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Flashcards in Psych Drugs Deck (65)
1

Name the typical antipsychotics

Haloperidol and the -azines (trifluoperazine, fluphenazine, thioridazine, chlorpromazine)e

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Mechanism of typical antipsychotics

block dopamine D2 receptors to increased cAMP

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High potency typical antipsychotics

Try to Fly High

Trifluoperazine, fluphenazine, haloperidol

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Side effects of high potency antipsychotics

extrapyramidal symptoms

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Clinical use of typical antipsychotics

schizophrenia (positive symptoms), psychosis, acute mania, Tourette syndrome, Huntington's

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Toxicity of typical antipsychotics

lipid soluble and stored in fat thus slowly removed from body
Extrapyramidal side effects
Endocrine side effects - hyperprolactinemia
Side effects from blocking:
muscarinic - dry mouth, constipation
alpha 1 - hypotension
histamine - sedation

can cause QT prolongation

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Extrapyramidal symptom treatment

Benztropine or diphenhydramine

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Low potency typical antipsychotics

Cheating THieves are low

chlorpromazine, thioridazine

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Side effects of low potency antipsychotics

non-neurologic side effects
anticholinergic, antihistamine and alpha1-blockade effects

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Side effect of chlorpromazine

Corneal deposits

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Side effect of Thioridazine

reTinal deposits

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Side effect of haloperidol

EPS

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Evolution of EPS side effects

4 hr dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day akathisia (restlessness)
4 wk bradykinesia (parkinsonism)
4 mo tardive dyskinesia

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Neuroleptic malignant syndrome

FEVER

fever, encephalopathy, vitals unstable, increased enzymes, rigidity of muscles

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Treatment of NMS

dantrolene or D2 agonists (bromocriptine)

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Tardive dyskinesia

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

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Name the atypical antipsychotics

clozapine, risperidone, olanzapine, quietapine, aripiprazole, ziprasidone

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Mechanism of atypical antipsychotics

not completely understood
varied effects on 5-HT2, dopamine and alpha and H1 receptors

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Clinical use of atypical antipsychotics

Schizophrenia (positive and negative symptoms
Bipolar, OCD, anxiety, depression, mania, Tourette syndrome

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What are negative symptoms?

Alogia = loss of speech
Affective flattening = loss of affect/emotion
Avolition = loss of motivation to do anything

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Toxicity of atypical antipsychotics

fewer EPS and anticholinergic side effects

prolong QT interval

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Toxicity of olanzapine and clozapine

Can cause significant weight gain

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Toxicity of clozapine

agranulocytosis and seizure

monitor WBC weekly

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Toxicity of risperidone

increase prolactin --> lactation and gynecomastia

increased prolactin --> decreased GnRH which leads to decreased FSH and LH and infertility/amenorrhea

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Mechanism of lithium

possibly related to inhibition of phosphoinositol cascade

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Use of lithium

mood stabilizer for bipolar disorder; blocks relapse of acute and manic events

also used for SIADH

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Toxicity of lithium

LMNOP

Movement issues (tremor)
Nephrogenic diabetes insipidis
hypOthryoid
Pregnancy (Ebstein's anomaly)

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Metabolism of lithium

excreted by kidneys and most is reabsorbed in PCT with Na+
narrow therapeutic window requiring close monitoring of serum levels

thiazide use implicated in lithium toxicity in pts with bipolar disorder

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Mechanism of buspirone

stimulates 5-HT1A receptors
also causes release of DA and Epi

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Use of buspirone

generalized anxiety

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Other positives of buspirone

no sedation, addiction or tolerance
takes 1-2 weeks to work
does not interact with alcohol

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Name the SSRIs

fluoxetine, paroxetine, sertraline, citalopram

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Mechanism of SSRIs

5-HT specific reuptake inhibitors

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Use of SSRIs

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

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Toxicity of SSRIs

GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido)

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Pharmacokinetics of SSRIs

takes 4-8 weeks for effect to be seen

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Serotonin Syndrome cause

caused by SSRI use with any drug that increases 5-HT (MAOIs, SNRIs, TCAs)

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Serotonin Syndrome symptoms

changes in mental status, muscle rigidity, autonomic instability and HYPERTERMIA

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Name SNRIs

venlafaxine, duloxetine

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Mechanism of SNRIs

inhibit 5-HT and NE reuptake

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Use of SNRIs

depression

venlafaxine - GAD, panic d/o, PTSD
duloxetine - diabetic peripheral neuropathy

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Toxicity of SNRIs

increased BP
also stimulant effects, sedation, nausea

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Name the tricyclic antidepressants

Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

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Mechanism of tricyclic antidepressants

block reuptake of norepinephrine and 5-HT

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Clinical use of TCAs

major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis

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Minor toxicity of TCAs

sedation, alpha-blocking effects (postural hypotension) and anticholinergic effects (tachycardia, urinary retention, dry mouth)

3 degree TCAs (amitriptyline) have more ANTICHOLINERGIC effects than 2 degree TCAs (nortriptyline)

Can prolong QT interval

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Major toxicity of TCAs

Convulsions, coma, cardiotoxicity (arrhythmias)
respiratory depression, hyperpyrexia
confusion and hallucinations in the elderly due to anticholinergic side effects (use noritriptyline)

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Treatment of arrythmia toxicity with TCA use

NaHCO3 to prevent arrhythmia

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Name the MAOIs

tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B inhibitor)

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What drug is a selective MAO-B inhibitor

Selegiline

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Mechanism of MAOIs

nonselective MAO inhibition increases levels of amine neurotransmitters (NE, 5-HT, dopamine)

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Clinical use of MAOIs

atypical depression, anxiety

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Toxicity of MAOIs

Hypertensive crisis
CNS stimulation

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Contraindications of MAOIs

with SSRIs, TCAs, St. John's wort, meperidine, dextromethorphan (to prevent serotonin syndrome)

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MAOIs and Tyramine

Tyramine is found in many foods such as cheese and wine
Tyramine acts as a catecholamine releasing agent and thus if you are eating a lot of tyramine but taking an MAOI you are unable to break down those catecholamines and get a hypertensive crisis

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Mechanism of bupropion

increase NE and DA via unknown mech

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Use of bupropion

smoking cessation and depression

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Toxicity of bupropion

stimulant effects (tachycardia, insomnia), headache, seizures in anorexic/bulimic patients

No sexual side effects

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Mechanism of Mirtazapine

alpha2-antagonist (increase release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist

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Use of mirtazapine

depression

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Toxicity of mirtazapine

sedation (desirable in depressed patients with insomnia), increased appetite, weight gain (good in anorexic or elderly pts), dry mouth

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Mechanism of trazodone

blocks 5-HT2 and alpha1-adrenergic receptors
also weakly inhibits 5-HT reuptake

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Use of trazodone

insomnia
high doses for depression

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Toxicity of trazodone

sedation, nausea, priapism, postural hypotension

65

NTs involved in generalized anxiety

decreased 5-HT and decreased GABA with increased NE/Epi