Flashcards in Psych Pharm from FA Deck (30):
Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”).
High Potency Typical Antipsychotics
Trifluoperazine, Fluphenazine, Haloperidol
(Try to Fly High)
neurologic side effects (EPS symptoms).
Low Potency Typical Antipsychotics
(Cheating Thieves are low)
non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).
MoA of typical Antipsychotics
block dopamine D2 receptors (increase cAMP])
ADR of typical Antipsychotics (6)
Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.
Extrapyramidal system side effects (dyskinesias). Treatment: benztropine or diphenhydramine.
Endocrine side effects (e.g., dopamine receptor antagonism-> hyperprolactinemia + galactorrhea).
Side effects arising from blocking muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors.
Neuroleptic malignant syndrome (NMS)— rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (e.g., bromocriptine).
Tardive dyskinesia—stereotypic oral- facial movements as a result of long-term antipsychotic use. Potentially irreversible.
Trmt for extrapyramidal system side effects caused by antipsychotics
benztropine or diphenhydramine.
Trmt for Neuroleptic malignant syndrome (NMS) caused by antipsychotics
dantrolene, D2 agonists (e.g., bromocriptine)
ADR Of Chlorpromazine?
ADR of haloperidol?
NMS, tardive dyskinesia
ADR of Thioridazine?
What are the atypical antipsychotics?
What is their MoA?
Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone.
MoA: Not completely understood. Varied effects on 5-HT2, dopamine, and α- and H1-receptors.
ADR that both Olanzapine/clozapine share?
ADR of Clozapine?
agranulocytosis (requires weekly WBC monitoring) and seizure.
ADR of risperidone?
increase prolactin (causing lactation and gynecomastia) -> decrease GnRH, LH, and FSH (causing irregular menstruation and fertility issues).
ADR of ziprasidone
Not established; possibly related to inhibition of phosphoinositol cascade.
ADR of Lithium?
Tremor, sedation, edema, heart block, hypothyroidism
polyuria (ADH antagonist causing nephrogenic diabetes insipidus),
teratogen - Ebstein anomaly and malformation of the great vessels
consideration when administering Lithium?
how is it metabolizd?
Narrow therapeutic window - requires close monitoring of serum levels.
Excreted by the kidneys; most is reabsorbed at the PCT following Na+ reabsorption.
Stimulates 5-HT1A receptors.
Generalized anxiety disorder.
Fluoxetine, paroxetine, sertraline, citalopram.
MoA: 5-HT–specific reuptake inhibitors.
sexual dysfunction (anorgasmia and low libido)
any drug that increase 5-HT (MAOi, SNRIs, TCAs)
Sx: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.
Trmt: cyproheptadine (5-HT2 receptor antagonist)
MoA: Inhibit 5-HT and norepinephrine reuptake.
ADR: increased BP, also stimulant effects, sedation, nause
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (all TCAs end in -iptyline or -ipramine except doxepin and amoxapine).
MoA: block NE, 5HT reuptake
ADR: Tri-C’s: Convulsions, Coma, Cardiotoxicity
TCA OD treatment
NaHCO3 to prevent cardiovascular toxicity.
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)
(MAO Takes Pride In Shanghai).
MoA: MAOi -> increase levels of amine neurotransmitters (NE, 5-HT, dopamine).
Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese)
These Rx are contraindicated w/ MAOis
St. John’s wort
(to prevent serotonin syndrome).
3 Atypical antidepressants
Pro about this Rx?
MoA: increase NE, Dopamine via unknown mxn
ADR: stimulant effects (tachycardia, insomnia), headache, SEIZURE IN BULIMIC PATIENTS
"PRO at causing seizures in BUlimics"
PRO: No sexual side effects.
Clinical Use vs ADR/
MoA: α2-antagonist (increase release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.
Clinical Use vs ADR:
- sedation (which may be desirable in depressed patients with insomnia)
- increase appetite, weight gain (which may be desirable in elderly or anorexic patients)
- dry mouth
Mitzy Mirtza takes Mirtazapine to sleep, gain weight, and eat (3 luxuries in life that med students do not have)