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56 Cards in this Set
- Front
- Back
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What are 3 main subdivisions of Psychopharmacotherapy?
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1. Antidepressants
2. Antipsychotics 3. Anxiolytic/hypnotics |
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What do many of the psycho drugs affect?
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Neurotransmitters
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What are the 3 main NT classes?
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1. Monoamines
2. Amino acids 3. Glutamic acid |
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What are the Monoamine NT's?
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-Serotonin
-Histamine -Acetylcholine -Norepi -Dopamine |
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What is the amino acid?
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GABA
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What are 3 subcategories of ANTIDEPRESSANTS?
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1. Tricyclics/heterocyclics
2. SSRIs/SNRIs 3. MAOIs |
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How do the Tricyclic antidepressants work?
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Increase NE and 5HT in the synapse by inhibiting their reuptake
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Why aren't TCAs the first line txmt anymore?
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They cause fatal cardiac arrythmias in overdose
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What are 5 major side effects of ALL TCA's?
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-Anticholinergic effects
-Sedation -Weight gain -Tachycardia/QT prolongation -Orthostatic hypotension |
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What are 4 anticholinergic side effects?
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Blurry vision
Dry mouth Constipation Urine retention |
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What are 4 of the major TCAs?
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-Amitriptyline
-Nortriptyline -Desipramine -Imipramine |
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What is a side effect unique to Amoxapine?
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May cause extrapyramidal syndrome
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Which TCA is the least anticholinergic and is also nonsedating?
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Desipramine
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Avg half life of TCAs:
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16 hrs
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What class is the most commonly used of antidepressants today?
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SSRIs
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What are 2 major side effects of SSRIs?
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-GI distress/diarrhea
-Sexual dysfunction |
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What sort of sex dysfunction do SSRIs cause in males vs females?
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Males - delayed ejaculation
Females - anorgasmia |
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What are 3 additional side effects of SSRIs?
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-Agitation/anxiety
-Headaches -Insomnia |
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What is a potentially FATAL complication of using SSRIs? How is it avoided?
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Serotonin syndrome - don't prescribe SSRIs along WITH an MAOI, and wait at least 5 wks after d/c the SSRI before starting on an MAOI.
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What is Serotonin syndrome?
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Similar to neuroleptic malignant syndrome - confusion, high temp, muscle twiches, loss of conscsnss
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What are 6 of the main SSRIs?
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For some people forks can eat
-Fluoxetine -Sertraline -Paroxetine -Fluvoxamine -Citalopram -Escitalopram |
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Which SSRI has the longest half-life?
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Fluoxetine; 1-3 days!
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Which SSRI causes diarrhea more commonly than others?
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Sertraline
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Which SSRI is mildly anticholinergic?
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Paroxetine
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Which SSRI more commonly causes nausea/vomiting than others?
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Fluvoxamine
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Which SSRI possibly has fewer sexual side effects?
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Citalopram
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Which class of antidepressants are LEAST commonly used? Why?
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MAOIs - because it requires a Tyramine-free diet in order to prevent hypertensive crisis!
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What does a tyramine-free diet consist of?
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No fermented bvgs, cheese, sausage
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What are MAOIs more useful for treating?
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Atypical depressive symptoms - overeating, oversleeping, irritability
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What is the main MAOI to remember?
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Phenelzine!
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What should you NEVER do with an MAOI?
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Coadminister with an SSRI
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What are 5 MISCELLANEOUS antidepressent meds?
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-Venlafaxine
-Nefazodone -Trazodone -Mirtazepine -Bupropion |
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What is Venlafaxine? mechanism?
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an SNRI - inhibits 5HT and NE reuptake
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What are Nefazodone and Trazodone? Mechanism?
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5HT2 receptor blocker AND serotonin reuptake inhibitors
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Which mixed 5HT2 antagonist/SRI is associated with decreased sexual dysfunction?
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Nefazodone
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What is a side effect that is associated with Trazodone?
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PRIAPISM - prolonged erection which can actually lead to impotence!
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What is the mechanism of Mirtazapine?
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NE/Serotonin antagonism
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What are 2 side effects of Mirtazapine?
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Weight gain
Sedation |
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What is the mechanism of Buproprion?
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NE and Dopamine reuptake inhibitor
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What are Antidepressant MOOD STABILIZERS used for treating?
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MANIA
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What are the 3 main Antidepressant MOOD STABILIZERS?
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-Lithium
-Valproic acid -Carbamazepine |
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What is Lithium's mechanism of action?
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Inhibits Adenylate cyclase
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What are 3 major side effects of Lithium?
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-Tremor
-Hypothyroidism -Diabetes insipidus |
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What can Lithium cause at toxic levels?
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Seizures Coma and Death
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What 5 tests should be done on patients on Lithium and how often?
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-Serum level tests q5-7 days w/ each dose change, q6-12 mo when stable
-Renal function tests q6-12 mo -Thyroid function tests q6-12 mo -Pregnancy test, ECG |
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What can be given to reduce the tremor caused by lithium in some patients?
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Propanolol
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What is the theory of Valproic Acid's mechanism?
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Opens chloride channels
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What are 4 major side effects of Valproic acid?
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-Thrombocytopenia
-Hair loss -Pancreatitis -Teratogenic - neural tube defects |
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So what 4 tests should be done for patients on Valproic acid?
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-CBC
-Liver function -Pancreatic enzymes -b-hCG in childbearing women |
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What is the mechanism of Carbamazepine?
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Inactivates Sodium channels so inhibits repetitive firing of AP's
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What are 4 major side effects of Carbamazepine?
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-Slurred speech
-Low WBC count (agranulocytosis) -High liver function tests -Craniofacial defects in newborns |
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So what are 4 tests you should run on patients on Carbamazepine?
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-LFT's
-Pancreatic enzymes -CBC -b-hCG in childbearing women |
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Another important point to remember about Carbamazepine?
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Potent inducer of the P450 system!
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What are 2 less commonly used mood stabilizers for mania?
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-Lamotrigine
-Gabapentin |
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What are 3 possible s/e's of Lamotrigine?
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-Leukopenia
-Rash (steven johnson syndrome) -Liver failure |
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How do you avoid the rash with Lamotrigine?
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Slowly increase the dosing
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