Psychiatry Flashcards
(28 cards)
Name 3 high potency typical antipsychotics
trifluoperazine, fluphenazine, haloperidol
Name 2 low potency antipsychotics (typical)
Chlorpromazine, thioridazone
What is the mechanism of typical antipsychotics, including secondary targets.
Mainly work via D2R antagonism, resulting in initial rebound increase in DA followed by a drop in DA release. They also inhibit M,alpha1 and histamine receptors.;
What are the major side-effects of typical antipsychotics. Consider high vs. low potency.
High Potency drugs have more EPS side-effects. EPS side-effects relate to dopamine antagonism in the brain and include early acute dystonia, followed by akathisia(restlessness), and much latert parkonsonism and tardive dyskinisia(stereotyped facial and oral movements). Low potency drugs tend to have more anticholinergic side-effects (dry mouth, constip), alpha1 effects(hypotension) and histamine effecys(sedation). All can cause a prolonged QT interval and Prolactinemia.
What is Neuroleptic Malignant Syndrome?
It is a rare, life-threatening side-effect associated with Dopamine recptor blockade. It presents with fever, encephalopathy, elevated muscle enzymes/proteins (myoglobin, creatine kinase), muscle rigidity and autonomic instability.
What is the treatment for neuroleptic malignant syndrome?
Dantrolene or bromocriptine (DA agonists)
List all atypical antipsychotics.
Olanzopine, Clozapine, Quietapine, Risperidone, Aripiprazole, Ziprasidone
What is the mechanism and advantages for use in atypical antipsychotics?
They act on Da, 5HT2 and H1 recptors. Unlike typical antipsychotics, they aleviate both positive and negative symptoms of schizophrenia. They also have wider use on deprtession, OCD, anxiety. They have reduced antimuscarinic and ESP side-effects.
What toxicities are associated with atypical antipsychotics?
Weight gain is seen with olanzapine and clozapine (appetite regulation effects). Clozapine carries a risk of agranulocytosis, requiring frequent WBC monitoring. Risperidone in particular causes increased PRL levels. All can cause QT prolongation.
What is the mechanism and use of Lithium
It is believed to inhibit the phosphatidylinositol cascade. It is used as a mood stabilizer in bipolar disorder to prevent relapses and acute manic events. It is also used to treat SIADH.
What are the toxicities of Lithium?
LMNOP: Lithium causes movement problems(tremor), nephrogenic diabetes insipidus, hypOthyroidism, and pregancy category X (Ebstein anomaly in newborns=tricuspid valve leaflet displacement)
What is busprinone?
It is a 5HT1 R angonist used for the treatment of generalized anxiety disorder. Its advantages over other specific anxiolytics is its lack of sedation, no addiction and tolerance formation. It also has no alcohol interactions by not acting on GABA receptors. It takes 1-2 weeks to take effect.
What neurotransmitter changes are associated with depression?
decreases in 5HT, DA and NE
Name 4 SSRIs
Fluoxetine, Paroxatine, Sertroline, Citalopram
What are the side effects of SSRIs?
GI disturbance, sex dysfunction and SIADH
What is Seratonin Syndrome?
It is from excess %HT levels, usually from combination of 5HT increasing medications. It presents with hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea and seizure. It is treated with the 5HT2 antagonist, cyproheptadine.
List 2 SNRIs
duloxetine and venlafaxine
What are the uses and toxicities of SNRIs
They may raise BP, cause sedation and nausea. Venlafaxine may also be used to treat generlaized anxiety, panic disorder and PTSD. Duloxetine can treat diabetic neuropathy.
Name as many TCAs as you can
amytryptiline, nortryptiline, imiprimine, desipramine, clomipramine, doxepin, amoxepine
What is the indication for TCA use and what NTs do they affect?
Like SNRIs, they inhibit reuptake of 5HT and NE. They are used to treat major depression. clomipramine can treat oCd. They can also be used to treat chronic pain and diabetic neuropathy and migraine prophylaxis.
What are the adverse effects of TCAs?
Sedation, M block, especially in tertiary amy, less so in secondary nortryp. They all prolong the QT interval. Overdose can cause convulsions, coma and cardio arrhythmias.
List 3 non-selective MAOIs and 1 selective MAOI
Nonselective: tranylocypromine, Phenelzine, Isocarboxazid
B selective: Selegiline
What is the mechanism of MAOIs?
They inhibit MAOs, thus increasing amine NT pools in the presynaptic neuron (5ht, ne, da)
What are mAOIs used for?
They treat atypical depression and anxiety disorders.
