Mental Health Pharm Exam Quick Guide

What is the most important to remember about SSRI and SNRI medications?

• Makes it harder to sleep from insomnia.

• Really annoying since it causes weight gain and lowers libido, making compliance difficult.

• No sudden withdrawal! For almost any psych med.

• Risk of serotonin syndrome if taking other meds.

What is the most important to remember about bupropion?

• This medication also affects dopamine, which is why it’s also used for ADHD! But also has similar ADHD side effects, like weight loss.

  • Mirtazapine is similar, except it focuses on serotonin for insomnia.

• Do not give if someone has seizures! Will make it worse.

What is the most important to remember about amitriptyline?

• This medication activates basically every receptor, so it’s going to interact with everything and have every side effect.

  • Remember: cholinergic, adrenergic, histamine receptors!

• Causes cardiotoxicity, so serum monitoring is necessary.

What is the most important to remember about phenelzine?

• MAOs are liver enzymes, so these are inactivated with this medication. Tyramine cannot be broken down, so aged and cultured foods may lead to hypertensive crisis (within 2 weeks of last dose).

  • Hypertensive crisis: Mainstay signs are bad headache, altered mental status, and increased vital signs. Seizure and coma if severe.

• Lots of drug interactions, so monitor for serotonin syndrome closely with this one. Remember all of the interactions from pharm! They were on like every card.

• Anticholinergic and adrenergic symptoms.

What is the most important to remember about lithium?

• Compliance is difficult because it causes you to pee a lot (polyuria) and also makes you thirsty (polydipsia) because this acts like a salt in the body. This is why it’s important to keep sodium and water content consistent!

• It’s easier to think about this drug in terms of labs it affects. Has a narrow therapeutic index (0.6-1.2 mEq/L serum levels), messes with thyroid (TSH), messes with kidneys (Creatinine/ Urea/ Urinalysis), causes cardiac symptoms (ECG), teratogenic (hCG). Just memorize labs!

  • Toxicity at lower levels causes ataxia, but goes on to delirium and seizures in later stages. Hold next dosage and push fluids!!

What is the most important to remember about antiseizure mood stabilizers?

• These medications mediate sodium and calcium to regulate seizures.

• For all of them: They are teratogenic. Valproic acid and carbamazepine are like sisters and have similar side effects, like sedation and weight gain (and lowkey gabapentin too).

• Valproic acid can cause hepatotoxicity! Serum levels are 45-125.

• Carbamazepine affects blood, causing patients to become anemic, with the added risk of SJS. Serum levels are 6-12.

• Lamotrigine causes a life threatening rash in rare cases!

• Neurontin, or gabapentin, can increase suicidality and contribute to DRESS syndrome, where your organs shut down. Fun! Who doesn’t want a little neurontin necrosis.

What is the most important to remember about buspirone?

• This is the antianxiety medication that does not provide sedation, so it’s a little safer than benzodiazepines. But it’s not tolerated as well if you have used benzos in the past, so keep that in mind!

• Also takes about a week to kick in and help with symptoms.

What is the most important to remember about benzodiazepines?

• These are CNS depressants (GABA) that reduce insomnia and anxiety.

• They are higher risk long-term due to CNS depression; sedation; and dependence, tolerance, and abuse (Schedule IV drug).

What is the most important to remember about Z drugs?

• Zolpidem and zaleplon cause drowsiness within 1 hour, but can cause excess sedation, parasomnias, and hallucinations, which is why these are not given long-term from the level of sedation they cause. Do not give as much to women!

  • Basically these are the same things that trazodone and antihistamines do, but they are also used for anxiety. Benadryl causes parkinsonism sometimes though.

• Eszopiclone is safe for long-term, which is easy to remember because it’s the only insomnia drug that starts with E.

• Dopamine blockers cause extrapyramidal symptoms.

• Histamine blockers cause sedation and weight gain.

• Alpha 1 blockers cause orthostatic hypotension.

• Muscarinic blockers

• Serotonin blockers

What side effects are similar across all antipsychotics?

• Neuroleptic malignancy syndrome (rare).

• Weight gain happens in many cases.

• Tardive dyskinesia and extrapyramidal symptoms are common.

• Danger in patients with dementia.

• All need cholesterol labs, but some require labs for blood cell counts and prolactin.

• All of these medications cause orthostatic hypotension unless otherwise specified.

• Many drug and alcohol interactions. Basically just don’t take these with any other medication.

What is the most important to remember about clozapine?

• Clozapine = HAM, these are the receptors it activates! (Histamine, alpha 1, muscarinic).

• Causes weight gain that’s even higher than normal antipsychotics (15-30lbs in one year).

• This one causes neutropenia, or agranulocytosis, so any medications or conditions that cause lower blood cell count may require extra monitoring.

• Be aware of myocarditis! Cardiac and clozapine both start with a C, so remember that this causes cardiac symptoms!

What is the most important to remember about ziprasidone?

• Nothing too special! Besides nausea, weight gain, OHTN, and TD, so the regular side effects.

  • Give with food to make sure it’s absorbed properly.

What is the most important to remember about olanzapine?

• Olanzapine = H&M for histamine and muscarinic receptors.

• Causes weight gain that’s even higher than normal antipsychotics, including increased appetite.

What is the most important to remember about risperidone?

• Risperidone - The “S” stands for serotonin, the D stands for dopamine, and the one represents alpha 1.

What is the most important to remember about quetiapine?

• Affects H1 and A1 receptors.

• Risk of SI in children.

What is the most important to remember about aripiprazole?

• This medication increases the risk of compulsive gambling!

What is the most important to remember about chlorpromazine?

• The only receptor that this medication activates is alpha 1! Chlorpromazine has one A in it, so this should be easy to remember.

• This is a first generation antipsychotic, so be careful about unique side effects like anticholinergic effects, cardiac arrhythmia, skin and ocular changes (sunscreen), and seizures.

• Always take first gen antipsychotics with food!

• Avoid many substances with this medication, even more than other ones! Weird ones like caffeine, grapefruit, st johns wort, nicotine, etc.

What is the most important to remember about haloperidol?

• This is a first generation antipsychotic, so be careful about unique side effects like anticholinergic effects and cardiac arrhythmia.

• Always take first gen antipsychotics with food!

• Avoid many substances with this medication, even more than other ones! Weird ones like caffeine, grapefruit, st. johns wort, nicotine, etc.

What is the most important to remember about lurasidone?