all psych drugs Flashcards
(189 cards)
1
Q
name 4 stimulants
A
methylphenidate (ritalin)
dexmethylphenidate (focalin)
amphetamine/ dextroamphetamine (adderall)
lisdexamphetamine (vyvanse)
2
Q
stimulants MOA
A
block NE and DA reuptake
transports, increases NE and DA in synaptic cleft
3
Q
what are stimulants used to treat?
A
ADHD
4
Q
common stimulant side effects
A
decreased appetite, insomnia
5
Q
serious/ uncommon stimulant side effects
A
tics (new or worsening), cardiac effects
6
Q
what is a reasonable test to consider before prescribing stimulants
A
EKG, especially if patient has personally history or direct relative with cardiac history
7
Q
name 2 alpha 2 agonists
A
clonidine, guanfacine
8
Q
what are clonidine & guanfacine used to treat?
A
ADHD, tic disorders
9
Q
common side effects of alpha 2 agonists?
A
fatigue, hypotension
10
Q
trazodone indications
A
MDD (2nd or 3rd line)
11
Q
trazodone MOA
A
SE reuptake inhibitor, alpha 1 agonist, H1 agonist
12
Q
trazodone common side effects
A
sedation, dizziness
13
Q
trazodone serious/ uncommon complications
A
orthostatic hypotension, priapism
14
Q
name 2 first generation antipsychotics
A
haloperidol, chlorpromazine
15
Q
main indications for use of first generation antipsychotics
A
agitation, delirium, schizophrenia
16
Q
MOA of first generation antipsychotics
A
D2 receptor antagonism
17
Q
haloperidol indications
A
agitation, delirium, schizophrenia, ADHD, tic disorders, acute psychosis
18
Q
haloperidol uncommon/ serious side effects
A
QTc prolongation, extrapyramidal symptoms, neuroleptic malignant syndrome, hyperprolactenima
19
Q
haloperidol potency
A
high
20
Q
chlorpromazine potency
A
low
21
Q
chlorpromazine MOA
A
D2 receptor antagonism, anticholinergic, antihistaminergic
22
Q
chlorpromazine common side effects
A
sedation, dizziness
23
Q
chlorpromazine uncommon/ serious side effects
A
anticholinergic effects, metabolic effects, QTC prolongation
24
Q
name the 4 “pine” atypical antipsychotics
A
clozapine, olanzapine (zyprexa), quetiapine (Seroquel), asenapine
25
name the 5 "done" atypical antipsychotics
risperidone (risperdal), paliperdone, iloperidone, lurasidone, ziprasidone
26
name the "2 pips, a rip, and a rone" atypical antipsychotics
aripiprazole (Abilify), brexpiprazole, caripraszine, lumateprone
27
MOA of atypical antipsychotics
serotonin 5HT2A receptor antagonism
28
MOA of "pine" atypical antipsychotics
serotonin 5HT2A receptor antagonism, D2 receptor antagonism, anticholinergic, antihistaminic
29
common side effects of "pine" and "done" atypical antipsychotics
constipation, orthostasis, sedation
30
MOA of "done" atypical antipsychotics
serotonin 5HT2A receptor antagonism, D2 receptor antagonism
31
serious side effects of "pine" and "done" atypical antipsychotics
bad metabolic profile
32
indications for atypical antipsychotics
first line for schizophrenia
bipolar disorder, psychosis
33
indications for clozapine
schizophrenia, tardive dyskinesia, suicidal ideation in patients with psychosis
34
serious/ uncommon side effects of clozapine
agranulocytosis, seizures, paralytic ileum, myocarditis
35
clozapine potency
low
36
olanzapine (zyprexa) indications
schizophrenia, aggression, agitation
37
olanzapine (zyprexa) potency
low
38
quetiapine (Seroquel) dosage significance
dosage determines the type of effect the drug has
low = hypnotic
medium = antidepressant
high = antipsychotic
39
what population is quetiapine especially good for?
geriatrics
40
what atypical antipsychotic is only available sublingual?
asenapine
41
risperidone (risperdal) indications
schizophrenia, ODD, autism
42
what should be kept in mind about the side effects of risperidone?
side effects very similar to first generation antipsychotics with things like pseudoparkinsonism and hyperprolactinemia
43
paliperdone indication
schizophrenia, schizoaffective disorder
44
lurasidone indication
schizophrenia, MDD
45
MOA of "2 pips and a rip" atypical antipsychotics
serotonin 5HT2A receptor antagonism, partial D2 agonist, some D3 activity
46
common side effects of "2 pips and a rip" atypical antipsychotics
akathisia
47
aripiprazole (abilify) indications
schizophrenia, ODD, autism (severe irritability and aggression)
48
aripiprazole (abilify) uncommon/ serious side effect
impulsive behaviors/ gambling
49
lumateprone MOA
serotonin 5HT2A receptor antagonism, D2 receptor antagonism, serotonin transporter, metabolic effects
50
what is special about lumateprone's receptor affinity?
affinity for 5HT2A is 60x higher than for D2
51
mirtazapine indications
MDD
52
mirtazapine MOA
noradrenergic & specific serotonin antidepressant
53
mirtazapine common side effects
sedation, dry mouth, dizziness, increased appetite, weight gain
54
mirtazapine uncommon/ serious side effects
agranulocytosis, hyperlipidemia
55
what antidepressant has a faster onset of action than SSRIs?
mirtazapine
56
bupropion (Wellbutrin) indications
ADHD, MDD, SAD, smoking cessation
57
bupropion (wellbutrin) MOA
Ne & DA reuptake inhibitor, nicotinic acetylcholine antagonist
58
bupropion common side effects
irritability, decreased appetite, insomnia
59
bupropion uncommon/ serious side effects
seizures
60
when is bupropion contraindicated?
seizure disorders, eating disorders, active substance withdrawal
61
tricyclic antidepressants MOA
block reuptake of NE & SE, interact with muscarinic, histamine, and adrenergic receptors
62
side effects of tricyclics
anticholinergic, antihistamine, NE alpha block (orthostatic hypotension, dizziness), cardiac arrhythmia, seizures, sexual side effects, sweating, serotonin syndrome
63
amitriptyline indications
depression, neuropathic pain
64
amitriptyline MOA
blocks NE and SE reuptake equally
65
nortriptyline indications
MDD
66
nortriptyline MOA
mostly blocks NE reuptake
67
imipramine indications
MDD, nocturnal enuresis
68
imipramine MOA
blocks NE and SE reuptake equally
69
desipramine indications
MDD, nocturnal enuresis
70
desipramine MOA
mostly blocks NE reuptake
71
what tricyclics require checking for therapeutic blood levels?
desipramine, imipramine, nortiptyline (DIN)
72
clomipramine indications
OCD
73
clomipramine MOA
parent drug mainly acts on SE, metabolite mainly acts on NE
74
MAO-A role
breaks down SE, melatonin, epilepsy, NE, DA
75
MAO-B role
breaks down phenylethyalmine, DA (mainly in gut)
76
MAOI meaning
monamine oxidase inhibitor
77
MAOI serious/ uncommon side effects
hypertensive crisis (from tyramine), serotonin syndrome, hepatotoxicity
78
what do you have to keep in mind when prescribing MAOIs?
need to do clean out of any serotonin based drugs at least 14 days before and 14 days after
restrict tyramine intake
79
name 2 MAOIs
phenelzine, selegiline
80
phenelzine indications
atypical & neurotic depression, treatment resistant depression, panic disorder
81
phenelzine MOA
irreversibly blocks MAO from breaking down NE, SE, and DA
82
selegiline indications
MDD, parkinson's
83
selegiline MOA
MAO-B irreversible inhibitor, MAO-A reversible inhibitor
84
what special route of administration is available for selegiline?
transdermal patch
85
name 3 benzodiazepines
clonazepam, lorazepam, alprazolam
86
benzodiazepine MOA
acts at GABA-A receptor increasing the flow of Cl- ions
87
common side effects of benzodiazepines
sedation, fatigue, dizziness, forgetfulness, nervousness, hyperexcitability
88
long term use of benzodiazepines
causes dependence, tolerance, and withdrawal
89
uncommon/ serious side effects of benzodiazepines
respiratory depression, hepatic or renal dysfunction
90
what drug can be used to reverse a benzodiazepine overdose?
flumazenil
91
what kind of metabolism do benzodiazepines have?
CYP450
92
clonazepam indications
panic disorder
93
lorazepam (Ativan) indications
anxiety disorders, status epileptics treatment, pre-anesthesia
94
alprazolam (xanax) indications
GAD
95
clonazepam duration of action
long acting
96
lorazepam duration of action
intermediate acting
97
alprazolam duration of action
short acting
98
SSRI MOA
block reuptake of SE in pre-synaptic neuron, increased serotonin at synapse
99
serious SSRI and SPARI side effects
photosensitivity, kidney or liver impairment, SIADH, seizures, increased bleeding, osteopenia, serotonin syndrome
100
fluoxetine (prozac) indications
MDD, PMDD, OCD, bulimia, anxiety disorders
101
fluoxetine common side effects
more activating/ agitating, appetite suppression, sexual side effects
102
which SSRIs inhibit CYP450 activity?
fluoxetine, fluvoxamine, paroxetine
103
fluvoxamine (Luvox) indications
OCD, MDD, social anxiety
104
sertraline (zoloft) indications
MDD, PMDD, OCD, panic disorder, PTSD, seasonal affective disorder
105
additional MOA for sertraline?
more DA activity than other SSRIs
106
sertraline common side effects
loose stools
107
citalopram (celexa) indicatons
MDD, anxiety disorders
108
additional MOA for citalopram?
weak effects at histaminic receptos
109
escitalopram (lexapro) indications
MDD, GAD, anxiety disorders
110
special MOA of escitalopram?
most selective SSRI for SE
111
paroxetine indications
MDD, GAD, OCD, panic disorder, PTSD, SAD, anxiety disorders
112
paroxetine additional MOA
some NE reuptake inhibition, antimuscarinic, anticholinergic, NO synthase inhibitor
113
paroxetine common side effects
sedation, weight gain, decreased cognition, sexual side effects
114
SPARI MOA
block reuptake of SE in presynaptic neuron, increased serotonin at synapse -- but not as strongly as SSRIs specifically at 5HT1A receptor
115
name 2 SPARIs
vilazodone, vortioxetine
116
SPARI indications
MDD, anxiety disorders
117
SNRI MOA
SE and NE reuptake inhibitors
118
name 4 SNRIs
venlafaxine (effexor), desvenlafaxine (Pristiq), duloxetine (cymbalta), levomilnacipran (fetzima)
119
SNRI common side effects
nausea, headache, GI upset, sedation, weight gain, sweating
120
SNRI uncommon/ serious side effects
increased bleeding, hyponatremia, seizures, serotonin syndrome, sexual side effects, palpitations, increased HR and BP
121
venlafaxine (effexor) indications
MDD, GAD, panic disorder, social anxiety disorder, pain conditions
122
special part of MOA of venlafaxine
more SE selectivity at low doses, NE at high doses
123
desvenlafaxine indications
MDD, anxiety disorders
124
duloxetine (cymbalta) indications
MDD, GAD, fibromyalgia, diabetic peripheral neuropathy
125
special part of MOA of duloxetine?
rate of SE to NE action is 1 to 1 no matter the dosage
126
serious side effect of duloxetine?
hepatotoxicity
127
levomilnacipran indications
MDD
128
special part of MOA of levomilnacipran?
more NE selectivity at low doses, SE at high doses
129
name 3 mood stabilizers
carbamazepine, valproic acid, lamotrigine
130
mood stabilizer indications
bipolar disorder
131
carbamazepine MOA
block voltage gated sodium channels
132
carbamazepine common side effects
diplopia, ataxia
133
carbamazepine uncommon/ serious side effects
stevens johnson syndrome, SIADH, agranulocytosis, liver toxicity
134
which mood stabilizer induces CYP450?
carbamazepine
135
valproic acid MOA
block voltage gated sodium channels, inhibit GABA transaminase
136
valproic acid common side effects
GI symptoms, tremors, sedation, alopecia, weight gain
137
valproic acid uncommon/ serious side effects
blood disorders, liver toxicity
138
lamotrigine MOA
block voltage gated sodium channels, inhibit release of glutamate
139
lamotrigine common symptoms
blurred vision, GI symptoms
140
lamotrigine uncommon/ severe side effects
stevens johnson syndrome
141
atomoxetine (Strattera) indications
ADHD
142
strattera MOA
selective NE transporter inhibitor, increases DA and NE in PFC, blocks NMDA receptor
143
Strattera common side effects
sedation, GI upset
144
what are 2 non stimulant medications used for ADHD treatment that come with black box warnings?
strattera, qelbree
145
viloxazine (qelbree) indications
ADHD
146
qelbree MOA
moderate NE transporter inhibitor, increases NE in amygdala and PFC, some SE activity
147
modafinil indications
ADHD (adults), narcolepsy
148
why is modafinil not approved for use in kids?
stevens johnson syndrome
149
desmopressin indications
enuresis
150
desmopressin MOA
synthetic vasopressin analogue
151
serious side effects of desmopressin
dilutional hyponatremia
152
buspirone (buspar) indications
anxiety disorders
153
buspirone MOA
partial agonist at serotonin receptor (post synaptic only)
154
common side effects of buspirone
headaches, dizziness, nervousness, restlessness
155
gabapentin indications
restless leg syndrome, neuropathic pain, adjunct in anxiety & bipolar disorder
156
gabapentin MOA
glutamate, voltage gated calcium channel blocker
157
gabapentin common side effects
sedation, dizziness, peripheral edema, vomiting, constipation, blurred vision
158
hydroxyzine indications
anxiety & tension associated with psychoneurosis
159
hydroxyzine MOA
antihistamine causes sedation by penetrating CNS at H1 receptor
160
propranolol indications
hypertension, angina pectoris, migraine, anxiety, essential tremors
161
propranolol MOA
nonselective beta receptor blocking agent
162
lithium indications
bipolar disorder
163
lithium common side effects
GI symptoms, tremors
164
lithium serious/ uncommon side effects
nephrogenic diabetes insipidus, hypothyroidism, leukocytosis
165
what is caused by toxic levels of lithium
renal failure and neurological symptoms
166
extrapyramidal symptoms from D2 blockade in nigrostriatal tracts
akathisia, pseudoparkinsonism, acute dystonic reaction, tardive dyskinesia
167
acute dystonic reaction
set of muscles acts & reacts at the same time
168
treatment for an acute dystonic reaction
need to increase dopamine and decrease acetylcholine -- antihistamine & anticholinergic
169
tardive dyskinesia
chronic movement disorder generally considered irreversible
170
hyperprolactinemia mechanism
dopamine involved in prolactin secretion, antipsychotics decrease dopamine in tuberoinfundibulnar tract, increase in prolactin secretion from anterior pituitary
171
which antipsychotic causes corneal and retinal deposits?
chlorpromazine
172
which antipsychotic causes retinal deposits only?
thioridazine
173
neuroleptic malignant syndrome
muscle rigidity, fever, autonomic instability, elevated creatinine kinase isozymes
174
neuroleptic malignant syndrome treatment
dantrolene
175
serotonin increase effects
mood, cognition, GI, sleep, musculoskeletal
176
norepinephrine increase effects
cardiovascular, increased HR, increased BP, sweating, pain
177
dopamine increase effects
pleasure, interest, concentration, impulse
178
histamine decrease effects
sedation, weight gain, increased hunger
179
acetylcholine decrease effects
red as a beet -- flushing, vasodilation
mad as a hatter -- delirium, confusion, poor memory, hallucination
hot as a hare -- high temp, high HR
blind as a bat -- pupil dilation, blurred vision, increased IOP
dry as a bone -- decreased salivation, urinary retention, constipation, decreased sweating
180
metabolic syndrome
weight gain, dyslipidemia, elevated BP, elevated fasting glucose, large waist circumference
181
safe antidepressant for pregnancy
sertraline, fluoxetine, escitalopram
182
safe antidepressants for lactation
sertraline, paroxetine
183
safe mood stabilizers for pregnancy
none, switch to antipsychotics
184
safe mood stabilizers for lactation
valproic acid, carbamazepine, lamotragine
185
safe antipsychotics for pregnancy
haloperidol, olanzapine, risperidone, quetiapine
186
safe antipsychotics for lactation
haloperidol, olanzepine
187
safe benzodiazepines for pregnancy
lorazepam, alprazolam
188
safe opioids for pregnancy
methadone, buprenorphine
189
safe opioids for lactations
methadone, buprenorphine
