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Midterm Review Flashcards

1
Q

Absorption

A

Getting the drug into the bloodstream

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2
Q

Distribution

A

Getting the drug from the bloodstream to the target organs/tissues.

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3
Q

Pharmacodynamics

A

How the Drug acts on the body

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4
Q

Pharmacokinetics

A

How the body acts on the drug

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5
Q

What is the primary excitatory neurotransmitter

A

Glutamate

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6
Q

What are the accessory excitatory neurotransmitters

A

Acetylcholine, norepinephrine, epinephrine

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7
Q

What is the primary neurotransmitter involved in schizophrenia

A

Dopamine

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8
Q

What neurotransmitters are involved in major depressive disorder

A

Dopamine, serotonin, norepinephrine

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9
Q

Reduction in what neurotransmitter produces anxiety?

A

GABA (serotonin is involved but goes down later in the process)

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10
Q

1st, 2nd line treatments for PTSD

A

1st: SSRI
2nd: SNRI

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11
Q

What combination of drugs treats Serotonin,norepinephrine and dopamine together?

A

SNRI and Welbutrin

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12
Q

What are common symptoms of loss of dopamine

A

Loss of purpose, deep sadness, low motivation

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13
Q

What is a common symptom of loss of serotonin

A

anxiety, irritability

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14
Q

What Condition can mimic ADHD in children prior to puberty?

A

depression

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15
Q

What are the most common side effects of SSRI’s

A

Weight gain, sexual dysfunction, GI symptoms

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16
Q

What is the black box warning for SSRI’s

A

All SSRI’s. Increased suicidality risk in children, adolescents and young adults with major depression and other psychiatric disorders.

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17
Q

What are the classes of antidepressants?

A

SSRI,SNRI, MAOI Inhibitor, atypical etc.

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18
Q

SIGECAPS mnemonic

A

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide

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19
Q

DIGFAST Mnemonic

A

Distractibility
Insomnia
grandiosity
Flight of Ideas
Activities: increase in goal directed activities
Speech(pressured speech)
thoughtlessness

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20
Q

When used for Anxiety, which neurotransmitter are SSRI’s primarily acting on?

A

Serotonin. (specifically Serotonin 1 A receptors ).
Increased serotonin increases calm and decreases anxiety.

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21
Q

What is the most common neurotransmitter in brain?

A

Glutamate, Primary excitatory neurotransmitter

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22
Q

What does glutamate do?

A

Excitatory neurotransmitter.
Helps learning and memory.

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23
Q

What is the gold standard treatment for bipolar

A

Lithium

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24
Q

What are the side effects of lithium

A

Nausea, dry mouth, thirst, acne, alopecia, mild fine tremor, Weight gain, psoriasis, leukocytosis

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25
What are the signs of Mild toxicity of lithium?
T-wave depression, mild twitching, tremor, muscle weakness, Lethargy, GI side effects (mild)
26
What are the signs of moderate Lithium Toxicity
Severe nausea, vomiting, diarrhea Confusion, slurred speech ataxia, muscle twitching EKG changes Seizure oliguria circulatory failure Coma/Death
27
What are the signs of severe lithium toxicity
Impaired level of consciousness, Coma, death increased DTR's Syncope Seizures
28
What patient education should be provided to the patient before prescribing lithium?
-Avoid exercising in hot weather -Balance fluid intake -Take medication as directed at the same time daily -Report Vomiting, tremor, sedation, weakness, vertigo -May need change in dose with illness, fever, sweating -Lithium levels need to be drawn 8-12 hours after last dose
29
Contraindications for lithium use:
-Pregnancy (Ebstein's anomaly) -cardiovascular insufficiency -untreated hypothyroidism -long term use can cause kidney changes. -Significant fluid loss increases risk of lithium toxicity
30
What other nutrient has an inverse relationship with lithium
Sodium
31
Define hypertensive crisis in MAOI use
-DBP more than 120. -Symptoms: Occipital headache, neck stiffness, palpitations, nausea, vomiting, sweating, dilated pupils, tachycardia/bradycardia, chest pain.
32
What do you need to educate your patient on before starting MAOI's.
-Report signs of hypertensive crisis -avoid tyramine, tyrosine, phenylalanine, tryptophan rich foods. -Ferments, Fava, avocado, caffeine.
33
what are the side effects of MAOI's
Dizziness, headaches, orthostatic hypotension, dry mouth, constipation, drowsiness, tremor, sweating, peripheral edema, weight gain, sexual side effects
34
What are the common uses of MAOI's currently
Parkinson's depression, treatment-resistant depression.
35
What condition do you avoid prescribing welbutrin in?
anorexia, bulimia
36
What effect does welbutrin typically have on appetite
decreases appetite
37
Which antidepressant bears a risk of priapism
trazodone
38
What are common side effects of trazodone
PRIAPISM, orthostasis, drowsiness, dry mouth, blurred vision, nausea, vomiting.
39
What are common side effects of remeron
Sedating, weight gain, increased serum cholesterol, increased appetite, rare agranulocytosis/neutropenia.
40
ARMS mnemonic for Serotonin syndrome
Anxiety Restlessness Myoclonus Sweating
41
What is the most worrisome side effect of lamotrigine
Steven's Johnson syndrome: need to increase dose slowly.
42
First and second line antidepressants with eating disorders:
1st line: SSRI 2nd line: SNRI
43
What medications are used to treat nicotine dependence:
Chantix and bupropion
44
What medications are used to treat Alcohol abuse
naltrexone, campral, disulfuram
45
What medications are used to treat narcotic abuse
Naltrexone, narcan, suboxone
46
How does smoking impact metabolism of medications?
Medications will likely be metabolized more quickly, will need to give a higher dose
47
How does the CYP 450 system effect medication metabolism
Found primarily in liver and affect 90% of psych drugs.
48
Depakote as mood stabilizer
See handwritten notes
49
Which medications are used off label for anxiety
clonidine,prazosin, lyrica, neurontin, propranolol
50
Which antidepressant class can cause urinary retention
Tricyclic antidepressants
51
Definition of normal metabolizer
Persons with 1 or 2 normal copies of CYP2D6 or CYP219
52
Definition of poor metabolizer
Persons with 2 inactivated copies of CYP2D6 or CYP219. High risk for toxicity
53
Definition of ultra-rapid metabolizer
Persons with multiple copies of CYP2D6 or CYP 219. High risk for low efficacy of rugs.
54
What medications used to treat Bipolar need bloodwork monitoring?
Lithium Valproic acid: 50-125 mg/dl Carbamazepine: 6-12 mg/dl
55
Where do drugs leading to addiction increase dopamine?
Ventral striatum
56
Where is the pleasure center in the brain?
Mesolimbic pathway
57
Valproic acid use as a mood stabilizer
-Used off-label to treat acute manic phase of bipolar(1st line for mania per multiple guidelines) -Long-term use to minimize future manic episodes -May help prevent future depressive episodes -Helps with rapid cycling and mixed manic episodes
58
MOA of Depakote(valproic acid)
-Works by inhibiting voltage-gated sodium channels -Boosts Action of GABA and regulation of downstream signal transduction cascades.
59
Common depakote side effects
Weight gain Metabolic complications Menstrual disturbances
60
Depakote Black Box Warning
Pancreatitis fetal injury hepatotoxicity
61
Names of MAOI's
Isocarboxazid(marplan) Phenelzine(nardil) Tranylcypromine(parnate) Selegiline (transdermal)
62
MAOI Mechanism of Action
Inhibits enzyme responsible for metabolism of serotonin, dopamine, norepinephrine and tyramine. -Therefore increases the level of NE and Serotonin in the CNS.
63
How long between transition from a serotonin agent to an MAOI?
5-7 days Fluoxetine: 5 weeks
64
How long between transition from MAOI to SSRI?
14 days
65
Names of common Tricyclics
Amitriptyline (Elavil) Nortriptyline(Pamelor) Imipramine (tofranil) Clomipramine (Anafranil) Doxepin(Sinequan)
66
Benzodiazepene Black Box Warning
Avoid concomitant use with opioids, monitor for sedation, avoid in pregnancy and laceration
67
Benzodiazepene Beer’s criteria
Avoid for insomnia, agitation,delirium

PMHNP (15 decks)

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