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Flashcards in FIrst Aid: Psychopharmacology Deck (163)
1

What antidepressant class is used to treat enuresis?

TCAs

2

What antidepressant class is used to treat Autism?

SSRIs

3

What antidepressant class is used to treat premenstrual dysphoric d/o?

SSRIs

4

What is the treatment for the depressive phase of manic depression?

SSRIs, bupropion

5

What is the treatment for insomnia?

-Mirtazapine
-TCAs

6

What antidepressant class is used to treat neuropathic pain?

TCAs

7

What antidepressant class is used to treat dysthymia?

SSRIs

8

What is the MOA of TCAs?

-Inhibit reuptake of NE and 5-HT

9

Why are TCAs not first-line agents?

higher incidence of side effects, require greater monitoring of dosing and are lethal in overdose

10

What is the hallmark of TCA toxicity?

widened QRS (>100 msec)

11

List examples of TCAs

-ipramine
-triptyline
Doxepin

12

Which TCA is least likely to cause orthostatic hypotension?

nortriptyline

13

Which TCA is least sedating (least anticholinergic side effects)?

desipramine

14

Which TCA is the most serotonin specific?

Clomipramine

15

What is clomipramine specifically used to treat?

OCD

16

How do you treat a TCA overdose?

IV sodium bicarbonate

17

What are the major TCA side effects?

-antiHistamine (sedation)
-antiAdrenergic (orthostatic hypotnesion, tachycardia, arrhythmia)
-antiMuscarinic (dry mouth, constipation, urinary retention, blurred vision, tachycardia)
-weight gain
-lethal in overdose
-3 C's

18

What dosage of TCA's is lethal in OD?

1 week supply

19

What are the 3 C's of TCAs?

-Convulsions
-Coma
-Cardiotoxicity

20

What is the MOA of MAOIs?

prevent the inactivation of biogenic amines such as NE, 5-HT, dopamine, and tyraminMOA-e (increase amount of these transmitters available in synapses)

21

MAO-A preferentially deactivates what neurotransmitter?

serotonin

22

MOA-B preferentially deactivates what neurotransmitter?

NE/epinephrine

23

MOAIs are very effective for what conditions?

-Refractory depression
-Refractory panic disorder

24

List some examples of MAOIs.

-Phenelzine
-Tranylcypromine
-Isocarboxazid

25

What are the common side effects of MAOIs?

-Orthostatic hypotension
-Drowsiness
-Weight gain
-Sexual dysfunction
-Dry mouth
-Sleep dysfunction

26

What happens when SSRIs and MAOIs are taken together?

serotonin syndrome (lethargy, restlessness, confusion, flushing, diaphoresis, tremor and myoclonic jerks)

27

What does serotonin syndrome progress into?

Hyperthermia
Hypertonicity
Rhabdomyolysis
Renal Failure
Convulsions
Coma
Death

28

What is the first step when suspecting serotonin syndrome?

discontinue medication

29

How long must you wait before you switch from an SSRI to MAOIs?

at least 2 weeks

30

When would you get a hypertensive crisis when on MAOIs?

if you take it with tyramine-rich food or sympathomimetics

31

What type of foods have tyramine?

-Chianti wine
-Cheese
-Chicken liver
-Fava beans
-Cured meats

32

Why do you get a hypertensive crisis when you take an MAOI with foods with tyramine?

causes a build-up of stored catecholamines

33

What is the MOA of SSRIs?

Inhibit presynaptic serotonin pumps, leading to increased availability of serotonin in synaptic clefts

34

Why are SSRIs the most commonly prescribed antidepressants?

-Low incidence of side effects
-No food restrictions
-Much safer in overdose

35

List the SSRIs.

-Fluoxetine, Fluvoxamine
-Paroxetine
-Sertraline
-Citalopram (and escitalopram)

36

Which SSRI has the longest half-life (so no need to taper)?

fluoxetine

37

Which SSRI has the highest risk of GI disturbances?

sertraline

38

Which SSRI is most serotonin specific and most activating?

paroxetine

39

Which SSRI is currently only approved for use in OCD?

fluvoxamine

40

Which SSRI is the levo enantiomer of citalopram?

escitalopram (much more expensive and fewer side effects)

41

What neurotransmitters do the SSRIs not act on?

histamine
adrenergic
muscarinic

42

What are the common side effects of SSRIs?

-Sexual dysfunction
-GI disturbance
-Insomnia
-HA
-Anorexia, weight loss
-Serotonin syndrome when used with MAOIs

43

Atypical antidepressants include which classes of drugs?

SNRIs (serotonin/NE)
NDRIs (NE/DA)
SARIs (5-HT antagonist)
NASAs (NE/5-HT)

44

What is the example of an SNRI?

venlafaxine

45

What is a side effect of venlafaxine?

can increase BP

46

What happens if you miss 1-3 doses?

potential withdrawal (flu-like symptoms and electric-like shocks or zaps)

47

What is the example of NDRIs?

Buproprion (Wellbutrin)

48

What are the major uses for buproprion?

-Smoking cessation
-Seasonal affective disorder
-Adult ADHD

49

What is the most significant advantage of buproprion?

Lack of sexual side effects

50

At high doses, what could buproprion do?

it's dopaminergic effect can exacerbate psychosis

51

What are some side effects of buproprion?

increased sweating
increased risk of seizures
psychosis

52

What patients should not take buproprion?

-Pts with significant anxiety
-Contraindicated in patients with seizure or active eating disorder

53

List the examples of SARIs.

-Nefazodone
-Trazodone

54

What are the uses of SARIs?

-Refractory major depression
-Major depression with anxiety
-Insomnia (secondary to its sedative effects)

55

What are the side effects of SARIs?

-Nausea
-Dizziness
-Orthostatic hypotension
-Cardiac arrhythmias
-SEDATION
-PRIAPISM

56

List an example of a NASA?

Mirtazapine

57

What is mirtazapine used for?

Refractory major depression (especially in patients who need to gain weight)

58

What are the side effects of mirtazapine?

-sedation
-weight gain
-dizziness
-somnolence
-tremor
-agranulocytosis

59

What is the dose of mirtazapine with the maximal sedative effect?

15 mg of less

60

What happens to the sedative effect of mirtazapine at higher doses?

increases NE uptake and is less sedating

61

What is the MOA of traditional (typical) anipsychotics?

block dopamine receptors

62

What is the MOA of atypical antipsychotics?

block both dopamine and serotonin receptors

63

Why do atypical antipsychotics have fewer side effects than typical?

their effect on dopamine is weaker

64

List the 2 low potency traditional antipsychotics.

Chlorpromazine
Thioridazine

65

What does "low potency" mean as far as antipsychotics go?

lower affinity for dopamine receptors (so higher doses are required)--DOES NOT MEAN LOWER LEVEL OF EFFICACY

66

True or false: low potency typical antipsychotics have higher incidence of anticholinergic and antihistaminic side effects

TRUE

67

True or false: low potency typical antipsychotics have higher incidence of EPS and NMS than high potency typical antipsychotics

FALSE- high potency do!

68

List the 5 major high potency typical antipsychotics.

Haloperidol
Fluphenazine
Trifluoperazine
Perphenazine
Pimozide

69

What does "high potency" mean as far as antipsychotics go?

greater affinity for dopamine receptors and a relatively low dose is needed to achieve effect

70

Which high potency typical antipsychotics are available in long-acting forms (decanoate)?

haloperidol and fluphenazine

71

How often must you give IM injections of haloperidol decanoate?

every 4-5 weeks

72

How often must you give IM injections of fluphenazine decanoate?

every 2-3 weeks

73

Dopamine naturally inhibits what chemicals?

Prolactin
Acetylcholine

74

List the 4 antidopaminergic effects.

-Parkinsonism
-Akathisia
-Dystonia
-Hyperprolactinemia

75

What word is used to describe the EPS of masklike face, cogwheel rigidity and pill rolling tremor?

parkinsonism

76

What word is used to describe the EPS of subjective anxiety and restlessness and objective fidgetiness?

akathisia

77

What word is used to describe the EPS of sustained contraction of muscles of neck, tongue, eyes (painful)?

dystonia

78

What does hyperprolactinemia cause?

-Decreased libido
-Galactorrhea
-Gynecomastia
-Impotence
-Amenorrhea
-Osteoporosis

79

How do you treat EPS?

Reducing dose of antipsychotic +treatment with antiparkinsonian, anticholinergic, or antihistaminic medications (ex. amantadine, benadryl, or benzotropine)

80

What is another name for benzotropine?

cogentin

81

What are some anti-HAM side effects of antipsychotics?

-Anti-Histamine- sedation
-Anti-Alpha Adrenergic- orthostatic hypotension, cardiac abnormalities, sexual dysfunction
-Anti-Muscarinic- dry mouth, tachycardia, urinary retention, blurry vision, constipation

82

What is another general side effect of antipsychotics?

WEIGHT GAIN

83

What hepatic side effects are associated with antipsychotics?

Elevated liver enzymes
Jaundice

84

What opthalmologic problems are associated with antipsychotics?

-Irreversible retinal pigmentation with high doses of thioridazine
-Deposits in lens and cornea with chlorpromazine

85

What dermatologic problems are associated with antipsychotics?

-Rashes
-Photosensitivity
-Blue-gray skin discoloration (chlorpromazine)

86

What type of antipsychotics are more likely to cause seizures?

low-potency (lower seizure threshold)

87

What is the word for choreoathetoid (writhing) movements of mouth and tongue that occur in pt's with long-term neuroleptic use?

tardive dyskinesia

88

What causes tardive dyskinesia?

Increase in number of dopamine receptors (causing lower levels of Ach)

89

How long do you take neuroleptics before you get tardive dyskinesia?

> 6 months (usually in older women)

90

What is the prognosis for tardive dyskinesia?

50% of cases spontaneously remit
Untreated cases may be permanent

91

Who gets neuroleptic malignant syndrome?

males early in treatment

92

What is the prognosis for NMS?

20% mortality rate if untreated

93

What often precedes NMS?

catatonic state

94

What are the s/s of NMS?

FALTER
Fever (most common)
Autonomic instability (tachycardia, labile hypertension, diaphoresis)
Leukocytosis
Tremor
Elevated CPK
Rigidity (lead pipe rigidity almost universal)

95

How do you treat NMS?

-Discontinue current medications
-Administer supportive medical care (hydration, cooling, etc.)
-Sodium dantrolene, bromocriptine, amantadine

96

Is NMS an allergic reaction?

no

97

Can you ever restart a specific neuroleptic after it causes NMS?

yes!

98

What is the MOA of atypical antipsychotics?

Block both dopamine and serotonin receptors

99

Why are atypical antipsychotics sometimes preferred over typical?

less side effects (rarely cause EPS, tardive dyskinesia, or NMS)

100

List some examples of atypical antipsychotics.

Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone

101

What atypical is FDA approved as an adjunct for depression?

aripiprazole

102

Which atypicals are FDA approved for the treatment of mania?

quetiapine
ziprasidone

103

Which atypical is only used in severe refractory cases?

clozapine

104

Which is the only generic atypical?

risperidone

105

Which atypical requires weekly blood draws to check WBCs due to 1% risk for agranulocytosis?

clozapine

106

True or false: atypical antipsychotics do not have anti-HAM side effects?

false! they do have some

107

Other than agranulocytosis, what is the major side effect of clozapine?

2-5% incidence of seizures

108

What must be monitored in patients on olanzapine?

LFTs (can cause liver toxicity

109

What is another common problem with olanzapine?

METABOLIC ISSUES
Weight gain, hyperlipidemia, glucose intolerance

110

Which atypical requires slit lamp eye exams every 6 months?

quetiapine

111

Which typical antipsychotic performs as well as the atypicals?

perphenazine

112

What is another term for mood stabilizers?

antimanics

113

What are mood stabilizers used for?

-acute mania
-preventing relapses of manic episodes

114

How might mood stabilizers be good in an agitated demented or mentally retarded individual?

can be used to treat aggression and impulsivity

115

Mood stabilizers are used to potentiate what 2 classes of drugs?

-Antidepressants (in refractory MDD)
-Antipsychotics (in treatment of schizophrenia)

116

What is the use for mood stabilizers in treating alcoholism?

enhancement of abstinence

117

List the mood stabilizers.

Lithium
Carbamazepine
Valproic acid

118

What is the proposed MOA for lithium?

alters neuronal sodium transport

119

What is the mechanism of excretion for lithium?

secreted by kidney

120

How long does it take lithium to work (onset of action)?

5-7 days

121

What is the major drawback of lithium?

VERY narrow therapeutic index (.7-1.2)
Toxic above 1.5
Lethal above 2

122

What factors affect lithium levels?

-NSAIDS (decrease)
-Aspirin
-Dehydration (increase)
-Salt deprivation (increase)
-Impairedrenal function (increase)
-Diuretics

123

What are some unique side effects of lithium?

Thyroid enlargement
Hypothyroidism
Nephrogenic DI
Metallic taste
Benign leukocytosis
Edema

124

What does a patient look like who has lithium toxciity?

-AMS
-Coarse tremors
-convulsions
-death

125

What should be monitored regularly in a patient on lithium?

-Blood levels of lithium
-TFTs
-Kidney function (GFR)

126

What drugs are used to treat mixed episodes and rapid-cycling bipolar disorder?

carbamazepine (tegretol)
valproic acid (depakene)

127

What can carbamazepine also be used to treat?

trigeminal neuralgia

128

What is the MOA of carbamazepine?

blocks sodium channels and inhibits action potentials

129

What is the onset of actionf or carbamazepine?

5-7 days

130

What are some unique side effects of carbamazepine?

-Leukopenia
-Hyponatremia
-Aplastic anemia
-Agranulocytosis

131

What must be taken before starting a patient on carbamazepine or valproic acid and regularly after starting?

CBC
LFTs

132

What is the teratogenic effect of taking carbamazepine or valproic acid during pregnancy?

neural tube defects

133

What is the proposed MOA of valproic acid?

increases CNS levels of GABA

134

What are some unique side effects of valproic acid?

-Hepatotoxicity
-Thrombocytopenia
-Hemorrhagic pancreatitis
-Alopecia

135

What are the most widely used class of psychotropic medications?

anxiolytics

136

What is an advantage of benzos over barbiturates?

Benzos are safer at high doses (but can be lethal if mixed with alcohol)

137

What is the MOA of benzos?

Potentiating effects of GABA (increase frequency of Cl- channel opening)

138

List examples of long acting (1-3 days) benzos.

Chlordiazepoxide
Diazepam
Flurazepam

139

What is chlordiazepoxide used to treat?

-alcohol detox
-presurgery anxiety

140

What is diazepam used to treat?

-anxiety
-seizure control

141

What is flurazepam used to treat?

insomnia

142

List the rapid onset benzos.

-Diazepam
-Flurazepam
-Triazolam

143

List some intermediate acting (10-20 hours) benzos.

Alprazolam
Clonazepam
Lorazepam
Temazepam

144

What is a common use for alprazolam, clonazepam and lorazepam?

panic attacks

145

What is another common use for orazepam?

alcohol withdrawal

146

What is temazepam used for?

insomnia

147

List the short acting (3-8 hr) benzos.

Oxazepam
Triazolam

148

What is triazolam used for?

insomnia

149

List some SE of benzos.

Drowsiness
Impaired intellectual function
Reduced motor coordination

150

What occurs with benzo toxicity?

respiratory depression in overdose (expecially if combined with ETOH)

151

What are zolpidem (ambien) and zaleplon used for?

short term treatment of insomnia

152

What is the MOA of zolpidem and zaleplon?

Selectively bind to benzodiazepine binding site on GABA receptor

153

What is an advantage of using zolpidem or zaleplon for insmonia?

-No withdrawal effects
-Minimal rebound insomnia
-Litter or no tolerance/dependence with long term use

154

What is the difference between zaleplon and zolpidem?

Zaleplon is a newer insomnia drug with a shorter half life than zolpidem

155

Are zaleplon and zolpidem benzos?

NO

156

What is buspirone used for?

Alternative to Benzos or venlafaxine for treating GAD

157

What is the onset of action for busprione?

1-2 weeks

158

What is the MOA of buspirone?

partial agonist at 5-HT-1a receptor

159

Can you use buspirone in alcoholics?

YES- does not potentiate CNS depression of alcohol

160

What is the use of propranolol in psych patients?

treats autonomic effects of panic attacks, performance anxiety and can be used to treat akathisia (side effect of typical antipsychotics)

161

Which psychotropic drugs have anti-HAM side effects?

TCAs
Low potency antipsychotics

162

What psychotropic drugs cause serotonin syndrome?

SSRIs + MAOIs

163

What is used to monitor patients on antipsychotics for tardive dyskinesia every 6 months?

AIMS (abnormal involuntary movement scale)
DISCUS