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CK3 Flashcards

1
Q

Psychoactive drug intoxication and withdrawal - depressants - intoxication non-specific synptoms

A
  1. mood elevation
  2. decreased anxiety
  3. sedation
  4. behavioural disinhibition
  5. respiratory depression
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2
Q

Psychoactive drug intoxication and withdrawal - depressants - withdrawal non-specific symptoms

A
  1. anxiety
  2. tremor
  3. seizures
  4. insomnia
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3
Q

Alcohol - intoxication

A
  1. emotional lability
  2. slurred speech
  3. ataxia
  4. blackouts
  5. coma
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4
Q

opioid analgesics - toxicity

A
  1. addiction
  2. respiratory depression
  3. constipation (no tolerance)
  4. miosis (pinpoint pupils) (no tolerance)
  5. addictive CNS depression with other drugs
  6. opioid withdrawal syndrome
  7. suppressed gag reflex
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5
Q

opioid - withdrawal

A
  1. Sweating
  2. DILATED PUPILS
  3. piloerection (cold turkey)
  4. nausea/stomach cramps, diarrhea, fever, rhinorrhea, yawning, nausea (flu like symptoms)
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6
Q

opioid - withdrawal - treatment

A

long term support, methadone, buprenorphine

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7
Q

barbiturates - toxicity

A
  1. respiratory and cardiovascular depression (can be fatal)
  2. CNS depression (can be exacerbated by alcohol use)
  3. dependence
  4. induces of P-450
  5. withdrawal syndrome
  6. teratogen
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8
Q

barbiturates - withdrawal

A
  1. delirium

2. life threatening cardiovascular (and respiratory) collapse

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9
Q

benzodiazepines - side effects

A
  1. dependence
  2. addictive CNS depression effects with alcohol
  3. respiratory deppresion less and coma (less risk that barbiturates)
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10
Q

benzodiazepines - overdose treatment (and mechanism of action)

A

flumazenil (comptetitive antagonist at GABA benzodiazepine receptor)
RARELY USED AS IT CAN PRECIPITATE SEIZURES

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11
Q

benzodiazepines - withdrawal

A
  1. sleep disturbances
  2. depression
  3. rebound anxiety
  4. seizures
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12
Q

overdose treatment of 1. opioids 2. benzodiazepines 3. barbiturates

A
  1. opioids –> naloxone, naltrexone
  2. benzodiazepines –> flumazenil
  3. mechanical respiration, hemodialysis, urine alkalinization
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13
Q

Psychoactive drug intoxication and withdrawal - stimulants - intoxication non-specific synptoms

A
  1. mood elevation
  2. psychomotor agitation
  3. insomnia
  4. cardiac arrhytmias
  5. tachycardia
  6. anxiety
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14
Q

Psychoactive drug intoxication and withdrawal - withdrawal stimulants non-specific symptoms

A

post-use “crash” including

  1. depression
  2. lethargy
  3. weight gain
  4. headache
  5. Increased appetite
  6. Sleep disturbances
  7. Vivid nightmares
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15
Q

Amphetamines intoxication

A
  1. euphoria 2. Grandiosity 3. pupillary dilation
  2. prolonged wakefulness and attention 5. hyperentsion
  3. tachycardia 7. anorexia 8. paranoia
    fever 9. cardiac arrest 10. seizures
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16
Q

Amphetamines withdrawal

A
  1. anhedonia
  2. increased appetite
  3. hypersomnolence
  4. existential crisis
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17
Q

nicotine intoxication

A

restlessness

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18
Q

nicotine withdrawal

A
  1. irritability
  2. anxiety
  3. craving
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19
Q

nicotine withdrawal - treatment

A
  1. nicotine patch/gum/lozenges
  2. bupropion
  3. varenicline
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20
Q

caffeine intoxication

A
  1. restlessness
  2. increased diuresis
  3. muscle twitching
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21
Q

caffeine withdrawal

A
  1. lack of concentrations
  2. headaches
  3. flu like symptoms
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22
Q

coccaine intoxication

A
  1. impaired judgment
  2. pupillary dilation
  3. hallucinations (including tactile)
  4. paranoid ideations
  5. angina
  6. sudden cardiac death
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23
Q

coccaine withdrawal

A
  1. hypersomnolence
  2. malaise
  3. severe psychological craving
  4. depression/suicidality
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24
Q

coccaine intoxication - treatment

A
  1. a-blockers
  2. benzodiazepines
    β blockers are not recommended
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25
Psychoactive drug intoxication and withdrawal - halllucinogens - drugs
1. PCP (Phencyclidine) 2. LSD (lysergic acid diethylamide) 3. Marijuana (cannabinoid) 4. MDMA (ecstasy)
26
PCP - intoxication
1. Belligerence 2. impislivity 3. fever 4. analgesia 5. vertical and horizontal nystagmus 6. tachycardia 7. homocidality 8. psychosis 9. delirium 10. seizures
27
PCP - intoxication - treatment
1. benzodiazepines | 2. rapid acting antipsychotic
28
LSD intoxication
1. Perceptual distortion (visual auditory) 2. depersonalization 3. anxiety 4. paranoia 5. psychosis 6. possible flashbacks
29
Marijuana (cannabinoid) - intoxication
1. euphoria 2. anxiety 3. paranoid delusions 4. perceptions of slowed time 5. impaired judgement 6. social withdrawal 7. increased appetite 8. dry month 9. conjunctival injecton 10 hallucinations
30
Marijuana (cannabinoid) - clinical use
1. antiemetic (chemotherapy) | 2. appetite stimulant (AIDS)
31
Marijuana (cannabinoid) - withdrawal
1. irritability 2. depression 3. insomnia 4. nausea 5. anorexia
32
Marijuana (cannabinoid) - course of withdrawal symptoms
Most symptoms peak in 48 hours and last for 5-7 days
33
Heroin addiction - methadone
long-acting oral opiate used for heroin detoxification or long-term maintenance
34
Heroin addiction - naloxone + buprenorphine
antagonists + partial agonist. Naloxone is not orally bioavailable, so withdrawal symtpoms occur only if injected (lower abuse potential)
35
Heroin addiction - naltrexone
long acting opioid antagonists used for relapse prevention once detoxified
36
Alcoholism - treatment
1. disulfiram (to condition the patient to abstain from alcohol use) 2. acamprosate 3. naltrexone 4. supportive care
37
Delirium tremens
life threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink
38
Delirium tremens - characterised by
autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
39
Alcoholic hallucinosis?
visual hallucinations 12-48 hours after last drink
40
Alcoholic hallucinosis - treatment
long acting benzodiazepines (chlorodiazepoxide, lirazepam , diazepa)
41
MDMA (ecstasy) - intoxication
1. euphoria 2. dishinibition 3. hyperactivity | 4. Life threatening effects (hyperentsion, tachycardia, hyperthermia, hyponatriemia, seretonin syndrome)
42
MDMA (ecstasy) - withdrawal
1. depression 2. fatigue 3. change in appetite 4. anxiety 5. difficulty concentrating
43
Bulimia - treatment
SSRIs (+ CBT, nutritional rehabilitation)
44
social anxiety disorder
SSRIs, venlafaxine | Performance only: β-blockers, benzodiazepines
45
Tourette syndrome - treatment
1. psychoeducation 2. behavioral therapy 3. for intractable tics --> a. low dose high potency antipsycotics (flyphenazine, pimozide) b. tetrabenazine c. clonidine d. guanfacine
46
Narcolepsy - treatment
daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHD)
47
CNS stimulants - drugs/mechanism/clinical use
1. Methylphenidate 2. dextroamphetamine 3. methamphetamine mechanism: increases catecholamines in the synaptic cleft, esp norepinephrine and dopamin clinical use: 1. ADHD 2. Narcolepsy 3. Appetite control
48
typical antipsychotics (neuroleptics) - drugs
HALOPERIDOL + "-azine" + pimozide 1. haloperidol 2. trifluoperazine 3. fluphenazine 4. thioridazine 5. chlorpromazine
49
typical antipsychotics (neuroleptics) - drug without "-azine"
haloperidol + pimozide
50
typical antipsychotics (neuroleptics) are divided to ... (and which)
high potency --> 1. haloperidol 2. trifluoperazine 3. fluphenazine low potency --> 1. thioridazine 2. chlorpromazine
51
typical antipsychotics (neuroleptics) - clinical use
1. positive symptoms of schizophrenia 2. psychosis 3. bipolar disorder 4. Turette syndrome 5. Huntington (haloperidol) 6. OCD 7. Delirium
52
typical antipsychotics (neuroleptics) - side effect
1. very slow to be removed from body (highly lipid soluble and stored in fat) 2. Extrapyramidal system side effects (parskinsonism, akinesia, akathisia, dyskinesia) - High potency (not exactly) 3. Endocrine side effects (hyperprolactinemia) --> galactorrhea and amenorrhea 4. long QT 5. anticholinergic (dry mount, constipation), anti-a1 (hypotnesion), anti-histamine (sedation) - low potency (not exactly) 6. Neuroleptic malignant syndrome 7. Tarditve dyskenisia 8. corneal deposits (chlorpromazine) 9. retinal deposits (thrioridazine) 10. metabolic: dyslipidemia, weight gain, hyperglycemia
53
neuroleptic malignant syndrome - manifestations
``` mnemonic FEVER Fever (hyperthermia) Encephalopathy Vitals instability (autonomic instability) Enzymes (myoglobinuria) Rigidity of muscles ```
54
evolution of extrapyramidal system side effects
4hr acute dystonia (muscle spasm, stiffness oculogyric crisis), can cause laryngospam requiring intubation 4 day akathisia (restlessness) 4 wk bradykinesia (parkinsonism) 4 mo tardive dyskinesia
55
typical antipsychotics (neuroleptics) - side effects - solution
1. Extrapyramidal system side effects --> benzotropine, diphenydramine, benzodiazepine 2. Neuroleptic malignant syndrome --> dantrolene, D2 agonists (eg. bromocriptine), stop causative agent
56
Atipical antipsychotics - drugs
1. Olanzapine 2. clozapine 3. quetiapine 4. risperidone 5. aripiprazole 6. ziprasidone 7. asenapine 8. iloperidone 9. paliperidone 10. lurasidone
57
Atipical antipsychotics - clinical use
1. Schizophrenia (both negative and positive symptoms) 2. Bipolar disorder 3. OCD 4. Anxiety disorder 5. Depression 6. Mania 7. Tourette syndrome
58
Atipical antipsychotics - side effects
1. Fewer anti-cholinergic and extrapyramidal side effets than traditional antipsychotics 2. Metabolic syndrome - weight gain, diabetes, hyperlipidemia (-pines) 3. agranulocytosis (clozapine) 4. seizures (clozapine) 5. increased prolactin --> lactation and gynecomastia --> decreased GnRH, LH, FSH --> irregular menstruation and fertility issues (risperidone) 6. prolonged QT intervals
59
Atipical antipsychotics - agranulocytosis - management
requires weekly WBC monitoring
60
use clozapine for
treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia
61
Lithium - clinical use
1. Mood stabilizer for bipolar disorder 2. Blocks relapse and acute manic events 3. SIADH
62
Lithium - side effects
1. tremor 2. hypothyroidism 3. polyuria (nephrogenic diabetes insipidus) 4. teratogenesis 5. NARROW THERAPEUTIC WINDOW (requires close monitoring of serum levels)
63
causes of lithium toxicity
- change in dosage or health status | - concurrent use of thiazide, ACEi, NSAID, or other nephrotoxic agents
64
buspirone - everything
stimulates 5-HT1A recetors general anxiety disorder TAKES 1-2 WEEKS TO TAKE EFFECTS - does not cause sedation, addiction, or tolerance - does not interact with alcohol (vs barbiturates, benzodiazepines)
65
Anttidepressants - groups
1. SSRI 2. SNRI 3. TCA 4. MAOi 5. atypical antidepres
66
SSRIs - drugs
1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram 5. fluvoxamine
67
SSRIs - mechanism
5-HT-specific re-uptake inhibitors | it takes 4-8 weeks for antidepressants to have an effect
68
SSRIs - clinical use
1. Depression 2. Generalized anxiety disorder 3. panic disorder 4. OCD 5. Bulimia 6. Social phobias 7. post-traumatic stress disorder 8. premature ejaculation 9. premanstrual dysphoric disorder it takes 4-8 weeks for antidepressants to have an effect
69
SSRIs - side effects
fewer than TCA 1. GI distress 2. SIADH 3. Sexual dyfunction (anorgasmia, decreased libido) 4. Seretonin syndrome (with other drugs that increase seretonin, eg. MAO inhibitors, SNRIs, TCAs)
70
Seretonin syndrome manifestations
3A - neuromascular Activity (clonus, hyperleflexia, hypertonia, tremor, seizures) - Autonomic stimulation (hyperthermia, diaphoresis, diarrhea - Agitation
71
Seretonin syndrome - treatment
cyproheptadine (5-HT-2 receotr antagonist)
72
SNRIs - drugs
1. venlafaxine 2. duloxetine 3. milnacipran
73
SNRIs - clinical use
1. Depression 2. Generalized anxiety disorder 3. Panic disorder (venlfaxine) 4. post-traumatic stress disorder (venlfaxine) 5. Diabetic peripheral neuropathy 6. OCD (venlafaxine) 7. social anxiety disorder
74
SNRIs - toxicity
1. increased BP (MC) | 2. also stimulant effect, sedation, nausea
75
Tricyclic antidepressants - drugs
1. Amitriptyline 2. nortripryline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxepin
76
Tricyclic antidepressants - clinical use
1. major depression 2. OCD (clomapramine) 3. peripheral neuropathy 4. chronic pain 5. migraine prophylaxis
77
Tricyclic antidepressants - toxicity
1. Cardiotoxicity (prolong QT) --> due to Na+ channels inhibition 2. Respiratory depression 3. Hyperpyrexia 4. a1 blocking (postural hypertension) 5. anticholinergic --> tachycardia, urinary retention, dry month, Confusion, hallucinations 6. Coma 7. Convulsions
78
Tricyclic antidepressants - anticholinergic effect
``` tachycardia, urinary retention, dry month, Confusion, hallucinations 3 TCAs (amitriptyline) have more anticholinergic effects than 2 TCA (nortripyline) ```
79
Tricyclic antidepressants - solution of side effects
1. NaHCO3 to prevent arrhythmia 2. Nortriptyline instead of amytriptyline for anticholinergic effects 3. supportive treatment and ECG monitor 4. ACTIVATED CHARCOAL
80
Monoamine oxidase inhibitors - drugs
1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegiline (selective MAO-B inhibitor)
81
Monoamine oxidase inhibitors - Clinical use
1. atypical depression 2. anxiety 3. agoraphobia 4. Parkinson (only selegiline, with levodopa)
82
Monoamine oxidase inhibitors - toxicity
1. hypertensive crisis (most notably with ingestion of tyramine, which is found in many food such as wine, cheese) 2. CNS stimulation 3. Contraindicated with SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John's wort
83
Monoamine oxidase inhibitors - contraindicated with
SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John's wort
84
atypical antidepressants - drugs
1. Bupropion 2. Mirtazapine 3. Trazodone 4. varenicline 5. Vilazodone 6. Vortioxetine
85
Bupropion - clinical use / mechanism
1. depression 2. smoking cessation increases norepinephrine and dopamine via unknown mechanism
86
Bupropion - toxicity
1. stimulants (tachycardia, insomnia) 2. headaches 3. seizures (in anorexic/bulimic patients, because low threshold of seizures) NO SEXUAL SIDE EFFECTS
87
Mirtazapine - mechanism of action
- α2 antagonist --> increases release of norepin and 5-HT - H1 antagonist - potent 5-HT2 and 5-HT3 antagonist
88
Mirtazapine - toxicity
1. sedation (may be desirable with depressive patients with insomnia) 2. increased appetite 3. weight gain (may be desirable in elderly or anorexic patients 4. dry month
89
Trazodone - mechanism of action
Primarily blocks 5-HT2 and a1 adrenergic receptors
90
Trazodone - clinical use
used primarily for insomnia, as high doses are needed for antidepressants effects
91
Trazodone - toxicity
1. sedation 2. nausea 3. priapism | 4. postural hypertension
92
MAO inhibitors - after?
wait 2 weeks after stopping MAO inhibitors before starting seretonergic drufs or stopping dietary restrictions
93
Varenicline - mechanism of action / clinical use
Nicotininic ACH receptor partail agonist | - smoking cessation
94
Varenicline - toxicity
sleep disturbances | depressed mood
95
Vilazodone - mechanism of action
inhibits 5-HT re-uptake | 5-HT1A partial agnostis
96
vilazodone - clinical use
major depressive disorder
97
vilazodone - toxicity
headache, diarrhea, nausea, weight gain, anticholinergic effects, Seretonin syndrome (if with other drugs)
98
Vortioxetine - mechanism of action
- inhibits 5-HT re-uptake - 5-HT1A agnostis - 5-HT3 receptor antagonists
99
Vortioxetine - clinical use
major depressive disorder
100
Vortioxetine - toxicity
nausea, sexual dysfunction, sleep disturbances (abnormal dreams), anticholinergics, Seretonin syndrome (if with other drugs)

psychiatry (6 decks)

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