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MJ- Mental Health EOR > Side effects, MOA, CI > Flashcards

Side effects, MOA, CI Flashcards

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1
Q

What are the 4 main side effects of clozapine

A
  • Agranulocytosis
  • seizures
  • myocarditis
  • increased mortality in elderly patients w/ dementia related psychosis
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2
Q

Which SSRI can prolong QT interval with increasing blood levels

A

citalopram

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3
Q

Which 2 SSRIs have a greater risk of insomnia/agitation

A

sertraline

fluoxetine

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4
Q

Which SSRI has more frequent diarrhea and GI complaints

A

sertraline

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5
Q

Which 2 SSRIs have withdrawal sxs if not tapered

A

paroxetine

fluvoxamine

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6
Q

Side effect of Venlafaxine

A

increased BP (primarily diastolic) and HR with increasing doses

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7
Q
A
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8
Q

What are the 3 contraindications for haldol

A

parkinson disease

anticoagulant use

severe cardiac disorder

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9
Q

MOA of 1st gen antipsychotics

A

blocks dopamine (D2) receptors

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10
Q

MOA of 2nd gen antipsychotics

A

Dopamine D4 receptor and serotonin (5HT2) antagonists

EPS less common b/c weakly bind to D2 receptors

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11
Q

6 side effects of 2nd gen antipsychotics in general

A
  1. EPS (less common than 1st gen)
  2. Increased prolactin levels
  3. hyperglycemia
  4. hyperlipidemia
  5. weight gain
  6. NMS
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12
Q

What are 2 side effects of olanzapine

A

weight gain

DM

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13
Q

9 side effects of 1st gen antipsychotics

A
  1. EPS (dystonic rxns aka dyskinesia, tardive dyskineia, parkinsonism)
  2. Neuroleptic malignant syndrome
  3. QT prolongation
  4. Cardiac arrhythmias
  5. Sedation
  6. Anticholinergic side effects
  7. Dermatitis
  8. Blood dyscrasias
  9. Incr. prolactin (more than 2nd gen)
  10. weight gain
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14
Q
A
  1. Mental status changes
  2. Extreme muscle rigidity
  3. tremor
  4. autonomic instability
    1. tachycardia
    2. tachypnea
    3. hyperthermia/fever*
    4. ​profuse diaphoresis

**LIFE THREATENING- caused by D2 inhibition**

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15
Q

When does NMS usually occur

A

within 90 days of initiation/dose increase

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16
Q

When do sxs of dystonic reactions (dyskinesia) usually occur

A

hours-days after initiation of typical antipsychotic

due to disruption of Dop-Ach balance (excess Ach)

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17
Q

What sxs are commonly seen in dyskinesia (EPS of antipsychotics)- 5

A
  • intermittent
  • spasms
  • sustained involuntary muscle contractions
    • trismus
    • protrusions of tongue
    • facial grimacing
    • torticollis
    • difficulty speaking
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18
Q

MOA of risperidone and ziprasidone

A

partial D2 receptor and serotonin 5-HT1A receptor antagonist, 5-HT2 receptor antagonist

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19
Q

6 side effects of risperidone and ziprasidone

A
  • EPS
  • Increased prolactin
  • sedation
  • weight gain
  • hypotension
  • prolonged QT
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20
Q

MOA of aripiprazole

A

D2 receptor and serotonin (5-HT2 & 5-HT1) receptor antagonist

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21
Q

MOA of lithium

A

Increases norepinephrine and serotonin receptor sensitivity

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22
Q

3 contraindications to lithium use

Study These Flashcards
A
  1. pregnancy
  2. severe renal disease
  3. cardiac disease
23
Q

side effects of lithium

Study These Flashcards
A
  1. hypothyrodism
  2. sodium depletion
  3. increased urination and thirst
  4. diabetes insipidus
  5. Hyperparathyroidism/hypercalcemia
  6. Seizures
  7. tremor
  8. Headache
  9. Sedation
  10. arrhythmias
  11. N/V/D
  12. weight gain
24
Q

8 common side effects of SSRIs

Study These Flashcards
A
  1. GI upset
  2. sexual dysfunction
  3. HA
  4. Changes in energy level (fatigue, restlessness)
  5. anxiety
  6. insomnia
  7. weight changes
  8. SIADH
25
Avoid citalopram in patients with what condition?
long QT syndrome
26
do patients with serotonin syndrome have mydriasis or miosis
mydriasis
27
SNRIs have similar side effects as SSRIs (like hyponatremia and noradrenergic sxs), what are 2 other side effects?
1. **_Hypertension_** 2. Dizziness
28
What are 5 CI/cautions of SNRIs
1. MAOI use 2. Renal/hepatic impairment 3. Seizures 4. Avoid abrupt discontinuation 5. Caution in patients w/ HTN
29
Increased risk of serotonin syndrome when you combine SNRIs with what?
St. John's Wort
30
MOA of Tricyclic antidepressants
inhibits reuptake of **serotonin** and **norepinephrine**
31
4 side effects of tricyclic antidepressants
1 .anticholinergic effects 2. sedation 3. weight gain 4. prolonged QT interval (best indicator of overdose)
32
What is the best indicator of TCA overdose
prolonged QT interval
33
4 sxs of TCA overdose
1. **_wide complex tachycardia_** 2. Neuro symptoms 3. ARDS 4. SIADH
34
3 contraindications of TCAs
1. Use of MAOIs 2. Recent MI 3. Seizure history
35
MOA of mirtazapine
enhances central noradrenergic and serotonergic activity
36
5 side effects of mirtazapine
1. **sedation** 2. dry mouth 3. constipation 4. weight gain 5. agranulocytosis \*less sexual dysfunction side effect
37
MOA of bupropion
inhibits the neuronal uptake of **_dopamine_** and **_norepinephrine_**
38
8 side effects of bupropion
1. seizures 2. agitation 3. anxiety 4. restlessness 5. weight loss 6. HTN 7. HA 8. Dry mouth \*\*\*less GI distress and sexual dysfunction compared to SSRIs\*\*\*
39
5 contraindictions for bupropion
1. **_Seizure disorder_****\*\*** 2. **_eating disorders_** (ex. bulimia, anorexia) 3. MAOI use 4. patients undergoing drug/ETOH detox \*\*avoid abrupt withdrawal\*\*
40
What is the MOA of MAOIs
blocks breakdown of neurotransmitters (dopamine, serotonin, epinephrine, norepinephrine) by inhibiting monoamine oxidase
41
6 side effects of MAOIs
1. **_Hypertensive crisis_** (must avoid tyramine contining foods- aged/fermented cheese, wine, beer, smoked meats, chocolates, coffee or tea) 2. insomnia 3. anxiety 4. orthostatic hypotension 5. weight gain 6. sexual dysfunction
42
What foods must you avoid when taking MAOIs
tyramine containing foods: * aged/fermented cheeses * wine * beer * chocolate * aged foods * smoked meats * cofee * tea
43
MAOI + TCA may cause what
delirium and hypertension
44
MOA of trazadone
serotonin antagonist and reuptake inhibitor antidepressant, anti-anxiety and hypnotic effects
45
3 side effects of trazadone
1. sedation 2. cardiac arrhythmias 3. priapism (rare)
46
What are the 3 SNRIs
venlafaxine desvenlafaxine duloxetine
47
What are the 6 tricyclic antidepressants
1. amitriptyline 2. nortriptyline 3. clomipramine 4. desipramine 5. doxepin 6. imipramine
48
what are the 3 nonselective MAOIs | (MAO A &B)
Phenelzine Tranylcypromine Isocarboxazid
49
Which is the selective MAOI? (MAO B)
Selegiline
50
Which MAOI has less chance of HTN crisis induced by tryamine
selegiline
51
MOA of dextroamphetamine
releases **dopamine, norepinephrine and serotonin** from the presynaptic neuron, increasing levels at the synaptic cleft
52
Side effects of dextroamphetamine (6)
1. Growth suppression (eventually normalize) 2. insomnia 3. appetite suppression 4. weight loss 5. GI upset 6. HA 7. anticholinergic effects 8. cardiac arrhythmia 9. Raynauds phenomenon 10. Reduced seizure threshold etc
53

MJ- Mental Health EOR (4 decks)

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