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27 Cards in this Set
- Front
- Back
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1. HAM side effects- Those found in TCAs and low-potency antipsychotics?
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1. antiHistamine-sedation, weight gain.
2. antiAdrenergic- hypotension 3. antiMuscarinic- Dry mouth, blurred vision, urinary retention. |
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2. When does Serotonin syndrome occur?
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a. When there is too much serotonin, classically when SSRIs and MAOIs are combined.
b. Tx: Stop drugs. |
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3. 10 Symptoms of serotonin syndrome?
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1. Confusion
2. Flushing 3. Diaphoresis 4. Tremor 5. Myoclonic jerks 6. Hyperthermia 7. Hypertonicity 8. Rhabdomyolysis 9. Renal failure 10. Death |
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4. When does hypertensive crisis occur?
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a. Caused by a build-up of stored catecholamines.
b. MAOIs plus foods w/tyramine (red wine, cheese, chicken, liver, cured meats) or plus sympathomimetics. |
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5. Extrapyramidal side effects (EPS)?
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a. Parkinsonism- Masklike face, cogwheel rigidity, pill-rolling tremor.
b. Akathisia- Restlessness and agitation. c. Dystonia- sustained contraction of muscles of neck, tongue, eyes, diaphragm. |
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6. When do extrapyramidal effects occur and are they reversible?
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a. Occurs w/high-potency traditional antipsychotics
b. Reversible c. Occurs w/in DAYS of starting med. d. Can be life threatening (eg, dystonia of the diaphragm causing asphyxiation). |
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7. DOC to treat extrapyramidal symptoms produced by neuroleptics?
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a. Benztropine.
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8. With what 2 classes of drugs does hyperprolactinemia occur?
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1. High-potency traditional antipsychotics
2. Risperidone |
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9. What is Tardive dyskinesia and when does it typically occur?
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a. Choreoathetoid muscle movements, usually of mouth and tongue.
b. Occurs after YEARS of antipsychotic use (particularly high-potency typical anti-psychotics. c. Can be irreversible. |
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10. Symptoms of Neuroleptic Malignant Syndrome?
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a. Fever
b. Tachycardia c. HTN d. Tremor e. Elevated CPK f. Lead pipe rigidity. |
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11. What can cause Neuroleptic Malignant Syndrome?
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a. All antipsychotics after short or long time (↑ with high-potency traditional antipsychotics).
b. It is a medical emergency w/20% mortality rate. |
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12. Important CYP450 inducers:
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a. Smoking (1A2)
b. Carbamazepine (Tegretol) (1A2, 2C9, 3A4). c. Barbiturates (2C9) d. St. John’s wort (2C19, 3A4). e. Also CRAP GPs |
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13. Tardive Dyskinesia?
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a. Characterized by grimacing and tongue protrusions.
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14. Acute Dystonia?
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a. Characterized by twisting and abnormal postures
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15. Akathisia?
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a. Characterized by inability to sit still.
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16. Bradykinesia?
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a. Characterized by ↓ or slow body movements.
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17. Constipation is a common side effect of what class of meds?
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a. Anticholinergics.
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18. What disease do anticholinergics exacerbate?
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a. Alzheimer disease.
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19. Important Enzyme inhibitors?
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a. Fluvoxamine (Luvox) (1A2, 2D6, 3A4)
b. Fluoxetine (Prozac) (2C19, 2C9, 2D6) c. Paroxetine (Paxil) (2D6) d. Duloxetine (Cymbalta) (2D6) e. Sertraline (Zoloft) (2C19) f. SICKFACES.COM |
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20. How long is an adequate trial of antidepressant, before considering changing meds?
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a. 1-2 months at full dose.
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21. Major categories of antidepressants?
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a. SSRIs
b. Heterocyclics, including TCAs and tetracyclic antidepressants. c. MAOIs d. Miscellaneous antidepressants. |
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22. Note: about 70% of pts w/major depression will respond to antidepressant meds. About 30% of this is placebo response.
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22. Note: about 70% of pts w/major depression will respond to antidepressant meds. About 30% of this is placebo response.
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23. Withdrawal phenomenon w/Antidepressants?
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a. Occurs w/most antidepressants.
b. Characterized by: 1. Dizziness 2. HA 3. Nausea 4. Insomnia 5. Malaise |
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24. SSRI MOA?
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a. SSRIs inhibit the presynaptic serotonin pumps that take up serotonin, -> ↑ availability of serotonin in synaptic clefts.
b. However research indicates that the MOA may be more complex. c. Although their structural differences are minimal, pts often respond differently, in terms of both efficacy and side effects, to different SSRIs. |
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25. Dosing of SSRIs?
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a. Based on their half-lives, most SSRIs can be dosed daily.
b. Fluoxetine also has a weekly dosing form available. c. There is no correlation between plasma levels and efficacy or side effects. |
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26. What advantages do the SSRIs have?
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a. Low incidence of side effects, most of which resolve w/time.
b. No food restrictions. c. Much safer in overdose. |
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27. 6 SSRIs?
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1. Fluoxetine (Prozac)
2. Sertraline (Zoloft) 3. Paroxetine (Paxil) 4. Fluvoxamine (Luvox) 5. Citalopram (Celexa) 6. Escitalopram ( Lexapro) |
