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psych drugs Flashcards

1
Q

Trazodone

A 
Old Sleep aid - sedating antidepressant
antidepressant: prodrug that's converted to 5HT2 antagonist
Adverse: 
- sedation
- GI
- orthostatic hypotension
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2
Q

Sinequan

A

Most sedating, antidepressant sleep-aid

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3
Q

mirtazapine

A 
sedating antidepressant (sleep aid)
antidepressant: 
5HT2 antagonist that affects both the alpha2 and NE auto receptor, ehancing release of NE and 5HT AND it acts as 5HT2 antagonist

Adverse:

  • sedating
  • increased appeptite and weight gain
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4
Q

amitriptyline Hcl

A

sedating antidepressant (sedative hynotic for insomnia)

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5
Q

doxepin

A

Sedating antidepressant, sedative hypnotic for insomnia

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6
Q

Benzodiazepines

A

Sedative hypnotics “BzRAs”
GABA-agonist, bind receptor sites on GABA receptor complex, facilitate GABA action on Cl channel to hyperpolarize neurons. Multiple CNS effects include sedation, amnesia, anxiolysis, myorelaxation, ataxia
Long Half Lives

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7
Q

3 Nonbenzodiazepine hypnotics

A
  1. Ambien (Zolpidem tartrate)
  2. Lunesta (Eszopiclone)
  3. Sonata (Zaleplon)
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8
Q

Ambien

A

Zolpidem tartrate

nonbenzodiazepine hynotic

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9
Q

Lunesta

A

eszopiclone

nonbenzodiazepine hypnotic

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10
Q

Sonata

A

Zaleplon

nonbenzodiazepine hypnotic

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11
Q

Nitrous Oxide

A

Inhaled general anesthetic

low potency, quick on and quick off, good safety margian, adds to amnesia and analgesia

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12
Q

Isoflurane

A

Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction

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13
Q

Sevoflurane

A

Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction

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14
Q

Desflurane

A

Inhaled general anesthetic
Halogenated ether (fluorinated to prevent flammable)
- used for maintenance rather than induction because it is pungent and takes a long time to work
- in peds sometimes used for induction

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15
Q

Propofol

A

Intravenous general anesthetic
- rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
- liver metabolism is rapid, later
- good for long term sedation
- “Milk of Amnesia,” used for INDUCTION and MAINTENANCE as well as SEDATION
- risk of bacterial contamination
GABA Agonist, non-analgesic, amnestic, anitemetic

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16
Q

Etomidate

A

Intravenous general anesthetic

  • rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
  • liver metabolism is rapid, later
  • the longer used, longer to wear off
  • INDUCTION and SHORT SEDATION
  • non-analgesic, potential endocrine effects
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17
Q

Ketamine

A

Intravenous general anesthetic

  • rapid resdistribution from highly perfused tissues into lean tissues for quick offset of action
  • liver metabolism is rapid, later
  • the longer used, longer to wear off
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18
Q

Dexmedetomidine

A

Intravenous general anesthetic

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19
Q

Effects of General Anesthesia (5)

A
  1. Unconsciousness
  2. Amnesia
  3. Analgesia
  4. Attenuation of autonomic reflexes
  5. Skeletal Muscle Relaxation
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20
Q

Malignant Hyperthermia

A

Hypermetabolic syndrome in genetically susceptible patients after exposure to halogenated inhalationals and succinylcholine
- decrease in reuptake of Ca from sarcoplasmic reticulum
uncontrollable muscle contraction
-hyperthermia due to muscle contraction
- hypercabnia (increased CO2)
- Dantroline antidote (inhibits Ca from sarcoplasmic R)

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21
Q

Properties of SSRIs

A
  • Inhibit 5-HT reuptake SELECTIVELY as compared to NE reuptake
  • Relatively selective for 5HT transporter, thus side effects limited to effects on 5HT - mediated response
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22
Q

Properties of SNRI’s

A

Inhibit reuptake transporters for BOTH NE and 5HT

–> elevation of both NE and 5HT at synapse

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23
Q

Properties of TCA’s

A

Inhibit reuptake transporters for both NE and 5HT (like SNRI’s)
- tend to interact with other receptors, therefore a broad range of side effects

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24
Q

Action of MAOIs

A

Inhibit monoamine oxidase, preventing NT breakdown
Type A MAO metabolizes NE, 5HT, tyramine
Tybe B MAO is more selective for metabolising DA

  • Pts taking MAOI’s must be careful with tyramine intake, which at high levels can reverse reuptake inhibitors, causing uncontroled catecholamine release, potential hypertensive crisis
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25
Q

SSRI adverse effects

A

Effects associated with enhanced 5HT:
- HA

  • GI (nausea, diarrhea)
  • weight gain
  • sexual dysfunciton + decreased libido
  • increased risk of bleeding
  • insomnia/hypersomnia
  • hyponatremia in elderly
  • teratogenic potential with SSRI PAROXETINE
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26
Q

SNRI adverse effects

A

SSRI effects (enhanced 5HT) plus NA affects:
((HA, GI, WG, sexual dysfunction/decreased libido, inc bleeding, sleeping, hyponatremia in elderly))
+
INCREASED BP, INCREASED HR
CNS ACTIVATION (Insomnia, anxiety, agitation)

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27
Q

TCA adverse effects

A

SNRI effects + effects from interaction with other receptors:

5HT(HA, GI, WG, SX, inc bleeding, Sleeping, hyponatremia in elderly)
+ NE (Inc BP, HR, CNS activation)

+ OTHERS: anticholinergic effects, orthostatic hypotension and sedation

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28
Q

5HT antagonist adverse effects

A

Trazedone: sedation, GI, orthostatic hypotension

Mirtazapine: significant sedation, inc in appetite and WG (good for elderly)

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29
Q

MAOI adverse effects

A

Orthostatic hypotension
WG
Sexual disturbances
- interactions with tyramine containing foods can precipitate HTN crisis
- serotonin syndrome can result in combo w SSRI, SNRI

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30
Q

Drug combos that can cause Serotonin syndrome

A

SSRI + MAOI
SNRI + MAO
SSRI/SNRI + linezolid (has MAOI activity)

SSRI/SNRI + serotonergic drug: dextromethorphan, sumatriptan, tramadol, St. John’s Wort

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31
Q

Methylphenidate compounds

A

Ritalin, Concerta, Metadate, Focalin

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32
Q

Dextroamphetamine compounds

A

Dexedrine, DextroStat

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33
Q

Amphetamine Salts

A

Adderall

34
Q

Treatment for Partial Siezures

A

Phenytoin, Carbamazepine, Valproate

35
Q

Treatment for General tonic-clonic seizures

A

Phenytoin, Carbamazepine, Valproate

36
Q

Treatment for Absence Seizures

A

Ethosuximide, valproate

37
Q

Treatment for Myoclonic seizures

A

Phenobarbital, valproate

38
Q

Treatment for Status Epilepticus

A

Phenobarbital, diazepam

39
Q

Carbamazapine

A

First line for tonic clonic, simple and complex focal seizures
Increased Na channel inactivation
- absorbed slowly and erratically after oral administration

  • adverse affects: drowsiness, blurry vision, diplopia, HA, dizziness, ataxia, nausea, vomiting
  • blood dyscrasias –> agranulocytosis, aplastic anemia
  • cognitive effects = interfere with learning
  • leukopenia, hyponatremia, thrombocytopenia, rash
  • Steven Johnson Syndrome
40
Q

Phenytoin

A

First line in Tonic-Clonic, first line for prophylaxis of status epileptics. Also used in focal simple and complex sezures.
- Fosphenytoin = prodrug designed for parental use, decreases glutamate release, enhances GABA release

  • gingival hyperplasia (increased PDGF), hirsutism, neuropathy
  • Effects cerebellum and vestibular system: Diplopia, ataxia, nystagmus
  • hirsutism

LT use:

  • Coarsening of facial features
  • Serum folic acid, thyroxine, vit K concentrations decreased
  • Vit D. metabolic problems –> osteomalacia
  • MEGALOBLASTIC ANEMIA (decreased folate absorption via inhbition of conjugase so folate never converted to monoglutamate form)
  • STeven-Johnson syndrome (purpuric macules, etc)
41
Q

Valproic Acid

A

ABSENCE, PARTIAL, and GENERAL TONIC CLONIC seizures

  • Na channel inactivation, reduce T-type Ca Currents, Increase GABA
  • absorbed rapidly and completely after orally taken

-GI (anorexia, nausea)
- CNS: sedation, ataxia, tremor
-rash, alopecia, stim appetite
- tremor, hair thining and loss, decreased platelet function, thrombocytopenia
hepatic effects, hepatitis
teratogenic effects (spinal bifida: maternal folate absorption inhibited)

42
Q

Ethosuximide

A

USED IN ABSENCE SEIZURES
- reduces T-type Ca currents

  • GI, fatigue, HA, uricaria, Steven Johnsons
43
Q

Phenobarbital

A

USED IN EVERY SEIZURE TYPE especially when attacks are difficult to control

  • considered safe for infants
  • Blocks Ca currents, blocks Na, Enhances GABA by prolonging Cl opening, decreases glutamate release
44
Q

Gabapentin

A

Simple partial, complex partial, partial with secondarily generalized tonic-clonic seizures

  • need high doses to improve seizure control
  • somnolence, ataxia, HA, tremor
45
Q

Felbamate

A
  • causes APLASTIC ANEMIA and severe hepatitis at unexpectively high rates, relegated to 3rd line drug for refractory cases
46
Q

Lamotrigine

A
  • dizziness, headache, diplopia, nausea, somnolence
  • SKIN RASH, STEVEN JOHNSON SYNDROME
  • pediatric patients are at high risk of rash, some studies suggest that a potentially life-threatening dermatitis will develop in 1-2% of peds pts
47
Q

Topiramate

A

SEdation, mental dulling, kidney stones, weight loss

48
Q

Atypical antipsychotics

A 
Its atypical for old closets to quietly risper from A to Z.
OLanzapine
CLOZapine (acts on D4 receptors)
QUIETIapine
RISPERidone
Aripiprazole
Ziprasidone
49
Q

Typical Antipsychotics

A

High Potency: Try to Fly HIGH
- Trifluoperazine, Fluphenazine, Haloperidol

Low Potency: Cheating Theives are Low
- Chloropromazine, Thioridazine

50
Q

Fluoxetine

A

SSRI Antidepressent (Prozac)

51
Q

Paroxetine

A 
SSRI Antidepressent (Paxil) 
- category D (positive evidence) for risk in pregnancy
52
Q

Sertraline

A

SSRI Antidepressent (Zoloft)

53
Q

Venlfaxine

A

SNRI Antidepressent

54
Q

Imipramine

A

TCA Antidepressent

55
Q

Amitriptyline

A

TCA Antidepressent

56
Q

Bupropion

A

Own Class… Antidepressent

  • enhances both NE and DA neurotransmission, inhibiting Reuptake transporters
  • may involve presynaptic release of NE and DA as well (VMAT2) that concentrates NE and DA
  • clinically used in SMOKING CESSATION PROGRAMS

Adverse:
- agitation, insomnia, anorexia

57
Q

Phenelzine

A

MAOI Antidepressent
- Binds to MAO irreversibly –> long-lasting inhibition of NT breakdown
Adverse:
- anorexia, weight gain, sexual disturbances, tyrisine food is bad

58
Q

Citalopram

A

SSRI antidepressant (Celexa)

59
Q

Escitalopram

A

SSRI Antidepressent

60
Q

Fluoxetine

A

SSRI Antidepressent
- Only drug approved by FDA for treating MDD in children (2-12) and adolescencts (13-19) due to concerns of rainsed increased of suicide in children on SSRIs and SNRIs

61
Q

Duloxetine

A

SNRI Antidepressent

62
Q

Clomipramine

A

TCA Antidepressent

63
Q

Desipramine

A

TCA Antidepressent

64
Q

Nortirptyline

A

TCA Antidepressent

65
Q

tranylcypromine

A

MAOI Antidepressent
- binds REVERSIBLY to MAO, but has a prolonged effect of blocking NT breakdown

Adverse:
- Orthostatic hypotension, weight gain, sexual disturbances, tyrosine food is bad

66
Q

Amphetamine

A

Substrate for reuptake transporter (NE)
- Inside cell, it inhibits VMAT
- Monoamine accumulates intracellulary, but not in the vesicles
- build-up causes NE transporter to reverse such that NE is released in a non-vesicular mechanism
–> vesicular release of NE decreases, non-vesicular decrease INCEASES
(5HT, etc are also affected)

67
Q

Lorazepam

A

Ativan

Benzodiazepine used for anxiety disorders

68
Q

Clonazepam

A

Klonopin

Benzodiazepine used for anxiety Disorders

69
Q

Chlordiazepoxide

A

Librium Benzo used for anxiety

70
Q

Oxazepam

A

Generic Benzo used for anxiety

71
Q

Clorazepate

A

Tranxene Benzo used for anxiety

72
Q

Diazepam

A

Valium Benzo used for anxiety

73
Q

Alprazolam

A

Xanax Benzo used for anxiety

74
Q

Midazolam

A

SHORT ACTING
Versed
Benzo used for anxiety

75
Q

Properties of Benzos

A

Easily absorbed

  • long-lasting active metabolites
  • not for pregnants - crosses bbb
  • can ca use amnesia, poor judgement
76
Q

Effects of Benzos

A
  1. Hypnosis - promotes sleep
  2. Sedation
  3. Anesthesia
  4. Anticonvulsant Effects
  5. Muscle Relaxation
  6. Respiratory Depression
  7. Cardiovascular Depression
77
Q

Short Acting Benzos

A 
MOAT: increased addictive, increased dependence
Midazolam
Oxazepam
Alprazolam
Trazolam
78
Q

Intermediate Acting Benzos

A

LET
Lorazepam
Estazolam
Temazepam

79
Q

Long acting Benzos

A 
CCDF
Chlordrazepoxide
Clorazepate
Diazepam
Fluazepam
80
Q

Flumazenil

A

Competitive antagonist for GABA receptors, used in Benzo OD

81
Q

Buspirone

A

Gaba-ergic antianxolitic that DOES NOT ACT THROUGH GABA! 5HT1a receptors, D2 receptors… unknown
no withdrawal if stopped immediately

Psych Drugs (2 decks)

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