Severe muscle rigidity (“lead pipe” rigidity)
  2. Mental status changes
  3. Autonomic instability (tachycardia, arrhytmias, labile BP, tachypnea, diaphoresis)
  4. High fever (can be over 104 F)
    * *Check for elevated serum CK and WBCs.

-Due to Dopamine (D2 receptor) antagonism from antipsychotics (typical and atypical), antiemetics (promethazine/metoclopramide), antiparkinson med withdrawal, infxtn, surgery

Tx: Stop neuroleptics or restart dopamine agents, supportive care (hydration, cooling), Dantrolene or Bromocriptine

26
Q

Tx of NMS:

A
  1. Stop neuroleptics or restart dopamine agents
  2. Hydration, cooling
  3. Dantrolene or Bromocriptine
27
Q

Tx for manic episode with psychotic features:

A
  1. Antipsychotics –> Cause NMS
  2. Mood stabilizers (ie. Lithium, Valproate) –> No NMS
  3. Benzos –> No NMS
28
Q

Benzodiazepines MOA:

A

-Enhance GABA receptors

29
Q

Tx of Bulemia:

A

-SSRIs (not effective in anorexia though)

30
Q

Tx of Social Anxiety Disorder:

A
  • SSRI/SNRI

- CBT

31
Q

Tx of Performance Subtype of Social Anxiety Disorder:

A
  • Beta Blockers or Benzos (avoid benzos in pts with h/o substance abuse)
  • CBT
32
Q

Tx of GAD:

A

-Buspirone

33
Q

Labs to monitor in pts on Lithium:

A

For 3-6 months after starting Lithium Tx, monitor:

  1. Cr
  2. TSH
34
Q

Buspirone

A

Tx for generalized anxiety disorder (GAD)

35
Q

Fluoxetine

A

1st line Tx for anxiety disorders (Panic disorder, GAD, social anxiety disorder, PTSD)

36
Q

Olanzapine

A

“Zyprexa”

37
Q

Quetiapine

A

“Seroquel”

38
Q

Ziprazadone

A

“Geodon”

39
Q

Aripiprazole

A

“Abilify”

40
Q

Respiridone

A

“Resperdal”

41
Q

Paliperidone

A

“Invega”

42
Q

Clonazepam

A

“Klonopin”

43
Q

Clozapine

A

“Clozaril”

44
Q

Mirtazepine

A

“Remeron”

45
Q

Fluphenazine

A

“Prolixin”

46
Q

Serotonin Syndrome Causes:

A

Combo of serotinergic meds or interaction of SSRIs & MAO-Is (ie. Phenelzine)

-Need 2-wk washout between stopping MAO-I and starting SSRI

47
Q

Serotonin Syndrome Sx:

A
  • Hyperthermia (fevers lower than in NMS)
  • Autonomic instability
  • Mental status changes
  • GI sx
  • Hyperreflexia
  • Myoclonus
  • NO RIGIDITY (vs. NMS)
48
Q

First line tx for bipolar depressive episodes:

A

-Lamotrigine

49
Q

Lamotrigine:

A

Tx: Bipolar depression

SEs:
-Stevens-Johnson syndrome (life-threatening mucocutaneous rxtn)

50
Q

What drugs precipitate/worsen manic episodes?

A
  • Bupropion

- Escitalopram

51
Q

ECT therapy

A

-1st line tx of Psychotic Depression, esp, if urgent and need rapid response, esp. in geriatric patients unable to eat/drink or who are actively suicidal

52
Q

Benztropine

A
  • Anticholinergic med.

- Tx for EPS induced by antipsychotic (ie. dystonias and parkinsonism)

53
Q

Cyproheptadine

A
  • Serotonin antagonist

- Tx severe Serotonin Syndrome (Autonomic Instability, Altered Mental Status, Neuromuscular Irritability)

54
Q

Carbamazepine

A

Mood Stabilizer & Anticonvulsant

SEs:
-If used in pregnancy, causes craniofacial defects, neural tube defects and genital anomalies in fetus.

55
Q

Depakote/Valproate

A

Mood Stabilizer & Anticonvulsant

ADD!!

SEs:
-If used in pregnancy, causes craniofacial defects, neural tube defects and genital anomalies in fetus.

56
Q

Tx for ADHD:

A
  1. Stimulants - Methylphenidate, amphetamines
  2. Nonstimulants - Atomoxetine, a2-adrenergic agonists
  3. Behavioral therapy
57
Q

Atomoxetine

A

“Strattera”

Tx: ADHD
MOA: NE reuptake inhibitor

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