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