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Flashcards in Psych Drugs Deck (62):
1

CNS Stimulants (4)

1. methylphenidate 2. dextroamphetamine 3. methamphetamine 4. phentermine

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Mechanism of CNS Stimulants

-increase catecholamines at the synaptic cleft, esp. NE and DA.

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Clincial use of CNS stimulants

ADHD Narcolepsy Appetite control

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Antipsychotics (neuroleptics) (5)

1. Haloperidol 2. Trifluoperazine 3. Fluphenazine 4. Thioridazine 5. Chlorpromazine

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Mechanism of Antipsychotics

All typical antipsychotics block dopamine D2 receptors (increase cAMP).

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Clinical use of antipsychotics

-schizophrenia (mainly + symptoms) -psychosis -acute mania -Tourette's

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Antipsychotics are very slow to be removed from the body because...

they are highly lipid soluble and are stored in body fat.

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Toxicity of antipsychotics

-extrapyramidal system effects (dyskinesias) -endocrine side effects (galactorrhea) -dry mouth, constipation (from blocking muscarinic receptors) -hypotension (from blocking alpha-1 receptors -sedation (from blocking histamine receptors)

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Neuroleptic malignant syndrome

toxicity of antipsychotics causing rigidity, myoglobinuria, autonomic instability and hyperpyrexia

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Treatment forNeuroleptic malignant syndrome

-dantrolene -D2 agnoists (bromocriptine)

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Tardive dyskinesia

toxicity of antipsychotics casuing oral-facial movements

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High potency antipsychotics

-Trifluoperazine, Fluphenazine, Haloperidol *these cause neurologic side effects (EPS system)

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Low potency antipsychotics

-Chlorpromazine, Thioridazine *these cause non-neurologic side effects

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Chlorpromazine can also cause...

cornela deposits.

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Thioridazine can cause...

retinal deposits.

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Haloperidol can also cause...

NMS or tardive dyskinesia.

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Evolution of EPS side effects

-4 hr acute dystonia -4 day akathisia -4 wk bradykinesia -4 month tardive dyskinesia

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Atypical Antipsychotics (6)

1. Olanzpaine 2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone

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Clinical use of atypical antipsychotics

-schizophrenia (+ and - symptoms) -Bipolar -OCD -anxiety disorder -depression -mania -tourette's

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Olanzapine/Clozapine may cause...

significant weight gain.

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Clozapine may cause...

agranulocytosis (requires weekly WBC monitoring) and seizure.

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Risperidone may increase...

prolactin (lactation/gynecomastia) leading to decreased GnRH, LH and FSH (irregular menstruation/fertility).

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Ziprasidone may...

prolong the QT interval.

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Clinical use of Lithium

-mood stabilizer for bipolar disorder -blocks relapse and acute manic episodes -SIADH

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Toxicity of Lithium

-tremor -sedation -edema -heart block -polyuria -teratogenesis

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Lithium causes polyuria because...

it is an ADH antagonist causing nephrogenic DI.

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Fetal cardiac defects from lithium include...

Ebstein anomaly and malformation of the great vessels.

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Buspirone mechanism

stimulates 5-HT(1A) receptors

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Use of Buspirone

-generalized anxiety disorder (1-2 wks to take effect) (does not interact with alcohol)

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SSRIs (4)

1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram

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Mechanism of SSRIs

5-HT specific reuptake inhibitors

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Use of SSRIs

-depression -GAD -Panic disorder -OCD -bulimia -social phobias -PTSD

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Toxicity of SSRIs

-GI distress -sexual dysfunction -serotonin syndrome w/ any drug that increases 5HT (MAO inhibitors, SNRIs, TCAs)

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Serotonin Syndrome

-hyperthermia -confusion -myoclonus -CV collapse -flushing -diarrhea -seizures

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Serotonin Syndrome is treated with...

Cyproheptadine (5-HT2 receptor antagonist)

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For SSRIs to start taking effect, it takes...

4-8 wks.

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SNRIs (2)

Venlafaxine Duloxetine

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Mechanism of SNRIs

inhibit 5-HT and NE reuptake

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Use of SNRIs

depression -Venlafaxine also for GAD and panic disorder -Duloxetine also for diabetic peripheral neuropathy

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Toxicity of SNRIs

increased BP stimulant effects sedation nausea

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Tricyclic Antidepressants (7)

1. amitriptyline 2. nortriptyline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxapine

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TCAs mechanism

block reuptake of NE and 5-HT

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Uses of TCAs

-depression -OCD (clomipramine) -fibromyalgia

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Toxicity of TCAs

-sedation -alpha-1 blocking effects (postural hypotension) -atropine-like effects (anticholinergic - tachycardia, urinary retention, dry mouth) -convulsions -coma -cardiotoxicity -respiratory depression -hyperpyrexia

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Tertiary TCAs (amitriptyline) have more...

anticholinergic effects than secondary TCAs (nortriptyline) have.

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Desipramine is less...

sedating but has higher seizure incidence.

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In the elderly, TCAs can cause...

confusion and hallucinations due to anticholinergic side effects (use nortriptyline).

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Treatment for cardiotoxicity from TCAs

NaHCO3.

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Monoamine oxidase inhibitors (4)

1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegine (slective MAO-B inhibitor)

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Mechanism of MAO inhibitors

inhibition of MAO leading to increased levels of amine neurotransmitters (NE, 5-HT, DA)

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use of MAO inhibitors

-atypical depression -anxiety -hypochondria

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Toxicity of MAOIs

-hypertensive crisis (typically w/ ingestion of tyramine) -CNS stimulation

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MAOIs are contraindicated with...

SSRIs TCAs St. John's wort Meperidine Dextromethorphan

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Atypical Antidepressants

1. Buproprion 2. Mirtazapine 3. Trazodone

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Buproprion increases...

NE and DA

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Besides depression, buproprion is also used for...

smoking cessation.

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Toxicity of Buproprion

-stimulant effects -HA -seizure in bulimic pts

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Mirtazapine MOA

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

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Toxicity of Mirtazapine

-sedation -increased appetite -weight gain -dry mouth

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Trazodone mechanism

-blocks 5-HT2 and alpha1-adrenergic receptors

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Trazodone is primarily used for...

insomnia.

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Toxicity of Trazodone

sedation nausea priapism postural hypotension