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Exam 4 spring P2 Flashcards

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1
Q

1st generation antipsychotics

A

-movement problems: EPS and tardive dyskinesia
- very effective for treating positive symptoms ( worse negative/ cognitive symptoms)

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2
Q

chlorpromazine (thorazine)

A

-antihistamine effects
- 1st antipsychotic

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3
Q

promethazine (phenergan)

A

-antihistamine effects
-antiemetic

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4
Q

fluepenazine (oermitil,proxilin)

A

-eps

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4
Q

thoridazine (mellaril)

A

-anticholingeric AEs
-sedation
-sexual dysfunction
- cv risk

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5
Q

prochlorperazine (compazine)

A

-antiemetic

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6
Q

perpehnazine (trilafon)

A

-CATIE studies-> combo with anticholinergics

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7
Q

thiothixene (navane)

A

-modest EPS

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8
Q

Haloperidol (haldol)

A

-EPS
-most commonly used routine and PRN
-most common standing order

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9
Q

haloperidol decanoate

A

IM injection
-z-track technique

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10
Q

Milindone (Moban)

A

-moderate EPS

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11
Q

Pimozide (orap)

A

-used in tourettes to supress tics

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12
Q

2nd gen antipsychotics

A
  • reduced EPS but more metabolic side effects
  • D2 (postsynaptic) and 5HT2A (presynaptic) antagonism -> increased synthesis and release of DA
    -13
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13
Q

clozapine (clozaril)

A

-weight gain, sedation, dry mouth, constipation, hypersalvation, GI hypomobility
- 1st atypical antipsychotic (very effective)
-agranulocytosis-> weekly blood monitoring
-third line
- risk of diabetes
- 1A2 substrate
- warning: neutropenia, orthostasis, bradycardia, syncope, seizures, myocarditit, cardiomyipathy
-QTc prolongation
-REMS: weekly, biweekly then every 4 weeks

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14
Q

Olanzapine (zyprexa)

A

-significant weight gain
-sedation
-risk of diabetes
-1A2 substrate
-high risk metabolic syndrome
-DRESS warning

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15
Q

Olanzapine/ samidorphan (lybalvi)

A

combo mitigates metabolic syndrome

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16
Q

zyprexa relpravv

A

-IM injection
-REMS program
-post dose delirium sedation syndrome -> Over dose (CNS depressant)
-can happen 24h later

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17
Q

loxapine (loxitane)

A

-older agent
-NET Inhibitor

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18
Q

adasuve (loxapine)

A

nasal spray for inhalation
-not commonly used

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19
Q

Quetiapine (seroquel)

A

-hypotension (alpha)
-sedation (H1)
-weight gain
-metabolite with antidepressant activity
-decent antipsychotic
-risk of diabetes
-3A4 substrate
-boxed warning -> suicidal ideation

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20
Q

risperidal consta

A

IM weekly
-must supplement with oral risperidone for first 4 weeks of treatment

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21
Q

perseris (risperidone)

A

q4w subQ injection
-abdominal
-3A4 inducer - 120mg dose
-may need oral supplementation

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22
Q

rykindo (risperidone)

A

q2w IM injection
-oral dose overlap is shorter than costa (7 days vs 21-28 days)

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23
Q

Uzedy (risperidone)

A

-abdominal or upper arm SubQ injection
-monthly or every other month

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24
Risperidone (risperidol)
-low eps -weight gain -sedation -hyperprolactinemia -orthostasis - designed to be both 5HT2A and D2 receptor antagonist A24 -2D6 substrate
25
paliperidone (invega)
-eps -weight gain - sedation - hyperprolactinemia -orthostasis -renally eliminated (dose adjustment) -QTc prolongation
26
invega sustenna (paliperidone)
-IM injection -loading dose and booster w/in 7 days then every 4 weeks -initial loading and booster given in deltoid -no need for oral overlap -may require dose adjustment -> renally eliminated
27
invega trinza (paliperidone)
-q3 months - deltoid injection -may be given to patient after 4 months of sustenna -recommended for deltoid -renal considerations
28
invega hafyra (paliperidone)
q6m gluteal IM injection -may be initiated after sustenna 4 months or 1 dose of trinza -gluteal only
29
IIoperidone (fanapt)
-structurally related to risperidone -very potent at alpha 1 receptors -high risk for orthostasis and syncope -QTc prolongation -2D6 substrate
30
aloperidone
sucks
31
ziprasidone (Geodon/ Zeldox)
- QT prolongation -5HT2A, D2, alpha 1 affinity -QTc prolongation -DRESS warning - take with food -3A4 substrate
32
asenapine (saphris)
-antihistamine -dopaminergic -alpha antimuscarinic AE -5HT2A -D2 antagonist -Sublingual ONLY -and patch formulations -1A2 substrate -QTc prolongation
33
asenapine transdermal patch
apply every 24h -reduce dose if given with strong 1A2 inhibitors-> fluvoxamine
34
lurasidone (latuda)
-less weight gain and metabolic effects -fast onset -low doses effectiveness similar to high dose -rapid titration -3A4 substrate -higher risk for akathisia -warning for suicide -take with food
35
pimavanserin (nuplazid)
-inverse 5HT2A agonist -used for PD psychosis -3A4 substrate
36
D2/D3 receptor partial agonist
-stabilize DA transmission - associated with more akathisia -adjunct in depression -warning for suicide
37
brexpiprazole (rexulti)
-moderate akathesis -low moderate weight gain -2D6 and 3A4 substrate
38
cariprazine (vraylar)
-akathesia -low moderate weight gain -3A4 substrate
39
lumateperone (caplyta)
-low risk for weight gain -metabolic side effects -EPS -akathesia -3A4 susbtrate -once daily
40
aripiprazole (abilify)
-weight gain -low risk for D2 effets -moderate akathesia -high affinity to 5HT2 and D2 -partial agonist at 5HT1A receptors (depression) -prodrugs -2D6 and 3A4 substrate -> interactes with fluoxetine
41
abilify maintena
-IM deltoid or gluteal q4w -must overlap with oral aripiprazole for at least 14 days
42
abilify asimtufii
- gluteal IM q2m -continue oral aripiprazole for 2 weeks after 1st injection
43
aristada
-prodrug of aripiprazole - overlap with oral aripiprazole for 1st 3 weeks
44
aristada initio
-avoids 21 day overlap of antipsychotic -avoid in pts who are poor 2D6 metabolizers -avoid with strong 3A4 or 2D6 inhibitors
45
VMAT inhibitors
-inhibit VMAT to decrease storage/ increase release DA serotonin and NE -treat TD -dose adjustment for 2D6 inhibitors or 3A4 inducers
46
valbenazine (ingrezza)
-QTc prolongation -weight gain - rash -anxiety 2D6 and 3A4 substrate
47
Deutetrabenazine (austedo)
-QTc prolongation -anxiety -2D6 substrate
48
Antipsychotics
increased risk of death in elderly pts with dementia with related behaviors -fall risk assessment
49
2D6
fluoxetine, paroxetine are inhibitors
50
1A2
cigarette smoke decreases antipsychotic serum concentrations -FLUVOZAMINE is a 1A2 inhibitor
51
3A4
inhibitors- conazole, mycin, grapefruit inducers- phenobarbital, phenytoin, st. johns wort CARBAMAZEPINE is inducer
52
Buspirone (buspar)
- 5HT1A receptor agonist -partial agonist on brain 5HT1A receptors -moderate affinity for D2 receptors -1st line-> GAD -not good for panic disorder -AEs: sedation, paradoxical effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -target dose of 10-15mg TID -3-4 weeks for efficacy
53
alprazolam (xanax)
-BZD -works on GABA to increase opening frequency -2nd line if necessart -short term use after sertonergic trial -BRIDGE therapy -approved for panic disorder -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -no active metabolites -D/C requires taper
54
lorazepam (ativan)
-BZD -increase GABA opening frequency -2nd line if necessary -preferred in elderly -bridge therapy -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment
55
clonazepam (klonopin)
-BZD -increase GABA opening frequency -2nd line -bridge therapy -approved for panic -AEs: sedation, paradoxial effects, swalloing difficulties, impairment of memory/recall, psychomotor impairment
56
diazepam (valium)
-BZD -increase GABA opening frequency -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -2nd line -bridge therapy -LONG ACTING metabolite-> accumulation
57
oxazepam (serax)
-BZD -increase GABA opening frequency -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -2nd line -bridge therapy -preferred in elderly -no active metabolite
58
temazepam (restoril)
-BZD -increase GABA opening frequency -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -2nd line -bridge therapy -short term hypnotic -preferred in elderly -no active metabolite
59
midazolam (rversed)
-BZD -increase GABA opening frequency -AEs: sedation, paradoxial effects, swallowing difficulties, impairment of memory/recall, psychomotor impairment -rapid anesthesia
60
hydroxyzine
-5HT2A antagonist -histamine (H1) receptor antagonist -GAD -prn anxiety or insomnia -avoid in elderly -AEs: sedation, anticholinergic, QTc prolongation, fall risk
61
Propranolol (inderal)
-beta blocker -low dose for anxiety -acute physiological symptoms of anxiety -preformance and situational anxiety -AEs: hallucination, vivid dreams, lethargy, impotence, CV effects -evaluate CV conditions -may require test dose
62
Gabapentin/ pregabalin
-occasionally prescribed for GAD -good for those with bipolar disorder with anxiety symptoms or neuropathic pain
63
quetiapine
-not endorsed -theorized to have anxiolytic properties at low doses -used for anxiety and sleep
64
paroxetine/escitalopram
-SSRI -1st line for all anxiety disorders -jitteriness syndrome-> start at low doses -AEs: insomnia, n/v, drowsiness -25-50% reduction in OCD symptoms -onset of action is 2-4 weeks
65
duloxetine/ venlafaxine
-SNRI -useful 1st line in GAD if pt also has pain syndrome -venlafaxine applicable for social and panic -jitteriness syndrome-> start low -onset of action ~2-4 weeks
66
aripiprazole/ risperidone
-atypical antipsychotics (serotonergic and dopaminergic blockade) -NOT FDA approved for anxiety -clinical evidence suggest efficac for tx resistant OCD (in addition to SSRI) -AEs: weight gain, low EPS risk, akathasia, jitteriness, constipation -do not drink on this medication -> enhance CNS depression
67
clomipramine
-TCA - 2nd line for OCD
68
azosin
- used for sleep nightmares associated with PTSD
69
clonidine (catapres)
-alpha 2 agonist -panic attacks, anxiety associated with withdrawl
70
fluoxetine (prozac)
-SSRI -jitteriness syndrome -> start low -AEs: insomnia, appetite supression, ED, n/v, drowsiness
71
setraline (zoloft)
-SSRI -PTSD -AEs: dizziness, trouble sleeping
72
Romazicon
-tx BZD overdose (and z-hypnotics) -AEs: agitation, confusion, nausea, vomiting, HA
73
BZDs
NOT USED IN PTSD
74
Zalepon (sonata)
-z-hypnotic -interacts with alpha 1 subunit of GABA-A receptor -sleep onset -SHORT TERM -AEs: somnolence, dizziness, ataxia, HA, parasomnia, n/v -rapid action and elimination -little tolerance or dependence -3A4 metabolite -flumazenil for OD
75
Eszopiclone (lunesta)
-z-hypnotic -interacts with alpha 1 subunit of GABA-A receptor -sleep onset and maintenance -LONG TERM -AEs: hangover, metallic taste, somnolence, dizziness, ataxia, HA, parasomnia, n/v -active enantiomer of zopiclone -only Z-hypnotic approved for long term use -3A4 metabolite -flumazenil for OD
76
zolpidem (ambien)
-z-hypnotic -interacts with alpha 1 subunit of GABA-A receptor -sleep onset and maintenance -SHORT TERM -AEs: somnolence, dizziness, ataxia, HA, parasomnia, n/v -intital dose in women and elderly is lower (5mg) -ambien CR for sleep maintenance -3A4 metabolite -flumazenil for OD
77
temazepam
-BZD -sleep onset and maintenance -Benzo drug of choice for sleep -AEs: drowsiness, dizziness, cognitive impairment, increased fall risk
78
Triazolam
-BZD -sleep onset
79
barbiturate moa
bind GABA-A -increase DURATION of channel opening
80
phenobarbital (luminal)
-barbituate -anticonvulsant - dependence, tolerance, abuse, withdrawl, after effect, respiratory and CNS depression at high doses - Higher risk of CNS/ respiratory depression
81
pentobarbital (nembutal)
-barbituate -sedative/hypnotic -not commonly used -dependence, tolerance, abuse, withdrawl, after effect, respiratory depression and CNS depression at high doses -HIGHER risk of CNS/respiratory depression
82
melatonin agonist
-high affinity for MT1 and 2 receptors -sleep onset -ramelteon -tasimelteon
83
Ramelton (rozerem)
-melatonin agonist -sleep onset -AEs: GI upset, next day somnolence, hyperprolactinemia, prolactinoma -1A2 substrate -contraindiacets w/ fluvoxamine -NO abuse, withdrawl/dependency
83
Tasimelton (hetlioz)
-melatonin agonist -sleep onset -FDA approved for non-24 sleep wake disorder in adults -orphan product
83
orexant receptor antagonist
-high affinity for OX1 and 2 receptors in the hypothalamus -decrease arousal and attention -reduce rewarding stimuli (DA release) that modulate mesolimbic projection between VTA and nucleus accumbens -Sleep maintenance -narcolepsy like side effects, morning impairment likely -3A4 substrates -contraindicated in narcolepsy -7 hours of sleep -potential for worsening depression and suicidal ideation -Suvorexant (belsomra) -lemborexant -daridorexant
84
Dozepin (silenor)
-TCA -low doses exert effect through H1 receptor antagonism -sleep maintenance -AEs: suicidality warning, sleep behaviors, anticholinergic side effects
85
trazadone
-antidepressant -NOT FDA approved for insomnia -daytime hangover
86
mirtazapine
-sleep agent for depressed pts -sedation and weight gain
87
quetiapine
-atypical antipsychotic - low dosed -not recommended without comoribid psychiatric disorder
88
modafinil
-wakefulness drug for excessive daytime sleepiness -sleep apnea and narcolepsy - shift work disorder -AE: rash -tx obstructive sleep apnea before recommending sedative/hypnotic drug
89
armodafinil
-wakefulness drug -sleep apnea and narcolepsy - low dose -only if other psychiatric comorbidity present -shift work disorder -AE: rash -tx sleep apnea FIRST
90
sorlamfetol
-tx excessive daytime sleepiness -treast sleep apnea first
91
sodium oxbyabte (GHB) -Xyrem
-binds to GABA-B, GABA-A, and GHB receptors -narcolepsy -AEs: loss of consciousness/reflexes, amnesia, n/v, HA, seizures, death -HIGH sodium content -2x night dosing -presribing program - can cause increased wakefulness in combo with stimulant -> CNS depression (dizziness, drowsiness, COMA
92
Sodium oxybate (GHB) - Xywav
- narcolepsy -lower sodium content -2x night dosing
93
sodium oxybate (GHB) - lumryz
-narcolepsy -ER dose -adult only -HIGH sodium content
94
pitolisant (wakix)
-H3 receptor antagonist/ reverse agaonist -excessive daytime sleepiness (narcolepsy) - prolongs QTc interval - contraindicated in hepatice impairment -2D6/3A4 substrate -weak 3A4 inducer -> decreases effect of oral contraceptives -avoid use with OTC antihistamines
95
solriamfetol (sunosi)
-dopamine noreponephrine reuptake inhibitor (DNRI) -wakefulness drug for excessive daytime sleepiness (sleep apnea and narcolepsey) -AEs: increases BP and HR -renal dosing 37.5mg -avoid use in unsatble CV disease and arrythmias -caution in pts with a history of psychosis or bipolar
96
restless leg syndrome
-gabapentin enacarbil -pramipexole -ropinerol
97
Anorexia
-refeeding inpatient: 2-3lbs/ week -outpatient is 0.5-1lb/ week -increase calories slowly: inpatient- 500 cals/day, outpatient- 1200-1500 cal/day -no approved drug therapy
98
olanzapine (zyprexa)
-atypical antipsychotic -anorexia -WEIGHT GAIN
99
SSRIs
-anorexia -little benefit for core symptoms
100
lisdexamfetamine (vyvanse)
-stimulant -FDA approved for binge eating disorder
101
drugs studied for binge eating
-atomoxetine -TCAs -armodafinil
102
fluoxetine (prozac)
-SSRI -FDA approved for bulimia nervousa
103
well studied for bulimia
-citalopram -sertaline
104
stimulant AEs
-loss of appetite -abdominal pain -sleep disurbances -decreased growth-hallucinations or other psychosis symptoms -increased BP and HR -sudden cardiac death (rara) -priapism -peripheral Raynauds
105
Methylphenidate
-1st line for preschool or elementary/middle school kids or adults -HTN, tachycardia, bipolar, anorexia, tourettes, seizure disorder -monitor CV health, height, and weight -IR for pts <16kg
106
amphetamine
-1st line for elementary/middle school aged children -HTN, tachycardia, bipolar, anorexia, tourettes, seizure disorder
107
mixed amphetamine salts
mydayis
108
methylphenidate LA
-daytrana -patch stimulant
109
lisdexamfetamine (vyvanse)
-1st line for adults -prodrug converted to dextroamphetamine -conversion requirement = missue detterent
110
methylphenidate HCL
-journay PM -take dose in the evening to cover next morning
111
alpha 2 agonist
-2nd line choice for elementary/middle school aged kids, adjunct tx with stimulants -AEs: decreased HR/BP, orthostasis, somnolence, dizziness, rebound hypertension -must be tapered to avoid rebound HTN
112
guanfacine ER (intuniv)
-3A4 substrate
113
clonidine ER
kapvay
114
atomoxetine (strattera)
-2nd line for elementary/middle school kids -Norepinephrine reuptake inhibitor -AEs: increase HR and BP, increase in suicidal thinking -2D6 substrate -weight based dosing around 70kg -monitor liver fxn
115
Vilozazine (quelbree)
-NET inhibitor -2D6 substrate/ UGT substrate -strong 1A2 inhibitor -swallow whole
116
bupropion (welbutrin)
-not FDA approved for ADHD -2D6 inhibitor -CI in siezure and eating disorder -3rd line
117
modafinil (provigil)
-FDA approved for narcolepsy, obstructive sleep apnea, shift work sleep disorder -AEs: HA, decrease appetite, GI intolerance -Warning for SJS/TENS
118
desipreamine
-TCA -AE: cardiac conditions -> sudden cardiac death
119
Carbamazepine and Valproate
-atypical antipsychotics -useful in comorbid bipolar, conduct disorder, intermittent explosive disorder -NOT MONOTHERAPY
120
clonidine (kapvay)
-1st line for tics-> 30% decrease -atypical antipsychotic
121
guanfacine (intuniv)
-tic disorder
122
aripiprazole
-2nd line for tics ->30-60% decrease -atypical antipsychotic
123
risperidone
-tic disorder
124
Haloperidol
-3rd line for tics -> 80% reduction -typical antipsychotic
125
pimozide
-tic disorder
126
Oppositional Defiant Disorder/ Conduct Disorder
- 1st line combo of stimulants and clonidine/guanfacine

Theraputics (4 decks)

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