Psych pharm Flashcards
(216 cards)
1
Q
Most psychotropic medications - how are they soluble?
A
lipid-soluble and metabolized by cytochrome P450 liver enzymes
2
Q
if you’re a slow metabolizer, more likely to get
A
seratonin syndrome or Parkinsonism. or if too fast, meds won’t be as effective - need higher doses.
3
Q
Most antipsychotics block which receptors?
A
postsynaptic dopamine (D2) receptors. (Atypicals also antagonize 5HT2 - this is serotonin) which reduces the amount of dopamine.
4
Q
dont need to memorize - Effects on the ***mesolimbic area (limbic hallucinations)
A
decrease psychotic symptoms, especially hallucinations and delusions
5
Q
dont need to memorize Effects on basal ganglia- too much (gang up on the ESPs)
A
produce EPS due to the many different transmitters and synapses utilized in this area
6
Q
dont need to memorize - Effects on the hypothalamus - think milk
A
lead to increased pituitary production of prolactin with endocrine side effects (e.g. gynecomastia and galactorrhea (breast milk in ppl who should not be lactating)
7
Q
Blockade of acetylcholine at muscarinic receptors results in
A
anticholinergic side effects - careful w/ elderly pts.
8
Q
Antagonism of norepinephrine at alpha-1 receptors results in (nora is slow w/ ejaculation)
A
orthostatic hypotension and ejaculatory dysfunction
9
Q
Blockade of H1 receptors for histamine results in (sneezing weight)
A
sedation and weight gain
10
Q
Abrupt withdrawal of antipsychotics may cause (a syndrome)
A
discontinuation syndrome - Therefore, antipsychotics should be tapered slowly, esp. after long-term use. - main reason is ppl can relapse
11
Q
Cross-tolerance can occur with
A
antipsychotics
12
Q
Typicals - less effective for what?
A
Effective at treating positive symptoms (e.g. hallucinations and delusions), but less effective at treating negative symptoms (e.g. avolition, alogia, apathy, social withdrawal)
13
Q
typicals - High potency neuroleptics (and examples) - (high potency, high EPS) (hi pro hal)
A
High potency neuroleptics (e.g. Haldol and Prolixin) have higher risk of EPS, but less anti-cholinergic side effects.
14
Q
typicals - Low potency neuroleptics (antipsychotics) (low potency, low BP)
A
have less risk of EPS, but higher risk for orthostatic hypotension, sedation and anticholinergic side effects (urinary retention)
15
Q
typicals - Depot injections: ex. and how long do they last? (hal is a pro at injections)
A
Haldol and Prolixin can both be given as IM Decanoates (deep muscle time released) that last q3-4 to weeks.
16
Q
deconoates - problem
A
No antidote for decanoates if someone has a bad reaction - ie. NMS or dystonia. it’s usually give PO to see if pt can tolerate it before a shot. Extremely useful for very disorganized and noncompliant clients. Don’t confuse Depot injections with short-acting IM solutions!
17
Q
atypicals - good or bad at selecting dopamine receptors?
A
Greater selectivity for dopamine receptor subtypes and/or block 5HT receptor sites.
18
Q
atypicals - better at treating what
A
Believed to be more effective than typicals at treating negative symptoms, with less risk of EPS (but CATIE study has cast doubt on this belief!)
19
Q
atypical - Clozaril (clozapine)
A
Clozaril (clozapine): very effective, but a “last-resort” drug b/c of the 1-3% chance of agranulocytosis (destruction of WBC). Pts must comply with life-long, frequent blood draws (WBC/ANC).
20
Q
atypical - Olanzapine - side effect
(Ola is severely heavy)
A
Zyprexa (olanzapine): also works well, but associated with severe weight gain (average = 28 pounds in first-year), DM, lipid abnormalities.
21
Q
atypical - Risperdal (risperidone) - side effect
(risper is unsteady and heavy)
A
Risperdal (risperidone): (most like typical antipsychotics) fewer anticholinergic side effects (considered safer in the elderly), but some orthostatic hypotension and weight gain.
22
Q
atypical - Seroquel - what abnormal lab?
A
Seroquel (quetiapine): most common side effects include orthostatic hypotension and sedation (often given off label for anxiety, agitation and insomnia). Can also cause some weight gain and lipid abnormalities.
23
Q
Ziprasidone - typical or atypical)
A
atypical
24
Q
atypical - Abilify - MOA (pip is able to stabilize dopamine)
A
Abilify (aripiprazole): technically a “Third generation antipsychotic (TGA); dopamine stabilizer; efficacy less clear
25
Newer SGAs (second generation psychotics): (larisa in 2nd)
Larisadone and Asenapine
26
Newer TGAs (third generation antipsychotics): (Brex's car is 3rd generation, but new)
brexpiprazole and Cariprazine
27
Atypical Decanoates: (a typical deacon taking Zs with Susan Vega)
Zyprexa Relprevv, Invega Sustenna
28
how to select which med
Conditions that contraindicate a certain med
Past response to a med in patient or relative
Predicted adherence
Present clinical status: PO or IM needed?
Genetic testing (CYP450 (liver) SNPs)
pregnancy
29
how to select which med
Vital signs, especially BP
MSE (one sign is fever)
Labs, especially CBC, LFTs, baseline glucose
EKG in elderly or PRN (esp with geodon) range of motion - some can cause dystonic symptoms - to assess - hold out arm and bend elbow, if it’s not smooth- it’s cogwheel rigidity - can be a sign of parkinsonism.
ROM
30
Polypharmacy - which meds metabolized by P450?
Polypharmacy - the possible complications are infinite. 80% of drug-drug interactions are not tested. All psychotropics except lithium are metabolized by cytochrome P450 (a class of 30+ hepatic isoenzymes) and many drugs can inhibit this.
31
Geriatric patients are more likely to develop which side effects?
confusion, agitation, restlessness, delirium, lethargy and orthostatic hypotension.
32
Plasma levels - indicated in the following circumstances (think the main drugs...and allergic)
most common are depakote and lithium
Possible nonadherence
Partial or poor response or adverse reaction
Monitoring side effects, especially in elderly
Determining drug-drug interactions
monotherapy is best - meaning 1 antipsychotic or just one drug.
33
Extrapyramidal symptoms (EPS) - what about dopamine?
Extrapyramidal symptoms (EPS) - caused by blockade of D2 receptors in the extrapyramidal motor system. Be careful to assess properly before giving any meds to treat EPS. Improper administration can cause or exacerbate anticholinergic crisis (which can look like delirium or worsening psychosis).
34
Parkinsonism - characteristics (a form of EPS) (Fox is slow and heavy) and pain?
Fatigue
Lack of interest
Slowness
Heaviness
Lack of ambition
Vague body discomforts
35
Dystonias
muscle spasms of the face, head, neck and back
36
dystonia - Oculogyric crisis
eyes rolled upward (treatment usually given IM)
37
dystonia - Torticollis –(stoned tortoise)
Torticollis – twistindg of cervical muscles w/ unnatural head position
38
dystonia - Retrocollis (retro stoned)
Retrocollis – head drawn directly backwards
39
dystonia - Glossospasm (glossy-eyed stoner) –
Glossospasm – stiff or thick tongue (most common) ppl will talk funny with this one
40
dystonia Usually occurs during what time frame?
first three months of treatment, but can happen anytime
41
risk factors for dystonia (young man is stoned)
Risk factors include: high-potency FGAs (first generation antipsychotics), high doses, IM injections, young males
42
treatment for dystonia/glossospasm? (Art has a stoned BAC)
Treatment is IM***(because this is emergent) Benadryl, Cogentin or Artane
43
Akathisia (Akilia can't stop moving)
Akathisia - motor restlessness accompanied by the subjective sense of restlessness, nervousness and in patients.
44
Tardive dyskinesia (TD) - (what body parts) (tardy tongue)
Tardive dyskinesia (TD) - involuntary tonic muscular spasms typically involving the tongue, fingers, toes, neck, trunk or pelvis
45
TD - when does it occur?
Usually occurs after long-term treatment (months to years)
Often irreversible (50%)
Risk is up to 5-10% with typicals, 1% with atypicals.
46
TD - how to treat?
Historically, treatment is to switch antipsychotics while slowly tapering original antipsychotic.
47
Neuroleptic malignant syndrome (NMS) - caused by what neurotransmitters? (and one more)
caused by dopamine deficiency in nigrostriatum (controls movement) and hypothalamus (regulates BP and temp).
48
NMS - Seen in patients on which meds? (Fox takes a holiday from names)
antipsychotics and in Parkinson's patients on a “drug holiday.”
49
NMS - risk factors (name the young males who get IM)
Risk factors include: use of FGAs, esp. high potency e.g. (Haldol, Prolixin), rapid titration, IM meds, young males
50
NMS - emergency? and what diseases does it cause? (name the rhab)
NMS is a medical emergency. Mortality rate =10% (complications include renal failure, rhabdomyolysis and DVTs)
51
NMS - s/sx (Akila is MAD as F at NMS)
****must know this - muscular rigidity, akinesia, dysphagia, fever
52
NMS - treatment
Hold all antipsychotics
Antipyretics, cooling blankets
53
Antidepressants - how long to start working?
Antidepressants – all have delayed onset (can take four to six weeks for full effects)
54
Tricyclics (TCAs) - works best for which patients?
Oldest group of antidepressants (first discovered in the 1950s), therefore well studied and inexpensive
May work best for clients with severe major depression
55
Monoamine oxidase inhibitors (MAOIs) EX -
(phen is trans w/ mono)
e.g. Tranylcypromine, Phenelzine
Many drug interactions (many drugs are metabolized by MAO. For example, patients must be off MAOIs at least two weeks before beginning other antidepressants)
Requires intensive teaching on the tyramine-reduced diet (e.g. avoid Chianti wine, smoked meats, aged cheeses, Fava beans, MSG, etc.)
56
Selective serotonin reuptake inhibitors (SSRIs) - ex (just the 3 main ones)
e.g. fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)
57
SSRIs
Newest and most widely used antidepressants (first-line agent)
Less side effects than TCAs and MAOIs
Side effects include HA, nausea, insomnia, initial anxiety/agitation and sexual side effects
Monitor closely for serotonin syndrome (slow metabolizers are at risk) and withdrawal syndrome
Many off-label uses (e.g. premature ejaculation)
58
Buproprion (Wellbutrin) - worst side effect if you take too much
acts on norepinephrine and dopamine (NDRI), rather than serotonin. Useful for clients who experience sexual side effects with SSRIs. Also used for smoking cessation (Zyban). Side effects include insomnia, seizures (only if you exceed the max dose), sweating. really not that helpful.
59
Mirtazapine (Remeron) - MOA- (Mirt makes me happy) and used for what?
is a norepinephrine and serotonin specific antidepressant (NaSSA).
60
Venlafaxine - what type of drug? (venla is a snail)
an SNRI.
61
Dysvenlafaxine (Pristiq), Levomolnacipran (Fetzima) and Duloxetine (Cymbalta) are (and esp good for what?)
the newest SNRIs. Cymbalta may also be effective for chronic pain. esp good for severe depression.
62
Desyrel - MOA (desrell makes me happy) and what else can it cause? and what is it used for? (desrell no issues there)
predominantly serotonergic. Used more for insomnia 2/2 side effect of pronounced sedation. Can cause priapism.
63
Esketamine (Spravato) - esp good for what?
is an NMDA receptor antagonist and a dissociative agent. Used especially for TRD (treatment resistant depression) and SI. Ketamine is also given off label for other conditions.
64
Brexanolone (Zulresso) (brex just had a baby)
is a neuroactive steroid given IV for postpartum depression.
65
panic disorder - how long?
Panic disorder - recurrent panic attacks followed by a month or more of persistent concern about having another panic attack — needs to be treated urgently
66
Generalized anxiety disorder - how long?
excessive, for 6 months, but no panic attacks.
67
what important assessment for anxiety?
Important to assess if anxiety is chronic (a.k.a. trait anxiety) vs situational or reactive anxiety (e.g., following a severe loss or stressor).
68
treatment for anxiety - benzos
Benzodiazepines are best for short-term, situational anxiety and initially for panic disorder. Provide immediate relief, but high potential for addiction/withdrawal requires careful screening. Less abuse potential with longer acting BZDs (e.g. Klonopin). Always assess respirations and level of sedation!
69
treatment for anxiety - SSRIs
SSRIs, especially Prozac, Lexapro and Zoloft and Paxil, are first-line agents for long-term maintenance and for chronic anxiety. SNRIs like Effexor and Cymbalta are also used frequently.
social anxiety - use propranolol
70
treatment for anxiety - Buspirone (Buspar) - how long to work? and who don't they work for? (bupe doesn't work for us)
Buspirone (Buspar) is a non-benzodiazepine and not addictive. However, it takes a few weeks to work and is often ineffective, particularly in patients who have a history of PSA. only about 30% effective.
71
general considerations w/ anxiety
Always teach non pharmacological relaxation techniques as well (e.g., deep breathing, progressive relaxation, guided imagery)
Monitor for side effects carefully, especially in the elderly (e.g. paradoxical agitation)
Screen for history of SUD prior to giving BZDs. Monitor for s/sx of abuse and/or withdrawal.
during a panic attack - use someone’s name, short statements “breathe with me”
72
drug detox
Etoh: BZDs (Ativan - used for elderly, safer for liver - 2nd choice), Librium (long half life, best choice), Serax, Valium)
Opiates: Clonidine (inpatient), Methadone, Buprenorphine
73
Disulfiram (Antabuse) –
Disulfiram (Antabuse) – produces extreme reaction (e.g. flushing, severe HA, sweating, increased BP, pulse) if patient drinks
74
Naltrexone (Revia)
Naltrexone (Revia) blocks the euphoric effects of opioids
75
Aside from BAD, mania can be induced by (3 things)
drugs, neurologic conditions and metabolic disorders.
76
Benzodiazepines or atypical antipsychotics (e.g. Zyprexa, Risperdal) can be used as an
adjunct until mood stabilizers take effect.
77
Antidepressants & mania?
precipitate (trigger) mania
78
lithium - do we understand the MOA?
Very efficacious, especially for mania/BAD Type I, but mechanism of action is still poorly understood (alters electrical conductivity)
79
lithium is made of what?
salt, so dehydration can cause lithium toxicity
80
how long for lithium to work?
Therapeutic effect takes two to four weeks.
81
Lithium levels can be affected by:
Medical illnesses, especially ones with GI effects
Surgery
Crash dieting
Very hot climate (diaphoresis/dehydration)
Advanced age
lithium is metabolized more in kidneys than the liver
Strenuous exercise
82
who doesn't respond to lithium? (lithium doesn't mix)
20 to 40% of patients do not respond to Li, especially BAD clients with more pronounced depressive symptoms or mixed episodes
83
lithium - how often for blood draws?
Initial blood draws are done one to two times a week, then monthly. Dosage and administration and lab draws should be standardized (i.e., done at the same time of day each time).
84
lithium - Mild to moderate toxicity number
Mild to moderate toxicity – 1.5 to 2.0 mEq/L
85
lithium -Severe toxicity - (number)
Severe toxicity - > 2.0 mEq/L
86
lithium is hard on what organs?
THYROID AND KIDNEYS****
87
what blood tests for lithium? (4)
Serum creatinine (renal function)
TSH/T4 (can cause hypothyroidism)
Electrolytes (especially calcium and potassium)
EKG - can be cardiac effects from lithium
88
common side effects of lithium (what you learned for the other test) - what about GI?
Diarrhea - very common
Fine hand tremor
Nausea
Polyuria and polydipsia
Muscle weakness, lethargy - usually transient except with toxicity. Lithium can affect cardiac conductivity.
89
common side effects of lithium (kurt by door)
Elevated WBCs
Hypothyroidism with goiter
Weight gain and acne
Alopecia and/or psoriasis
90
lithium toxicity - s/sx (slurring on lithium)
Course tremors
Ataxia (walking into things)
Confusion
Slurred speech
Lethargy/sedation
Cardiovascular collapse, seizures, coma, death
Vomiting
91
treatment for lithium toxicity
dialysis
92
Valproic acid (Depakote) - with food or without? (val needs a snack)
give it with a snack or milk
93
depakote - MOA (depak loves gluten)
Mechanism of action: increase GABA (calming neurotransmitter), decrease glutamate (excitatory neurotransmitter) and probably membrane stabilizing effect
94
depakote - esp. effective for who? (dep is mixed)
Especially effective for BAD - depressed type, rapid cycling, mixed episode
95
depakote side effects
GI distress, sedation and weight gain are common.
96
what labs for depakote? (dep has liver problems)
Monitor LFTs (can be hepatotoxic)*****
97
Carbamazepine - MOA (carbs and gluten make me calm)
Similar mechanism of action to Depakote - increase gaba and decrease glutamate
98
Carbamazepine good for who? (rapid ppl love carbs)
Works well with rapid cycling patients, but has many drug interactions (e.g. decreases serum levels of Warfarin, Haldol and OCPs).
99
Carbamazepine side effects (carbs give me double vision and make me dizzy)
Common side effects include dizziness, diplopia, ataxia and sedation
100
Carbamazepine - what labs to monitor (watch your liver and platelets on carbs)
Monitor LFTs and platelets
101
Lamotrigine (Lamictal) - MOA (sodium and milk)
Mechanism of action: inhibits voltage sensitive sodium channels and stabilizes neuronal membranes
102
Lamotrigine - good for who? (milk is good for bad II)
Especially effective and usually used for BAD II and depressed episodes. Shows promise as an adjunct tx for depression.
103
lamictal - how to administer? (slow milk for jason)
Titrate very slowly and monitor for rash and allergic reaction!**** (Risk for Stevens-Johnson syndrome or toxic epidermal necrolysis = 0.1% - often fatal)
104
Topiramate (Topamax) - does it cause weight gain?
Not very effective as monotherapy, but often used as an adjunct with other mood stabilizers (esp. to counteract weight gain)
105
topamax - off label (top of the PTSD to ya)
Off label uses include PTSD, anxiety, migraine prophylaxis, bulimia
106
topamax - side effects (you know this - migraine)
Most common side effect is cognitive dysfunction (about 1/3 of ppl have it) can be disabling. helps with cravings in general
107
Gabapentin (Neurontin)
Not a first-line treatment for BAD, but can be used as an adjunct treatment. Also used for major depression, anxiety and neuropathic pain.
108
Many atypical antipsychotics are also now FDA approved for treatment of (psycho can treat mania)
acute mania and/or BAD maintenance: Zyprexa, Risperdal, Geodon, Seroquel, Saphris, Latuda
109
dementia - Cholinesterase inhibitors - how do they work?
slow down deterioration of cognitive functioning by increasing acetylcholine production, but benefits decline as more cholinergic neurons are lost (most dementia is irreversible).
110
Donezepil - what type of drug
Cholinesterase inhibitor
111
Donezepil (Aricept). - when to give it?
Only mildly helpful, but it’s the most commonly used med for dementia. Give in AM due to nightmares.
112
NMDA (glutamate) receptor antagonist EXAMPLE: (decreases glutamate) (MDMA is a meme)
Namenda (memantine)
113
memantine - MOA (think - you know this)
may temporarily slow deterioration of dementia by reducing excitotoxicity (glutamate).
114
Cylert treats what?
ADHD
115
Atomoxetine (Strattera) - MOA - (atoms are not as effective)
this is not a stimulant, usually not as effective.
116
ADHD meds - do they work well?
Highly efficacious (75 to 90% of ADHD pts respond to medication)
117
ADHD meds - side effects
Monitor for side effects such as headache, nervousness, dizziness, emotional lability, anorexia, insomnia (may need to decrease dose). appetite and sleep are the biggest deal.
118
Electroconvulsive therapy (ECT) - esp good for which patients? (shock into consciousness)
clients with catatonia, psychosis and/or vegetative symptoms
119
Electroconvulsive therapy (ECT) - pre operative care
Empty bladder, remove jewelry
NPO after midnight
IV usually started in OR
Prepare patient and family for common side effects: confusion, short-term memory loss and headache
signed consent.
120
Electroconvulsive therapy (ECT) - post operative care
Analgesics, usually NSAIDs, for HA
Reorient client PRN
Allow client to eat (saved breakfast/lunch) and sleep.
Reassure client and family that memory loss is usually temporary.
121
antipsychotics - withdrawal - discontinuation syndrome symptoms (zap the withdrawals)
sleep disturbances, dizziness, tremors, “brain zaps (when ppl change positions), anxiety and muscular discomfort.
122
Low potency neuroleptics - ex (thor and mel are low, but they're psycho)
thorazine and mellaril
123
clozapine - pros and cons (claus is 2nd generation) - and what about the heart?
Very low risk for EPS, but high risk for weight gain and DM, and myocarditis
124
olanzapine trade name
Zyprexa
125
Slightly higher risk for EPS, TD and hyperprolactinemia than other atypicals. (respiradol gives me ESP)
respiradol
126
lactation
respiradol
127
quetiapine trade name
seroquel
128
ziprasidone - trade name
geodone
129
Ziprasidone - not good for who? (Zip not good for ppl w/ broken hearts)
Not good for cardiac patients as it can cause prolongation of QT wave interval.
130
Ziprasidone - with food, or not?
(Zipping around you need a lot of food)
Absorption is doubled when taken with food. Eat a full meal before taking it, breakfast and dinner.
131
aripiprazole - weight gain? (pip doesn't gain much weight)
not much weight gain, 10 lbs a year.
132
aripiprazole - trade name
(Pip is able)
abilify
133
aripiprazole - weight? and higher risk for? (pip is able stay stable akila)
more “weight neutral”, somewhat activating w/ possibly higher risk for akathisia.
134
lurasidone (L)
Latuda
135
Saphris (saphire ascends)
asenapine
136
Rexulti (rex is brex)
brexpiprazole
137
Vraylar (vrm car)
cariprazine
138
atypical decanoates (a typical deacon is able to wrisper)
Risperdal Consta, Abilify Maintena
139
how is akisthesia treated? (treat akila's public speaking)
In contrast to agitation, akathisia is relieved by reducing dose of antipsychotic. Often treated with Propranolol (monitor BP!)
140
early signs of TD
Earliest signs include: rapid blinking, vermiform tongue. Also: grimacing, lip smacking, choreoathetoid movements of the extremities and trunk (jerky full body)
141
parkinsonism - muscles?
Muscular rigidity (e.g. cogwheeling, lead pipe - arm stays in a position)
Alterations of posture (stuck in a position)
142
parkinsonism - tremors? (Fox rolls the pills)
Tremor (especially resting hand tremor) (pill rolling)
Mask-like faces
Shuffling gait
143
parkinsonism - salivation? (Fox drools)
Hypersalivation (most common), drooling, difficulty swallowing
144
parkinsonism and dystonia - treatment (Fox is BACS to the same 3)
Tx = PO Cogentin, Artane, Benadryl or Symmetrel. Also, consider reducing the dose of antipsychotic and/or changing med. Do not treat EPS prophylactically!
145
TD - meds (Ted was treated in Austin w/ val)
Ingrezza (valbenazine) and deutetrabenazine (Austedo) are now FDA approved for tx of tardive dyskinesia (can cause QT prolongation)
146
NMS - s/sx (Akila is MAD as F at NMS with a heart rate and pee)
must know this - tachycardia, labile hypertension, incontinence
147
NMS - labs (3 things) - (name the blood, liver, and kidneys)
must know this - and altered labs (high WBC, LFTs, CPK- creatinine, r/t muscle necrosis), severe muscle rigidity
148
NMS - treatment - fluids?
Restore fluid/electrolyte balance
Monitor for renal failure
149
NMS - what meds treat it (think about what causes NMS)
Anticholinergics are not useful and may exacerbate signs and symptoms
Dopamine agonists (increase dopamine) are sometimes helpful
Ativan may be helpful in early stages for rigidity
150
TCAs - examples (Amine works for the TSA)
e.g. Clomipamine, Amitriptyline, Desipramine, Imiprimine (ends in amine it’s usually a TCA)
151
TCA - mechanism of action (TCA confiscates epi and sera)
block both norepinephrine and serotonin reuptake
Many side effects: endocrine, anticholinergic, orthostatic, cardiac and sexual
High suicide potential (frequently lethal in overdose)
152
MAOIs - risk for what? (high salt, high BP)
Risk for hypertensive crisis (double vision, headache)
Generally used as a last resort medication or for atypical depression (increased appetite, etc)
153
SSRIs (Sirrr Luvs celexa)
fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro)
154
Prozac - generic name (pro flu)
fluoxetine
155
Zoloft - generic name
sertraline
156
Paxil - generic name
paroxetine
157
Luvox - generic name
fluvoxamine
158
Celexa
citalopram
159
SSRIs - withdrawals - which drugs are the worst and best?
worst for zoloft and paxil (shortest half life). prozac has a long halflife, so lesser withdrawals.
160
Remeron - generic name
Mirtazapine
161
mirtzapine - side effect? (mirt is slow and heavy)
Causes fewer sexual side effects. 2/2 side effects of sedation and weight gain. makes ppl hungry and tired.
162
remeron good for which clients? (cameron's mom)
Good for elderly clients with vegetative symptoms
163
Effexor - generic name
Venlafaxine
164
effexor - risk for what (the effects are high BP)
Risk for increased DBP (diastolic bp) at high doses. High remission rate, especially for severe, refractory depression.
165
effexor - effects on high and low doses
acts more serotonin at low dose, and norepinephrine at a high dose.
166
Pristiq - generic name (prissy is dysen)
Dysvenlafaxine
167
Fetzima - generic
Levomolnacipran
168
Cymbalta - generic name
Duloxetine
169
Trazodone - generic name
Desyrel
170
Spravato - generic name
Esketamine
171
Zulresso - generic name (brex is a zulu)
Brexanolone
172
benzos increase what? MOA
increase gaba
173
what to watch for w/ anxiety in kids and elderly?
in elderly or kids - be careful w/ benzos. they can develop paradoxical affects, ie. increased anxiety
174
lithium and pregnancy
Pregnancy (crosses placental barrier) cannot take during pregnancy - it’s a teratogen
175
Namenda - generic name (name that meme)
memantine
176
memantine - does it work well?
Slightly improves mood, well-being and functioning (doesn’t help as much with cognition).
177
namenda - works best when?
Most effective when combined with a cholinesterase inhibitor for additive effects.
178
namenda - approved for what types of dementia?
Approved for moderate to severe dementia.
179
Cylert - generic name
Pemoline
180
Strattera - generic name
Atomoxetine
181
Ritalin - generic name
methylphenidate
182
Concerta
OROS methylphenidate
183
Strattera treats what? (Struttin w/ ADHD)
ADHD
184
Clonidine and guanfacine treats what?
ADHD
185
dextroamphetamine (Dexedrine, Adderall) treats what?
ADHD
186
Concerta treats what?
ADHD
187
Clonidine and guanfacine - MOA - and works better for who? (clonidine changes my behavior)
Clonidine and guanfacine are alpha agonists (used for BP) better for behavioral.
188
Strattera - generic name (atoms in the stratosphere)
Atomoxetine
189
strattera - MOA (epinephrine in the stratosphere)
is a norepinephrine reuptake inhibitor.
190
atomoxitine works better for who? (atoms are inattentive)
works better for inattentive type.
191
ADHD meds - with food?
eat a large breakfast and then take meds.
192
ECT - what meds are given before? (atop ECT)
IM Atropine (to reduce secretions and prevent bradycardia) is sometimes given with a muscle paralyzing agent and a sedative, such as Ativan.
193
clozaril - what to ask patients every day?
bowel impaction (ask pt every day if they’ve had a BM)
194
Geodon (ziprasidone) - how can it be administered?
Geodon (ziprasidone): first atypical to be available for short-acting IM injection. also available PO.
195
NMS - s/sx (MAD and sweaty and confused)
diaphoresis, confusion, disorientation
196
respiradol - typical or atypical?
atypical
197
Antabuse - generic name (difuse the antibuse)
Disulfiram
198
tegratol - drug class (tigers don't convulse)
anticonvulsant
199
galantamine - what type of drug
(galantly against cholenestarase)
cholenesterase inhibitor
200
rivastigmine - what type of drug (riveted by alzheimers)
cholenesterase inhibitor
201
2nd generation antipsychotics - ex
clozapine (clozaril)
olanzapine (zyprexa)
risperidone (Risperdal)
quetiapine( Seroquel)
ziprasidone(Geodon)
aripiprazole (abilify)
202
the most weight gain
clozapine
203
olanzapine - side effects (ola is large)
weight gain, DM, abnormal lipids
204
ESP turns into
blockade of D2 receptors
leads to anticholinergic crisis-> delirium, worsening psychosis
205
types of ESP
Parkinsonism
dystonia
akathisia
TD( tarditive diskinesia)
NMS (neuroleptic mallignant syndrome)
206
how to get off antipsychotics
taper slowly
207
can build a tolerence to
antipsychotics
208
the MOST weight gain
clozapine - last resort drug
209
clozaril - generic name
clozapine
210
clozapine - drug class
antipsychotic
211
olanzapine - drug class
antipsychotic
212
respiradone - drug class
antipsychotic
213
quetiapine - drug class
antipsychotic
214
cylert treats what?
ADHD
215
proloxin - generic name (pro has the flu)
Fluphenazine
216
respiradone - ok for elderly or not?
ok
