1
Q
What is pharmacokinetics?
A
What the body does to the drug
Key components include Absorption, Distribution, Metabolism, and Elimination (ADME).
2
Q
What does ADME stand for?
A
- Absorption
- Distribution
- Metabolism
- Elimination
3
Q
What is pharmacodynamics?
A
What the drug does to the body
Think: Dynamics and Drug both start with D.
4
Q
What are primary drug selection criteria?
A
- Patient’s history of response
- Family history of response
- Patient’s medical status/age
- Other comorbidities and medical conditions
- Side effect profile
- Patient’s clinical presentation
5
Q
What are secondary drug selection criteria?
A
- Medical comorbities
- Adherence
- Cost
- Stigma/Personal preference
- Generics + dosing frequency
6
Q
Which drugs can cause induced mania?
A
- Cocaine
- Stimulants (Amphetamines)
- Caffeine
- Cortico Steroids
- Anticonvulsants
- Anxiolytics/hypnotics
- Alcohol withdrawal
- PCP
- LSD
7
Q
True or False: All antidepressants have the same efficacy.
A
True
8
Q
Name a drug that can cause psychosis.
A
- Hallucinogens
- Cannabis
- Amphetamine
- Alcohol
- NSAIDs
9
Q
What is Acute Dystonia?
A
Severe muscle rigidity and involuntary muscle contractions
Use IM injections, Benztropine 1-8mg.
10
Q
What is Pseudoparkinsonism?
A
Drug-induced Parkinson’s symptoms: slowed movements, muscle stiffness
Use benzos orally, Benztropine 1-8mg.
11
Q
What are the symptoms of Akathisia?
A
Motor restlessness and inability to sit still
Use propranolol or benzodiazepine.
12
Q
What is Tardive Dyskinesia?
A
Abnormal involuntary hyperkinetic movements due to long-term dopamine blockage
Change dose or use an inhibitor.
13
Q
What are common symptoms of anxiety?
A
- Hyperthyroidism
- Hyperventilation
- Hypoglycemia
14
Q
What is the BBW for all antidepressants?
A
BBW on suicidality is in ALL antidepressants and mood stabilizers.
15
Q
What are the five BBWs for clozapine?
A
- Seizures
- Agranulocytosis
- Premature death in older adults
- Orthostatic hypotension
- Myocarditis
16
Q
What are the side effects of typical antipsychotics?
A
- Sedating
- Higher risk of EPS
- Weight Gain
- Worsen cognition
- Decrease in blood pressure
17
Q
What are the side effects of atypical antipsychotics?
A
- Weight gain
- Anticholinergic effects
- Metabolic syndrome
- Sedation
18
Q
Fill in the blank: The term for involuntary muscle contractions is _______.
A
Dystonia
19
Q
What conditions can mimic depressive symptoms?
A
- Cardiovascular disease
- HIV/Aids
- Vitamin deficiencies
- Infections
- Chronic pain
20
Q
What conditions can mimic manic symptoms?
A
- Encephalitis
- Neurosyphilis
- Hyperthyroidism
21
Q
What is the recommended treatment for acute Dystonia?
A
IM injections of Benztropine 1-8mg
Acute Dystonia usually occurs within 24-96 hours of initiation.
22
Q
What is the typical onset time for Pseudoparkinsonism?
A
Usually within 1-3 months
23
Q
What is the common treatment for Akathisia?
A
Propranolol or benzodiazepine
24
Q
What is the maximum dose for Aripiprazole (Abilify Maintena)?
A
300-400mg/month
25
How often should Fluphenazine (Prolixin) be administered?
Every 2-3 weeks
26
What is the dosing frequency for Paliperidone (Invega Trinza)?
819 mg/12 weeks
27
What are the common side effects of benzodiazepines?
* Memory problems
* Disinhibition
* Dependence/Addiction
* Sedation
28
What should be monitored in patients on atypical antipsychotics?
Weight gain and metabolic syndrome
29
What are the potential concerns with using a medication for PTSD in a patient with alcohol use?
Risk of exacerbating alcohol use or increasing side effects
30
What is the diagnosis based on DSM-5?
Diagnosis based on DSM-5 is determined by specific criteria outlined for each disorder.
31
Which pharmacotherapy would you start for MDD?
All SSRIs except Fluvoxamine (Luvox), all SNRIs, all MAOIs except isocarboxazid.
32
What are the FDA-approved medications for Bipolar disorder?
Lurasidone, Lumateperone, Symbyax, Cariprazine, Olanzapine, Quetiapine, Ziprasidone.
33
Which medications are FDA-approved for OCD?
Fluvoxamine (Luvox CR), Fluoxetine (Prozac), Paroxetine, Sertraline, Clomipramine.
34
Fill in the blank: For Post-Partum Depression, the FDA-approved medications include _______.
-Brexanolone (Zulresso) *BBW Sedation
-Zuranolone (Zurzuvae)
35
What is the FDA-approved treatment for PTSD?
Sertraline and Paroxetine.
36
What are the FDA-approved medications for Generalized Anxiety Disorder?
Paroxetine and Escitalopram.
37
Which medications are FDA-approved for Bipolar Depression?
Quetiapine, Lurasidone, Olanzapine + Fluoxetine, Cariprazine, Lumateperone, Lamotrigine.
38
What are the FDA-approved medications for Bipolar Mania / Mixed Episodes?
Lithium, Valproic Acid, Carbamazepine, Olanzapine, Risperidone, Quetiapine, Ziprasidone, Aripiprazole, Asenapine, Cariprazine.
39
True or False: Lamotrigine is FDA-approved for acute mania.
False.
40
What is the mechanism of action for aripiprazole?
Partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors, antagonist at 5-HT2A receptors.
41
What are the common side effects of SSRIs?
Headache, sexual dysfunction, insomnia.
42
Fill in the blank: All benzodiazepines do the same thing, except for the _______.
Pharmacokinetics.
43
What is the first-line treatment for Generalized Anxiety Disorder?
Duloxetine, Escitalopram, Paroxetine, Sertraline, Venlafaxine XR.
44
Which medication is approved for anxiety and pre-op sedation?
Lorazepam.
45
What are the first-line treatments for Panic Disorders?
SSRIs, Venlafaxine XR.
46
Which medications are considered 2nd line for PTSD?
Amitriptyline, Imipramine, Mirtazapine.
47
What is the recommended treatment for acute agitation associated with dementia?
Brexpiprazole.
48
What is the primary treatment for acute dystonia?
IM injection of benztropine or diphenhydramine.
49
What are the first-line treatments for Social Anxiety Disorder?
Escitalopram, Fluvoxamine CR, Paroxetine, Sertraline, Venlafaxine XR.
50
What is the 2nd line treatment for Generalized Anxiety Disorder?
Benzodiazepines, Buspirone, Imipramine, Pregabalin.
51
What are the 3rd line treatments for Generalized Anxiety Disorder?
Quetiapine.
52
Fill in the blank: For PTSD, the 1st line of treatment is _______.
Paroxetine, Sertraline, Fluoxetine, Venlafaxine XR.
53
What is the significance of 'LOT' when referring to benzodiazepines for the elderly?
The L represents intermediate acting; O and T represent slow acting.
54
What is the main use for Clonazepam?
Approved for seizures.
55
What medications are FDA-approved for postpartum depression?
Brexanolone (Zulresso) and Zuranole (Zurzuvae).
56
What should be considered when prescribing medications for anxiety?
Determine alcohol use.
57
Which medications are used off-label for agitation associated with dementia?
Brexpiprazole, Pimavanserin.
58
What is the mechanism of action for Risperidone?
Dopamine D2 receptor antagonist and serotonin 5-HT2A receptor antagonist.
59
What is the treatment for akathisia?
Propranolol or benzodiazepine.
60
What is Tardive Dyskinesia?
Years of dopamine receptors being blocked leading to increased dopamine production.
61
What is the FDA-approved treatment for Schizophrenia?
Aripiprazole, Risperidone, Ziprasidone.
62
What should be done if a patient with psychosis is severely suicidal?
Consider clozapine.
63
What is the main reason for milky nipple discharge in male patients on Risperidone?
Increased prolactin levels.
64
Which drug is used for treatment-resistant depression in postpartum patients?
Brexanolone (Zulresso).
65
What is the significance of the term 'off-label' in pharmacotherapy?
Medications used for conditions not specifically approved by the FDA.
66
What is the most appropriate recommendation for an 11-year-old diagnosed with OCD?
Fluvoxamine or Sertraline.
67
What is the best recommendation for a patient currently on Sertraline for PTSD but still experiencing symptoms?
Consider increasing the dose or adding another medication.
68
Fill in the blank: Quetiapine is a treatment option for _______.
Bipolar depression.
69
What are the common side effects of atypical antipsychotics?
Weight gain, metabolic syndrome, sedation.
70
What is the diagnosis for the patient described in the case?
Bipolar depression
71
What medication class is associated with the lowest sexual dysfunction?
Wellbutrin
72
True or False: SSRIs are the safest drugs in overdose situations.
True
73
Define an inducer in the context of pharmacology.
You need more of the drug
74
Define an inhibitor in the context of pharmacology.
You need less of the drug
75
List common side effects of benzodiazepines.
* Sedation
* Disinhibition
* Memory impairment
* Addiction
76
What is the FDA approved medication for OCD?
Fluvoxamine (Luvox), Paxil, Zoloft, Clomipramine, Prozac
77
What is the pregnancy category for most psychotropics?
C
78
Which antipsychotic is indicated for acute mania?
Olanzapine
79
What is the B52 treatment?
5mg Haldol, 50mg Benadryl, 2mg Ativan
80
What is the therapeutic dose rule of thumb for dosing?
Quarter is starting, half is target
81
What is the risk associated with MAOIs?
Hypertensive crisis from tyramine
82
What is the first line treatment for long-term bipolar disorder?
Lithium
83
Fill in the blank: Antidepressants take time to work, usually _____ to _____ weeks.
4 to 8
84
What is the maintenance dose range for Lithium?
0.4-1.0 mEq/L
85
What is the mnemonic for valproic acid?
Val Likes Carbs like Lamb
86
What are the side effects of Lithium?
* Tremors
* Excessive thirst
* Excessive urination
* Renal damage
87
What is the risk of using carbamazepine?
Stevens-Johnson Syndrome and agranulocytosis
88
What is Neuroleptic Malignant Syndrome (NMS)?
A life-threatening reaction to antipsychotics characterized by high fever, muscle rigidity, and altered mental status
89
What is the role of lamotrigine in bipolar disorder?
It is used for bipolar depression and is considered safe in pregnancy
90
Which medications are indicated for treating acute mania?
* Aripiprazole
* Olanzapine
* Lithium
91
What is the significance of LAIs (Long-Acting Injectables)?
They improve adherence in treatment
92
What are the common disease states that can cause mania?
* Aids
* Post-concussion
* Hyperthyroidism
* Epilepsy
93
What should be avoided when taking Lithium?
* NSAIDs
* Diuretics
* Cardiovascular issues
94
True or False: Benzodiazepines can control manic symptoms faster.
True
95
What is the maintenance treatment for schizophrenia?
Long-term antipsychotic therapy
96
What are the side effects associated with valproic acid?
* Hepatotoxicity
* Pancreatitis
* Fetal abnormalities
97
Fill in the blank: Extrapyramidal Symptoms (EPS) can occur with _____ medications.
antipsychotic
98
Which drugs are considered safe in pregnancy?
* Clozapine
* Risperidone
99
What is the typical duration of antidepressant therapy to prevent relapse?
1 to 1.5 years
100
What is the impact of kindling theory in bipolar disorder?
Minor life events can trigger mood disturbances after an initial manic episode
101
What is the significance of monitoring lithium levels?
To prevent toxicity and manage side effects
PSYCHOPHARM
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