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55 Cards in this Set
- Front
- Back
Anticholingergics are used in psychiatry mainly for what reason?
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Counteract neuroleptic induced movement disorders such as DYSTONIA
(Akathisia should be treated with propranolol) (Parkinsonism should be treated with Levodopa or Amantadine) |
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What anticholinergics are used most often? (3)
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Benztropine (Cogentin)
Trihexyphenidyl Diphenhydramine |
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Peripheral side effects of anticholinergics?
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Blurry vision (inability to accomodate)
Constipation Urinary retention Hyperthermia |
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Central side effects of anticholinergics?
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DELIRIUM!!!
(especially in elderly) |
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Beta blocker indications in psychiatry
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1) Peripheral manifestations during anxiety (performance/social)
2) Akathisia from neuroleptics |
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Side effects of beta blockers
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Bradycardia
Hypotension Asthma exacerbation Masked hypogycemic symptoms |
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What is the mechanism of Atomoxetine?
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Selective norepi reuptake inhibitor
(Different from SNRI which is Serotonin Norepi Reuptake Inhibitor) |
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Main indication for atomoxetine?
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ADHD
"Focus down to the level of the atom" |
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Clonidine mechanism?
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Central Alpha-2 receptor AGONIST
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What is the alpha-2 receptor?
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Presynaptic autoreceptor that inhibits the release of more CNS norepi when it is stimulated
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What is the main use of clonidine in medicine?
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Anti-HTN
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What are some uses of clonidine in psychiatry? (4)
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1) Decreasing ANS sx from opiate WD
2) Treating ADHD 3) Treating Tourette's 4) Impulsiveness |
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S/E of clonidine?
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Sedation, dizziness, hypotension
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S/E of atomoxetine?
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Like other meds with monoamine reuptake as a primary mechanism of action, there is a risk of suicide in younger pts during initiation/tapering of therapy
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Indications of psychostimulants in psychiatry? (3)
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1) ADHD
2) Narcolepsy 3) Depression (certain forms) |
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Common psychostimulants used? (4)
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Dextroamphetamine (Dexedrine)
Methylphenidate (Ritalin) Amphetamine Mixture (Adderall) Pemoline (Cylert) |
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Mechanism of action of psychostimulants?
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Facilitate endogenous NT release rather than act as a direct agonist
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Problem with long term use of psychostimulants?
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Dependence and tolerance
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Side effects of psychostimulants?
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Tachycardia, insomnia, anxiety, HTN, diaphoresis
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Naltrexone mechanism of action?
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mu-opioid antagonist
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What are the benefits of naltrexone? (3)
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1) Prevent alcohol relapse
2) Reduce alcohol cravings 3) Reduce severity of relapse |
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When is naltrexone started in terms of its use in alcohol?
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Once detox of alcohol has finished
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When should naltrexone be started if the pt is using opiates?
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1 week after last opiate exposure (can precipitate severe opiate WD if dependent upon them)
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What is Acamprosate used for?
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Treatment of alcohol dependence
Maintain abstinence in previous dependent subjects |
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Mechanism of acamprosate?
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Modulator of glutamate function
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Benefits of Acampropsate (3)
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1) Reduce cravings
2) Maintain abstinence 3) Reduce relapse severity (All 3 are similar to naltrexone) |
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Disulfiram mechanism?
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Blocks the oxidation of acetaldehyde (causing a build up)
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Disulfiram indicated for?
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Prevent alcohol ingestion through fear of consequences
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What does a buildup of acetaldehyde do?
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Toxic reaction making the person ill in 5-10 minutes
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Symptoms of acetaldehyde buildup?
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Flushing, HA, sweating, dry mouth, N/V, dizzy
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Disulfiram should be restricted to those patients who...
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Are highly motivated and fully understand the consequences of drinking alcohol while using this medication
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Side effects of disulfiram (intrinsic)... (3)
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1) Hepatitis
2) Optic neuritis 3) Impotence |
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Buprenorphine mechanism?
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Partial opioid agonist
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Buprenorphine indication?
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Opiate addiction therapy
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How is Buprenorphine different from Methadone?
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Methadone is a weak agonist, but still a full agonist
Buprenorphine is a partial agonist |
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Various formulations of Buprenorphine?
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1) Subutex (oral)
2) Suboxone (Buprenorphine + Naloxone) 3) Buprenex (parenteral) |
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Why is there a mixed tablet containing Buprenorphine and Naloxone?
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To prevent diversion of the tablets for recreational IV injection. If taken by mouth, the naloxone is poorly absorbed and the patient only gets the partial agonist effect of Buprenorphine
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What are the non-BDZ meds that treat insomnia? (3)
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1) Zolpidem (Ambien)
2) Zaleplon (Sonata) 3) Eszopiclone (Lunesta) |
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How do the 3 ZZZ insomnia medications work?
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GABA receptor modulators
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Problems with the ZZZ meds?
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May have tolerance and depenence
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What are 3 other types of psychiatric meds that can be used for insomnia aside from the ZZZ meds?
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1) TCA
2) Trazodone 3) BDZ |
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What is Ramelteon?
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Another new medication that helps with insomnia
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Mechanism of Ramelteon?
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Agonist of melatonin receptors in the suprachiasmatic nucleus
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What are some medications used to treat cognitive dysfunction associated with Alzheimer's disease? (4)
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1) Donepezil
2) Rivastigmine 3) Galantamine 4) Tacrine "Done gallantly attacking rivals" |
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How do the DRGT meds for Alzheimer's work?
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Reversible inhibitors of acetylcholinesterase
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Neurotransmitter pathology in Alzheimer's?
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Reduced cholinergic neurons in the basal forebrain that project to the cortex and hippocampus (decreased cholinergic neurotransmission)
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Common S/E of DRGT drugs?
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Cholinomimetics effects... bradycardia, increased gastric acid secretion...
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Tacrine is second line treatment compared to DRG because?
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Severe hepatoxocity
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Memantine is indicated for what?
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New class of cognitive enhancers for Alzheimer's. Approved for moderate to severe Alzheimer's
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Mechanism of Memantine?
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Antagonist at excitatory glutaminergic NMDA receptors
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Why does Memantine's mechanism of action work?
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Preventing NMDA receptor from activating may prevent glutamate excitotoxicity
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Thyroid hormone and its indications in psychiatry (2)?
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1) Augment antidepressants
2) Adjuncts to rapid cycling bipolar |
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Theory behind thyroid hormone benefits in those with depression?
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Altered hypothalamic-pituitary-adrenal axis in depressed individuals
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Intrinsic psychiatric problem of having hypothyroidism?
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Mimics depression
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Lithium + Thyroid Hormone together may be helpful in treating?
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Rapid cycling bipolar
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