Medications from Notes Flashcards
1
Q
Agitation, restlessness, confusion, tachycardia, sweating, shivering, myoclonus fever, abdominal cramping are sx of what?
A
Sx of serotonin syndrome
2
Q
Treatment for depression
A
Psychotherapy
ECT
Medications: SSRI, MAOI, TCA, SNRI, NDRI, TeCA
3
Q
What drugs do you not use with MAOI’s
A
SNRI OR SSRI
4
Q
What is the treatment of serotonin syndrome?
A
Main treatment is stop the drugs causing it
Pentactin or cyproheptidine
5
Q
Which class of drugs will increase the amount of tyramine which will cause a release of norepinephrine
A
MAOI’s
6
Q
Which MAOI is can be used for Parkinson’s disease?
A
Selegiline (Emsam)
7
Q
What drug can cause the following side effects: Drowsiness/fatigue Low blood pressure Decreased sexual function Weight gain Decrease urine output
A
MAOI’s
8
Q
What are some complications of MAOIs?
A
Serotonin syndrome
Hypertensive crisis
9
Q
What is the antidote for hypertensive crisis?
A
Phentolamine
10
Q
What is the MOA of antidepressants?
A
Increase the activity of chemicals in our brain
11
Q
What is the purpose of antidepressants?
A
Increase the neurotransmitters in the synapse
12
Q
Is electroconvulsive therapy safe to use in pregnancy?
A
Yes
13
Q
If you’re on in MAOI what can cause hypertensive crisis?
A
High tyramine levels
14
Q
What diagnosis are MAOI’s most commonly used for?
A
Major depression
15
Q
What drug can cause the following side effects:
Arrhythmias, dyspepsia, constipation, sedation, weight gain, and postural hypotension
A
TCA’s
16
Q
What is the most common TCA used?
A
Amitriptyline (Elavil) – it is the most effective
17
Q
Which TCA can be used for bedwetting?
A
Imipramine (Tofranil)
18
Q
Which TCA can be use for Migraine prophylaxis?
A
Amitriptyline (Elavil)
19
Q
Which TCA can be use for itching?
A
Doxepin (Sinequan)
20
Q
Which TCA can be use for insomnia?
A
Amitriptyline (Elavil) and Desipramine (Norpramin)
21
Q
Which TCAs can be used for neuropathic pain?
A
Amitriptyline (Elavil)
Nortripyline (Pamelor)
22
Q
What medication can cause the following side effects: Urinary retention Blurred vision Constipation Confusion Dry mouth
A
Anticholinergics
23
Q
Where in the body does tetracyclic antidepressants work at?
A
Alpha – 2 antagonist
24
Q
Which drug is great for appetite stimulation to help patients get their appetite back?
A
Mirtazapine (Remeron)
25
Will a higher dose of Mirtazapine be more or less sedating?
Higher dose= less sedation
26
What is the mechanism of action of SSRI's?
Block reuptake of serotonin
27
What drug can cause these side effects?
| Nausea/vomiting, bruxism, changes in sexual behavior, suicidal thoughts,
SSRI's
28
How long does it take for most signs/symptoms of SSRI's to disappear?
Within 4 weeks (adaptation phase)
29
If you have a pt on an SSRI and they develop flu-like sx what most likely happened?
They stopped taking their SSRI
30
What drug has the black box warning of:
| Caregivers of children on This drug should monitor them for depression that is getting worse and thoughts of suicide.
SSRI's
31
What is the dosing of fluoxetine (Prozac)
10-40mg once daily
32
Which SSRI's are strong 2D6 inhibitors?
Fluoxetine (Prozac) and Paroxetine (Paxil)
33
What meds do you have to avoid with Fluoxetine (Prozac) and Paroxetine (Paxil) because of their MOA ?
Tramadol and Tamoxifen
34
What drug may cause decreased libido, nausea, diarrhea, anorexia, hyponatremia, possible increase risk of bleeding
Fluoxetine (Prozac)
35
When should you take Fluoxetine (Prozac)
Take in the morning, it is the most activating SSRI
36
Which SSRI is the most sedating?
Paroxetine (Paxil)
37
What is the dosing of Paroxetine (Paxil)
10-40mg daily
38
What is the dosing of Sertraline (Zoloft)
25-100 mg daily
39
What is the dosing of Citalopram (Celexa) and Escitalopram (Lexapro) ?
Celexa 10-40mg
| Lexapro 5-20mg
40
Which SSRI drugs are you worried about QT prolongation ?
citalopram (Celexa) and Escitalopram (Lexapro)
41
What class of drugs works on both serotonin and norepinephrine
SNRI's
42
Which drug has the black box warning of an increase in suicide if <25 so you can not use in adolescents
SNRI's
43
What is the dosing of Venlafaxine (Effexor)
37.5-225mg
44
What drug can cause HTN if the doses are greater than 225mg ?
venlafaxine (Effexor)
45
What is the dosing of Desvenlafaxine (Pristiq)
50-100mg
46
What is the dosing of Duloxetine (Cymbalta)
20-60mg
47
What are some other things you can treat with Duloxetine (Cymbalta)
Fibromyalgia, neuropathic pain
48
What drug blocks the reuptake of norepinephrine and epinephrine
Mirtazapine (Remeron)
48
What drug lowers seizure threshold and can cause suicide
Bupropion (Wellbutrin)
49
What drug does not cause weight gain or sexual dysfunction?
Bupropion (Wellbutrin)
50
What drug can help with smoking cessation and lacks sexual dysfunction?
Bupropion (Wellbutrin)
51
What drug can cause priapism, constipation, dry mouth, sedation
Trazodone (Desyrel)
52
What drug has a black box warning of hepatic failure ?
Nefazodone (Serzone)
53
If a mood stabilizer is also used to treat seizures is it considered a psychotropic med?
No it is not
54
What mood stabilizers can also be used to treat seizures?
Cabamazine (Tegretol)
Divalproex (Depakote)
Lamotrigine (Lamictal)
55
What class of drugs can affect the metabolism, liver, kidneys and thyroid?
Mood Stabilizer
56
With what mood stabilizers must you get routine bloodwork on?
Tegretol, Depakote and lithium
57
What drug works on (HLA)-B 1502 allele
Carbamazepine (Tegretol)
58
What drug can reduce what's a production in the bone marrow in May cause mild leukopenia and hyponatremia
Carbamazepine (Tegretol)
59
With what drug do you need a monitor children on and they should have regular bloodwork to rule out decrease blood cells?
Carbamazepine (Tegretol)
60
With Carbamazepine (Tegretol) what should the serum concentration be between?
4-12 mcg/ml
61
If someone has the human leukocyte antigen HLA-B 1502 what drug can cause worse adverse reactions ?
Carbamazepine (Tegretol)
62
What is the dosing of valproic acid (Depakote) for both epilepsy and mania?
Epilepsy 50-100 mcg/mL
| Mania 50-125 mcg/mL
63
Which drug stabilizer is the drug of choice for tonic/clonic seizures?
Valproic Acid (Depakote)
64
What drug has the side effects of hair loss, change is a menstrual cycle, pancreatitis, constipation, nausea, vomiting
Valproic Acid (Depakote)
65
What are some drug interactions with valproic acid (Depakote)
Carbamazepine (Tegretol)
| Lamotrigine (Lamictal)
66
If you're on valproic acid what can happen if you stop at abruptly?
Seizures
67
What adverse effects can be seen in children taking multiple antipsychotics?
Liver toxicity and liver failure
68
Why should children taking a Valproic acid have regular bloodwork?
To check for liver problems and make sure the dose is safe and affective
69
What drug can cause Steven Johnson syndrome?
Lamotrigine (Lamictal)
70
If a patient comes to you with swelling of the face and tongue, pale skin, blisters, shedding of the skin, fever and cough what drug might they be on and what possibly might they have?
Lamotrigine (Lamictal) and they have Stevens Johnsons Syndrome
71
What drug is first line for partial seizures and can't be used for migraine prophylaxis and weight loss?
Topiramate (Topamax)
72
If a patient comes to you with ataxia or impaired concentration or fatigue what drug might they be on?
Topiramate (Topamax)
73
What should the concentration of lithium be in both acute mania in maintenance?
Acute mania: 0.8-1.2 mEq/L
| maintenance: 0.6-1 mEq/L
74
What drug can cause confusion, essential tremor, hypothyroid, nephrotoxicity, and peripheral edema
Lithium
75
With what drug can you not use nsaids, ACEI, ARBS, and diuretics?
Lithium
76
How often do you need a monitor the serum levels in a stable patient on lithium?
6-12 months
77
A patient on this drug should have regular bloodwork to make sure the drug is in a safe and effective range and they should have a TSH done every six months
Lithium
78
Why do you have to Watch patients on lithium so closely?
Narrow therapeutic index
79
If a patient comes to you with repeated vomiting, diarrhea, severe tremors, difficulty walking, extreme sleepiness, slurred speech, and extreme sleepiness what drug might they be on and what is this a sign of?
Lithium these are signs of lithium toxicity
80
What drug can use it if the patient starts to experience extrapyramidal side effects?
Benadryl
81
What drugs can cause tardive dyskinesia, neuroleptic malignant syndrome, or extrapyramidal side effects?
Anti-psychotics
82
If you have a patient taking an antipsychotic and they come to you with involuntary muscle movement's but do not resolve with stopping the drug what side effects are they experiencing?
Tardive Dyskinesia
83
If you have a patient on an antipsychotic and they start to experience severe muscle rigidity, fever, altered mental status and have an elevated white blood cell and LFTs what side effects are they experiencing?
Neuroleptic malignant syndrome
84
If a patient of yours is on an antipsychotic and they start to experience acute dystonia and Parkinson's syndrome what side effect might be experiencing?
Extrapyramidal side effects
85
Name some conditions that antipsychotics can treat
```
Psychosis
Bipolar disorder
Schizophrenia
Autism
Threat syndrome
Severe aggression
```
86
What four things must you get on all patients before starting them on an atypical antipsychotic?
Fasting lipid profile
Fasting blood sugar
LFTs
CBC
87
What drug affects of dopamine and serotonin neurotransmission in the four key dopamine pathways in the brain?
Atypical antipsychotics
88
What class of drugs can cause weight gain, difficulty urinating, sleepiness or tiredness, changes in menstrual cycle, constipation?
Atypical antipsychotics
89
If a patient on an antipsychotic comes to you with dystonia, akathisia, and akinesia what can be used to treat them?
Benzodiazepines
90
What is it called if you have muscle spasms, stiff neck,'s tongue sticking out of the mouth, and trouble swallowing?
Dystonia
91
What is it called if you have restlessness and are unable to sit still
Akathisia
92
What is it called if you have rigid muscles, shuffling walk, drooling, and Tremor
Akinesia
93
Is Tardive dyskinesia more common in the typical or atypical antipsychotics?
Typical antipsychotics
94
Are typical or atypical antipsychotics more commonly used?
Atypical antipsychotics
95
What drug can cause a dangerous drop in white blood cells?
Clozapine (Clozeril)
96
What drug class has the black box warning of weight gain in new onset diabetes?
Atypical antipsychotics
97
What drug requires weekly blood work and close monitoring...every week for the first six months then every two weeks and so on?
Clozapine (Clozaril)
98
What atypical antipsychotic is most likely to induce hyperprolactinemia and can cause a lot of sexual dysfunction?
Risperidone (Risperadal)
99
Because of what side effect should you start Risperidone (Risperadal) at a low dose in the elderly
Postural hypotension
100
What is it called it the patient has obesity, hypertension, increase blood glucose, triglycerides and cholesterol?
Metabolic syndrome
101
Which atypical antipsychotic can cause weight gain as much as 30 to 50 pounds? It may also cause hypertriglyceridemia, hypercholesteremia, and hyperglycemia
Olanzapine (Zyprexa)
102
If you are giving a patient Ativan what drug is contraindicated in IM form?
Olanzapine (Zyprexa)
103
What drug has a black box warning of May cause hypertriglyceridemia, hypercholesteremia, hyperglycemia?
Quetiapine (Seroquel)
| However this is less likely with Quetiapine than with Olanzapine (Zyprexa)
104
What atypical antipsychotic is most likely to cause orthostatic hypotension?
Quetiapine (Seroquel)
105
Which atypical antipsychotic is very useful for bipolar disorder with both manic and depressive stage?
Quetiapine (Seroquel)
106
What drug can cause significant QT prolongation but has no associated weight gain with it?
Ziprasidone (Geodon)
107
With what atypical antipsychotic drug must you take with a meal?
Ziprasidone (Geodon)
108
What atypical antipsychotic has no associated weight gain, no QT prolongation, low sedation, and low EPS?
Aripiprazole (Abilify)
109
What drug will work as a D2 partial agonist?
Aripiprazole (Abilify)
110
What atypical antipsychotic is associated with the most sedation, weight gain, and transaminitis?
Clozapine (Clozaril)
111
If you have a patient come to you and say that they have been getting weekly blood draws every two weeks since starting a medication because it can cause a drop in their white blood cells what drug might they be on?
Clozapine (Clozaril)
112
With what atypical antipsychotic must you titrate over 4 days to 12mg/day in order to minimize the risk of orthostatic hypotension?
Iloperidone (Fanapt)
113
What drug is an inhibitor of 3A4 or 2D6 and can increase blood levels
Iloperidone (Fanapt)
114
What to atypical antipsychotics may cause QT prolongation?
Iloperidone (Fanapt) and Ziprasidone (Geodon)
115
With what atypical antipsychotic drug can you not have food or liquid for 10 minutes after taking it?
Asenapine (Saphris)
116
Patients with what problems should you avoid exceeding 40 mg a day of Lurasidone (Latuda)
Severe renal or hepatic impairment
117
What 3 high potency typical antipsychotics bind to the D2 receptor with high affinity and as a result have a higher risk of extrapyramidal side effects
Fluphenazine, Haloperidol, and Pimozide
118
What low potency typical antipsychotic has less affinity for the D2 receptors but results in more cardiotoxic an anti-cholinergic adverse effects such as sedation and hypotension?
Chlorpromazine (Thioridazine)
119
These three drugs are D2 receptor antagonist and have a higher risk of extrapyramidal side effects
Fluphenazine, Haloperidol, and Pimozide
120
What to benzodiazepines are given for sleep?
Temazepam (restoril) and triazolam (Halcion)
121
What drug class can cross the blood brain barrier?
Benzodiazepines
122
What drug has a side effect of dependence, tolerance, amnesia, somnolence
Benzodiazepines
123
If you have a patient coming to you unconscious, and respiratory depression, CNS depression, and shallow breathing what drug might they have overdosed on?
Benzodiazepines
124
If you have a patient on benzodiazepines and they come to you with the symptoms of euphoria, fatigue, shallow breathing, and trouble coordinating their movements could they be on a low or high dose?
Low dose
125
If a patient comes to you while being on benzodiazepines and they have the symptoms of aggression, easily agitated, difficulty remembering, paranoia, and irritability could they possibly be on a low or high dose?
High dose
126
What are some long term effects of staying on benzodiazepines?
Rebound effects,
tolerance develops which will result in dependence,
withdrawl
127
If you have a patient come to you who is in respiratory depression, walking difficultly, shallow breathing, and has CNS depression what antidote can you give him for his overdose?
Flumazonil Romazicon
128
What drug is a 5HT1A agonist and works by releasing serotonin and has no sedation affects. This drug Will not reduce anxiety and patients that are used to taking benzo's.
Buspirone (Buspar)
129
What is the most activating SSRI?
Fluoxetine (Prozac)
130
What SSRI has a very long half life (7-9 days)
Fluoxetine (Prozac)
