Chapter 15: psych Flashcards Preview

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Flashcards in Chapter 15: psych Deck (100):
1

 

 

which receptors are blocked by antipsychotics

 

 

cholinergic

muscarinic

histamine

dopamine

2

 

 

antipsychotic action

 

 

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

3

 

 

EPS is the result of

 

 

dopamine blocking in other parts of the body

4

 

 

EPS

 

 

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

5

 

 

symptoms of EPS

 

dystonia usually occurs within first 5-30 days

tardive dyskkinesia after 6 months (can be reversible)

rhythmic tongue protrusion, puffing cheeks, puckering of mouth

6

 

 

neuroleptic malignant syndrome (NMS)

 

 

life-threatening

starts months after therapy begins but rapidly progresses

7

 

 

treatment of NS

 

 

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

8

 

 

how should antipsychotic therapy be discontinued

 

 

slowly reduce dose over 2-3 weeks

9

 

 

first generation antipsychotics (typical)

 

 

phenothiazines

10

 

 

examples of phenothiazines

 

 

haloperidol (Haldol)

trifluoperazine (Stelazine)

chlorpromazine (Thorazine)

11

 

 

second generation antipsychotics (atypicals)

 

 

aripiprazole (Abilify)

risperidone (Risperdal)

Olanzapine (Zyprexa)

12

 

 

largest group of psychotropic agents

 

 

phenothiazines

13

 

 

phenothiazine mechanism of action

 

unknown

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

14

 

 

effects of long term phenothiazine usage

 

cardiac arrythmia

hyperlexia (life-threatening)

HTN

rigidity

tardive dyskinesia

15

 

 

clinical uses of phenothiazines

 

 

acute, idiopathic psychotic illness marked by agitation

manic phase of bipolar disorder

schizophrenia

16

 

 

phenothiazines interactions

 

  • 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)

17

 

 

phenothiazines contraindications

 

parkinsonism

blood dyscrasia

severe liver impairment, cardiac disease, or CNS depression

Reye's syndrome

18

 

 

overdose of phenothiazines

 

 

fairly common but not fatal

symptoms: worsening CNS depression, hypotension, worsening of EPS

19

 

 

why are atypical antipsychotics considered atypical

 

 

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

20

 

 

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

 

 

clozapine (Clozaril)

21

 

 

black box warning for all antipsychotics

 

 

may increase mortality in elderly with dementia-related psychosis

22

 

 

Clozaril places at increased risk for

 

 

agranulocytosis, aeizures, and myocarditis

23

 

 

clinical uses for atypical antipsychotics

 

 

psychosis in patients with schizophrenia

depression or mania with psychotic features

bipolar disorder

severe agitation and delusions in dementia patients

24

 

 

when are antipsychotic medications used

 

 

 

 

psychotic episodes when tranquilizing effect is needed

Tourette's (pimozide)

25

 

 

examples of atypical antipsychotics

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

26

 

 

atypical antipsychotic interactions

 

 

any drug requiring liver metabolism (including alcohol)

27

 

 

atypical antipsychotic contraindications

 

 

liver impairment

28

 

 

drug classes used for depression

 

MAOIs (Monoamine oxidase inhibitors)

 TCAs (tricyclic antidepressants)

SSRIs (selective serotonin reuptake inhibitors)

non-TCA Antidepressants

29

 

 

examples of third line MAOIs

 

tranylcypromine (parnate)

selegiline (Emsam)

phenylamine (Nardil)

RARELY USED ANYMORE

30

 

 

MAOI mechanism of action

 

 

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

depression relief immediately or within 1 week

 

31

 

 

HTN crisis with MAOIs can be precipitated by

 

foods rich in tyramine (alcohol, aged cheese)

sympathomimetic drugs (cough meds containing ephedrin)

tricyclic antidepressants

32

 

 

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

 

 

St. John's wort

33

 

 

MAOI contraindication

 

 

liver impairment

34

 

 

wash out period when witching from MAOI to SSRI

 

 

2 weeks

35

 

 

foods high in tyramine

 

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

36

 

 

second line tricyclic antidepressants (TCAs)

mechanism of action

 

 

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

37

 

 

how long to clinical effect of TCAs

 

 

2-8 weeks

38

 

 

clinical uses of TCAs

 

 

endogenous depression

reactive depression

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

39

 

 

examples of TCAs

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

40

 

 

TCA interactions

 

 

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

41

 

 

TCA contraindications

 

 

MAOI use

recovery phase of MI

doxepine is contraindicated with glaucoma or urinary retention

42

 

 

TCAs are most effective in which population

 

 

severe depression, especially with greater disturbances and melancholia

43

 

 

advantages of SSRI

 

 

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

44

 

 

SSRI mechanism of action

 

 

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

45

 

 

SSRI effect on norepinephrine and dopamine reuptake

 

 

little to no effect

46

 

 

clinical uses of SSRIs

 

 

major depression

depression in patients with comorbidities

panic disorder

47

 

 

examples of SSRIs

 

citalopram (Celexa)

fluoxetine (Prozac)

fluvoxamine (Luvox)

paroxetine (Paxil)

sertraline (Zoloft)

escitaloprma (Lexapro

48

 

 

how long does it take SSRIs to relieve depression

 

 

up to 6 weeks

49

 

 

Luvox (SSRI) is used only for

 

 

OCD

(produces no anticholinergic effects)

50

 

 

which SSRIs should be taken in the morning and why

 

 

Prozac, Paxil, Zoloft because they can induce insomnia

51

 

 

SSRIs and NSAIDs

 

 

concurrent use can increase GI bleeding risk

52

 

 

SSRI interactions

 

buspirone

diazepam

lithium

MAOIs

neuroleptics

tricyclics

53

 

 

SSRI contraindications

 

 

MAOI use within 14 days

pregnancy and lactation

54

 

 

Prozac dosage with liver problems

 

 

 

 

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

55

 

 

Prozac elevates the levels of which drugs

 

 

antiarrhythmics, other antidepressants, phenothiazine, risperidone, theophylline

56

 

 

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

 

 

Prozac because it one of the more stimulating SSRIs

57

 

 

most sedating SSRI

 

 

Paxil

58

 

 

depressed patient that presents with anxiety, agitation and severe insomnia

 

 

Paxil

59

 

 

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

 

 

Paxil

60

 

 

symptom of abrupt d/c of Paxil

 

 

flu-like syndrome

61

 

 

middle of the road SSRI

 

 

Zoloft

62

 

 

newer SSRI that is highly bound to plasma protein

 

 

Celexa

63

 

 

SSRi with the most favorable drug-drug interaction profile

 

 

Celexa because it has the least effect on the CYP450 system

64

 

 

when did non-TCA antidepressants enter the market

 

 

1990's

65

 

 

classes of non-TCAs

 

 

SNRI (serotonin and norepinephrine reuptake inhibitors)

NDRIs (norepinephrine and dopamine reuptake inhibitors)

SRIs (serotonin reuptake inhibitors)

TeCa (tetracycline antidepressant)

66

 

 

examples of SNRIs

 

 

Ymbalta

Pristiq

Effexor

67

 

 

aside from depression, SNRIs are approved to treat

 

 

anxiety

panic disorder

OCD

bulimia

68

 

 

common off label uses for SNRIs

 

 

insomnia

chronic pain (diabetic neuropathy)

69

 

 

SNRI contraindications

 

 

MAOI use within 14 days

70

 

 

example of NDRIs

 

 

bupropion (Wellbutrin)

71

 

 

wellbutrin adverse reactions

 

  • 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

 

 

wellbutrin interactions

 

 

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

73

 

 

wellbutrin contraindications

 

 

history of seizure, anorexia, bulimia

MAOI use within 14 days

74

 

 

example of SRI

 

 

trazadone (Desyrel)

75

 

 

clinical uses of trazadone

 

 

depression with insomnia, anxiety, and chronic pain

 

76

 

 

off label uses of trazadone

 

 

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

77

 

 

trazadone interactions

 

 

digoxin and coumadin

(take in divided doses)

78

 

 

trazadone contraindications

 

 

hypersensitivity

79

 

 

example of tetracyclic antidepressant (TeCA)

 

 

mirtazipine (Remeron)

80

 

 

clinical uses of remeron

 

 

depression

PTSD

81

 

 

remeron interactions

 

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

82

 

 

remeron contraindications

 

 

hypersensitivity

83

 

 

agents used to treat bipolar mania

 

 

lithium

valproates

carbamazepine

84

 

 

itium mechanism of action

 

 

unknown

85

 

 

clinical uses of lithium

 

 

bipolar disorder

with other antidepressants for major depression

with antipsychotics for schizophrenia

86

 

 

what are lithium side effects related to

 

 

serum level

87

 

 

signs of lithium toxicity and serum levels at which they occur

 

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

 

 

lithium contraindications

 

significant renal impairment

significant cardiovascular disease

significant thyroid disease

diabetes

severe dehydration

sodium depletion

pregnancy

89

 

 

how often should lithium levels be drawn

 

 

biweekly until stable and then every 2-3 months

90

 

 

what can happen with abrupt withdrawal of depakote

 

 

status epilepticus

91

 

 

valproaes mechanism of action and uses

 

 

mechanism of action is unknown

acts as an anticonvulsant, anti-manic, and antimigraine

92

 

 

Benzo pharmacokinetics

 

 

page 288

93

 

 

benzo interactions

 

 

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

94

 

 

benzo contraindications

 

 

comotose

uncontrolled severe pain

severe hypotension

angle-closure glaucoma

sleep apnea

95

 

 

specific contraindications for Halcion and Xanax

 

taking ketoconazole and itraconazole

96

 

 

schedule of benzodiazepines

 

 

IV

97

 

 

Meprobamate (Equanil, Miltown)

 

 

schedule IV drug that is a carbamate derivative

use today is almost non-existant

98

 

 

meprobamate

mechanism of action 

 

 

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

99

 

 

clinical use of meprobamate

 

 

relieve pain of muscle spasms and rigidity

100

 

 

implications for special populations

 

 

pages 289-290