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Flashcards in Psych Drugs Deck (77):
1

Rx for Alcohol Withdrawal

Benzodiazpines

2

Tx: Anxiety

SSRIs, SNRIs, buspirone

3

Tx for ADHD

Methylphenidate, amphetimines

4

Tx for Bipolar Disorder

"Mood stabilizers" (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics

5

Tx for Bulimia

SSRIs

6

Tx for Depression

SSRIs, SNRIs, TCAs, buspirone, mirtazapine (especially with insomnia)

7

Tx for OCD

SSRIs, clomipramine

8

Tx for Panic Disorder

SSRIs, venlafaxine, benzodiazepines

9

Tx for PTSD

SSRIs

10

Tx for PTSD

SSRIs

11

Tx for Schizophrenia

Antipsychotics

12

Tx for Social Phobia

SSRIs

13

Tx for Tourette's Syndrome

Antipsychotics (e.g haloperidol)

14

CNS Stimulants

Methylphenidate, Dextroamphetamine, Methamphetamine

15

CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Mechanism

Increase catecholamines at synaptic cleft, especially NE and dopamine

16

CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Clinical Use

ADHD, narcolepsy, appetite control

17

Antipsychotics (typical)

Haloperidol, Trifluoperazine, Fluphenazine, Thioridazine, Chlorpromazine,

Haloperidol + ("-azines")

18

Typical Antipsychotics ("-azines"+ haloperidol) : Mechanism

Block D2 receptors (increase cAMP)

19

High potency typical antipsychotics

Trifluoperazine, Fluphenazine, Haloperidol

(Try to Flying High)
* associated with extrapyramidal effects

20

Typical Antipsychotics ("-azines + haloperidol): Clinical Use

Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette's syndrome

21

Low potency antipsychotics

Chlopromazine, Thioridazine

(Cheating Leaves are low)
* associated with non-neurological side effects (anti-cholinergic, antihistamine, and alpha-1 blockade)

22

Typical antipsychotics ("-azines"+ haloperidol): Toxicity

Highly lipid soluble and stored in body fats; thus very slow to be removed from body

Endocrine side effects (e.g. dopamine receptor antagonism --> hyperprolactinemia --> galactorrhea)

Side effects arising from muscarinic blockage (dry mouth, constipation); alpha-1 blockade (hypotension) and histamine (sedation) receptors

23

Extrapyramidal effects associated with which typical antipsychotics?

Trifluoperazine, Fluphenazine, Haloperidol

24

Specific side effect for Chlorpromazine (typical antipsychotics)?

Corneal deposits

"C"hlorpromazine -- "C"orneal deposits

25

Specific side effect for Thioridazine (typical antipsychotic)?

retinal deposits

"T"hioridazine - re"T"inal deposits

26

Haloperidol side effects

Neuroleptic Malignant Syndrome, tardive dyskinesia

27

Evolution of EPS side effects

4 HOUR acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 DAY akathisia (restlessness)
4 WEEK bradykinesia (parkisonism)
4 MONTH tardive dyskinesia

28

Neuroleptic Malignant Syndrome

Associated with typical antipsychotics
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

29

Tx for Neuroleptic Malignant Syndrome

Dantrolene, D2 agonists (e.g. bromocriptine)

30

Tardive dyskinesia

Stereotypic oral-facial movements as a result of long-term antipsychotic use. Often irreversible

31

Mneumonic for NMS symptoms

Think "FEVERS"
F-ever
E-ncephalopathy
V-itals unstable
E-levated enzymes
R-igidity of muscles

32

Atypical antipsychotics

Olanzapine, Clozapine, Quetiapine, Risperidone, Apiprazole, Ziprasidone

33

Atypical antipsychotics: Mechanism

Not completely understood. Varied effects on 5-HT2, dopamine, alpha and H1 receptors

34

Atypical antipsychotics: Clinical Use

Schizophrenia - both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette's syndrome

35

Atypical antipsychotics: Toxicity

Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics

36

Side effects for Olanzapine/Clozapine

May cause significant weight gain

37

Side effects for clozapine

May cause agranulocytosis (requires weekly WBC monitoring) and seizure

38

Side effect for Ziprasidone

May prolong the QT interval

39

Lithium: Mechanism

Not established; possible related to inhibition of phosphoinositol cascade

40

Lithium: Clinical Use

Mood stabilizer for bipolar disorder; blocks relapse and acute maniac events. Also SIADH.

41

Mneumonic for Lithium

LMNOP
L-ithium side effects
M-ovements
N-ephrogenic diabetes insipidus
O- HypOthyroidism (constipation, dry skin, hair loss, weight gain)
P-regnancy problems

42

Lithium Toxicity

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis

43

Teratogenic effects for lithium

Fetal cardiac defects
- Ebstein's anomaly (atrialized right ventricle)
- Malformation of great vessels

44

Excretion of Lithium

Almost excreted exclusively by the kidneys; most is reabsorbed at the proximal convoluted tubules following Na reabsorption

45

Buspirone: Mechanism

Stimulates 5-HT1A receptors

46

Buspirone: Clinical Use

Generalized anxiety disorder.
Does not cause sedation, addiction, or tolerance.
Takes 1-2 weeks to take effect.
Does not interact with alcohol (vs. barbituates, benzodiazepines)

47

SSRIs

Fluoxetine, Paroxetine, Sertaline, Citalopram

"Fl"ashbacks "Par"alyze "Se"nior "Cit"izens

48

SSRIs: Mechanism

Serotonin-specific reuptake inhibitors

49

SSRIs: Clinical Use

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

*It normally takes 4-8 weeks for antidepressants to have an effect"

50

SSRIs: Toxicity

Fewer than TCAs, GI distress, sexual dysfunction (anorgasmia and decreased libido)

* When combined with SNRIs, MOA inhibitors - drugs that can raise serotonin levels can cause serotonin syndrome)

51

Serotonin syndrome

Combination of drugs that raise serotonin levels (e.g. SSRIs, MOAis, SNRIs) - can cause hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures

52

Treatment for SSRI Toxicity

Cyproheptadine (5-HT2 receptor antagonist)

53

SNRIs

Venlafaxine, duloxetine

54

SNRIs: Mechanism

Inhibit serotonin and NE reuptake

55

SNRIs: Clinical Use

Depression. Venlafaxine is also used in generalized anxiety and panic disorder

56

Aside from depression, duloxetine is used to treat what?

Duloxetine is indicated for diabetic peripheral neuropathy. It has greater effect on NE.

57

SNRIs: Toxicity

Increase in BP in most common; Also stimulant effects, sedation, nausea

58

Tricyclic Antidepressants:

Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine

(Except for doxepin, amoxapine, TCAs end in "-yline" and "-mine")

59

TCAs ("-iptyline" and "-amine"): Mechanism

Block reuptake of NE and serotonin

60

TCAs ("-iptyline" and "-amine"): Clinical Use

Major depression. Bedwetting (imipramine), OCD (clomipramine), fibromyalgia

61

TCAs (-itpyline and -amine): Toxicity

Sedation, alpha-1 blocking effects including postural hypotension and atropine/anti-cholinergic side effects (tachycardia, urinary retention, dry mouth).

Tertiary TCAs (amitiptyline) have more anticholinegic effects than secondary TCAs (nortryptilline) have.

62

Desmipramine: Side effects

Is less sedating than other TCAs and has higher seizure threshold

63

TCAs Toxicity (Mneumonic)

"Tri-C's"- "C"onvulsions, "C"omas, "C"ardiotoxicity (arrhythmias),

Also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic effects (use nortriptyline)

64

Treatment for TCA toxicity

Sodium bicarbonate for cardiotoxicity

65

Monoamine Oxidates (MAO) inhibitors

Trancyclopromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).

"MAO" "T"akes "P"ride "I"n "S"hanghai

66

MAO Inhibitors

Non-selective MAO inhibition increases levels of amine neurotransmitters (NE, serotonin, dopamine)

67

MAO Inhibitors: Clinical Use

Atypical depression, anxiety, hypochrondriasis

68

MAO Inhibitors: Toxicity

Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS Stimulation
Contrainidicated with SSRIs, SNRIs, TCAs, St. John's Wort, Meripirine, Dextromethorphan - to precent serotonin syndrome

69

Atypical antidepressants

Buproprion, Mirtazapine, Maprotiline, Trazodone

70

Bupropion: Clinical Use

Also used
for smoking cessation. Increases NE and dopamine via unknown mechanism

71

Bupropion: Toxicity

Stimulant effects (tachycardia, insomnia) headache, seizure in bulimic patients.
No sexual side effects

72

Mirtazapine: Mechanism

A-2 antagonist (increase release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist

73

Mirtazapine: Toxicity

Sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may desirable in elderly or anorexic patients), dry mouth

74

Maprotiline

Blocks NE reuptake

75

Maprotilline: Toxicity

Sedation, Orthostatic Hypotension

76

Trazodone: Mechanism

Primarily inhibits serotonin reuptake. Primarly used for insomnia, as high doses are needed for antidepressant effects

77

Trazodone: Toxicity

Sedation, nausea, priapism, postural hypotension

Called trazo"bone"due to male-specific side effects