Psych Flashcards
(70 cards)
1
Q
Phenelzine
A
MAOI Antidepressant MOA: irreversibly blocks monoamine oxidase --| metabolizes 5HT,NE, DA
ADR: Very effective (50+%) sig side effects, 3rd line tx sedating, serotonin syndrome HTN crisis (cheese syndrome from too much tyramine
DDI:
AVOID: SSRI, SNRI, TCA, tramadol, meperidine, dextromethorphan, amphetamines, lethal
2
Q
Trancycpromine
A
MAOI Antidepressant MOA: irreversibly blocks monoamine oxidase --| metabolizes 5HT,NE, DA
ADR: Very effective (50+%) sig side effects, 3rd line tx sedating, serotonin syndrome HTN crisis (cheese syndrome from too much tyramine
DDI:
AVOID: SSRI, SNRI, TCA, tramadol, meperidine, dextromethorphan, amphetamines, lethal
3
Q
Imipramine
A
TCA (tertiary amine) Antidepressant (off label ADHD) MOA: \+++ serotonergeric reuptake blockade \++ NE reuptake blockade also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)
ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating
DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD
4
Q
Amiptyline
A
TCA (tertiary amine) Antidepressant MOA: \+++ serotonergeric reuptake blockade \++ NE reuptake blockade also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)
ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating
DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD
5
Q
Clomipramine
A
TCA (tertiary amine) Antidepressant MOA: \+++ serotonergeric reuptake blockade \++ NE reuptake blockade also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)
ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating
DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD
6
Q
Despramine
A
TCA (Secondary amine) (ADHD off label) Antidepressant MOA: \+++NE reuptake blockade \+Serotonergic reuptake blockade
ADR:
Secondary amines; same as tertiary bu weaker
monitor [plasma]
DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD
7
Q
Nortriptyline
A
TCA (Secondary amine) (ADHD off label) Antidepressant MOA: \+++NE reuptake blockade \+Serotonergic reuptake blockade
ADR:
Secondary amines; same as tertiary bu weaker
monitor [plasma]
DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD
8
Q
Fluoxetine
A
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
9
Q
Sertraline
A
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
10
Q
Citalopram
A
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
11
Q
Escitalopram
A
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
12
Q
Paroxetine
A
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
13
Q
Venlafaxine
A
SNRI Antidepressant (ADHD off label) MOA: dual action seratonin and NE reuptake pump blocks and prevents reuptake Mostly locus coeruleus
ADR: Diastolic BP increase discontinuation sxs terrible QT prolongation BBox: increased suicidal ideation
14
Q
Duloxetine
A
SNRI Antidepressant MOA: dual action seratonin and NE reuptake pump blocks and prevents reuptake Mostly locus coeruleus
ADR: Diastolic BP increase discontinuation sxs terrible QT prolongation BBox: increased suicidal ideation
15
Q
Nefazodine
A
SNRI Antidepressant MOA: dual action seratonin and NE reuptake pump blocks and prevents reuptake Mostly locus coeruleus
ADR: Diastolic BP increase discontinuation sxs terrible QT prolongation BBox: increased suicidal ideation
16
Q
Trazadone
A
Dual Action
Antidepressant
MOA:
Blocks 5Ht2a/c receptors; 5HT transporter, a1 receptors, H1 antagonism
NERI
17
Q
Bupropion
A
NE/DA reuptake inhibitor Antidepressant (ADHD off label) MOA: blocks NE/DA reuptake reduced sexual side effects vs other ADDs
ADR:
Insomnia, tremor, tinnitus, seizures
avoid in eating disorders (reduces appetitie0
least likely to cause mania
DDI
CYP2D6 inhibition
Increases MAOI, TCA, tramadol, levodopa
18
Q
Mirtazepine
A
Alpha-2 antagonist
Antidepressant
MOA:
Alpha -2 antagonist
SRI
Histamine receptor antagonist
ADR:
weight gain, sedation
low sexual side effects
DDI:
No CYP450
Don’t combine w/ MAOI
19
Q
Diazepam
A
Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant
MOA: non-selective GABA agonist a1-3 and a5 possitive allosteric modulator for GABA --sleep/anterograde amnestic = a1 --anxiolytic = a2 --muscle relaxant = a3
ADR:
sedation, depression, amnesia, ataxia, dependence, withdrawal
Very long half life 20-50 hrs
metabolite buildup - liver cirrhosis
DDI:
- EtOH - additive for sedation, resp arrest
- Opiates, cimetadine
- flumazenil reverses
- safe, non- GABA activating
- addictive a1 effects
20
Q
Chlordiazepoxide
A
Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant
MOA: non-selective GABA agonist a1-3 and a5 possitive allosteric modulator for GABA --sleep/anterograde amnestic = a1 --anxiolytic = a2 --muscle relaxant = a3
ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- Half life 5-30 (metabolite cirrhosis)
DDI:
- EtOH - additive for sedation, resp arrest
- Opiates, cimetadine
- flumazenil reverses
- safe, non- GABA activating
- addictive a1 effects
21
Q
Lorazepam
A
Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant
MOA: non-selective GABA agonist a1-3 and a5 possitive allosteric modulator for GABA --sleep/anterograde amnestic = a1 --anxiolytic = a2 --muscle relaxant = a3
ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- renal clearance;
- half life 10-20h
DDI:
- EtOH - additive for sedation, resp arrest
- Opiates, cimetadine
- flumazenil reverses
- safe, non- GABA activating
- addictive a1 effects
22
Q
Alprazolam
A
Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant
MOA: non-selective GABA agonist a1-3 and a5 possitive allosteric modulator for GABA --sleep/anterograde amnestic = a1 --anxiolytic = a2 --muscle relaxant = a3
ADR: Sedation, depression, amnesia, ataxia, dependence, withdrawal - shortest half life 6-12hrs - most addictive - strongest
DDI:
- EtOH - additive for sedation, resp arrest
- Opiates, cimetadine
- flumazenil reverses
- safe, non- GABA activating
- addictive a1 effects
23
Q
Clonazepam
A
Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant
MOA: non-selective GABA agonist a1-3 and a5 possitive allosteric modulator for GABA --sleep/anterograde amnestic = a1 --anxiolytic = a2 --muscle relaxant = a3
ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- popular with psychiatrists
- half life = 18-50 hrs
DDI:
- EtOH - additive for sedation, resp arrest
- Opiates, cimetadine
- flumazenil reverses
- safe, non- GABA activating
- addictive a1 effects
24
Q
Zolpidem
A
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
25
Zalaplon
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
26
Eszopiclone
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
27
Busprione
Anxiolytic
Non-BZDP
GAD
adjuvant for MDD
MOA:
Serotonin receptor partial agonist 5HT-1a
```
Clin Use:
GAD
non sedating, addictive, tolerancing
1-2 weeks for effect
no EtOH/BZD interactions
```
ADR:
Dizziness, HA, sedation, nervousness/restlessness
No dependence/withdrawal
4+ weeks for effect
DDI:
MAOI
28
Lithium
Classic Mood stabilizer
MOA:
unknown
PK:
narrow therapeutic range - monitor
urine excretion
Vd = TBW
ADR:
tox: N/V/D, ataxia
SEs: lethargy, weight gain, blurred vision, tremor, polyuria/dipsia, cog slowing
DDI:
diuretics, NSAID, ACEI, CCB
29
Valproic Acid
Anticonvulsant, mood stabilizer
MOA:
increases GABA, inhibits Glu
PO for seizures, mood stabilization, HA prophylaxis
PK:
hepatic metabolism; inhibits some enzymes
T1/2 = 16h
monitor levels, LFTs, ovaries, CBC
ADR:
Hepatotox
teratogenic
pancreatitis
30
Carbamazepine
Anticonvulsant, mood stabilizer
```
MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain
```
PK:
Hepatic metabolism
enzyme self inducer
T1/2 = 12 hrs
```
AE:
increase toxic potential of other drugs
Drowsiness, HA, incoordination, decreased EtOH tolerance, weight gain
aplastic anemia
Derm rxns in asians
```
31
Lamotrigine
Anticonvulsant - Mood stabilizer
```
MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain
Depressed phase
```
PK:
glucuronidation
T1/2 13h
AE:
serious skin rashes - Stevens-Johnson syndrome
topical epidermal necrolysis
N/V. dizziness visual disturbance, somnelence, ataxia, HA
32
Oxcarbazepine
Anticonvulsant, mood stabilizer
```
MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain
```
PK:
Renal
T1/2 ~3hrs
AE:
Dizziness, drowsiness, visual changes, fatigue, HA, N/V, cog impairment, hyponatremia
33
Olanzapine
Atypical-Antipsychotic
Dibenzodiazepine
MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
-->Releases DA to PFC --> mesolimbic pathway inhibition
Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette's
```
PK:
Hepatic;
renal/fecal excretion
dissolves rapidly
T1/2 = 21-50h
```
AE:
Drowsiness, flu-like sx, weigh tgaine, salivation
Tardive dyskinesai, QTc prolongation,
neuroleptic-malignangt syndrome
34
Modafinil
Narcolepsy, TBI
| MOA unknown
35
Amantadine
Cog impairment
| non-competitive NMDAr antagonist
36
Memantine
Cog impairment
MOA:
non-competitive NMDAr antagonist
DA agonist - improves motivation
Ind:
mod-severe AD
AE:
constipation, dizziness, HA, pain
37
Methylphenidate
ADHD
Amphetamine
MOA:
NE/DA reuptake blocker
PK:
rapid PO absorption
short half life
3-4hr effect
Ind:
ADHD, TBI?
AE:
Nervousness, insomnia, shakiness, potential for dependence/abuse
DDI:
MAOI
38
Dextroamphetamine
ADHD
Amphetamine
NE/DA reuptake blocker
39
Atomoxetine
ADHD
Selective NE reuptake inhibitor
PK:
rapid GI absorption
Hepatic metabolism
Use:
ADHD
AE:
liver tox, Suicidal ideation
40
Duloxetine
ADHD
| Selective NE reuptake inhibitor
41
Donepezil
Alzheimers
Acetylcholinesterase inhibitor
PK:
good PO absorbtion
high protein binding
long half life
Use:
AD treatment
AE:
N/V/D, dizziness, sinus bradycardia, 1st * AV block, Monitor LFTs,
42
Rivastigmine
Alzheimers
| Acetylcholinesterase inhibitor
43
Galantimine
Alzheimer's
| Acetylcholinesterase inhibitor
44
Amphetamine
ADHD
Psychostimulant
Indirect adrenergic, stimulates NE, DA, 5HT release
45
Lisdexamfetamine
ADHD
| Amphetamine prodrug
46
Atomoxetine
ADHD non stimulant
| SNRI
47
Guanfacine
```
ADHD non-stimulant
a2 agonist (central acting)
```
48
clonidine
```
ADHD non-stimulant
a2 agonist (central)
```
49
Chlorpromazine
Typical antipsychotic
Neuroleptic
low potency
Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes
MOA:
Blocks DA D2 receptors
Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight
Minimal improvement of negative/cog symptoms
limited efficacy because of SEs
SEs:
Low potency, sedation, dry mouth, blurred vision, constipation, urinay retention, weight gain
EPS effects: acute dystonia, Parkinsonism, akaathesia, dyskinesia
Prolactin elevation
50
Haloperidol
Typical antipsychotic
Neuroleptic
High potency
MOA:
Blocks DA D2 receptors
Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes
Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight
Minimal improvement of negative/cog symptoms
limited efficacy because of SEs
SEs:
High potency: rigidity stiffness, acute dystonia, Parkinsonism, akasthesia, dyskinesia
51
Fluphenazine
Typical antipsychotic
Neuroleptic
High potency
MOA:
Blocks DA D2 receptors
Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes
Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight
Minimal improvement of negative/cog symptoms
limited efficacy because of SEs
SEs:
High potency: rigidity stiffness, acute dystonia, Parkinsonism, akasthesia, dyskinesia
52
Perphenazine
Typical antipsychotic
Neuroleptic
mid potency
MOA:
Blocks DA D2 receptors
Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes
Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight
Minimal improvement of negative/cog symptoms
limited efficacy because of SEs
SEs:
Mid range potency
53
Clozapine
Atypical antipsychotic
dibenzodiazepine
MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
-->Releases DA to PFC --> mesolimbic pathway inhibition
Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette's
```
Effects:
Most powerful antipsychotic
both +/- sx
only approved refractory tx
decreases suicide/relapse/comorbid SUD
```
```
SEs:
SEizures
agranulocytosis (weekly WBC)
myocarditis
Weight gain (significant)
```
54
Risperidone
Atypical antipsychotic
dibenzodiazepine
MOA:
MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
-->Releases DA to PFC --> mesolimbic pathway inhibition
Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette's
Effects:
fewer relapses
SEs:
EPS symptoms
prolactin elevation
55
Quetiapine
Atypical antipsychotic
dibenzodiazepine
MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
-->Releases DA to PFC --> mesolimbic pathway inhibition
Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette's
Effects
SEs:
minimal EPS/prolactin
56
Aripiprazole
Atypical antipsychotic
Dopamine system stabilizer
MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
-->Releases DA to PFC --> mesolimbic pathway inhibition
Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette's
Effects
Not as good as clozapine/olanzapine but safer
```
SE:
minimal EPS sx
no prolactin elevation
low weight gain
Early activation,
insomnia
```
57
D-cycloserine
Experimental antipsychotic
58
mGluR
Experimental Antipsychotic
59
Buprenorphine
Opioid
u partial agonist
combined w/ naloxone in Suboxone
60
Opioids (morphine, codeine)
Opium - Poppy fluid
Opiate - derived from opium poppy
Opioid - synthetic/semi-synthetic opioid agonist
Intox:
Euphoria, resp, CNS depression
--v gag reflex, pupillry constriction
Seizures
W/D:
Sweating, dilated pupils, piloerection, ever rhinorrhea, yawning, N/V/D, abd cramps, flu like sx
Tx.
Acute = Naloxone
Chronic = Naltrexone, buprenorphine, methadone
61
Cocaine
Stimulant, drug of abuse
Pharm:
IV/ smoked = diminished IN
Intox:
Impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death
W/D:
Hypersomnolence, malaise, severe psychological craving, depression/suicidality
Tx.
Benzos.
62
Heroin
```
Analgesic drug of abuse
PK:
prodrug - diacetyl morphine
lipid soluble rapid bbb penetration
2x morphine
short acting
```
W/D:
Early -- lacrimation, yawning, rhinorrhea, sweating, sense of anxiety, doom
Middle -- restless sleep, dilated pupils, anorexia, gooseflesh, irritability, tremor
Late: increase of early/middle sx + HR/BP, N/V/D, abd cramp, depression, muscle cramps, weakness, bone pain
63
Methadone
Opioid abuse
Pk: slow tolerance development (chronic pain)
long half life, high PO availability
delayed onset of action
Neurobio:
Fulll u-opiod receptor agonist
Ideal for addiction treatment
S/Sx use:
warm skin, pruritis, pleasure, relaxation, satisfaction, nodding off, euphoria
S/Sx OD:
Miosis, coma, resp depression, Pulm edema, seizures
Tx- naloxone
W/D:
delayed onsed +3 days
3+ weeks of withdrawal
64
Marijuana
Hallucinogen, drug of abuse
RF for psychosis, esp during adolescence
Intox:
stimulates appetite, impairs learning, memory, decrease peripheral sensations, impairs cog function
inhibits N/V
euphoria, tachycardia, conjunctival injection
OD: tachycardia, anxiety, panic, paranoia
W/D:
anxiety, irritability, insomnia, decreased mood/food, physical discomfort
Cannabinomimetics:
'4-5x potency
65
Methamphetamine
stimulant, drug of abuse
sympathomimetic amine
NeuroBio:
Enter DA neurons via reuptake -> DA release
Intox:
- intense short lasting euphoria(alertness, energy, confidence, increased sexuality)
- binge till the money runs out
OD:
- hypomania, grandiosity, insomnia, irritability, psychosis, rhabdomyolysis, CV events, bruxism, periodontal disease
W/D:
depression, irritability, suicidal ideation carb craving, relapse
66
Alcohol
```
Stimulant and Depressant
Intox:
- slurred speech, incoordination, unsteady gait, nystagmus,
- impaired attention/memory
- stupor/coma
```
Binge: BAC >0.08
Cogners - additives/byproducts that cause hangovers
BAC vs exam tolerance?
W/D
- HTN, tachycardia, altered, tremors, N/V, hallucinations, SZs, death,
- Tx w/ BZDS and taper
Mech:
- chronic exposure to EtOH - upregulateion of Glu, downregulation of GABA
- cessation = net excitation
Other:
- liver
- dilated cardiomyopathy
- brain damage
- FAS
67
Thiamine
Alcohol abuse
Vitamin
common deficiency in alcoholics
Beri-beri/Wernickie-Korsakoff
68
Naltrexone
Alcohol & Opioid dependence
long term use
~~~don't confuse w/ naloxone~~~
69
Acamprosate
Alcohol abuse
| GABA agonist for withdrawal
70
Disulfram
```
Alcohol abuse (Antabuse)
Aldehyde dehydrogenase inhibitor
```
