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Flashcards in PSYCH - Pharm Deck (94):
1

Typical Antipsychotics

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

2

Typical Antipsychotics MOA

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Block D2-Rs to increase cAMP

3

Typical Antipsychotics use

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Schizophrenia (+ symptoms)
Psychosis
Acute mania
Tourettes

4

Typical Antipsychotic toxicities

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Lipid soluble - stored in fat for long time
EPS
Hyperprolactinemia
Anti-muscarinic (dry mouth, constipation)
Anti-a1 (hypotension)
Anti-histamine (sedation)
QT prolongation
NMS
Tardive Dyskinesia

5

EPS =

Extrapyramidal symptoms
MC with high-potency: trifluoperazine, fluphenazine, haloperidol

4h = dystonia (muscle spasms, stiff, oculogyric crisis)
4d-4w = akathisia (restless)
4w = bradykinesia (parkinsonian, "haldol shuffle"
4m = tardive dyskinesia (stereotypes oral/facial movements)

6

EPS Rx

Benztropine (anti-muscarinic)
Diphenhydramine (H1G1 blocker)

7

NMS =

Neuroleptic malignant syndrome
"FEVER"
Fever
Encephalopathy
Vitals unstable (autonomic instability)
Enzymes elevated (myoglobinuria)
Rigidity

8

NMS Rx

Dantrolene (prevents Ca++ release from SR)
D2 agonists (bromocriptine)

9

Tardive dyskinesia

Stereotypes oral-facial movements from long-term antipsychotic use

10

High potency vs. low potency typical antipsychotics

High potency: trifluoperazine, fluphenazine, haloperidol
= neurological AE (huntingtons, delerium, EPS)

Low Potency: Chlorpromazapine, Thioridazine
= non-neurological AE (anti-cholinergic, anti-a1, anti-histamine)

11

Atypical Antipsychotics

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

12

Atypical antipsychotics MOA

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Not well known, alter 5HT2, DA, a, and H1 receptors

13

Atypical antipsychotics use

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Schizophrenia (+ and -)
Bipolar
mania
depression
anxiety
OCD
Tourette's

14

Atypical Antipsychotic toxicities - general

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Fewer EPS and anti-cholinergic s/s than typicals
All may prolong QT (except aripiprazole)

15

Antipsychotics causing weight gain

clonzapine and olanzapine

16

Clozapine AE

weight gain, agranulocytosis, seizures
*requires weekly WBC counts

17

Antipsychotic causing agranulocytosis

clozapine

18

antipsychotic causing seizures

clozapine

19

Olanzapine AE

weight gain

20

Risperidone AE

prolactinemia

21

Lithium mechanism

unknown, related to PIP pathway

22

Lithium use

Mood stabilizer for bipolar! blocks their relapse and acute manic events
SIADH (SSRIs cause SIADH)

23

Lithium toxicity

Tremor
Hypothyroidism
Nephrogenic DI (increase with thiazides via increase Na co-transport in PCT from dehydration)
Teratogen (Ebstein anomaly = low tricuspid)

24

Buspirone mechanism

stimulates 5HT1A-Rs

25

Buspirone use

GAD

26

Buspirone profile

No sedation, addiction, or tolerance. Does not interact with alcohol. Good for old addicts.

BUT takes 1-2 weeks to start working

27

SSRIs

Paroxetine, sertraline, flluoxetine, citalopram

28

SSRI use

Paroxetine, sertraline, flluoxetine, citalopram

Depression
GAD
Panic disorder
OCD
Bulemia
social phobia
PTSD

29

SSRI toxicity

Paroxetine, sertraline, flluoxetine, citalopram

GI
SIADH (lithium treated SIADH)
SEXUAL DYSFUNCTION
SEROTONIN SYNDROME

*less AE than TCAs

30

Serotonin syndrome: causes, s/s, Rx

Seen with any drug that increases 5HT: TCA, SSRI, SNRI, MAO-I; Ondansetron, detromethorphan, meperidine, tramadol, trypans, linezolid

Hyperthermia
Confusion
Myoclonus
CV instability
Flushing
diarrhea
seizures

Rx = cyproheptadine (5HT-2 antagonist)

31

Serotonin syndrome causes

Any drug that increases 5HT: TCA, SSRI, SNRI, MAO-I

32

Serotonin syndrome s/s

Hyperthermia
Confusion
Myoclonus
CV instability
Flushing
diarrhea
seizures

33

Serotonin syndrome rx

Rx = cyproheptadine (5HT-2 antagonist)

34

SNRIs

Venlafaxine and duloxetine

35

SNRI mechanism

Venlafaxine and duloxetine

inhibits 5-HT and NE uptake

36

SNRI use

Venlafaxine and duloxetine

Depression

Venlafaxine - GAD, panic, PTSD
Duloxetine - diabetic peripheral neuropathy

37

Venlafaxine use

Depression
GAD
Panic disorder
PTSD

38

Duloxetine use

Depression
Diabetic peripheral neuropathy

39

SNRI toxicity

Venlafaxine and duloxetine

INCREASE BP
stimulant
sedation
nausea

40

TCAs

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

41

TCA mechanism

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

Inhibit 5HT and NE reuptake

42

TCA use

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

Major depression
OCD (clomipramine)
Peripheral neuropathy
Chronic pain
Migraine prophylaxis

43

TCA toxicity

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

Anti-muscarinic (3' amitriptlyine is worse than 2' nortriptyline); causes confusion and hallucinations in the elderly
Anti-a1 --> Orthostatic hypotension
anti-histamine --> sedation
Prolong QT
Convulsions
Coma
Prolong Cardiac Fast Na+ channels --> Cardiotoxicity (arrhythmias) - prevent with NaHCO3
Respiratory depression
Fever
inc. NE/5HT --> Tremor, insomnia

44

TCA to use in elderly

Nortriptyline because 2' so less anticholinergics

45

NaHCO3

prevents arrhythmias with TCAs

46

MAO-I

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

47

MAO-I mechanism

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

Causes increased amine NTs (NE, 5HT, DA)

48

MAO-I use

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

ATYPICAL depression, anxiety

49

MAO-I toxicity

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

CHEESE REACTION - hypertensive crisis with tyramine-rich foods (wine, cheese, beer, smoked meats)
CNS stimulation

Contraindicated with: (to prevent serotonin syndrome)
SSRI
TCA
St. John's Wort
Meperidine (opioid)
Dextromethorphan (opioid)

50

Cheese reaction mechanism

Hypertensive crisis with tyramine-rich foods while on MAO-Is

MAO normally breaks down tyramine in GIT
MAO blocked, so tyramine absorbed
Tyramine causes displacement of NE from its vesicles, and thus increases NE release
excess NE causes hypertensive crisis

51

Bupropion mechanism

increase NE and DA (don't know how)

52

Bupropion use

ATYPICAL depression
Smoking cessation

53

Bupropion toxicity

stimulant
HA
SEIZURES IN ANOREXIC/BULEMICS

*NO sexual AE (SSRIs do)

54

Mirtazapine mechanism

a2-antagonist - increases NE and 5HT release
5HT-2 and 5HT-3 - R Antagonists

55

Mirtazapine use/AE

ATYPICAL depression
Sedation (good for insomnia)
Increased appetite and weight gain (good for elderly/AIDS)

56

Trazadone mechanism

Blocks 5HT-2 and a1-Rs
Weakly inhibits presynaptic reuptake of serotonin
Blocks postsynaptic H1 receptors

57

Trazodone use

MC = insomnia (because very high doses needed for atypical depression treatment)

58

Trazodone AE

PRIAPISM
sedation (obviously)
nausea
postural hypotension

59

CNS stimulants

Methylphanidate, dextroamphetamine, methampnetamine

60

CNS stimulant mechanism

Methylphanidate, dextroamphetamine, methampnetamine

Increase catecholamines in the synaptic cleft (especially NE and DA)

61

CNS simulant use

Methylphanidate, dextroamphetamine, methampnetamine

ADHD, narcolepsy, appetite control

62

Methylphenidate

CNS Stimulant

63

Dextroamphetamine

CNS stimulant

64

Methamphetamine

CNS stimulant

65

Haloperidol

Typical antipsychotic - high potency

66

Trifluoperazine

Typical antipsychotic - high potency

67

Fluphenazine

Typical antipsychotic - high potency

68

Chlorpromazine

Typical antipsychotic - low potency

69

Thioridazine

Typical antipsychotic - low potency

70

Antipsychotics name general

haloperidol + ___azine

71

Quetiapine

Atypical antipsychotic

72

Olanzapine

Atypical antipsychotic

73

Risperidone

Atypical antipsychotic

74

Aripirazole

Atypical antipsychotic

75

Clozapine

Atypical antipsychotic

76

Ziprasidone

Atypical antipsychotic

77

Paroxetine

SSRI

78

Fluoxetine

SSRI

79

Fluoxetine vs. fluphenadine

fluoxetine = SSRI
fluphenazine = typical antipsychotic

80

Citalopram

SSRI

81

Sertraline

SSRI

82

Venlafaxine

SNRI

83

Duloxetine

SNRI

84

Amitriptyline

TCA - 3'

85

Noramitriptyline

TCA - 2'

86

Imipramine

TCA

87

Desipramine

TCA

88

Clomipramine

TCA

89

Doxepin

TCA

90

Amoxapine

TCA

91

Tranylcypromine

MAO-I

92

Phenelzine

MAO-I

93

Selegiline

MAO-I (B selective)

94

Isocarboxazid

MAO-I