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Flashcards in psychopharm 2 Deck (38):
1

monovalent cation, blocks manic behavior, no behavioral effects in "normals"

Inhibits recycling of inositol substrates, may cause depletion of the 2nd messenger source of PIP2 and therefore reduce the release of IP3 and DAG 

lithium

Levels raised by diuretics (Na levels affect excretion and retention), ACE inhibitors, Ang II receptor blockers

2

lithium side effects

fatigue, tremor, GI symptoms, ataxia higher levels cause hyperactive deep reflexes, rigidity, coma

3

CI of lithium

pregnancy

4

clinical uses of lithium

mania, prevent recurrences of bipolar disease, cluster headaches

5

alternatives to lithium

carbamazepine, valproic acid (Divalproex) for initial control of manic symptoms: haloperidol

6

Mechanism of action of Antiseizure agents

Alters ion conductance, use dependent effect on Na+ channels; inhibits generation of repetitive action potentials 

7

blocks sodium channels, no interaction with GABA unpredictable absorption, hepatic enzyme induction used for partial seizures, bipolar I disorder and acute manic/mixed episodes

carbamazepine

8

blocks repetitive neuronal firing, can reduce some Ca currents, increases GABA concentrations; bound to plasma protein, distributes in extracellular fluid used as first line drug in bipolar disease, sedating

valproic acid (Divalproex); inhibits metabolism of drugs including carbamazepine

9

treatment of depressive episodes associated with bipolar disease (drug combination)

olanzapine and fluoxetine

10

carbamazepine side effects

CNS side effects such as sedation, confusion and ataxia, diplopia; Teratogen --> Spina Bifida 

11

valproic acid side effects

GI upset, weight gain, hair loss not dose related: hepatotoxicity and teratogenic (spinal bifida)

12

somatic correlates of anxiety

ANS arousal, voluntary muscle activation (jitteriness, tremor) complications: substance abuse

13

treatment of anxiety and insomnia

benzodiazepines, SSRIs, buspirone, classical antihistamines, EtOH, cannabis, opiates, barbiturates

14

benzodiazepine receptor agonists

diazepam, zolpidem

15

benzodiazepine receptor antagonists

flumazenil

16

partial agonist for 5-HT 1A, also binds to dopamine receptors delayed onset, little sedation, no dependence or cross-tolerance used for GAS

buspirone

17

benzodiazepines used to treat anxiety

diazepam, alprazolam, lorazepam

18

Effects of benzodiazepines

decreased anxiety, sedation, hypnosis, muscle relaxation (diazepam), anterograde amnesia, anticonvulsant action, minimal CV/resp actions alone

19

benzodiazepine drug interactions

produce additive CNS depression with other depressants; can affect hepatic metabolism of drugs like cimetidine

20

clinical uses of benzodiazepines

anxiety states, sleep disorders, seizure treatment, IV sedation and anesthesia some used for alcohol withdrawal, acute manic episodes

21

Antianxiety, rapid onset of action, long duration used as hypnotic

flurazepam

22

Antianxiety benzodiazepine; Does not form active metabolite; less lipophilic, slower absorption and onset of action, longer duration of action after single dose used as hypnotic

Lorazepam 

23

fast onset of action, high lipid solubility, rapid redistribution; muscle relaxant due to actions in spinal cord; intravenous sedation and anethesia 

diazepam

24

Antianxiety benzo, used for panic disorder

Alprazolam 

25

benzo used for alcohol withdrawl

chlordiazepoxide

26

symptoms of benzo withdrawal

anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures

27

Anti-anxiety; high affinity for 5-HT1A receptors, partial agonist; elimination half life: 2-11 hrs; less sedating than benzodiazepines; used for treatment of GAD

Buspirone 

28

other treatments for anxiety

SSRIs & SNRIs, beta-blockers, other sedatives (rarely)

29

hypnotic that binds to BDZ receptor on GABA complex; weak anxiolytic, muscle relaxant and anticonvulsant; preserves stage 3 and 4 sleep, duration 5-6hr

zolpidem

30

adverse effects of hypnotic effects

daytime sedation, ataxia, rebound insomnia, tolerance and dependence, occasional idiosyncratic excitement and stimulation

31

act at GABA A, rapidly absorbed and distributed, highly lipid soluble, renal excretion, additive with other CNS depressants used as anticonvulsant

barbiturate

32

barbiturate side effects

general CNS depression, anticonvulsant, respiratory depression tolerance (not uniform) physical dependence with withdrawal symptoms (seizures)

33

skeletal muscle relaxants

used to reduce muscle tone associated with spasticity related to MS injuries/other musculoskeletal disorders

34

Barbituate hypnotic, anticonvulsant; rarely used today

Phenobarbital 

35

Aldehyde hydrate with pungent taste and somewhat caustic taste; metabolized o tricholoroethanol which is the active form of the drug; Pharmacology similar to barbiturates; Less effects on stages of sleep than benzos and barbiturates

Chloral Hydrate 

36

Muscle relaxant; GABA-mimetic agent working at GABA B receptors, Results in hyperpolarization, causing presynaptic inhibition; decreased release of excitatory transmitters such as glutamate 

Baclofen

37

alpha2 adrenergic agonist, relieves muscle spasm side effects include drowsiness, hypotension, dry mouth interacts with CYP1A2 inhibitors

Tizanidine

38

other agents used as muscle relaxants

botulinum toxin, dantrolene