CHAPTER 6 PSYCH3 Flashcards by MA CARMELA CONCEPCION SALES

irreversibly inhibit monoamine
oxidase, blocking metabolism of monoamine
neurotransmitters

MAOIs:

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Indications of MAOI

atypical depression, panic disorder, social
phobia, posttraumatic stress disorder, OCD, bulimia
nervosa, pain management

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Severe hypertension and complications of malignant hypertension if taking MAOIs and _____

tyramine-containing substance or food is ingested

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___________ if MAOIs taken in combination
with SSRIs or other antidepressants, over-the-counter
medications, meperidine, stimulants, sympathomimetics

Serotonin syndrome

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MAOI

better than SSRIs for ______
also used for insomnia, pain, obsessive-compulsive
disorder, panic, anxiety

melancholic depression,

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Contraindications of MAOI:

recent myocardial infarction, 
bundle branch block, 
widened QRS,
 narrow-angle glaucoma,
cardiac disease, 
prostatic hypertrophy,

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Mixed-mechanism antidepressants:

bupropion, duloxetine,

mirtazapine, nefazodone, trazodone, venlafaxine

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Mechanism of Bupropion

Dopamine-NE reuptake inhibitor: preferentially
increases dopamine (weak inhibitor of dopamine
reuptake)

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Clinical use of Buproprion

FDA-approved for depression,
smoking cessation;
non-FDA–approved—attention

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Buproprion Can increase seizure risk at doses more than ________

450 mg/day

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Contraindications of Buproprion: patients with ___ and _______

seizure disorders,

eating disorders

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Duloxetine (Cymbalta) clinical use

Clinical uses: FDA-approved for depression, diabetic

peripheral neuropathic

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Enhances release of NE and 5HT, inhibits 5HT2 and
5HT3 receptors, also potent histamine antagonist,
moderate α2-adrenergic antagonist

Mirtazapine (Remeron)

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Indications for Mirtazapine (Remeron)

FDA-approved for depression; non-

FDA–approved—improves appetite and sleep

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SE of Mirtazapine

early sedation, weight gain, possible

agranulocytosis

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Serotonin (5HT2) receptor-antagonist, weak
inhibitor of 5HT reuptake (5HT2 antagonist/reuptake
inhibitor

What anti-depressant

Nefazodone (Serzone)

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Serotonin (5HT2) receptor-antagonist, weak inhibitor
of 5HT reuptake (5HT2 antagonist/reuptake inhibitor

Clinical uses: FDA-approved for depression; non-
FDA–approved—insomnia

Trazodone (Desyrel)

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Inhibits 5HT reuptake at lower doses, inhibits NE
reuptake at moderate doses, and dopamine reuptake
at higher doses

Venlafaxine (Effexor)

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Examples of Typical anti-psychotics

chlorpromazine (Thorazine), mesoridazine
(Serentil), thioridazine (Mellaril), fluphenazine
(Prolixin), perphenazine (Trilafon), trifluoperazine
(Stelazine), thiothixene (Navane), loxapine (Loxitane),
haloperidol (Haldol), molindone (Moban)

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1) Favorable side-effect profile (useful in emergency
settings)
2) Useful for positive symptoms but not negative symptomsof schizophrenia
3) High potential for dose-dependent acute extrapyramidalside effects and sexual dysfunction

Haloperidol: high-potency agent

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_________ also has potential to cause retinitis pigmentosa, retrograde ejaculation, QTc prolongation

Thioridazine

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1) Effective for positive symptoms, less effective for negative symptoms of schizophrenia
2) Has a relatively favorable risk versus benefit ratio, so is
widely used

Thiothixene, perphenazine, trifluoperazine: medium

potency agents

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Atypicals: _____________

clozapine, risperidone, olanzapine, quetiapine,

aripiprazole, ziprasidone

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Clozapine (Clozaril): low-potency agent, for _____

1) Choice for patient with______ and ____
2) Effective for ____ and _____ symptoms of
schizophrenia
3) Should have had at least three failed trials of antipsychotics from different classes and at least one depot formulation trial

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refractory schizophrenia

tardive dyskinesia or at high risk for tardive dyskinesia
positive and negative

Serious side effects of Clozapine:

agranulocytosis, seizures

Risperidone (Risperdal): high-potency agent 1) Effective for ______ and ______ symptoms of schizophrenia 2) Reduced potential for acute or chronic extrapyramidal side effects 3) Can significantly increase serum _______, more _________ is possible

positive and negative prolactin levels sexual dysfunction

1) Is structurally similar to and acts like clozapine but with less risk for agranulocytosis and seizures 2) Acute extrapyramidal side effects no more frequent than reported for placebo, low chance for chronic extrapyramidal side effects

Olanzapine (Zyprexa): medium- to high-potency agent

SE of Olanzapine

weight gain, hypertriglyceridemia, sedation, | diabetes (?) , elevated liver function enzymes

low potency, few EPS, less | sexual dysfunction, no prolactin increase antipsychotic

Quetiapine (Seroquel)

Antipsychotics Typicals bind to _______, blocking dopamine at the site, more prone to extrapyramidal side effects

D2 receptors

Antipsychotics Atypicals are weaker D2 receptor antagonists but are potent ______ receptor antagonists and also have ______ and ______

5HT2A anticholinergic and antihistaminic activity

______ and _____dopaminergic pathways | are affected by antipsychotics

Mesocortical and mesolimbic

Adverse effects of anti-psychotics _____________- abnormal involuntary movements (usually mouth and/or tongue) after long-term use -Elderly, women, and those with mood disorders more susceptible

Tardive dyskinesia:

Adverse effects of anti-psychotics __________ (tremor, rigidity, hypokinesia): treat by lowering dose of antipsychotic or adding antiparkinsonian agent

Parkinsonism

Adverse effects of anti-psychotics ______ (subjective feelings of anxiety, tension, agitation): treat by lowering dose of antipsychotic, try β- blocker, clonidine, amantadine, or benzodiazepine

Akathisia

Adverse effects of anti-psychotics sustained contraction of muscles of neck, mouth, tongue): treat with intravenous benztropine or diphenhydramine

Acute dystonic reaction

Adverse effects of anti-psychotics ________ (dry mouth, urinary retention, blurry vision, constipation, exacerbation of narrowangle glaucoma): treat by reducing dose or change to more potent antipsychotic or to atypical antipsychotic

Anticholinergic side effects

Adverse effects of anti-psychotics Agranulocytosis (associated with low-potency antipsychotics and especially clozapine; potentially fatal): requires weekly blood counts for_____ and ____

first 6 months, then | every 2 weeks thereafter

Adverse effects of anti-psychotics rigidity, high fever, delirium, autonomic instability, increased serum levels of creatine kinase and liver enzymes): treat by stopping offending drug, supportive care, try dantrolene or bromocriptine, ECT for severe cases

Neuroleptic malignant syndrome

Rapid removal of medications with dopaminergic properties such as those used to treat _______ can also cause neuroleptic malignant-like syndrome

Parkinson’s disease

________: most often prescribed psychotropic | medications

Anxiolytics

BZD with long half life

``` chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), flurazepam (Dalmane ```

BZD with Medium half-life:

estazolam (ProSom), lorazepam | Ativan), temazepam (Restoril

BZD with Short half-life:

alprazolam (Xanax), oxazepam (Serax), | triazolam (Halcion)

Preferred benzodiazepines for the elderly:

oxazepam, | lorazepam, temazepam (“out the liver”)

anxiolytics, sedative-hypnotics 1) Used for generalized anxiety disorder: effects seen after 1 to 2 weeks 2) Relatively nonsedating, no abuse potential

Buspirone (BuSpar)

Electric current applied across scalp electrodes, producing a grand mal seizure

ECT

ECT may improve both mood and motor symptoms of patients with _______, but effects may be short-lived from days to weeks to 6 months, according to various studies

advanced Parkinson’s disease

MOA of Lithium

inhibits inositol-1-phosphatase

Indications of Lithium therapy

mania, augmentation of antidepressants, prophylaxis of mania/depression, schizoaffective disorder, aggression, impulsivity

Concerns for Lithium:

thyroid/kidney, pregnancy (Ebstein’s | anomaly

Clinical indications for Amphetamine:

1) Narcolepsy and other sleep disorders, attentiondeficit/ hyperactivity disorder in children, obesity 2) Has also been used for depression by augmenting antidepressant effects, neurasthenia, AIDS dementia, encephalopathy from brain injury

MOA of Amphetamine

1) Causes direct release of dopamine and NE from neurons 2) Blocks reuptake of catecholamines 3) Peak plasma levels in 1 to 3 hours

___________ related to amphetamine, but milder stimulant (little or no abuse potential)

Methylphenidate (Concerta, Ritalin):

________ novel stimulant for narcolepsy

Modafinil (Provigil):

Sympathomimetics decrease efficacy of many antihypertensive | agents, especially ______ and _______

guanethidine (Ismelin) and | guanethidine-hydrochlorothiazide (Esimil)

Techniques for behavioral therapy

classic conditioning, operant conditioning, positive reinforcers, negative reinforcers, relaxation training, systematic desensitization, flooding, behavioral modification

a person’s evaluation of a perceived adverse event largely determines the degree and type of emotional state experienced

Cognitive-behavioral therapy:

CHAPTER 6 PSYCH3 Flashcards

(58 cards)