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drug Flashcards

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1
Q

what are the first gen antipsychotics or the typicals and what are their mechanisms of action

A

haloperidol, perphenazine, chlorpromazine, fluphenazine

primarily D2 antagonists.

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2
Q

What do the typical antipsychotics treat

A

the positive symptoms mainly. not good at the negatives

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3
Q

what are the side effects of the typicals

A

extrapyramidals, neuroleptic malignant syndrome, and tardive dyskinesia.

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4
Q

what is another name for the typical antipsychotics

A

neuroleptics

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5
Q

what are the atypical or second generation antipsychotics

and the mechanism of action

A

aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, quetiapine, risperidone, ziprasidone.
these are D4>2 antagonists. they also antagonize the serotonin HT2 receptors. j

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6
Q

what are the benefits of the second gens

A

lower incidence of extrapyramidal symptoms, there is an increased risk for metabolic syndrome.

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7
Q

what is the worst antipsychotic and what are the risks and why is it used?

A

clozapine. this is last ditch for people who are refractory. there is a risk of agranulocytosis

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8
Q

what are the important SE of antipsychotics in general?

A

extrapyramidal symptoms, anticholinergic symptoms, metabolic syndrome, tardive dyskinesia and neuroleptic malignant syndrome. prolonged QT syndrome. watch for hyperprolactinemia and gynecomastia

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9
Q

what are the anticholinergic SE of the antipsychotics

A

dry mouth, constipation, blurred vision, hyperthermia.

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10
Q

what is tardive dyskinesia

A

(more likely to be caused by first gen antipsychotics) choreoathetoid movements usually of the face, tongue, and head.

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11
Q

what do we use to treat specific phobias or acute anxiety

A

Benzos.

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12
Q

what do we use to treat public speaking

A

nonselective beta-blockers, such as propanolol, atenolol, nadolol

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13
Q

what does the withdrawal of Benzos look like

A

alcohol.

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14
Q

how do we treat chronic anxiety such as OCD, PTSD, GAD

A

SSRI/SNRI

psychotherapy.

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15
Q

how do we treat Benzodiazepines withdrawal

A

with long acting Benzos such as diazepam and chlordiazepoxide

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16
Q

what causes the positive symptoms of schizophrenia

A

mesolimbic D2c receptors

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17
Q

what causes the negative symptoms of schizophrenia

A

serotonin receptors and mesocortical hypo function

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18
Q

what does blocking the tubuloinfundibular path do?

A

gynecomastia in men

amenorrhea and galactorrhea in women

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19
Q

what are the potent typical antipsychotics

A

haloperidol, trifluoptazine and fluphenazine

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20
Q

what are the lower potency typical antipsychiotics

A

thioridizine and chlorpromazine

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21
Q

what other SE are caused by the typical antipsychotics

A

anticholinergic effects: dry mouth, urinary retention

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22
Q

what are the atypical antipsychotics

A

quetiapine, clozapine, rispiradone, olanzapine, aripiprazole, zaprasidone

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23
Q

most likely SE of quetiapine

A

somnolence. also used to treat insomnia and a mood stabilizer.

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24
Q

most likely SE of olanzapine

A

metabolic syndrome

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25
most likely SE of risperadone
highest risk for EPS
26
what do all of the atypicals have for SE
QTc prolongation and anticholinergic effects
27
what drugs do we use to help people quit drinking
naltrexone, acamprosate and disulfiram
28
when do we use naltrexone
can still be drinking. used to achieve sobriety
29
what are the contraindications for using naltrexone in alcohol abuse treatment
if the person is not taking opioids, has poor liver function or hepatitis.
30
when is acamprosate used for alcohol abuse treatment
used to decrease cravings, but the person has to achieve sobriety first.
31
what is acute dystonia and what to treat
sudden, sustained contraction of the neck, mouth, tongue and eye muscles. treat with benztropine and diphenhydramine
32
what is akathisia and how to treat
subjective restlessness and inability to sit still treat with beta blocker, benztropine and Benzodiazepines (lorazepam).
33
how do we treat drug induced Parkinson's
benztropine and amantidine
34
what is tardive dyskinesia and how to treat
gradual onset after prolonged therapy, dyskinesia of the mouth face and truck treat with valbenazine
35
what is the first line therapy for major depressive disorder with psychotic features
antidepressants and antipsychotics or ECT
36
what is the treatment of choice for specific phobia
CBT. short acting benzos can also be used.
37
what are the short acting benzos
oxelapram, midazolam, triazolam
38
what are the intermediate benzos
Alprazolam (Xanax), lorazepam (Ativan), estazolam (Prosom), and temazepam (Restoril)
39
what are the long acting benzos
diazepam and chlordiazoxide
40
what are the long term treatments for people with panic disorder
CBT and SSRIs/SNRI
41
what is pseudo dementia and what to treat
dementia secondary to MDD, treat with SSRIs.
42
what is the MSE for someone with pseudodementia
≤25
43
what is the first and second-line therapy for OCD
SSRI -1 | clompiramine -2
44
what is clomipramine and why is it second line therapy for OCD
TCA and has a nasty SE profile.
45
what is the SE profile for aripiprazole
metabolic. low EPS. low QTc. low
46
what is the SE profile for quetiapine
metabolic. high EPS. low QTc. low
47
what is the SE profile for clozapine
metabolic. Very high EPS. low QTc. low
48
what is the SE profile for risperidone
metabolic. high EPS. high QTc. high
49
what is the SEprofile for olanzapine
metabolic. very high EPS. low QTc. low same as clozapine
50
what is the SE profile for ziprasidone
metabolic. low EPS. low QTc. high
51
what is delirium
insomnia, fluctuating level of consciousness, agitation and paranoid delusions
52
what is the treatment of choice for catatonia
1-benzo | 2-ECT
53
how does catatonia present
patient with a long history of bipolar that presents with immobility, resistance to movement and mutism. treat with Benzodiazepines (lorazepam) or ECT
54
when is a person supposed to be on lifetime antidepressants
>3 lifetime depressive episodes, suicide attempts or episodes >2 years
55
which atypical antipsychotics have the least risk of hyperprolactinemia
aripiprazole and quetiapine
56
which two atypical antipsychotics have the least SE
aripiprazole and quetiapine
57
what pathway is involved in the prolactinemia path?
Think the EPS pathway or the niagrostriatal path.
58
what class should you use in a patient with depression and diabetic neuropathy
SNRIs or TCAs.
59
what is the SE profile for lurasidone
metabolic. low EPS. medium QTc. low
60
what are the first line treatments for acute bipolar depression
quetiapine, lurasidone, lamotrigine, lithium, valproate, and the combination of olanzipine and fluoxetine.
61
what drugs treat akathisia
beta blockers, benztropine and Benzodiazepines
62
what drugs treat acute dystonia
anticholinergics benztropine and diphenhydramine remember that acute dystonia can be muscle spasms and result in random movement of a limb.
63
what is the treatment for intractable hiccups
chlorpromazine
64
what is the treatment for acute mania in a pregnant woman?
depends on the date of the pregnancy but ECT works
65
what are the symptoms of opioid withdrawal
The withdrawal sequalae can include dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, nausea/vomiting, fever, dilated pupils, abdominal cramps, athralgia, myalgia, hypertension, tachycardia, and craving.
66
what drug should be avoided in a patient in opioid withdrawal f they have a QTc prolongation
methadone. this can cause arrhythmia
67
what drug is given to avoid the withdrawal symptoms of opiates
clonidine
68
what are the side effects for verenicline
nausea, suicidal ideation, constipation.
69
what sleep aid do you use for an elderly man? with insomnia
zolpidem | do not use trazodone due to postural hypotension, priapism.
70
what are the best choices for antipsychotics in acute mania
olanzapine, haloperidol, risperadone
71
what the drug used for dyspareunia
ospemifine this is a ZSERM.
72
SE of ospemifine
Side effects associated with ospemifene include vaginal discharge, hot flashes, and diaphoresis.
73
what is a phsyiological argument against using imipramine for enuresis
cardiac arrhtythimia
74
what are some of the criteria for avoidant and restrictive food intake disorder
avoiding food based on its texture and having nutritional definciency
75
what is the most common cardiac arrhythmia for psychiatry
torsades.
76
what does torsades look like on an ekg?
like a twisting of peaks
77
what is the treatment for torsades
magnesium sulfate
78
What treatment can be used for bipolar disorder maintenance in the second trimester
lamotrigine can be used during the second and third trimester
79
What treatment is used for acute mania in pregnancy and what is used for maintenance therapy
1st trimester: maintenance therapy --NONE. 2-3 trimester maintenance --lamotrigine acute mania: ECT
80
what is first line pharm for ADHD with tourettes
atomoxetine. do not use methylphenidate because it worsens the symptoms of Tourettes
81
what drug can be used to augment SSRI therapy ---what drugs should not be used
lithium | Do not add another SSRI or SNRI never add a MOAi or st johns wort as there is a risk of serotonin syndrome
82
what are the only treatments FDA approved for hyperactivity and irritability in autism
risperidone and aripiprazole
83
what are the best choices for Benzodiazepines in alcohol withdrawal
ChLOT chlordiazepoxide, lorazepam (first line), oxezepam and temazepam
84
is cocaine a teratogen
no. but it can cause placental abruption including low birth weight, preterm delivery and intra-uterine growth restriction.
85
what is a lesser known SE of carbamazepine toxicity
ataxia
86
what are the treatments for anorexia
family and psychotherapy are the best, but if these fail use olanzapine
87
what mood stabilizer can cause hypercalcemia
lithium
88
what are the SE of lithium
hypercalcemia via hyperparathyroidism, nephrogenic diabetes insipidus, chronic kidney disease, thyroid dysfunction. watch for teratogenic effects
89
is clozapine used for acute management of agitation
NO
90
what are the indications for SSRIs
major depression, OCD, bulimia, anxiety, PTSD and premature ejaculation
91
what are the causes of U waves and inverted T waves on an EKG
hypokalemia from lithium toxicity
92
what pathway do the atypical antipsychotics inhibit which can cause sexual dysfunction?
tubloinfundibular
93
what pathway do the atypical antipsychotics inhibit which can cause gynecomastia
tubuloinunfdibular
94
what pathway do the atypical antipsychotics inhibit which can cause infertility
tubuloinunfdibular
95
what drugs inhibit the reuiptake of serotonin
SSRIs, SNRIs, TCAs, trazodone
96
what drugs inhibit the reuptake of norepinephrine
TCAs and SNRIs
97
what drugs increase the release of NE
bupropion
98
what drug inhibits the inhibition of NE release
mirtazapine
99
what are the pharmacological treatments for insomnia
Remember that the best treatments are sleep hygiene and CBT 1) Benzos --short term 2) Non-benzos zolpidem, eszopiclone, zaleplon 3) antidepressants like trazodone, amitriptyline, and doxepin
100
what are the treatments for narcolepsy
``` sleep hygiene scheduled day time naps. avoidance of shift work amphetamines for daytime sleepiness sodium oxybate for day time sleepiness and cataplexy \ ```
101
what are the treatments for cataplexy
sodium oxybate 0--drug of choice. | imipramine, despiramine, clomipramine SSRIs are also used.
102
what class do milnacepram and levomilnacepram belong
SNRIs
103
why don't we give beta blockers to cocaine overdose
because that would cause unopposed alpha and cause severe hypertension

Psychiatry (11 decks)

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