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Flashcards in Psych Deck (35)
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1

Stimulants
Drug names

Methylphenidate
Dextroamphetamine
Methamphetamine

2

Stimulants
MOA

Inc. catecholamines in synaptic cleft (NE, Dopa).
Also blocks NE/Dopa reuptake.

3

Stimulants
Clinical use

ADHD, narcolepsy, appetite control

4

Typical antipsychotics (neuroleptics)
Drug names
(Try to Fly High)
(Cheating Thieves are low)

>High potency: Trifluoperazine, Fluphenazine, Haloperidol
>Low potency: Chlorpromazine, Thioridazine
(Haloperidol + -azines)

5

Typical antipsychotics
MOA

Block D2 receptors in nigrostriatal pathway -- inc. cAMP.
(Normally inhibited D2 effects are balanced by excitatory M1 effects -- blocked D2 means inc. M1 cholinergic activity).
Highly lipid soluble -- stored in fat -- slow to be removed.

6

Typical antipsychotics
Clinical use

Schizophrenia
Psychosis, Acute mania
Tourette syndrome

7

Typical antipsychotics
Toxicity (High potency)

Neuro SE (Huntington dse, delirium, EPS sx).
EPS sx evolution:
- 4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
- 4 day: akathisia (restlessness)
- 4 wk: bradykinesia (parkinsonism)
- 4 mo: tardive dyskinesia

8

Typical antipsychotics
Toxicity (Low potency)

Anticholinergic, antihistamine, a1-blockade effects.
Dry mouth, constipation; sedation; hypotension, possible QT prolonged.

9

Neuroleptic malignant syndrome

Disordered thermoregulation and skeletal muscle metabolism (rigidity, myoglobinuria, autonomic instability, hyperpyrexia).
*Mnem. FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes inc., Rigidity
>Tx: Dantrolene, D2 agonist (bromocriptine).

10

Tardive dyskinesia

Stereotypic oral-facial movements due to chronic antipsychotic use.
Lipsmacking, choreoathetoid movements.
Can persist ff. meds discontinuation.

11

Atypical antipsychotics
Drug names

Olanzapine, Clozapine, Quetiapine
Risperidone, Aripiprazole, Ziprasidone

12

Atypical antipsychotics
MOA

Varied effects on 5HT2-receptors, D-receptors, a-receptors, H1-receptors.

13

Atypical antipsychotics
Clinical use

Schizophrenia.
Bipolar d/o (mood-stabilizing).
OCD, anxiety, depression, mania, Tourette syndrome.
Tx-resistant schizophrenia (clozapine).

14

Atypical antipsychotics
Toxicity

Fewer EPS and anticholinergic effects vs. typical antipsychotics.
All may prolong QT interval.
>Clozapine: agranulocytosis, wt. gain, seizures, sialorrhea.
>Olanzapine: wt. gain.
>Risperidone: inc. prolactin (lactation, gynecomastia).

15

Lithium
MOA, clinical use

May be related to inhibition of phosphoinositol pathway.
Mood stabilizer for bipolar -- blocks relapse and acute manic events.
SIADH.

16

Lithium
Toxicity

Movement (tremor).
Nephrogenic DI (polyuria), Hypothyroidism -- close monitoring of TFT, creatinine.
Pregnancy problems (ebstein anomaly).
CI w/ ACEi -- deplete Na, dec. GFR.
*Tx for lithium toxicity: Thiazide

17

Buspirone
MOA, clinical use

Anxiolytic (non-BZ) -- not muscle relaxant or anticonvulsant.
Stimulates 5HT1A-receptors.
For generalized anxiety d/o.
*Takes 1-2 wks for effect

18

SSRIs
Drug names

Fluoxetine, Paroxetine, Sertraline
Citalopram

19

SSRIs
MOA

5HT-specific reuptake inhibitors. Antidepressant.
*Takes 4-8 wks for effect -- take BZ during initiation period.

20

SSRIs
Clinical use

Depression, Generalized anxiety d/o, panic d/o, OCD, bulimia, social phobias, PTSD

21

SSRIs
Toxicity

Sexual dysfunction, GI distress, SIADH
Serotonin syndrome

22

Serotonin syndrome

Caused by any drug that inc. 5HT (MAOi, SNRI, TCA) -- uncommon in pts taking a single serotonergic drug.
Hyperthermia, confusion, myoclonus, CVS instability, flushing, diarrhea, seizures.
Tx: cyproheptadine (5HT2-receptor antagonist).

23

SNRIs
Drug names

Venlafaxine, Duloxetine

24

SNRIs
MOA, clinical use

Inhibit 5HT, NE reuptake, antidepressants.
For depression.
>Venlafaxine: GAD, panic d/o, PTSD.
>Duloxetine: diabetic peripheral neuropathy.

25

Tricyclic antidepressants
Drug names

Amitriptyline, Nortriptyline
Imipramine, Desipramine, Clomipramine, Amoxapine
Doxepin

26

Tricyclic antidepressants
MOA

Block NE, 5HT reuptake

27

Tricyclic antidepressants
Clinical use

Major depression.
Peripheral neuropathy, chronic pain.
Migraine prophylaxis.
OCD (clomipramine).

28

Tricyclic antidepressants
Toxicity

Tri-C's: Convulsions, Coma, Cardiotoxicty (Tx w/ NaHCO3 to prevent arrhythmia).
Respi depression, hyperpyrexia
Sedation, anticholinergic effects, sexual dysfunction.

29

MAO inhibitors
Drug names

Tranylcypromine, Phenelzine, Isocarboxacid
Selegiline (selective MAO-B inhibitor)

30

MAO inhibitors
MOA

Antidepressant.
Irreversible binding of MAO, w/c normally breaks down amine neurotransmitters.
Inc. NE, 5HT, Dopa.