Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

The Mind > Psychopharm > Flashcards

Psychopharm Flashcards

(109 cards)

Start Studying
0
Q

Presynaptic 5HT: function and targets

A
  • reuptake channels
  • TCAs and SSRIs
    ~ clomipramine
    ~ fenfluramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Sumatriptan receptors

A
  • vasoactive
  • presynaptic: 1B, 1D
  • postsynaptic: 1F; 1B,1D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

5HT-3 receptors

A
  • most clinically active

- ondansterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • 5HT-2C/2A receptor
A
  • active site of atypical antipsychotics and LSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mesolimbic pathway

  • decreased DA
  • increased DA
A
  • increase: antipsychotic, anti-anxiety, anti-agitation
  • decrease: inhales pleasure; increases psychosis, mania, agitation
  • note: nucleus acumbens is center for addiction and pleasure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Meso-cortical path

  • increased DA
  • decreased DA
A
  • decrease: negative symptoms of schizophrenia, depression, cog. Impairment, inattention (hypofrontality, ADD)
  • increased: opposite of above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nigro-striatal pathway

  • increased DA
  • decreased DA
A

Decreased: 4 extra-pyramidal symptoms
~ dystonia, akinesia, Parkinsonism, NMS (fever, AMS, autonomic instability and increased CK)
Increased: tardive dyskinesia, chorea, Tourette’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tuberinfundibular pathway

  • decreased DA
  • increased DA
A
  • decreased: increased prolactin
    ~ results in -> galactorrhea, amenorrhea, gynecomastia,
    infertility, impotence
  • increased: decreased prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chemoreceptive trigger zone for DA

A
  • decreased: antiemetic

- increased: N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5HT/NE synthesis

A 
5HT
- tryptophan derived 
- tryptophan hydroxylase - rate limiter 
NE
- Tyrosine derived
- tyrosine hydroxylase (first step) - rate limiter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Selective monamine transporters (3)

A
  • 5HTT
  • NET
  • DAT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

VMAT

A
  • recycling of monoamines int vesicles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5HT N2K receptors

A
  • 5HT3 is the only non-G protein receptor

- 5HT1D,1A, 2A, 2C (involved in depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5HT1A

A
  • in raphe nuclei and post synaptic cell bodies hippocampus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5HT1D

A
  • auto-inhibitors of 5HT release at axon terminals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

alpha adrenergic receptors

A
  • a1, 2 and B1, 2 most relevant

- a2: auto inhibitory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MAO-A, B

A
  • anti depressant is primarily MAO-A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Phenelzine (selegiline): MAOI, use, side effects

A
  • MOA: MAOB inhibitor (Parkinson’s, dermal patch depression)
  • SE: result from a-adrenergic blockade
    ~ orthostatic hypotension
    ~ weight gain
    ~ sexual dysfunction
    ~ potentially lethal drug interaction (carbidopa, meperidine,
    linezolide, St. John wort, SSRIs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tricyclic antidepressants: effects, examples

A
  • TCAs With secondary amines preferentially affect NE systems
  • TCAs With tertiary amines preferentially affect 5HT systems
  • don’t effect DA
  • can also trt neuropathic pain
  • amytriptyline, nortriptyline, desipramine, imipramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tricyclics specs

A
  • MOA: non-selective 5HT and NE uptake inhibition
  • SE: cardio-conduction delays, first degree blocks
    ~ also blocks: 5HT, NE, a-1, hist, ACh
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Histamine blockade SE

A
  • sedation
  • weight gain
  • impaired coordination
  • orthostatic hypotension
  • cognitive impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Muscarinic blockade

A

Anti-parasympathetic

  • dry mouth
  • constipation
  • urinary hesitancy
  • decreased visual acuity (loss of accommodation)
  • aggravation of glaucoma
  • tachycardia
  • cognative impairment
  • impotence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A adrenergic blockade SE

A
  • orthostatic hypotension
  • reflex tachycardia
  • ejaculation
  • cognitive impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

5HT blockade SE

A
  • anxiety
  • anorexia
  • N/V
  • insomnia
  • sedation
  • sexual SE: arousal
  • weight gain
  • serotonin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
NE blockade SE
- anxiety - tremor - tachycardia
25
SSRIs
- first line antidepressants - also trt OCD, panic disorders, PTSD, Social phobias, GAD - fluoxetine, paroxetine, sertraline, citalopram - microsomal interactions
26
1A 5HT autoreceptors
- desensitize/down regulate in increased concentrations of 5HT
27
5HT2A
Anxiety, akinesia, myoclonus, sexual dysfunction (orgasm and ejaculation (spinal cord), decreased libido
28
5HT2C
Anxiety and panic attacks
29
5HT3
N/V/D
30
5HT4
Increased bowel motility, cramps and diarrhea
31
Serotonin syndrome
- excessive 5HT - agitation, insomnia - diaphoresis, hyperpyrexia, tachycardia, hypertension - rigidity, tremor - can be life threatening, onset may be acute or insidious
32
SSRI withdrawal
- flu like const. Symp. - restlessness, confusion - irritability - circadian disturbance - less likely with loner 1/2 life drugs - moral: for SSRIs taper off.
33
Venlafaxine, duloxetine
- mixed 5HT/NE (both preferential for 5HT, vel is stronger) - appears to have increased efficacy due to synergy - marketed as management if painful effects of depression
34
Mirtazapine
- MOA: a-2 antagonist - SE: weight gain, sedation (5HT3 inhibition) - is also a 5HT2A
35
Bupropion
- MOA: augments NE release and inhibits DA reuptake (exact mech unknown) - SE: potential seizure risk: Cind in epileptics or bulimic PTs. - helpful in smoking cessation
36
Trazadone
- MOA: 5HT2A antagonism, weak 5HT reuptake inhibition - associated with priapism - extremely sedating - SE make it most useful at very low doses for insomnia
37
Common SE for all antidepressants
- cardiac effects (esp TCAs) - allergic rxns (Stevens Johnson's) - mania (esp is bipolar or manic predisposition) - seizures (practically only bupropion, TCAs) - hepatotoxicity (mostly benign enzyme elevation) - hematoxic - agranulocytosis, neutropenia
38
Overdose: MAOIs, TCAs, SSRIs
- MAOI, TCAs: 7-10 day supply can be lethal - TCAs: cardiac, seizures - MAOIs: HTN crisis, hyperpyrexia - SSRI: safer theraputic index lethal interactions can occur with as little as 25 day supply
39
Antidepressants and pregnancy
- most are category C (paraxetone: cat D) - cross placenta DNA breast milk - increase spontaneous abortion
40
Lithium
- trt for bipolar disorder - IP3/DAG blockade via inhibition of PIP2 regeneration - renal metabolism: GFR makes a big difference (PCT resorb, competes with Na) - 17-26 hr 1/2life - carbonate salt in solid form; citrate salt in liquid form
41
Lithium absorption
- mostly in PCT | - distal tubule diuretics can increase resorption (thiazides, amino ride, spironolactone)
42
Lithium SE (common)
- weight gain - N/V - fine tremor - polyurea, polydypsia - skin rxn - hypothyroidism - benign leukocytosis - edema
43
Lithium SE (uncommon)
- bradycardia - syncope - cog/ NPsych symptoms - nephrogenic diabetes insipidus - renal insufficiency - decreased seizure threshold
44
0.6-1.2 mEqs
Desired lithium lvl | - > 2 mEqs sever toxicity
45
Elevators of lithium levels
- ACE inhibitors - NSAIDS - Distal Tubule Diuretics (DTDs)
46
Decreasers of lithium levels
- caffiene - carbonic anhydrase inhibitors - laxatives - PTDs - theophylline
47
Toxic interactions with lithium
- antipsychotics | - drugs that increase seizure risk
48
Lithium and pregnancy
- cardiac anomalies (Ebsteins anomaly) | - not particularly hazardous
49
Bipolar trt: valproic acid
``` Valproic acid (depakote): GABA agonist (exact unknown) - SE: dyspepsia, weight gain (common), dysphoria, dizziness, hair loss, HA, N/V, (uncommon), hepatotox, pancreatitis (rare) ```
50
Bipolar trt: carbamazepine
- Na channel inhibitor (exact unknown) - rare but serious SE: agranulocytosis, aplastic anemia - NTDs in preggers - drowsiness, dizziness, slurred speech, ataxia
51
Bipolar trt: oxcarbazepine
- similar to CBZ - less side effects (hyponatremia) - preferred
52
Bipolar trt: Lamotrigine
- Na and Ca channel inhibition - common SE: HA, dizziness, insomnia - associated with Stevens-Johnson's syndrome (slow titration to avoid)
53
Bipolar and women's health
- contraceptive interactions | - osteoporosis (supplement vitamin D and C)
54
Brain heart liver blood skin
- common antidepressant SE
55
Ebsteins anomaly
- cardiac event resultant from Lithium use in pregnancy
56
5HT2
Responsible for sexual side effects - NDRIs (bupropion) don't have sexual side effects because they don't - S5HT antagonist: blocks non-depressive 5HT receptors
57
Buspirone use
Effective in trt of GAD.
58
Phenylzene side effects
- MAOI results primarily from a-adrenergic blockade - orthostatic hypotension - also weight gain, sedation - Tyramine interactions: lethal (wine, beer, soy sauce, aged cheeses)
59
Venlafexine (moa, SE)
- mixed (pure) NSRI | - diastolic BP elevation
60
SSRI withdrawal
- flu like symptoms - irritability, confusion, restlessness - circadian disturbance - risk reduced with longer 1/2 life
61
Lithium MOA
- PIP2 inhibitor -> results in lack of recharge of IP3/DAG decreasing cell activity
62
Typical antipsychotics
- 1st generation - significant side effects - chlorpromazine, haloperidol, thiothixine, biphenylbutylpiperdine
63
Atypical antipsychotics
- 2nd generation - much lower Sx profile - Clozapine, resperidone, olanzapine, quietapine, aripiprazole
64
Clozapine: MOA, Use, side effect
- 5HT-2a antagonist - useful in the trt of drug resistant schizophrenia - rare but serious: agranulocytosis - common: weight gain, hypotension, sinus tach, anticholinergia, sedation
65
Aripiprazole: MOA, use
- partial D2 agonist | - agonism depends on the [DA]: can treat both hyperDA in mesolimbic, and hypofrontality in mesocortex
66
Early treatment of psychosis
- early is essential | - antipsychotics are neuroprotective
67
Significant risk of suicidality in psychosis indication
- clonazapine
68
Acute bipolar mania indication
- all atypicals
69
Bipolar mania indication
- olanzapine or aripiprazole
70
Tic disorder indication
- pimozide
71
Tardive dyskinesia: cause, at risk, treatment
- D2 upregulatory theory - elderly females at highest risk - all 1st gen antipsychotics higher risk - of the 2nd gens, only resperidone significant - trt with antioxidants, clonazapine(benzo)/naltrexone, high dose branched chain AA
72
Common antipsychotic side effects (6)
- hypotension - NMS - Tardive dyskinesia (quietapine) - prolonged QT - sinus tach - sedation
73
Dystonia
- hypercholinergic effect - more common in younger males IM admin - trt: anticholinergics
74
Parkinsonism: (non-idiopathi) etiology and trt
- more common in elderly or brain trauma | - trt with amantadine
75
Metabolic syndrome
- greater risks with second gen antipsychotics
76
Common benzo SE
- impaired motor effects - amnesia - disinhibition (more common in elderly) - essentially resembles a drunk
77
Flumazenil
- benzo overdose trt (GABA antagonist)
78
Benzos vs barbs
- benzos alter NMDA receptors t increase binding affinity | - barbiturates potentiate the kinetics such that they are active longer and can even open Cl- channels directly
79
Chlorodiazepoxide metabolism
- benzo | - metabolized to multiple intermediates (desmethylchloridiazepoxide, desmethyldiazepam)
80
Benzos with no clinically active metabolites (3)
- Alprazolam (Xanax) - triazolam - lorazepam
81
Diazepam metabolism
- desmethyldiazepam -> oxazepam | - more highly metabolized benzos have a longer 1/2life (wide variability)
82
Buspirone: MOA, uses
- 5HT1A - non-sedating, muscle relaxing, or physical dependance inducing - used in a med student because it won't effect her performance
83
Kava
Interacts with benzos | - rare liver toxicity
84
Omega (BZ-1) benzos: examples and use
- zolpidem sedating (sleep aid) - zaleplon (less memory issues, more metabolic interactions) - Eszopiclone (longer duration) (ZZE like the letter BZ-1 is for ZZZZs)
85
Non-selective BZs
- alter stage 2 sleep (which can rebound when off med) - Temazepam: intermediate duration (little accumulation) - Trazolam: retrograde amnesia, rebound insomnia/anxiety (TT- two non selective)
86
Flurazepam
- long lived -> accumulation | - residual sedation
87
Anesthetic Barbiturates
- thiopental, thioamylal | ~ really short acting makes them useful in this setting
88
Anticonvulsant barbiturates
- phenobarbital: long duration
89
Barbiturate effects
- increase stage 2 sleep/decrease rem - Overdose is extremely dangerous - Hyoeralgesia is common can cause insomnia - Lots of interactions including microsomal, ALA synth, and aldehyde dehydrogenase - porphyriase -> contraindication
90
Methaqualone
- illegal drug - "Mickey" date rape - reacts with EtOH to form sedating compound
91
Nocturnal myoclonus trt
- Clonazepam | - etiology includes lots of drugs: SSRIs, uremia, TCAs et al
92
Restless leg trt
- Clonazepam, carbamazepine, quinine
93
OCT extras: valerian, antihistamines, melatonin, ramelteon
- Antihistamines: sleep aid (drowsiness: may look like delirium in elderly) - valerian: sleep aid (reqs several days to stack) - melatonin: great for jet lag - ramelteon: melatonin receptor agonist
94
Thiopental/thioamylal
Short acting anesthetic barbiturates
95
Tramazepam/Trazolam
- sedating barbiturates ~intermediate acting ~ retrograde amnesia, rebound in stag 2 sleep
96
Xanthine examples
Caffeine (caffeine with ergotamine): vasoactive migraine trt | Theophylline: asthma prophylaxis
97
Sympathomimetics e.g.
- amphetamines: NE-> DA-> 5HT - sibutramine - norepinephrine - DA - OTC: St. John's wort, ma Huang (ephedra)
98
Sympathomimetics action and effects
- NE>DA>5HT - increase alertness - restlessness, insomnia, decreased fatigue and appetite, increased BP - assoc with use in anorexia nervousa
99
Clinical use of amphetamines
- limited, primarily to increase satiety - sibutramine: NE/5HT reuptake inhibition - narcolepsy treatment: drug holidays are important ~ GHB current trt: obtained in precursor Na Oxybate - methylphenidate: Ritalin phenylpiperdine precursor preferentially releases NE/DA
100
ADHD trt
- methylphenidate - atomoxatine: NETi - pemoline: DA releasing and hypatotoxic - clonidine: a2 agonist
101
Atomoxatine
- NETi - lacks abuse potential - cardiac and BP SEs - abdominal cramps
102
Methylphenidate
- NE/DA release - ADHD trt - anorexia side effect -> trt for morbid obesity
103
Clonadine
- trt ADHD | - can resolve vigilance issues and tics
104
Bupropion
- NE/DA uptake inhibitor | - along with anti-depressants are also useful
105
Sibutramine
NE/DA reuptake inhibition
106
Phenylpiperdine
Active for of methylphenidate | Ritalin
107
Gamma-hydroxy-butyrate
- trt for narcolepsy
108
5HT3A
- key to atypicality of 2nd gen antipsychotics

The Mind (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions