Exam 3- Neuro and Psych Flashcards
(30 cards)
Donepezil
Galantamine
Rivastigmine
M: AChE inhibitors
S/E: Nausea, dizziness, insomnia
Memantine
M: NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca)
S/E: dizziness, confusion, hallucinations
Alcohol
Intox: Emotional lability, slurred speech, ataxia, coma, blackouts. Serum gamma-glutamyltransferase is sensitive indicator of alcohol use. AST 2x ALT in alcohol abuse.
Withdrawal: mild alcohol withdrawal- anxiety, tremor, seizures, insomnia. Severe- can cause autonomic hyperactive and DT’s 5-15% mortality. tx with bento’s for DT’s
Opioids
Intoxication: euphoria, respiratory, and CNS depression. decreased gag reflex and bowel sounds, pupillary constriction, seizures. Tx with naloxone or naltrexone
Withdrawal: sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea,
tx with methadone, buprenorphone, long-term support
Barbiturates
Intoxication: low safety margin. marked respiratory depression. tx with symptom management (assist breathing and BP)
Withdrawal: delirium, life threatening cardiovascular collapse
Benzodiazepines
Intoxication: Greater safety margin. Ataxia, minor respiratory depression, tx with supportive care and flumazenil (competitive benzo antagonist)
Withdrawal: sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reversal with flumazenil)
Amphetamines
Intox: euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. severe: cardiac arrest and seizure.
Withdrawal: anhedonia, increased appetite, hyper somnolence, existential crisis
Cocaine
Intox: impaired judgement, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. tx with benzo’s
Withdrawal: hypersomnolence, malaise, sever psychological craving, depression/suicidality.
Caffeine
Intox: restlessness, increased diuresis, muscle twitching
Withdrawal: lack of concentration and headache
Nicotine
Intox: restlessness
Withdrawal: irritability, anxiety, craving. tx with nicotine patch, gum, or lozenges; bupropion/ varenicline.
PCP- phencyclidine
Intox: belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. tx with benzo’s, rapid acting antipsychotic.
Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
Lysergic acid diethylamide
Intox: perceptual distortion (visual and auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks
Marijuana
Intox: euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations. prescription form is dronabinol-used as antiemetic and appetite stimulant.
Withdrawal: irritability, depression, insomnia, nausea, anorexia. most symptoms peak in 48 hours and last for 5-7 days. generally detectable in urine for 4-10 days.
methyphenidate
dextroamphetamine
methamphetamine
phentermine
CNS Stimulants
M: increase catecholamines at synaptic cleft, especially NE and Dopamine
C: ADHD, narcolepsy, appetite control
Haloperidol trifluoperazine fluphenazine thioridazine chlorpromazine
Neuroleptics
M: block dopamine D2 receptors (increase cAMP)
C: schizophrenia (primarily postive symptoms), psychosis, acute mania, and Tourette syndrome
T: highly lipid soluble and stored in body fats; thus have very slow removal from body.
-extrapyramidal system side effects, tx with benztropine or diphenhydramine
-endocrine side effects: hyperprolactinemia (dopamine antagonist)
-anti muscarinic: dry mouth and constipation
-anti alpha-1: hypotension
-anti histamine: sedation
Chlorpromazine - corneal deposits
Thioridazine - retinal deposits
Neuroleptic Malignant Syndrome- rigidity, myoglobinuria, autonomic instability, hyperpyrexia. tx with dantrolene, D2 agonists (bromocriptine)
Tardive Dyskenesia: stereotypic oral facial movements as a result of long term antipsychotic use potentially irreversible.
try to fly high- Triflu, fluphen, and halo are high potency and cause more neurologic side effects than the rest.
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
Atypical Antipsychotics
M: not completely understood. varied effects on 5-HT2, dopamine, alpha, and H1 receptors
C: schizophrenia- both positive and negative symptoms. bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome
T: fewer extrapyrimidal and anticholinergic side effects than tradition antipsychotics.
-Olanzapine/clozapine may cause significant weight gain.
-Clozapine may cause agranulocytosis (weekly CBC) and seizure.
-Risperidone may increase prolactin (decrease GnRH, LH, FSH)
-Ziprasidone may provolone the QT
*watch clozapine clozely
Lithium
M: not established; possibly related to inhibition of phosphoinositol cascade
C: mood stabilizer for bipolar disorder; blocks relapse and acute manic events. also SIADH
T: tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis. Fetal cardia defects include Ebstein anomaly and malformation of the great vessels. Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by the kidneys; most is reabsorbed at the PCT following Na reabsorption
Buspirone
M: stimulates 5-HT1A receptors
C: generalized anxiety disorder. does not cause sedation, addition, or tolerance. takes 1-2 weeks to take effect. does not interact with alcohol (vs barbiturates and benzo’s)
Fluoxetine
Paroxetine
Sertraline
Citalopram
SSRI’s
M: 5-HT specific repuptake inhibitors, take 4-8 weeks to work
C: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD
T: fewer than TCA’s. GI distress, sexual dysfunction (anorgasmia and decreased libido)
-when taken with drug that increases 5-HT (MAOI’s, SNRI’s, TCA’s) can cause:
Serotonin syndrome: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures. tx with cyproheptadine (5-HT2 receptor antagonist)
Venlafaxine
duloxetine
SNRI’s
M: inhibit 5-HT and NE reuptake
C: depression. Venlafaxine also used in generalized anxiety disorder and panic disorder. Duloxetine is also used for diabetic peripheral neuropathy.
T: increased BP most common; also stimulant effects, sedation, and nausea
Amitriphtyline nortriptyline imipramine desipramine clomipramine doxepin amoxapine
TCA’s
M: block repute of NE and 5-HT
C: major depression, OCD (clomipramine), and fibromyalgia
T: - Convulsions, coma, cardiotoxicity (Tri-C’s), respiratory depression, hyperpyrexia, confusion and hallucinations in elderly do to anti-Ach effects. tx cardiotoxicity with NaHCO3
-sedation, alpha 1 blocking effects (postural hypotension), and anticholinergic effects (dry mouth, urinary retention, tachycardia).
-tertiary TCA’s (amitriptyline) have more anticholinergic effects than secondary (nortriptyline)
-desipramine is less sedating but has higher seizure incidence.
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
MAOI’s
M: nonselective MAO inhibition. increases levels of amine neurotransmitters (NE, 5-HT, dopamine). Selegiline MAOB selective.
C: atypical depression, anxiety, hypochondriasis
T: hypertensive crisis (most notably with tyramine rich foods, like wine and cheese), CNS stimulation. contraindicated with SSRI’s, TCA’s, St John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)
Bupropion
atypical antidepressant
M: unknown mechanism, increases NE and dopamine
C: antidepressant and smoking cessation
T: stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. no sexual side effects.
Mirtazapine
Alpha 2 antagonist
M: increase release of NE and 5-HT and potent antagonist of 5-HT-2/3.
C: depression, some side effects may be desirable in specific patients.
T: sedation, increased appetite, weight gain,
