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phm 701 neuro/psych/sub abuse > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Non Pharm Treatment for schizo

A

Realistic goals and time course
-social rehabilitation
-psych education
-targeted cognitive therapy
-active community treatment
-therapeutic alliance
-comprehensive care ( psych services and psych med)

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2
Q

General Approach for schizo

A

-Optimized monotherapy, combo for treatment resistant (clozapine)
-lack of evidence supporting APS polypharmacy
-2nd gen A> 1st gen A
-Substantial risk of suicide or attemp- add clozapine

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3
Q

CATIE trial

A

-equal efficiency between old and newer antipsych
-newer agents have more permanent SEs and more expensive

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4
Q

Dopamine antagonism effects

A

-Movement disorders
-Relief of psychosis
-akathisia
-increased prolactin (causes abnormal periods and gynecomastia)
-impulsivity

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5
Q

clozapine class, major se, dosing

A

-only m4 agonist; 2nd gen antipsych
-se inc hyper-salivation (add scopolamine patch), severe constipation, orthostatsis
-if dose interrupted for more than 48hrs, re-titrate fro starting dose

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6
Q

Clozapine DDI

A

Antiepileptics dec ANCs
-Lithium helps by inc ANC

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7
Q

Clozapine BBW and REMS

A

Blood dyscrasis

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8
Q

when to start clozapine

A

must trail 2 other antipsych b/f (treatment resistant)
-if severe risk of suicide can start clozapine earlier

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9
Q

Clozapine DDI

A

benzos especially lorazepam IM

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10
Q

Treatment considerations for schizo

A

-lifelong for most; rare possibility of d/c
-relapse is high
-watch out for incomplete switch/titrations
-recommend IM meds for initial rapid relief of sym
-limit time over MDD to 2-4 weeks and re-eval

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11
Q

who is considered treatment resistant in schizo, include time frame

A

lack of improvement with at least 2 APS from different classes at optimal dose for 8 weeks

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12
Q

What should you do for treatment augmentation in schizophrenia

A

-add non-APS agent with mood stabilizers
-ECT and/or ziprasidone with clozapine

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13
Q

1st gen antipsych (6)

A

ChlorprOmaziNe
Fluphenazine
halopeRidOl
perpheNazine
ThioridAzine
ThIOthixeNe
(confrontation)

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14
Q

1st gen antipsych SE (8)

A

-Extrapyramidal side effects
-OT prolongation
-Prolactin elevation (w/ longer use)
-Dermatologic
-photosensitivity
-blue gray skin
-orthostatic hypotension
-altered thermoregulation

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15
Q

Antipsych BBW

A

-dementia related psychosis inc mortality
-pt has dementia and schio is okay to use antipsych but if they experience psychosis d/c

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16
Q

2nd gen antipsych LAI approved for BP

A

Aripiprazole
Risperdone

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17
Q

2nd gen antipsych SE (8)

A

-Metabolic syndrome (inc trigycleride, glycemia and weight gain)
-QT prolongatio
-Blood dyscrasia/Neutopenias
-Seizure threshold
-Anticholingeric
-Sedation
-prolactin inc
-Ophthalmic effects

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18
Q

Only approved medication for agitation in alzheimers

A

Brexpiprazole

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19
Q

2nd gen approved for MMD (4)
All brokies owe five quarters

A

Aripiprazole
Brexpiprazole
Olanzapine w/ Fluoxetine
Quetiapine
- no LAI

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20
Q

Olanzapine
-Class, se, monitoring

A

2nd gen antipsych
-se for metabolic risk in younger men
-REMS for post inj delirium with LAI
-dress
-3 hr monitoring (rems)

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21
Q

which drug is in niosh and why

A

Ziprasidone
-2nd gen
-se : DRESS
-short acting inj requiring reconstitution, tablet

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22
Q

LAI pearls

A

-good for non-adherent patients
-should stabilize on mono therapy before initiating
-oral challenge with the same drug
-oral overlap needed b/c LAI take a while to show effect

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23
Q

which 2 first gen antipsychs are high potency and consequence

A

fluphenazine & haloperidol
*inc risk of EPS b/c target D2

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24
Q

which 2 first gen antipsychs are low potency and consequence

A

Chlorpromazine & thioridazine
*high anticholingeric risk

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25
New combination therapy for schizo & BD and its moa
Lybalvi (olanzapine & samidorphan) - treat acute and maintenance -mono or adj -samidorphan is a opioid system modulator acts on mu receptor to reduce metabolic effects of olanzapine -CI use of opioids *less weight gain
26
special populations
-elderly: start low go slow, avoid anticholingerics risk of fall; use SSRI first for depression -Preg: better to be on therapy; use SSRI
27
What 1st gen drugs are LAI (2)
Fluphenzaine & Haloperidol
28
What 2nd gen drugs are LAI (4) and indication
Aripiprazole Olanzapine Risperidone Paliperidone *water based and better tolerated - for schizo
29
Paliperidone LAI
invega hafyera has a dosing interval of 6 months
30
which 2nd gens cause weight gain (3)
Clozapine Olanzipine Quetiapine
31
2nd gen antipsych that cause EPS
Risperidone & Paliperidone
32
2nd gen antipsych that cause inc prolactin
Risperidone & Paliperidone
33
Acute Dystonias symptom, risk and treatment
-Symptom: painful prolong muscle contraction -Risk: high potency or high dose FGA, younger men -Treatment: Anticholingersics (benzotropic or diphenhydramine), IM> PO Benzo, dec dose or d/c offending agent
34
Psuedo-parkinsonism symptom, risk and treatment
-Symptom: Tremor, rigidity, etc. -Risk: high potency or high dose FGA, older age, female -Treatment: Anticholingerics, dec dose or d/c offending agent
35
Akathisia symptom, risk and treatment
-Symptom: restlessness, distress, etc -Risk: high potency FGA, aripiprazole, risperidone -Treatment: Beta blockers dec dose or d/c offending agent
36
Tardive dyskinesia symptom, risk and treatment
-Symptom: tongue thrusting, lip smacking, etc -Risk: high potency or high dose FGA, female, older age, AA -Treatment: DC offending agent, dont use anticholingeric, VMAT2i (Valbenazine & Deutetrabenazine)
37
NMS symptom, at risk, treatment
-Symptom: rapidly over 24-72 hrs, inc muscle rigidity, inc wbc/lfts/bp, normal pupils, dec or norm bowel sounds -Rare potentially lethal, seen with high potency drugs and ALL antipsychs -at risk: dehydrated, organic mental disorder -Treatment: d/c antipsychs & da agonist like bromo -re-challenge in 2 weeks
38
Serotonin syndrome
- Onset: less than 12 hours - inc muscle tone - Hypereflexia - Dilated pupils - Inc bowel sounds
39
Which drugs have CYP1A2 activity
Clozapine and Olanzapine
40
Medication class that can cause depression (7)
-CV: Beta blockers, Calcium Channel Blockers -Hormonal: oral contraceptives and steroids -Antiepileptics: Levetiracetam & Topiramate -Opioids -Stimulants
41
SSRI approved in MDD (5)
Citalopram Escitalopram Fluoxetine Paroxetine Sertraline
42
SNRI approved in MAD
Desvenlafaxine Duloxetine Levomilnacipran Venlafaxine
43
SSRI approved in GAD (2)
Escitalopram Paroxetine
44
SNRI approved in GAD (2)
Duloxetine Venlafaxine
45
SSRI approved for OCD (4)
Fluoxetine Fluvoxamine Paroxetine Sertraline
46
SSRI approved for PAD (3)
Fluoxetine Paroxetine Sertraline
47
SNRI approved for PAD
Venlafaxine
48
SSRI approved for PTSD
Paroxetine Sertaline
49
SSRI approved for SAD
Paroxetine Sertraline
50
SNRI approved for SAD
Venlafaxine
51
best 2ng gen antipsych
Lurasidone, Aripiprazole, Ziprasidone -less metabolic effects
52
Which antipsychs cause DRESS
Olanzapine & Ziprasidone
53
Asenapine class and clinical pearls
2nd gen comes in sublingual tab and transdermal patch
54
hallmark NMS symptoms
-autonomic instability -altered mental -muscle ridigity -fever
55
what drug is approved for agitation in schizo and bipolar depression
Dexmedetomidine
56
Bupropion se and caution
-caution in eating disorders and both hepatic and renal function -se hypertension, insomnia, activation and anxiety
57
Mirtazapine se
very sedating, inc cholestrol and extreme weight gain, inc LFTs
58
Esketamine se, CI, clinical pearls
-Nasal spray -Control sub; reserved for resistant patients -SE: impaired ability to drive, inc BP, cog impairment -CI: aneurysm and intracranial hemorrhage
59
Eskatamine BBW and CI
- Sedation, disassociation, abuse and misuse, suicidal thoughts and behaviors - REMS given under supervision of healthcare provider w/ 2 hr observation - CI anerysm intracerebral hemorrhage
60
Brexanolone use, dosing, ae, who to avoid
-postpartum depression -IV inf over 2.5 days -ae: hypoxia and excessive sedation not recommended in preg -Avoid in end stage renal disease
61
What med to avoid in pts with seizures and eating disorders
Bupropion
62
what med to avoid in patients w/ substance abuse
benzo
63
what med to avoid in patients with cardiac complications
TCA : amitriptyline, amoxapine, clomipramine, doxepin
64
what med to avoid in pts w/ GI bleeding and anticoag
SSRI
65
What should you use to as augmentation in Depression
- mood stabilizer: lithium, valproate - 2nd gen antipsych - triiodothyronidine
66
Nefazodone class and clinical pearl
-5HT3 modulator -BBW: Hepatic failure (child pough)
67
MAOI clinical pearls
-washout periods vary b/w 2-5 wks -usually takes 4-5 half lives -DDI w/ Tyramine foods; hypertensive crisis
68
Treatment for PTSD nightmares
Antiadrenergrics: Prazosin, Clonidine, (add trazodone for sleep)
69
Treatment for PSTD anger
Anticonvulsants: Lamotrigene
70
Treatment for PTSD psychosis/flashbacks/dissocation
Antipsych: Quetiapine, Rispersidone, Olanzapine
71
FDA approved anticonvulsants and when are they used
Valproate - acute mania & mixed episodes; mood stabilizer Lamotrigene - maintenance (slowly titrate to avoid SJS) Carbamazepine - acute mania & mixed episodes
72
What two agents can be used in all 3 stages of bipolar depression (acute mania, maintenance, acute depression)
Olanzapine and quetiapine
73
2nd gen antipsychotics that can not be used in BP Can’t use In BiPolar
Clozapine, iloperidone, Brexpiprazole, Paliperidone, pimavanserin.
74
Which 2nd gen drugs can cause akathisia
Aripiprazole and risperidone
75
Valproate se & formulations
- se: weight gain & alopecia - er formulation less bioavailability
76
Valproate BBW
Hepatic toxicity (childs pough), teratogenic , pancreatitis
77
What are beta blockers indicated in and how to take it
- used in SAD - helps with autonomic symptoms but not curative - take 1 hr prior to event.
78
Which benzo is not metabolized heptically (no cyp metabolism)
Over the liver - oxazepam, temazepam, lorazepam
79
Which SSRI can be used in patients with bulimia
Fluoxetine
80
High risk of nms
High potency antipsychotics ( haloperidol & fluohenazine) But all antipsychotics can lead to it
81
TCA Side effects
- anticholingeric, delirium, lethal overdose, suicide attempts
82
lithium toxicity and DDI that might worsen it (affects renal)
greater or equal to 1.5 is toxic, monitor ANC, can cause Blood dyscrasis *renal metabolism - ACEs, ARBs, Loops, CCB (Dilitiazem, Amlodipine, Nifedipine), ECT (neuro complications)
83
Lithium ADE
Hypothyroidism
84
What is SIADH and what drugs can cause this
SIADH (syndrome of inappropriate secretion of antidiuretic hormone) can lead to water retention that leads to HYPONATREMIA na <135 - Carbamazepine (and metabolite), SSRI, SNRI
85
LAI FDA approved for Bipolar
Aripiprazole Risperidone
86
What meds are teratogenic
- Valproate - Paroxetine - Carbamazepine - Lithium - Lamotrigine - Divalproex
87
Buspirone indication
- GAD on a scheduled basis
88
Venlafaxine class and indication
SNRI - MDD, GAD, PAD, SAD
89
Fluvoxamine class and indication
SSRI OCD
90
Fluoxetine class and indication
- SNRI - MDD, OCD, PAD, PMDD, Bulimia
91
Which antipsychotics are sedating
Low potency FGA Clozapine Quetiapine
92
When to dose adjust for SSRI
Hepatic dysfunction (childs pough)
93
Citalopram dosing adj in MDD
hepatic dysfunction, 60yrs and older, poor cyp2c19 metabolizer
94
escitalopram dosing adj in MDD
Hepatic dysfunction; 10 mg
95
floxetine dosing
once weekly doing due to long half life, comes in liquid
96
What drug class should be avoided in Bipolar Depression and why
SNRI and TCA cause manic episodes
97
What meds can be used in Acute Depression as monotherapy (Our queen loves little cakes)
Olanzapine, Quetiapine, Lumateperone, Lurasidone, Cariprazine
98
When to use Benzos
GAD and PAD after they fail SSRI
99
Dec lipophilic Benzos and its effect
Lorazepam (best tolerated), Oxazepam -slower absorption, longer duration
100
Inc Lipophilic Benzos and its effect
Dizepam, Clorazepam -faster absorption, shorter duration, more misuse, cross BBB
101
HAMD
inc score= inc severity depression
102
MADRS
tells treatment response depression
103
Duloxetine indications
MDD, GAD, pain
104
Doxepin indications
TCA - Depression and Insomnia
105
High potency benzos and indication
- Alprazalam, clonzapem, lorazepam - Rapid relief in panic disorder
106
Which two 2nd gen antipsychs are most sedating
Quetiapine & Clozapem
107
Which two 1st gen antipsych are most sedating
Low potency; Chlorpromazine & Thioridazine
108
Which antipsych is most activating
Aripiprazole
109
In which anxiety disorder is CBT most often used and what is always CI w/ that treatment
- PTSD - Benzos can interfere w/ CBT
110
Which 1st gen antipsychotic can be used for a cute psychosis
Chlorpromazine

phm 701 neuro/psych/sub abuse (3 decks)

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