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Pharm Flashcards

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0
Q

FGA Contraindications

A

Comatose patients

Severe CNS depression

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1
Q

Chlorpromazine indications

A

Schizophrenia
Mania
Behavioral problems in kids
Intractable hiccups

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2
Q

Chlorpromazine SE’s

A

Sedation
Anticholinergic (dry mouth, blurry vision, urinary retention)
Postural hypotension
EPS

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3
Q

Haldol indications

A

Schizophrenia
Tourette’s
Acute inpatient psychosis

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4
Q

Haldol SE’s

A

EPS & TD

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5
Q

Lithium serum levels & toxicity levels

A

Ideal levels = 0.6-1.2

Toxicity if >1.2-1.5

Dialysis if > 4

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6
Q

Lithium:
Half life
Trough
Steady State

A

Half life = 24h
Trough level at 12h
Steady state at 5d

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7
Q

Lithium SE’s

A 
LITHIUM:
	Leukocytes Increased
	Tremor
	Hypothyroidism
	Increased Urine
	Mother's beware (Ebstein's anomaly)
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8
Q

Tests to get yearly for Lithium

A

Serum level
TSH
BUN & Cr

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9
Q

Types of EPS

A

Akithisia
Pseudoparkinsonism
Dystonia (torticollus, oculogyric crisis)
Tardive Dyskinesia

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10
Q

Symptoms of NMS

A 
FALTER
	Fever
	Autonomics (BP, pulse variable)
	Leukocytosis
	Tremor
	Elevated CPK
	Rigidity (lead pipe)
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11
Q

Who is NMS seen in?

A

Young males early in their treatment. Preceded by catatonia.

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12
Q

What FGA’s are available IM?

A

Fluphenazine & Haldol

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13
Q

What psychotropics are renally excreted?

A

Lithium
Gabapentin
Mirtazapine

That’s it!

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14
Q

Indications of Depakote

A

Acute Bipolar mania
Maintenance bipolar
**1st line for mixed episode or rapid cycling

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15
Q

What is the MOA of Depakote?

A

Increases GABA

Inhibits Na+ channels and Glutamate release

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16
Q

What drugs doe Depakote interact with?

A

Carbamazepine –> decreases Depakote levels
Depakote –> ^ Carbamazepine levels
Depakote DOUBLES Lamotrigine levels
CYP inducers decrease Depakote levels

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17
Q

Depakote SE’s

A

VALPROATE

- Vomiting
- Alpecia
- Liver toxicity
- Pancytopenia
- Retention of weight
- Oedema
- Appetite^
- Tremor
- Enzyme induction

Also NTD’s in fetus

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18
Q

What drugs can be used to combat EPS?

A

Benzatropine (anticholinergic, ^Dop)
Diphenhydramine (anticholinergic)
Trihexyphenidyl (antimuscarinic)

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19
Q

What antipsychotics cause LFT elevations?

A

CHOQ full of LFT’s:

- Clozapine
- Haldol
- Olanzapine
- Quetiapine
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20
Q

What antipsychotics cause QT prolongation?

A

QT HORZ:

- Quetiapine
- Thioridazine
- Haldol
- Olanzapine
- Risperidone
- Ziprasidone

(Beginning and end cause the most)

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21
Q

SE’s of Ziprasidone

A

Cardiotoxicity (most QT prolongation)
Activating at low doses (raise dosage)
LEAST metabolic SE’s (use in obese/DM pts)

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22
Q

What SGA’s are available IM?

A

ROPA:

- Risperidone
- Olanzapine
- Palliperidone
- Abilify
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23
Q

What SGA’s are approved for Tx of bipolar?

A

Quetiapine
Lurasidone
Olanzapine
Abilify

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24
MOA of Abilify
Partial agonist of D2 & 5-HT1a | Antagonist of 5-HT2a
25
MOA of most SGA's
``` D2 antagonist (positive symptoms) 5-HT2a antagonist (negative symptoms) ```
26
MOA of FGA's
D2 antagonist
27
Abilify indications
Bipolar acute mania MDD adjunct Schizophrenia Tourette's
28
Switching between SGA's
Washout period if switching to Abilify or could induce acute psychosis.
29
SE's of Abilify
HA Anxiety/Activation Orthostatic hypotension Vomiting/Diarrhea
30
Clozapine SE's
``` Agranulocytosis (weekly CBC's) Weight gain & Hyperglycemia Hypersalivation Seizures Anticholinergic ``` Lowest risk of EPS
31
Lurasidone SE's
Lurasidone & Risperidone = highest risk of SGA's for EPS
32
Olanzapine indications
Symbyax for Bipolar & Tx-resistant MDD 2nd line for schizophrenia Acute agitated psychosis (sedating)
33
Olanzapine SE's
Metabolic syndrome (2nd most) Hepatotoxic (monitor LFT's) Anticholinergic QT prolongation
34
Quetiapine indications
Psychosis Bipolar Preferred SGA in psychotic pt with Lewy Body dementia or Parkinson's (no EPS)
35
Quetiapine SE's
``` Cataracts (slit lamp exam Q6mo) Sedation Orthostatic hypotension QT prolongation Some weight gain ```
36
Risperidone SE's
EPS (most of SGA's with Lurasidone) | Insomnia/Agitation
37
First psychotic episode treatment guidelines
SGA Different SGA FGA or Clozapine Continue for 6mo-1y If 2+ relapses in 5y --> continue indefinitely
38
What antipsychotic is used as an antiemetic?
Prochlorperazine
39
What SGA's show the least metabolic syndrome?
Ziprasidone Abilify Lurasidone
40
Smoking & schizophrenia
75% smoke Increases antipsychotic metabolism Often pt will be discharged and become acutely psychotic, this is because they started smoking again.
41
What SGA should be taken with food?
Ziprasidone - can double bioavailability
42
What antipsychotic is sublingual?
Arsenapine
43
What tests should be done prior to starting Depakote?
LFT's & CBC
44
Ideal Carbamazepine serum levels
4-12 ug/mL
45
Half life of Carbamazepine
Initial: 25-65h Induced: 12-17h
46
MOA of Carbemazepine
Decreased Na+ channel function Decreased Glutamate Increased 5-HT
47
Indications for Carbemazepine
Acute & maintenance bipolar Epilepsy Trigeminal neuralgia
48
Carbamazepine SE's
HAHA Carbamazepine - Hyponatremia - Ataxia/Sedation - Hepatotoxicity - Agranulocytosis/Aplastic anemia
49
What drug levels are affected by Carbamazepine?
CYP induction decreases: - OCP's!! - Benzodiazepines - Clozapine, Olanzapine, Haldol
50
How is Oxcarbazepine different?
Less SE's No need to monitor CBC or LFT's Main SE is hyponatremia
51
Lamotrigine SE's
``` 10% - benign rash 0.3% - SJS Dizziness/Ataxia Blurred vision N/V HA ```
52
Lamotrigine drug interactions
Must decrease Lamictal dose by 50% if Depakote on board
53
Lamotrigine indications
Bipolar DEPRESSION Bipolar maintenance (especially if strong depressive picture) Adjunct in MDD
54
What is the MOA of Gabapentin?
Inhibits Ca2+ transmission --> increases GABA release
55
What is Gabapentin used for?
``` Inidcations: -Bipolar adjunct -Neuropathic pain Off label: -Anxiety -Drug/EtOH craving ```
56
Gabapentin SE's
Sedation | Ataxia/Dizziness
57
What are the uses of Topiramate?
EtOH abstinence Bipolar (low efficacy) Weight loss in psych patients
58
Mood stabilizers in pregnancy
Lamotrigine Gabapentin Topiramate (all grade C, others are D)
59
What classes of drugs are used in anxiety?
``` 1st line - SSRI's/SNRI's Buspirone Benzos Gabapentin TCA's & MAOI's ```
60
MOA of Benzodiazepines
Potentiates GABA at its receptor (ligand-gated Cl- channel)
61
Indications for Benzodiazepines
``` Anxiety disorders (GAD, Panic, Phobias) Insomnia EtOH withdrawal Acute mania Acute agitation Catatonia ```
62
Short/Med/Long acting Benzodiazepines
``` Short: -Alprazolam (Xanax) Intermediate: -Lorazepam (Ativan) -Chlordiazepoxide (Librium) Long: -Diazepam (Valium) -Clonazepam (Klonepin) ```
63
Benzodiazepine SE's
Sedation, disinhibition, amnesia (drunkenness) Respiratory depression Tolerance & Dependence (taper slowly) Pregnancy Category D
64
Buspirone MOA
5-HT1 partial agonist
65
Buspirone indication
GAD
66
Buspirone SE's
Anxiety Dizziness HA Anger
67
What drugs are used to treat ADHD?
Psychostimulants: -Dextroamphetamine (Adderall) -Methylphenidate (Ritalin, Focalin, Concerta) Atomoxetine (Strattera)
68
What is the MOA of psychostimulants for ADHD?
^DA & NE release | Decreased GABA in striatum
69
What are psychostimulants used for?
ADHD Stroke/TBI recovery Obesity
70
What are the contraindications to psychostimulant therapy?
``` Marked anxiety Seizures Glaucoma Hyperthyroidism HTN Active psychosis ```
71
Psychostimulant SE's
``` Nervousness/Agitation Insomnia Anorexia HA Convulsions Psychosis Arrhythmia Hyperpyrexia/Rhabdomyolysis ```
72
What must be monitored with Naltrexone use? | Acamprosate?
Naltrexone - LFT's | Acamprosate - Renal function
73
MOA of Atomoxetine
Selective NE reuptake inhibitor Used to treat ADHD
74
What are the indications for Clonidine?
Adjunct in ADHD for sleep 2nd line ADHD when PS contraindicated Opiate withdrawal
75
MOA of Clonidine & Guanfacine
Post-synaptic Alpha2-agonist Improves NE-mediated cognition in frontal lobe Helps with hyperactivity of ADHD
76
Alpha2-agonist SE's
Hypotension Sedation Contraindicated in pts with cardiac Hx
77
Where does 5-HT modulate mood in the brain?
Between Raphe nucleus & frontal cortex
78
What Serotonin receptors modulate GI function?
5-HT3 & 5-HT4
79
General SSRI SE's
``` GI upset Sedation/Insomnia/Vivid dreams Weight gain Agitation/Anxiety if pt has comorbid anxiety HA Sexual dysfunction Seizures (rare) ```
80
What is the SSRI with the longest half life? | What is the half life?
Fluoxetine Half life = 1 week
81
What antidepressants are good for atypical depression?
Bupropion & Fluoxetine Both are activating.
82
What SSRI for pregnant pts?
Fluoxetine
83
What is considered the safest SSRI to start with?
Sertraline Best CV safety profile Sedating
84
Paroxetine (Paxil) SE's
Sedation - good for anxious depression Weight gain Discontinuation syndrome when stopped (shortest half life)
85
Citalopram SE's
Sedating (H1 antagonism) Doesn't interact with much - good for elderly on many meds Escitalopram is 2x more potent & less interactions
86
Which SSRI has most interactions? | Least?
Fluvoxamine = most Escitalopram = least
87
Shortest half life of SSRI's?
Fluvoxamine & Paroxetine
88
What specific combination of SSRI & TCA is good for Tx-resistant OCD?
Fluvoxamine & Clomipramine
89
Symptoms of serotonin syndrome
HARM: - Hyperpyrexia - Autonomic instability - Rigidity - Myoclonus
90
Symptoms of antidepressant discontinuation syndrome
Lhermitte's sign Flu-like (n/v, HA, sweating) Autonomic instability Sleep disturbance Must have been taking antidepressant for >4 weeks
91
How long of a washout period between MAOI & SSRI?
2 weeks Longer if switching from Fluoxetine
92
What neurotransmitters are affected by Venlafaxine?
With increasing dosage: Blocks 5-HT reuptake --> Blocks NE reuptake --> Blocks Dop reuptake
93
What are the SNRI's?
Venlafaxine (Effexor) Desvenlafaxine (Pristiq; metabolite of Venlafaxine) Duloxetine (Cymbalta)
94
What is Venlafaxine typically used for?
Anxiety & Depression comorbid Perimenopausal hot flashes/night sweats Neuropathic pain (Duloxetine moreso)
95
Venlafaxine SE's
``` HTN Sweating n/v/d Sedation Sexual dysfunction ```
96
What is Duloxetine typically used for?
Diabetic neuropathic pain Painful symptoms of depression Stress incontinence
97
Duloxetine SE's
Dry mouth Sedation Sweating HTN (rare)
98
Duloxetine contraindications
Hepatic insufficiency ESRD Cardiac problems EtOH abuse
99
What drug class is Bupropion?
NDRI | Norepinephrine-Dopamine Reuptake Inhibitor
100
What is Bupropion typically used for?
Atypical depression Depression adjunct to help with sexual dysfunction ADHD Smoking cessation
101
Bupropion SE's
``` Lowers seizure threshold Insomnia CNS activation - can worsen anxiety Tremor HA Constipation Dry mouth Nausea ```
102
Contraindications for Bupropion
Anorexia/Bulemia EtOH abuse/withdrawal TBI h/o seizure disorder
103
What drug class is Mirtazapine (Remeron)?
NaSSa's Noradrenergic and Specific Serotonergic Antidepressants
104
Mirtazapine SE's
Sedation (low doses) Activation (high doses) ^Appetite, weight gain
105
What is Mirtazapine good for?
Depression with anxiety | Eating disorders
106
What subpopulation shows the most weight gain on Mirtazapine?
Pre-menopausal women
107
What are MAOI's used for?
2nd line for Tx-resistant depression or anxiety
108
MAOI side effects
``` Orthostaic hypotension (a1) Sedation & weight gain (H1) MAOI diet (no soft cheeses, soy sauce, red wine) ```
109
MOA of TCA's
Block reuptake of 5-HT, NE, some DA
110
TCA SE's
Anticholinergic (dry mouth, blurred vision, urinary retention) Antihistaminic (sedation, weight gain) Anti-adrenergic (orthostatic hypotension) Lethal in overdose
111
What drug combinations (outside of psychotropics) can contribute to Serotonin Syndrome?
Tramadol & Linezolid
112
Treatment for Serotonin Syndrome
Stop the drug | +/- Cyproheptadine (5-HT antagonist)
113
What non-antidepressants can be added to treat resistant MDD?
Antipsychotics Lithium Estrogen T4
114
How long to continue antidepressant after depressive episode?
1st episode - 1 year 2nd episode - 5 years 3+ episodes - indefinitely
115
Tx for adjustment disorder
Brief psychotherapy
116
Anorexia treatment
CBT Olanzapine if refractory
117
Treatment for Bulemia & Binge Eating Disorder
CBT SSRI if refractory
118
Trichotillomania treatment
Habit reversal training | a type of CBT
119
Treatment for NMS
Dantrolene Amantadine Bromocriptine
120
When do Autism-spectrum disorders present?
2nd year of life
121
Treatment of acute mania
Antipsychotics +/- mood stabilizers +/- benzos (if agitated)
122
What effects on the fetus are seen with Lithium?
1st trimester - Ebstein's anomoly (atrialization of the RV) | 2nd & 3rd - Goiter & transient neuromuscular dysfunction
123
Clozapine absolute contraindication
ANC < 1,000 | WBC < 3,500
124
Risperidone Indications
Acute & maintenance psychosis - preferred in demented pts Acute mania or mixed episodes Irritability in autism spectrum disorder
125
What is the pattern of CBC's for Clozapine?
Weekly for 6 months, then Biweekly for 6 months, then Monthly forever
126
Treatment for NMS
1) Stop antipsychotic 2) Supportive (IVF, anti-pyretic) 3) No consensus: - Dantrolene - Bromocriptine (D2 agonist) - Amandatine (^Dop) - Ativan - ECT
127
What is the clinical course in most schizophrenics?
Chronic course > Intermittent course > Single episode
128
What is lifetime prevalence of schizophrenia? | Males vs. Females?
1% Males = Females
129
Rate of suicide attempts in schizophrenia | Completed suicides
Attempts = 40% Completed = 10%
130
Risk factors for suicide in schizophrenics
Young, male, higher functioning Good insight Most risky time is right after discharge from hospital
131
Poor prognostic factors in schizophrenia
``` Poor initial response to meds (strongest predictor) Extensive prodrome Family history Early onset Male Negative symptoms ```
132
Life expectancy in schizophrenia | Causes
50y Causes: CVD, cigarettes use, suicide
133
Risk of schizophrenia: - General population - Parent or sibling has it - Both parents - Identical twins
- General population = 1% - Parent or sibling has it = 10% - Both parents = 40% - Identical twins = 50%

Psych Clerkship (2 decks)

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