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PMHNP > 8013 week 1 pharm review > Flashcards

8013 week 1 pharm review Flashcards

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1
Q

3 monoamine neurotransmitters

A

Dopamine
Norepinephrine
Serotonin

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2
Q

Dopamine NT receptors

A

D1-5

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3
Q

Dopamine is responsible for

A

movement control, emotional response, pleasure and pain

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4
Q

Dopamine
Too little:
Too much:

A

Parkinsons

Psychosis and mood disorders

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5
Q

Norepinephrine receptors

A

Adrenergic NT binds to alpha & beta adrenergic receptors

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6
Q

NE increase in adrenergic activity causes…

A

causes increased HR, BP, alertness, anxiety and hyperactivity

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7
Q

NE reuptake inhibitors do what…

NE Agonists do what…

A

increase NE and improve symptoms of depression

decrease NE and help with symptoms of anxiety

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8
Q

Serotonin receptors…

A

5HT 1-7

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9
Q

Serotonin regulates…

A

sleep
mood
pain
peristalsis
Appetite
vasoconstriction

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10
Q

5HT 1A is associated with

A

depression

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11
Q

5HT 2A is associated with

A

psychosis

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12
Q

Gaba vs Glutamate (how they work)

A

inhibitory (hyperpolarizing a receptor preventing it from firing and results in anti-anxiety, anti-epileptic, and sedative effect)

excitatory (master switch that works on any receptor and contributes to learning and memory. Excess can lead to neurodegeneration like Parkinsons/Alzheimers/Schizophrenia)

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13
Q

All antipsychotics block the ___ system in the brain

A

DA

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14
Q

Low potency FGAs require…

A

higher dosing and vice versa

potency of rx determines dose needed to elicit response

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15
Q

high potency FGA cause AE due to..

A

not hitting ACH

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16
Q

Low potency FGA example

A

Chlorpromazine/Thorazine

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17
Q

2 moderate potency FGAs

A

Loxapine/Loxitane

Perphenazine/Trilafon

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18
Q

2 high potency FGAs

A

Haloperidol/Haldol

Fluphenazine/Prolixin

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19
Q

How do FGAs work

A

Antagonism of D2 receptors with an optimal effect at a 60-70% D2 receptor blockade

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20
Q

low potency FGAs have a high potency for which receptors

A

cholinergic and andrenergic

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21
Q

high potency FGAs block ___ but not ___

A

DA

ACH

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22
Q

low potency FGAs AE

A

Anticholinergic: Dry mouth, constipation, blurred vision, orthostatic hypotension

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23
Q

high potency FGAs AE

A

Extrapyramidal : Akathesia, akinesia, dyskinesia, dystonia, tardive dyskinesia

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24
Q

FGAs target all DA which may result in ___

A

increased neg AE, EPS, hyperprolactinemia

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25
NMS risk from FGA is high with ____ but increased with ___
high dose FGA dehydration, exercise, exhaustion
26
10 SGAs
Clozapine/Clozaril Aripiprazole/abilify Asenapine/saphris Cariprazine/vraylar Iloperidone/fanapt Lurasidone/Latuda Olanzapine/Zyprexa Quetiapine/Seroquel Risperidone/Risperdal Ziprasidone/geodon
27
How do SGAs work?
Both DA and 5ht antagonist counterbalancing DA depletion in areas of the brain that cause EPS, hyperprolactinemia, and negative sx reducing occurrence shorter duration of DA block than FGAs
28
SGA AEs
cardiometabolic syndrome: Wt gain, HTN, inc lipids, inc glucose Also sedation, EPSE, anticholinergic possible
29
SGAs with least likely cardiometabolic syndrome AE
Abilify and Geodon
30
How do SSRIs work?
inhibit uptake of 5ht, some DA, NE
31
Most common AE for SSRI
GI Neuropsych Sex dysfunction Also consider: SI, SS, W/D, Apathy
32
4 SNRIs
Desvenlafaxine/Pristiq Duloxetine/Cymbalta levomilnacipran./Fetzima Venlafaxine/Effexor xr
33
How do SNRIs work?
inhibit 5ht and NE
34
Most common SNRI AE
Drowsy Dry mouth Dizzy Constipation Nervous Sweat Anorexia
35
NDRI example
Bupropion
36
How does Bupropion (NDRI) work
inhibit NE and DA (not 5ht) impacts adrenergic system
37
Bupropion CI and most common AE
CI: Sz hx AE: Insomnia and agitation (no dec libido)
38
If anxiety is worse than depression choose
SSRI over NDRI
39
NASSA example
norandrenergic and specific serotonergic antidepressants Mirtazapine/Remeron
40
How does Mirtazapine (NASSA) work?
Antagonnist of adrenergic and specific serotonin receptors antagonist of histamine tx Major depression
41
Mirtazapine (NASSA) AE
Wt gain somnolence (dec with higher dosing) ortho hypo dizzy less libido issues than SSRI Poss to cause agranulosis
42
Serotonin modulator and stimulator example
Vilazodone/viibryd
43
How does Viibryd work
inhibit and partial agonist of 5ht does not bind to NE or DA take with food metab CYP3A4 comes with starter kit but expensive
44
Viibryd AE
GI HA
45
SRI example
Serotonin reuptake inhibitor Vortioxetine/brintellix
46
How does Brintellix work?
inhibit 5ht very long half life and high protein bound
47
Brintellix caution
Do not use with Bupropion due to inc blood level
48
SSRI/Antipsychotic combo rx
Symbyax/fluoxetine-olanzapine
49
How does Symbyax/fluoxetine-olanzapine work?
Agonist of 5ht/DA/NE Used to tx BP1 acute depression and tx resistant depression
50
Symbyax/fluoxetine-olanzapine AE
Dry mouth somnolence inc apetitie peripheral edema drowsiness blurred vision
51
TCA examples
Amitriptyline/Elavil Clomipramine/Anafranil Imipramine/Tofranil Desipramine/norpramin Nortriptyline/Pamelor Protriptyline/vivactil
52
How does a TCA work
Block 5ht and NE Used to tx severe depression
53
TCA AE and caution
drowsy, wt gain, hypotension, dizzy lethal in overdose with poss arrhythmia and Sz
54
1st line tx for anxiety
SSRI/SNRI THEN Anxyolitics
55
3 anxyolitics
BZO Buspirone Clonidine
56
1 short BZD and length and what better for
Triazolam/Halcion=short <12 hrs sleep/insomnia
57
3 long BZD and length
Chlordiazepoxide/Librium=long Clonazepam/klonopin=long Diazepam/valium=long >24 hours
58
4 intermediate BZD and length
Alprazolam/Xanax=intermediate Lorazepam/Ativan=intermediate Oxazepam/serax=intermediate Temazepam/Restoril=intermediate 12-24 hours
59
How does a BZD work?
Increase the inhibitory effect of GABA as an agonist
60
How does Buspirone work?
partial 5ht agonist
61
Gold standard and only true mood stabilizer
Lithium
62
Lithium manages...
Depressive and Manic phases of BP for acute and prophylaxis
63
Other rx considered mood stabilizers
Anticonvulsants: carbamazepine, Lamictal and valproic acid and some atypical antipsychotics
64
Sx of manic phase of BP
grandiosity, elevated mood, hyperactivity, irritability, pressured speech, reduced need for sleep, flight of ideas, impulsivity and agitation
65
Sx of depressive phase of BP
sadness, anhedonia, hypersomnia, weight gain, fatigue, indecisiveness, and suicidality
66
Lithium reduces the risk of suicidality in BP to
80%
67
Lithium onset
slow (6-10 days) may need to be paired with antipsychotic for faster effect
68
Lithium therapeutic index
0.6-1.2 >1.5 is toxic
69
How often check serum lithium
q2wks during mania q2mo for maintenance
70
Lithium AE early
Diarrhea commit drowsy muscular weakness lack of coordination
71
Lithium AE intermediate
Ataxia Tinnitus Blur vision polyuria
72
Lithium AE severe
Multiple organ involvement
73
Lithium CI
Renal and cardiac dz severe dehydration sodium depletion
74
Anticonvulsant rx
Valproic acid/Depakene Divalproex/Depakote Carbamazepine/Tegretol Lamotrigine/Lamictal Oxcarbazepine/Trileptal Gabapentin/Neurontin Topiramate/topamax
75
Anticonvulsant black box warning
hepatotoxicity and pancreatitis
76
Anticonvulsant AEs
Inc SI, depression Lamictal associated with SJS Lithium/Carbamazepine/Valproate may cause hypothyroid
77
6 atypical antipsychotics FDA approved for BP
Aripiprazole/abilify Clozapine/Clozaril Olanzapine/Zyprexa Quetiapine/Seroquel Risperidone/Risperdal Ziprasidone/Geodon but none have significant evidence for prophylaxis of BP and dont prevent new mania or depression episodes
78

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