Medications

Question 1

Haloperidol, Droperidol, and Chlorpromazine (Thorazine) are examples of what class of medication?

*Note “peridols” and “azines”

Answer 1

“Typical”- 1st Generation Antipsychotics

Dopamine Antagonists

Question 2

What is the MC side effect associated with 1st Gen. Antipsychotic agents?

Answer 2

EPS: rigidity, bradykinesia, tremor, akathisia (restlessness)

Question 3

What are 3 typical EPS Syndromes?

Answer 3

1. Dystonic Reactions (Dyskinesia): Reversible EPS hours-days after initiation associated with Trismus, protrusion of tongue, facial grimacing, torticollis, and difficulty speaking
   - TREAT with Benadryl or Benztropine
2. Tardive Dyskinesia: lip smacking, teeth grinding, rolling of tongue
   - This is seen with LONG-TERM use
3. Parkinsonism: due to decreased dopamine leads to rigidity and tremor

Question 4

_______ is a life-threatening disorder due to D2 inhibition that leads to mental status changes and extreme muscle rigidity. Also see tremor and autonomic instability (tachycardia)

Answer 4

Neuroleptic Malignant Syndrome (NMS)

-TREAT: stop drug, can start dopamine agonist like Bromocriptine

Question 5

Increased prolactin levels and weight gain are associated with which class of psychiatric medications?

Answer 5

1st generation antipsychotics

Question 6

Haldol should not be used in what patient populations?

Answer 6

• Parkinson pts
• Anticoagulant pts
• Pts with severe cardiac disorder

Question 7

Quetiapine (Seroquel), Olanzapine (Zyprexa) and other “apines” are examples of what class of medication?

Answer 7

“Atypical” or 2nd generation antipsychotic agents

Question 8

What medications are first line for psychotic disorders?

Answer 8

2nd generation antipsychotics such as Seroquel (Quetiapine) and Zyprexa (Olanzapine)

Question 9

Marked weight gain and DM are common side effects of which specific atypical antipsychotic?

Answer 9

Olanzapine (Zyprexa)

Question 10

What are common SEs of 2nd generation antipsychotics?

Answer 10

• Increased prolactin
• Hyperglycemia
• Hyperlipidemia
• Weight gain
• NMS

Question 11

Increased prolactin levels are most commonly associated with which medications?

Answer 11

Risperidone (Risperdal) and Ziprasidone (Geodon)

-Can also cause QT prolongation

Question 12

What is sometimes casually referred to as a 3rd generation antipsychotic?

Answer 12

Aripiprazole (Abilify)

Question 13

What are some SEs of lithium?

Answer 13

• Endocrine: hypothyroidism, sodium depletion, increased urination and thirst, diabetes insipidus, hyperparathyroidism/hypercalcemia
• Neuro: Seizures
• Cardio: Arrhythmias
• GI: N/V/D, weight gain

Question 14

Patients on lithium must have their plasma levels monitored every __ to __ wks due to narrow therapeutic index.

Answer 14

4-8

Question 15

_____ and _____ are two anticonvulsants that may help suppress impulsive and aggressive behavior. SO mood stabilizing effects.

Answer 15

Valproate and Carbamazepine

Question 16

SSRIs: Brand and Generic match-up

Answer 16

Citalopram=Celexa

Escitalopram=Lexapro

Paroxetine=Paxil

Fluoxetine=Prozac

Sertraline=Zoloft

Question 17

Serotonin Syndrome more likely if SSRI is used with a ____ (another class of med)

Answer 17

MAOI

Question 18

Acute AMS, seizures, and autonomic symptoms such as restlessness, diaphoresis, tremor, hyperthermia, N/V, abd pain, mydriasis, and tachycardia is associated with what condition (HINT- think SSRIs)?

Answer 18

Serotonin Syndrome

Question 19

Venlafaxine (Effexor), Desvenlafaxine (Pristiq), and Duloxetine (Cymbalta) are in what class of medicine?

Answer 19

SNRIs

Question 20

SNRIs should be used with caution in patients with what diagnosis?

Answer 20

HTN

*Can cause HTN

Question 21

There is an increased chance of serotonin syndrome if SNRIs are used with what other medication/supplement?

Answer 21

St. John’s Wort

Question 22

_____ class of medication is used less often because of their SE profile and severe toxicity with OD.

Answer 22

TCAs

-Amitriptyline, and “amines”

Question 23

What are some SEs of TCAs?

Answer 23

• Non-depressed people feel sleepiness (opposite for depressed)
• Anticholinergic effects, prolonged QT interval (best indicator of OD)
• OD: Na channel blocker effects, Sinus or wide complex tachycardia, neurologic sxs, ARDS, SIADH

Question 24

A little about Remeron (Mirtazapine)…

Answer 24

Used for depression- causes less sexual dysfunction

-SE= Sedation

Question 25

Wellbutrin (Bupropion) is used for depression and ____ (Bupropion) is used for smoking cessation.

Answer 25

Zyban

*CI in Seizure D/o and Eating D/o!

Question 26

Must avoid ____ foods for fear of HTN crisis in patients taking MAOs.

Answer 26

Tyramine containing foods

Aged or fermented cheese, wine, beer, aged foods, smoked meats, chocolate, coffee, tea

Question 27

Priapism is a rare SE of ____.

Answer 27

Trazadone

Indications= antidepressant, anti-anxiety, hypnotic effects