Psychopharm

Card Set Information

Author:
sashatom
ID:
36999
Filename:
Psychopharm
Updated:
2010-09-23 23:20:41
Tags:
psychopharmacology depression bipolar anxiety insomnia
Folders:

Description:
Dr. Kverno's lecture on psychopharmacology
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user sashatom on FreezingBlue Flashcards. What would you like to do?


  1. What kind of drugs are substrates, inducers or inhibitors of P450s?
    Psychotropic drugs
  2. What happens if a highly protein bound drug is displaced off its protein by another more protein bound drug?
    It can result in increased circulating levels of the free drug
  3. What would cause an increase in serum concentration of drugs that are excreted by the kidneys?
    Renal disease or drugs that reduce renal clearance
  4. Why are the elderly more sensitive to psychotropic drugs?
    • Decreased intracellular water, protein binding and tissue mass
    • Increased body fat
  5. What class of sedative hypnotics have a high amount of adverse effects?
    Barbituates
  6. Why are barbituates rarely used to treat psychiatric disorders?
    • High potential for abuse
    • Fatal in overdose
  7. What are the drugs of choice for anxiety?
    Benzodiazepines
  8. What are the drugs of choice for insomnia?
    Benzodiazepine-like drugs
  9. What two conditions can an anxiety syndrome be related to?
    • Substance disorders
    • Medical conditions
  10. What are the four mechanisms of anxiety in the brain?
    • Limbic system sensitivity
    • Sympathetic nervous system activation
    • Hypothalamic-Pituitary-Adrenal activation
    • Neurotransmitter alterations
  11. What two neurotransmitters when altered cause anxiety?
    • GABA
    • NE
  12. What is the first line of treatment for anxiety disorders?
    SSRIs
  13. What are five examples of anxiety disorders?
    • Generalized Anxiety Disorder (GAD)
    • Panic Disorder
    • Phobic Disorders (social/simple)
    • Post-traumatic Disorder (PTSD)
    • Obsessive Compulsive Disorder (OCD)
  14. What three classes of drugs are used to treat anxiety disorders?
    • Benzodiazepines
    • Buspirone (Buspar)
    • SSRIs
  15. What anti-anxiety drug does not cause CNS depression, has no abuse potential, and does not intensify the effects of the CNS?
    Buspirone
  16. What will increase the levels of Buspirone?
    • Grapefruit juice
    • Erythromycin
  17. How long before therapeutic effects are felt from Buspar?
    3-4 weeks
  18. Why are Benzodiazepines used for brief/short-term treatment?
    They have a risk for dependence with long-term use
  19. What are other indications for Benzodiazepines (besides anxiety)?
    • Insomnia
    • Seizures
    • Muscle spasticity
    • ETOH withdrawal
    • Induction of anesthesia
  20. What two factors determine the selection of benzodiazepines?
    • Onset
    • Duration of Effect
  21. What is the MOA for benzodiazepines?
    Increase the effectiveness of GABA, inhibiting neurotransmission in the limbic system and cortex.
  22. Which administration route has the longest onset of anxiolytic effects for benzodiazepines?
    PO (30-60 min)
  23. Which administration route has the shortest onset of anxiolytic effects for benzodiazepines?
    IV (1-5 min)
  24. What are the indications for rapid onset of anxiolytic effects?
    • Episodic burst of anxiety
    • Falling asleep rapidly
  25. What are three advantages of longer half-lives with benzodiazepine?
    • Less frequent dosing
    • Less variation in plasma concentration
    • Less severe withdrawal
  26. What are two advantages of shorter half-lives with benzodiazepine?
    • No drug accumulation
    • Less daytime sedation
  27. What are three disadvantages of longer half-lives with benzodiazepine?
    • Drug accumulation
    • Daytime sedation
    • Daytime psychomotor impairment
  28. What are three disadvantages of shorter half-lives with benzodiazepine?
    • More frequent dosing
    • Earlier and more severe withdrawal syndromes
    • Rebound insomnia
  29. What are the indications for treatment with long-duration benzodiazepines?
    • Seizures
    • Alcohol withdrawal
  30. What are the indications for treatment with intermediate-duration benzodiazepines?
    Anxiety
  31. What are the indications for treatment with rapid-onset, short-acting benzodiazepines?
    • Sleep onset insomnia
    • Preoperative anesthesia
  32. What are some common side effects of benzodiazepines?
    • Drowsiness
    • Fatigue
    • Depression
    • Dizziness
    • Ataxia
    • Slurred speech
    • Weakness
    • Forgetfulness
  33. What are the adverse effects associated with stopping benzodiazepines abruptly (not tapering)?
    • Seizure
    • Death
  34. What is the first line of treatment for Schizophrenia?
    atypical anti-psychotics
  35. What is the first line of treatment for depression?
    SSRIs
  36. What is the first line of treatment for anxiety disorders?
    • SSRI’s (long term)
    • Benzodiazepines (short-term)
  37. What is the mechanism of action of Tricyclic Antidepressants?
    Blocks reuptake of transmitter causing an increase in concentration in the synaptic cleft
  38. What is 5HT?
    Serotonin
  39. What are SNRIs used for?
    Depression
  40. What is sensitization?
    Stressors and episodes that predispose an individual to increased chances of having a manic episode
  41. What is kindling?
    Repeated intermittent subthreshold stimulation of a given region of the brain that leads to a full blown amygdala seizure
  42. What is the plasma level that you want to stay below when taking lithium?
    1.5 mEq/L
  43. What is the MOA of Abilify?
    • D2 and 5HT1 partial agonist
    • 5HT2 antagonist
  44. What is insomnia?
    The complaint of sleep that is insufficient to support good daytime functioning
  45. What is the first line drug treatment for insomnia?
    Benzodiazepine-like drugs (the ZZZs)
  46. What is abooby trap of benzodiazepine like drugs?
    Psychomotor or cognitive impairment that lasts into the morning
  47. Two other treatments for insomnia?
    • Melatonin agonists
    • Benadryl
  48. What is unipolar depression?
    An episode of depression without history of mania
  49. What is hypomania?
    Functioning at a level just below mania
  50. What are the three phases of treatment for major depressive disorder?
    • Acute/Initiation
    • Stabilization
    • Maintenance
  51. How long does the acute/initiation phase last in the treatment of major depressive disorder?
    4-8 weeks
  52. How long does the stabilization phase last in the treatment of major depressive disorder?
    16-20 weeks
  53. How long does the maintenance phase last when treating major depressive disorder?
    6 mos – 1 yr after symptoms subside
  54. What is the main goal of acute/initiation phase of treating major depressive disorder?
    Monitor for side effects and suicide ideation (SI)
  55. What is the main goal of stabilization phase of treating major depressive disorder?
    Monitor response, prevent relapse
  56. What is the main goal of the maintenance phase of treating major depressive disorder?
    Monitor response, prevent recurrence
  57. What is the main treatment for children with depression?
    SSRIs
  58. When is the risk for suicide highest in patients being treated for depression?
    The time between the onset of medication administration and the therapeutic effect
  59. Which anti-depressant is not safe for kids?
    Tricyclics
  60. What are four classes of drugs used to treat depression?
    • Tricyclic Antidepressants
    • SSRIs
    • SNRIs and other novel antidepressants
    • MAOIs
  61. Which of the anti-depressants have the fewest adverse effects?
    SSRIs
  62. What are some common side effects of antidepressants?
    • Anticholinergic effects
    • Sedation
    • Hypotention/orthostatic hypotension
    • Weight gain
    • Sexual dysfunction
  63. What four indications are there for trycyclic antidepressants?
    • Depression
    • OCD
    • Chronic pain
    • Sleep disorders
  64. What is the most worrisome adverse effect of tricyclic antidepressants?
    Cardiac arrhythmia and possibly death
  65. Why are TCAs relatively contraindicated in the elderly, children, pregnant women and suicide individuals?
    Because of the potential for severe side effects and death
  66. What indications are SSRIs used for?
    • Depression
    • OCD
    • Panic disorder
    • Social anxiety disorder
    • PTSD
    • Eating disorders
    • Borderline personality disorder
  67. Most worrisome adverse effect of SSRIs?
    Coma and possibly death (serotonin syndrome)
  68. What does FLUSH stand for?
    • Flu-like
    • Lightheadedness, dizziness
    • Uneasiness, restlessness
    • Sleep and sensory disturbances
    • Headache
  69. What is the indication for MAOIs?
    Atypical depression: with anxiety or phobia symptoms
  70. Most frequent adverse effects associated with MAOIs.
    • Orthostatic hypertension
    • Insomnia
    • Weight Gain
    • Edema
    • Sexual dysfunction
  71. Rare side effect of MAOIs
    Tyramine-induced hypertensive crisis caused by pickled or aged foods.
  72. What is the recommended treatment for severe mania or mixed episodes?
    Lithium or Valproate in combination with antipsychotic
  73. What can be used to treat less severe bipolar?
    Monotherapy of lithium, valproate or atypical antipsychotic
  74. What tests are used to assess baseline when treating with Lithium?
    • BUN
    • Creatinine clearance
    • Thyroid
    • ECG
    • Pregnancy
  75. What tests are used to assess baseline when treating with Valproate?
    • Hepatic, hematological and bleeding abnormalities
    • Pregnancy
  76. What three types of drugs are used as mood stabilizers?
    • Lithium
    • Antiepileptic Drugs
    • Antipsychotic Drugs
  77. Acute adverse effects associated with lithium?
    • Nausea
    • Thirst
    • Increased urination
    • Fine hand tremor
  78. Chronic adverse effects associated with lithium?
    • Weight gain
    • Hair loss
    • Acne
    • Cognitive impairment
    • Polyuria
    • Impaired kidney function
    • Goiter
  79. What can lithium toxicity lead to?
    • Severe dehydration
    • Seizures
    • Coma
    • Arrhythmia
    • Multiorgan toxicity
    • Death
  80. Most common transient adverse effects of anticonvulsants?
    • Nausea
    • Diarrhea
    • Vomiting
  81. Why would atypical antipsychotics be good to use in conjunction with lithium and mood stabilizers?
    More rapid onset of action
  82. What is the mechanism of schizophrenia?
    Too much dopamine in mesolimbic pathway of the brain and too little in the mesocortical pathwy
  83. Positive symptoms of schizophrenia?
    • Hallucinations
    • Delusions
    • Disorganized speech/behavior
  84. Negative symptoms of schizophrenia?
    • Poverty of speech/thought
    • Flat affect
    • Low motivation
  85. What is the first line drug treatment for Schizophrenia?
    Atypical antipsychotics
  86. What is the MOA of typical antipsychotics?
    Dopamine (D2) receptor antagonism
  87. What side effect of typical antipsychotics are common due to dopamine receptor blockade?
    Extrapyramidal symptoms

What would you like to do?

Home > Flashcards > Print Preview