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Psych Meds Flashcards

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1
Q

TCAs MOA:

A

Increase Norepinephrine

-Tx for Depression/Anxiety, relieve Chronic Pain

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2
Q

SSRIs MOA:

A

Increase Serotonin

-Tx for Depression, Anxiety Disorders (Panic DO, GAD, Social Anxiety DO, PTSD) - 1st line, OCD

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3
Q

MAOIs MOA:

A
  • FILL IN

- Not used much b/c cause hypertensive crisis with tyramine exposure

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4
Q

Nefazodone (Serzone)

A
  • Increase Serotonin BOTH pre- and post-synaptically

- Tx for Depression and ???

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5
Q

Venlafaxine (Effexor)

A
  • Mixed Serotonin/Norepinephrine agent

- Tx for Depression and ???

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6
Q

Buproprion (Wellbutrin)

A

-Acts on Dopamine receptors

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7
Q

Chlorpromazine (Thorazine)

A

Antipsychotic that blocks dopamine receptors

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8
Q

Thioridazine (Mellaril)

A

Antipsychotic that blocks dopamine receptors

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9
Q

Haloperidol (Haldol)

A

Antipsychotic that blocks dopamine receptors

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10
Q

Clozapine (Clozaril)

A

Atypical antipsychotic
1. Tx: Tx-resistant schizophrenia & schizoaffective DO (pt who failed 2+ antipsychotics)

  1. SEs:
    - Leukopenia (Neutropenia) - Agranulocytosis
    * *Must monitor WBCs & Abs Neutrophil Ct
    - Eosinophilia is possible
    - Wt gain, metabolic syndrome, seizures, ileus, myocarditis, hypotension
    - LEAST LIKELY to cause EPS
    - DOES NOT CAUSE tardive dyskinesia
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11
Q

Risperidone (Risperdal)

A

Atypical antipsychotic

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12
Q

Olanzapine (Zyprexa)

A

Antypical antipsychotic

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13
Q

Benzodiazepines

A

Sedative hypnotics

  • Affect GABA neurotransmitter system & relieve anxiety
  • SEs: Sedation, reduced reflexes, tolerance, potential for addiction
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14
Q

Atypical antipsychotics with risk of orthostatic hypotension:

A

HIGH RISK:

  1. Quetiapine
  2. Clozapine
  3. Respiridone

LOW RISK:

  1. Aripiprazole
  2. Olanzapine
  3. Ziprasidone
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15
Q

Atypical antipsychotics with risk of metabolic syndrome:

A

HIGH RISK: Clozapine, Olanzapine

MEDIUM RISK: Quetiapine, Respiridone

LOW RISK: Aripiprazole, Ziprasidone

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16
Q

Atypical antispychotics with risk of anticholinergic side effects:

A

HIGH RISK:

  1. Clozapine
  2. Olanzapine
  3. Quetiapine

LOW RISK:

  1. Aripiprazole
  2. Respiridone
  3. Ziprasadone
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17
Q

Short-acting injectible atypical antipsychotics:

A
  1. Olanzipine

2. Ziprasidone

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18
Q

Long-acting/Depot form injectible atypical antipsychotics:

A
  1. Aripiprazole (dangerous) (Abilify mantenna)
  2. Olanzapine
  3. Respiridone (Resperdal consta) or Paliperidone (Invega sustenna)
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19
Q

Lithium indications:

A
  • Tx for acute mania and maintenance therapy in Bipolar Disorder
  • Has narrow therapeutic index, so can cause toxicity easily –> monitor drug levels every 6-12 months and 5-7 days after dose change or starting other meds that could interact.
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20
Q

Lithium side effects:

A

Acute:

  • Tremor, ataxia, weakness
  • Polyuria, polydipsia
  • Vomiting, diarrhea
  • Cognitive impairment
  • Wt gain

Chronic:

  • Nephrogrenic diabetes insipidus
  • Thyroid dysfunction
  • Hyperparathyroidism w/hypercalcemia

Pregnancy:

  • Exposure in 1st trimester causes cardiac malformations (septal defects & Ebstein’s anomoly –> atrialization of rt ventricle)
  • Exposure in 2nd/3rd trimesters causes goiter and transient neonatal neuromuscular dysfunction.
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21
Q

Lithium contraindications:

A

Don’t use lithium in pts with:

  1. Heart disease (HD)
  2. Chronic kidney disease (CKD)
  3. Hyponatremia or Diuretic use
  4. Pregnancy - Litihium should be avoided or dose adjusted b/c it can cause complications in 1st trimester (Ebstein’s anomoly) and later stages (Polyhydramnios, DI, Floppy Baby)
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22
Q

Baseline studies required before Lithium use:

A
  1. BUN, Cr, Calcium, Urinalysis
  2. Thyroid Fxtn Tests
  3. ECG in pts w/coronary/CAD risk factors (HTN, DM, smoking)
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23
Q

Drugs that affect Lithium levels:

Study These Flashcards
A

INCREASE Lithium in body:

  1. Thiazide diuretics
  2. NSAIDs (except ASA)
  3. ACE-Is, ARBs
  4. Abx (ie. Tetracycline, Metro.)

DECREASE Lithium in body:

  1. K-sparing diuretics
  2. Theophylline

INCREASE or DECREASE Lithium in body:

  1. Loop diuretics
  2. Ca-channel blockers
24
Q

Tx for Delusional Disorder

Study These Flashcards
A

-Antipsychotics and/or CBT

25
Neuroleptic Malignant Syndrome (NMS):
Key Sx: 1. Severe muscle rigidity ("lead pipe" rigidity) 2. Mental status changes 3. Autonomic instability (tachycardia, arrhytmias, labile BP, tachypnea, diaphoresis) 4. High fever (can be over 104 F) * *Check for elevated serum CK and WBCs. -Due to Dopamine (D2 receptor) antagonism from antipsychotics (typical and atypical), antiemetics (promethazine/metoclopramide), antiparkinson med withdrawal, infxtn, surgery Tx: Stop neuroleptics or restart dopamine agents, supportive care (hydration, cooling), Dantrolene or Bromocriptine
26
Tx of NMS:
1. Stop neuroleptics or restart dopamine agents 2. Hydration, cooling 3. Dantrolene or Bromocriptine
27
Tx for manic episode with psychotic features:
1. Antipsychotics --> Cause NMS 2. Mood stabilizers (ie. Lithium, Valproate) --> No NMS 3. Benzos --> No NMS
28
Benzodiazepines MOA:
-Enhance GABA receptors
29
Tx of Bulemia:
-SSRIs (not effective in anorexia though)
30
Tx of Social Anxiety Disorder:
- SSRI/SNRI | - CBT
31
Tx of Performance Subtype of Social Anxiety Disorder:
- Beta Blockers or Benzos (avoid benzos in pts with h/o substance abuse) - CBT
32
Tx of GAD:
-Buspirone
33
Labs to monitor in pts on Lithium:
For 3-6 months after starting Lithium Tx, monitor: 1. Cr 2. TSH
34
Buspirone
Tx for generalized anxiety disorder (GAD)
35
Fluoxetine
1st line Tx for anxiety disorders (Panic disorder, GAD, social anxiety disorder, PTSD)
36
Olanzapine
"Zyprexa"
37
Quetiapine
"Seroquel"
38
Ziprazadone
"Geodon"
39
Aripiprazole
"Abilify"
40
Respiridone
"Resperdal"
41
Paliperidone
"Invega"
42
Clonazepam
"Klonopin"
43
Clozapine
"Clozaril"
44
Mirtazepine
"Remeron"
45
Fluphenazine
"Prolixin"
46
Serotonin Syndrome Causes:
Combo of serotinergic meds or interaction of SSRIs & MAO-Is (ie. Phenelzine) -Need 2-wk washout between stopping MAO-I and starting SSRI
47
Serotonin Syndrome Sx:
- Hyperthermia (fevers lower than in NMS) - Autonomic instability - Mental status changes - GI sx - Hyperreflexia - Myoclonus - NO RIGIDITY (vs. NMS)
48
First line tx for bipolar depressive episodes:
-Lamotrigine
49
Lamotrigine:
Tx: Bipolar depression SEs: -Stevens-Johnson syndrome (life-threatening mucocutaneous rxtn)
50
What drugs precipitate/worsen manic episodes?
- Bupropion | - Escitalopram
51
ECT therapy
-1st line tx of Psychotic Depression, esp, if urgent and need rapid response, esp. in geriatric patients unable to eat/drink or who are actively suicidal
52
Benztropine
- Anticholinergic med. | - Tx for EPS induced by antipsychotic (ie. dystonias and parkinsonism)
53
Cyproheptadine
- Serotonin antagonist | - Tx severe Serotonin Syndrome (Autonomic Instability, Altered Mental Status, Neuromuscular Irritability)
54
Carbamazepine
Mood Stabilizer & Anticonvulsant SEs: -If used in pregnancy, causes craniofacial defects, neural tube defects and genital anomalies in fetus.
55
Depakote/Valproate
Mood Stabilizer & Anticonvulsant ADD!! SEs: -If used in pregnancy, causes craniofacial defects, neural tube defects and genital anomalies in fetus.
56
Tx for ADHD:
1. Stimulants - Methylphenidate, amphetamines 2. Nonstimulants - Atomoxetine, a2-adrenergic agonists 3. Behavioral therapy
57
Atomoxetine
"Strattera" Tx: ADHD MOA: NE reuptake inhibitor

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