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psych- not in EH's cards Flashcards

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1
Q

failure to taper down antidepressants will result in this syndrome

A

withdrawal syndrome w FINISH sx

flu like sx, insomnia, nausea, imbalance, sensory changes, hyperarousal

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2
Q

which two SSRIs have dual MOAs

A

V for 2

Vilazodone= SSRI and partial agonist of 5HT1A
Vortioxetine= SSRI and partial agonist of 5HT1B and full antagonist of 5HT1A,D,3-7
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3
Q

sx of serotonin syndrome

A

sweating, hyperreflexia, myoclonus, shivering/tremors

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4
Q

SSRIs w LEAST cyp450 interaction

A

escitalopram

vortioxetine

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5
Q

describe receptor sensitivity of different types of SNRIs

A

NON-TCA= 5HT > NE
3 amines= mostly equal (except A+C act like non-TCA)
2 amines= NE> 5HT

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6
Q

AEs of trazodone

A

= SARA
sedation and orthostatic hypotension
priapism

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7
Q

AEs of mirtazapine

A

sedation and weight gain

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8
Q

bupropion

A

nicotine withdrawal
antidepressant
trx ADHD sx (inattentiveness)

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9
Q

MOA of MAO-I

A

MAO breaks down NE, 5HT, DA so we stop that

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10
Q

what are the MAO inhibitors

A

isocarboxazid
phenelizine
selegiline
tranylcypromine

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11
Q

what is the only indication for fluoxemine

A

OCD

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12
Q

imipramine special indication

A

enuresis = bed wetting

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13
Q

which two antidepressants work with DA

A

amoxipine and bupropion

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14
Q

MOA of nefazodone and trazodone

A

antagonize SERT presynpatically

postsynaptically antagonize a1 (on NE neurons) and 5HT2

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15
Q

MOA of mirtazepan

A

presynaptic block a2, postsynaptic 5HT2

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16
Q

MOA of bupripion

A

block NET and D2 receptors
agonist VMAT2
=an NDRI

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17
Q

pharmokinetics +dynamics of MAO inhibitors

A 
=nonselective
except selegilline (MAO-B selective, is a patch so least sideeffects bc not systemically absorbed)

oral agents are irreversible, takes 14 days for MAO to regenerate

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18
Q

how to prevent serotonin syndrome w MAO inhibitors

A

titrate off MAO inhibitors before starting other serotonin syndrome

for 2 weeks
4 weeks for fluoxetine

due to MAO-A making tyramine, so less risk for sergelline

dont eat foods w high tyramine (picked and cheeses)

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19
Q

esketamine indication

A

treatment resistant depression, give nasally
highly addictive,
observe for 2 hours after you give it, by checking BP

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20
Q

Brexanolone

MOA and indication and how is it delivered

A

GABA(A) receptor modulator

used for postpartum depression

60 hour IV admission, lasts for 30 days

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21
Q

what mood stabilizer is considered neuroprotective

and in what part of the pbrain

A

lithium

hippocampus, anterior cingulate cortex, superior temporal gyrus, ventral prefrontal cortex

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22
Q

explain the effect of lithium function at different receptors

A 
inhib D2 (Gs and Gi) --> trx mania
inhibit NMDA receptor--> glutamate modulation

promote GABA R–> GABA release

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23
Q

MOA of benzos

A

allosteric modification of GABA A receptors–> increased Cl influx–> CNS inhibition

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24
Q

indication for benzos

A

short term insomnia (tho associated w lots of AEs+dependence)
parasomnias in children (sleepwalking/night terrors)
sk M relaxation
IV administration for status epilepticus, seizures, sedation and anesthesia
withdrawal from alc/drugs

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25
AEs of benzos
tolerance (down-regulation of GABA A) physical dependence dose related CNS depression and decreased memory central ataxia and confusion in elderly
26
general indication for barbiturates | +MOA
sedation for critically ill patients and occasionally for refractory seizures modulate GABA-A receptors to keep it open--> CNS depression
27
which barbiutate only lasts 5-10 minutes because it is redistributed quickly to sk M and fat
thiopental
28
AEs of thiopental
``` myocardial depression arrhythmia somnolence cough/sneeze bronchospasm/laryngospasm shivering ```
29
indication and contraindication for secobarbital
``` ind= insomnia and pre-anesthetic contra= respiratory ds, porphyria (dark urine, AMS, skin photophobia) ```
30
contraindications for phenobarbital
porphyria (dark urine, skin photophobia, AMS) relative contra= mental depression, suicidal tendencies, hx of drug abuse
31
describe the metabolism of barbituates
= cyp450 inducers | hepatic metabolism, renal excretion
32
describe MOA of zolpidem, zaleplon, and eszopidone
``` zolpidem= GABA A1 receptor modulator zaleplon= GABA A1 eszopidone= GABA A1 ``` --> CNS depression
33
describe use of zolpidem/zaleplon/eszopidone in elderly populations
have a higher half life in elderly so overdose can lead to cognitive impairment, delerium, impaired balance and increased falls
34
describe metabolism of zolpidem, zaleplon, and eszopidone
cyp450 inducer
35
flumazenil is an antidote for what substances
benzos, barbs, zolpidem, zaleplon, eszopidone
36
ramelteon MOA, use, metabolism
= melatonin receptor modulator in superchiasmatic nucleus of hypthalamus a hypnotic that is proven to be safe in elderly patients CYP1A2 , v big first pass AE= dizzy, fatigue, incr PRL, dec T
37
indication for buspirone | metabolism
= a hypnotic used for trx of GAD (NO sedation or M relax) | CYP3A4
38
what hypnotic can be used for short acting anxiety relief
meprobomate
39
indications for chloral hydrate
short term sedative | sleep, alc withdrawal or anxiety secondary to withdrawal
40
describe the dopamine pathways associated with sxhizophrenia
increased activity of the mesolimbic pathway (VTA-->NA) is associated with the (+) sx abn mesocorticol pathway (VTA-->cortex) is associated with (-) sx
41
what NT is associated with schizophrenia
DA
42
AEs associated w first generation antipsychotics
dry mouth, urinary retention, constipation, orthostatic hypotension, dizzy, syncope, sedation, QTC prolongation, seizure EPS+TD+prolactinemia
43
indication for primavanserine
parkinson and psychosis
44
contraindication to second generation antipsychotics
pts w heart ds, on statins or antiangina meds, high BMI - elderly w dementia -->hx of stroke - increased risk of QtC prolongation in women, elderly and those w hx of arrhythmias
45
which second gen antipsychotic is associated with agranulocytosis and metabolic changes
clozapine--> monitor WBCs before starting trx and enroll in REMS program
46
which second generation antipsychotic is associated with DRESS Syndrome and metabolic changes
olanzapine (fatal hypersensitivity 2-8 weeks after exposure) sx of skin&blood and lymphadenopathies
47
what is neuroleptic malignant syndrome and how is it treated
=severe parkinsonian like syndrome that can occur in response to antipsychotic meds starts w just AMS, progresses to rhabdomyolysis--> circulatory collapse and death trx= dantrolene (ANTIDOTE) : works at ryanodine receptor to induce peripheral M relaxation
48
antipsychotic trx for multidrug resistant patients and psychotic patients with suicidal ideation
clozapine
49
first generation antipsychotics with ZERO anticholinergic AEs or orthostatic hypotension
fluphenazine | haloperidol
50
first generation antipsychotics with A LOT OF anticholinergic AEs or orthostatic hypotension
thioridazine | chlorpromazine
51
second generation antipsychotics with least amount of AEs all of which have NO qtc prolongation, PRL change, or antichol
aripriprazole cariprazine lurasidone
52
which second generation antipsychotic is especially associated with QTC prolongation
ziprasidone
53
DA in what brain area leads to EPS and TD in what area leads to increase PRL, decreased libido
1. nigrostriatal path | 2. tuberinfundibular
54
trx for psychotic depression
olanzapine and fluoxetine combo
55
trx for mania+psychosis
lithium and anticonvulsants combo
56
benzos metabolism
cyp3a4, renal excretion
57
alprazolam indication and contra
short term anxiety, | contra a acute narrow angle glaucoma and antifungal
58
chlordiazepoxide | indication and contra
for alcohol withdrawal and management of anxiety and preop anxiety no use w opioids
59
trx for anxiety
``` alprazolam diazepam clonazepam lorazepam buspirone meprobamate ```
60
contra against lorazepam
no give to delusional old people
61
triazolam indication and contra
insomnia drugs no give w opioids
62
diazepam contraindication
myasthenia gravis sleep apnea narrow angle glaucoma
63
benzos vs barbiturates which is more sedative, which is more hypnotic
``` benzos= sedative barbituates= hypnotic ```
64
trx for tension HA
barb + acetaminophen+ caffeine
65
AE of eszopiclone
``` bad taste HA resp/viral infection dizzy rash hallucination dry mouth ```
66
indication of zaleplon
short term trx of insomnia
67
indication of zolpidem
trx of insomnia specifically w sleep initiation
68
trx of insomnia
``` secobarbitol chloral hydrate eszopiclone zolpidem zaleplon rameltion ```
69
what AEs of opioids will develop only minimal tolerance
constipation convulsions miosis
70
opioids + antidepressants -->
serotonin syndrome
71
opioids + sedative hypnotics
increased CNS depression
72
opioids + antipsychotics
increased sedation and CV effects
73
opioids + MAO inhibitors
hyperpyrexic coma (hypertensive...)
74
metabolism of atomexatine | AEs
(NE reuptake inhibitor, for ADHD) CYP2D6 AE= fatigue, dry mouth, dizzy, nervous
75
MOA of cannabis
stimulus--> increase intracellular CA post synaptic--> activate DAG lipase --> increased endocannaboid made by post-synaptic neuron --> CB1 on pre-synpatic --> anandamide (partial agonist) degraded by FAAH post synapse + 2-AG (full agonist) degraded by MAG lipase presynapse
76
dronabinol MOA indication
synthetic THC oral administration, peak effect in 2-4 hours equal affinity for CB1+CB2, less efficacious of CB2 ``` indications= anorexia in AIDS pts, chemo induced N/V off-label= obstructive apnea ```
77
CANNABIS conditions w proved efficacy conditions w/o proved efficacy
w proved efficacy= chronic pain (RA, fibromyalgia, CA, co-admin w opioids) mild N/V MS: spasticity, pain and bladder function w/o proved efficacy= ACUTE pain, tremor of Ms, huntingtons glaucoma, schizo, depression, slowing of CA growth
78
contra to cannabis
hx of psychosis, substance abuse, CV ds, resp ds
79
nabilone- who he?
THC capsule, for N/V secondary to chemo
80
missouri regulations for cannabis
need an ID card, costs $25 qualifying conditions= CA, epilepsy, glaucoma, intractable migraines, chronic pain/spasm, HIV/AIDs can grow but no more than 6 at any stages
81
CBD pharmacokinetics??
poor aqueous solubility, builds up in fat oral bioavail= 6%, more if inhaled rapid distribution CYP3A4, CYP2C19
82
CBD actions at different receptors
agonist of PPARy --> antiinflammatory neuroprotection agonist TRPV --> neuroprotection agonist of 5HT in the dorsal raphe nucleus inverse agonist of CB1 and CB2 agonist of GPR55
83
cannabis is indicated in decreasing seizures in what two seizure syndromes
Dravet Syndrome (seizures associated w warm baths) Lennox-Gastite Syndrome (seizures associated w REM sleep, start 3-5 yo but persist into adulthood)
84
what are the indications for CBD specifically
alzheimers, N/V, pain, fragile x syndrome, unwanted skin growth, CA, anxiety and depression
85
describe drug schedules
schedule 1= no med use, high addiction potential schedule 2= med use, high addiction potential schedule 3= med use, mod addiction potential schedule 4= med use, low addiction potential
86
meds for agitation in autsim
aripriprazole | risperidone

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