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Flashcards in Psych Pharm from FA Deck (30):
1

Antipsychotics (neuroleptics)

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”).

2

High Potency Typical Antipsychotics

Trifluoperazine, Fluphenazine, Haloperidol

(Try to Fly High)

neurologic side effects (EPS symptoms).

3

Low Potency Typical Antipsychotics

Chlorpromazine, Thioridazine

(Cheating Thieves are low)

non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).

4

MoA of typical Antipsychotics

block dopamine D2 receptors (increase cAMP])

5

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.

6

Trmt for extrapyramidal system side effects caused by antipsychotics

benztropine or diphenhydramine.

7

Trmt for Neuroleptic malignant syndrome (NMS) caused by antipsychotics

dantrolene, D2 agonists (e.g., bromocriptine)

8

ADR Of Chlorpromazine?

Corneal deposits

9

ADR of haloperidol?

NMS, tardive dyskinesia

10

ADR of Thioridazine?

reTinal deposits

11

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.

12

ADR that both Olanzapine/clozapine share?

weight gain

13

ADR of Clozapine?

agranulocytosis (requires weekly WBC monitoring) and seizure.

14

ADR of risperidone?

increase prolactin (causing lactation and gynecomastia) -> decrease GnRH, LH, and FSH (causing irregular menstruation and fertility issues).

15

ADR of ziprasidone

prolonged QT

16

Lithium MoA?

Not established; possibly related to inhibition of phosphoinositol cascade.

17

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

18

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.

19

Buspirone
MoA?
Clinical Use?

Stimulates 5-HT1A receptors.

Generalized anxiety disorder.

20

SSRIs
MoA?

ADR:

Fluoxetine, paroxetine, sertraline, citalopram.

MoA: 5-HT–specific reuptake inhibitors.

ADR:
GI distress
sexual dysfunction (anorgasmia and low libido)
serotonin syndrome

21

Serotonin syndrome
Cause?
Sx?
Treatment?

any drug that increase 5-HT (MAOi, SNRIs, TCAs)

Sx: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.

Trmt: cyproheptadine (5-HT2 receptor antagonist)

22

SNRIs

MoA?
ADR:

Venlafaxine, duloxetine.

MoA: Inhibit 5-HT and norepinephrine reuptake.

ADR: increased BP, also stimulant effects, sedation, nause

23

TCAs

MoA?
ADR?

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

24

TCA OD treatment

NaHCO3 to prevent cardiovascular toxicity.

25

MAOi

MoA?
ADR?

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)

(MAO Takes Pride In Shanghai).

MoA: MAOi -> increase levels of amine neurotransmitters (NE, 5-HT, dopamine).

ADR:
Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS stimulation

26

These Rx are contraindicated w/ MAOis

SSRIs
TCAs
St. John’s wort
meperidine
dextromethorphan

(to prevent serotonin syndrome).

27

3 Atypical antidepressants

Bupropion
Mirtazapine
Trazodone

28

Bupropion

MoA?
ADR:
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.

29

Mirtazapine

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)

30

Trazodone

Clinical use?

ADR?

MoA: blocks 5-HT2 and α1-adrenergic receptors

Use: insomnia, as high doses are needed for antidepressant effects.

ADR: BONER, sedation, nausea, postural hypotension.