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Flashcards in Somatic Therapies II Deck (61):
1

What are the four major general classes of anxiolytics?

-Antidepressants
-benzos
-Buspirone
-Antihistamine

2

What are the antidepressants that are used to treat anxiety disorders? (3)

SSRIs
SNRIs
Mirtazapine

3

For treating OCD using SSRIs or clomipramine, what are the changes compared to treating depression?

-SSRIs need higher doses
-Need longer response time

4

What is the drug of choice for an acute panic attack? What is the major issue with this?

Alprazolam (xanax)

Fast onset, but short acting, and highly addictive because of that.

5

What is the only benzo that is absorbed IM?

Lorazepam

6

What are the side effects of benzos?

-Drowsiness
-Reduced motor coordination
-potential for tolerance

7

What are the withdrawal s/sx of benzos?

Like alcohol withdrawal

8

True or false: benzos have major adverse effects in pregnancy

False--generally safe PRN

9

True or false: benzos have adverse effects with breastfeeding

True

10

What is the MOA of buspirone? Use?

-5HT1a agonism
-Anxiolytic w/o sedation
-No risk of tolerance

11

True or false: buspirone is effective for treating OCD, but not panic attacks or phobias

False--not effective for any of them. Only GAD.

12

What is buspirone used for now?

Augment antidepressants for anxiety disorders

13

What is the general treatment regimen for anxiety?

-SSRIs
-SNRIs if SSRIs fail
-Mirtazapine

14

What is the role of benzos in the treatment of anxiety disorders?

Short term, acute episodes PRN

15

Is buspirone used PRN or long term?

Long term

16

What are the four major typical antipsychotics? Which is a weak one?

-Haloperidol
-Chlorpromazine**
-Thioridazine**
-Fluphenazine

17

What are the atypical antipsychotics? (6)

-Olanzapine
-Clozapine
-Quetiapine
-Risperidone
-Aripiprazole
-Ziprasidone

18

What is the general MOA of antipsychotics?

Postsynaptic D2 receptor blockade in the mesolimbic and mesocortical pathway

19

What are the uses of FGAs?

-Schizophrenia
-Psychosis
-Agitation
-Tourette's syndrome

20

What is the only antipsychotic that is not approved for use with schizophrenia? What is it used for?

Clozapine
Refractory schizophrenia

21

What is the use for risperidone that is unlike the other FGAs?

ASD

22

How fast are antipsychotics in treating agitation?

30-60 minutes

23

What organ metabolizes antipsychotics?

Liver

24

What is the duration of an adequate trial of antipsychotics?

4-6 weeks

25

What percent of pts taken off of antipsychotics for schizophrenia will relapse?

75%

26

True or false: prevention of relapse with schizophrenia is more important than side effects

True

27

What is the psychotic drug that causes agranulocytosis?

Clozapine

28

What is the psychotic drug that causes hyperprolactinemia? How?

Risperidone
Dopamine antagonism

29

What is neuroleptic malignant syndrome? S/sx?

Reaction to antipsychotics

-Fever
-Elevated CPK
-Vital sign instability
-Encephalopathy
-Rigidity

30

What is the treatment for NMS? (3)

-IVFs
-Dantrolene
-Bromocriptine or other dopamine agonist

31

Why do SGAs have a lower risk of movement disorders?

Blockade of 5HT2a receptors

32

What is acute dystonic reaction? Treatment?

-Reaction to FGAs or SGAs that causes painful muscle contractions

-Treat with antihistamine or benztropine

33

What are the s/sx of pseudoparkinsonism?

-Rigidity
-Coarse tremor
-Hypokinesia/ bradykinesia

34

What is the treatment for pseudoparkinsonism?

Anticholinergics

35

When does akathisia usually occur with antipsychotic use?

within the 1st few weeks of treatment

36

What are the subjective symptoms of akathisia

anxiety and tension

37

How do you differentiate between akathisia and anxiety?

Akathisia will point to extremities as source of symptoms, as opposed to chest

38

What is the treatment for tardive dyskinesia?

-Beta blockers such as propranolol
-Switch drugs

39

What is the early sign of tardive dyskinesia?

See tongue fasciculations

40

Which gender is at greater risk of tardive dyskinesia?

Women

41

What happens initially with decreasing dose of antipsychotic with TD?

Gets worse, but you should not increase

42

What is the most sedating antipsychotic?

Quetiapine

43

What is the antipsychotic with the most EPS?

Risperidone

44

What are the two antipsychotics that have weight gain as a major side effect?

Clozapine
Olanzapine

45

What are the two antipsychotics that do NOT have weight gain as a major side effect?

Aripiprazole
Ziprasidone

46

What atypical has the least EPS?

Clozapine

47

What are the disadvantages of SGAs?

-Metabolic syndrome and DM

48

Which generally is more effective for the positive symptoms of schizophrenia: FGAs or SGAs?

FGAs

49

What is the major advantage of SGAs?

Lower movement disorders

50

What is the major side effect of risperidone?

CVAs

51

What is paliperidone?

Risperidone active metabolite

52

What is the role of clozapine in the treatment of schizophrenia?

Second or third line treatment

53

Drooling is caused by what SGA?

Clozapine

54

What is the major side effect of clozapine?

Agranulocytosis

55

What must be followed with clozapine?

Weekly absolute neutrophil count for 6 months, then every other week for 6 months

56

What is the major side effect with ziprasidone?

-QT prolongation

57

What is asenapine?

SGA

58

True or false: SGAs are first line for psychosis

True

59

What should be done if there are significant side effects with SGAs or FGAs?

switch or lower dose

60

What are depot formulations?

IM injections q 2-4 weeks

61

Which type of antipsychotic has a risk of metabolic symptoms?

SGAs