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Psychopharm Flashcards

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0
Q

Dopamine pathways

A

Mesolimbic (+ symptoms)
Mesocortical (- symptoms)
Tuberoinfundibular (dopamine suppresses prolactin production)
Nigrostiatal (movement)

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1
Q

HAM side effects

A 
H = weight gain and sedation 
A = orthostasis 
M = can't pee, see, poo, think clearly
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2
Q

Akethesia

A

Subjective sense of restlessness. Treat with beta blocker or benzo.

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3
Q

Acute dystonia

A

Usually involves oral/buccal/facial. Treat with benztropine, Benadryl, or aromatidine.

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4
Q

Parkinsonism

A

Cogwheel rigidity, shuffling gait, resting tremor. Can treat by changing meds, may ultimately need to change to clozaril.

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5
Q

TD

A

Late in onset, insidious, oral/buccal choreathoid movements. Treat by discontinuing medications to prevent this from becoming permanent

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6
Q

Low potency typical antipsychotics

A

Chlorpromazine, thioridazine.

More likely to have HAM side effects than EPS.

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7
Q

NMS

A

Autonomic instability (high fever, tachy, sweating, HTN), muscle rigidity, dystonia, agitation. Treat by discontinuing agent and giving dantrolene

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8
Q

Side effects of thioridazine

A

Retinitis pigmentosa

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9
Q

High potency typical antipsychotics

A

Haldol, prolexin, pimozide

More likely to have EPS, less likely to have HAM side effects

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10
Q

Possible side effects of all antipsychotics

A

EPS, HAM, raise QTC, lower seized threshold

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11
Q

Mechanism of atypicals

A

Block D2 and 5HT2

Will commonly see metabolic syndrome as side effect

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12
Q

Mechanism and side effects of abilify

A

Partial agonist at dopamine and serotonin 1a receptor and antagonist at post synaptic serotonin 2a receptors

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13
Q

Side effects of clozaril

A 
Agranulocytosis 
Anticholinergic 
Weight gain and sedation
NMS 
cardiomyopathy
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14
Q

Actions of various serotonin receptors

A

5HT1a – decrease depression and anxiety
5HT2a/c – headaches and jitteriness, decreased libido long term
5HT3/4 – gi disturbances

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15
Q

MoA of TCAs

A

Increase levels of norepi and serotonin in synapse

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16
Q

Highly cholinergic TCAs

A

Amitryptiline, doxepin, imipramine, clomipramine trimipramine

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17
Q

TCA used to treat OCD

A

Clomipramine

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18
Q

Less anticholinergic TCAs

A

Desipramine, nortriptyline, protryptiline, amoxapine

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19
Q

Preventing serotonin syndrome

A

2 week washout period for SSRIs, but 5 weeks for Prozac because of long half life

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20
Q

SSRI with shortest half life

A

Paroxetine (Paxil)

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21
Q

Buspirone

A

Partial 5HT1a agonist

Used to treat GAD

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22
Q

Mirtazapine

A

Alpha 2 antagonist – leads to increased norepi and serotonin by blocking feedback inhibition.
No interference with sexual function.
Can cause sedation and weight gain

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24
Q

Bupropion

A

Norepi and dopamine reuptake inhibitor
Lowers seizure threshold
Used for smoking cessation

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25
Nefazadone and trazadone
serotonin antagonist and reputake inhibitor often used as sleep aid Trazadone can cause priapism
26
Lithium dosing range
0.8 - 1.0
27
Carbamazepine dosing range
8-12
28
Valproic acid dosing range
80-120
29
Lithium side effects
neurotoxicity, hypothyroid, diabetes insipidus, leukocytosis | can cause Ebsteins anomaly
30
Carbamazepine side effects
autoinducer at liver, S/J rash, CBC anomalies can cause hepatitis can cause craniofacial and neural tube defects
31
Valproic acid side effects
hepatitis, CBC abnormalities, sedation, weight gain | can cause neural tube and defects
32
Lamictal
good for preventing depression | causes serious S/J rash
33
shortest acting benzo
Alprazolam (xanaz) -- quick onset and short half life, so high risk for abuse
34
mid acting benzo
lorazepam (ativan) -- longer to onset and moderate risk of abuse
35
Longest acting benzo
Clonazepam (klonopin) -- long to onset and long half life, so lowest risk of abuse
36
Patient with cirrhosis needs to go on benzo taper for etoh withdrawal. what do you use?
LOT -- Lorezapam, oxazepam, and tomezapm (?) are only glucuronidated, so they spare the liver unlike other benzos
37
How is benzo overdose reversed?
use Flumazenil. But watch out because it can theoretically lower sz threshold.
38
What receptor do Benzos and Etoh act on?
GABA-a
39
Uses of lithium
acute mania, prophylaxis for manic and depressive episodes in bipolar and schizoaffective d/o.
40
Testing needed to initiate lithium treatment
ECG, basic chemistries, thyroid function tests, CBC, pregnancy test. Need to check lithium blood levels five days after starting therapy
41
Factors that influence lithium levels
Decrease - NSAIDS | Increase = dehydration, salt deprivation, sweating, impaired renal function, diuretics
42
Carbamazepine (tegretol) uses
treating mixed episodes and rapid cycling BD. | not as effective in depressed phase
43
tests needed when starting tegretol
CBC and LFTs
44
Depakote uses
treating mixed episodes and rapid cycling
45
what is the interaction between lamictal and depakote?
Valproate will increase lamictal levels, and lamictal will decrease valproate levels. D is delicious, so it gets eaten first when paired with other drugs.
46
Dextroamphetamine and amphetamine side effects
weight loss and insomnia
47
MoA of psychostimulants
increase dopmane and norepi
48
atomoxetine (strattera) MoA. What is special about it?
presynaptic norepi transport inhibitor Unlike other stimulants this is less likely to cause tics has a more gradual onset of action.
49
Watch out for what with ritalin?
Leukopenia, anemia, increased LFTs | may cause weight loss and insomnia
50
Donepezil
Acetylcholinesterase inhibitor -- dementia
51
Galantamine
Acetylcholinesterase inhibitor -- dementia
52
Rivastigmine
Acetylcholinesterase inhibitor -- dementia
53
Tacrine
Acetylcholinesterase inhibitor -- dementia
54
Memantine
NMDA receptor antagonist -- dementia (augments therapy)
55
order of atypicals in terms of metabolic syndrome (worst to least)
olanzapine -- risperidone -- quetiapine -- ziprasidone -- aripiprazole
56
What is so typical about risperdal?
It causes the most EPS side effects of the atypicals
57
Why were we giving out so much seroquel on spruce 6?
Because it's extremely sedating (and it can also cause orthostatis (anti adrenergic effect)
58
What is the FALTERED pneumonic for NMS?
``` F = fever A = autonomic instability L = leukocytosis T = tremor E = elevated CPK R = rigidity E = excessive sweating D = delirium ```
59
how is a hypertensive crisis mediated by MAOIs treated?
Give an alpha adrenergic blocker -- like phentolamine
60
What is the initial presentation of serotonin syndrome?
lethargy, restlessness, confusion, flushing, diaphoresis, tremor, mycolonic jerks.
61
What does the end stage of serotonin syndrome look like?
Hyperthermia, hypertonicity, rhabdo, renal failure, convulsions, coma, and death.
62
treatment of cateplexy
use sodium oxygate -- agonizes GABA b receptor
63
What are the FDA approved pharm agents for treating acute mania?
Li, VPA, Carb, SGA's and thorazine. | NOTE: lamictal is not approved to treat mania
64
What are the FDA approved pharm treatments for bipolar depression?
Olanzapine + fluoxetine, Seroquel, Latuda. | Lithium and lamictal don't have FDA approval but are still used.
65
What are the best agents for preventing mania in the maintenance phase?
Antipsychotics > Li >>>> LMT
66
What are the best agents for preventing bipolar depression in maintenance phase?
LMT>Li
67
What are the common side effects of lithium?
Acne, tremor, N/V/D, sedation
68
Who is most susceptible to SJS with carb?
Asians!
69
What does VPA do to the blood?
decreases platelet levels
70
What does carb do to the blood?
Decreases WBC count (watch out for aplastic anemia)
71
Why do carb levels fall over time, even if the patient is compliant?
Carb is an autoinducer of its own metabolism by the P450 system, so its level will gradually decrease over time before reaching a new steady state.
72
side effects of nefazadone
hepatitis and liver failure
73
lithium toxicity syndrome
dysarthria, ataxia, coarse tremor, and ab pain seen early. | later see seizures, neuromuscular irritabilty, impaired consicousness.

Psychopharm (1 decks)

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