Final exam review Flashcards by Paige Tustanowsky

What does chronic activation of the monoamine receptors do?

-increases BDNF signaling
-downregulates the HPA axis

How well did you know this?

Not at all

Perfectly

What medication is MAO-B selective?

Selegiline

How well did you know this?

Not at all

Perfectly

What medication is MAO-A selective?

Moclobemide

How well did you know this?

Not at all

Perfectly

What are the non-selective MAO inhibitors?

Phenelezine, Tranylcypromine

How well did you know this?

Not at all

Perfectly

What must be present for a diagnosis of depression?

Depressed mood OR loss of interest or pleasure in doing things

How well did you know this?

Not at all

Perfectly

What is SIGE CAPS?

S- Sleep (insomnia/hypersomnia)
I- Interest Decreased
G- Guilt/worthlessness
E- Energy loss/fatigue
C- Concentration difficulties
A- Appetite change (increase/decrease)
P- Psychomotor agitation/retardation
S- Suicidal Ideation

How well did you know this?

Not at all

Perfectly

What are the SSRI medications?

fluoxetine, escitalopram, citalopram, paroxetine, fluvoxamine, sertraline

How well did you know this?

Not at all

Perfectly

What SSRI has the most weight gain, sedation, and anticholinergic effects?

Paroxetine (Paxil)

How well did you know this?

Not at all

Perfectly

What SSRI has more GI upset than other antidepressants?

Sertraline (Zoloft)

How well did you know this?

Not at all

Perfectly

What SSRI has QTc prolongation (high doses)?

citalopram

How well did you know this?

Not at all

Perfectly

What SSRI has weight loss and a long T 1/2 (96-144 hours)?

fluoxentine

How well did you know this?

Not at all

Perfectly

What class effect adverse effects are there for the SSRIs?

sexual dysfunction, increased risk of bleeding (platelet inhibition), Hyponatremia (more likely in elderly)

How well did you know this?

Not at all

Perfectly

What SNRI has an FDA warning for hepatotoxicity and needs slow titration due to nausea side effect?

Duloxetine
-obtain LFTs every 6 months or if symptomatic

How well did you know this?

Not at all

Perfectly

What SSRIs/SNRIs are 2D6 inhibitors?

Fluoxetine, Paroxetine, Sertraline, Duloxetine, Venlafaxine (higher doses)

How well did you know this?

Not at all

Perfectly

What SNRI has a fibromyalgia indication?

Milnacipran

How well did you know this?

Not at all

Perfectly

What SNRI must be adjusted for renal impairment or strong 3A4 inhibitors?

Levomilnacipran

How well did you know this?

Not at all

Perfectly

What SNRI has a dose-limiting side effect of nausea but no major CYP reactions?

Desvenlafaxine

How well did you know this?

Not at all

Perfectly

What are the SNRI class effects?

blood pressure elevation, nausea
-can be useful in fibromyalgia, musculoskeletal pain, neuropathic pain

How well did you know this?

Not at all

Perfectly

What are the TCA class effects?

CNS: sedation, confusion, lower seizure threshold
Cardiovascular: tachycardia, orthostatic hypotension
Anticholinergic: blurred vision, urinary retention, constipation
Other: weight gain, sexual dysfunction, narrow therapeutic index
Caution: serotonin syndrome, hypertensive crisis

How well did you know this?

Not at all

Perfectly

What MAO inhibitor does not require the tyramine diet?

Selegiline 6mg/24 hour patch

How well did you know this?

Not at all

Perfectly

What class of antidepressants requires a 2 week washout period before switching to another class (5 weeks for fluoxetine)?

MAO inhibitors

How well did you know this?

Not at all

Perfectly

What are the bupropion clinical pearls?

-2D6 inhibitor, CI in seizure and eating disorders

How well did you know this?

Not at all

Perfectly

What medications can be combined with SSRIs/SNRIs?

Bupropion, Mirtazapine

How well did you know this?

Not at all

Perfectly

What are the mirtazapine clinical pearls?

warnings: agranulocytosis, increased cholesterol
-sedation, increased appetite (doses < 15 mg/day)

How well did you know this?

Not at all

Perfectly

What are the SSRI + 5HT1A partial agonists?

Vilazodone, Vortioxetine -do not use these with SSRIs/SNRIs -nausea

What are the FDA approved augmentation agents for depression?

Aripiprazole, Brexpiprazole, Cariprazine, Quetiapine

What is the criteria needed for Bipolar I disorder?

at least 1 or more manic episodes

What is the criteria needed for Bipolar II disorder?

hypomanic episodes that generally last 4 or more days

What are the adverse effects/toxicities associated with Lithium?

polyuria, polydipsia (diabetes inspidus), hypothyroidism, acne, GI toxicity, ataxia, seizure, lethargy, confusion, agitation, dry mouth, weight gain, ECG changes, coarse/fine hand tremor, teratogenic (cardiac structural abnormality in 1st trimester)

What drugs can decrease renal clearance of Lithium (increase lithium levels)?

ACEis, ARBS, NSAIDS, thiazide diuretics, dehyrdration

What drugs can increase renal clearance of Lithium (decrease lithium levels)?

osmotic diuretics, +/- loop diuretics, caffeine

What drugs can increase excretion of Lithium (decrease lithium levels)?

sodium bicarbonate, high Na intake

What adverse effects/toxicities are associated with valproate/valproic acid/divalproex?

Thrombocytopenia, hyperammonemia, N/V/D, teratogenicity (neural tube defects and lower IQ in offspring), PCOS, increased appetite-weight gain, anoxeria, dyspepsia, ulceration, platelet dysfunction

What drug interactions are important to consider for valproate?

Lamotrigine -increased risk for SJS

What are important clinical pearls for carbamazepine (tegretol) in bipolar disorder treatment?

thrombocytopenia/hematologic effects

What are important clinical pearls for oxcarbazepine (trileptal) in bipolar disorder treatment?

CYP3A4 inducer (no auto-induction), hyponatremia

What are important clinical pearls for lamotrigine in bipolar disorder treatment?

-1st line treatment for depressive symptoms of bipolar; not useful for acute treatment or manic/hypomanic symptoms

What are important clinical pearls for topiramate in bipolar disorder treatment?

weight loss, heat intolerance/hypohydrosis, metabolic acidosis, kidney stones, possible teratogen (cardiac structural effects), DRESS warning

What are the FDA-approved antipsychotics for bipolar disorder treatment?

quetiapine, lurasidone, olanzapine/fluoxetine

What antipsychotics are commonly used off-label for bipolar disorder treatment?

aripiprazole, brexpiprazole

What clinical pearls are important to consider for use of atypical antipsychotics in bipolar disorder treatment?

all monitoring parameters for metabolic syndrome and movement side effects apply when used for bipolar disorder!

What are the known/possible teratogenic medications for bipolar disorder treatment?

Lithium, Valproic acid, carbamazepine, topiramate

What is periphery pain circuit system?

peripheral nociceptors -----> peripheral neurons ------> dorsal root ganglion ------> dorsal horn (spinal cord) ------> spinothalamic tract (ascending input) -------> brain + nocicpetion-inhibiting neurons -----> descending modulation -----> dorsal horn (spinal cord)

What channels and receptors are involved in temperature sensitive pain signaling?

Transient receptor potential cation channel (TRP) heat sensitive: TRPV (Vanniloid) cold sensitive: TRPM (Melastatin)

What channels and receptors are involved in acid sensitive pain signaling?

Acid sensing ion channel (ASIC) -activated by H+ -conduct Na

What channels and receptors are involved in chemical irritant sensitive pain signaling?

-Histamine, Bradykinin

What ion channels are responsible in conduction of pain signals from the periphery to the spinal cord?

Nav1.8 (action potential signaling along axon), Glutamate receptors, AMPA receptos, NMDA receptors

What are the three fibers involved in transducing pain signals?

AB fibers- fastest, non-noxious, responds to touch, pressure ADelta fibers- first pain sensation, cold, myelinated, fast C-Fibers - second pain sensation, dull, aching, unmyelinated, slow

What role does substance P play in peripheral sensitization?

1. vasodilation 2. degranulation of mast cells 3. release of histamines 4. inflammation and prostaglandins leads to increase in pain receptors and sensitization of area

What are the two pathways thought to lead to neuropathic pain sensitization (spinal cord)?

spinal sensitization - increased AMPA and NMDA expression/sensitivity, glutamate Spontaneous afferent activity- enhanced expression of Na channels, increased cellular excitability and action potential

What type of receptors play a role in pain in the brain circuitry?

Mu opioid receptors -abundant & play a role in modulation of pain signals

What are the types of opioid receptors?

GPCRs Mu -what morphine brings to Kappa -is dysphoric, can offset euphoria of Mu receptors Delta -no FDA approved due to seizures, can help pain, alcoholism, hyperalgesia, hibernation receptor Nociceptan/orphanin FQ receptor

What does CYP3A4 do in opioid metabolism?

CYP3A4 (four) makes opioids start with nor (less active metabolites)

What is the endogenous opioid for Mu opioid receptors?

Endorphins

What is the endogenous opioid for Kappa Opioid receptors?

Dynorphins

What is the endogenous opioid for Delta Opioid receptors?

Enkephalins

What is the endogenous opioid for Orphanin-Receptor-Like Subtype 1 (ORL1), Nociceptin?

Nociceptin/Orphanin FQ

What role does VTA and NAc play in addiction?

Ventral tegemental area- source of dopamine Nucleus accumbens -pleasure, valuation

What are the analgesic adjuvants?

gabapentinoids, serotonin norepinephrine re-uptake inhibitors, tricyclic antidepressants, skeletal muscle relaxants, anti-epileptics, topical agents

What are the non-opioid options for pain treatment?

acetaminophen, NSAIDs

What is the pediatric dosing for tylenol?

10-15 mg/kg PO Q4H PRN MAX: 75mg/kg/day or 3-4 g/day

What is the pediatric dosing for Ibuprofen?

5-10mg/kg/day PO q4-6h PRN MAX: 40mg/kg/day or 2400 mg whichever is less;;l

What are the clinical pearls for ketorolac (Teradol)?

-max duration is 5 days (parenteral + oral formulations) due to high risk for GI bleed

What is the recommended dosing for the Gabapentinoids?

Gabapentin (Neurontin)- 100-300 mg po tid MAX 3600mg/day) Pregabalin (Lyrica) - 75 mg po bid MAX 600 mg/day (schedule V)