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Psych Meds Flashcards

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1
Q 
1. Mechanism of action of:
Fluoxetine
Sertraline
Citalopram
Paroxetine
Fluvoxamine
Escitalopram
A

SSRI

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2
Q

List 5 common side effects of SSRI’s.

What psych disorder can SSRI’s make worse?

A 
Nausea, diarrhea
Sexual dysfunction
Headache
Anxiety
Bleeding risk- dysfunction of platelets

Can worsen mania

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3
Q

Fluoxetine

  1. Half-life (long or short)
  2. Inducer or Inhibitor
A
  1. Longest- therefore less discontinuation syndrome and need more time (3-4 weeks) before starting MAOi
  2. Inhibitor (increases TCA’s, warfarin, CBZ, PHT, thioridazine, buproprion
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4
Q

Fluvoxamine

  1. Inducer or Inhibitor
  2. Marketed for what disorder specifically
  3. Half-life (long or short)
A
  1. Inhibitor (increases warfarin levels)
  2. OCD
  3. Short (higher risk of serotonin synd)
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5
Q

Paroxetine

  1. Inducer or Inhibitor
  2. Half-life (long or short)
A
  1. Inhibitor (increases warfarin levels)

2. Short (higher risk of serotonin synd)

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6
Q

Sertraline

  1. Inducer or Inhibitor
  2. Can cause what false positive on drug tox screen?
  3. What is an additional mechanism of action?
A
  1. Inhibitor (sometimes inhibits warfarin metabolism)
  2. Benzo’s
  3. DA transporter inhibitor
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7
Q

Citalopram

  1. Specific side effect warning at high doses?
A
  1. QT prolongation- irregular cardiac rhythms
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8
Q

Serotonin syndrome:

  1. List the electrolyte and lab abnormalities.
  2. List the clinical symptoms (different from NMS).
  3. What if a person has repeated episodes of serotonin-like syndromes?
A 
1. Hyponatremia
hypocalcemia
hypomagnesium 
elevated LFTs
elevated CK (rhabdo)- most serious complication
leukocytosis
  1. Shivering, myoclonus
  2. Order CT Chest- may be lung cancer.
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9
Q
  1. Mechanism of action of:
    Venlafaxine
    Desvenlafaxine
    Duloxetine
A

SNRI’s (5HT reuptake inhib and NE reuptake inhib)

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10
Q

Venlafaxine

  1. Can cause what false positive on drug tox screen?
  2. Most common side effect?
A
  1. PCP

2. HTN- do not use with anticoagulation or acute angle glaucoma

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11
Q

Trazodone

  1. Can cause what false positive on drug tox screen?
  2. Mechanism of action
A
  1. Amphetamine
  2. 5HT reuptake inhib
    Presynaptic 5HT antagonist
    Postsynaptic 5HT agonist at high dose
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12
Q

Buproprion

  1. Mechanism of action
  2. Also used for what?
  3. Major side effect concern
  4. What side effect does it NOT cause that other anti-depressants do?
A
  1. Increases NE and DA
  2. Smoking cessation
  3. Lowers seizure threshold (especially with eating disorder)
  4. Sexual dysfunction
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13
Q

Mirtazapine

  1. Mechanism of action
A
  1. Increases 5HT and NE
    Post-synaptic 5HT1 agonist
    Presynaptic 5HT 2 and 3 antagonist
    Presynaptic alpha antagonist
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14
Q

List 3 major psych meds (1 med and 2 categories) that cause weight gain.

A

Mirtazapine
TCA’s
MAOi’s

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15
Q

Side effects of ECT?

A

Temporary anterograde and retrograde amnesia

Anethesia risks

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16
Q

Lithium

  1. List side effects
  2. List 2 additional side effects with toxic doses
A 
1. Tremor
Ataxia
Acne
Weight gain
Polyjria
Hypokalemia
Hyperparathyroidism and hypercalcemia
  1. QT prolong
    Renal failure- May need dialysis
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17
Q

Which 2 antipsychotics are lowest risk of worsening PD?

Study These Flashcards
A

Clozapine and quetiapine

18
Q

1a. List typical antipsychotics- low potency
1b. Mechanism of action.

2a. List typical antipsychotics- high potency
2b. Mechanism of action

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A

1a. chlorpromazine and thioridazine
1b. DA blockade, anti-ACh, anti-NE, and anti-H1 (more side effects but less EPS)

2a. Haloperidol, thiothixene, fluphenazine
2b. Mainly DA blockade

19
Q

Typical antipsychotics

  1. Which one safest in pregnancy?
  2. Which one least risk of metabolic syndrome?
  3. What is the black box warning?
Study These Flashcards
A
  1. Haloperidol
  2. Haloperidol
  3. Increased mortality in elderly with dementia related psychosis
20
Q
  1. List atypical antipsychotics

2. Mechanism of action

Study These Flashcards
A 
1. Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
Aripiprazole
Paliperidone
Lurasidone
  1. 5HT>DA blockade and D4>D2 blockade
21
Q

Clozapine

  1. Category of drug
  2. Side effects
  3. What condition does it specifically decreases suicide attempts?
  4. What side effects does it NOT have?
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A
  1. Atypical antipsychotic
2. Greatest risk of seizures
Agranulocytosis
Neutropenia
Severe anti-ACh and Anti-H1 side effects- sedation and drooling (most common)
Eosinophilic colitis
  1. Schizophrenia
  2. EPS and tardive dyskinesia
22
Q

Olanzapine

  1. Category of drug
  2. Side effects
Study These Flashcards
A
  1. Atypical antipsychotic
  2. Massive weight gain
    Sedation
23
Q

Quetiapine

  1. Category of drug
  2. Side effects
Study These Flashcards
A
  1. Atypical antipsychotic

2. Weight gain, sedation (anti-H1), hypotension (alpha blockade)

24
Q

Risperidone

  1. Category of drug
  2. Mechanism- how is it different from other atypicals?
  3. Side effects
Study These Flashcards
A
  1. Atypical antipsychotic
  2. Highest D2/ 5HT blockade ratio
  3. Dose related EPS
    Hyperprolactinemia- gynecomastia
    Decreased libido
    Ortho hypotension
25
Aripiprazole 1. Category of drug 2. Mechanism
1. Atypical antipsychotic | 2. partial agonist, high affinity at D2 and 5HT receptor
26
Ziprasidone 1. Category of drug 2. Side effects
1. Atypical antipsychotic 2. Prolong QT the most EPS
27
Lurasidone 1. Category of drug 2. Mechanism 3. List 3 meds that increase Lurasidone.
1. Atypical antipsychotic 2. Antagonist at D2 and 5HT Partial agonist at 5HT1A 3. Ketoconazole, rifampin, and diltiazem
28
What do you use to treat EPS: acute dystonia?
Benadryl or benztropine
29
What do you use to treat EPS: akathisia?
Propranolol, benzo, or anticholinergic
30
What do you use to treat EPS: parkinsonism?
Reduce antipsychotic Add anticholinergic Switch to more "atypical" drug
31
NMS 1. Mechanism of pathology 2. Symptoms 3. Treatment
1. DA blockade- temp is reset in hypothalamus and EPS ``` 2. AMS Rigid Fever Tremor Autonomic instability Leukocytosis Elevated CK ``` 3. Stop antipsychotic, cooling and hydration, bromocriptine, dantrolene
32
Bromocriptine mechanism
DA agonist
33
Dantrolene mechanism
Blocks Ca release (muscle relaxant)
34
Buspirone mechanism of action
Partial agonist at 5HT1A
35
Benzo mechanism of action
GABA-A agonist
36
Barbituate mechanism of action
GABA-A agonist
37
Flumazenil 1. Mechanism 2. What is it used for
1. Benzo antagonist | 2. Benzo overdose
38
Naloxone 1. Mechanism 2. What is it used for
1. Opioid antagonist | 2. Opioid overdose
39
Naltrexone 1. Mechanism 2. What is it used for
1. Competative antagonist at opioid receptor | 2. maintain drug-free state in opioid dependence
40
Methadone 1. Mechanism 2. What is it used for
1. Opioid agonist | 2. Replace Heroin
41
Buprenorphine 1. Mechanism 2. What is it used for
1. Partial mu-opioid agonist | 2. Alternative to methadone

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