Psychiatric Flashcards
(138 cards)
1
Q
Do Selective Serotonin Reuptake Inhibitors (SSRI) increase or decrease Serotonin (5-HT)?
A
Increase Serotonin (5-HT)
2
Q
What is the main contraindication of SSRIs?
A
Concurrent use with MAO Inhibitors
3
Q
Selective Serotonin Reuptake Inhibitor Warnings?
A
QT Prolongation, Syndrome of Inappropriate secretion of ADH (SIADH), Hyponatremia (Low Sodium), Bleeding (w/ NSAID, anticoagulant or antiplatelet use).
4
Q
What is one major risk of SSRI use?
A
Serotonin Syndrome
5
Q
What are the main side effects of SSRIs?
A
Somnolence, Insomnia, Nausea, Dry Mouth, Diaphoresis (dose related), Weakness, Tremor, Dizziness, HA, Sexual (decreased libido).
6
Q
Citalopram
A
Celexa
7
Q
Citalopram Drug Class
A
SSRI
8
Q
Citalopram Max Dose
Citalopram Max Dose (elderly)
A
40mg/day
20mg/day
9
Q
Escitalopram
A
Lexapro
10
Q
Escitalopram Max Dose
Escitalopram Max Dose (Elderly)
A
20mg/day
10mg/day
11
Q
Escitalopram Drug Class
A
SSRI
12
Q
Fluoxetine
A
Prozac
13
Q
Fluoxetine Drug Class
A
SSRI
14
Q
Sarafem Use & Generic
A
PMDD (Pre-Menstrual Dysphoric Disorder) & Fluoxetine
15
Q
What time of day is it best to take Fluoxetine?
A
QAM
16
Q
Does Fluoxetine require a taper? Why or why not?
A
No, due to it’s long half life.
17
Q
Why is it recommended to taper SSRIs?
A
To prevent rebound depression
18
Q
Paroxetine
A
Paxil
19
Q
Paroxetine Drug Class
A
SSRI
20
Q
Which SSRI is the most sedating?
A
Paroxetine
21
Q
What time of day should Paroxetine be taken?
A
QPM
22
Q
Sertraline
A
Zoloft
23
Q
Sertraline Drug Class
A
SSRI
24
Q
Sertraline is preferred in patients with what comorbidity?
A
Cardiac Risk
25
Fluvoxamine
Luvox
26
Fluvoxamine Drug Class
SSRI
27
Which SSRI has the most drug interactions?
Fluvoxamine
28
What time of day should Fluvoxamine be taken, and why?
QPM due to it's sedating effects.
29
What SSRI is sometimes used to treat OCD?
Fluvoxamine
30
What is the major contraindication of SSRI/5HT-1A Partial Agonists?
Concurrent use, or use within 14 days of MAO Inhibitors.
31
Main Side Effect of SSRI/5HT-1A Partial Agonists
Decreased libido (less sexual se than SSRI or SNRI)
32
Vilazodone
Viibryd
33
Vilazodone Drug Class
SSRI/5HT-1A Partial Agonst
34
Should Vilazodone be taken with or without food? Why or why not?
Take with food; to increases drug absorption
35
What is the major contraindication of SSRI/5-HT3 Receptor Antagonist/5HT-1A Partial Agonist?
Concurrent use, or use within 14 days of MAO Inhibitors.
36
Main side effect of SSRI/5-HT3 Receptor Antagonist/5HT-1A Partial Agonist
Decreased libido (less sexual se than SSRI or SNRI)
37
Vortioxetine
Trintellix
38
Vortioxetine Drug Class
SSRI/5-HT3 Receptor Antagonist/5HT-1A Partial Agonist
39
What is the major side effect associated with Vortioxetine?
Constipation
40
Vortioxetine is contraindicated for use in patients with what comorbidities?
IBS and IBD
41
What actions should be taken if a patient is on a strong CYP2D6 inhibitor (such as bupropion, fluoxetine, or paroxetine) and adds Vortioxetine as drug therapy?
Decrease the Vortioxetine dose by 50%
42
What is the major contraindication of Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)?
Concurrent use, or use within 14 days of an MAOI.
43
What two drug classes have similar side effects?
SSRIs & SNRIs
44
What specific side effects are associated with SNRIs?
Increased NE, Increased HR, Dilated Pupils, Dry Mouth, Excessive Sweating, Constipation, and Increased BP.
45
Desvelafaxine
Pristiq
46
Desvelafaxine Drug Class
SNRI
47
Duloxetine
Cymbalta
48
What are the main uses for Duloxetine?
Neuropathy, Fibromyalgia, General Anxiety Disorder (GAD).
49
Duloxetine Drug Class
SNRI
50
Venlafaxine
Effexor
51
Venlafaxine Drug Class
SNRI
52
What is Venlafaxine used to treat?
General Anxiety Disorder (GAD), Panic Disorder, Seasonal Affective Disorder (SAD).
53
What is the major side effect associated with Venlafaxine?
QT Prolongation
54
Which SNRI tends to increase BP to a higher extent?
Venlafaxine
55
What type of patients are not suited for treatment with SNRIs?
Patients with uncontrolled Hypertension
56
How do Tricyclic Antidepressants (TCAs) work?
Inhibit NE and 5-HT, also block Acetylcholine and histamine receptors.
57
What is the major contraindication of TCAs?
Concurrent use, or use within 14 days of MAOIs.
58
What Anticholinergic side effects are associated with TCAs?
Dry mouth, Urinary Retention, and Constipation.
59
What cardiac side effects are associated with TCA use?
Cardiotoxicity, QT Prolongation, and Arrhythmias.
60
Tertiary Amines are associated with increased or decreased Anticholinergic Properties?
Increased Anticholinergic Properties
61
Amitriptyline
Elavil
62
Amitriptyline Drug Class
TCA - Tertiary Amine
63
Doxepin Drug Class
TCA - Tertiary Amine
64
Doxepin brand for treatment of Insomnia
Silenor
65
Doxepin brand of cream formulation
Zonalon & Prudoxin
66
What additional properties does Doxepin have?
High Anticholinergic & Antihistamine Properties
67
Nortriptyline
Pamelor
68
Nortriptyline Drug Class
TCA - Secondary Amine
69
What major contraindications are associated with Dopamine & Norepinephrine Reuptake Inhibitors (NDRI)?
Seizure Disorders, H/O Anorexia/Bulimia, Concurrent use with MAOIs.
70
What side effects are associated with NDRIs?
Dry Mouth, Insomnia, Tremors/Seizures (dose-related), Weight loss, Sexual Dysfunction (rare), CNS Stimulation (anxiety, restlessness, insomnia).
71
Bupropion
Wellbutrin
72
Bupropion brand for treatment of smoking cessation only
Zyban
73
Bupropion Drug Class
NDRI
74
What is the maximum dose for Bupropion?
450mg/day
75
Why do some patients switch from SSRIs to NDRIs?
To help with weight loss, or for relief of sexual dysfunction side effects.
76
Which Antidepressant is usually used in elderly patients?
Mirtazapine
77
Mirtazapine
Remeron
78
Mirtazapine Drug Class
TCA/Alpha-2-Agonist
79
How does Mirtazapine affect NE and 5HT?
Mirtazapine increases both NE and 5HT
80
What is Mirtazapine indicated for?
Primarily sleep and to increase appetite
81
What side effects are associated with Mirtazapine?
Anticholinergic Effects, Weight Gain, Increased Appetite, and Sedation.
82
Trazodone
Desyrel
83
Trazodone Drug Class
SSRI/Alpha-1-Agonist/Histamine Blocker
84
How does Trazodone work?
Inhibits 5-HT reuptake, blocks Histamine & Alpha-1
85
What is the primary indication for Trazodone?
Sleep
86
What side effects are associated with Trazodone?
Sedation and Priapism (prolonged erection)
87
What is the MOA of First Generation Antipsychotics?
Block Dopamine and 5HT-2A
88
What effects are associated with High Potency First Generation Antipsychotics?
High risk of EPS (Extrapyramidal Symptoms - Uncontrolled body movements), Moderate risk of Sedation, Low risk of CV Effects (orthostatic hypotension, tachycardia), and Anticholinergic Effects.
89
What effects are associated with Low Potency First Generation Antipsychotics?
Low risk of EPS, High risk of Sedation, High risk of CV Effects, and Anticholinergic Effects.
90
What general side effects are associated with First Generation Antipsychotics?
Moderate Weight Gain, Low risk of Metabolic Effects, High risk of Sexual Side Effects.
91
What is the MOA of First Generation Antipsychotics?
Block Dopamine and 5HT-2A
92
Haloperidol
Haldol
93
Haloperidol Drug Class
First Generation Antipsychotics
94
Is Haloperidol a high or low potency First Generation Antipsychotic?
High Potency
95
What major side effect is associated with Haloperidol?
QT Prolongation
96
What is the MOA of Second Generation Antipsychotics?
Block Dopamine and 5HT-2A
97
What type of side effects are associated with Second Generation Antipsychotics?
Metabolic Side Effects?
98
What specific side effects are associated with Second Generation Antipsychotics?
Weight Gain, Lipid Abnormalities, Hyperglycemia, EPS (dose-related).
99
What CV Effects are associated with Second Generation Antipsychotics?
QT Prolongation
100
Increased Prolactin associated with Second Generation Antipsychotics can cause what?
Gynecomastia & Irregular Periods
101
Aripiprazole
Abilify
102
Aripiprazole Drug Class
Second Generation Antipsychotics
103
What side effects are associated with Aripiprazole?
Akathisia & Insomnia
104
Lurasidone
Latuda
105
Lurasidone Drug Class
Second Generation Antipsychotics
106
What major side effect is associated with Lurasidone?
Extrapyramidal Symptoms (EPS)
107
What is a major counseling point for Lurasidone? Why?
Take with food ( >350kcal) to help with drug absorption.
108
Olanzapine
Zyprexa
109
Olanzapine Drug Class
Second Generation Antipsychotics
110
What side effects are associated with Olanzapine?
Somnolence, Weight Gain, Increased Lipids, Increased Glucose.
111
Clozapine
Clozaril
112
Clozapine Drug Class
Second Generation Antipsychotics
113
What Black Box Warning is noted on Clozapine bottles?
May cause Neutropenia/Agranulocytosis; REMS Program Drug; May cause Myocarditis, Cardiomyopathy, and Seizures.
114
What side effects are associated with Clozapine?
Weight Gain, Increased Lipids, Increased Glucose, Sialorrhea, & Agranulocytosis.
115
What should be monitored throughout the duration of Clozapine Therapy?
Baseline ANC ( >1,500)
116
At what ANC should Clozapine Therapy be stopped?
ANC < 1,000
117
Paliperidone
Invega
118
Paliperidone Drug Class
Second Generation Antipsychotics
119
What dose related side effect is associated with Paliperidone?
Extrapyramidal Symptoms (EPS)
120
What non-dose related symptoms are associated with Paliperidone?
Increased Prolactin
121
Quetiapine
Seroquel
122
Quetiapine Drug Class
Second Generation Antipsychotics
123
Does Quetiapine have a high or low EPS risk?
Low EPS Risk
124
What symptom is caused by Quetiapine use in Parkinson's patients?
Psychosis
125
Should Quetiapine be taken with or without food?
Without food, or with a light meal ( <300kcal)
126
Risperidone
Risperdal
127
Risperidone Drug Class
Second Generation Antipsychotics
128
What dose related side effect is associated with Risperidone use?
Extrapyramidal Symptoms (EPS) - Typically seen with higher doses
129
Ziprasidone
Geodon
130
What major side effect is associated with Ziprasidone?
QT Prolongation
131
Should Ziprasidone be taken with or without food?
With food
132
Lithium
Lithobid
133
Lithium Drug Class
Mood Stabilizer
134
How should Lithium be dosed?
BID
135
What side effects are associated with Lithium use?
GI Upset, Cognitive Effects, Cogwheel Rigidity, Fine Hand Tremor, Weight Gain, Polyuria/Polydipsia, & Hypothyroidism.
136
At what point has Lithium toxicity produced irreversible damage?
> 2.5 mEq/L
137
Lithium is contraindicated in patients with what comorbidity? Why?
Renal Failure, because Lithium is 100% renally cleared.
138
What side effects are associated with Stimulant Drugs for ADHD?
Nausea, Insomnia, Headache, Irritability, Blurry Vision, & Dry Mouth.
