Psych Drugs Flashcards
(39 cards)
Emotional lability, slurred speech, ataxia, coma, blackouts. Serum γ-glutamyltransferase (GGT)—sensitive indicator of alcohol use. AST value is twice ALT value.
Alcohol INTOxication
Symptoms seen in Alchol withdrawl and the recommended Tx
Mild alcohol withdrawal: anxiety, tremor, seizures, insomnia.. Severe alcohol withdrawal can cause autonomic hyperactivity and DTs (5–15% mortality rate).
Treatment for DTs: benzodiazepines.
Euphoria, respiratory and CNS depression, gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose).
What’s goint on? How do you Tx the pt?
Opiod Intoxication
Treatment: naloxone, naltrexone.
Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms).
What’s wrong with pt?
What should you Tx with?
Opiod withdrawl
Treatment: long-term support, methadone, buprenorphine.
Intox on this drug causes severe resppiratory depression
Withdrawl causes Delirium, life-threatening CV collapse
Barbituates
Ataxia, minor respiratory depression when you are Intoxicated on this drug.
What do you tx it with?
Benzos
Treatment: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures).
Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. Severe: cardiac arrest, seizure.
What drug causes this?
What does this pt look like when they are withdrawing from drug?
Amphetamines
Anhedonia,appetite, hypersomnolence, existential crisis.
Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.
What’s going on with pt and how do we tx them?
Cocaine intoxication;
Treatment: α-blockers, benzodiazepines. β-blockers not recommended.
Pts intoxicated with nicoteine
Pt is Belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures.
What do you treat with?
What do they look like when they are in withdrawal?
PCP
Treatment: benzodiazepines, rapid-acting antipsychotic.
Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.
Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks.
LSD intoxication
Signs and symptoms of Marjuiana intox and withdrawal
Intox: Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal,appetite, dry mouth, conjunctival injection, hallucinations
Withdrawal: Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5–7 days. Generally detectable in urine for up to 1 month
Why do we use Naloxone and buprenorphine together?
Antagonist + partial agonist. Naloxone is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential).
Long-acting oral opiate used for heroin detoxification or long-term maintenance.
Long-acting opioid antagonist used for relapse prevention once detoxified.
Methadone
Naltrexone
Prefered Tx for:
ADHD
Alcohol withdrawal
Bipolar
Bulemia
Depression
ADHD: Methylphenidate
Alcohol withdrawal: Benzos
Bipolar:Mood stabalizers “Lithium, Valproic acid, Cabamazepine)
Bulemia: SSRI
Depression: SSRI, SNRI, TCA, buproprion, Mirtazapine
Tx for:
OCD
Panic disorder
PTSD
Schizophrenia
Social Phobia
Tourettes
OCD: SSRI or Clomipramine
Panic disorder: SSRI, Venlafaxine, Benzos
PTSD: SSRIs
Schizophrenia: Antipychotics
Social Phobia: SSRI, B-blocker
Tourettes: Haloperidol or Risperpidone
Mechanism and Clincal application of Typical antipychotics
All typical antipsychotics block dopamine D2 receptors ([cAMP]).
Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette syndrome.
What drugs are high potentency Typical antipsychotics and what side effect do we see from them?
High potency: Trifluoperazine, Fluphenazine, Haloperidol
(Try to Fly High)
neurologic side effects (e.g., Huntington disease, delirium, EPS symptoms).
What are low potency typical antipyschotics and what side effects do we see with them?
Low potency: Chlorpromazine, Thioridazine
(Cheating Thieves are low)
—non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).
Chlorpromazine = corneal deposits
Thioridozine = retinal deposits
General on Side effect profile of Typical antipsychotics:
Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine
Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.
Extrapyramidal system side effects (e.g., dyskinesias). Treatment: benztropine or diphenhydramine.
Endocrine side effects (e.g., dopamine receptor antagonismhyperprolactinemia galactorrhea).
Side effects arising from blocking muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors.
Can cause QT prolongation.
Pt comes in with Fever, encephalopathy, unstable vitals, elevated enZ on labs and rigdig muscles. Have a history of Schizophrenia managed with medications.
What’s going on and how do we tx?
Neuroleptic malignant syndrome (NMS)— rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
Treatment: dantrolene, D2 agonists (e.g., bromocriptine).
What is the rule of 4 involving the evolution of EPS side effects
Evolution of EPS side effects:
4 hr acute dystonia (muscle spasm, stiffness,
oculogyric crisis)
4 day akathisia (restlessness)
4 wk bradykinesia (parkinsonism)
4 mo tardive dyskinesia
What are the Atypical antipsychotics?
What is their mechanism?
What is their clinical use?
Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone.
Not completely understood. Varied effects on 5-HT2, dopamine, and α- and H1-receptors.
Schizophrenia—both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Side effects we worry about with Clozapine
With Risperidone
With Olanzapine
Clozapine: agranulocysosis
Olanzapine: wt gain
Risperidone: may increase prolactin (causing lactation and gynecomastia)–> Decreased GnRH, LH, and FSH (causing irregular menstruation and fertility issues).
****All may prolong QT interval
