Week 8 Flashcards
(100 cards)
1
Q
Fluoxetine, Paroxetine, Sertraline, Citalopram
1. What category are these drugs under?
2. MOA
3. Side effects
A
- SSRI Drugs
- Inhibit presynaptic re-uptake of 5-HT
- Serotonin syndrome - GI distress - SIADH -Sexual dysfunction, and more
2
Q
- SSRIs are the first line agent for what disorder?
- Can also be used for (7)
A
- Major depressive disorder (along with CBT)
- Generalized anxiety disorder, panic disorders, phobias, PTSD, OCD, Bulimia, Social Anxiety Disorder
3
Q
- What is serotonin syndrome?
- Sx?
- Tx
A
- SSRIs and SNRIs can potentially lead to excessive levels of synaptic serotonin
- hyperthermia, hypertension, hyperreflexia and clonus
- Cyproheptadine
4
Q
Venlafaxine, Duloxetine
1. What category of drugs are these considered?
2. What is the MOA of these drugs?
3. Side effects
A
- SNRIs
- Inhibit presynpatic re-uptake of 5-HT and NE
- Serotonin syndrome, Hypertension
5
Q
- What are SNRIs (Venlafaxine, Duloxetine) indicated for?
A
- Depression, generalized anxiety disorder, diabetic neuropathy.
- Venlafaxine is also indicated for social anxiety disorder, panic disorder, PTSD, OCD.
- Duloxetine and milnacipran are also indicated for ibromyalgia.
6
Q
Imipramine, Amitriptyline, Nortriptyline
1. What kind of drug are these?
2. MOA? (4)
A
- TCAs
- Inhibit presynaptic NE and 5-HT reuptake + Block H1 receptors + Blocks alpha 1 receptors + inhibits fast myocardial sodium channels
7
Q
TCAs
1. Side effects:
A
- Sedation (blockage of H1)
- α1-blocking effects (orthostatic hypotension)
- anticholinergic side effects (tachycardia, urinary retention, dry mouth)
- Can prolong QT interval.
- Tri-CyCliC’s: Convulsions, Coma, Cardiotoxicity (arrhythmia due to Na+ channel inhibition)
- Confusion and hallucinations are more common in the elderly -> so do not recommend for elderly
8
Q
TCAs
1. what are they primarily used for
2. other uses
A
- to treat tx resistant depression - but it is 2nd or 3rd line because of the side effects and danger
- Neuropathic pain, migraine prophylaxis, OCD (Clomipramine -> but not first line)
9
Q
Tranylcypromine, phenelzine, isocarboxazid, selegiline
1. What type of drug is this?
2. MOA?
3. Side effects?
A
- MAO inhibitor
- Block MAO from breaking down monoamines (NE, 5-HT, and dopamine)
- Cheese and wine effect (hypertensive crisis, sweaty), Serotonin syndrome (if taken with other drugs that increase 5-HT presence)
10
Q
MAO Inhibitor
1. Primarily used for?
2. Other uses:
A
- atypical depression, tx resistent depression
- anxiety; Selegiline -> Parkinson disease
11
Q
Bupropion
1. What type of drug is this?
2. MOA
3. What is it primarily used for?
A
- atypical antidepressant
- inhibits re-uptake of NE and dopamine
- can be used to tx tobacco dependence
12
Q
Bupropion
1. Side effects
2. Benefits
A
- Toxicity: stimulant effects: (tachycardia, insomnia); headache; seizures in patients with bulimia and anorexia nervosa.
- Less risk of sexual side effects and weight gain
13
Q
Mirtazapine
1. What type of drug is this?
2. MOA
3. What can it be used for?
A
- atypical antidepressant
- alpha 2 blocker causes increase in presynaptic release of 5-HT and NE
- MDD and insomnia
14
Q
Trazodone
1. What type of drug is this?
2. MOA
3. What is it primarily used for?
A
- atypical antidepressant
- 5-HT modulater to increase effects of 5-HT
- insomnia
15
Q
Mirtazapine
1. side effects
A
- Sedation
- Appetite, weight gain
- Dry mouth.
16
Q
Trazodone
1. Side effects
A
- Sedation (H1 block), nausea, priapism (alpha 1 block), postural hypotension (alpha 1 block)
17
Q
What is the suffix of first generation (typical) antipsychotics?
A
-azine
18
Q
Haloperidol, Trifluoperazine, Fluphenazine, Chlorpromazine, Thioridazine
1. What kind of drugs are these?
2. MOA
A
- First generation anitpsychotics
- Blocks D2 receptors in CNS - mesolimbic system
19
Q
in psychotic disorders what are the levels of dopamine in
1. mesolimbic system
2. mesocortical system
A
- increased
- decreased
20
Q
Typical/First generation antipsychotics
1. High potency means what type of binding on D2 receptors + what generalized side effects
2. Low potency means what type of binding on D2 receptors + what generalized side effect
A
- high potency -> greater D2 receptor binding -> more extrapyramidal effects (motor)
- low potency -> less D2 receptor binding but more histamine and muscarinic binding -> leading to sedation and anti-cholinergic effects
21
Q
What are Typical and Atypical Antipsychotics used for? (5)
A
- Schizophrenia (typical antipsychotics primarily treat positive symptoms; atypical antipsychotics treat both positive and negative symptoms)
- Disorders with concomitant psychosis (eg, bipolar
disorder) - Tourette syndrome
- OCD
- Huntington disease.
22
Q
What are side effects of low potency typical/first generation antipsychotics?
A
- anticholinergic effects
- Orthostatic hypotension (alpha 1 block)
- Sedation (H1 block)
- Chlorpromazine can cause corneal deposits
- Thiordazine can cause retinal deposits
23
Q
What are side effects of high potency typical/first generation antipsychotics?
A
- extrapyramidal symptoms (EPS) - ADAPT (acute dystonia, akathisia, parkinsonism, tardive dyskinesia)
- hyperprolactinemia
- Neuroleptic malignant syndrome (NMS) - generalized rigidity, fever, rhadbdomyolysis
- QT prolongation
- lower seizure threshold
24
Q
Olanzapine, quetiapine, aripiprazole, ziprasidone, risperidone, clozapine
1. What kind of drugs are these
2. MOA
A
- Atypical/2nd generation antipsychotics
- Blocks D2 receptors in CNS but more week than 1st generation
25
Atypical/Second generation antipsychotic
1. Does it cover negative or positive sx?
2. What is this used for?
1. both - but this med is more expensive
2. Schizophrenia, depression (tx resistant kind), Risperidone can manage OCD and Tourettes
26
What are the side effects of atypical second generation antipsychotics?
1. sedation (H1 block)
2. Orthostatic hypotension (alpha 1 blocker)
3. Anticholinergic side effects -> dry mouth, constipation, urinary retention
4. Not much extrapyramidal sx bc FGA have greater D2 blockage
27
Olanzapine, clozapine (second generation antipsychotics)
1. what are some specific side effects for these?
1. Metabolic side effects (weight gain, dyslipidemia, hyperglycemia)
2. Clozapine -> neutropenia, agranulocytosis, myocarditis, lowers seizures threshold
28
BIPOLAR DISORDER
1. what is used for acute mania episode (3)
2. What can be used for maintenance therapy (2)
1. Lithium (but also antipsychotics [haloperidol-FGA, quetiapine-SGA], valproate or carbamazepine [anticonvulsant])
2. Lithium, lamotrigine
29
Lithium
1. therapeutic efficacy
2. side effects (acute, long term)
1. narrow therapeutic index
2. Acute: tremor
3. Long term: hypothyroidism, nephrogenic diabetes insipidus, cardiac issues (bradycardia, syncope), Teratogenic (Ebsteins anomly)
30
Lithium
1. What are some drug-drug interactions
1. thiazide diuretics, NSAIDs, ACE inhbitors -> leads to increased lithium levels
31
What mental health providers can provide DSM diagnosis?
1. psychiatrist (MD)
2. Psychologits (PhD or PsyD)
32
What is the difference between screening and assessment tools?
1. Screening- early ID of individuals at high risk, part of routine clinical visit, not dx
2. Assessment - comprehensive, provides complete clinical picture, establishes clear diagnosis, requires expertise to administer
33
1. PSQ-9 is a screening questionnaire for what?
2. CES-D is for what?
3. Edinburgh scale is for what?
4. GDS is for what
1. depression
2. depression
3. postnatal depression
4. geriatric depression scale
34
1. SAD PERSON - risk factor for what?
2. stands for?
*suicide*
1. S- sex (male)
2. A -age (19-45)
3. D - depression
4. P - previous suicide attempt
5. E - ethanol abuse
6. R - rational thinking loss
7. S - social supports lacking
8. O - Organized plan
9. N - No spouse
35
What is SCID used for ?
1. structured clinical interview for DSM diagnosis
36
The symptoms of major depressive disorder
SIG E CAPSS
1. Sleep
2. Interest -lack of interest
3. Guilt
4. Energy lacking
5. Concenration lacking
6. Appetite lacking
7. Psychomotor retardation
8. Suicide ideation
9. Sadness
37
1. How is REM latency affected in depression?
1. decreased REM latency - REM starts faster
2. increased total REM sleep
38
Explain the genetics theory of neurobiology of depression?
1. First degree relatives have a 2-3 times risk of major depression
2. Dizygotic concordance is 20% while monozygotic concordance is 60%
39
Explain the monoamine hypothesis of neurobiology of depression?
1. poses that disorders stems from a deficiency or imbalance in brain monoamines (low 5HT, low DA, low NE)
40
Symptom clusters and their NTs
1. Serotonin dysfunction is associated with?
2. DA dysfunction is associated with?
3. GABA dysfunction is associated with?
4. NE dysfunction is associated with?
1. general anxiety and obsessional thoughts
2. anhedonia, psychomotor retardation, amotivation
3. panic
4. fatigue, co-morbid chronic pain
41
Explain the Neurogenesis hypothesis of neurobiology of depression?
1. Mood disorders may reflect abnormalities in neurogenesis factors
a. NGF, FGF, DBNF - mood disorders may show abnormalities in these
b. BDNF has been shown to be low in patient with depression
2. Stress impairs adult neurogenesis
3. Antidepressants promote neurogenesis
42
Explain the Neuroendocrine (HPA) hypothesis of neurobiology of depression?
1. Chronic stress leads to impaired negative feedback on cortisol release so cortisol is elevated for longer periods of time
2. This has shown to cause damage to Hippocampal neurons and decreases Hippocampal volume → assoc. with depression
43
Explain the Neuroinflammation hypothesis of neurobiology of depression?
1. Elevation of inflammatory molecules (usually after sickness) can be associated with depression
2. Elevations in IL-2, IL-6, TNF-a, IFN are associated with major depression
44
What changes in the brain can be seen in someone who has MDD?
1. Decreased frontal blood flow
2. Lower hippocampal volume
3. Grey matter volumes decreases in anterior singular, orbitofrontal cortex
4. White matter hyperintensities
45
What is a mood disorder is?
1. A mood disorder is a psychiatric condition in which there is an abnormal emotional state
-> Extreme sadness is depression while extreme happiness is mania
46
What is the dx criteria for depression?
1. at least 5 out of the 9 SIG E CAPSS sx for atleast 2 weeks
47
What is the dx criteria for mania episode?
1. DIG FAST sx for at least one week, most of the day
48
What are the sx of mania?
DIG FAST
1. Distractibility
2. Irresponsibility
3. Grandiosity
4. Flight of Ideas
5. Agitation
6. Sleep (less sleep)
7. Talking to much, pressured speech
49
What are the dx criteria for Bipolar I disorder?
1. manic episode with or without depression with or without hypomania
50
What is dx criteria for Bipolar II disorder?
1. Hypomania and depression - BUT NO EVIDENCE OF MANI
51
What are sx of hypomania (differentiated from mania) (4)
1. little to no impairment in functioning
2. inflated self-esteem (but no delusions of grandeur or idea that they can do anything)
3. More organized thoughts than mania + more energy that leads to productive activity
4. Milder risk taking behavior
*episodes lasts at least 4 days and resolves over weeks*
52
Cyclothymic Disorder
1. What is it
2. Dx criteria?
1. Mild mania and mild depression
2. Sx come and go over at least 2 years and are never absent for more than 2 consecutive months
53
Persistent Depressive Disorder
1. What is it
2. Dx criteria?
1. Low grade from of depression but much more chronic
2. Depressed mood most of the time for at least 2 years with no symptoms-free period lasting greater than 2 months
54
Disruptive Mood Regulation Disorder
1. Presentation
2. Dx criteria/pattern?
3. Age of onset/age range
1. Temper outbursts shown verbally and/or behaviorally, out of proportion
2. 3+ times a week with irritable/angry mood;; For 12 months, with no more than 3 months break
3. after 6 years old and onset before 10 years (between 6-10 years old)
55
Premenstrual Dysphoric Disorder (severe PMS)
1. What is it
2. Dx criteria
1. Marked affective lability or irritability or depressed mood/hopelessness/self-deprecating or anxiety/tension/keyed up/edgy
2. Symptoms improves within a few days after onset of menses;; sees doctor regularly since it affects day to day life
56
1. What is a psychotic disorder?
2. What are the three main manifestations
1. W/ Pyschosis -> loss of perception of reality that occurs in medical and psychiatric disorders
2. Three manifestations: Delusions, disorganized thought, hallucinations
57
What is delusions vs hallucination
1. Delusions: persistent beliefs that are not based on reality. (like when someone thinks others can hear their thoughts)
2. Hallucinations: some sort of sensory experience that no one else is experiencing (like hearing voices, or seeing things)
58
What are examples of positive and negative symptoms in psychosis?
1. Positive: hallucinations, delusions, disorganized thoughts
2. Negative: absence of normal behavior, flat affect, lack of motivation, anhedonia
59
1. What are somatic delusions?
2. Delusions of reference?
1. ex: there are worms in my chest
2. TV news caster is talking about me
60
Explain these types of disorganized thoughts?
1. Loosening of association
2. Tangentiality
3. Clanging
4. Perseveration
1. Disorganized speech due to indirect connection between ideas. (I like to dance; my feet are wet)
2. Person constantly digresses to random, irrelevant ideas and topics. (When asked how was your week someone may respond with "when I was five, my cat was killed")
3. using words that rhyme but don't make sense
4. repeating words or ideas persistently
61
What changes or alterations are found in the brain of a person with Schizophrenia? (3)
1. Enlarged lateral ventricles
2. Dendritic spine loss in many brain regions
3. Excess DA activity (plus influence of other NT)
62
Schizophrenia
1. What is it
2. Dx criteria?
1. Chronic psychiatric syndrome with recurrent episodes of psychosis (auditory hallucinations, paranoid, grandiose delusions, diosrganized thought) + progressive cognitive impairment
2. At least one month with two or more of the following sx for at least 6 months: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative sx
63
Schizophreniform Disorder
1. How is this different from Schizophrenia
1. Meets criteria for Schizophrenia but duration is less than 6 months
64
Brief psychotic disorder
1. what is it?
2. Duration?
3. What causes it?
1. Psychotic sx w/sudden onset but full remission within a month
2. 1 day- 1 month
3. commonly follows stressful life events
65
Schizoaffective Disorder
1. What is it? (differentiate it from Schizophrenia)
2. Dx criteria
1. Schizophrenia with mania or depression BUT must have episodes of psychosis alone
2. delusions or hallucinations for 2 or more consecutive weeks without mood sx sometime during the life of the illness. Mood sx are present for majority of the illness.
66
Mania or Depression with Pyschotic Features
1. Dx criteria
1. All psychotic episodes have occured with mania or depression
67
Delusional Disorder
1. What is it? + Dx criteria
1. One or more delusion that lasts one month or longer.
2. Hallucinations can be present but are not prominent and relate to delusional theme
3. Functioning is not markedly impaired and behavior is not obviously bizarre
68
Postpartum Psychosis
1. What is it
2. when does it occur
3. What type of pt does it occur in?
1. Delusions, hallucinations, disorganized thoguht
2. Within 2 weeks of delivery
3. Women with known psychiatric disorders
*Requires hospitalization bc high risk of suicide or harm to baby *
69
1. In what sex is schizophrenia more common?
2. Genetic aspect of schizophrenia (genetic mutations)
1. Male
2. C4A or deletion of chrom 22 (digeorge syndrome) - may have higher incidence of schizoprenia
70
1. What levels of DA lead to positive sx
2. What levels of DA lead to negative sx
1. Excess DA in mesolimbic DA pathway
2. Low DA in mesocortical DA pathway
71
1. What is an anxiety based disorder?
2. Dx criteria
1. Chronic persistent anxiety about diff events or activities
2. Lasts >= 6 months and have anxiety more days than not
72
Panic Disorders
1. What is it?
2. How long are episodes
3. Physical sx
1. Sudden onset of intense fear often with no trigger. Pt may get persistent concern about getting panic attacks and may even change behavior to avoid them.
2. minutes to an hour
3. palpitations, sweating, trembling, etc
73
Panic Disorder
1. Dx criteria
2. Tx?
1. Recurrent: two or more
2. Unexpected "out of the blue"
3. Quick, intense, frightening rush of atleast 4 out of 13 sx
*Tx: CBT, SSRIs, Benzos*
74
Generalized Anxiety Disorder
1. What is it?
2. Dx criteria
1. Chronic excessive, out of control worry about many diff events or activities - difficult to control and can cause distress or disability
2. Lasts >= 6 months and has anxiety on most days of those 6 months
PLUS: worry focused on multiple life events
PLUS: 3 or more of the following (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance)
75
Specific Phobias
1. What is it?
2. Dx criteria
1. fear of specific object or situation, leads to avoidance behavior
2. persists > 6 months
76
Social Anxiety Disorder
1. What is it?
2. What types are there
3. Dx
1. Phobia of social settings due to fear of being subject to scrutiny by others, fear of being embarassed, humiliated, or judged -> leads to distress in daily lives
2. Performance only (speaking, writing, eating, palying an instrument, testing, playing sports in front of others) vs Generalized (having to socialize, small talk, being questioned, dating, making a phone call, speaking to authority figure)
3. THIS HAS TO BE DISTRESSING AND DISABLING IN DAILY LIVES
77
Social Anxiety Disorder
1. tx for performance anxiety
2. Other options
1. Beta blockers
2. SSRIs, MAO inhibitors
3. BZDs if all else fails
4. but CBT is most useful
78
Agoraphobia
1. What is it?
1. afraid of public spaces because they are fearful of leaving a safe place and not being able to flee a public space with no help
2. This is NOT a fear of scrutiny by others
79
OCD
1. what are the two parts of this disorder?
1. Obsessions (recurrent, persistant thought, urges, or images) - intrusive and unwanted thoughts that pts try to suppress and this causes distress
2. Compulsions - repetitive behaviors or mental acts that relieve the distress caused by obsessions. Pt feels driven to perform in response to obsessions
*usually egodystonic (behaviors that conflict with the goals of the ego)*
80
OCD
1. First line tx
1. Combined Meds and CBT
2. Meds (SSRIs or TCA)
81
Body Dysmorphic Disorder
1. Clinical presentation/what is it?
2. Abnormal behaviors that present
1. Physically normal pts are preoccupied with physical appearance. They focus on nonexistent or minor effects that cause the pt to believe they look abnormal or ugly.
2. Leads to repetitive behaviors such as checking in mirror or combing hair
82
PTSD
1. what is it?
2. Dx criteria?
3. Typical tx?
1. Stress that follows a traumatic event that leads to thoughts, nightmares, and flashbacks. Leads to avoidance of reminders. Can cause hypervigilance, sleep problems, and may lead to social dysfunction
2. Sx last for more than 1 month
3. CBT (therapy), SSRIs, Prazosin (alpha 1 blocker - to reduce nightmares)
83
Acute Stress Disorder
1. What is it?
2. Dx criteria
3. Tx?
1. the initial response to trauma exposure. Includes recurrent, intrusive memories or dreams but a person has dissociative sx. Dissociative sx may include altered sense of reality, in a daze, cannot remember aspects of trauama.
2. Lasts less than one month
3. CBT only, no drugs
84
1. What is somatic symptom disorder?
2. Dx critera
1. Somatic sx that cause distress;;; Persistent thought about seriousness of sxs w/accompanying anxiety;; Excessive time and energy devoted to sx
2. persistent (more than 6 months)
85
What is factitious disorder on self (Munchausen syndrome)
1. falsified medical or psychiatric symptoms - done **consciously** out of desire for attention
2. pt often willing to go for tests/surgeries
86
Illness Anxiety Disorder
1. What is it
2. Dx criteria
1. Preoccupation with having undiagnosed illness but **has mild or no somatic symptoms**;;; anxiety about health;;; excessive health related behaviors like checking for signs of illness
2. persistent for at least 6 months
87
Conversion Disorder
1. What is it?
2. What is la belle indifference?
1. Voluntary motor or sensory neurologic sx (unable to speak, blindness, seizures) with sudden onset usually following stressor -> neuro workup is normal
2. Pt shows lack of concern about sx
88
Somatic disorder, Illness anxiety disorder, conversion disorder, factitious disorder - what type of treatment can be offered?
CBT
89
What happens if you mix benzos with alcohol?
this is fatal! Do not do this
90
Buspirone
1. MOA
2. How is it useful?
3. What should it NOT be used for
1. partial agonist of 5-HT1a receptor
2. Used for GAD - in short term tx of sx of anxiety (but remember SSRIs are first line for anxiety disorders)
3. Panic disroder
91
Trazodone
1. type of drug
2. MOA
3. What is it used for
4. Side effects?
1. sedating atypical antidepressant
2. blocks 5-HT2, alpha 1 adrenergic, and H1 receptors + weakly inhibits 5-HT reuptake
3. as a sleep agent bc it does not have abuse potential
4. Orthostatic hypotension, priapism, daytime hangover
92
Antihistamine
1. MOA
2. How are they used as hypnotics?
3. adverse effects
4. avoid in what pt population
1. crosses BBB and blocks H1 - causes drowsiness and sometimes cognitive dysfunction
2. sleep aids (trance like states)
3. higher incidence of day time sedation
4. AVOID IN ELDERLY
93
Suvorexant and Lemborexant
1. MOA
2. What are they used for
3. Contraindicated for??
1. Orexin receptor antagonists (remember orexin promotes wakefulness)
2. To treat insomnia. Helps you get to sleep faster and sleep through the night. (not as effective as BZD or hypnotics)
3. narcolepsy
94
Melatonin Receptor Agonists
1. function
2. drugs
3. abuse potential and side effects
1. regulates sleep and helps those who have trouble falling asleep (not for those who have trouble staying asleep)
2. Ramelteon (mimics melatonin)
3. no abuse potential + side effects (headache, somnolence, nausea)
95
Z-hypnotics (zaleplon, esczopiclone, zolpidem)
1. MOA
2. purpose
3. adverse effects
4. duration
1. selective for omega 1 containing GABAa receptors
2. increases quality of slow wave sleep - helps with insomnia
3. somnabulism and confused behaviors
4. short duration bc rapidly metabolized by liver enzymes
96
What drug types can be used for inducing or maintaining sleep [insomnia]? (7)
1. melatonin receptor agonists (Ramelteon)
2. BZD
3. Barbiturates
4. Z-hypnotics (nonbenzodiazepine hypnotics)
5. Suvorexant (orexin receptor antagonists)
6. Atypical antidepressant (Trazodone)
7. Antihistamines
97
Why are non-BZD preferred over barbiturates and BZD as hypnotics?
1. Barbs and BZD are have higher addictive risk
2. There is respiratory and CV depression that can be fatal in barbs
3. CNS depression that can be worsened by alcohol or mixing (barbs and BZD)
98
What are usually the first line tx as anxiolytic for anxiety disorder?
1. SSRIs, SNRIs
99
What bipolar drug requires asian decent patients to get tested for genetic makeup?
Carbamazepine
1. If they have HLA-B-1502 then they are at risk of getting SJS from this drug use
100
xIn what situation would you choose duloxetine (SNRI) over fluoxetine (SSRI)
1. Duloxetine has been seen to be a good antidepressant for those with diabetic neuropathy and back pain
