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Flashcards in Psych Pharm Deck (253):
1

What is the preferred drug for alcohol withdrawal?

Benzodiazepines

2

What is the preferred treatment for anxiety?

SSRIs, SNRIs, buspirone

3

What is the preferred treatment for ADHD?

Methylphenidate
Amphetamines
Atomoxetine (non-stimulant: NE selective reuptake inhibitor)

4

What is the preferred drug for bipolar disorder?

Lithium
Valproate
Carbamazepine
Atypical antipsychotic

5

What is the preferred drug for bulimia?

SSRIs

6

What is the preferred drug for depression?

SSRIs, SNRIs, TCAs, buspirone, mirtazapine

7

What is the preferred drug for obsessive compulsive disorder?

SSRIs, clomipramine

8

What is the preferred drug for panic disorder?

SSRIs, venlafaxine, benzodiazepines

9

What is the preferred drug for PTSD?

SSRIs

10

What is the preferred drug for schizophrenia?

Antipsychotic

11

What is the preferred drug for social phobias?

SSRIs

12

What is the preferred drug for Tourette's?

Antipsychotics - haloperidol, risperidone

13

What are the CNS stimulants?

Methylphenidate, dextroamphetamine, meth

14

What is the MOA of CNS stimulants?

Increase catecholamines at the synaptic cleft, especially NE and DA

15

What is the clinical use of CNS stimulants?

ADHD, narcolepsy, appetite control

16

What are the antipsychotics?

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine

17

What is the MOA of antipsychotic?

Block D2 receptors (inc. camp)

18

What are the high potency antipsychotics?

Trifluoperazine
Fluphenazine
Haloperidol
These have extra pyramidal effects

19

What is the clinical use of antipsychotics?

Schizophrenia
Psychosis
Acute mania
Tourette's

20

What are the low potency antipsychotics?

Chlorpromazine
Thioridazine
These cause anticholinergic, antihistamine and alpha 1 blockade effects

21

What is the toxicity of antipsychotics?

Slow to be removed from body because lipid soluble.
Extrapyramidal effects - dyskinesia, dystopia, Parkinsonian effects
Endocrine: hyperprolactinemia, galactorrhea
Antimuscarinic: dry mouth, constipation
AntiHistamine receptors: sedation
Neuroepileptic malignant syndrome
Tardive dyskinesia
Alpha 1 blockade: hypotension, vasodilation -- reflex tachycardia

22

What is neuroepileptic malignant syndrome?

Rigidity, myoglobinuria, autonomic instability, hyperprexia

23

What is the treatment for neuroepileptic malignant syndrome?

Dantrolene
d2 agonist - bromocriptine

24

What is tardive dyskinesia?

Stereotypic oral-facial movements as a result of long term antipsychotic use
Often irreversible

25

What is the acronym for remembering what happens with NMS?

Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles

26

What are the atypical antipsychotics?

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

27

What is the MOA of atypical antipsychotics?

Varied effects on 5-HT, dopamine, alpha, and histamine receptors

28

What is the clinical use of atypical antipsychotics?

Schizophrenia
Bipolar
OCD
Anxiety
Depression
Mania
Tourette's

29

What is the toxicity of olanzapine?

Weight gain

30

What is the toxicity of clozapine?

Weight gain
Agranulocytosis
Seizure

31

What is the toxicity of ziprasidone?

Prolonged QT interval

32

What is the MOA of lithium?

Inhibitor of phosphoinositol cascade?
MOA unclear

33

What is the clinical use of lithium?

Bipolar disorder
Blocks relapse and acute mania events and SIADH

34

What is the toxicity of lithium?

LMNOP:
Movement (tremor).
Nephrogenic diabetes insipidus
HypOthyroidism
Pregnancy problems (teratogenicity)

35

Where is the lithium excreted?

In the kidney
Mostly reabsorbed at the PCT

36

What is the MOA of buspirone?

Stimulates 5HT1A receptors

37

What is the clinical use of buspirone?

Generalized anxiety disorder
1-2 weeks to take effect
Does not interact with alcohol

38

What is the advantage of buspirone?

Does not cause Sedation, addiction, tolerance

39

What are the SSRIs?

Fluoxetine, paroxetine, sertraline, citalopram

40

What is the clinical use of SSRIs?

Depression
Bulimia
Anxiety disorder
Panic disorder
OCD
Social phobias
PTSD

41

What is the toxicity of SSRIs?

GI
Sexual dysfunction
Serotonin syndrome

42

What is serotonin syndrome?

Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

43

What it the tx for serotonin syndrome?

Cyproheptadine - 5HT2 receptor antagonist

44

What are the SNRIs?

Venlafaxine
Duloxetine

45

What is the MOA of SNRIs?

Inhibit serotonin and NE uptake

46

What is the clinical use of SNRIs?

Depression

47

What is the clinical use of venlafaxine?

Generalized anxiety and panic disorder

48

What is the clinical use of duloxetine?

Diabetic peripheral neuropathy
Has greater effect of NE

49

What is the toxicity of SNRIs?

elevated BP
Sedation
Nausea
Stimulant effects

50

What are the TCAs?

Amitryptyline, nortriptyline, imipramine, desipramine, doxepin, clomipramine, amoxapine

51

What is the MOA of TCAs?

Block reuptake of NE and serotonin

52

What is the clinical use of TCAs?

Major depression
Bed wetting (imipramine)
OCD (clomipramine)
Fibromyalgia

53

What is the toxicity of TCAs?

Sedation
Alpha 1 blockade effects
Anticholinergic effects
Convulsions
Coma
Cardio toxicity
Respiratory depression
Hyperprexia
In elderly: hallucinations, confusion

54

What is the treatment for cardio toxicity from TCA?

NaHCO3

55

What are the MAOi's?

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

56

What is the MOA of MAOi's?

Nonselective MAO inhibition
Increase amine NTs (NE, serotonin, dopamine)

57

What is the clinical use of MAOi's?

Atypical depression
Anxiety
Hypochondriasis

58

What is the toxicity of MAOi's?

Hypertensive crisis
CNS stimulation

59

What is contraindicated with the use of MAOi's?

SSRIS
TCAS
St. John's Wort
Meperidine
Dextromethorphan

60

What are the atypical antidepressants?

Bupropion
Mirtazapine
Maprotiline
Trazodone

61

What is trazadone used for?

Insomnia

62

What is the MOA of trazadone?

Primarily inhibits serotonin reuptake

63

What is the toxicity of trazadone?

Sedation
Nausea
Priapism
Postural hypotension

64

What is the MOA of maprotiline?

Blocks NE reuptake

65

What is the toxicity of maprotiline?

Sedation
Ortho static hypotension

66

What is the MOA of mirtazapine?

Alpha 2 antagonist, potent 5-HT2/3 receptor antagonist

67

What is the toxicity of mirtazapine?

Sedation
Increased appetite
Weight gain
Dry mouth

68

What is the MOA of bupropion?

Increases NE and DA

69

What is the toxicity of bupropion?

Tachycardia
Insomnia
Headache
Seizure

70

What is bupropion used for?

Smokin cessation

71

What is the advantage of bupropion?

No sexual side effects

72

What is the MOA of memantine?

Uncompetitive NMDA receptor antagonist
Competes with Mg2+ after calcium influx thereby preventing over excitation

73

What is the toxicity of memantine?

Dizziness, confusion, hallucinations, constipation, H/A

74

What is the treatment of choice for Alzheimer's?

Anti-acetylcholinesterases

75

What are the anti-acetylcholinesterases?

Donezapil
Galantamine
Rivastigmine

76

What is the disadvantage to using rivastigmine?

It also inhibits butyrylcholinesterase thereby inhibiting the breakdown of succinylcholine and giving it longer duration of action. Patients on this drug can't go under surgery.

77

What are the side effects of anti-AchEs?

Diarrhea, incontinence, N/V, dizziness, insomnia, miosis

78

What anti-AchE treats all forms of Alzheimer's?

Donezapil

79

What is the toxicity of tacrine?

Liver toxicity

80

When are galantamine and rivastigmine used?

In mild to moderate Alzheimer's

81

What is the tx for Lewy Body disease?

Low dose anti-AchE and Parkinson drugs

82

What do all anti-psychotics do?

Block dopamine receptors

83

Where are the dopamine tracts in the brain?

Ventral tegmental area --> nucleus accumbens, prefrontal cortex
Substantia nigra --> striatum
Hypothalamus --> pituitary
Medulla

84

What are the effects of dopamine?

Euphoria, psychosis, reinforcement
Voluntary motor activity
Prolactinemia
Eating, hiccups, vom

85

Why do schizophrenics get negative symptoms?

From decrease DA in the nucleus accumbens and prefrontal cortex

86

What accounts for the positive sx in schizophrenia?

Excess dopamine in the Mesolimbic system

87

What drugs can cause psychotic episodes in normal individuals?

Dopaminergic agonists:
Amphetamines
PCP
Cocaine

88

What do the typical antipsychotics do?

Block DA receptors, especially D2
These are usually messy and also block histamine, muscarinic and cholinergic receptors --> lots of side effects

89

What are the general effects of antipsychotics?

Control bizarre behavior and calm agitation, impulsivity, aggression
Improve the core thought disorders
Tx: Tourette's, hiccups, and nausea

90

What are the typical psychotics?

Phenothiazines: chlorpromazine, prochlorperazine, promethazine
Butyrophenomes: haloperidol

91

What is the prototype typical antipsychotic?

Chlorpromazine

92

What are the side effects of chlorpromazine?

Urinary retention, dry mouth - from anti muscarinic effects
Ortho static hypotension - from alpha blockade

93

What is the risk of taking haloperidol?

Cleaner D2 antagonist so it causes more extra pyramidal side effects: dystonias, Parkinsonism, neuroleptic malignant syndrome

94

What is the tx for the extrapyramidal side effects of haloperidol?

Reduce the dose of the antipsychotic
Give anticholinergics

95

What is the tx of neuroleptic malignant syndrome?

Stop antipsych and anticholinergics!
Give antipyretic
Give DA agonist

96

What are the general side effects of antipsychotics?

Dysphoria,
hyperprolactinemia: galactorrhea, gynecomastia, menstrual disturbances
Impotence
Sexual dysfunction
Poikilothermia
Weight gain
Hypotension

97

What is the major long term side effect of antipsychotics?

Tardive dyskinesia

98

What is the tx for tardive dyskinesia?

Decrease the dose of anti-psychotics --> will get worse initially but then it will be ok

99

What are the atypical antipsychotics?

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole

100

What is the advantage of atypical antipsychotics?

Greater efficacy for negative sx
Less likely to cause tardive dyskinesia

101

What are the side effects of olanzapine?

Weight gain
Somnolence
Type II diabetes

102

What is the MOA of atypical antipsychotics?

Block DA receptors and 5HT2 receptors

103

What is the FDA warning against atypical antipsychotics?

They cause hyperglycemia, type II diabetes

104

What atypical antipsychotic is more efficacious than other antipsychotics?

Clozapine

105

What are the advantages to clozapine?

Better efficacy
No extrapyramidal side effects

106

What is the major side effect of clozapine?

Agranulocytosis

107

What are the other side effects of clozapine?

Strong Sedation
Anticholinergic effects: urinary retention
Hypotension

108

What is the most prescribed atypical antipsychotic?

Quetiapine

109

What other disorder is quetiapine used for?

Bipolar disorder

110

Why do you give quetiapine at night?

Because it is slightly more sedative

111

What is the disadvantage of risperidone?

It has a higher affinity for D2 receptors so it is more likely to cause tardive dyskinesia and extrapyramidal sx

112

What are the side effects of risperidone?

Anxiety
Somnolence
Extrapyramidal sx
Dizziness
Type II diabetes

113

What is the MOA of aripiprazole?

Partial DA agonist and partial 5HT1 agonist
5HT2 antagonist.

114

What is the aripiprazole?

Used for depression and schizophrenia

115

What are the advantages of aripiprazole?

Causes less weight gain than olanzapine
No incidence of Type II diabetes
And can be used for schizophrenia and depression

116

How can aripiprazole be used for schizophrenia when it's a dopamine agonist?

As a weak partial agonist it inhibits the full agonist

117

What drugs may cause depression by lowering bio genic amines?

Reserpine
Propranolol
Methyldopa and clonidine
Amphetamines
OCs
Drugs of abuse

118

What is the MOA of TCAs?

Block mono amine reuptake with more effect on 5HT
Down regulate norepinephrine and/or 5HT receptor

119

What are the side effects of TCAs?

Anti muscarinic: blurred vision, dry mouth, constipation, confusion
Weight gain
Sexual disturbance
Tremor
Insomnia
Ortho static hypotension
Arrhythmias

120

What is the danger of TCAs?

Patients OD easily

121

What other conditions are TCAs used for?

Chronic pain and panic disorder

122

What's the drug of choice for chronic pain?

Amitryptiline

123

Which TCA has the most sedative and strongest anti muscarinic side effects?

Amitryptiline

124

What are the TCAs?

All the -pramines, amitryptiline, nortriptyline, doxepin, protripyline

125

What are the second generation antidepressants?

Venlafaxine
Bupropion
Trazadone
Duloxetine
Mirtazapine

126

What is the MOA of venlafaxine?

SSNRI a selective serotonin and NE reuptake inhibitor
More potent at 5ht

127

What are the side effects of venlafaxine?

HTN
Tachycardia

128

What are th disadvantages of venlafaxine compared to SSRIs?

More intense withdrawal
Greater toxicity in OD

129

What second generation is used for physical pain symptoms of depression and diabetic neuropathic pain?

Duloxetine

130

What is the MOA of bupropion?

Occupies 25% of DA uptake sites

131

What is the advantage of bupropion?

Causes little to no sexual dysfunction

132

What is bupropion used for?

Smoking cessation

133

What is the contraindication to using bupropion?

Seizure disorder

134

What is the MOA of trazadone?

5HT-2 antagonist
Weak selective 5HT reuptake inhibitor

135

What are the side effects of trazodone.?

Priapism
Sedation

136

What is the advantage to trazodone?

Less toxic in OD

137

What is the MOA of mirtazapine?

Selective stimulation of 5Ht1 receptors due to blockade of 5HT2/3
Increase 5HT cell firing due to increase in NE and blockade of alpha2 adrenergic receptors.

138

What are the side effects of mirtazapine?

Significant sedation
Increased appetite
Weight gain

139

Why are SSRIs the first choice for depression?

Much safer in OD

140

What is another advantage of SSRIs?

Little action at other receptors so little side effects
Longer half life

141

What is the most common side effect of SSRIs?

Sexual dysfunction

142

What is discontinuation syndrome?

Flu like syndrome from stopping SSRIs abruptly
Most pronounced with paroxetine
Sx: agitation, anxiety, anorexia, insomnia, sweating, tremor, vom

143

Why don't you ever give an SSRIS with an MAOi?

Can cause serotonin syndrome

144

What are the sx of serotonin syndrome?

Altered mental status, fever, agitation, sweating, myoclonus, tremor, hyperprexia, ataxia, GI

145

What are the SSRIs?

Fluoxetine
Sertraline
Paroxetine
Citalopram
Fluvoxamine

146

Which SSRI has the longest half life?

Fluoxetine

147

What are the side effects of fluoxetine?

Nausea
Insomnia
Weight loss
Agitation
Sexual dysfunction

148

Which SSRIs have the potential for drug interactions because they inhibit CYP2D6?

Fluoxetine
Paroxetine

149

Which SSRI is most likely to cause a discontinuation syndrome?

Paroxetine

150

Which SSRI is most likely to cause GI upset as a side effect?

Sertraline

151

Which SSRI causes the most sexual dysfunction?

Paroxetine

152

Which SSRI is less likely to produce mania?

Citalopram

153

What disorder is fluvoxamine usually prescribed for?

Obsessive compulsive disorder

154

Which SSRI is the most selective?

Citalopram

155

What is the mechanism of action of MAOi's?

Block the deamination of tyramine which results in increased norepinephrine release and therefore a deadly increase in bp

156

What foods contain tyramine?

Aged cheese
Wine
Beer
Pickled herring
Liver
Yeast extract
Fava beans

157

What are the MAOi's?

Phenelzine
Tranylcypromine

158

Which MAOi is irreversible?

Phenelzine

159

What are antipsychotics useful for in the treatment of bipolar disorder?

Acute mania
Not good for depressive episodes
Use for rapid correction of a manic episode then add a mood stabilizer

160

What is the tx for lithium OD?

Dialysis

161

What are the side effects of lithium?

Most common = tremor
Decreased thyroid fxn
Mild cognitive impairment
Acne eruptions
Leukocytosis
Polydipsia/polyuria
Chronic interstitial nephritis
Minimal change glomerulopathy
GI
Edema
Weight gain

162

What condition is a contraindication to using lithium?

Sick sinus syndrome because lithium suppresses the sinus node

163

Why do patients get polydipsia/polyuria on lithium?

Lithium makes the collecting tubule unresponsive to ADH

164

What is the MOA of lithium?

Substitutes for Na in generating action potentials and in the Na/K pump (causes seizures)
Also decreased PIP2 therefore decreasing the responsiveness to synaptic transmission (decreased calcium influx)

165

Is lithium contraindicated in pregnancy?

N

166

What is th leading cause of death in bipolar disorder if left untreated?

Suicide

167

How long does it take before lithium effects are seen?

2-3 weeks

168

What can cause the concentration of lithium to go up in the body?

NSAIDs
Diuretics

169

What are the mood stabilizing drugs?

Lithium
Valproate
Lamotrigine
Carbamazepine
Oxycarbazepine

170

What is the advantage to using valproate over lithium?

Faster onset (4-5 days)

171

What are the side effects of valproate?

GI upset
Hepatotoxicity
Neural tube defects
Alopecia
Increases appetite and weight gain

172

What is the MOA of carbamazepine?

Blocking of voltage gated sodium channels

173

What are the side effects of carbamazepine?

Agranulocytosis -stop if you see a rash
Diplopia
Ataxia
GI upset
Sedation
Weight gain

174

What is lamotrigine not effective for?

Acute mania

175

What is the MOA of lamotrigine?

Blocks sodium and calcium channels

176

What is the side effect of lamotrigine?

Steven-Johnson syndrome
Raise levels very slowly

177

When are atypical antipsychotics or benzodiazepines used?

During an acute manic episode

178

What are the first choice drugs for treating anxiety?

SSRI
Venlafaxine
TCAs

179

Why are these the first drugs of choice for anxiety?

Because they have no potential for abuse/dependence

180

What is the timing of onset for the first choice drugs for anxiety?

Slow - 2-4 weeks which is considered a negative for the patient

181

How many subunits make up the GABA receptor complex?

5

182

Which unit binds GABA?

Alpha

183

What is the binding site for BZD?

Alpha/beta

184

What subunit must be present for BZDs to modulate GABA?

Gamma

185

What happens when GABA binds the receptor complex?

The channel opens up to chloride ions causing the cell to become more negative inside making it harder to depolarize - decreased neural firing

186

What is the endpoint of the using the GABA receptor?

Coma and death

187

What do inverse agonists of BZDs do?

They decrease chloride conductance by inhibiting GABA in a non-competitive way

188

What are the overall effects of BZDs?

Anxiolytix
Hypnotic
Anticonvulsant
Amnestic
Produce confusion
DO NOT produce coma

189

What is the major problem with BZDs?

Dependency
Don't use more than 3 days at a time
Shorter half-lives have worse withdrawal effects
Longer half-lives have less severe withdrawal effects but they effects are longer

190

How can death ensue with BZDs and anoth CNS depressant?

Respiratory depression

191

What are the uses of diazepam?

Anxiolytic
Hypnotic
Muscle relaxant
Amnestic
Pre-anesthetic
Terminates status epilepticus
Block convulsions of withdrawal from BZD or EtOH

192

What is the half-life of diazepam?

50+ hours

193

What is the half life of alprazolam?

12-15 hours
More rapid oral absorption

194

What are the advantages to alprazolam?

Shorter half life
Faster absorption
Less sedative

195

What is the BZD of choice for anxiety?

Alprazolam

196

What is a potential side effect of alprazolam ?

Early morning wakening

197

Which BZD has a longer duration of action then diazepam?

Lorazepam

198

What is oxazepam used for?

Anxiolytic
Sleep induction

199

Who do you give oxazepam to?

The elderly because of more reliable pharmacokinetics

200

What are the properties of midolazam?

Very short acting
Water soluble

201

What is midolazam used for?

Pre-op anesthesia
Anxiolytics and muscle relaxant
Amnestic

202

What is flumazenil?

It is an antagonist of BZD receptor.
No action without BZD in the system

203

What is flumazenil used for?

Post anesthesia
BZD overdose

204

What is the thing you should watch out for with flumazenil?

Precipitated withdrawal from the BZD -- seizures!

205

What do inverse agonist?

Anxiety then seizures

206

What drugs can cause lethality if combined with a BZD?

EtOH
Opioids
Antipsychotics
TCAs
Antihistamines

207

What is the action of cimetidine?

Inhibits liver oxidase so prolonged the action of BZDs.

208

What BZDs would you prescribe for someone on cimetidine?

Alprazolam
Lorazepam
Oxazepam
Because of shorter duration of action

209

What are the signs of BZD withdrawal?

Tremors
Seizures

210

What are the sx of withdrawal sx?

Anxiety
Insomnia
Nausea
Malaise

211

What is the MOA of 5-HT1a agonists?

Increase K conductance via same channels as GABAb receptors

212

What is the MOA of buspirone?

5-HT1a agonist

213

What is the advantage to using buspirone over a BZD?

No sedation
No motor impairment

214

What is the use of buspirone?

Anxiety

215

What are the disadvantages to buspirone?

Takes 3-6 weeks to work
Can cause anxiety

216

What are the side effects of buspirone?

Dizziness, nausea, vomiting
No dependence or tolerance
No cross tolerance with BZDs
Does not alleviate BZD or EtOH withdrawal

217

What are the drug interactions of buspirone?

Increase bp with MAOi
Better effects against obsessive-compulsive behavior with SSRI

218

What are the signs of TCA toxicity?

QRS prolongation
Anticholinergic effects
Agitation
Seizures
Coma

219

Why should you wait 2 weeks to switch a patient from an MAOi to an SSRI?

Because it takes up to 2 weeks to resynthesize MAO and without normal levels, catecholamines will not be degraded. Add an SSRI and we have even more catecholamines in the synapse --> serotonin syndrome

220

What should people on levodopa avoid?

Vitamin B6 because it catalyzes peripheral metabolism of levidopa and decreases its effectiveness

221

What is infused with IV lorazepam to reduce recurrence of seizures?

Phenytoin

222

What is the MOA of phenytoin?

Increase sodium channel inactivation in cortical neurons

223

What is infused if status epilepticus does not stop with lorazepam?

Phenobarbital

224

Why is methadone effective in treating heroin addiction?

It is a mu agonist with a long half life so it allows for continuous suppression of withdrawal sx

225

What are the high potency antipsychotics?

Haloperidol
Fluphenazine
Pimozide

226

What are the high potency antipsychotics more likely to cause?

Extrapyramidal sx - increased skeletal muscle tone

227

What are the higher potency antipsychotics less likely to cause?

Anticholinergic and antihistamine effects

228

What are the lower potency typical antipsychotics?

Chlorpromazine and thioridazine

229

What antipsychotic causes retinitis pigmentosa?

Thioridazine - typical, low potency

230

What is chlorpromazine associated with?

Corneal deposits

231

What is ziprasidone associated with?

Prolonged QT interval

232

What is the MOA of varenicline?

Partial agonist at nicotine receptor - competes with nicotine for binding.
Causes limited downstream dopamine release resulting in less stimulation of the reward pathway.
Decreases withdrawal sx, reduces craving and reduces pleasure from other tobacco products

233

What is the MOA of reserpine?

Inhibits dopamine entry into synaptic vesicles - reduces heart rate and bp

234

What are beta blockers used for?

Performance anxiety
Use where sympathetic outflow is high and serves no purpose

235

Treat alcoholism in someone that needs a deterrent?

Disulfiram
(causes aldehyde syndrome = hangover)

236

What do you treat the initial phases of DTs with?

benzodiazepines
*just supportive care if already enter true DT's

237

What is the treatment for SSRI toxicity?

Cyproheptadine
(5-HT2 receptor antagonist)

238

What are the common SNRI's?

Venlafaxine & Duloxetine

239

MOA of SNRI'S?

Inhibits serotonin and NE reuptake

240

Use of Venlafaxine?

Depression
Generalized anxiety and panic disorder

241

Use of Duloxetine?

Depression
Diabetic peripheral neuropathy

242

How do you treat TCA toxicity?

NaHCO3
Treats cardiotoxicity/ arrhythmia

243

Use of Imipramine?

Sleep enuresis

244

DOC for sleep enuresis?

DDAVP (desmopressin)
2DOC- Imipramine (TCA)

245

What to you treat night terrors and sleep walking with?

Benzodiazepines

246

What do you treat narcolepsy with?

Aronodafinil & Modafinil
Amphetamines
(day-time stimulants)
and night time Sodium oxybate (GHB)

247

What do you treat restless leg syndrome with?

Dopamine agonists (Ropinirole & Gabapentin)

248

What do you treat REM-behavioral disorder with?

Clonazepam

249

What do you treat acute insomnia with?

BZD's- short term

250

What do you treat chronic insomnia with?

CBT w/ pyschophysiologic treatment
sleep hygiene

251

What drug may cause an exaggerated response to ADH?

Carbamazepine

252

What does an exaggerated response to ADH cause?

Hyponatremia because of increased volume - dilution

253

What is primidone?

An anti epileptic drug that is metabolized to phenobarbital