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Flashcards in Pharmacology Psychiatric Deck (36):
1

What are some typical antipsychotics? Mechanism of action?

High potency: Haloperidol, trifluoroperazine, fluphenazine Low potency: thioridazine, chlorpromazine (haloperidol + "-azines"). Block dopamine D2 receptors (increase cAMP)

2

Uses of typical antipsychotics?

Schizophrenia, psychosis, acute mania, Tourette's

3

Toxicity of typical antipsychotics? Generally speaking.

Highly lipid soluble, takes long time to clear, greater risk of EPS than atypicals, NMS, dopamine receptor antagonism-->hyperprolactinemia-->galactorrhea

4

Treatment of extrapyramidal side effects?

benztropine or diphenhydramine

5

treatment of NMS?

dantrolene (muscle relaxant), D2 agonists (bromocriptine)

6

Chlorpromazine

low potency typical antipsychotic, corneal deposits

7

Thioridazine

low potency typical antipsychotic, retinal deposits

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Haloperidol

high potency typical antipsychotic, NMS, tardive dyskinesia

9

What are some atypical antipsychotics? Mechanism of action? Uses?

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone. Varied effects on 5-HT2, D, alpha, H1 receptors. Schizophrenia, bipolar disorder, OCD, anxiety disorders.

10

Treatment of tourette's syndrome?

antipsychotic (eg haloperidol or risperidone)

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Toxicity profile of atypical antipsychotics

Less EPS, NMS risk than typical antipsychotics (less anticholinergic)

12

Olanzapine

atypical antipsychotic, significant weight gain

13

Clozapine

atypical antipsychotic, significant weight gain, agranulocytosis (requires weekly RBC monitoring), seizure

14

Risperidone

atypical antipsychotic, anti-dopaminergic effects --> increase prolactin --> lactation and manboobs --> decreased GnRH, LH, FSH -->irregular menstruation and fertility problems

15

Ziprasidone

atypical antipsychotic, prolong QT interval

16

What is mechanism of action of Lithium? Uses?

Unknown MoA (possible inhibition of phosphoinositol cascade). Mood stabilizer for bipolar disorder. Acute mania. SIADH.

17

Lithium toxicity?

LMNOP: Lithium, movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems. Exclusively renal excreted and re-absorbed at PCT with Na-->requires close monitoring of serum levels

18

Lithium toxicity to fetus?

Ebstein anomaly (apically displaced tricuspid valve), malformation of great vessels

19

Buspirone. MoA? Uses? Toxicity?

Stimulates 5-HT1A receptor. Used in generalized anxiety disorder. Does NOT cause addiction/dependence but takes 1-2 weeks to become effective. Does not interact with alcohol (vs barbiturates/benzos)

20

What are some SSRIs? Mechanism?

Fluoxetine, paroxetine, sertraline, citalopram. 5-HT specific reuptake inhibitors (inhibit serotonin specific re-uptake pump).

21

Uses of SSRIs?

Depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD--First line for most things except bipolar disorder, psychosis (schizo) and tourette

22

Toxicity of SSRIs?

Generally fewer than TCAs, GI distress, sexual dysfunction, serotonin syndrome

23

What is serotonin syndrome? Causes? Tx?

Hyperthemia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures. Tx with cyproheptadine (5-HT2 receptor antagonist). Caused by any drug that increased 5HT (MAO inhibitors, SNRIs, SSRIs, TCAs)

24

What are some SNRIs? Mechanism?

Venlafaxine, duloxetine. Inhibit 5-HT and norepinephrine uptake.

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What is an unusual use for duloxetine?

Diabetic peripheral neuropathy

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SNRI toxicities?

Increased BP, stimulant effects, sedation/nausea, serotonin syndrome

27

What are some TCAs? Mechanism

Amitriptyline, nortriptyline, imipramine, desipramine (-iptyline and -ipramines). Block reuptake of norepinephrine and 5-HT.

28

TCA uses?

Major depression, OCD (clomipramine), fibromyalgia

29

TCA toxicities? Tx?

Sedation, alpha1-blocking effects (postural hypotension), anti-cholinergic tox (amitriptyline). Three Cs: coma, convulsions, cardiotoxic (arrythmias, prolonged QT). Tx with sodium bicarbonate for cardiac toxicity. Serotonin syndrome.

30

What are some MAO inhibitors? MoA?

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline. Inhibits MAO resulting in increase of amine neurotransmitters (norepi, 5-HT, dopamine)

31

Use of MAO inhibitors?

Never use, only as last resort given potential side effects. Atypical depression, anxiety, hypochondriasis.

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MAO inhibitor toxicities?

HTN crisis from tyramine effect (wine, cheeses). CNS overstimulation.

33

What are some contraindications to prescribing MAO inhibitors?

Serotonin syndrome risk: SSRIs, TCAs, St John's wort (CYP450 inducer), meperidine (opioid with 5HT-ergic effects), dextromethorphan (cough supressant, SNRI effects)

34

Bupropion

atypical antidepressant; smoking cessation; increases norepi and dopamine via unknown mechanism; Tox: stimulant effects/headache/seizure in bulimic patients/no sexual SEs

35

Mirtazapine

atypical antidepressant; alpha2-antagonist/potent 5HT2 and 5HT3 receptor antagonist (increases release of norepi and 5HT); Tox: sedation, increased appetite/weight gain

36

Trazadone

atypical antidepressant; insomnia; blocks 5HT2 and alpha1-adrenergic receptors; Tox: priapism, postural hypotension