Psychopharm Flashcards
(88 cards)
1
Q
What type of drug is amitryptyline?
A
Antidepressants
2
Q
What type of drug is haloperidol
A
First gen antipsychotic
High potency
Typical
3
Q
What type of drug is fluphenazine
A
First gen antipsychotic
High potency
Typical
4
Q
What type of drug is chlorpromazine
A
First gen antipsychotic
Low potency
Typical
5
Q
What type of drug is clozapine?
A
Second gen antipsychotic
Atypical
6
Q
What type of drug is olanzepine
A
Second gen antipsychotic
Atypical
7
Q
What type of drug is Risperidone
A
Second gen antipsychotic
Atypical
8
Q
What are the 4 types of psychiatric medications
A
antidepressants
antipsychotics
bipolar medications
anxiolytics
9
Q
What are the major groups of antidepressants?
A
- Tricyclics
- SNRIs
- SSRIs
- NDRIs
- MAOIs
10
Q
What type of drug is amitryptyline?
A
Antidepressant
Tricyclic
11
Q
What type of drug is imipramine
A
Antidepressant
Tricyclic
12
Q
What type of drug is venlafaxine
A
Antidepressant
SNRI
13
Q
What type of drug is citalopram
A
Antidepressant
SSRIs
14
Q
What type of drug is Fluoxetine
A
Antidepressant
SSRIs
15
Q
What type of drug is sertraline
A
Antidepressant
SSRIs
16
Q
What type of drug is phenelzine
A
Antidepressant
MAOI
17
Q
What type of drug is Carbamazepine
A
Mood disorder medication
(Bipolar)
(Also antiepileptic)
18
Q
What type of drug is Lithium
A
Mood disorder medication
(Bipolar)
19
Q
What type of drug is valproic acid
A
Mood disorder medication
(Bipolar)
20
Q
What type of drug is lorazepam, diazepam
A
Anxiolytic
Benzo
21
Q
What type of drug is Phenobarbital
A
Anxiolytic
Barbiturates
22
Q
What type of drug is thiopental
A
Anxiolytic
Barbiturates
23
Q
what are the different depressive disorders?
A
unipolar major depression, persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, and depressive disorder due to another medical condition. Major depressive disorder (MDD)
24
Q
what is the MOA of SSRIs?
A
SSRIs block reuptake and enhance and prolong serotonergic neurotransmission
25
what is the first line for treatment of depression?
SSRIs
26
what is the MOA of SNRIs?
Serotonin and norepinephrine reuptake inhibitors (SNRIs) block serotonin and norepinephrine reuptake in the synapse, increasing postsynaptic receptors' stimulation.
In contrast with other selective serotonin-norepinephrine reuptake inhibitors like duloxetine, venlafaxine, and desvenlafaxine; milnacipran and levomilnacipran has higher selectivity for inhibiting norepinephrine reuptake than serotonin reuptake
27
what is the MOA of the atypical antidepressants?
They're all different, but Bupropion, for example, works by inhibiting the reuptake of dopamine and norepinephrine at the presynaptic cleft.
28
what is the MOA of tricyclic antidepressants?
TCA, like amitriptyline, inhibits the reuptake of norepinephrine and serotonin at the presynaptic neuronal membrane.
Amitriptyline also has an affinity for muscarinic M1 receptors and histamine H1 receptors.
TCA thus can cause sedation and anticholinergic side effects.
29
what is the MOA of MAOIs?
MAOIs work by inhibiting the monoamine oxidase enzyme, catabolizing serotonin, norepinephrine, and dopamine.
Monoamine oxidase inhibitors were the first antidepressants discovered.
MAOIs are not recognized as first-line treatment for depression because of the adverse effects, drug-drug interactions.
30
how to you switch antidepressants?
A washout period of 2–5 half-lives (most frequently 2–5 days) between cessation of previous drug and the introduction of a new drug is the safest switching strategy from the point of view of drug interactions.
31
what is treatment resistant depression?
patients are considered to have treatment-resistant depression (TRD) when their major depressive disorder fails to respond sufficiently to ≥2 consecutive antidepressants in a single episode.
32
what happens to treatment resistant depression? how do you treat?
Treatment-resistant depression requires augmentation with another antidepressant or atypical antipsychotic agent.
33
what are the specific adverse effects of SSRIs?
Sexual dysfunction
Headache
QTc prolongation
34
what are the specific adverse effects of SNRIs?
Hypertension
Headache
Diaphoresis
Bone resorption
35
what are the specific adverse effects of the atypical antidepressants?
Bupropion- Seizures
36
what are the specific adverse effects of tricyclic antidepressants?
Dry mouth
Urinary Retention
Constipation
QRS prolongation
Seizures
Orthostatic Hypotension
37
what are the specific adverse effects of MAO inhibitors?
Potential for serotonin syndrome
Sexual dysfunction
38
which antidepressants are the most toxic?
toxicity is higher for TCAs and MAO inhibitors followed by venlafaxine, bupropion, and mirtazapine and is lower for SSRIs.
Among the selective serotonin reuptake inhibitors, citalopram and fluvoxamine appear to be associated with the higher case fatality rates in overdose.
39
So someone comes in with SSRI poisining, how are they going to present?
CNS- drowsiness, tremor
CVS- QRS and QTc interval prolongation(especially with citalopram and escitalopram)
Potential serotonin syndrome: hyperthermia, hypertonia, hyperreflexia, clonus.
40
someone comes in with
CNS- drowsiness, tremor
CVS- QRS and QTc interval prolongation(especially with citalopram and escitalopram)
Potential serotonin syndrome: hyperthermia, hypertonia, hyperreflexia, clonus.
what's wrong?
SSRI poisoning
41
what is the management of SSRI poisoning?
Secure airway, breathing, and circulation; intubate as clinically indicated.
Treat prolonged QRS interval with sodium bicarbonate
Prolonged QTc leading to torsades- Administer magnesium sulfate 2 g IV.
Treat seizures with benzodiazepines (e.g., lorazepam 1 to 2 mg IV) as needed.
In general, SSRIs are relatively safe in overdose despite serotonin syndrome being common. The exception is citalopram, which is significantly associated with QTc prolongation.
42
So someone comes in with TCA poisoning, how are they going to present?
Anticholinergic- Dilated pupils, absent bowel sounds, constipation, urinary retention
Cardiac- Tachycardia, hypotension, conduction abnormalities, QRS duration >100 msec
Neurologic- Sedation, seizures
43
someone comes in with
Anticholinergic- Dilated pupils, absent bowel sounds, constipation, urinary retention
Cardiac- Tachycardia, hypotension, conduction abnormalities, QRS duration >100 msec
Neurologic- Sedation, seizures
what's wrong?
TCA poisoning
44
how do you manage someone with TCA poisoning?
Maintain airway, breathing, circulation
Treat hypotension with intravenous crystalloid. Administer vasopressors such as norepinephrine in refractory hypotension.
If QRS >100 msec, administer IV sodium bicarbonate.
Administer activated charcoal(1g/kg) if the patient presents within 2 hours of ingestion; often, charcoal is avoided due to the presence of ileus.
Administer benzodiazepines (lorazepam 2 mg IV) for seizures.
QRS interval longer than 100 ms is a reliable predictor of serious complications.
45
what are the indications for mood stabilisers?
One of the strongest indications for mood stabilizers is bipolar disorder
Bipolar I disorder is defined by at least one manic episode in a lifetime, while bipolar II disorder is defined by at least one past or present hypomanic episode with at least one past or present major depressive episode.
The manic and depressive characteristics of bipolar disorder require particular mood stabilizers that can cater to the patient’s individual needs
46
someone comes in with acute mania, what medication is your first line?
Lithium
It has approval as monotherapy or combination therapy for acute manic episodes
and as maintenance therapy in bipolar disorder.
47
in what mood disorder situations is lithium used?
Lithium
It has approval as monotherapy or combination therapy for acute manic episodes
and as maintenance therapy in bipolar disorder.
48
in what mood disorder situations is carbamazepine used?
Carbamazepine has approval for monotherapy and combination therapy for acute manic and mixed episodes in bipolar disorder
and may additionally be a treatment for seizure disorders and trigeminal neuralgia.
49
in what mood disorder situations is lamotrigine used?
Lamotrigine is approved for maintenance therapy in bipolar disorder
and also as an anti-seizure medication.
50
what is the MOA of lithium?
Lithium’s mechanism of action is still under investigation for its neuroprotective benefits.
lithium inhibits neuronal excitation, leading to its benefits as a mood stabilizer.
51
what is the MOA of lamotrigine?
Lamotrigine is an anticonvulsant. It causes opposite effects on glutamate and GABA transmission, downregulating glutamate release and increasing GABA release.
52
what are the adverse effects of lithium?
Lithium may cause tremors, weight gain, or lead to hypothyroidism. Due to lithium's excretion via the kidneys, adverse effects manifest in the form of nephrogenic diabetes insipidus and, more rarely, chronic tubulointerstitial nephritis.
About 20 to 40% of patients taking lithium chronically develop polyuria and polydipsia.
the nephrogenic diabetes insipidus that occurs due to lithium therapy is managed similarly with thiazide diuretics, NSAIDs, and a low salt diet.
53
what are the adverse effects of valproic acid?
Valproic acid's adverse effects include weight gain and GI disturbances such as nausea and vomiting, as well as alopecia, tremor, and easy bruising, most probably owing to its effects on coagulation.
Other more serious forms of valproic acid toxicity include encephalopathy secondary to hyperammonemia, hepatotoxicity, and acute pancreatitis.
Also increased teratogenic risk
54
what are the adverse effects of carbamazepine?
Carbamazepine has both systemic and neurological side effects.
The systemic adverse effects are dual-faceted, including GI and integumentary systems.
GI upset is characterized by nausea, vomiting, diarrhea, and hyponatremia.
The integumentary issues characteristically are pruritis and rash.
The neurologic defects associated with carbamazepine therapy include headache, dizziness, vision changes (blurry or diplopia), lethargy, and drowsiness.
55
what are the adverse effects of lamotrigine?
Lamotrigine therapy has a similar adverse effect profile as carbamazepine in that it involves rash and nausea as prominent side effects.
Neurologic side effects include diplopia, dizziness, and tremor.
56
what are the contraindications to giving lithium?
Lithium clearance is through the kidneys. As renal function decreases with age, prescribers should exercise caution in patients over the age of 60 and those with renal failure
lithium should be avoided in those with cardiac failure due to its ability to alter the functioning of the sodium-potassium transporter, which can worsen arrhythmias.
Lithium should be discontinued within the first three months of pregnancy, and the decision to resume therapy is up to the patient’s psychiatrist and whether the benefits of treatment outweigh the risks
There is some evidence that lithium can cause facial malformations in infants born to mothers on lithium therapy.
57
what are the contraindications to giving valproate?
Valproic acid should be avoided in pregnancy and harbors a serious adverse effect of fatal hepatotoxicity.
It may also cause pancreatitis, SIADH, hyponatremia, headache, nausea, vomiting, weight gain, diarrhea, and abdominal pain
58
what are the contraindications to giving lamotrigine and carbamazepine?
Lamotrigine and carbamazepine are both capable of causing Stevens-Johnson syndrome; therefore, patients should learn to monitor themselves for any skin changes or new rashes after initiation of a mood stabilizer regimen with either of these drugs.
59
what tests should you do one someone before starting them on valproic acid?
check if they're pregnant
Due to valproic acid’s ability to cause fatal hepatotoxicity, LFTs are necessary before initiating therapy to establish a baseline for the comparison of LFTs for follow-up monitoring.
60
what tests should you do one someone before starting them on lithium?
Before initiating lithium therapy, the clinician should perform a thorough physical exam that includes palpation of the thyroid gland
and obtain creatinine, blood urea nitrogen, and thyroid function test, including T3, T4, and TSH levels, along with a urinalysis and electrocardiogram.
61
how does someone with lithium toxicity present?
Treatment with the ion lithium affects multiple organ systems, most notably the central nervous system and the GI system, causing tremors, twitching, drowsiness, a feeling of sluggishness, vomiting, diarrhea, and loss of appetite. Most minor symptoms of toxicity are treatable by adjustment of the medication dose
Lithium's toxicity profile is also remarkable for a decreased ability to concentrate urine, hypothyroidism, weight gain, and hyperparathyroidism.
62
how does someone with sodium valproate toxicity present?
Valproic acid toxicity is manifested most commonly as central nervous system depression and potential cerebral edema, potentially leading to coma and respiratory depression.
These manifestations can occur alongside pancreatitis and hyperammonemia.
63
what's antipsychotic is used for the treatment of an acute episode of psychoses
Schizophrenia and Schizoaffective disorders: First and second-generation antipsychotics (except clozapine) are indicated for the treatment of an acute episode of psychoses
64
what's antipsychotic is used for the maintenance therapy of schizophrenia and schizoaffective disorders.
Schizophrenia and Schizoaffective disorders: First and second-generation antipsychotics (except clozapine) are indicated for the maintenance therapy of schizophrenia and schizoaffective disorders.
65
what types of antipsychotics are better for treating positive symptoms of SCHIZOPHRENIA & SCHIZOAFFECTIVE DISORDER?
First-generation antipsychotics are better for treating positive symptoms of schizophrenia, e.g., hallucinations, delusions, among others.
66
what antipsychotics treat the positive and negative symptoms of SCHIZOPHRENIA & SCHIZOAFFECTIVE DISORDER?
Second-generation antipsychotics treat both positive symptoms and negative symptoms of schizophrenia, e.g., withdrawal, ambivalence, among others, and are known to reduce relapse rates
67
what antipsychotic is best for acute mania WITH psychotic symptoms
Acute Mania: First-generation antipsychotics are effective in the treatment of acute mania with psychotic symptoms.
68
what antipsychotic is used for the treatment of acute mania?
All second-generation antipsychotics except clozapine can also be used as a treatment of symptoms of acute mania.
69
which mood stabilizers are antipsychotics combined with to treat acute mania with psychosis in bipolar disorder?
Antipsychotics are used with mood stabilizers like lithium, valproic acid, or carbamazepine initially, and then after symptoms stabilize can be gradually decreased and withdrawn.
70
what antipsychotics are used to treat MDD with psychotic features?
Major Depressive Disorder with Psychotic features: First or second-generation antipsychotics, along with an antidepressant, is the treatment of choice for depression with psychotic features.
71
what is the medical managmeent of treatment-resistant depression?
Olanzapine and fluoxetine, as a combination therapy, have FDA approval for treatment-resistant depression.
72
what is the medical management of delusional disorder?
First-generation antipsychotics are indicated in the treatment of delusional disorder and paranoia associated with personality disorders.
73
someone comes in with severe agitation, how do you medically manage them?
Severely agitated, irritable, hostile, and hyperactive patients can be treated with a short-term course of first-generation antipsychotics irrespective of the etiology of the behavioral disturbance
Second-generation antipsychotics can also be used for treating acute agitation.
74
what antipsychotic is useful for controlling aggrerssion in children?
Risperidone and olanzapine are useful for controlling aggression in children.
75
what antipsychotic is used for borderline personality disorder?
Borderline Personality Disorder: This type of personality disorder can have symptoms of psychosis and paranoia.
Both first and second-generation antipsychotics are used for the treatment of these symptoms.
76
what antipsychotic is used for the treatment of dementia and delirium?
A low dose of high potency first-generation antipsychotics like haloperidol is recommended for the treatment of agitation in delirium and dementia.
use caution in elderly patients as the antimuscarinic effects can cause significant adverse effects
Second-generation antipsychotics can also be used for treating behavioral disturbances in dementia.
77
what antipsycotic is used for SIPD?
Substance-induced psychotic disorder: In cases of severe psychosis secondary to substance use, antipsychotics can be used to control agitation symptoms.
Caution is necessary when using first-generation antipsychotics in alcohol withdrawal and phencyclidine intoxication.
78
what antipsychotic do you use for treatment resistant psychosis?
Clozapine
This drug is the agent of choice when the patient has failed multiple trials of standard antipsychotic therapies. Clozapine is also useful in the treatment of tardive dyskinesia.
79
what is the MOA of first generation antipsychotics?
The first-generation antipsychotics work by inhibiting dopaminergic neurotransmission; their effectiveness is best when they block about 72% of the D2 dopamine receptors in the brain.
They also have noradrenergic, cholinergic, and histaminergic blocking action.
80
what is the MOA of second generation antipsychotics?
Second-generation antipsychotics work by blocking D2 dopamine receptors as well as serotonin receptor antagonist action.
5-HT2A subtype of serotonin receptor is most commonly involved.
81
what first gen antipsychotics can be given in long-acting depo form?
First gen: Haloperidol and fluphenazine can be delivered in long-acting depot parenteral form.
82
what second gen antipsychotics can be given in long-acting depo form?
Second gen: Risperidone, olanzapine, aripiprazole, and paliperidone are available as extended-release or long-acting injectable forms.
83
what are the adverse effects of first gen antipsychotics?
Anticholinergic adverse effects like dry mouth, constipation, urinary retention are common with low potency dopamine receptor antagonists like chlorpromazine, thioridazine.
The action of H1 histamine blocking by first-generation antipsychotics causes sedation. Chlorpromazine is the most sedating
First-generation antipsychotics can also lower the seizure threshold, and chlorpromazine and thioridazine are more epileptogenic than others.
Haloperidol can cause abnormal heart rhythm, ventricular arrhythmia, torsades de pointes, and even sudden death if injected intravenously.
Other FGAs can cause prolongation of QTc interval, prolonged atrial and ventricular contraction, and other cardiac conduction abnormalities.
Allergic dermatitis and photosensitivity can occur with chlorpromazine. Chlorpromazine is also associated with blue-gray skin discoloration and benign pigmentation of the lens and cornea.
Neuroleptic malignant syndrome is a rare but fatal adverse effect that can occur at any time during treatment with FGAs.
84
what is neuroleptic malignant syndrome?
life-threatening neurologic emergency
characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.
85
how does neuroleptic malignant syndrome present?
The onset of symptoms is over 24 to 72 hours with increased temperature, severe muscular rigidity, confusion, agitation, elevation in white blood cell count, elevated creatinine phosphokinase concentrations, elevated liver enzymes, myoglobinuria, and acute renal failure.
86
how do you manage NMS?
The antipsychotic should be immediately discontinued, and dantrolene 0.8 to 2.5 mg/kg every 6 hours up to 10 mg per day is the drug of choice.
Adequate hydration, cooling, and there should be close monitoring of vital signs and serum electrolytes.
87
what are the adverse effects of second gen antipsychotics?
SGAs are associated with significant weight gain and the development of metabolic syndrome.
Risperidone is associated with dizziness, anxiety, sedation, and extrapyramidal side effects.
88
so what are examples of the extrapyrymidal side effects?
acute dystonia
akathesia
parkinsonism
NMS
late tardive dyskinesia
