medications exam 2

Question 1

antidepressant drug classes

Answer 1

SSRIs
SNRIs
tricyclic antidepressants (TCAs)
MAOIs

Question 2

atypical antidepressants (smaller classes)

Answer 2

bupropion (wellbutrin)
mirtazapine (remeron)
trazadone (desyrel)

Question 3

first line treatment for most depressive disorders, eating disorders, and anxiety disorders

Answer 3

SSRIs and SNRIs

Question 4

why are MAOIs hardly used anymore?

Answer 4

dietary restrictions – food with tyramine

Question 5

how are TCAs different from SSRIs or SNRIs?

Answer 5

carry more side effects and are more lethal in overdose

Question 6

what should you ask about when giving antidepressants?

Answer 6

use of supplements like st. john’s wort

Question 7

what should be assessed before giving TCAs and why?

Answer 7

suicidality – due to overdose potential

Question 8

what is an important reminder for patients taking antidepressants?

Answer 8

take several weeks to work

Question 9

there is a black box warning with children and young adults for increasing suicidal thoughts primarily with which antdepressants?

Answer 9

SSRIs and SNRIs

Question 10

what causes serotonin syndrome?

Answer 10

too much serotonin resulting in CNS hyperactivity

Question 11

7 symptoms of serotonin syndrome

Answer 11

hypertension
high fever
sweating
agitation
disorientation
myoclonus
hyperreflexia

Question 12

examples of SSRIs

Answer 12

fluoxetine/prozac
paroxetine/paxil
sertraline/zoloft
fluvoxamine/luvox
escitalopram/lexapro
citalopram/celexa

Question 13

3 common side effects of SSRIs and SNRIs

Answer 13

GI issues
headache
sexual dysfunction

Question 14

what side effects are SOMETIMES experienced with SSRIs and SNRIs?

Answer 14

tiredness
alertness

Question 15

what happens with abrupt withdrawal of SSRIs and SNRIs?

Answer 15

brain zaps

Question 16

SSRI and SNRI black box warning

Answer 16

suicidal thoughts in kids and young adults

Question 17

SNRIs examples

Answer 17

venlafaxine/effexor
duloxetine/cymbalta
desvenlafaxine/pristiq

Question 18

what is an additional side effects of SNRIs?

Answer 18

hypertension

Question 19

5 tricyclic antidepressant and MAOI side effects

Answer 19

sedation
weight gain
bP variations
dry mouth
constipation

Question 20

TCA black box warning

Answer 20

suicidal thoughts in kids and adults – worry about overdose risk due to lethality of overdose

Question 21

MAOI black box warning

Answer 21

hypertensive crisis – must avoid tyramine rich foods

Question 22

3 side effects of Bupropoin/Wellbutrin

Answer 22

agitation
insomnia
decreased appetite

Question 23

Mirtazapine/Remeron 2 side effects

Answer 23

significant sedation
weight gain

Question 24

trazadone side effects

Answer 24

sedation

Question 25

bupropion black box warning

Answer 25

lowers seizure threshold plus risk of suicidal thoughts in kids and young adults

Question 26

mood stabilizers treat ...

Answer 26

mood disorders -- usually bipolar disorders

Question 27

gold standard for bipolar disorder

Answer 27

lithium carbonate

Question 28

most mood stabilizers require _____ regularly

Answer 28

bloodwork

Question 29

which mood stabilizers require blood work?

Answer 29

lithium carbonate divalproex sodium/valporic acid (Depakote) carbamazepine/Tegretol

Question 30

lithium patients need to be adequately ____ and eat adequate ___ in diet

Answer 30

hydrated; sodium

Question 31

which mood stabilizers require monitoring of liver and education to avoid heavy alcohol usage and tylenol?

Answer 31

divaloprex sodium cabamezapine

Question 32

divalproex sodium and carbemazepine safety concern

Answer 32

liver

Question 33

what is the safety concern with lamotrigine/lamictal

Answer 33

monitor for rash -- stevens-johnsons syndrome is black box warning

Question 34

mood stabilizer drug classes

Answer 34

lithium anticonvulsants

Question 35

6 side effects with lithium carbonate

Answer 35

GI issues dry mouth headache metallic taste dizziness drowsiness

Question 36

what is important to remember about lithium

Answer 36

narrow therapeutic range

Question 37

therapeutic range of lithium

Answer 37

0.6-1.2mEq/L

Question 38

what range of lithium can cause toxicity

Answer 38

1.5-2.0

Question 39

what lithium value is considered severe toxicity?

Answer 39

2.0+

Question 40

mild lithium toxicity <1.5 side effects

Answer 40

metallic taste fine hand tremor (resting) nausea polyuria polydipsia diarrhea or loose stools muscular weakness or fatigue weight gain edema memory impairments

Question 41

moderate lithium toxicity 1.5-2.5 side effects

Answer 41

severe diarrhea dry mouth N/V mild to moderate ataxia incoordination dizziness, sluggishness, giddiness, vertigo slurred speech tinnitus blurred vision increasing tremor muscle irritability or twitching asymmetric deep tendon reflexes increased muscle tone

Question 42

severe lithium toxicity >2.5 side effects

Answer 42

cardiac arrhythmia blackouts nystagmus coarse tremor fasciculations visual or tactile hallucinations oliguria, renal failure peripheral vascular collapse confusion seizures coma and death ** think hyponatremia

Question 43

6 side effects of anticonvulsants

Answer 43

GI issues mood changes fatigue dizziness drowsiness rash -- lamotrigine

Question 44

what is the therapeutic level for Depakote

Answer 44

50-100 mcg/mL

Question 45

what are the therapeutic levels for tegretol?

Answer 45

4-12 mg/L

Question 46

what neurotransmitters do antipsychotics regulate

Answer 46

dopamine and sometimes serotonin

Question 47

older antipsychotics

Answer 47

typical, only work on dopamine

Question 48

newer antipsychotics

Answer 48

atypical, work on dopamine and serotonin

Question 49

which antipsychotic requires blood monitoring

Answer 49

clozapine/clozaril

Question 50

what signs should be reported when monitoring for tardive dyskinesia with antipsychotics?

Answer 50

unusual mouth movements like lip smacking or tongue protrusion

Question 51

many antipsychotics cause _____

Answer 51

weight gain

Question 52

what is a major concern to be aware of with antipsychotics

Answer 52

neurologic malignant syndrome (NMS)

Question 53

what is NMS

Answer 53

caused by depleted dopamine due to antipsychotics, resulting in CNS hyperactivity

Question 54

what are the 6 signs/symptoms of NMS?

Answer 54

hypertension fever sweating agitation disorientation lead pipe muscle rigidity***

Question 55

what is the safety concern/black box warning with clozapine/clozaril?

Answer 55

agranulocytosis

Question 56

how should agranulocytosis be monitored with clozapine?

Answer 56

monitor for signs of infection and sickness like fever and monitor WBCs

Question 57

what are the 6 side effects of antipsychotics?

Answer 57

EPS -- more common with typicals sedation weight gain risk of insulin resistance constipation dry mouth

Question 58

what is the black box warning for antipsychotics

Answer 58

can increase risk of death in elderly dementia patients

Question 59

tricyclic antidepressant examples

Answer 59

amitriptyline (elavil) clomipramine (anafril) doxepin (sinequan) nortriptyline (pamelor) imipramine (tofranil)

Question 60

MAOI examples

Answer 60

phenelzine (nardil) selegiline (eldepryl) isocarboxazid (marplan) rasagiline (azilect) tranylcypromine (parnate)

Question 61

anticonvulsant examples

Answer 61

Divalproex sodium/valporic acid (depakote) lamotrigine (lamictal) carbamazepine (tegretol) oxcarbamazepine (trileptal) levetiracetam (keppra) topiramate (topamax)

Question 62

typical antipsychotics examples

Answer 62

haloperidol (haldol) chlorpromazine (thorazine) pimozide (orap) fluphenzaine (proxlin)

Question 63

atypical antipsychotic examples

Answer 63

clozapine (clozaril) risperidone (risperdal) olanzapine (zyprexa) aripiprazole (abilify) ziprasidone (geodon) lurasidone (latuda) quetiapine (seroquel)