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Adv Pharm Faculty Page (Smoller/Bose) > Psych > Flashcards

Psych Flashcards

1
Q

Monoamine oxidase inhibitors (MAOIs) examples/concerns

A

Phenelzine (Nardil, tranylcypromine (Parnate), selegiline (Emsam), isocarboxazid (Marplan)

Very rarely used

Many potentially lethal drug interactions

Must avoid foods with tyramine

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2
Q

SSRI MOA

A

prevent the reuptake of serotonin into presynaptic nerve terminals.

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3
Q

SNRI MOA

A

prevent the reuptake of serotonin and norepinephrine into presynaptic nerve terminals.

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4
Q

dopamine deficiency results in

A

Anhedonia, lack of ability to love/feel attachment to others, lack of remorse about actions, distractability

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5
Q

Common SSRIs

A

Citalopram; Escitalopram; Sertraline; Fluoxetine; Paroxetine; Fluvoxamine

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6
Q

which ssri side effects are most common at initiation and often improve

A

šNausea

šLightheadedness

šHeadache

šSedation/sleep disruptions

šIncreased sweating

šAgitation

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7
Q

SSRI GI effects are

A

Impaired attention, problems concentrating, deficiencies in working memory, slowness of information processing, depressed mood, psychomotor retardation, fatigue

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8
Q

Serotonin deficiency results in

A

Depressed mood, anxiety, panic, phobia, obsessions and compulsions, food cravings

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9
Q

sexual side effects are common with which classes of antidepressants

A

SSRIs, SNRIs, TCAs (NNSRIs)

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10
Q

How long for SSRI to start working?

A

4 to 6 weeks

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11
Q

SSRI benefits

A

cheap and low toxicity

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12
Q

Common SNRIs

A

venlafaxine, duloxetine, desvenlafaxine

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13
Q

SNRI and SSRI not all

A

not all are created equally. Depending on the brand it may have a greater affinity for one neurotransmitter over another. As an example sertraline as a greater effect for dopamine then others. It can also be impacted by dose. An example of this would be effexor that has a greater impact on serotonin at lower doses and will not have an impact on norepi until you reach higher dosese

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14
Q

SNRI uses

A

anxiety, depression, panic, neuropathic pain, phobias, PTSD

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15
Q

SNRI side effects

A

HTN, headache, GI, insomnia, sexual side effects,

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16
Q

NDRI example

A

bupropion (wellbutrin, Zyban)

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17
Q

NDRI MOA

A

šblocks reuptake of dopamine and norepinephrine at the presynaptic cell

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18
Q

Bupropion side effects

A

sleep disturbance, appetite suppression, lowers seizure , jitteriness, irritability, headache, dry mouth

minimal sexual side effects

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19
Q

indications for NDRIs

A

Depression, SAD, smoking cessation

Can exacerbate anxiety

Off label: ADHD, chronic fatigue, medication induced sexual dysfunction

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20
Q

Mirtazpaine MOA, pro/cons

A

šEffects both serotonin and norepinepherine along with alpha 2 blockade

šCause significant weight gain and sedation – good for patients with depression and poor appetite and/or sleep disturbance

šLess nausea or sexual side effects

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21
Q

Trazadone MOA, risks/benefits

A

šSerotonin modulator (SSRI subclass), also blocks H1 and alpha adrenergic receptors

šDoses required for antidepressant effect (>300mg daily) are too sedating, much more often used for sleep (50-150mg qhs)

šHeadache, dizziness, hypotension common side effects

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22
Q

Bupropion cautions/contraindications

A

use with caution in people who use ETOH as it lowers seizure threshold

avoid in anyone who has ever had a seizure

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23
Q

symptoms of serotonin syndrome

A

šnausea, diarrhea, chills, sweating, htn, tremor, agitation, disorientation, seizures

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24
Q

drugs that can cause depression

A

šBeta blockers

šCorticosteroids (mania and euphoria common with short term use)

šFluoroquinolones

šInterferon

šAnticonvulsants (CNS depression)

šOpioids

šHormonal BC

šPPI (inhibits absorption of B-12)

šAnti-depressants (increased suicidal ideation)

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25
Q

NNSRI (TCA) indications

A
  • Depression, Obsessive compulsive disorder, Chronic pain, Enuresis (imipramine)
  • Off label: Panic disorder, Bulimia, Phantom leg pain, Premenstrual symptoms, Migraine prophylaxis
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26
Q

Tricyclic MOA

A
  • Blocks reuptake of serotonin and/or NE at presynaptic terminals
    • tertiary amines- inhibits serotonin and NE reuptake
    • secondary amines- inhibit NE reuptake
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27
Q

What are side effects of tricyclics?

A
  • Anticholinergics
    • dry mouth, tachycardia, urinary retention, ileus, slow gastric emptying
  • cardiovascular
    • orthostatic hypotension, modest increase in heart rate, depresses conduction through the atria & ventricles
  • Central nervous system
    • lower sz threshold, weakness, fatigue
  • **these effects can be fatal with overdose
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28
Q

Common TCAs

A

Amitriptyline

Imipramine

Desipramine

Nortriptyline

29
Q

How long for TCAs to take effect?

A

2-4 weeks

30
Q

Stimulant MOA

A

block reuptake of NE and DA

31
Q

Stimulants Indications

A

ADD/ADHD Narcolepsy Fatigue, depression (palliative care setting)

32
Q

Stimulant Adverse effects

A

Anorexia, weight loss, appetite suppression Sleep disturbance Jitteriness Emotional lability Increased pulse and BP

33
Q

Stimulant contraindications

A

diabetes, hyperthyroidism, hypertension, issues with aggression, bipolar disorder, psychosis

34
Q

Non-stimulant alternative for ADHD

A

atomoxetine (Strattera) Selective norepinepherine reuptake inhibitor Not a controlled substance

35
Q

Commonly used stimulants

A

Methylphenidate (Ritalin, Concerta) Dexmethylphenidate (Focalin) Amphetamines Dextroamphetamine (Dexedrine) Dextroamphetamine-amphetamine (Adderall) Lisdexamfetamine (Vyvanse)

36
Q

lithium excretion

A

not metabolized by the liver, excreted into the urine unchanged - therefore kidney function is critical when prescribing.

37
Q

Lab monitoring - lithium

A

baseline renal function, TSH, electrolytes - especially sodium, CBC, ECG at baseline and yearly, lithium levels every 3-6 months once stable

38
Q

signs/symptoms lithium toxicity

A

tremor, N/V/D, polydipsia/polyuria, confusion, muscle weakness, ataxia

39
Q

Lithium indications

A

bipolar disorder (mania)

40
Q

Things that effect lithium level

A

dehydration, excessive sweating, illness, AKI. Anything that effects fluid and electrolyte imbalance.

41
Q

Lithium adverse effects

A

fine tremor, dry mouth, nausea, headache, drowsiness

42
Q

Benzodiazepines MOA

A

enhancing the effect of GABA

43
Q

Benzodiazapines ADR

A

withdrawal, dizziness, fall risk in elderly, cognitive effects long term

44
Q

Common Benzodiazepine Uses

A

Insomnia Induce relaxation and loss of memory of medical procedures or surgery Reduce anxiety (anxiolytic) Panic disorders Treat or prevent seizures Alcohol withdrawal treatment Muscle relaxant

45
Q

Benzo black box warning

A

2016 - avoid use with opioids

46
Q

Non-benzodiazepine hypnotic examples

A

(zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta) controlled substances - can cause withdrawal if stopped abruptly

47
Q

ramelteon (Rozerem) MOA

A

melatonin receptor agonist not a controlled substance

48
Q

Benzo with highest addiction potential and why?

A

Alprazolam - shortest half life (6-12 hours)

49
Q

Non-benzodiazepine hypnotic side effects

A

headache, dizziness, somnolence, nausea, mild transient anterograde amnesia abnormal behaviors such as sleep driving, worsening depression

50
Q

Zolpidem dosing for women/older adults vs men

A

Women/older adults max 5mg, men 10mg

51
Q

Nonbenzodiazepine hypnotics patient education

A

take immediately before bed time Get at least 6 hours of sleep Use caution/avoid driving, heavy machinery Do not combine with other sleep aides, alcohol

52
Q

4 dopamine pathways

A

Mesocortical Mesolimbic Tuberoinfundibular Nigrostriatal

53
Q

Mesocortical SE

A

underactive D1 stimulation = responsible for negative symptoms

54
Q

Mesolimbic SE

A

overactive D2 stimulation = responsible for positive symptoms

55
Q

Tuberoinfundibular SE

A

increase polactin galactorrhea amenorrhea

56
Q

nigrostriatal SE

A

controls motor function and movement Too much dopamine = tics, dyskinesias Not enough dopamine = dystonia, Parkinsonian symptoms

57
Q

Typical Antipsychotics Examples

A

Chlorpromazine Acetaphenazine Fluphenazine Haloperidol Trifluoperazine Triflupromazine

58
Q

Typical antipsychotics MOA

A

Blockade of Dopamine (D2) receptors causing: Reduced positive symptoms (mesolimbic pathway) Less effective treating negative symptoms (mesocortical pathway)

59
Q

Atypical antipsychotics examples

A

Aripiprazole (Abilify) Clozapine (Clozaril) Risperidone (RIsperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon)

60
Q

Atypical antipsychotics MOA

A

Effect on multiple dopamine pathways as well as serotonin pathways reducing negative and positive symptoms

61
Q

Black box warning antipsychotics

A

Increased Mortality in Elderly Patients With Dementia-Related Psychosis Suicidal behavior when combined with antidepressants

62
Q

Atypical Antipsychotics risk/benefit

A

Decreased risk for EPS and tardive dyskinesia than typicals Higher incidence of metabolic syndrome (weight gain, hypertriglyceridemia, altered glucose metabolism, hypercholesteremia)

63
Q

Drugs for Alzheimer’s Disease

A

Cholinesterase inhibitors Other drugs used – Namenda – decreases glutamate levels – Adjunctive and symptom management also done with: SSRI, Atypical Antipsychotics, Anxiolytics

64
Q

Cholinesterase inhibitors

A

indirect-acting parasympathomimetic Alzheimers patients usually have a defeciency in aCh so these are used

65
Q

Other drugs used for Alzheimers

A

Namenda – decreases glutamate levels – Adjunctive and symptom management also done with: SSRI, Atypical Antipsychotics, Anxiolytics

66
Q

Positive symptoms of psychosis

A

, delusions, disorganized thinking, agitation

67
Q

Negative symptoms of psychosis

A

anhedonia, social withdrawal, apathy, depression

68
Q

Typical antipsychotics adverse effects

A

Too much D2 blockade leads to EPS (nigrostriatal pathway) motor abnormalities (parkinsonism), tardive dyskinesia or hyperkinetic movement disorder, sedation, anticholinergic effects Hyperprolactinemia (Tuberoinfundibular pathway)

Adv Pharm Faculty Page (Smoller/Bose) (32 decks)

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