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Pharmacology > Psych > Flashcards

Psych Flashcards

1
Q

Mesolimbic (+) SS

A
  • Hallucinations
  • Delusions
  • Disorganized speech, Behavior, Thought
  • Poor Attention
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2
Q

Mesocortical (-) SS

A
  • Loss of interest, motivation, emotion
  • Poor Hygiene
  • Social withdrawal
  • Lack of speech, flat affect
  • Feeling blue
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3
Q

Schizophrenia Tx

A
  1. 2GA x2 (except Clozapine)
  2. 1GA
  3. CLOZAPINE
  4. ECT
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4
Q

Antipsychotics MOA

A
  • Blocks DOPAMINE Receptors
  • 2GA also blocks SEROTONIN Receptors
  • Blocks ALPHA, HISTAMINE, and PROLACTIN receptors
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5
Q

What does the Mesolimbic dopamine tract do?

A

Arousal, Memory, Stimulus, Processing (sensations)

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6
Q

What does the Mesocortical dopamine tract do?

A

cognition, communication, social fn

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7
Q

What does the Nigrostriatal dopamine tract do?

A

Motor Mvmnt

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8
Q

What does the Tuberoinfundibular dopamine tract do?

A

Regulates Prolactin release

i think incr dopamine = decr PRL release

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9
Q

Antipsychotics effect on the dopamine tracts
- Mesolimbic
- Mesocortical
- Nigrostriatal
- Tuberinfundibular

A
  • Mesolimbic -> DECR (+) SS
  • Mesocortical -> (-) SS not often improved. 2GA may help a lil
  • Nigrostriatal -> EPS
  • Tuberinfundibular -> INCR PRL Release
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10
Q

ALL ______ may cause death in elderly pts with dementia-related psychosis

what class of meds?

A

Antipsychotics

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11
Q

Antipsychotics that may also be used as Antidepressants have a high risk of _______

A

SUICIDE

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12
Q

Are SE more common in LOW or HIGH Potency 1st Gen Antipsychotics?

Typicals

A

LOW Potency 1GA

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13
Q

1GA: LOW Potency SE

A
  • Sedation
  • Orthostatic HypoTN
  • Tachy
  • Anticholinergic (dry, constipated)
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14
Q

1GA: HIGH Potency SE

A

EPS

  • Tardive Dyskinesia -> Jerky
  • Dystonia -> Continuous muscle spasms
  • Bradykinesia -> SLOW Mvmnts
  • Parkinsonism -> RIGIDITY, Tremors
  • Akathisia -> inner RESTLESSNESS
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15
Q

2 LOW Potency 1GA

A
  • Chlorpromazine (Thorazine) -> also used for intractable hiccups
  • Thioridazine (Mellaril) -> highest QTc prolongation risk
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16
Q

Which Antipsychotic may also be used for intractable hiccups?

A

Chlorpromazine (Thorazine)

LOW Potency

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17
Q

Which 1GA has the highest QTc prolongation risk?

A

Thioridazine (Mellaril)

LOW Potency

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18
Q

8 HIGH Potency 1GA

A
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Loxapine (Loxitane)
  • Molindone (Moban)
  • Perphenazine (Trilaphon)
  • Prochlorperazine (Compazine)
  • Thiothixene (Navane)
  • Trifluoperazine (Stelazine)
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19
Q

Which antipsychotic has a LOW risk of Wt Gain, has a LAI option, and is also used for Tourettes?

A

Haloperidol (Haldol)

HIGH Potency 1GA

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20
Q

Which Antipsychotic causes WT LOSS

A

Molindone (Moban)

HIGH Potency 1GA

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21
Q

Which Antipsychotics is also used for N/V and also comes as IM or a suppository?

A

Prochlorperazine (Compazine)

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22
Q

2GA SE

A
  • METABOLIC -> WT Gain, Incr Lipids, Incr Blood Sugar
  • INCR PRL -> Gynecomastia, Galactorrhea
  • LOWER, but poss risk of EPS
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23
Q

Which 2GA carries the HIGHEST RISK OF SE

A

CLOZAPINE
- AGRANULOCYTOSIS (MONITOR NEUTROPHILS/ANC)
- MYOCARDITIS
- GI HYPERMOBILITY
- WT GAIN
- REMS PROGRAM

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24
Q

Which 2GA are for Bipolar Mania

A
  • Ziprasidone (Geodon)
  • Cariprazine (Vraylar)
  • Olanzapine (Zyprexa)

Risperidone (Risperdal) - Bipolar Maintenance

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25
Q

Which 2GA are for adjunct Depression

A
  • Ariprazole (Abilify)
  • Brexiprazole (Rexulti)
  • Quetapine (Seroquel)
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26
Q

Which 2GAs increase PRL Release?

A
  • Papilleridone (Invega)
  • Risperdone (Risperdal)
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27
Q

Which 2GA must you take with food to ensure absorption (350cal+)

A

Lurasidone (Latuda)

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28
Q

Which 2GA?
* must monitor for 3Hr after injection
* causes WT GAIN
* used for bipolar mania

A

Olanzapine (zyprexa)

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29
Q

Which 2GA?
* WT GAIN
* LOWEST RISK OF EPS
* Adjunct for Depression
* Bipolar Depression

A

Quetapine (Seroquel)

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30
Q

Which 2GA?
- NO food/drink 10-15min after dose
- MOUTH NUMBESS
- HEPATIC FAILURE
- Sublingual and patch avail

A

Asensapine (Saphris)

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31
Q

Major Depressive DO Tx
- 1st line
- 2nd line
- 3rd line

A
  1. SSRI/SNRI, Bupropion (Welbutrin), Mirtazapine (Remeron)
  2. SWITCH SSRI/SNRI, ADD Diff antidepress, ADD 2GA
  3. SWITCH SSRI/SNRI, TCA, MAOI, Esketamine, ECT
32
Q

MDD Med Therapy Timeline
- ___ - ____ Wks -> PHYSICAL SS improve
- ____ - _____ Wks -> EMOTIONAL improvement
- ____ - ____ Wks -> FULL EFFECTS SEEN

A
  • 1-2 Wks -> PHYSICAL
  • 3-4 Wks -> EMOTIONAL
  • 6-8 Wks -> FULL EFFECTS
33
Q

6 SSRIs

A
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertaline (Zoloft)
34
Q

Which 2 SSRIs can cause QTc Prolongation

A
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
35
Q

Which SSRI has the longest half-life (~50Hr)

A

Fluoxetine (Prozac)

36
Q

Which SSRI is ONLY used for OCD (Off-label for depression)

A

Fluvoxamine (Luvox)

37
Q

Which SSRI causes the MOST SE -> SLEEPY, WT GAIN, Anticholinergic

A

Paroxetine (Paxil)

38
Q

Whcih SSRI?
- FOOD increases absorption
- HIGHEST GI (DIARRHEA)
- Slightly sedating

A

Sertaline (Zoloft)

39
Q

3 Serotonin Modulators

A
  • Trazodone (Desyrel) -> Priapism risk, Sleepy
  • Vilazodone (Viibryd)
  • Vortioxetine (Trintellix)
40
Q

Which Serotonin Modulator has a risk of PRIAPISM & SLEEPY

A

Trazodone (Desyrel)

41
Q

Serotonergic SE

A
  • Hyponatremia
  • GI
  • Weak, Fatigue
  • Sleep disturb
  • Incr Risk BLEEDING (effect on PLT)
  • Sexual Dysfn
  • Wt Changes
42
Q

5 SNRIs

A
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristia)
  • Duloxetine (Cymbalta)
  • Levomilnacipran (Fitizima)
  • Viloxazine (Qelbree)
43
Q

_______ is also great for neuroathy

SSRI or SNRI?

A

SNRI

44
Q

Venlafaxine (Effexor) is an SSRI at ______ doses & an SNRI at ______ doses

LOW or HIGH?

A

LOW Dose = SSRI
HIGH Dose = SNRI

45
Q

Which SNRI?
* BAD For LIVER
* Risk of Acute Angle Glaucoma

A

Duloxetine *Cymbalta)

46
Q

Which SNRI is for ADHD, NOT Depression

A

Viloxazine (Qelbree)

47
Q

Noradrenergic SE

A
  • Tremors, Jittery
  • Tachy, HTN
  • Sweating, Urinary Retention
48
Q

True or False?
SSRIs & SNRIs cause Hyponatremia and are CI with MAOIs

A

TRUE

49
Q

Bupropion (Welbutrin) MOA

A

Blocks Dopamine & Norepi reuptake

50
Q

Bupropion (Welbutrin) Contraindications

A
  • Hz Sz or ETOH abuse -> SEIZURE RISK
  • Anorexia /Bulemia
  • Acute Angle Glaucoma
51
Q

Which Bupropion formulation is for SMOKING CESSATION?

A

Bupropion SR (Zyban)

NOT Welbutrin

52
Q

Dopaminergic SE

A
  • EUPHORIA
  • Nightmares/Odd dreams
  • Seizures
  • Psychosis aggrivation
53
Q

True or False: Bupropion has a LOWER RISK OF SEXUAL DYSFN and is CI with MAOIs

A

TRUE

54
Q

TCAs MOA

A
  • Blocks Serotonin and Norepi Reuptake
  • Blocks Alpha-adrenergic, Histamine, Muscarinic receptors
55
Q

TCAs -> 2ndary vs Tertiary Amines
* Amitriptyline (Elavil
* Doxepin (Sinequan)
* Desipramine (Norpramin)
* Imipramine (Tofranil)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)

A

SECONDARY AMINES (DNP)
* Desipramine (Norpramin)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)

TERTIARY AMINES (AID)
* Amitriptyline (Elavil
* Imipramine (Tofranil)
* Doxepin (Sinequan)

  • Secondary amines -> more selective for norepi reuptake block -> LOWER RISK FOR SE
  • Tertiary amines -> more selective for serotonin reuptake block, Histamine block, Ach block -> MORE SE
56
Q

Which TCA is also used for
- HA prevention
- Pain syndromes

A

Amitriptyline (Elavil)

57
Q

Which TCA is also used for Insomnia

A

Doxepin (Sinequan)

58
Q

TCAs -> ___ Amines have MORE SE

Secondary or Tertiary?

A

TERTIARY

59
Q

True or False -> TCAs incr QTc prolongation risk and DECR Seizure threshold

A

TRUE

60
Q

do TCAs cause anticholinergic or cholinergic SE?

A

ANTICHOLINERGIC (DRY)

61
Q

Anti-histamine SE

A
  • Sedation
  • WT gain
  • Confusion
62
Q

Alpha-1 blcoker SE

A
  • HypoTN
  • Dizzy
63
Q

Mirtazapine (Remeron) MOA

A

blocks alpha-2 adrenergic receptors -> inhibits (-) feedback -> allows for more SEROTONIN & NOREPI to be secreted and avail

64
Q

Which antidepressant is best for MDD if ELDERLY & WANT WT GAIN

A

Mirtazapine (Remeron) SE:
* ** Decr anxiety
* INCR APPETITE**
* Insomnia
* GI upset
* Sexual dysn

LESS bad SE than in SSRIs

65
Q

MAOIs MOA

A

blocks the MAO enzyme -> more neurotransmitters avail

normally, the MOA enzyme metabolizes Dopamine, Serotonin, Norepi

66
Q

4 MAOIs

A
  • Tranylcypromine (Parnate)
  • Phenelzine (Nardil)
  • Isocarboxazid (Marplan)
  • Selegiline (Emsan)
67
Q

Which Low-dose MAOI is used for Parkinson’s?

A

Selegiline (Emsan)

Selefiline at LOW doses is selective for MAOB = Dopamine

68
Q

MAOIs Considerations

A

HUGE HTN RISK
* AVOID TYRAMINE-Rich diet (aged cheese, smoked meats, pickled foods, red wine, craft beer, soy sauce, fava beans, yeast extract)
* DO NOT TAKE IF Heart prob or have HAs

69
Q

SSRIs, SNRIs, and TCAs need a ___wk washout period before transitioning to/from MAOIs

A

2

to prevent Serotonin Syndrome

70
Q

Which meds have a HTN risk **bc they incr Norepi & Dopamine

A
  • SNRIs, TCAs, Bupropion (Welbutrin)
  • Stimulants
  • OTC Pseudophedrine
71
Q

Serotonin Syndrme Tx

A

Benzos
Cyprohepatadine

72
Q

Neuroepileptic Malignant Syndrome
- ET?
- SS?
- Tx?

A
  • ET: Antipsychotics (1GA>2GA), Nausea meds that incr Dopamine (Metoclopramide, Promethazine)
  • SS: LONG onset & Resolution -> Bradyflexia, Muscle rigidity, Hyperthermia, Flunctuating BP
  • Tx: Bromocriptine (Dopamine agonist)
73
Q

Tx for Bipolar Acute mania or mixed episode

A
  • Lithium
  • Valproic acid
  • Carbamazepine
  • 2GA
  • SEVERE -> Lithium or Valproate + 2GA
74
Q

Bipolar Depression Tx

A
  • Lithium or Lamotrigine
  • +/- Antidepressant (NO TCAs & NEVERE AS MONOTHERAPY)
75
Q

Bipolar Maintenance Tx

A
  • used what worked best in the past
  • only consider antipsychotics when in psychosis or trying to prevent psychosis relapse

BREAKTHROUGH SS -> ADD ANY
1. Lithium, Valproic acid
2. Lamotritigine, Carbamazepine
3. 2GA
4. Antidepressant

Pharmacology (14 decks)

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