Psych Drugs

Question 1

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine

Answer 1

Antipsychotics - Neuroleptics

Block D2 receptors - ↑cAMP

Question 2

What are the antipsychotics used for?

Answer 2

Schizophrenia - + symptoms
Psychosis
Acute mania
Tourette

Question 3

What are the high potency antipsychotics

Answer 3

Trifluoperazine, fluphenazine, haloperidol

EPS symptoms

Question 4

What are the low potency antipsychotics

Answer 4

Chlorpromazine, thioridazine

Antichol, antihistamine, α1-blockade

Question 5

What is the evolution of EPS symptoms

Answer 5

4 hr: Acute dystonia (spasm)
4 day: Akathesia (restlessness)
4 week: Bradykinesia (Parkinonism)
4 month: Tardive dyskinesia (oral/facial movements)

Question 6

How do you treat the EPS symptoms from antipsychotics?

Answer 6

Benztropine

Diphenhydramine

Question 7

What is a unique side effect of chlorpromazine?

Answer 7

Corneal deposit

Question 8

What is a unique side effect of Thioridazine?

Answer 8

Retinal deposits

Question 9

Neuroleptic Malignant Syndrome

Answer 9

Fever
Encephalopathy
Vitals unstable - autonomic instability
Enzymes ↑
Rigidity

→Dantrolene, D2 agonist (Bromocriptine)

Question 10

What are the atypical antipsychotics?

Answer 10

Olanzapine, clozapine, quetiapine, risperidone, aripirazole, ziprasidone

Question 11

What is the mechanism of the atypical antipsychotics

Answer 11

Varied effects on 5-HT, dopamine, α, H1 receptors

Question 12

When are atypical antipsychotics indicated?

Answer 12

Schizophrenia: Neg and Pos symptoms
Bipolar
OCD
Anxiety
Depression
Mania 
Tourette

Question 13

What are the side effects of Clozapine?

Answer 13

Agranulocytosis - weekly WBC monitoring

Seizure

Question 14

Which two atypical antipsychotics cause weight gain?

Answer 14

Olanzapine

Clozaine

Question 15

What are the side effects of Risperidone

Answer 15

↑Prolactin -

gynecomastia, ↓GnRH, fertility/menstruation problems

Question 16

What are the side effects of Ziprasidone

Answer 16

Prolong the QT

Question 17

When is Lithium indicated?

Answer 17

Bipolar
Blocks relapse of manic events
SIADH

Question 18

What are the side effects of Lithium?

Answer 18

Nephrogenic diabetes insipidus
Tremor, sedation
Heart block 
Hypothyroidism
Fetal: Ebstein anomaly, malformation of the great vessels
**Inc. by Loop/thiazide diuretics**

Question 19

Buspirone

Answer 19

Stimulates 5-HT 1A receptors
Generalized anxiety
Takes 1-2 weeks to work
No interaction with Alcohol

Question 20

SSRI

Answer 20

Fluoxetine, paroxetine, sertraline, citalopram

“flashbacks paralyze senior citizens”

Question 21

What are SSRIs indicated for?

Answer 21

Depression, GAD, panic disorder, OCD

Bulimia, social phobias, PTSD

Question 22

What are the side effects of SSRIs

Answer 22

GI distress, sexual dysfunction
Serotonin Syndrome w/ any drug that ↑5-HT
MAOI, SNRI, TCA

Question 23

Serotonin Syndrome

Answer 23

Too much serotonin - SSRI/SNRI/MAOI/TCA
Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
Cyproheptadine - 5HT2 R antagonist

Question 24

How long does it take for antidepressants to have an effect?

Answer 24

4-8 weeks

Question 25

SNRIs

Answer 25

Venlafaxine, duloxetine, milnacipran | Inhibit 5-HT and NE reuptake

Question 26

Duloxetine is also indicated for ___________.

Answer 26

Diabetic Peripheral Neuropathy

Question 27

What are the side effects of SNRIs

Answer 27

↑BP, stimulant effects, sedation, nausea

Question 28

Amitriptyline, nortriptyine, imipramine, desipramine, clomipramine, doxepin, amoxapine

Answer 28

TCAs: Block reuptake of NE and 5-HT | Major depression, OCD, fibromyalgia, peripheral neuropathy

Question 29

What are the side effects of TCAs

Answer 29

``` Convulsions Coma Cardiotoxicity (arrhythmias-block fast NA channels α-1 blocking Atropine like ```

Question 30

MAOIs

Answer 30

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (MAO-B) ↑amine NT: NE, 5-HT, dopamine

Question 31

When are MAOIs indicated?

Answer 31

Atypical depression, anxiety, hypochondriasis

Question 32

What are the side effects of MAOIs

Answer 32

Hypertensive crisis - ingestion of tyramine | Treat with Phentolamine (α-blocker)

Question 33

MAOIs are contraindicated with which things?

Answer 33

SNRIs, TCAs, St. Johns wort, meperidine, dextromethorphan - prevent Serotonin Syndrome

Question 34

Bupropion

Answer 34

Blocks presynaptic reuptake of dopamine and NE * Seizure in bulimic patients* * No sexual side effects*

Question 35

Mirtazapine

Answer 35

α2-antagonist - ↑release of NE and 5-HT 5-HT2 and 3 antagonist SE: sedation, ↑appetite/weight gain, dry mouth

Question 36

Trazodone

Answer 36

Blocks 5-HT2 and α1-adrenergic receptors Treats Insomnia SE: Priapism, sedation, nausea