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Psychiatry Clerkship > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

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1
Q

Indications for supportive psychotherapy

A
  1. Adjustment disorders
  2. Acute emotional crises
  3. When a long-lasting “cure” is not expected, but improved functioning is hoped for (as in chronic schizophrenia, for example)
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2
Q

Indications for insight-oritented psychotherapy

A
  1. Treatment of anxiety and depression in all of their forms
  2. Somatoform and dissociative disorders
  3. Personality disorders
  4. Neuroses
  5. Chronic effects of psychosocial trauma
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3
Q

Goal of supportive psychotherapy

A

To form a close therapeutic alliance with the patient and help to define current problems, consider and implement possible solutions

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4
Q

Goal of insight psychotherapy

A

Recognize transference/countertransference feelings as they occur, uncover unconscious wishes and defenses that may have caused the patient to behave in a maladaptive manner

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5
Q

Substitution therapy

A

Form of behavioral modification therapy that is aimed at replacing an undesirable behavior with a desirable one

Ex, replace smoking with chewing gum

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6
Q

Types of “talk therapy”

A

Individual psychotherapy

Behavior modification therapy

Cognitive therapy

Social therapy (therapy as a group of similar patients, family, couple, etc)

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7
Q

Indications for ECT

A
  1. Depression that is unresponsive to medication
  2. Depression that is severe and acutely life-threatening (unrelenting, serious suicidal ideation, patient will not eat/drink, etc)
  3. Severe, unrelenting mania (less common)
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8
Q

What is the single most effective treatment for severe major depressive disorder?

A

ECT

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9
Q

Side effects of ECT

A
  • Postictal state (brief)
  • Possible retrograde memory loss
  • Headache, nausea
  • Muscle stiffness
  • Very small to nonexistent risk of long-term cognitive impairment
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10
Q

Contraindications to ECT

A
  • Elevated ICP
  • Space-occupying lesion in the brain
  • Recent MI (< 3 months since event)
  • Severe arterial hypertension

Note that pregnancy is NOT a contraindication to ECT.

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11
Q

Transcranial magnetic stimulation

A

Similar idea to ECT, but not inducing a seizure

Must be used repetitively (generally daily, 5x/week, 4-6 weeks). For this reason it is usually called “repetitive” TMS, or rTMS.

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12
Q

Side effects of rTMS

A
  • Syncope
  • Twitching/tingling of facial musculature
  • Scalp discomfort at site of treatment
  • Headache
  • Rarely, hearing loss, seizure
  • Rarely may induce a manic episode in those with bipolar disorder
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13
Q

Tricyclic antidepressants

A
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14
Q

SSRIs and SNRIs

A
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15
Q

MAOis

A
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16
Q

Miscellaneous antidepressants

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17
Q

Mood stabilizers

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18
Q

1st generation antipsychotics

A
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19
Q

2nd generation antipsychotics

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20
Q

Nonbenzodiazepines

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21
Q

Stimulants

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22
Q

Treating antipsychotic-induced dystonias

A

Anticholinergics (or 1st generation antihistamines with anticholinergic properties) are used for this indication:

Bantropine, biperiden, diphenylhydramine, trihexyphenidyl

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23
Q

Treating antipsychotic-induced akithisias

A

Remember, akithisias = motor restlessness

Propranolol or benzodiazepines are useful for this indication

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24
Q

Medications used to treat parkinsonian side effects of antipsychotics

A

Amantadine and/or levodopa are typically used

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25
Important side effect of chronic quetiapine use
Cataracts may develop Slit-lamp exam when starting chronic use and q6 month are recommended
26
Possible acute side effect of trazodone
Priapism Treat with intra-corporal injection of epinephrine. This is a medical emergency.
27
What is the single most imporant side effect of buproprion?
Lowering the seizure threshold
28
Important side effects of clozapine
Agranulocytosis -- frequent monitoring of leukocyte count is necessary Anticholinergic effects Like all antipsychotics, possibility of NMS
29
Treatment for life-threatening lithium toxicity
Dialysis
30
Treatment of benzodiazepine overdose
Flumenazil A benzodiazepine antagonist
31
Treatment for excessive daytime sleepiness in shift workers
Modafinil Just like narcolepsy!
32
Amoxapine - loxapine relationship
The tricyclic **antidepressant amoxapine** also happens to be a metabolite of the **antipsychotic loxapine** Due to their structural similarity, amoxapine can also cause some **extrapyramidal symptoms,** making it unique among the tricyclics
33
Serotonin syndrome symptoms in order of appearance
* Diarrhea * Restlessness * Extreme agitation * Hyperreflexia and autonomic instability * Myoclonus, seizure, hyperthermia, rigidity, delirium * Coma, death
34
Most common side effects of SSRIs
Sexual dysfunction GI disturbance
35
Foods containing tyramine
Red wine Aged cheese Liver Smoked foods
36
Use buproprion in patients with \_\_\_ Avoid buproprion in patients with \_\_\_
Use buproprion in patients with **smoking history** Avoid buproprion in patients with **eating disorders, seizures**
37
Who can't use valproate as a mood stabilizer?
Women of child-bearing age
38
Benzo withdrawal looks a *lot* like \_\_\_
Benzo withdrawal looks a *lot* like **alcohol withdrawal** Which makes sense. Both GABA antagonists.
39
ehat is ths crap?
i dunno
40
Main drug specific side effect of olanzapine
Atypical antipsychotic (serotonin-dopamine antagonist) ## Footnote **Somnolence**
41
All tricyclics end with:
* -yline * -amine Exception: amoxapine
42
Notable side effects of all tricyclics
* Anticholinergic effects * Orthostatic hypotension and/or tachycardia * QT prolongation * Weight gain
43
Side effects of venlafaxine
"Activating SNRI" that may worsen anxiety Poor choice for insomnia. Increases BP at high doses -- poor choice for hypertension Great for patients who need an activating antidepressant
44
How long of a window should there be between stopping an SSRI/SNRI and starting a MAOi
5 weeks To prevent serotonin syndrome
45
Side effects of all SSRIs or SNRIs
Akathisia, anxiety, agitation Diarrhea/GI upset Sexual dysfunction Risk of serotonin syndrome May increase suicidal thoughts/behaviors
46
Main drug specific side effect of these SSRIs: Sertraline Paroxetine Fluvoxamine Citalopram
* Sertraline: Diarrhea * Paroxetine: Anticholinergic effects * Fluvoxamine: Nausea/vomiting * Citalopram: Less sexual side effects than other SSRIs
47
Mood stabilizers with high risk of neural tube defect in pregnant patients
* Valproate * Divalproex
48
Drug specific side effect of Thioridazine
Retinitis pigmentosa A form of degenerative retinopathy. Characterized by "pigment clumps" in the retina. Images shown. Technically all antipsythotics can cause this, but it is usually associated with this one
49
Main drug specific side effect of Ziprasidone
QT prolongation An atypical antipsycbotic
50
Only four MAOis you need to know
Phenelzine Isocarboxazid Selegiline Trancylcypromine
51
If it ends in any of these, it is either a 1st or 2nd generation antipsychotic:
* -zine / -azine * -apine * -done / -idone
52
Why might a TCA be a poor therapeutic choice for a patient with MDD with suicidality?
Because you can OD on it! TCA toxicity causes potentially fatal cardiac arrhythmias
53
Buproprion side effect profile
* **Reduced seizure threshold** * **Tachycardia w/ possible arrhythmias** * **Insomnia** * Activating side effects like jitteriness * Also helps with smoking cessation! * Weight loss
54
Effects of mirtazapine
* Effective in treating both depression and anxiety * Encourages appetite * Helps induce sleep/to treat insomnia
55
Best SNRI for the purpose of treating neuropathic pain
Duloxetine
56
Only two atypical antipsychotics that can be used in an *acute* setting (fast acting)
Olanzapine Ziprazidone
57
Final active metabolite of benzodiazepines
Oxazepam
58
If someone is delirious, you cannot . . .
. . . **comment on psychosis or mood** You have to treat the delirium before you can evaluate these.
59
Benzos at a low dose can induce ___ rather than \_\_\_
Benzos at a low dose can induce **disinhibition** rather than **sedation**
60
Antidepressant rule of 6's
* It takes **6 weeks** to see efficacy * Stay on it for **6 months** at an effective dose before trialing off * If changing medications, allow for a **6 week washout period**
61
Most common SSRIs
(Es)citalopram Sertraline Fluoxetine Paroxetine
62
Most common SNRIs
(Des)venlafaxine Duloxetine
63
Buproprion cannot be used in \_\_\_
Buproprion cannot be used in **bulimia** Since they are high risk for seizures
64
Serotonin modulators
**Mirtazepine** (SE: orexogenic) **Trazodone** (SE: sleep aid, may cause priapism) More used for their side effects than as primary antidepressants.
65
TCA's that don't end in "-tryptyline"
Imipramine Doxepin
66
3 C's of the TCAs
* **C**onvulsions (increased risk of seizure) * **C**ardiotoxicity (predispose to arrhythmias, prolong QT interval) * **C**oma (altered mental status)
67
Patient with a history of depression has a hypertensive crisis after attending a wine and cheese party. What antidepressant are they taking?
One of the MAOis, either **phenylzine** or **selegiline.**
68
Lines of therapy for bipolar
1st line: Li or valproate 2nd line: Quetiapine *or* Li/valproate + quetiapine *or* lamotrigine 3rd line / almost never: Carbamazepine
69
Only FDA approved medication for pediatric depression
Fluoxetine
70
SSRI with the most cardiac effects
(Es)citalopram QTc prolongation
71
What SSRI is contraindicated in pregnancy?
Paroxetine
72
Lithium toxicity
Lithium toxicity results in an **altered mental status, dysarthria, decreased muscle strength,** and a **coarse tremor.** It happens in the case of **overdose OR dehydration.** Treat w**/ hemodialysis.**
73
Fluphenazine
1st generation antipsychotic belonging to the Phenothiazine subgroup Fluphenazine in particular can cause **impaired thermoregulation (hyper or hypothermia)** Patients on fluphenazine who are likely to be exposed to **extreme temperatures** should be monitored
74
If a patient who smokes is already willing and motivated to quit. . .
. . . **there is no additional benefit to motivational interviewing** Start buproprion if there is no contraindication. Otherwise, start varenicline.
75
Antidepressant discontinuation syndrome
Caused by **abrupt cessation of antidepressant** drugs without appropriate tapering Onsets in 1-4 days Sx include: headache**, depressed mood,** fatigue, **insomnia,** nausea, **sensory disturbances,** irritability, **ataxia, tremor, and myalgia** **Paroxetine** discontinuation has an increased risk of antidepressant discontinuation syndrome.

Psychiatry Clerkship (53 decks)

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