18. Psychopharmacology Flashcards by Katie Casper

“HAM” side effects

antiHistamine: sedation, weight gain
antiAdrenergic: hypotension
antiMuscarinic: dry mouth, blurred vision, urinary retention, constipation

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What classes of drugs have HAM side effects?

TCAs

Low-potency antipsychotics

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Serotonin syndrome classically occurs when which 2 classes of drugs are combined

MAOIs

SSRIs

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When does a hypertensive crisis occur?

A buildup of stored catecholamines

Caused by the combination of MAOIs with tyramine-rich foods or with sympathomimetics

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First line treatment for extrapyramidal symptoms causes by antipsychotics

Benztropine

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3 categories of EPS

Parkinsonism: masklike face, cogwheel rigidity, bradykinesia, pill-rolling tremor

Akathisia: restlessness, need to move, agitation

Dystonia: sustained, painful contraction of muscles of neck, tongue, eyes, diaphragm

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Hyperprolactinemia is caused by which drugs

Risperidone
Typical (first) generation antipsychotics

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Occurs after YEARS of antipsychotic use

Tardive dyskinesia

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What is tardive dyskinesia

Choreoathetoid muscle movements: usually of mough and tongue

Usually irreversible

More likely to occur due to high-potency, first-generation antipsychotics

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Symptoms of neuroleptic malignant syndrome

MENTAL STATUS CHANGES
fever
tachycardia
hypertension
tremor
elevated CPK
Lead pipe rigidity

*Can be caused by any antipsychotic after a short or long time

20 % mortality rate

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Characteristics of acute dystonia

twisting and abnormal postures

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Bradykinesia

decreased or slow body movement

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Common side effect of anticholinergic meds

constipation

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Anticholinergic meds exacerbate what type of disorders?

Neurocognitive

Dementias

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Important CYP450 Inhibitors

Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline

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Over the counter cough suppressant that increases serotonin

Dextromethorphan

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Location of serotonin pumps inhibited by SSRIs

Presynaptic

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SSRI with longest t1/2

Fluoxetine (Prozac)

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FDA blackbox warning for SSRIs

May increase suicidal thinking and behavior

*applies to children up to age 25, but may be accurate for adults as well

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SSRI with higher risk for GI upset

Sertraline (Zoloft)

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SSRI with short t1/2 leading to withdrawal phenomena if not taken consistently

Paroxetine (Paxil)

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SSRI currently approved only for sue in OCD

Fluvoxamine (Luvox)

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SSRI with dose dependent QTc prolongation

Citalopram (Celexa)

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Enantiomer of citalopram, possibly fewer side effects, also has dose dependent QTc prolongation

Escitalopram (Lexapro)

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What class of drugs that is used for headaches can cause serotonin syndrome when used with SSRIs?

Triptans

Used in fibromyalgia

Duloxetine

SNRI major uses

Depression | Neuropathic pain

SSRIs can increase the level of what drug?

Warfarin

Carries a blackbox warning for rare but serious liver failure

Nefazodone

Sedation Weight gain Used in treatment of major depression

Mirtazapine

MOA of TCAs

inhibit reuptake of NE and serotonin, increasing availability of monoamines in the synapse

Treatment for TCA overdose

Sodium bicarbonate

TCA: useful in chronic pain, migraines, insomnia

Amitriptyline

Useful in enuresis (2nd line)

Imipramine

TCA used in treatment of OCD

Clomipramine

Secondary amines (2) that are metabolites of tertiary amines so they are less anticholinergic, antihistaminic, and antiadrenergic

Nortriptyline | Desipramine

Tetracyclic antidepressant

Amoxapine | *metabolite of antipxychotic loxapine

Majof complications of TCAs

Cardiotoxicity Convulsions Coma

More effective in depression with atypical features: MAOIs or TCAs?

MAOIs

Highly protein bound and lipid soluble

TCAs

Transdermal MAOI patch that does not require patients to follow dietary restrictions

Selegiline

MAOIs reversible of irreversible?

Irreversible

The MAOIs

Phenelzine Tranylcypromine Isocarboxazid

When are MAOIs used?

Refractory depression

First step when suspecting serotonin syndrome Next?

discontinue meds Supportive care, benzodiazepines *The serotonin antagonist cyproheptadine can also be used

Patients should supplement with what vitamin when taking MAOIs?

Why do low potency typical antipsychotics require higher doses than high potency typicals?

Because they have lower affinity for the dopamine receptors

Commonly causes orthostatic HTN Can cause blue-gray skin discoloration can cause photosensitivity

Chlorpromazine

Retinitis pigmentosa association

Thioridazine

Low potency typicals

Chlorpromazine | Thioridazine

High potency typicals

Haloperidol Fluphenazine Trifluoperazine Pimozide

Category with greater risk for EPS and TD

High potency typical antipsychotics

Positive symptoms of Schizophrenia pathway

mesolimbic

negative symptoms of schizophrenia pathway

mesocortical

Extrapyramidal symptoms occur through blockade of what pathway

DA in nigrostriatum

Most common presenting symptom of neuroleptic malignant syndrome

fever

category of antipsychotics more likely to lower seizure threshold

low-potency

There is a ____ % chance of developing tardive dyskinesia for each year treated with a typical antipsychotic

Atypical antipsychotics less associated with weight gain

Ziprasidone | Aripiprazole

Scale used to quantify and monitor tardive dyskinesia

AIMS: Abnormal involuntary movement scale

Hypersalivation

Clozapine

Myocarditis

Clozapine

Agranulocytosis

Clozapine

When must clozapine be stopped?

ANC below 1500/microliter

Only antipsychotic shown to decrease the risk of suicide

Clozapine

QTc prolongation | Must be taken with food

Ziprasidone

Elevated LFTs or ammonia may be present

2nd generation antipsychotics

Metabolic syndrome

2nd generation antipsychotics

Patients on Clozapine must have weekly blood draws for how long?

6 months

Only mood stable shown to decrease suicidality

Lithium

Drug of choice for acute mania

Lithium

Drug of choice as prophylaxis for both manic and depressive episodes in bipolar & schizoaffective disorders

Lithium

What is it important to monitor in patient taking Lithium?

Creatinine | Thyroid function tests

Blood levels coorelate with clinical efficacy

Lithium

Blood levels are used for what drugs

Lithium Valproic acid Carbamazapine Clozapine

Factors that increase Lithium levels

``` NSAIDs Aspirin (may) Thiazides Dehydration Salt deprivation Sweating Impaired renal function ```

Good for rapid cycling bipolar disorder

Carbamazepine

Side effect of leukocytosis

Lithium

Induces its own metabolism (autoinduction)

Carbamazepine

Neural tube defects

Carbamazepine

Efficacious for bipolar depression but not acute mania

Lamotrigine

May be helpful with impulse control disorders Side effect of weight loss Side effect of cognitive slowing Can cause metabolic acidosis, kidney stones

Topiramate

Long acting benzos

Diazepam (Valium) | Clonazepam (Klonopin)

Short acting benzos

Triazolam | Midazolam

Partial agonist at 5HT-1A

Buspirone

NMDA glutamate receptor antagonist

Memantine

Anticholinergics and antihistamines may cause _______

confusion/delirium

Corticosteroids may cause__________

depression

Antibiotic that may cause psychosis

Isoniazid

Most effective treatment for Major Depressive Disorder

ECT

18. Psychopharmacology Flashcards

(90 cards)