Term
| criteria for diagnosing MDD |
|
Definition
| five or more symptoms (at least 1 must be mood/interest) for at least 2 weeks |
|
|
Term
| norepi is released from the… |
|
Definition
|
|
Term
| norepi is responsible for |
|
Definition
| mood, attention, cognition, energy, activity |
|
|
Term
| NE deficiency syndrome consists of.. |
|
Definition
| depressed mood, impaired attention, diff concentrating, deficits in working memory, slowness of info processing, psychomotor retardation, fatigue |
|
|
Term
| Serotonin is released from the… |
|
Definition
|
|
Term
|
Definition
| mood, movements (OCD), anxiety, panic, appetite, sleep, sexual dysfunction |
|
|
Term
|
Definition
| depression asocciated with anxiety, OCD, bulimia/overeating (5HT1A) |
|
|
Term
|
Definition
| GI, sexual, insomnia (5HT 2A/C, 3, 4) |
|
|
Term
|
Definition
| if eat tyramine (cheese, red wine) --> dangerous elevations of BP, intracerebral hemorrhage, death. |
|
|
Term
| anticholinergic side effects of TCAs |
|
Definition
| dry mouth, sedation, memory disturbances, constipation, urinary retention, blurry vision) |
|
|
Term
| antihistaminic side effects of TCAs |
|
Definition
|
|
Term
| alpha 1 blockade side effects of TCAs |
|
Definition
| orthostatic hypotension, dizziness, falls |
|
|
Term
| block Na channels side effects of TCAs |
|
Definition
| cardiac arrhythmias, arrest/seizure |
|
|
Term
| why are SSRIs preferred over TCAs? |
|
Definition
| better side effect profile (because only works on 5ht and not cholinergic/histaminic receptors) and difficult to OD on) |
|
|
Term
|
Definition
| anxiety, restlessness, insomina, sexual dysfunction, GI side effects. These diminish over time |
|
|
Term
| class of drugs that is essentially a "safer TCA" because they have both SRI and NRI actions |
|
Definition
| SNRI (5ht/NE reuptake inhibitors) |
|
|
Term
|
Definition
| effexor --> anxiety. Sibutramine --> obesity drug. |
|
|
Term
| mechanism by which alpha 2 antagonists work |
|
Definition
| inhibits NE's interaction with its presynaptic autoreceptor --> no feedback inhibtion --> increase in both NE and 5ht |
|
|
Term
| why are alpha 2 antagonists "more selective" than SSRIs? |
|
Definition
| block 5ht2,3,4 (side effect causing) and blockade only goes to 5ht1A |
|
|
Term
| side effects of alpha 2 antag? |
|
Definition
| antihistaminic (wt gain, sedation) |
|
|
Term
| SARIs mechanism of action |
|
Definition
| serzone/trazadone --> 5ht2A antagonism and 5HT1A reuptake inhibition |
|
|
Term
|
Definition
| priapism (sustained erection), wt gain, sedation |
|
|
Term
|
Definition
| NE/DA reuptake inhibitors |
|
|
Term
| NDRIs (buproprion) used for.. |
|
Definition
| in addition to an SSRI to relieve sexual side effects and anhedonia. Rx of anorexia, cigarette cessation (decreases nicotine cravings) |
|
|
Term
| 5ht 1A partial agonist mechanism of action? |
|
Definition
| if not enough 5ht for SSRIs to even be effective can help the neuron replete its 5ht. |
|
|
Term
| 5ht1A (buspirone) used for? |
|
Definition
|
|
Term
| brand name, class and use of..buspirone |
|
Definition
| buspar. 5HT1A partial agonist. GAD |
|
|
Term
| brand name, class and use of..buproprion |
|
Definition
| wellbutrin, zyban. NDRI. In conjuction with SSRI, anorexia, cigarette cessation |
|
|
Term
| brand name, class and use of nefazodone/trazadone |
|
Definition
| serzone/desyrel. SARI. Depression (insomnia) |
|
|
Term
| brand name, class and use of mirtazapine |
|
Definition
| remeron. Alpha 2 antag. Depression. Anorexia? |
|
|
Term
| brand name, class and use of venlafaxine/sibutramine |
|
Definition
| effexor, sibutramine. SNRI. Anxiety, obesity. |
|
|
Term
| brand name and class of fluoxetine |
|
Definition
|
|
Term
| brand name, class and use of sertraline |
|
Definition
| zoloft. SSRI. PTSD (among other things) |
|
|
Term
| brand name, class and use of paroxetine |
|
Definition
| paxil. SSRI. PTSD (among other things) |
|
|
Term
| brand name and class of fluvoxamine |
|
Definition
| luvox, feverin, dumirox, floxyfral. SSRI |
|
|
Term
| brand name and class of citalopram |
|
Definition
| celexa, cipramil, serostat, cipram. SSRI |
|
|
Term
| brand name, class and use of amitriptiline |
|
Definition
| elavil. TCA. Chronic pain |
|
|
Term
| brand name, class and use of nortryptiline |
|
Definition
| Pamelor, Noratren. TCA. Depression |
|
|
Term
| brand name, class and use of clomipramine |
|
Definition
|
|
Term
| DSM criteria for diagnosing schizophrenia |
|
Definition
| 2 of the following: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms. Social/occupational dysfunction. Duration of at least 6 months. |
|
|
Term
| difference between schiophrenia and schizopreniform |
|
Definition
| schizophrenia but duration is between 1-6 months. |
|
|
Term
| which subtype of schizo has the best outcome? The worst? |
|
Definition
| paranoid (prominent delusions, hallucinations) has the best. Vs. diroganized (speech/behavior) is the worst type. |
|
|
Term
| DA in mesolimbic cortex responsible for.. |
|
Definition
| reward/pleasure. In excess, causes psychosis |
|
|
Term
| DA in mesocortical pathways responsible for.. |
|
Definition
| emotions. Decrease in DA here causes blunting of emotions (flat affecet, apathy, avolition..ie negative symptoms of schizo) |
|
|
Term
| what is neuroleptic induced deficit syndrome? |
|
Definition
| negative symptoms of schizo 2/2 decreased DA in the mesocortical pathways |
|
|
Term
| DA in nigrostriatal pathways responisble for |
|
Definition
| movement. Too much DA --> too much movement. When decrease DA get EPS side effects (rigidity, cogwheeling, bradykinesia, masked facies) due to Ach imbalance. |
|
|
Term
| DA in tuberoinfundibular tracts responsible for… |
|
Definition
| supresses prolactin. Thus, decreasing DA will increase prolactin --> prolactinemia, gynecomastia |
|
|
Term
| side effects of high potency typicals |
|
Definition
| EPS problems (bc more DA blockade) |
|
|
Term
|
Definition
| cogentin (benztropine) or diphenhydramine (benadryl). If still present --> add benzo (lorezapam-ativan) as a last resort. |
|
|
Term
|
Definition
| propanolol, then benztropine (cogentin). Then benzo |
|
|
Term
|
Definition
| neuroleptic malignant syndrome- life threatening! Muslce rigidity, fevers, autonomic instability, change in mental status, elevated CPK. |
|
|
Term
|
Definition
| dantrolene (muscle relaxant), bromocriptine (DA agonist) |
|
|
Term
| Low potency typicals side effects? |
|
Definition
| less EPS, but sedation 2/2 antiAch activity, orthostatis 2/2 alpha 1 adrenergic blockage) |
|
|
Term
| brand name and class of fluphenazine |
|
Definition
| prolixin, high potency typical |
|
|
Term
| brand name and class of haloperidol |
|
Definition
| haldol, high potency typical. Use in delirium and tourettes |
|
|
Term
| brand name and class of pimozide |
|
Definition
| orap, high potency typical |
|
|
Term
| brand name and class of trifluoperazine |
|
Definition
| stelazine, high potency typical |
|
|
Term
| brand name and class of thiothixene |
|
Definition
| navane, high potency typical |
|
|
Term
| brand name and class of perphanzine |
|
Definition
| trilafon, mid potency typical |
|
|
Term
| brand name and class of chlorpromazine |
|
Definition
| thorazine, low potency typical |
|
|
Term
| brand name and class of clozapine |
|
Definition
|
|
Term
| brand name and class of olanzapine |
|
Definition
|
|
Term
| brand name and class of quetiapine |
|
Definition
|
|
Term
| brand name and class of resperidone |
|
Definition
|
|
Term
| brand name and class of ziprasidone |
|
Definition
|
|
Term
| side effects of atypical antipsychotics |
|
Definition
| alpha 1 adrenergic: postural hypotension, reflex tachy, dizziness. Histamine: sedation, wt gain. 5HT2a: sexual dysfunction |
|
|
Term
| which atypical is most like haldol in SE profile? |
|
Definition
|
|
Term
| only 2 drugs known to decrease suicide events |
|
Definition
|
|
Term
|
Definition
| agranulocytosis, tachycardia, hypotension. Decreases seizure threshold. wt neutral (?) |
|
|
Term
| SE of ziprasidone (geodon) |
|
Definition
| prologation of qtc, sedation. But is wt neutral! Is lipophilic-so tell patients to take with meals. |
|
|
Term
| DSM criteria for manic episode |
|
Definition
| lasts for at least one week or requires hospitalization. Elevated, expansive mood plus 3 other symptoms. OR irritable mood plus 4 other symptoms. Other symptoms: inflated self esteem/grandiosity, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal directed activity or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences |
|
|
Term
| how is rapid cycling diff from manic episode? |
|
Definition
| at least 4 episodes of mood d/o in previous 12 months (either depressive or manic types) |
|
|
Term
| diff in treating a rapid cycler vs. bipolar |
|
Definition
| rapid cycler: 1st choice is valproic acid (depakote) and carbamezepine (tegretol) vs. Lithium for bipolar |
|
|
Term
| should you use an anti depressant with mood disorders? |
|
Definition
| eventually, but 1st optimize mood stabilizer because antidepressants can switch people into mania and make someone a rapid cycler. |
|
|
Term
| When is ECT the treatment of choice? |
|
Definition
| in severe acute mania/depression of pregnant patients (bc all mood stabilizers are teratogenic) |
|
|
Term
| Lithium treatment indications |
|
Definition
| acute manic/hypomanic episodes. Maintenance rx to diminish intensity and frequency of subsequent manic episodes. To prevent bipolar depression. |
|
|
Term
| off label uses for lithium |
|
Definition
| use alone to tx unipolar depression in schizoaffective disorders. Augment anti depressives. Vascular headaches (episodic/chronic cluster headaches), neutropenia (reduce incidence of infections) |
|
|
Term
|
Definition
| 1. renally excreted. Use with caution w/ renal impairment. 2. reabsorption competes with Na so diuretics can cause toxicity |
|
|
Term
|
Definition
| inositol depletion theory: inositol causes chronic cell stimulation --> manic symtoms. Also inhibits adenyl cyclase pathway --> decreases cAMP --> decreases sensitivity (this also leads to SE - antithyroid effects in ability to concentrate urine (nephrogenic diabetes insipidus) |
|
|
Term
| tests to do before initiating Li |
|
Definition
| pregnancy test, serum Ca and phos if < 12yo, EKG, electrolytes, BUN/Cr, UA, BMI, TFTs, WBC |
|
|
Term
|
Definition
| polyuria, polydipsia, tremor, wt gain |
|
|
Term
| Tx for late/severe Li toxicity |
|
Definition
| induce emesis/gastric lavage, hemodialysis, IV acetazolamide or mannitol. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| first line for mania when mixed states or other comorbidities (b/c of superior side effect profile and better efficacy) |
|
|
Term
| between lithium and depakote, which has faster onset of action? |
|
Definition
| depakote: effect in a few days after achieving therapeutic levels. And unlike Li, don't usually need to add antipsychotics/benzos |
|
|
Term
| labs to check in pts on depakote |
|
Definition
| LFTs (rare hepatic toxicity), CBC (rarely thrombocytopenia/plt dysfunction), VPA levels q6 months. If late onset N/V/fatigue --> check ammonia levels |
|
|
Term
|
Definition
| n/v/d, anorexia, heartburn, sedation, tremor, ataxia. Alopecia and wt gain |
|
|
Term
| carbamazepine's trade name is? |
|
Definition
|
|
Term
|
Definition
| first choice for partial epilepsy and trigeminal neuralgia (and neuropathic pain) and primary generalized seizures. Used for refractory BAD such as mixed-episode and rapid cycling |
|
|
Term
|
Definition
| opens Na channels --> become inactivated --> inhibits repetitive firing. Also blocks presynaptic Na channels , and voltage gated Ca cahnnels --> decreased NT release. |
|
|
Term
|
Definition
| common: GI and neurologic. Serious: hepatitis, blood dyscrasias, exfoliative dermatitis |
|
|
Term
| labs to monitor in pts on tegretol |
|
Definition
| CBCs (for blood dyscrasias), LFTs (for hepatitis) |
|
|
Term
| fetal abnormalities caused by lithium |
|
Definition
| CV abnl = ebsteins anomaly |
|
|
Term
| which organ systems does lithium affect? |
|
Definition
| heart, brain, kidney, thyroid/parathyroid (hypoT and hyperPTH in peds), derm, hem |
|
|
Term
| drugs that increase lithium levels |
|
Definition
| diuretics, NSAIDs, Antibiotics (metro/tetracycline), ACEi |
|
|
Term
| drugs that decrease lithium levels |
|
Definition
| acetazolamide, xanthines (theophylline, caffeine, aminophylline), osmotic diuretics (mannitol) |
|
|
Term
| fetal abnormalities caused by depakote |
|
Definition
| neural tube defects (so add folate if you MUST use this drug during pregnancy) |
|
|
Term
| most severe side effect of depakote |
|
Definition
| fatal hepatotoxicity, sedation, thromobocytopenia/plt dysfunction, hemorrhagic pancreatitis, agranulocytosis |
|
|
Term
| fetal abnormality caused by tegretol |
|
Definition
|
|
Term
| interactions b/w depakote and tegretol? |
|
Definition
|
|
Term
| life threatening SE of tegretol? |
|
Definition
| hepatitis, severe blood dyscrasias, exfoliative dermatitis |
|
|
Term
| Dementia pts have deficits in |
|
Definition
| 1. memory and 2. aphasia (language), apraxia (motor activity), agnosia (can't recognize objects) and problems in executive functioning (planning, organizing, sequencing, abstracting). --all deficits must cause significant impairment in social or occupational fxning and sig decline from previous level of functioning |
|
|
Term
| dementia is usually acute/chronic and sudden onset/progressive |
|
Definition
|
|
Term
| t/f: you see clouding of consciousness in dementia |
|
Definition
| F. pt is alert and NO clouding of consciousness |
|
|
Term
| w/u for new onset dementia |
|
Definition
| RPR (syphillis), TSH, folate, B12, BMP, CBC, UA, head CT |
|
|
Term
|
Definition
| behavioral response to a widespread disrubance in cerebral metabolism |
|
|
Term
| NT implicated in delirium |
|
Definition
| Ach (reason why anticholinergics are most often the culprits for delirium) |
|
|
Term
| primary disturbance in delirium is.. |
|
Definition
| level of consciousness. Have associated impariments in orientation, memory, judgement and attention |
|
|
Term
| delirium is generally acute/chronic and suddent onset/progressive? |
|
Definition
| acute onset and brief in duration. Often fluctuating course. |
|
|
Term
| describe arousal in delirium |
|
Definition
| can be both increased/decreased. If increased --> sympathetic autonomic signs. If decreased --> daytime somnolence |
|
|
Term
| describe language and cognition in delirium |
|
Definition
| nonsensical rambling and incoherent speech |
|
|
Term
| describe perception in delirium |
|
Definition
| diff discriminating sensory stimuli. A/V illusions. |
|
|
Term
| describe orientation and mood in delirium |
|
Definition
|
|
Term
| describe neurological functioning in delirium |
|
Definition
| dysphagia, tremor, asterixis, poor coordination, gait apraxia, frontal release signs, chroreiform mvmts, seizures, babinski, dysarthria. No focal findings |
|
|
Term
|
Definition
| tx underlying cause. For disturbed sleep --> short acting benzos. For psychosis/agitation --> haldol |
|
|
Term
| symptoms of depressive dementia (vs. true dementia) |
|
Definition
| rapid onset, more insight into cognitive defects, some vegetative signs of depression, + response to psychostimulant trial, pervasive but inconsistent cognitive defects, pt says "I don’t know" to questions, past hx of depression |
|
|
