Psychopharmacology Flashcards
(206 cards)
1
Q
Depressive disorders are multi-factorial. What are some of those factors?
A
Genetics
NT changes
Altered neuroendocrine function
Psychosocial factors
2
Q
Methohexital helps facilitate
A
Seizures
3
Q
5-HT3 is associated with
A
Anti-emetics
4
Q
5-HT outside the CNS can cause
A
GI Motility
PLT Aggregation
Vascular Tone
Inflammatory Response
Henatopoiesis
Genital Arousal
5
Q
Physiological effects of Serotonin include
A
Social
Affective
Cognition
6
Q
5- HT 1A is
A
Inhibitory
Regulates serotonergic neuronal activity
Affects neurogenic effects of antidepressants
7
Q
5- HT 2A is
A
Excitatory
Regulates cognition, attention, working memory revenant to psychosis
Implicates in serotonin syndrome
8
Q
5 HT 2A is antagonized by
A
2nd generation atypical antipsychotics
9
Q
5 HT 2A agonist is by
A
Hallucinogens
10
Q
Which serotonin receptor is targeted by anesthesia?
A
5HT3
11
Q
Which serotonin receptor regulates N/V and beneficial target of psychotropic drugs?
A
5HT3
12
Q
Common SSRIs include?
(Shay Ford Can Play)
A
Sertraline
Fluoxetine
Citalopram
Paroxetine
13
Q
SSRIs most commonly treat
A
Mild-Moderate depression
Panic
OCD
Phobias
PTSD
14
Q
Where do SSRIs work?
A
At the serotonin trip take transporter
15
Q
MOA for SSRIs
A
Blockade of 5HT reuptake transporter, which increases synaptic serotonin
16
Q
SSRIs will eventually cause
A
A down-regulation of serotonin receptors since they are overwhelmed by agonists
17
Q
5HT 1A has what effects?
A
Antidepressant
Anxiolytic
18
Q
5HT 2A has what effects
A
Anxiety
Insomnia
Sexual dysfunction
19
Q
5 HT3 has what effects
A
Nausea
Headache
20
Q
Most common side effects of SSRIs
A
Insomnia
Agitation
Headache
Nausea
Diarrhea
21
Q
SSRIs can cause this in the elderly, women, & in CV disease
A
Hyponatremia
22
Q
What is the black box warning with SSRIs?
A
Shouldn’t be used in children and adolescents
Can cause suicidal thoughts & behaviors
23
Q
SSRIs can inhibit
A
CYP 450 (Fluoxetine), increasing plasma concentrations (warfarin, phenytoin, antiarrhythmics, beta blockers)
24
Q
SSRI can cause this due to its effects on warfarin & increased anti platelet activity
A
Bleeding risk
Increases anticoagulant effect on warfarin (paroxetine,fluoxetine)
25
SSRI has this effect in the heart
Can prolong QT (citalopram & escitalopram)
26
Should SSRI be continued perioperatively?
YES
27
What happens if SSRI is stopped abruptly?
Can lead to Discontinuation Syndrome
major depressive episode
Dizzy
Parenthesis
Myalgias
Irritable
Insomnia
Visual Disturbances
28
What is serotonin syndrome?
Excessive CNS serotonergic activity
29
Phenylpiperidine opioids (fent & meperidine), ondansetron, metoclopramide, erythromycin, metronidazole should all be
Used in caution since there’s a risk of Serotonin Syndrome
30
Serotonin syndrome symptoms include
Tachycardia
HTN
Hyperthermia
Tachypnea
Diaphoresis
HOTN
31
What are the neuromuscular abnormalities of Serotonin Syndrome
Hyperreflexia
Tremors
Myoclonus
Trismus
Muscle rigidity
32
Serotonin syndrome can cause what mental status changes?
Restlessness
Agitation
Visual Hallucinations
Disoriented
Confusion
Seizures
Coma
33
What does SNRI stand for?
Serotonin Norepinephrine Reuptake Inhibitors
34
Common SNRI drugs are
Venlafaxine
Duloxetine
Desvenlafaxine
35
SNRIs can be what type of therapy?
1st or 2nd line
36
SNRIs can be used to treat
Depressions
Anxiety
Chronic Pain
37
MOA of SNRI
Blockade of 5HT & NE reuptake transporters
Increasing synaptic levels of serotonin & NE
MOST selective for NE reuptake inhibition
38
SNRI adverse effects include
HTN
Inhibition of CYP 2D6 enzymes
39
Common TCAs include
Amitriptyline
Nortriptyline
Imipramine
40
TCAs treat
MDD
Chronic Pain Syndromes
OCD
41
TCAs affect what Neuro chemical system?
Serotonin
NE
Histamine
ACh
42
MOA for TCA
Inhibit 5 HT & NE reuptake transporters
43
TCAs can causes a depletion in
Catecholamines, so use Ketamine & Ephedrine with caution since they also release catecholamines
44
What happens if TCA and ketamine/ephedrine are given together?
CV collapse
45
TCA receptor antagonism include
5HT 2A
Alpha 1
NMDA
H1 H2
mACh receptors
46
TCAs cause what common CNS side effect?
Anticholinergic
(Dry mouth, blurred vision, tachycardia, urinary retention, lieu’s, sedation, delirium risk with elderly)
47
TCAs cause what in pediatric population?
Lowers seizure threshold
48
TCA is toxic with MAOIs as it will cause
Hyperthermia
Seizure
Coma
49
TCAs can cause
Extrapyramidal symptoms & tremors
50
TCA CV side effects
Ortho HOTN
Increased HR
Widen QRS
Inverted T wave
QT prolongation
Slowed AV conduction
Enhanced cardiac depressant effects of anesthesia
51
Characteristics of TCA overdose
Rapid
Fatal
Agitation, seizures
Cardio respiratory & Neuro depression
52
How do you treat TCA overdose?
Treat seizure with Diazepam or phenytoin
Treat dysthymias with lidocaine & sodium bicarbonate
Treat HOTN with IVF, sympathomimetics, & inotropes
53
TCAs will _________anesthetic requirements
Increase
54
TCAs will cause a/an_________response to Anticholinergic s like________ & ________as it passes the BBB
Exaggerated; Atropine; Scopolamine,
(Will place the patient at risk for delirium & confusion)
55
TCAs will cause a/an________response to indirect acting vasopressin’s & SNS stimulation
Exaggerated
(Should use smaller doses or direct acting vasopressors)
56
TCAs will cause a/an________ ventilators depressant effect on opioids
Exaggerated
( avoid pancuronium, ketamine, meperdine & epinephrine)
57
What should be used in small doses when treating HOTN due to TCAs?
Neosynephrine
58
Common MAOIs
Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine
59
MAOIs treat
MDD
Panic
Parkinson’s
Phobias
60
Monoamine oxidase is a______enzyme & _____& _______ NE, E, DA, & 5 HT
Mitochondrial enzyme
Inactivates & Removes
61
Older MAOIs increase_______& are stable & ______complex with cerebral neuronal MAO leading to _____
NT Release
Irreversible; Inhibition
62
Newer MAOIs are ______ of monoamine oxidase
Reversible
63
MAOI side effects include
Ortho HOTN
Anticholinergic like effects
Paresthesia
Wt gain
Hepatitis
64
MAOIs cause this side effect that’s a crisis
Hyperadrenergic crisis related to tyramine in the diet
Causing HT , hyperpyrexia, CVA, & dysrhythmias
65
MAOIs can cause there 2 reactions
Type 1- excitatory
Type 2- inhibitory
66
In MAOI Type 1 (excitatory) reactions, what medications are safe to give
Morphine & hydromorphone
67
Type 1 excitatory reactions resemble
Serotonin Syndrome
68
Type 1 excitatory reactions happens with the administration of
Meperidine & dextromethorphan
69
Type 1 excitatory reactions will cause
Agitation
Headache
Muscle rigidity
Hyperpyrexia
High temp
AVOID GIVING PIPERDINES
70
Type 2 depressive reactions are reversed with
Naloxone
71
Type 2 depressive reactions will cause
Neurological depression & coma
Ventilators depression
72
MAOI of hepatic enzymes ________effects of all_______
Enhancing
Opioids
73
MAOIs given with indirect sympathomimetics such as ephedrine will_______
Place the patient at increased risk for fatal hypertensive crisis
74
What sympathomimetics is preferred over ephedrine?
Indirect acting Neosynephrine at smaller doses
(Has hypersensitivity, risking exaggerated effects)
75
What anesthetic medications should be avoided when a patient is taking MAOIs?
Ketamine
Ephedrine
Pancuronium
Epinephrine in LA mixtures
76
(MAOI) Phenezine decreased plasma cholinesterase levels, prolonging_____
NMB SCh
77
MAOIs cause a reduced metabolism of____, requiring a decrease in dose
Barbiturates
78
What anesthetic medications are okay to give when a patient in on MAOIs
Propofol
Etomidate
BZs
Inhalation agents
Anticholinergic
79
Trazadone, a monoamine, has the MOA of
STI activity
5 HT 2A antagonism
Alpha 1 antagonism
80
Side effects of Trazadone
Ortho HOTN
Dry mouth
Rare dysrhythmias
81
Buspirone is used to treat________
Mechanism________
May elevate___________
Generalized Anxiety
Partial agonist at 5 HT receptors
May elevate NE & DA levels
82
Mirtazapine/tetracycline have multimodal mechanisms such as
Alpha 2 antagonism ( increases NE)
5 HT 2A/3 antagonism
H1 antagonism
83
Mirtazapine/tetracycline is associated with
Lower risk of serotonin syndrome
84
Buprion MOA
Inhibition of DA & NE reuptake
85
Side effects of Bupropion includes
Seizures
Stimulant like effects
86
Bupropion may have some benefit in
Neuropathic pain
87
Mania is treated with
Lithium
Antipsychotics+ BZ
88
Lithium is good for treat resistant_____
MDD
89
Lithium is an _______ion with a variety of
Inorganic; Neurobiologic effects
90
Lithium inhibits_______neurotransmission of _____&______
Excitatory; dopamine; glutamate
91
Lithium causes ________of __________ receptors
Downtegulation; NMDA
92
Lithium increases _______neurotransmission in the CSF & presynaptic release, _________ __________receptors
GABA; up-regulating GABA
93
Renal side effects of Lithium include
Polydipsia
Polyuria
Nephrogenic DI
CKD
94
Endocrine side effects of Lithium includes
Hypothyroidism
95
Cardiac side effects of Lithium include
T wave changes
SA Nodal Block (sick sinus syndrome)
Bradycardia
Changes reversible within 2 weeks of discontinuation
96
There are increased lithium levels with the administration of
Thiazides
Loops
NSAIDS
ACEIs
97
Lithium can cause increased neurotoxicity, causing
Extrapyramidal symptoms ( neuroleptic drugs)
Anticonvulsants
98
Beta blocker and Lithium
Decreased lithium induced tremor
99
Depolarizing + non- depolarizing MR
Prolonged blockade
100
Lithium+inhaled+ IV anesthetics
Possible decrease in anesthetic requirements
101
Lithium + Barbs
Delayed recovery
102
Lithium has a narrow
Therapeutic index
103
Patients need regular____ for a goal of______
Monitoring or serum levels
Goal 1-1.2 mEq/L
104
Lithium toxicity may occur_____
At doses close to therapeutic
(High risk of toxicity)
105
It’s important to avoid this with lithium
Avoid Na+ depletion
106
What medications are avoided with lithium
Diuretics & NSAIDS
Avoid hypotonic solutions
107
Lithium toxicity will present with
Widen QRS, AV block, dysrhythmias, HOTN
Seizures & confusion
108
How to treat lithium toxicity
Dialysis
Sodium Bicarbonate
109
What is psychosis
Lost contact w/ reality
110
What’s is Hallucination
False perceptions
111
Delusion
False beliefs
112
Typical neuroleptic 1st generation antipsychotic include
Haldol
Chlorpromazine
Perphenazine
Fluphenazine
Dopamine ( D2 ) receptor antagonist
113
Typical neuroleptic 1st generation antipsychotic can cause
Extrapyramidal side effects
114
Atypical antipsychotic 2nd generation drugs include
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
115
Atypical antipsychotic 2nd generation drugs have this antagonism + these effects
D2 antagonism + effects on H1, 5 HT2, mACh, & alpha
116
Atypical antipsychotic 2nd generation drugs cause
Low/ no tendency to cause extrapyramidal side effects
117
Typical FGA are less
Favorable due to side effects
118
Typical FGA are commonly used
In emergency & acute care settings
119
Typical FGA have a high
Therapeutic index
120
Typical FGA cause no
Physical dependence
121
Typical FGA have this effect
Antiemetic effects by working on the DA receptor in CRTZ
Helps with opioid induced N/V
122
Haldol may decrease
Psychosis relate anxiety & has an off label use of ICU delirium, severe acute agitation & agression
123
MOA of Haldol
D1 & D2 antagonism
RAS Depression
Inhibition of hypothalamic hormone release
124
Common dose of Haldol IV & IM. May repeat dose & double initial dose every_____
2-10mg IV
5mg IM
Repeat q15-30min
125
Haldol onset IV & IM
IV: 3-20min
IM: 30 min
126
Duration of Haldol IV & IM
IV: 3-24 hours
IM: 2 hours
127
How long can postoperative & emergence delirium last?
Minutes to 7 days
128
What are risk factors of postoperative/ emergence delirium?
Age
Gender
Cognitive function/mental health/emotional status
Substance use, ETOH, BZ use
Prolonged surgery
Residual NM Blockade
Temp/BP changes
Hypoxemia
Pain
Sleep/wake disturbances
Presence of ETT
129
Differential diagnosis of postoperative/ emergence delirium
Hypoxia, hypercarbia, acidemia, hypothermia,hypoglycemia, stroke, seizure, central cholinergic syndrome
RASS, CAM-ICU, PAED
130
Symptoms of delirium
Disturbed attention, cognition & impaired awareness
Disoriented & memory deficit
Verbal & physical agitation
131
Treatment for delirium
Control pain & agitation with pre-emotive multimodal analgesia & sedation
132
Droperidol, a typical FGA, is a/an__________&________
Anti dopaminergic antiemetic
Sedative
133
Droperidol, a typical FGA is a great
Antiemetic
134
Droperidol, a typical FGA can cause this unwanted off label side effect
Delirium- immediate effects for undifferentiated agitation, alcohol intoxication & other etiology
135
Off label, Droperidol, a typical FGA, is a good
GA adjunct- neuroleptic anesthesia/analgesia
136
What is neuroleptanalgesia?
Combination of a neurolept AP + potent opioid
137
What is an example of a neuroleptanalgesia?
Droperidol+ Fentanyl (Innovar)
(Butyrophenone + phenylpiperidine)
138
Neuroleptanalgesia can cause
CNS depression w/ altered pain response cause a detached trance like & pain- free state, immobility & variable amnesia
139
What is Droperidol black box warning
High doses can cause cardiac risks
(effective & safe treatment for nausea, HA & agitation)
140
What is the dose of Droperidol?
0.625-1.5mg IV/IM for antiemesis with a max dose of 2.5
5 mg IM for sedation
141
What is the onset & duration of Droperidol
Onset 3-10 min IV/ IM
Duration 2-4 hours (up to 12)
142
Perphenazine, a typical FGA is a/an
Anti dopaminergic antiemetic
143
What is the dosing of Perphenazine?
5mg IV/IM
8-16 mg PO
144
Which populations are okay to receive Perphenazine?
Less than 70 years
No history of EPS/Parkinson’s
No Class III antiarrhythmics
145
Extrapyramidal effects are cause by a blockade of
Dopamine in the limbic system
146
Extrapyramidal effects can cause tardive dyskinesia, which is
Abnormal involuntary movement of tongue, face, neck, extremities, & trunk
147
Extrapyramidal effects can cause akathisia, which leads to
Restlessness & inability to tolerate activity
148
Extrapyramidal effects can cause dystonia, which is
Acute muscle rigidity & cramping
Oculogyric crisis
Respiratory distress (laryngeal dyskinesia/spasm)
Tremors
149
How is dystonia treated?
Diphenhydramine 25-50mg IV
150
FGA CV side effects
HOTN (alpha blockade & hypothalamic effects)
Antidysrhythmic affects
QT prolongation
151
FGA endocrine side effects
Excess prolactin (gynecomastia)
Wt gain
152
FGA CNS side effects
Sedation
Skeletal muscle relaxation (CNS- mediated)
Abnormal thermoregulation & hypothermia
Decreased……
153
FGA Hepatic side effects
Obstructive jaundice
Elevated liver Enzymes
154
Do we know the cause of Neuroleptic Malignant Syndrome?
No
155
Risk factors of Neuroleptic Malignant Syndrome
Young
Male
Dehydration
Iron deficiency
Illness
Catatonic state
156
Neuroleptic Malignant Syndrome develops over
24-72 hours
157
Neuroleptic Malignant Syndrome will cause
Hyperthermia
Generalized hypertonicity of skeletal muscle
Autonomic instability
Altered LOC
158
With Neuroleptic Malignant Syndrome causing hypertonicity, how is this treated? What are its potential side effects?
May require mechanical ventilation
May elevate CK and cause renal failure
159
Neuroleptic Malignant Syndrome may lead to autonomic instability, causing
Labile BP
Tachycardia
Dysrhythmias
160
NDMRs produce this in Neuroleptic Malignant Syndrome
Flaccid paralysis
161
How is Neuroleptic Malignant Syndrome treated
Dantrolene- direct acting muscle relaxant
Dopamine agonist (bromocriptine & amatadine)
Benzos to treat agitation & arousal
IV hydration
Cooling
Support
162
FGA affects on the heart
Prone to increased HR
HOTN
increased risk of CV disease present
QT prolongation
T wave changes- arrhythmia risks
163
FGA affects on endocrine system
Higher incidence of DM & glucose intolerance
Wt gain
164
FGAs can cause a change in
Pain response
165
FGA effect on temperature
Causes impaired regulation causing hypothalamic effects
Should monitor & do active warming
166
FGAs can alter this function and cause
Altered HPA function causing abnormal autonomic nerve functioning
Antipsychotics decrease cortisol
167
FGAs can cause this on skeletal muscles
Relaxation, which is synergistic with non depolarizers
You should monitor neuromuscular function
168
FGAs combined with your anesthetic can cause
Risk for over sedation with the use of BZ & CNS depressants
You should monitor for serotonergic symptoms w/ phenylpiperidines
169
Postoperative considerations with FGAs
Surgical stress may worsen psychotic symptoms in schizophrenia
Risk for postop confusion, which is associated with increased NE & cortisol in schizophrenia
Risk for postop infection due to immune system dysregulation
170
What medications are favored if FGAs
Atypical SGA
171
Atypical SGAs benefits over FGAs include
Greater benefit for cognitive + affective
5 HT2A antagonism & other serotonergic actions
Tolerated & efficacy in psychotics
172
Other uses for Atypical SGA
Manic/ depressive episode
Irritability in autistic disorders
Tourette disorder
173
Side effects of Clozapine, an SGA
Agranulocytosis
Fever
Myocarditis
Excessive salivation
174
Clozapine is the most effective SGA due to
5 HT, mACh, Alpha 1 & little D2 antagonism
175
Side effects of Olanzapine, an SGA
Sedation, HOTN
WT gain, metabolic syndrome
176
What medication should be avoided when taking Olanzapine, an SGA
Benzodiazepine due to the risk of cardio respiratory depression
177
Side effects of resperidone & paliperidone
HOTN
Gynecomastia
178
Rispiridone & paliperidone are similar to
FGAs in dopamine antagonism & EPS risks
179
Aripiprazole & brexpipeazole are mixed
Agonist/antagonist at D2
180
Side effects of Aripiprazole & brexpipeazole
Akathisia
Engagement of risky behavior
181
Aripiprazole & brexpipeazole are
Highly tolerable & effective in treating bipolar & MDD
182
Side effects of Ziprasidone & lurasidone SGAs
QT prolongation & akathisia
These drugs are moderately effective
183
SGA Quetiapine is primarily a
5 HT antagonism & little D2 antagonism with minimal EPS risk
184
What is the active metabolite of SGA Quetiapine
Norquetiapine which inhibits NE transporter
185
SGA Quetiapine is a _____& _____ antagonist
H1 & Alpha -1
186
Sid effects of SGA Quetiapine
Sedation & ortho HOTN
187
SGA side effects are similar to FGA as they can cause
Extrapyramidal effects like tardive dyskinesia & Neuroleptic Malignant Syndrome
188
Metabolic side effects of SGAs
Wt gain
Hypercholesterolemia
Insulin resistance
Associated CV morbidity
189
How are neurodevelopmental disorders treated?
Stimulant drugs, behavioral therapy & educational interventions
190
Methylphenidate ( Ritalin) is a _______, indirect acting ________
CNS stimulant (psychostimulant)
Sympathomimetics
191
Methylphenidate (Ritalin) blocks
Reuptake if NE & DA causing catecholamine depletion & receptor down regulation in chronic exposure
192
Methylphenidate (Ritalin) increased release of
DA, increasing presynaptic firing
193
Methylphenidate (Ritalin) side effects include
Increased HR& BP
Risk for arrhythmias
Wt loss
Insomnia
Anxiety
194
Methylphenidate (Ritalin) is found to
Actively induce emergence in ISO & Propofol ( increased arousal & respiratory drive, resulting in higher anesthetic requirement)
195
Mixed amphetamine salts (Adderall) consist of
Levoamphetamine + Dextroamphetamine
196
Mixed amphetamine salts (Adderall) block
Reuptake of NE & DA
197
With Mixed amphetamine salts (Adderall), there’s an increase in
Presynaptic DA release
198
Mixed amphetamine salts (Adderall) side effects
Tolerance & dependency risk
Anxiety
Insomnia
Exacerbation if tics
Increased HR & BP
199
What alpha 2 agonist medication is approved for ADHD
Clonidine
200
Side effects of Clonidine
HOTN
Beadycardia
201
Other uses of Clonidine
Anxiolytic
Opioid withdrawal
Personality disorders
Manage impulsivity & aggression in TBI
202
Which part in Cannabis is psychotropically active
D9THC
203
PO peak of Cannabis
1-2 hours, duration 4-6 hours
204
Uses of Cannabis
N/V
Analgesia
Chronic pain
Cachexia
205
Acute cannabis intoxication causes
Euphoria
Relaxation
Altered perception & intensification of normal sensory experiences
Decreased reaction time
Poor motor skills
Trachycardia
HOTN
Increased appetite
206
Anesthesia considerations when patient is taking Cannabis
Increase anesthetic
Will have CV, airway/pulmonary effects
