Psychiatry General Memorize

Front 1

1) Name 8 tricyclics.

2) Name a tetracyclic

Back 1

1) Tricyclics

• Amitriptyline (Elavil)
  
• Doxepin (Adapin)
  
• Imipramine (Tofranil)
  
• Clomipramine (Anafranil)
  
• Trimipramine (Surmontil)
  
• Desipramine (Norpramin)
  
• Nortriptyline (Pamelor)
  
• Protriptyline (Vivactil)
  

2) Amoxapine (Asendin)

Front 2

What are the common side effects of tricyclics in general. 5 categories

Back 2

• Anticholinergic: Dry mouth, blurry vision, urinary retention, constipation, sedation
  
• Alpha Adrenergic blockage: Orthostatic Hypotension
• Tachycardia
• QT Interval Prolongation
• Antihistamine-1 effect: Weight gain

Front 3

1) Which general class of TCAs is more anticholinergic and very sedating?

2) Name them.

Back 3

1) Tertiary Amines are more anticholinergic and highly sedating.

Secondary Amines (Still tricyclics) and Tetracyclics have less anticholinergic effect and less sedation.

2) Tertiary

• Amitriptyline (Elavil)
• Doxepin (Adapin)
• Imipramine (Tofranil)
• Clomipramine (Anafranil)
• Trimipramine (Surmontil)

Secondary

• Desipramine (Norpramin)
• Nortriptyline (Pamelor)
• Proptriptyline (Vivactil)

Tetracyclic

• Amoxapine (Asendin)

Front 4

1) Which TCA can cause extrapyramidal syndrome and NMS?

2) What is it a metabolite of?

Back 4

1) Amoxapine (Asendin)

2) Loxapine which is a typical antipsychotic

Front 5

Name the SSRIs (6)

Name an SNRI

Name an SSNRI

Back 5

• Fluoxetine (Prozac)
  
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

• Venlafaxine (Effexor)
  

• Duloxetine (Cymbalta)

Front 6

What are the common side effects of SSRIs/SNRIs/SSNRIs?

Back 6

1) Agitation, Akathisia, Anxiety, Panic , Insomnia, HA

2) Diarrhea, GI Distress

3) Sexual Dysfunction, Delayed ejaculation, impotence or anorgasmia in females.

Front 7

Which SSRIs can be used for GAD?

Back 7

Venlafaxine (Effexor) and Duloxetine (Cymbalta)

Front 8

Which SSRIs can be used for OCD? (4)

Back 8

1) Fluoxetine (Prozac)

2) Setraline (Zoloft)

3) Paroxitine (Paxil)

4) Fluvoxamine (Luvox)

Front 9

Specific Characteristics of SSRIs

1) Which SSRI causes the most diarrhea?

2) Which SSRI is mildly anticholinergic?

3) Which SSRI has the most N/V?

4) Which SSRI has the least sexual side effects?

Back 9

1) Setraline (Zoloft)

2) Paroxetine (Paxil)

3) Fluvoxamine (Luvox)

4) Citalopram (Celexa)

Front 10

What side effects are characteristic of Venlafaxine (Effexor)

Back 10

• Anxiety
  
• Increased Blood PRessure
• HA
• Insomina
• Sweating

Front 11

Which "SSRI" can be used for depression and pain caused by diabetic neuropathy?

Back 11

Duloxetine (Cymbalta)

Front 12

What is recommendation regarding "SSRIs" and MAOIs?

Back 12

Don't. The combination can cause fatal serotonin syndrome

When starting an MAOI make sure that the patient hasn't used any SSRIs in at least 5 weeks.

Front 13

What are the MAOIs?

Back 13

• Phenelzine (Nardil)
  
• Isocarboxid (Marplan)
• Selegiline (Eldepry)
• Tranylcypromine (Parnate)

Front 14

What side effects are common to all MAOIs?

Back 14

Do NOT administer with "SSRIs" and make sure that "SSRIs" have not been used in at least 5 weeks.

Avoid cheese, fermented or aged foods, wine, and liver.

Weight gaine, somnolence, orthostatic hypotension

Front 15

Which MAOI has an indication for Parkinson's?

Back 15

Selegiline which can be given as a transdermal patch although irritation at this site can occur.

Front 16

What are the Miscellaneous antidepressants and their mechanisms? (4)

Back 16

1) Nefazodone (Serzone), Serotonin-2 antagonist and SSRI

2) Trazodone (Desyrel), Serotonin-2 antagonist and SSRI

3) Mirtazapine (Remeron), Noradrenergic antagonist and Serotonin antagonist

4) Buproprion (Wellbutrin) Norepinephrine and Dopamine reputake inhibitor

Front 17

What are the niches of the miscellaneous antidepressants?

What are the side effects of the miscellaneous antidepressants?

Back 17

1) Nefazodone (Serzone): Decreased sexual side effects but with sedation and hepatotoxicity.

2) Trazodone (Desyrel): In low doses can be used for insomnia but can cause priapism, orthostatic hypotension and sedation

3) Mirtazapine (Remeron): No sexual SEs, no nausea, no diarrhea BUT has weight gain and sedation.

4) Bupropion (Wellbutrin): Used in smoking BUT contraindicated in patients with an eating or seizure disorder.

Front 18

Name the mood stabilizers?

What are their mechanisms of action?

Which of these are contraindicated in pregnancy?

Back 18

1) Lithium: Inhibits Adenylate Cyclase

2) Valproic acid, valproate (Depakene): Opens Chloride channels

3) Divalproex Sodium (Depakote): Opens Chloride channels

Valproic acid and Divalproex Sodium (Depakene and Depakote? More like Don't Depagive to Depapregnant ladies)

4) Carbamazapine (Tegretol): Inactivates Na channels which inhibits repetitive firing of action potentials.

5) Lamotrigine (Lamictal):

6) Gabapentin (Neurontin)

7) Topiramate (Topamax):

Front 19

What are the general considerations when starting a patient on Depakene or Depakote?

Back 19

• Neural Tube Defects --> Serum hCG
• Thrombocytopenia --> CBC
• Pancreatitis --> Amylase, Lipase
• Liver Function Tests
• Weight gain, Hair loss, GI Distress
• Cognitive Dulling

Front 20

What are the general considerations when starting a patient on Lithium?

Back 20

• This drug can cause Diabetes Insipidus
  
• Lithium levels should be monitored every 3 months at least until the patient is stable.
• Hypothyroidism --> TSH Levels
• Cardiac Dysrhythmias --> ECG
• Renal dysfunction --> BUN, Specific gravity, Creatine
• Benign Increased WBCs --> Try propanolol? This also can help with tremor.

Front 21

What are the general considerations when starting a patient on Carbamazapine (Tegretol)?

Back 21

• Agranulocytosis --> CBC
• High LFTs --> LFT baseline
• Carbamazapine levels

These should all be done Q2 weeks for the first 2 months.

Then Q3 months afterward.

Serum electrolytes and ECG should be done for baseline then yearly, afterward.

• Craniofacial defects in the newborn
• Cognitive slowing, Slurred Speech, N/V

Front 22

What are the general considerations when starting a patient on Lamotrigine (Lamictal)

Back 22

• Leukopenia --> CBC with platelet count Q6-12 months
  
• Rash
• Hepatic failure
• N/V/D
• Somnolence and dizziness