Psych Drugs Flashcards Preview

Neuro > Psych Drugs > Flashcards

Flashcards in Psych Drugs Deck (125):
1

Typical antipsychotics

Dopamine-2 receptor antagonists

2

Atypical antipsychotics

Serotonin-dopamine antagonists
D2 partial agonists

3

Indications of typicals

Psychotic disorders
Mood disorders
Dementia
Psychosis secondary to medical conditions, medications, and drugs of abuse
Personality disorder
Obsessive-compulsive disorder
Autism
Tourette’s disorder

4

dopamine-mediated effects: nigrostriatal pathway

EPS (Parkinsonism, Akathisia, Dystonic reactions, Tardive dyskinesia, NMS)

5

dopamine-mediated effects: mesolimbic pathway

dysphoria

6

dopamine-mediated effects: mesocortical pathway

worsening negative and cognitive symptoms

7

dopamine-mediated effects: tuberoinfundibular pathway

Hyperprolactinemia, and resultant galactorrhea, amenorrhea, sexual dysfunction

8

acute EPS

Dystonia – usually within hours
Akathisia – usually within days
Parkinsonism – usually within days to weeks

9

chronic/late set EPS

Tardive Dyskinesia usually after 3 months

10

treatment of dystonia (EPS)

Anticholinergics – injectable if needed

11

treatment of akathisia

beta blockers, anticholinergics

12

treatment of parkinsonism

anticholinergics, amantadine

13

Dopamine does what to ACh

suppresses

14

Dopamine blockade ___ ACh

increases

15

EPS caused by

decreased dopamine and increased ACh

16

improvement of EPS by

anticholinergics

17

mechanism of tardive dyskinesia

blockade of receptors in nigrostriatal dopamine pathway causes up-regulation, increased ACh

18

increased risk of TD w/

age > 50
dose
total exposure
mood disorder

19

anticholinergic side effects (M1)

constipation, blurred vision, dry mouth, drowsiness

20

antihistaminergic side effects (H1)

weight gain, drowsiness

21

anti-alpha adrenergic side effects

dizziness, decreased BP, drowsiness

22

neuroleptic malignant syndrome

life-threatening condition of
hyperpyrexia, autonomic instability, muscle rigidity, and delirium
Death occurs secondary to arrhythmia, rhabdomyolysis or respiratory failure
Discontinue the antipsychotic, aggressive hydration
Mortality rate of 20-30%

23

how to increase compliance

depot preparations

24

why was clozapine originally withdrawn

agranulocytosis

25

benefits of clozapine

Much lower incidence of extrapyramidal symptoms and tardive dyskinesia
Improves negative and cognitive symptoms

26

indications of clozapine

Treatment resistant schizophrenia
Schizophrenia with tardive dyskinesia
Schizophrenia or schizoaffective disorder with recurrent suicidal behavior

27

agranulocytosis

Life-threatening drop in white blood count
Contraindicated with pre-existing blood disorder
Estimated at 1-2%, about 0.38% with monitoring
Requires continuous monitoring

28

adverse effects of atypicals

Sedation
Anticholinergic side effects, including dry mouth, constipation, blurry vision, urinary retention, confusion, ECG changes
Myocarditis
Orthostatic hypotension
Weight gain, which can be substantial
Hypersalivation
Seizures, especially with high doses or fast titrations
Metabolic problems, including diabetes and hyperlipidemias

29

benefits of atypicals

Cause fewer EPS, little-to-no TD
Improve positive symptoms
Improve negative and cognitive symptoms

30

blocking 5HT2A receptor

disinhibits DA release and reduces D2 blockade

31

indications of atypical anatipsychotics

Psychotic disorders
Mood disorders
? Dementia
Psychosis secondary to medical conditions, medications, and drugs of abuse
Personality disorder
Obsessive-compulsive disorder
Autism
Tourette’s disorder
**Mania

32

atypical agents

-pine
-zine
-done (risperidone)

33

aripiprazole

D2 partial agonist

34

metabolic side effects of atypicals

weight gain
hyperlipidemia
hyperglycemia
diabetes
ketoacidosis

35

metabolic syndrome (Syndrome X)

central obesity
high PB high triglycerides
low HDL-cholesterol
insulin resistance

36

CATIE trial

atypicals vs. perphenazine.

found to be equally effective

olanzapine more efficacious but worst for weight gain

37

mania symptoms

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Attention is easily drawn to unimportant or irrelevant items
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

38

depression symptoms

Depressed mood most of the day, nearly every day,
Markedly diminished interest or pleasure in all, or almost all, activities most of the day
Significant weight loss when not dieting or weight gain or decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

39

Definition of Mood stabilizer

efficacy in at least one of the three phases of bipolar disorder (acute mania, acute depression, or prophylaxis), AND it should not cause affective switch to the opposite mood state nor should it worsen the acute episode.

40

Indications for mood stabilizers

Bipolar Disorder: Mania/Hypomania, Depression, Prophylaxis, Cyclothymia
Depression Augmentation
Schizoaffective Disorders
Borderline Personality Disorder
Intermittent Explosive Disorder
Post-Traumatic Stress Disorder
Neuropathic Pain
Alcohol Detoxification
Refractory Schizophrenia

41

Lithium formulations

Li2CO3
LiCl
LiCitrate

42

Lithium mechanism

Thought to involve modulation of second messenger systems, particularly in phosphatidyl inositol system
Alteration of G proteins, signal tranduction
Alteration downstream enzymes
Regulation of gene expression

43

Lithium first-line indications

Classic euphoric mania
Pure bipolar depression
Bipolar maintenance

44

Lithium second-line indications

Mixed mania
Rapid cycling

45

Lithium adverse effects

GI
abdominal cramps, nausea, vomiting, diarrhea
Neurologic
cognitive dulling, decreased creativity
tremor
decreased memory and concentration
Metabolic
weight gain
increased thirst and urination
Dermatologic
Psoriasis, acne
Benign leukocytosis

46

Lithium: medically serious side effects

Hypothyroidism
Renal polyuria and polydipsia (nephrogenic diabetes insipidus
Nephrotoxicity (long-term)
Cardiac arrhythmias
Teratogenicity: Ebstein’s anomaly
Overdose

47

Lithium therapeutic levels

0.8-1.2 mEq/L

48

Lithium Toxicity

1.5 + mEq/L

49

lithium management issues

requires blood monitoring
significant drug-drug interactions

50

lithium interactions

NSAIDs
Thiazide diuretics
ACE Inhibitors
Calcium channel blockers

51

valproic acid proposed mechanism

Proposed: Inhibition of Na+/Ca++ channels, thereby boosting GABA inhibition and decreasing glutamatergic excitation

52

valproic acid first-line indications

Mixed (dysphoric) mania
Rapid cycling

53

valproic acid second-line indications

Pure depressive states
Classic euphoric mania

54

valproic acid adverse effects

Dyspepsia and diarrhea
Sedation
Dizziness
Increased appetite and weight gain
Tremor
Edema
Neurotoxicity (cognitive blunting, ataxia)
Hair loss

55

valproic acid serious adverse effects

Thrombocytopenia
Hepatotoxicity
Pancreatitis
Polycystic Ovarian Syndrome?
Teratogenicity: Neural tube defects
Overdose

56

carbamazepine mechanism

Proposed: Effects at Na+/K+ channels, enhancement of GABA inhibition

57

carbamazepine indications

bipolar disorder: mixed mania, rapid cycling

58

carbamazepine indications

Nausea, anorexia, vomiting
Sedation
Dizziness
Cognitive dulling
Electrolyte abnormalities
Anticholinergic effects

59

carbamazepine =

tegretol

60

carbamazepine medically serious side effects

Hematologic (thrombocytopenia, agranulocytosis, aplastic anemia)
Hepatotoxicity
Allergic reactions, rash
Teratogenicity: Neural tube defects, craniofacial abnormalities
Overdose

61

oxcarbazepine description

Metabolite of carbamazepine
Fewer drug-drug interactions, toxicities as compared to carbamazepine
Does not require therapeutic blood monitoring

62

Lamotrigine =

lamictal

63

lamotrigine mechanism

Inhibits Na+, glutamate

64

lamotrigine indication

maintenance (FDA), depression

65

lamotrigine adverse effects

Nausea, vomiting, diarrhea
Sedation, lightheadness, tremor
Cognitive blunting
Weight gain less of an issue than with the others

66

lamotrigine serious adverse effects

Rash, common, 8-10%, usually benign
but can progress to..
Stevens-Johnson Syndrome, 0.08%, potentially life threatening rash that can lead affect multiple organs

67

Stevens-Johnson rash management

Rapid increases in dose correlated with rash
Careful titration
Hold drug, at sign of serious rash
Watch for drug interactions

68

gabapentin =

neurontin

69

gabapentin description

Mechanism: Unclear; GABA analogue, decreases glutamate
Not effective as monotherapy
Has anxiolytic, analgesic properties
Well tolerated

70

topiramate =

topamax

71

topiramate description

Mechanism: Unclear; Inhibits Na+ and Ca++ channels, inhibits glutamate and enhances GABA
Not effective as monotherapy
Has weight loss effects
Significant sedation, cognitive dulling

72

other bipolar agents

Atypical Antipsychotics
Typical Antipsychotics
Omega 3 Fatty Acids?
Calcium Channel Blockers?
Benzodiazepines

73

TCA actions

antagonism at 5HT and NE presynaptic reuptake pumps

74

why are TCA's dirty?

also block muscarinic, alpha-adrenergic, and histamine receptors

75

how long do TCA's take to work?

3-4 weeks

76

are TCA's lethal in overdose?

yes

77

amitriptyline (elavil)

TCA- for pain, headache, insomnia

78

clomipramine (anafranil)

highly serotonergic TCA
indicated for OCD

79

nortriptyline (Pamelor)

demethylated imipramine (secondary amine)
least orthostasis of TCA's

80

indications for TCA's

major depressive disorder
bipolar depression
dysthymia
panic disorder
generalized anxiety disorder
OCD
pain disorder

81

contraindications for TCA's

cardiac conduction delays
arrhythmias

82

adverse effects of TCA's

anticholinergic
sedation
weight gain
orthostatic hypotension
sexual dysfunction
mania (bipolar)
seizures

serious:
cardiotoxicity
neurotoxicity

83

MAOI mechanism

irreversible monoamine oxidase inhibitors
disables monoamine degradation

84

which MAO blockage is necessary for antidepressant effect?

MAO A

85

do MAOIs block any other receptors?

alpha 1 adrenergic receptors
histamine receptors

86

serious adverse effects of MAOIs

tyramine-induced hypertensive crisis

87

SSRI's mechanism

selective antagonism at 5HT reuptake pumps

88

when do SSRI's take effect?

3-4 weeks of administration

89

SSRI major plus

well tolerated, widely indicated

90

SSRI contraindications

co-administration w/ MAOI's

91

serotonin syndrome

associated w/ hyperthermia, myoclonus, autonomic instability, rigidity, coma, death

need MAOI washout of 2 weeks prior to SSRI treatment

92

serotonergic side effects- 5HT3

GI system: diarrhea, nausea, vomiting

93

serotonergic side effects- 5HT2C

CNS: anxiety and mental agitation

94

serotonergic side effects- 5HT2A

CNS: akathisia, insomnia, myoclonus, sexual dysfunction

95

serotonin discontinuation syndrome

headache, dizziness, irritability, fatigue
upon abrupt discontinuation

96

SNRI mechanism

selective antagonism at NE and 5HT presynaptic reuptake pumps

97

curvilinear dose response of SNRI

additional dopamine reuptake inhibition at higher dosages

98

SNRI contraindications

co-administration w/ MAOIs

99

SNRI indications

major depressive disorder
generalized anxiety disorder
panic disorder
generalized social phobia

100

NaSSAs mechanism

dual mechanism of action

antagonism at central alpha-2 autoreceptors (disinhibition of NE and 5HT release)
stimulation of alpha-1 somatodendritic receptors on serotonin neurons, boosting 5HT release

101

NaSSA agent

mirtazapine (Remeron)

102

indications of NaSSA

major depressive disorder

103

serious NaSSA adverse effect

agranulocytosis and other blood dyscrasias

104

SARIs mechanism

selective antagonism at 5HT presynaptic reuptake pumps w/ simultaneous 5HT2A blockade

105

SARI indications

major depressive disorder
dysthymia

106

trazodone (type, adverse effect)

SARI
priapism (rare)

107

nefazodone (type, adverse effect)

SARI
liver toxicity

108

bupropion (wellbutrin, zyban)- type

noradrenergic and dopaminergic reuptake inhibitor

109

bupropion indications

major depressive disorder
dysthymia
bipolar depression
ADHD
smoking cessation

110

bupropion contraindications

co-administration w/ MAOI's
anorexia nervosa
bulimia nervosa
seizure disorder

111

bupropion adverse effects

activation
insomnia
nausea
tremor
seizures at higher doses

112

benzodiazepines action

increased frequency of GABA receptor open- hyper polarizes cell by Cl influx

113

why are benzo's used in detoxification in sedative and alcohol addiction?

they are cross tolerant with alcohol and barbiturates

114

which benzo's don't undergo Phase II glucuronidation

lorazepam
oxazepam
temazepam

115

alprazolam (Xanax)

perhaps greater addictive potential, but very effective for panic

116

lorazepam (ativan)

available in PO, IM, and IV forms
widely used

117

clonezepam (kloponin)

long half life, most potent

118

diazepam (valium)

fast onset but w/ active metabolite

119

chlordiazepoxide (librium)

used for alcohol detox

120

how to counteract benzo overdose

flumazenil

121

nonbenzodiazepine anxiolytics

various forms and mechanisms, generally non-addictive

122

buspirone

5HT1A agonist, effective in anxiety

no sedationor addictive potential of benzos

123

benzo withdrawal toxicity

potentially lethal

anxiety, insomnia, restlessness, agitation, irritability, muscle tension

124

nonbenzodiazepine hypnotics

indicated for insomnia

125

ramelteon (rozerem)

agonist at melatonin receptors, thought to normalize circadian rhythms