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Psych drugs Flashcards

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1
Q

SGA that cause hypertriglyceridemia

A

Clozapine, Olanzapine, Quetiapine

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2
Q

SGA that cause significant weight gain

A

Clozapine and Olanzapine

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3
Q

SGA that might cause weight gain

A

Aripiprazole, Brexipiprazole, Cariprazine, Lurasidone, Ziprasidone

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4
Q

SGA that cause EPS ADEs

A

Risperidone and Paliperidone

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5
Q

SGA least likely to cause EPS ADEs

A

Quetiapine and Clozapine

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6
Q

SGA that increase prolactin

A

Risperidone and Paliperidone

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7
Q

SGA that prolong QTc

A

Clozapine, Ziprasidone, Paliperidone, Quetiapine, Iloperidone

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8
Q

SGA with anticholinergic

A

Olanzapine, Quetiapine, *Clozapine

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9
Q

SGA that cause orthostatic HoTN

A

Clozapine, Iloperidone
-Moderate: Quetiapine, Risperidone, Paliperidone

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10
Q

SGA that cause sedation

A

Clozapine
-Moderate: Olanzapine, Quetiapine, Ziprasidone

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11
Q

SGA that cause seizures

A

Clozapine (dose dependent)

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12
Q

SGA with hematologic effects

A

Clozapine

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13
Q

MOA of FGA

A

block D2 receptors, minimal 5-HT2A blockade

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14
Q

FGA ADEs

A

EPS- Acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia
NMS
Dermatologic
Hyperprolactinemia
QTc prolongation (Thioridazine Haloperidol)
M1/H1/Alpha1

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15
Q

Acute dystonia management

A

Occurs w/in 24-96 hours
NO ORAL MEDS! Diphenhydramine/Benztropine IM

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16
Q

Pseudoparkinsonism management

A

Occurs w/in first month
decrease dose/swith to SGA
Benztropine, Trihexyphenidyl, or Amantadine Tx for several months

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17
Q

Akathisia management

A

Occurs w/in 3 months
Swith to SGA
Tx w/ Propranolol

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18
Q

Tardive Dyskinesia management

A

Long term exposure
discontinue anticholinergics
Ingrezza or Austedo (VMAT2 inhibitors)

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19
Q

Neuroleptic Malignant Syndrome (NMS) management

A

supportive care
Dantrolene, Bromocriptine, BDZs
wait at least 2 weeks to restart new antipsychotic therapy

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20
Q

Asenapine pearl

A

SL only, no food/drink for 10 minutes after dose

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21
Q

Cariprazine pearl

A

steady state takes several weeks

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22
Q

Lurasidone pearl

A

must take w/ at least 350 calories

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23
Q

Paliperidone pearls

A

bioavailability increased when taken w/ food

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24
Q

Quetiapine pearl

A

hypnotic at 50mg, antidepressant at 300mg, antipsychotic at 600mg

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25
Ziprasidone pearl
must take w/ at least 500 calories
26
Clozapine pearls
DOC for Tx resistant Schizo (failed 2 others) titrate slowly due to orthostatic HoTN REMS due to risk of neutropenia- monitor ANC= total WBC x [%neutrophils (segs+bands)/100] can initiate if ANC >1500 for most or >1000 if BEN. monitor ANC q week for 6 moths then every other week from months 6-12 then monthly after 12 months
27
Clozapine ADEs
-HoTN, Bradycardia, Syncope, CArdiac arrest (during initiation) -Seizures are dose dependent -Myocarditis and cardiomyopathy most likely in first 8 weeks of Tx. DO NOT CHALLENGE -weight gain, hypertriglyceridemia, QT prolongation, anticholinergic, orthostatic HoTN, sedation, seizure, hematologic
28
Acute mania treatment
1. LITHIUM 300mg TID level 0.6-1.2mEq/L 2. VPA or Carbamazepine 3. SGA +/- Benzos
29
Lithium side effects
short term: GI, hand tremor, polyuria/polydipsia long term: cognitive, hypothyroidism, derm, weight gain
30
Lithium DDIs
1. NSAIDs increase Li+ 2. HCTZ incrase Li+ 3. ACEi increase Li+ 4. Sodium decreases Li+
31
Valproic Acid ADEs
alopecia, sedation, dizzy, tremor, GI, INCREASED LFTs, increased ammonia, TCP, hepatotoxicity/pancreatitis rare
32
Carbamazepine ADEs
for Tx failure w/ Li+ or VPA hyponatremia, nausea, dizziness, hepatotox, SJS, agranulocytosis
33
Oxcarbazepine ADEs
3rd line acute mania, 4th line maintenance somnolence, h/a, dizzy, hyponatremia, derm, less heme effects than Carb
34
Lamotrigine ADEs
ONLY Maintenance h/a, RASH, drowsy, nausea, ataxia, SJS
35
Bipolar maintenance monotherapy options first line
1. Lithium 2. Divalproex, Lamotrigine, Quetiapine, Olanzapine, Aripiprazole, Ziprasidone
36
Bipolar maintenance second line
Carbamazepine, Paliperidone, Asenapine, Combos with lithium/divalproex
37
Treatment of bipolar depression
1. Lithium 2. Quetiapine, Lurasidone 3. Olanzapine, Fluoxetine 4. Lamotrigine, Valproate
38
Anxiety Treatment
1. Antidepressants- Paroxetine, Escitalopram, Sertraline, Duloxetine, Venlafaxine (TCAs were but only Imipramine used now) 2. Buspirone, BDZs (not for long term Tx) 3. Hydroxyzine, Quetiapine, Pregabalin
39
Panic disorder Tx
1. Sertraline, Fluoxetine, Paroxetine, Venlafaxine 2. switch to another SSRI or Venlafaxine 3. Imipramine, Venlafaxine, or another SSRI 4. Beta blocker, Clonazepam, Alprazolam
40
Social anxiety disorder tx
1. Paroxetine, Sertaline, Venlafaxine -if partial response add Buspirone or Klonopin
41
Performance anxiety treatment
Propranolol 10-80mg or Atenolol 25-100mg
42
OCD Tx
1. Fluoxetine, Fluvoxamine, Sertraline, Paroxetine, Clomipramine 2. try different SSRI 3. Clomipramine
43
PTSD Tx
1. Sertraline, Paroxetine, Venlafaxine 2. TCAs or Mirtazapine 3. MAOIs 4. Prazosin
44
Depression Tx
1. SSRIs, SNRIs, Bupropion, Mirtazapine 2. TCAs, MAOIs, serotonin modulator (Trazodone, Viibryd, Britellix)
45
SSRI ADEs
N/V/D, h/a, tremor, akathisia, serotonin syndrome *sexual dysfunction most common reason to d/c
46
Serotonin syndrome SEs
Shivering Hyperreflexia Increased temp Vital signs unstable Encephalophathy Restlessness Sweating
47
Serotonin syndrome Tx
mild- lorazepam for agitation moderate to severe- cyproheptadine, chlorpromazine propranolol
48
Best SSRI in cardiac patients
Sertraline
49
SSRIs that cause QTc prolongation
Citalopram and Escitalopram
50
Sedating SSRI
Paroxetine
51
Activating SSRI
Fluoxetine
52
SNRIs
n/v/d, sexual dysfunction, insomnia, dizziness, h/a, dry mouth, increased HR Increase in DBP
53
Duloxetine ADEs
urinary difficulty, hepatotoxicity
54
TCA ADEs
dry mouth, constipation, blurry vision, urinary retention, weight gain, memory, delirium
55
Bupropion ADEs
seizures**, h/a, anxiety, n/v, weight loss, insomnia
56
Mirtazapine ADEs
somnolence, dry mouth, increased appetite, weight gain**, sedation**, minimal sexual dysfunction
57
Esketamine Intranasal (Spravato)
for treatment resistent depression w/ oral antidepressant 56mg twice weekly (28mg each nostril) ADEs: HTN, sedation
58
Depression in Pediatrics
*Fluoxetine and Escitalopram*
59
Depression in pregnancy
SSRIs!
60
61
Olanzapine ADEs
Weight gain Hypertriglyceridemia Anticholinergic Sedation
62
Risperidone ADEs
EPS Increased prolactin Orthostatic HoTN
63
Risperidone ADEs
EPS Increased prolactin Orthostatic HoTN
64
Quetiapine ADEs
Hypertriglyceridemia QTc prolongation Anticholinergic Orthostatic HoTN Sedation
65
Paliperidone ADEs
EPS increased prolactin QTc prolongation Orthostatic HoTN
66
Ziprasidone ADEs
QTc prolongation Sedation

IPCS 3 (5 decks)

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