Psychiatry Potpourri
What is a common side effects of tricyclic antidepressants? Must list 1 common side effect for credit.
Blurry vision, constipation, dry mouth, sedation, urinary retention, weight gain
What drug schedule are benzodiazepines?
C-IV
What is the boxed warning for all antipsychotics?
These are not indicated to manage agitation in elderly patients with dementia-related psychosis. There is an increased risk of mortality when used for this purpose.
What antidepressant is contraindicated in patients with a seizure disorder?
bupropion
Bupropion is also contraindicated in patients with a history of anorexia or bulimia, patients who are abruptly withdrawing from alcohol or benzodiazepines, and patients who are taking MAO inhibitors, linezolid, IV methylene blue, or other forms of bupropion.
What is a common side effect of SSRIs? Must list 1 common side effect for credit.
Diaphoresis, dizziness, dry mouth, headache, insomnia, nausea, sexual side effects, somnolence, tremor, and weakness
What drug classes are first-line for treatment of anxiety? Must list 1 first-line drug class for credit.
SSRIs & SNRIs
What is a common side effect of benzodiazepines? Must list 1 common side effect for credit.
Ataxia, dizziness, lightheadedness, and somnolence
Pharmacies must be certified and the patient must be enrolled in a REMS program to receive what antipsychotic?
clozapine
What is the natural product that may be beneficial in treating depression but is a strong CYP3A4 inducer with many significant drug interactions?
St. John's wort
Other natural products that may be helpful for treating depression include SAMe and 5-HTP.
What medication for depression is also FDA approved for neuropathy, fibromyalgia, and chronic musculoskeletal pain?
duloxetine (Cymbalta)
What is the boxed warning for all antidepressants?
Increased risk of suicidal thoughts or actions in children, teens, and young adults.
A MedGuide is REQUIRED when dispensing any antidepressant.
What benzodiazepines are safe for use in patients with liver impairment? Must list 1 benzodiazepine that is safe for use in patients with liver impairment for credit.
lorazepam, oxazepam, and temazepam (LOT)
What is a common side effect of olanzapine? Must list 1 common side effect for credit.
Metabolic syndrome and somnolence
What SSRI is the most sedating?
paroxetine
True or False: Paroxetine is a first-line agent for depression in pregnancy.
False
SSRIs are often used initially for treatment of depression during pregnancy but paroxetine should be avoided, if possible, due to the potential cardiac effects.
What is a second-line treatment for anxiety that takes 2-4 weeks for effect and does NOT have potential for abuse, tolerance, or physical dependence?
buspirone (Buspar)
Based on the boxed warning, benzodiazepines should NOT be used with what other class of medication?
Opioids
Use with opioids can result in sedation, respiratory depression, coma, and death.
What is the first-generation antipsychotic that is high-potency and is in the butyrophenone class?
What medications may cause or worsen depression? Must list 1 medication that may cause or worsen depression.
anabolic steroids, atomoxetine, benzodiazepines, beta-blockers, clonidine, efavirenz, hormonal contraceptives, interferons, isotretinoin, rilpivirine, systemic steroids, and varenicline
Second-generation antipsychotics have a lower incidence of what side effects compared to first-generation antipsychotics?
Extrapyramidal symptoms (EPS)
Extrapyramidal symptoms include Parkinsonism, dystonic reactions, akathisia, and tardive dyskinesia.
What medications may cause anxiety? Must list 1 medication that can cause anxiety for credit.
albuterol, antipsychotics, bupropion, caffeine, decongestants, illicit drugs (cocaine, LSD, and methamphetamine), levothyroxine, steroids, stimulants, and theophylline
With albuterol, anxiety can occur with frequent use or incorrect use.
With levothyroxine, anxiety can occur when the dose is too high.
Withdrawal of benzodiazepines can cause what serious effect?
Seizures
A patient's baseline ANC must be above what before starting clozapine?
1500/mm^3
When switching from most SSRIs to MOA inhibitors, what is the recommended length of the washout period?
2 weeks
Exception when switching from fluoxetine to an MAO inhibitor. With this switch, a 5 week washout period is required.
What antidepressant is commonly used in skilled nursing facilities to help with sleep and to increase appetite?
mirtazapine (Remeron)
A hypertensive crisis or serotonin syndrome can occur when MAO inhibitors are taken with foods rich in what?
Tyramine
MAOIs cannot be used with drugs or food that increase concentrations of dopamine, epinephrine, norepinephrine, or serotonin.
Tyramine-rich foods increase norephinephrine.
True or False: Benzodiazepines are first-line treatment for anxiety to be used as monotherapy.
False
Benzodiazepines provide quick relief of symptoms but they do NOT treat the underlying causes of anxiety.
1000/mm^3
What is the most activating SSRI?
fluoxetine
What is the recommended therapeutic range for lithium? Must to provide the correct range for credit.
0.6-1.2 mEq/L
Acute mania may require levels up to 1.5 mEq/L initially.
What sedating antihistamine is FDA approved for anxiety?
hydroxyzine
Hydroxyzine is for short-term use as it does NOT treat the underlying condition. It is used as an alternative to benzodiazepines.
What benzodiazepine is contraindicated with strong CYP3A4 inhibitors such as ketoconazole and itraconazole?
alprazolam
What is a possible irreversible side effect of antipsychotics?
Tardive dyskinesia
What is the brand name of desvenlafaxine?
Pristiq
What is a monitoring parameter for lithium? Must list 1 monitoring parameter for credit.
Electrolytes (calcium, potassium, and sodium), renal function, serum lithium levels, and thyroid function
What natural products increase the risk of bleeding when taken with SSRIs? Must list 1 natural product that will increase bleeding risk when taken with a SSRI.
fish oi, garlic, ginger, ginkgo, ginseng, and glucosamine
What is the antidote for a benzodiazepine overdose?
flumazenil
What second-generation antipsychotic is the most likely to increase prolactin levels?
paliperidone or risperidone
What is a severe side effect of trazodone that can occur in male patients only?
Priapism
What medications have immediate effects for anxiety but are NOT FDA approved for anxiety? Must list 1 medication with immediate effects for anxiety that is NOT FDA approved for anxiety for credit.
gabapentin and pregabalin
What SSRI is preferred in patients with cardiac risk?
sertraline
What benzodiazepine is available as a rectal gel for treatment of seizures?
diazepam (Diastat)
What first-generation antipsychotic has a boxed warning about QT prolongation?
thioridazine
What is the brand name of the combination medication olanzapine + fluoxetine?
Symbyax
What medications are MAO inhibitors? Must list 1 MAO inhibitor for credit.
isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate)
What is the recommended maximum daily dose of citalopram in patients older than 60 years old?
20 mg
Due to the risk of QT prolongation, the recommended maximum dose of citalopram in patients older than 60 is 20 mg. Patients who are CYP 2C19 poor metabolizers or who are taking CYP 2C19 inhibitors should also not exceed 20 mg/day.
What is the generic name of Versed?
midazolam
What was the first FDA approved medication for the treatment of tardive dyskinesia?
valbenazine (Ingrezza)
What SSRIs are CYP 2D6 inhibitors? Must list 1 SSRI that inhibits CYP 2D6 for credit.
fluoxetine, fluvoxamine, and paroxetine
What antibiotic is contraindicated in patients taking MAO inhibitors?
linezolid (Zyvox)