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Flashcards in PSYCHIATRY Deck (119):
1

General drugs for alcohol withdrawal

Benzodiazepines

1

What level of potency do trifluoperazine, fluphenazine, and haloperidol have as typical antipsychotics?

high

1

A schizophrenic pt that has weekly CBC monitoring is most likely taking what drug?

clozapine because it causes agranulocytosis

1

Which SNRI can be used to treat the neuropathic pain of diabetic neuropathy?

Duloxetine

1

Which TCA can be used to Tx bedwetting?

Imipramine

1

Which TCA can be used to Tx OCD?

Clomipramine

1

Name 4 MAOI antidepressants

Tranylcypromine, Isocarboxazid, Selegiline, and Phenelzine

2

Name 5 typical antipsychotics

Haloperidol, trifluoperazine, fluphenazine, thioridazine, and chlorpromazine (haloperidol and the zines)

2

Which drug is known to cause the Ebstein anomaly?

lithium

2

What is the Tx for serotonin syndrome? MOA?

Cyproheptadine (5HT2 antagonist)

3

Which drugs are best for Tourette's syndrome?

antipsychotics (haloperidol and risperidone)

3

In general, which generation of antipscyhotics is known to 1) Cause EPS and tardive dyskinesia 2) cause weight gain?

1) typicals (1st gen) 2) atypicals (2nd gen)

4

What is the MOA of the typical antipsychotics?

Blocks D2 and therefore increases cAMP

4

Clozapine and Olanzapine are atypical antipsychotics most notorious for causing ______-

weight gain (clozapine also causes agranulocytosis)

4

NaHCO3 is the antidote to OD of which antidepressant?

TCA's--esp to prevent cardiotoxicity

4

What kind of drug is tranylcypromine?

MAO-I antidepressant

5

What are the major AE of trazodone (4)

PRIAPISM (trazoBONE), sedation, nausea, and postural hypotension

7

2 types of drugs for ADHD

amphetamines and methylphenidate

8

What is the primary endocrine AE of typical antipsychotics?

galactorrhea because they block DA and DA is aka prolactin-inhibiting factor

9

Which drug is a selective MAOB inhibitor?

Selegiline

9

Which drug is an alpha-2 antagonist, and 5HT2 and 5HT3 antagonist?

mirtazapine

10

What is the Tx for TCA overdose?

NaHCO3 (alkalinize urine)

11

What drugs are best for PTSD?

SSRIs

11

What kind of drug is ziprasidone? Major AE?

Atypical antipsychotic, QT prolongation

11

Where can you find tyramine? With which class of drug is it an issue? What happens?

Wine and cheese; MAOI's; HTN crisis

13

High potency typical antipsychotics primarily have what AE?

neurological AE (i.e. EPS and tardive dyskinesia)

13

What is buspirone used to Tx?

Generalized anxiety disorder

14

Which population is most at risk for seizure on bupropion?

Bulimics

15

What may provoke a HTN crisis in a patient on an MAOI?

Tyramine

16

Which class of drugs can cause HTN crisis if taken with tyramine containing foods?

MAOIs

18

What other indication does bupropion have aside from depression?

smoking cessation

19

What sexual AE are present in bupropion?

NONE

20

Name 2 SNRI's

venlafaxine, duloxetine

20

Which atypical antidepressant is an alpha-2 antagonist?

mirtazapine

20

Why is mirtazapine preferrable in depressed pts with insomnia?

one of its AE is sedation

21

What is the major AE of clozapine (2)

agranulocytosis (weekly CBC monitoring) and weight gain

23

What atypical antidepressant primarily inhibits serotonin reuptake and is used for insomnia?

Trazodone

24

What is the Tx of neuroleptic malignant syndrome (2)

Bromocriptine and Dantrolene

24

What is the MOA of mirtazapine?

Atypical antidepressant that is an alpha-2 antagonist that increases release of NE and serotonin; it also inhibits 5HT2 and 5HT3

26

What kind of drugs are sertraline and citalopram?

SSRIs

27

What class of drug has a similar MOA to tricyclic antidepressants?

SNRI's, both block reuptake of serotonin and NE

29

Dantrolene and Bromocriptine are important for the Tx of what?

Neuroleptic malignant syndrome (dantrolene for muscle rigidity, and bromocriptine to agonize the antagonized D2 receptors)

30

MOA of lithium

unknown but likely affects the phosphoinositol cascade

31

Which drugs are best for OCD? (2)

SSRI and clomipramine (a TCA)

31

7 indications for SSRI's

Depression, Generalized Anxiety Disorder, Panic Disorder, OCD, bulimia, social phobias, and PTSD

32

DOC class for bulimia

SSRI

32

What are 4 AE of mirtazapine?

sedation (good for insomnia), increase appetite, wieght gain (good for anorexia), and dry mouth

34

Which drugs MOA are not completely understood but block 5HT2, D2, and alpha 1 and H1?

atypical antipsychotics (2nd Gen)

35

Why do typical antipsychotics take so long to leave the body?

They are highly fat soluble

36

Which drugs are best for social phobias?

SSRIs

37

What is the MOA of the CNS stimulants: methylphenidate, dextroamphetamine, and methamphetamine?

increase catecholamines at the synaptic cleft (NE and DA, in particular)

39

What is the MOA of MAOI's?

Block monoamine oxidase so increase concentration of amine neurotransmitters (NE, DA, and 5HT)

40

What is the MOA of maprotiline?

blocks NE reuptake

41

What kind of drugs are olanzapine, clozapine, quetiapine, risperidone, aripiprazole, and ziparasidone?

atypical antipsychotics

42

What kind of drugs are fluoxetine, paroxetine, sertraline, and citalopram?

SSRIs

43

Which typical antipsychotic causes corneal deposits? Retinal deposits?

Chlorpromazine, thioridazine

45

What 5 drugs are CI with MAOIs as it may provoke serotonin syndrome?

Meperidine, Dextromethorphan, SSRI, TCA, and St. John's Wort

46

What 3 disorders can be Tx'd by methylphenidate, dextroamphetamine

Narcolepsy, ADHD, and appetite control

47

What atypical antipsychotic causes weight gain and agranulocytosis which requires weekly CBC monitoring?

clozapine

49

Which atypical antidepressant increases NE and DA via an unknown mechanism and may cause seizures in bulimics?

Buproprion

50

Why do TCAs sometimes cause postural hypotension?

alpha-1 blockade

52

Which anxiolytic does NOT interact with alcohol?

Buspirone because it is not GABAergic, rather it stimulates 5HT-1A

52

What kind of drug is phenelzine?

MAOI antidepressant

53

Which atypical antipsychotic is most likely to cause QT prolongation?

Ziprasidone

54

Which sexual dysfunctions may arise with SSRI's?

Anorgasmia and decreased libido

56

What SNRI is also approved for Tx of generalized anxiety and panic disorder?

Venlafaxine

58

What is the MOA of the SNRI's?

Block reuptake of BOTH serotonin and norepi

59

What kind of drugs are duloxetine and venlafaxine?

SNRI's

60

What is the MOA of 1) Buspirone and 2) Bupropion

1) anxiolytic that stimulates 5HT-1A 2) Atypical antidepressant that increases NE and DA via unknown mechanism

62

Which AE of typical antipsychotics is typically irreversible?

Tardive dyskinesia

63

What level potency typical antipsychotics generally have non-neurologic side effects? i.e. anticholinergic, antihistaminergic, and alpha-1 blockade?

low potency typical antipsychotics (i.e. chlorpromazine and thioridazine)

65

Name 7 TCA's

Amitryptaline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, and Amoxapine

66

What are the Tri-C's of TCA toxicity?

Convulsions, Comas, and Cardiotoxicity

67

What is the least sedating TCA with the highest seizure threshold?

Desipramine

68

What are the low potency typical antipsychotics?

Chlorpromazine and thioridazine

69

Which 2 MAOI's do NOT end in iptyaline or impramine?

Doxepin and Amoxapine

70

What kind of drug is selegiline?

MAOI antidepressant; also used for Parkinsons (it is a SELECTIVE MAO-B INHIBITOR)

71

How long does it take for antidepressants to have an effect?

4-8 weeks

73

What is the caution for using bupropion in bulimics?

Can cause seizure; in general it lowers seizure threshold

75

How long does buspirone take to take effect?

1-2 weeks (would not use for panic disorder)

76

What are the special uses of the TCA's: 1) Imipramine and 2) Clomipramine

1) Bedwetting (anticholinergic effect) 2) OCD

77

Which psychiatric med has an unestablished MOA but likely affects the phosphoinositol cascade?

lithium

78

Which antipsychotics can Tx both positive and negative Sx of schizophrenia

2nd gen

79

What receptors do typical antipsychotics block to cause 1) dry mouth and constipation 2) drowsiness 3) hypotension

1) muscarinic 2) histaminergic (H1) and 3) alpha 1

81

Which drugs block the D2 receptors (only) and increase cAMP?

typical antipsychotics (neuroleptics)

82

Which typical antipsychotic causes corneal deposits?

Chlorpromazine

83

MOA of atypical antipsychotics

not completely understood but affect 5HT-2, DA, and alpha and H1 receptors

84

Which SNRI has the greatest effect on NE?

Duloxetine

85

What kind of drug is isocarboxazid? Isoniazid?

MAOI antidepressant; anti-TB drug that blocks mycolic acid synthesis

86

What other indication aside from depression is duloxetine used for?

Diabetic peripheral neuropathy (neuropathic pain)

87

Why would you want an EKG for 1 )Lithium 2) Ziprasidone

1) Causes heart block (CI in sick sinus syndrome) 2) causes QT prolongation

88

What drugs are indicated for atypical depression, anxiety, and hypochondriasis

MAOI

89

Name 4 SSRIs

Fluoxetine, paroxetine, sertraline, and citalopram

90

4 signs and symptoms of neuroleptic malignant syndrome

rigidity, autonomic instability, hyperpyrexia, and myoglobinuria

91

What fetal cardiac defects are associated with maternal use of lithium when pregnant?

Ebstein anomaly and great vessel defects

92

Which drug is best for depression with insomnia?

mirtazapine

94

What level of potency do chlorpromazine and thioridazine have as typical antipsychotics?

low

96

Which 2 atypical antipsychotics are most likely to cause weight gain?

clozapine (and agranulocytosis) and olanzapine

97

What is the most severe AE of SSRI's?

serotonin syndrome

99

Which level of potency typical antipsychotics display primarily neurologic AE?

High potency (trifluoperazine, fluphenazine, and haloperidol)

100

Which type of drug causes neuroleptic malignant syndrome?

Typical antipsychotics

101

What kind of drugs are tranylcypromine, phenelzine, selegiline, and isocarboxazid?

MAOI antidepressants

102

Which atypical antidepressant can cause priapism?

trazodone (recall from Rohrbach, the one thing he actually taught us)

103

Which typical antipsychotic causes retinal deposits?

Thioridazine

104

With which opioids (2) are MAOI's contraindicated because it may lead to serotonin syndrome?

Meperidine and dextromethorphan

105

What is the major psych use of cyproheptadine?

To treat serotonin syndrome

107

What syndrome involves hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea and seizures?

Serotonin syndrome

108

What can imipramine be used to Tx aside from major depression?

Nocturnal enuresis due to anticholinergic effect

109

What else can clomipramine be used to Tx aside from major depression?

OCD

110

Indications for MAOI's (3)

Atypical depression, anxiety, and hypochondriasis

111

What is the most common AE of SNRI's? Most severe?

HTN; serotonin syndrome

112

What are the most common AE of SSRI's? Most severe?

GI distress and Sexual dysfunction (anorgasmia and decreased libido); Serotonin syndrome

113

What is the Tx for neuroleptic malignant syndrome? Serotonin syndrome?

NMS = Bromocriptine and Dantrolne; SS = Cyproheptadine

114

What are 4 major AE of lithium?

Hypothyroidism, Nephrogenic DI, teratogenic (ebstein anomaly), tremor, and heart block (sick sinus syndrome)

115

Where in the kidney is lithium reabsorbed?

PCT (follows Na)

116

Name 6 atypical antipsychotics

Quetiapine, olanzapine, clozapine, risperidone, aripiprazole (ablify), ziprasidone

117

What are the AE of TCA's?

Antimuscarinic, Anticholinergic, and Antihistaminergic (Convulsions, Coma, and Cardiotoxicity (Tri-C's))

118

Which drug, approved for generalized anxiety disorder stimulates 5HT-1A receptors?

Buspirone

119

What non-psychiatric condition can lithium be used to Tx?

SIADH (because it causes nephrogenic DI)