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NAPLEX STUDY > Psych > Flashcards

Psych Flashcards

1
Q

DSM-5 (depression): M SIG E CAPS

A

Mood
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal ideation

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2
Q

drugs that can cause or worsen depression

A

ADHD meds: atomoxetine (strattera)
indomethacin
NNRTIs: Efavirenz (in Atripla) and Rilpivirine (in Complera, Odefsey)
BB (especially propranolol)
OCs and anabolic steroids
antidepressants, benzos, steroids, interferons, chantix, alcohol

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3
Q

natural products

A

st johns wort, SAMe, valerian rool or 5-HTP

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4
Q

SSRIs

A

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
-do not use with MAOi or linezolid
-citalopram/escitalopram risk of QT prolongation do not use more than 20 mg/day (citalopram) and 10 mg/day (escitalopram) in elderly
-risk of SIADH/hyponatremia, bleeding
-most activating: fluoxetine
-most sedating: paroxetine
-zoloft preferred in patients with cardiac risk

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5
Q

SNRIs

A

Venlafaxine (Effexor XR)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)
-do not use with MAOis
-same as SSRIs with risks
-increased HR and dilated pupils, dry mouth, excessive sweating and constipation, increased BP

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6
Q

TCAs: Tertiary amines

A

amitriptylline (Elavil) and doxepin

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7
Q

TCAs: secondary amines

A

nortriptyline (Pamelor)

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8
Q

TCAs safety

A

-do not use with MAOis, linezolid, or methylene blue
-QT prolongation with OD, can cause fatal arrhythmias
-orthostasis
-anticholinergic side effects: dry mouth, blurred vision, urinary retention, constipation; tertiary amines have increased anticholinergic effects

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9
Q

dopamine and NR reuptake inhibitor

A

Bupropion (Wellbutrin SR, Xl)
-Zyban for smoking cessation
-do not exceed 450 mg/day due to seizure risk
-do not use in those with seizure disorder, hx of anorexia/bulimia, MAOi/linezolid/methylene blue
-dry mouth, tremors/seziures, weight loss

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10
Q

MAOi’s

A

Isocarboxazid (Marplan), Phenzine (Nardill), Tranylcypromine (Parnate)
-DDI and DFI (tyramine rich foods) - can be fatal
-hypertensive crisis or serotonin syndrome

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11
Q

avoiding serotonin syndrome

A

-2 week wash out period is required between MAOis and SSRIs, SNRIs, TCAs, and bupropion
-5 week wash out period is required when changing from fluoxetine to MAOi due to fluoxetines half life

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12
Q

tetracyclic antidepressant

A

mirtazapine (Remeron)
-helps with sleep and appetite stimualtio

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13
Q

Trazodone

A

used for sleep
-risk of priaprism

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14
Q

depression in preganacy

A

-do not use paroxetine
-mild-moderate psychotherapy is first line
-severe depression: citalopram, escitalopram, fluoxetine, sertraline first line

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15
Q

most sedating antidepressants

A

paroxetine, mirtazapine, trazodone

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16
Q

most activating antidepressants

A

fluoxetine and buproprion

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17
Q

adjunct therapies for treatment-resistant depression

A

aripiprazole (abilify) and Quetiapine (Seroquel)
-boxed warning for elderly patients with dementia-related psychosis
-olanzapine/fluoxetine do not use and do not use with MAOis, linezolid, or methylene blue
-aripirazole: anxiety, insomnia, akathisia
-olanzapine: sedation, weight gain, increase lipids and glucose
-quetiapine: sedation, orthostasis, weight gain, lipids, glucose

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18
Q

medications/recreational drugs that can cause psychotic symptoms

A

anticholinergics, dextromethorphan, dopamine or dopamine agonists, interferons, stimulants, systemic steroids, bath salts, cannabis, cocaine, LSD, methamphetamine, PCP

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19
Q

1st gen antipsychotics

A

low potency: chlorpromazine, thioridazine
high potency: haloperidol (haldol)
-dementia related psychosis
-QT prolongations, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, NMS

20
Q

2nd gen antipsychotics

A

Abilify, clozapine, latuda, zyprexa, invega, Seroquel, risperdal, geodon

21
Q

Aripiprazole (Abilify)

A

oral, injection
-akathisia, activing

22
Q

Clozapine (Clozaril)

A

-3rd line agent due to side effects
-neutropenia/agranulocytosis
-myocarditis and cardiomyopathy
-seziures
-REMS
-ANC must be > 1500

23
Q

Lurasidone (latuda)

A

somnolence, EPS, nausea
-risk of metabolic syndrome

24
Q

Paliperidone (Invega)

A

increased prolactin
-EPS
-metabolic syndrome

25
Q

Quetiapine (Seroquel)

A

somnolence, metabolic syndrome,
-low EPS risk often used for psychosis in Parkinsons disease

26
Q

Risperidone (Risperdal)

A

increased prolactin
-EPS
-metabolic syndrome

27
Q

Ziprasidone (Geodon)

A

QT prolongation; do not use with QT risk

28
Q

NMS

A

stop antipsychotic, IV fluids, dantrolene

29
Q

diagnosis of BPD

A

exhibits > 3 symptoms (if mood is only irritable, exhibits > 4 symptoms)

30
Q

acute tx of BPD

A

-manic episode: valproate, lithium, or an antipsychotic
-depressive episode: antipsychotic - lithium, valproate or lamotrigine can be added

31
Q

tx of BPD in preganancy

A

lamotrigine is the safest option

32
Q

Lithium (Lithobid)

A

-trough: 0.6-1.2 mEq/L
-GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydypsia, weight gain, hypothyroidism
-> 1.5 toxicity - > 2.5 coma, seizures
-renally cleared

33
Q

5 mL of lithium citrate syrup

A

= 8 mEq of lithium ion
-8 mEq of lithium ion = 300 mg of lithium carbonate tabs/caps

34
Q

tx of adhd

A

first line: stimulants (methylphenidate, lisdexamfetamine, adderall)
second line: non-stimulants (atomoxetine)

add on medication: guanfacine ER (Intuniv) or Clonidine ER (Kapvay)

35
Q

Methylphenidate

A

IR tab: Ritalin
ER tab: concerta (OROS - ghost tab)
ER capsule: Ritalin LA
transderm: Daytrana

36
Q

Amphetamine/dextroamphetamine

A

IR: Adderall
ER: Adderall XR

37
Q

Lisdexamfetamine

A

-Vyvanse
-low abuse potential - prodrug

38
Q

Selective Norepi reuptake inhibitor

A

Atomoxetine (Strattera)
-risk of suicidal ideation
-decrease appetite, insomnia, somnolence, dry mouth, hypertension, tachycardia

39
Q

alpha 2 adrenergic receptor agonists

A

clonidine (Kapavay) clonidine IR (catapres)
Guafacine (Intuniv)
-rebound hypotension > titrate off

40
Q

drugs that cause anxiety

A

albuterol, antipsychotics, bupropion, caffiene, decongestants, illicit drugs, levothyroxine, steroids, stimulant, theophylline

41
Q

Buspirone

A

used for anxiety

42
Q

drugs that worsen insomnia

A

acetylcholinesterase inhibitors, alcohol, antiretrovirals, Abilify, Strattera, bupropion, caffeine, decongestants, diuretics, fluoxetine, steroids, stimulants, varenicline

43
Q

Help falling asleep

A

eszopiclone, zolpidem, ramelteon, zaleplon

44
Q

Help staying asleep

A

eszopiclone, zolpidem, doxepin, suvorexant

45
Q

Help falling and staying asleep

A

eszopiclone, zolpidem

46
Q

eszopiclone

A

lunesta

47
Q

RLS

A

-gabapentin, pramipexole (Mirapex) and ropinirole (requip)

NAPLEX STUDY (25 decks)

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