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125 Cards in this Set

  • Front
  • Back
clinical features of depression include
physiologic (GI, Cardiac); psychological (easiest to id); cognitive
etiology of depression
biochemical disturbance (deficiency of 5HT-3, NE); genetic background; cognitive state; ability to cope with mood changes
tx options of depression
psychotherapy (not good monotherapy); ECT; pharmacologic
pharmacological tx of depression
MAOIs; TCAs; others; new generation agents (SSRIs & SNRI)
MAOIs are not a ____ line drug and are used only when ________ or _________
first; all others fail; already on them and doing well and don't want to change
examples of MAOIs are _______, _________, ________
Phenelzine (Nardil); Tranylcypromine (Parnate); Isocarboxazid (Marplan)
MAOIs prevent inactivation of ______, such as ____, ____, ____which then leads to a ______ of the NTers in the ______
monoamines; 5HT-3 and NE & domapine; increase; synaptic cleft
MAOIs are
pts on MAOIs should avoid food with _______ such as
tyramine; pickled hering, aged cheddar cheese, red wine
The "washout period" needed before changing or starting new meds is _____ weeks
two (books says 6)
examples of TCAs
Amitriptyline (Elavil); Nortriptyline (Pamelor, Aventyl); Protriptyline (Vivactil); Imipramine (Tofranil); Desipramine (Norpramin); Doxepin (Sinequan)
inhibit reuptake of 5HT3, NE or both
These inhibit mostly 5HT-3 reuptake
amitriptyline; protryptiline; imipramine; dexepin
These inhibit mostly NE
Nortriptyline; desipramine
_______ is a metabolite of amitrityline
________ is a metabolite of tofranil
sedation; anticholinergic effects; activation of mania (pretty much all); orthostatic hypotn
other (atypical) antidepressants
Maprotiline (Ludiomil); amoxiapine (Asendin); Trazadone (Desyrel)
Trazadone is a ____ inhibitor of _____ re-uptake. It has a sedating effect probably secondary to its _______ blocking activity
weak; 5HT-3; H-1
Trazadone is also use in treating _____ pain
Newer agents to treat depression include
SSRIs and SNRIs and alpha-2 antagonists
examples of SNRIs are
Venlafaine (Effexor), effexor XR; Duloxetine (Cymbalta)
Duloxetine also has ______ properties
examples of alpha-2 antagonists are
Mirtazapine (Remeron)
alpha -2 antag. cause an ___ release of ______ (NT)
increase; NE
all antidepressants that cause an ______ of NT in the ______, are good for _____ pain
increase; synaptic cleft; neuropathic
examples of SSRIs are
Fluoxetine (Prozac); Sertratline (Zoloft); Paroxetine(Paxil); Citalopram (Celexa); Escitalopram (Lexapro)
________ causes more insomnia than the other SSRIs
only _______ undergoes a significant 1st pass metabolism
fluoexetine differs from others in the class; as it has a _____ half-life (____ hrs) and it is available in _______, allowing ____ weekly dosing
longer; 50; sustained release; once
_________ & _________ are potent inhibitors of cytochrome P450
fluoxetine and paroxetine
_________ has less nausea than celexa
constipation; diarrhea; dry mouth; fatigue; activation of mania; suicide; suicidal ideation; sexual side effects
two important considerations in selecting a drug
past hx of response; differences in adverse effect profile
other issues to consider
cost of aquisition; overal cost of therapy; coverage
Major SE of SSRI
sedation; anticholinergic effects; orthostatic hyptotn
meds from most to least with sedation SE
meds from most to least with anticholinergic effects
elavil>doxepin >nortriptyline>trazadone=SSRIs=venlafaxine/duloxetine (effexor/cymbalta)
meds from most to least with orthostatic hypotn
elavil>Trazadone>nortriptyline =SSRIs=venlaxafine(effexor)(?doxazosin)
pharmacoeconomic considerations
acquisition costs; cost of hospitalization; cost of missed days at work; cost on managing side effects; cost of managing lack of efficacy
complications of bipolar illness
increased cardiovascular mortality; increased suicide rate; excessive risk-taking behavior; substance abuse
goal of tx of BPD
stabilize mood
pharmacologic options for tx of BPD
lithium; carbamazepine; valproic acid
Lithium has a _____ onset of action, a ___ therapeutic range, and ____-______ interactiosn
long; narrow; food-drug
lithium is a ___ molecular ion, in competes with __ at absorption excretion sites. It affects the ____ and if in excess can lead to ____ ____
low; Na; kidneys; diabetes insipidous
monitoring parameters are
Cr, BUN, Urine sg, electrolytes, EKG, CBC, thyroid fxn, glucose, lithium level, beta HCG (repeat q 3 mo)
lithium SE
cognitive effects, fine tremor, GI upset, diarrhea, hypothyroidism, polyuria, polydypsia (signs of diabetes insipidus), wt gain, rashes
_______ increase the level of lithium
NSAIDS, Diuretics, ACE inhibitors
________ decrease lithium levels
theophyline, caffine, acetazolamide, sodium
all diuretics will lead to lithium ________ as they inhibt ______ reabsorption, but not lithium reabsorption
toxicity; NA
if a pt is on lithium, eats a lot of salt chips then takes an antacid, they will have a _______ overload which will ______ lithium off reabsorption site, leading to ______
Na, kick, mania
drugs that lead to lithium toxicity
methyldopa; carbamazepine; Ca channel blockers; antipsychotics; SSRIs
Carbamazepine (tegretol) acts on ______ channels, dosing starts at ____ mg _____, is available as ______ and ______and target drug level is ____ mcg/ml
sodium; 200; BId; tablets; suspension; 8-12
tegretol is usually a _____ line med
firt line
SE of tegretol are
leukopenia; thrombocytopenia; hyponatremia; sedation; tremor; diplogia;
drug interactions
importance of expoxide
valproate SE
nausea (divalproex better tolerated); elevation in transaminases; teratogenicity
LFTs should be tested
at start of tx, then monthly for first 3 mo, the q 6 months
what drug should you choose for a child bearing age female
tegretol and give folate supplementation
valproate drug interactions. It ______ other drugs from ____ binding sites, it ___ hepatic metabolism, hepatic ____ ____ lower its efficacy
displaces; protein; inhibits; enzyme inducers
other BPD agents
verapamil, gabapentin; levothyroxine (best for type 2)
if increased mania use _____
The need for antipsychotic therapy starts with evaluation of
agitation; aggressiveness and evaluation of other causes (hypoxia)
antipsychotic drugs block _______ receptors in _____ (5) and affect ___ and ______ receptors
dopamine; basal gangila; hypothalmus; limbic system; brain stem; medulla; D-1; D-2
examples of phenothyzines are
chlorpromazine (Thorazine); Thioridazine (Mellaril); Mesoridazine (Serentil); Thiothixine (Navane); Fluphenzine (Prolixin)
All phenothyzines lower __ ___ and accentuate _____ pain
sz threshold; neuropathic
if pt has hx dm with neuropatic pain should you use Thorazine?
______ has SE of QT segment prolongation
Thiordazine (mellaril)
_______ is the injectible form of Thiordazine
Mesoridazine (Serentil)
________ is also injectable
Thiothixene (Navane)
________ is used a lot in pts secondary to its fast acting and available in lq
Fluphenazine (Prolxin)
SE of phenothiazines
sedation; extrapyramidal sx (erratic movements to muscle spasm to sz), sz (can get with antiemetics)
Drug interactions
etoh (accentuates CNS depression); valproic acid; tegretol (inducing enzyme?)
haloperidol (Haldol) has ____ effect on sz threshold; is administered via ____ and _____, ____ and ______ acting
no; po and injectible; sustained release and short acting injectible
SE of haldol
extrapyramidal sx; tardive dyskinesia (with phenothiazines)p therapy stops, no way to prevent; pseudoparkinsonism (gait disturbance, will go away p 1 mo stopped
When Haldol is given IM it forms a ________ that has slow release x ___ weeks
precipiate, 2, ___ acute setting
tx extrapyramidal sx with _______, or _______
benztropine (cogentin); benadryl
the key is _______ and monitoring
prevention (start above when starting Haldol)
examples of newer antipsychotic agents
clozapine (clozaril); Risperidone (rispradal); olanzapine (zyprexa); quetiapine fumarate (seroquel); ziprasidone (geodon) aripiprazole (abilify); paliperidone (invega)
SE specific to clozapine (clozaril) and how to manage that se
agranulocytosis, CBC Q 2 weeks with only two weeks of meds distributed at a time
routes of admin for riperidone
orally dis. tab and injectable (risperdol consta) given q 2 weeks
problem with olanzapine (zyprexa)and routes of admin
qt segment prolongation; po orally dis. tab (zytres) and injection
olanzapine has _____ se than clozaril
quetiapine fumarate (seroquel) is metabolized by the ______. It has a better effect with _____ dose. It is admin via _____ only. and has a se of _____
liver; increased; po; qt seg prolongation that can lead to fatal arrhythmia
aripiprazole (abilify) has ___ se than others, but its drawback is:____ despite it being available to be admin via what route
less; doesn't work fast enough; injectible
paliperidone (invega)is a metabolite of ________
ziprasidone (geodon)is availble by ________
po and injection
SE of newer antipsychotics
hematologic; pro-arrhythmic effects (tor sades); metabolic disturbance (inc lipid, inc wt, inc DM II, leads to heart dz); dyskinesias (less than orginals); postural hyptotn; risk of stroke (independent of cardiovascular status)
one should avoid the combo of ______ and antipsychotic meds as the combo could lead to ________
valproic acid; fatal arrhythmia
failure to dx and tx ______ can lead to increase in morbidity and _______
anxiety; mortality
associated medical disorders
cardiovascular dz; respiratory; endocrinology; GI; neurologic
drugs that cause anxiety
cns stimulants (legal and illicit); cns depressant (etoh in excess)
a deficiency of ______ and _______ NT can lead to anxiety
GABA; 5HT (with depression)
excess of ______ and _______ can lead to anxity
neurochemical theories are
noradrenergic model; benzodiazepine model; serotonin model
noradrenergic model deals with
shortage of NE
benzodiazepine model deals with
GABA inhibition
serotonin models deal with
decrease in 5HT in synaptic cleft
when tx GAD there is no _____-______ relief with ____ only. ______ is needed also
long-term; meds; therapy/counceling
benzodizaepines used to tx GAD
Alprazolam (xanax); lorazepam (ativan); oxazepam (serax); diazepam (valium); chlordiazepoxide (librium)
______ is the most commonly used axietolytic drug. It is _______ acting
xanax; very short
_______ has the highest incidence of sz with abrupt discontinuation
these benzos are can be administered via injection as well
ativan; valium; librium
these benzos are pro drugs
valium; librium
adverse effects of benzos
sedation (when taken with other cns depressants, esp etoh, effect is addative and synergistic; dependence (sz upon withdrawl)
meds to tx anxiety
benzos; buspirone; beta blockers; antidepressants
buspar is a partial _____ agonist, has a _____ onset
serotonin; long
adverse effects of buspar
light sedation and drug interactions (cytochrome P450 metabolism)
beta blockers used to tx anxiety
propranolol (max 20mg TID)
buspirone can make anxiety ______ on a rare occassion
BB don't ______ BP considerably and are good for ______ anxiety. a SE is _______ loss
lower; situational; short-term memory
particularly _______ are good antidepressants to tx anxiety
#1 drug used to tx panic do is _______ and it works by enhancing _______
benzos; GABA
______ and _______ are used in the prevention of panic attacks
TCA (elavil max 50mg qd); SSRIs
another thing to look at in tx of panic attacks
lifestyle; dont watch news or read scare book before bed; avoid etoh as it exacerbates panic do
specific phobias are ______ to pharmacotherapy. One must stear away from _____ situations
unresponsive; fearfull
Tx for social phobias are
MAOIs (low dose); benozos; SSRIs
a concern with use of benzos is
they need to be used chronically and then dependence is an issue
Buproprion (wellbutrin) works as an _______ and ______
antidepressant and antianxiety
buproprion (wellbutrin) is a ______ inhibitor of neuronal uptake of _____, ______, and _______
dopamine; NE; serotonin
zyban is used for _______, and helps to decrease ______ for _______ and _______
smoking cessation; cravings; tobacco; etoh
caution must be used with chronic etoh use as withdrawl can lead to
precautions in using wellbutrin
sz; incrased risk of suicidal behavior
SE of wellbutrin is
hypertension; mania; depression