Pharmacology-Psychiatry Flashcards by Sadaf S

CNS stimulants – names

methylphenidate, dextroamphetamine, methamphetamine

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CNS stimulants – mechanism

increase catecholamines (NE + D) at the synaptic cleft

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CNS stimulants – use

ADHD, narcolepsy, appetite control

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Antipsychotics (neuroleptics) – names

haloperidol + (trifluoper-, fluphen-, thiorid-, chlorprom-)-AZINE

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Antipsychotics (neuroleptics) – mechanism

all typical antipsychotics block D2 receptors thus increasing [cAMP]

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Antipsychotics (neuroleptics) – stored or excreted

highly lipid soluble thus stored in body fat and slow to be removed

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Antipsychotics (neuroleptics) - high potency

Trifluoperazine, Fluphenazine, Haloperidol

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Side effects of high potency Antipsychotics (neuroleptics)

neurologic side effects (Extrapyrimidal symptoms)

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Explain Extrapyramidal symptoms (EPS)

4h - acute dystonia (musc spasm, stifness, oculogyric crisis)
4d - akathisia (restlessness)
4wk- bradykinesia (parkinsonism)
4mo- tardive dyskinesia

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Antipsychotics (neuroleptics) - low potency

Chlorpromazine, Thioridazine

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Side effects of low potency antipsychotics (neuroleptics)

non-neurologic:

anticholinergic - dry mouth, constipation
antihistamine - sedation
alpha1 blockade effects - hypotension

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Antipsychotics (neuroleptics) - other side effects

endocrine effects: dopamine receptor antagonism leads to hyperprolactinemia leads to galactorrhea

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Chlorpromazine – side effects

corneal deposits

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Thioridazine – side effects

NAME?

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Haloperidol – side effects

NMS (neuroleptic malignant syndrome), tardive dyskinesia

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What is neuroleptic malignant syndrome?

rigidity, myoglobinurea, autohomic instability, hyperpyrexia

think FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigid muscles

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What is the treatment of NMS

dantrolene

- D2 agonists (eg. bromocriptine)

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What is tardive dyskinesia

oral facial movements as a result of long-term antipsychotic use. irreversible

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Atypical Antipsychotics – names

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

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Atypical Antipsychotics – mechanism

effects 5HT2 (not 3), D, alpha and H1 receptors

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Atypical Antipsychotics – use

Schizophrenia – positive and negative symptoms

- Also: Bipolar, OCD, anxiety, depression, mania, tourettes

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Atypical Antipsychotics – toxicity

fewer extrapyrimidal and anticholinergic side effects than traditional ones

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Olanzapine/clozapine – side effects

significant weight gain

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Clozapine – side effects

agranulocytois (requires weekly Wbc count) and seizures

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Ziprasidone -- side effects

prolong QT interval

Lithium -- mechanism

possibly due to inhibition of phosphoinositol cascade

Lithium -- use

Bipolar: blocks relapse and acute manic events | SIADH

Lithium -- toxicity

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antag, causing nephrogenic diabetes insipidus), teratogenesis "LMNOP: Lithium: Movement, Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy probs"

What effects does lithium have on fetus

fetal cardiact defects (ebstein anomaly, malformations of great vessels)

what is the therapeutic window of lithium

very narrow

how is lithium excreted

kidneys, most reabsorbed at PCT following Na+ reabsorption

Buspirone -- mechanism

(+) 5HT1a receptors

Buspirone -- use

generalized anxiety disorder "i always get anxious if the BUS will be on time so i take buspirone)

Buspirone -- why is it advantageous

- does not cause sedation, addiction, tolerance and takes 1-2wks - does not interact with alcohol (unlike barbs/benzos)

Antidepressants -- typical types

SSRI, SNRI, TCA, MAO inhibitors

Antidepressants -- time it takes for effect

4-8wks

SSRI -- names

Fluoxetine, paroxetine, sertraline, citalopram

SSRI -- mechanism

serotonin specific reuptake inhibitor

SSRI -- use

depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD

SSRI -- toxicity

fewer than TCAs - GI distress, sexual dysfunction (decreased libido and anorgasmia) - serotonin syndrome

What is serotonin syndrome

- occurs w/ any drug which increases serotonin | - hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures

Which drugs increase serotonin

MAO inhibitors, SNRIs, TCAs, SSRI's

What is the treatment of serotonin syndrome

cyproheptadine (5HT2 receptor antagonist)

SNRI -- names

Venlafaxine, Duloxetine

SNRI -- mechanism

inhibit serotonin and NE reuptake

SNRI -- general use

depression

Venlafaxine -- use

depression, generalized anxiety, panic disorder

Duloxetine -- use

- depression, diabetic peripheral neuropathy | - greater effect on NE

SNRI -- toxicity

- increased BP most common | - stimulant effects, sedation, nausea

TCA -- names

(Ami, Nor)-triptyline; (Im, Des, Clom)-ipramine; Doxipin, Amoxapine **All end in -iptyline or -ipramine except last two

TCA -- mechanism

blocks reuptake of NE and S

TCA -- use

- major depression, fibromyalgia

Imipramine -- use

bedwetting

Clomipramine -- use

OCD

TCA -- toxicity

Tri-C's: convulsion, coma, cardiotoxicity (arrhythmias), - Sedation - a1 blocking effects: postural hotn - atropine-like (anti-cholinergic): tachycardia, urinary retention, dry mouth

TCA -- which have more anticholinergic effets

tertiary TCAs (amytriptyline) than secondary (nortriptyline)

TCA -- What is special about desipramine

less sedating and has higher seizure threshold

TCA -- toxicity in elderly

confusion, hallucinations due to anticholinergic Sx (use nortriptyline)

TCA -- treatment of cardiotoxicity

NaHCO3

MAO inhibitors -- names

Tranycypromine, phenelzine, isocarboxazid, selegiline

What is Selegeline selective for

MAO-B

MAO inhibitor -- mechanism

nonselective MAO inhibition increases levels of amine NT's: ME, S, D

MAO inhibitors -- use

atypical depression, anxiety, hypochondriasis

MAO inhibitors -- toxicity

- hypertensive crisis (especially w/ ingestion of tyramine from wine/cheese) - CNS stimulation

MAO inhibitors -- contraindications and why

contraindicated w/ SSRIs, TCAs, St. Johns wort, meperidine, dextromethorphan to prevent serotonin syndrome

Bupropion -- use

depression, smoking cessation

Bupropion -- mechanism

increase NE and D

Bupropion -- toxicity

stimulant effects -- tachycardia, insomnia headache seizures in bulimic pts no sex sx

Mirtazapine -- mechanism

a2 antag (increase release NE and S) and potent 5ht2 and 5ht3 antag

Mirtazapine -- toxicity and uses

sedation (useful in insomniacs) increased appetite and wt gain (useful in elderly/anorexics) dry mouth

Maprotiline -- mechanism

blocks NE reuptake

Maprotiline -- toxicity

sedation, orthostatic hOtn

Trazodone -- mechanism

inhibits S reuptake

Trazodone -- use

Primarily for insomnia as high doses are needed for antidepressant effect

Trazodone -- toxicity

sedation, nausea, priaprism, postural hOtn

Atypical Antidepressants - Names

Bupropion, Mirtazapine, Maprotiline, Trazodone

Pharmacology-Psychiatry Flashcards

(76 cards)