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USMLE Step I Pharmacology > Psychiatry Pharmacology > Flashcards

Psychiatry Pharmacology Flashcards

1
Q

preferred medications for ADHD

A
  • stimulants
    • methylphenidate
    • amphetamines
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2
Q

preferred medications for alcohol withdrawal

A
  • benzodiazepines
    • chlordiazepoxide
    • lorazepam
    • diazepam
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3
Q

preferred medications for Bipolar disorder

A
  • lithium
  • valproic acid
  • atypical antipsychotics
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4
Q

preferred medications for bulimia nervosa

A
  • SSRIs
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5
Q

preferred medications for depression

A
  • SSRIs
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6
Q

preferred medications for generalized anxiety disorder

A
  • SSRIs
  • SNRIs
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7
Q

preferred medications for obsessive compulsive disorder

A
  • SSRIs
  • venlafaxine
  • clomipramine
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8
Q

preferred medications for panic disorder

A
  • SSRIs
  • venlafaxine
  • benzodiazepines
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9
Q

preferred medications for PTSD

A
  • SSRIs
  • venlafaxine
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10
Q

preferred medications for schizophrenia

A
  • atypical antipsychotics
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11
Q

preferred medications for social anxiety disorder

A
  • SSRIs
  • venlafaxine
  • performance only
    • beta blockers
    • benzodiazepines
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12
Q

preferred medications for Tourette syndrome

A
  • antipsychotics
    • fluphenazine
    • pimozide
  • tetrabenazine
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13
Q

name the CNS stimulants

A
  • methylphenidate
  • dextroamphetamine
  • methamphetamine
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14
Q

CNS stimulants–mechanism

A
  • increase catecholamines in the synaptic cleft
    • especially norepinephrine and dopamine
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15
Q

CNS stimulants–use

A
  • ADHD
  • narcolepsy
  • appetite control
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16
Q

name the antipsychotics (neuroleptics)

A
  • haloperidol
  • trigluoperazine
  • fluphenazine
  • thioridazine
  • chlorpromazine
    • “haloperidol + ‘-azines’”
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17
Q

antipsychotics (neuroleptics)–mechanism

A
  • alltypical antipsychotics block dopamine D2 receptors
    • increase [cAMP]
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18
Q

antipsychotics (neuroleptics)–stored or excreted?

A
  • highly lipid soluble, so stored in body fat and slow to be removed
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19
Q

antipsychotics (neuroleptics)–high potency drugs

A
  • Trifluoperazine
  • Fluphenazine
  • Haloperidol
    • “Try to Fly High”
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20
Q

antipsychotics (neuroleptics)–high potency drug side effects

A

neurologic side effects, including extrapyramidal symptoms (EPS)

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21
Q

explain the onset of extrapyramidal symptoms (EPS)

A
  • ​ADAPT
    • ​hours to days: Acute Dystonia–muscle spasm, stiffness, oxulogyric crisis
    • days to months: Akathisia (restlessness) and Parkinsonism (bradykinesia)
    • months to years: Tardive dyskinesia
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22
Q

antipsychotics (neuroleptics)–low potency drugs

A
  • chloropromazine
  • thioridazine
    • “Cheating Thieves are low”
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23
Q

antipsychotics (neuroleptics)–low potency drug side effects

A
  • non neurologic side effects
    • anticholinergic
    • antihistamine
    • alpha 1 blockade effects
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24
Q

Chlorpromazine–side effects

A
  • (antipsychotic)
  • ​Corneal deposits
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25
Q

Thioridazine–side effects

A
  • (antipsychotic)
  • reTinal deposits
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26
Q

haloperidol–side effects

A
  • (antipsychotics)
  • NMS
  • tardive dyskinesia
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27
Q

Neuroleptic Malignant Syndrome (NMS)

A
  • rigidity
  • myoglobinuria
  • autonomic instability
  • hyperpyrexia
  • “FEVER”
    • ​Fever
    • Encephalopathy
    • Vitals unstable
    • Enzymes increase
    • Rigidity of muscles
  • treatment: dantrolene, D2 agonists (bromocriptine)
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28
Q

treatment for extrapyramidal system side effects

A
  • caused by antipsychotics
  • treatment:
    • benztropine
    • diphenhydramine
    • benzodiazepines
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29
Q

antipsychotics (neuroleptics)–toxicity

A
  • EPS side effects
  • endocrine side effects
  • side effects arising from:
    • blocking muscarinic Rs–dry mouth, constipation
    • blocking alpha 1 Rs–orthostatic hypotension
    • blocking histamine Rs–sedation
  • may cause QT prolongation
  • Neuroleptic Malignant Syndrome (NMS)
  • Tardive Dyskinesia
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30
Q

explain endocrine side effects that may result from taking antipsychotics (neuroleptics)

A
  • dopamine receptor antagonism –> hyperprolactinemia –> galactorrhea, oligomenorrhea, gynecomastia
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31
Q

Tardive Dyskinesia

A
  • orofacial chorea as a result of long term antpsychotic use
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32
Q

name the antypical antipsychotics

A
  • aripiprazole
  • asenapine
  • clozapine
  • iloperidone
  • lurasidone
  • olanzapine
  • paliperidone
  • quetiapine
  • risperidone
  • ziprasidone
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33
Q

atypical antipsychotics–mechanism

A
  • not completely understood
    • most are D2 antagonists
      • aripiprazole is a D2 partial agonist
    • varied effects on 5-HT2, dopamine, and alpha and H2 receptors
34
Q

atypical antipsychotics–use

A
  • schizophrenia–both positive and negative symptoms
  • also used for:
    • bipolar disorder
    • OCD
    • anxiety disorder
    • depression
    • mania
    • Tourette syndrome
35
Q

atypical antipsychotics–toxicity

A
  • prolonged QT interval
  • fewer EPS and anticholinergic side effects than typical antipsychotics
36
Q

what is a possible adverse effect of asenapine, clozapine, olanzapine, quetiapine?

A
  • (atypical antipsychotics)
  • metabolic syndrome
    • weight gain
    • diabetes
    • hyperlipidemia
      • “Olanzapine –> Obesity”
37
Q

clozapine–toxicity

A
  • (atypical antipsychotics)
  • agranulocytosis
    • have to monitor WBC weekly
    • “Must watch bone marrow clozely with clozapine”
38
Q

risperidone–toxicity

A
  • (atypical antipsychotic)
  • hyperprolactinemia
    • amenorrhea
    • galactorrhea
    • gynecomastia
39
Q

lithium–mechanism

A
  • not established
    • possibly related to inhibition of phosphoinositol cascade
40
Q

lithium–use

A
  • mood stabilizer for bipolar disorder
  • blocks relapse and acute manic events
41
Q

lithium–toxicity

A
  • tremor
  • hypothyroidism
  • polyuria
    • causes nephrogenic diabetes insipidus
  • teratogenesis
  • LMNOP–Lithium Side Effects
    • Movement (tremor)
    • Nephrogenic diabetes insipidus
    • HypOthyroidism
    • Pregnancy problems
42
Q

what effects does lithium have on a fetus if taken by a pregnant mother?

A
  • cardiac defects
    • causes Ebstein anomaly in newborn–malformations of great vessels
43
Q

therapeutic window of lithium

A
  • therapeutic window is very narrow and requires close monitoring of serum levels
44
Q

how is lithium excreted?

A
  • almost exclusively excreted by the kidneys
    • most is reabsorbed at PCT with Na+
45
Q

what has been implicated in lithium toxicity in bipolar patients?

A
  • thiazide use
46
Q

buspirone–mechanism

A
  • stimulates 5-HT1A receptors
47
Q

buspirone–use

A
  • generalized anxiety disorder
    • “I’m always anxious if the bus will be on time, so I take buspirone”
    • does not cause sedation, addiction, or tolerance
    • takes 1-2 weeks to take effect
    • does not interact with alcohol (vs. barbiturate, benzodiazepines)
48
Q

name the selective serotonin reuptake inhibitors (SSRIs)

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
    • “Flashbacks paralyze senior citizens.”
49
Q

SSRIs–mechanism

A
  • 5-HT specific reuptake inhibitors
  • normally takes 4-8 weeks for antidepressants to have an effect
50
Q

SSRIs–use

A
  • depression
  • generalized anxiety disorder
  • panic disorder
  • OCD
  • bulimia
  • social anxiety disorder
  • PTSD
  • premature ejaculation
  • premenstrual dysphoric disorder
51
Q

SSRIs–toxicity

A
  • fewer than TCAs
  • GI distress
  • SIADH
  • sexual dysfunction
    • anorgasmia
    • decreased libido
52
Q

name the serotonin-norepinephrine reuptake inhibitors

A
  • venlafaxine
  • desvenlafaxine
  • duloxetine
  • levomilnacipran
  • milnacipran
53
Q

serotonin-norepinephrine reuptake inhibitors–mechanism

A
  • inhibit 5-HT and norepinephrine reuptake
54
Q

serotonin-norepinephrine reuptake inhibitors–use

A
  • depression
  • general anxiety disorder
  • diabetic neuropathy
  • Venlafaxine is also indicated for:
    • social anxiety disorder
    • panic disorder
    • PTSD
    • OCD
55
Q

serotonin-norepinephrine reuptake inhibitors–toxicity

A
  • increase BP is the most common problem
  • stimulant effects
  • sedation
  • nausea
56
Q

serotonin syndrome

A
  • can occur with any drug that increases 5-HT (ie. MAO inhibitors, SNRIs, TCAs)
  • characterized by 3 A’s:
    • neuromuscular Activity–clonus, hyperreflexia, hypertonia, tremor, seizure
    • Autonomic stimulation–hyperthermia, diaphoresis, diarrhea
    • Agitation
  • treatment: cyproheptadine–5-HT2 receptor antagonist
57
Q

name the tricyclic antidepressants

A
  • amitriptyline
  • nortriptyline
  • imipramine
  • desipramine
  • comipramine
  • doxepin
  • amoxapine
58
Q

tricyclic antidepressants–mechanism

A
  • block reuptake of norepinephrine and 5-HT
59
Q

tricyclic antidepressants–use

A
  • major depression
  • OCD (clomipramine)
  • peripheral neuropathy
  • chronic pain
  • migraine prophylaxis
60
Q

tricyclic antidepressants–toxicity

A
  • sedation
  • alpha 1 blocking effects including postural hypotension
  • atropine like (anticholinergic) side effects
    • tachycardia
    • urinary retention
    • dry mouth
  • prolong QT interval
  • Tri-C’s: Convulsions, Coma, Cardiotoxicity–arrhythmia due to Na channel inhibition
  • respiratory depression
  • hyperpyrexia
61
Q

why are the elderly at risk for confusion and hallucinations as a result of taking tricyclic antidepressants?

A
  • b/c of the anticholinergic side effects
62
Q

how would you prevent an arrhythmia that may result from taking tricyclic antidepressants?

A
  • administer NaHCO3
63
Q

tertiary tricyclic antidepressants (amitriptyline) vs. secondary tricyclic antidepressants (nortriptyline)

A
  • tertiary tricyclic antidepressants have more anticholinergic effects than secondary TCAs
64
Q

name the monoamine oxidase inhibitors

A
  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline
    • selective MAO-B inhibitor
      • “MAO Takes Pride In Shanghai”
65
Q

monoamine oxidase inhibitors–mechanism

A
  • nonselective MAO inhibition increase levels of amine neurotransmitters, like norepinephrine, 5-HT, dopamine
66
Q

monoamine oxidase inhibitors–use

A
  • atypical depression
  • anxiety
67
Q

monoamine oxidase inhibitors–toxicity

A
  • hypertensive crisis–most notably with ingestion of tyramine, which is found in many foods such as aged cheese and wine
  • CNS stimulation
68
Q

what are contraindications for monoamine oxidase inhibitors?

A
  • SSRIs
  • TCAs
  • St. John’s wort
  • meperidine
  • dextromethorphan (to prevent serotonin syndrome)
69
Q

what do you need to wait to take 2 weeks after stopping MAO inhibitors?

A
  • wait 2 weeks after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions
70
Q

what are the 4 atypical antidepressants?

A
  • bupropion
  • mirtazapine
  • trazodone
  • varenicline
71
Q

buproprion–mechanism

A
  • inc norepinephrine and dopamine
    • mechanism unknown
72
Q

bupropion–use

A
  • depression
  • smoking cessation
73
Q

bupropion–toxicity

A
  • stimulant effects
    • tachycardia
    • insomnia
  • headache
  • seizures in anorexic/bulimic patients
  • no sexual side effects
74
Q

mirtazapine–mechanism

A
  • alpha 2 antagonist–inc release of NE and 5-HT
  • potent 5-HT2 and 5-HT3 receptor antagonist
  • H1 antagonist
75
Q

mirtazapine–toxicity

A
  • sedation
    • may be desirable in depressed patients with insomnia
  • increased appetite
  • weight gain
    • may be desirable in elderly or anorexic patients
  • dry mouth
76
Q

trazodone–mechanism

A
  • primarily blocks 5-HT2, alpha 1 adrenergic, and H2 receptors
  • also weakly inhibits 5-HT reuptake
77
Q

trazodone–use

A
  • primarily for insomnia
  • high doses needed for antidepressant effects
78
Q

trazodone–toxicity

A
  • sedation
  • nausea
  • priapism
  • postural hypotension
    • called traZZZobone due to sedative and male specific side effects
79
Q

varenicline–mechanism

A
  • nicotinic ACh receptor partial agonist
80
Q

varenicline–use

A
  • depression
  • smoking
81
Q

varenicline–toxicity

A
  • sleep disturbance

USMLE Step I Pharmacology (17 decks)

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