Term
Which antidepressant used for treating:
Neuropathic pain? |
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Definition
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Term
Which antidepressant used for treating:
OCD? |
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Definition
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Term
Which antidepressant used for treating:
Social phobia |
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Definition
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Term
Which antidepressant used for treating:
enuresis? |
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Definition
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Term
Which antidepressant used for treating:
Migraines? |
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Definition
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Term
Which antidepressant used for treating:
smoking cessation? |
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Definition
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Term
Which antidepressant used for treating:
Autism |
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Definition
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Term
Which antidepressant used for treating:
Insomnia? |
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Definition
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Term
| Which antidepressants work by inhibiting the reuptake of NE and serotonin? |
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Definition
TCAs
-rarely used because of side effects and lethality in overdose
-patients are usually started on low doses to allow acclimation to the common early anticholinergic side effects |
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Term
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Definition
-tyline, -pramine
-Imipramine
-Amitriptyline
-Trimipramine
-Desipramine
-Clomipramine
-Doxepin |
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Term
| Nortriptyline is the TCA least likely to cause what SE? |
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Definition
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Term
| What is the least sedating and least anticholinergic TCA? |
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Definition
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Term
| What is the most serotonin specific TCA? |
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Definition
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Term
| What are the common TCA side effects? |
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Definition
Anti-HAM (histamininc, cholinergic, muscarinic)
1. Antihistiminic=sedation
2. Antiadrenergic=cardiovasc (orthostatic hypotension which is the most life threatening, tachycardia, arrhythmias
3. Antimuscarinic-dry mouth, constipation, urinary retention, blurred vision, tachycardia
4. Weight gain
5. Lethal in overdose (assess suicide risk)
6. Major complications: 3Cs-->convulsions, coma, cardiotoxicity; avoid in patients with with preexisting cardiotoxicity |
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Term
| Patinet in ER with tachycardia, orthostatic hypotension, urinary retention. You get an EKG and it shows widened QRS complex. What is next step? |
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Definition
IV Sodium Bicarbonate (reverses TCA toxicity).
-What is the threshold to treat?
QRS>100msec |
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Term
| Antidepressant that prevents the inactivation of biogenic amines such as NE, serotonin, dopamine, and tyramine |
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Definition
| MAOIs
-inhibit MAO-A and MAO-B
-great for refractory depression |
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Term
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Definition
-Phenelzine
-Tranylcypromine
-Isocarboxazid |
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Term
| What are the common side effects of MAOIs? |
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Definition
-Orthostatic hypotension
-drowsiness
-weight gain
-sexual dysfunction
-dry mouth
-sleep dysfunction |
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Term
| Initially, patient is lethargic, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks progressing to hyperthermia, hypertonicity, rhabdo, renal failure, convulsions, coma, death |
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Definition
| Serotonic Syndrome
-Occurs when SSRIs and MAOIs are taken together
-Wait at least 2 weeks before switching from an SSRI to MAOI (longer if fluoxetine because of its longer half-life)
Tx: D/C medications |
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Term
| Eating tyramine-rich foods (wine, cheese, fava beans or taking sympathomimetics (often in OTC cold remedies) while on an MAOI may lead to |
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Definition
| Hypertensive crisis due to build-up of catecholamines |
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Term
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Definition
Paroxetine
Fluoxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine |
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Term
| SSRI with longest half life |
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Definition
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Term
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Definition
-fewer than TCAs and MAOIs due to serotonin selectivity
- Sexual dysfunction (25-30%)
-GI
-Insomnia
-Headache
-Serotonin syndrome when used with MAOIs |
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Term
| Name an SNRI (serotonin-NE reuptake inhibitor) |
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Definition
Venlafaxine (Effexor)
-good for treating refractory depression and CAP
-similar side effects to the SSRIs
-can increase BP |
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Term
| Which drug can cause withdrawal symptoms after 1-3 missed doses= flu-like sxs and electric-like shocks or zaps? |
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Definition
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Term
| Aids in smoking cessation and treatment of seasonal affective d/o and adult ADHD. What is the drug and its most significant advantage? |
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Definition
Buproprion
-NO SEXUAL SEs! |
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Term
| What is a potential major complication of Buproprion use? |
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Definition
-Lowers the seizure threshold and may exacerbate psychosis
-Not optimal for patients with anxiety and contraindicated in patients with active eating disorders or seizure d/o
-Can't give if patient on MAOI |
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Term
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Definition
| Useful in treatment of refractory major depression, major depression with anxiety, and insomnia
SEs: sedation, Priapism, SIADH |
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Term
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Definition
Useful in the treatment of refractory depression in patients who need to gain weight
-SEs:
weight gain, sedation |
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Term
| What is the difference between typical and atypical antipsychotics? |
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Definition
Typical- work by blocking D2-R
Atypical- block both dopamine and serotonin receptors but effect on dopamine is less so they have fewer side effects |
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Term
| How can you categorize typical antipsychoitcs? |
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Definition
| High vs Low potency
Low potency:
-lower affinity for dopamine receptors-> higher dose required
-Higher anticholinergic/histiminc SEs than high-potency
-lower incidence of EPS
-Chlorpromazine, Thiordazine
High-potency
-greater affinity for dopamine receptors, low dose needed
-higher incidence of EPSEs and NMS
-Examples: Haldol, Fluphenazine, Perphenazine, Pimozide |
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Term
| What type of antipsychotics are best for treating positive schizophrenic sxs? |
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Definition
Positive sxs: Typical
Negative sxs: atypical |
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Term
| Side-effects of traditional anti-psychotics |
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Definition
1. Antidopiminergic
-Parkinsonism, Akathisia, Dystonia, Tardive dyskinesia, NNS; tx=remove offending drug;+ benedryl, benztropine (Cogentin)
-Hyperprolactinemia
2. Anti-HAM
-sedation, orthostatic hypotension, ALice in wonderland, weight gain, liber, rashes, seizures (lower seizure threshold) |
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Term
| Fever, autonomic instability (tachy, HTN, sweating), rigidty, elevated CPK, leukocytosis in patient on Haldol or other antipsychotic |
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Definition
Neuroleptic malignant syndrome
-MEDICAL EMERGENCY
-Discontinue current meds and supportive care
-Tx: Dantrolene, bromocriptine, amantadine |
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Term
| First line treatment of schizophrenia |
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Definition
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Term
| Name 5 atypical antipsychotics |
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Definition
-Olanzapine
-Clozapine
-Respiridone
-Quetiapine
-Ziprasidone |
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Term
| Side effects of atypical antipsychotics |
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Definition
1. Some anti-HAM
2. Agranulocytosis
3. Metabolic (DM, weight gain, metabolic syndrome) |
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Term
| What must be done in pts on Clozapine? |
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Definition
| Weekly CBCs to check for agranulocytosis |
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Term
| What should be done for patients with chronic quetiapine use? |
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Definition
| Slit lamp exam (can cause cataracts) |
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Term
| Drug of choice for treatment of acute mania and ppx for manic and depressive episodes in bipolar d/o |
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Definition
Lithium
-narrow therapeutic range (monitor levels)
-Level >2.0 is lethal. 1.5 is toxic. Ideal is between 0.7 and 1.2
-Toxic levels may cause AMS, coarse tremors, convulsions and death |
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Term
| What are some lithium side effects? |
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Definition
Major: hypothyroidism, nephrogenic diabetes insipidus (poluria, polydipsia)
Others: tremor, sedation, ataxia, leukocytosis |
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Term
| Useful in treating mixed episodes and rapid-cycling bipolar disorder (seizure drugs) |
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Definition
| Carbamazepine
SEs: agranulocytosis, hyponatremia, aplastic anemia
-must get pretreatment CBCs and LFTs
Valproic Acid
-SEs: sedation, weight gain, thrombocytopenia, hepatotoxicity
-monitor LFTs adn CBCs |
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Term
| What are the most commonly prescribed psychotropic medications? |
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Definition
Anxiolytics (benzos, barbs, buspirone, etc)
-work by diffusely depressing the CNS->sedation |
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Term
| What are the 3 main categories of benzodiapzepines (BDZs?) |
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Definition
1. Long-acting (1-3 days)
-chlordiazepoxide (used in alcohol detox)
-Diazepam (Valium)
2. Intermediate Acting (10-20 hrs)
-Alprazolam (Xanax)
-Lorazepam (Atiban)
-Clonazepam (Klonopin)
-Temazepam (Restoril, used for insomnia)
3. Short-acting
-Oxazepam
-Triazolam (insomnia) |
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Term
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Definition
Sedation, impairment of intellectual function, reduced motor coordination
Toxicity: respiratory depression |
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Term
| BDZs can be lethal when mixed with ... |
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Definition
alcohol
-leads to severe respiratory depression |
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Term
| HOw does Zolpidem (Ambien) work? ` |
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Definition
Binds to GABA receptor-->short-term treatment of insomnia
-same effect as BDZ, but different chemically |
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Term
| Where is the anxiolytic action of Buspirone? |
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Definition
5HT-1A receptor
-used for GAD (in place of venlafaxine, or BDZs)
-better anxiolytic in alcoholics because lower risk of CNS depression
-slower onset than BDZs (1-2 weeks) |
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Term
| Drug used in treating the autonomic effects fo panic attacks or performance anxiety (palpatations, sweating, tachycardia); can also be used to tx akisthesia |
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Definition
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Term
| What are the HAM SEs, which drugs produce them? |
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Definition
antihistiminic (sedation), antiadrenergic (orthostatic hypotension), muscarinic (dry mouth, dry eyes, urinary retention, blurry vision)
-low-potency traditional antipsychotics, TCAs |
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Term
| What EPS's and what drugs cause them? |
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Definition
Parkinsonism, NMS, akisthesia, dystonia
-highpotency traditional antipsychotics
-dystonia can be life threatening (i.e dystonia of the diaphragm, laryngeal muscles causing azphyxiation) |
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Term
| Hyperprolactinemia occurs as a SE of which medications? |
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Definition
| HIgh potency traditional antipsychotics |
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Term
|
Definition
| withdrawal or reduce dose of offending agent-->propranolol-->benzo |
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Term
| Retinal pigmentation caused by prolonged use of |
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Definition
|
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Term
| List benzos in order of decreasing potency |
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Definition
| clonazepam, triazolam, alprazolam, diazepeam, chlordiazepoxide |
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Term
| What is the only medication determined to improve TD? |
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Definition
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Term
| What is the only medication determined to improve TD? |
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Definition
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Term
| What classes of agents have been shown to help with borderline PD? |
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Definition
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Term
| which SSRI increases carbamazepine levels? |
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Definition
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Term
| What is the ECG change associated with Lithium> |
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Definition
| Li can invert the T waves |
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Term
| In ocd patients tx'd with SSRI's but with lingering obessions, which medication may help? |
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Definition
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Term
| Which TCA is preferred in elderly due to lowest alpha-1 blocked which means reduction in risk of orthostasis? |
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Definition
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Term
| You are called to consult on an 85 year-old patient who has become combative and violent. Which is the best intervention |
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Definition
Low-dose atypical antipsychotics (i.e. seroquel, resperidone)
-avoid benzos in elderly persons |
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Term
| Which drug has been shown to be useful in reducing cravings? |
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Definition
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Term
| Old man is delirious. YOu see on his MAR that he has gotten 8 mg of diazepam in the last 24 hours. what is the next step |
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Definition
| Taper benzos. Oldies don't do well on them |
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Term
| What is appropriate heroin detox method? |
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Definition
-1st: clonidine
-2nd: methadone
-If acutely toxic, give naloxone/naltrexone |
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Term
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Definition
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Term
| Safest tx of acute mania in pregs? |
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Definition
|
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Term
| what medication used for tx of Tourette's may cause long QT? |
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Definition
Pimozide (Orap)
-Typical high-potency antipsychotics |
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Term
| Paxil found to increase ______ in children |
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Definition
|
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Term
| nephrogenic Diabetes due to... |
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Definition
|
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Term
| Sialorrhea is often due to... |
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Definition
Clozapine
tx: PTU, anticholinergics |
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Term
| Spectrum of secondary DM in 2nd generation antipsychotics |
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Definition
Most DM-genic: clozapine, olanzepine
Intermediate: risperidone, quetiapine
Low DM-genic: aripiprazole, ziprasidone |
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Term
| What are 2 major contraindications to ECT? |
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Definition
| Recent MI, space occupying brain lesion (increased seizure risk) |
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Term
| Antidepressant for the treatment of depression and peripheral neuropathy |
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Definition
|
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Term
| what 3 antidepressants do not have sexual side effects> |
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Definition
| Mirtazepine, buproprion, nefazodone |
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