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AN401 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Can MAOI and SSRI be given together

A

No
Need at least 2wks between
Can cause serotonin syndrome

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2
Q

Tricyclic antidepressants (TCAs)
Name

A

Amitriptyline

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3
Q

TCAs
Amitriptyline
(When to give)

A

At night (their sedative)

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4
Q

TCA
Amitriptyline
Uses

A

Migraine
Sleep (sedative)
Anxiety
Depression (mainly)

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5
Q

TCAs
Amitriptyline
Major AR

A

Cardiotoxic:
CI: cardiac condition (their lethal in overdose)

Cholinergic: drying, urine retention, blurry vision.

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6
Q

SSRI
Names

A

Citralopram (take at bed time)
Escitalopram
Sertraline
Fluvoxamine
Paroxetine
Fluoxetine (long half life)

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7
Q

SSRI are safe, effective and well tolerated?

A

Yes
Has a low SE profile bc it is selective

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8
Q

SSRI
Use

A

Depression (gold standard for it)
Anxiety

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9
Q

SSRI SE

A

GI (transcient SE. starts early and goes away)
*take meal 1st before taking

Sleepiness
Wt changes (gain)
Hyponatremia
Sexual dysfunction

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10
Q

SSRI
123 approach

A

1: SE

2: boost of energy (big worry (black box warning)

3: mood benefits help w/ anxiety

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11
Q

SSRI take how long to be fully effective

A

4-6wks
Slow acting

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12
Q

SSRI black box warning

A

Under age of 25

Super depressed w/ boost of energy causes them to go through with suicidal ideations

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13
Q

What meds should you avoid with SSRIs

A

MAOIs
TCAs
St johns wort
MDMA
(Migraine meds:-triptins)

All risk of serotonin syndrome

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14
Q

SRNIs
Names

A

Venlafaxine (bad d/c syndrome d/t short half-life)
Desvenlafaxine

Duloxetine

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15
Q

SRNI use

A

Depression (works on both serotonin and norepi)

Duloxetine (pain/anxiety/depression)

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16
Q

SRNI Se

A

Increased BP & HR

Less sexual dysfunction than SSRIs

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17
Q

Atypical antidepressants
Name
When to take

A

Bupropion

In AM (gives you energy)

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18
Q

Atypical antidepressants
Bupropion
Use

A

Adhd
Depression
Smoking cessation

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19
Q

Atypical antidepressants
Bupropion
CI

A

Hx of seizures
Eating disorder (lowers appetitie)
Alcohol withdrawal (causes seizures)

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20
Q

Atypical antidepressants
Bupropion
Can it be used with SSRI

A

Yes

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21
Q

monoamine oxidase inhibitors (MAOIs)
Names

A

Phenelzine
Selegiline

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22
Q

monoamine oxidase inhibitors (MAOIs)
Phenelzine
Selegiline

Complications

A

HTN crisis: d/t tyramine

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23
Q

Tyramine type foods

A

Aged cheese
Cured meats (charcuterie board)
Sauerkraut
Red wine

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24
Q

Benzodiazepines
Names

A

Lorazepam
Diazepam
Alprazolam (short half-life) addictive bc of this

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25
Q

Benzodiazepines:

Lorazepam
Diazepam
Alprazolam

Use

A

Sleep (sedating, slows reflexes)
Anxiety (fast acting)(panic)
Seizures

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26
Q

Which benzos have a long HL vs short

A

Long HL: Lorazepam and diazepam

Short HL: Alprazolam

Short half lifes causes a worry with addiction (med wears off quicker)

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27
Q

Buspirone

Use
Is it addictive?
Can use with what med

A

Use: anxiety

Is not addictive

Can use w/ SSRIs

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28
Q

Buspirone

How long to start working
Take how many times a day

A

4-6 wks to work (not for anxiety attacks)

BID or TID

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29
Q

Hydroxyzine
Use

A

Anxiety

30
Q

Antidepressant (betablocker)

A

Propranolol

31
Q

Propranolol

Use
How often to take
Monitor what

A

Use: performance anxiety

Take PRN

Monitor: HR, BP (get baseline)

32
Q

Dopamine
Too much vs enough

Related to what center
Effects what

A

Too much: psychotic
Enough: happy

Related to reward center (addiction)

Effect on movement (EPS extrapyramidal syndrome)

33
Q

First gen typical antipsychotics
Names
Route
Do what

A

Chloropromazine
Haloperidol

IM
PO (do before LAI to see tolerability)
LAI (long acting injectible)

Block dopamine

34
Q

First gen typical antipsychotics (blocks dopamine)
Chlorpromazine
Haloperidol

SE

A

Sedative
Wt gain
Orthostatic HOTN
EPS (most common in 1st gen due to block of dopamine)

35
Q

EPS 4 signs (could happen with any psychotic)
Mainly with 1st gen though

A

Acute dystonia: muscle tone issue (ex: cant turn neck)

Pseudo-parkinsonism: tremors, shuffled fait, masked face, arms dont swing

Akathisia: uncontrollable motor restlessness
(increase risk of suicide due to feeling miserable)

Tardive dyskinesia (TD): late onset bad movement
*cant be tx by meds its irreversible)

36
Q

EPS meds to treat

A

Benztropine

Diphenhydromine

37
Q

AIMS

A

Abnormal involuntary movement scale

Helps provider assess for EPS

38
Q

Second gen atypical antipsychotic
Name

A

Lurasidone
Ziprasidone
Olanzapine
Quetiapine

ADDED:
Clozapine
Risperidone

39
Q

Second gen atypical antipsychotics

Lurasidone
Ziprasidone
Olanzapine
Quetiapine

Which ones need to be taken with food
Big picture with these meds
When to give quetiapine

A

Lurasidone, ziprasidone need to be taken with food

Big picture: metabolic burden (wt gain)

quetiapine: give at bedtime (sedating)

40
Q

Second gen atypical antipsychotics

Lurasidone
Ziprasidone
Olanzapine
Quetiapine

Education
Monitor

A

Education:
-healthy lifestyle
-dietician

Monitor:
-wt
-BMI
-waist circumference

41
Q

Third gen atypical antipsychotics
Name

A

Aripiprazole

42
Q

Third gen atypical antipsychotics
Aripiprazole

Less what than 2nd gen
High likely of what SE
How to tx that SE

A

Less metabolic strain than 2nd gen

Atkathesia (uncontrolled motor reslessness)

Can tx with EPS meds (benztropin, diphenhydramine)

43
Q

Serotonin syndrome

Meds that can cause
S/s

A

MAOI
TCAs
St johns wort
MDMA
triptins

S/s:
Hyperreflexia
GI disturbances (diarrhea)
Dilated pupils

44
Q

Neuroleptic malignant syndrome

What is it
Hallmark signs

A

Adverse effect of any antipsychotic

Hallmark:
-high temp (104)
-labile BP
-muscle rigidity (led pipe rigidity)

45
Q

What can also work for Bipolar disorder

A

Antipsychotics
1st gen typical
2nd gen atypical
3rd gen

46
Q

NEW 2nd gens
Clozapine
-best what
-is it 1st line and why or why not
-pharmacy needs what
-worries

A

Best antipsychotic
Not 1st line d/t risk of granulocytosis (low WBCs)

Pharmacy will need WBCs before releasing med

Worries:
Fever
Sore throat

47
Q

NEW 2nd gen
Risperidon
Worry
Main thing (lab for it)

A

Metabolic syndrome is a worry (wt gain)

Main thing: prolactin
-leak from breast
Enlarged breast

Lab: prolactin

48
Q

Bipolar meds (mood stabilizers)
Main one

A

Lithium

49
Q

Lithium Carbonate
-therapeutic range (narrow or short)
-monitor what (what it can cause)
-What do we want consistent
-replace what if lost

A

Narrow
0.6-1.2=maintence range (pt stable)
1-1.5= more aggressive

Monitor fluids and Na
*dehydration increases lithium
*overhydration decreased lithium

Keep fluids constant and replace them if lost

50
Q

Lithium use

A

Mood stabilizer
Protective against suicide

51
Q

Lithium SE

A

Gi upset (nauseous)
Fine hand tremors
Polyuria
Polydipsia
Wt gain (d/t polydipsia)

52
Q

Lithium toxicity

A

Se worsen

Vomiting/diarrhea
Coarse hand tremors

Can progress to:
sz
coma
death
ataxia
Speech slurred

53
Q

Lithium:

minimize intake of what
Avoid

A

Caffeine

Diuretics
Nsaids

54
Q

Lithium

Hard on what organs
Labs for this

A

Kidney
Thyroid

Labs:
BUN & Creatinine
TSH & T4
Lithium levels

55
Q

Antiseizures/anticonvulsants can be used for what also

A

Mood stabilizing effect

56
Q

Anti epileptic medications for bipolar disorder

Names

A

Valporic acid
Carbamazepine
Lamotrigine

57
Q

Valporic acid

Used for what type of pts
Dose in blood

A

Elderly

50-125mg

58
Q

Valporic acid

Hard on what organs (s/s)
Labs

Other S/s

A

Liver
Labs: LFT thru a CMP

Pancreas (pancreatitis)
Labs: amylase, lipase
S/s: pain in stomach, vomiting

Other s/s:
Wt gain
Teratogenic (birth control)
Thrombocytopenia (look out for bleeding)

59
Q

Carbamazepine

Main SEs

A

Steven johnson syndrome
Slows neurons (tired)
Thrombocytopenia (watch out for bleeding)

60
Q

Lamotrigine

Best what
SE

A

Most tolerated mood stabilizer

SE:
Benign rash(okay) or SJS

61
Q

Lamotrigine

Look out for what
What to worry about with SJS (s/s of this)

Other S/S

A

Look out for a rash

Worried about SJS becoming systemic:
-fever
-uper trunk, neck, mouth
-notify provider of any rash

Other S/S:
HA
Tremors

62
Q

Lamotrigine

Titration

A

25mg 2wks
50mg 2wks
For 5 weeks until reach 200mgs

*this decreases risk of rash
*takes 5 wks to get to therapeutic use/ slow)

63
Q

When do you have to restart titration of Lamotrigine

A

If you miss 5 days of dose

64
Q

Mirtazapine (tca)

-used for
-Se
-Give when

A

Depressive disorders

Se:
-cns depression (sleepiness)
-hungry (help you eat with elderly)

Give at night

65
Q

Which meds to take in the morning

A

Bupropion

66
Q

Which meds to take at bedtime (sedative)

A

Amitriptyline
Citralopram
Benzos
Quetiapine
Mirtazapine

67
Q

Which meds to take with food

A

Lurasidone
Ziprasidone

68
Q

Which meds to take after eating

A

SSRIs (due to GI disturbances)

69
Q

which meds have a long half life

A

Fluoxetine
Lorazepam
Diazepam

70
Q

Which meds have a short half life

A

Venlafaxine (d/c syndrome)
Alprazolam (addictive)

71
Q

Antipsychotics can help what

Anticonvulsants can help what

A

Antipsychotics can help bipolar disorder

Anticonvulsants can help what mood stabilizing

72
Q

Which med causes qt prolongation

A

Ziprasidone

AN401 (11 decks)

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