Psychopharmacology Flashcards
(76 cards)
1
Q
4 categories of major antidepressants
A
TCAs, MAOIs, SSRIs, atypicals
2
Q
OCD treatment
A
SSRIs, TCAs
3
Q
Panic disorder tx
A
SSRIs, TCAs, MAOIs
4
Q
eating disorder tx (pharm)
A
SSRIs, TCAs, MAOIs
5
Q
dysthymia tx
A
SSRI
6
Q
social phobia tx
A
MAOI and SSRI
7
Q
PTSD tx
A
SSRI, TCA
8
Q
IBS tx
A
SSRI, TCA
9
Q
Enuresis tx
A
TCA
10
Q
neuropathic pain tx
A
TCA
11
Q
migraine headaches tx
A
TCA, SSRI, bupropion
12
Q
smoking cessation tx
A
bupropion
13
Q
TCAs MOA
A
inhibit reuptake of NE and serotonin, increasing availability in synapse
14
Q
hallmark of TCA toxicity
A
widened QRS (>100msec) used as threshold to treatment
15
Q
TCA used for OCD
A
clomipramine
16
Q
mainstay of treatment for TCA overdose is
A
IV sodium bicarbonate
17
Q
antihistaminic property of TCAs
A
sedation
18
Q
antiadrenergic properties of TCAs
A
CV side effects- orthostatic hypotension, tachycardia, arrhythmias
19
Q
antimuscarinic effects of TCAs
A
dry mouth, constipation, urinary retention, blurred vision, tachycardia
20
Q
MAOI MOA
A
prevent the inactivation of biogenic amines such as NE, serotonin, dopamine, and tyramine
21
Q
MAO-A preferentially deactivates what?
A
serotonin
22
Q
MAO-B preferentially deactivates what?
A
NE/Epi
23
Q
MAO A and B both act on which neurotransmitters
A
dopamine and tyramine
24
Q
Three MAOIs
A
phenelzine (Nardil), tranylcypromine (parnate), isocarboxazid (marplan)
25
side effects of MAOIs
orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction
26
serotonin syndrome
SSRIs and MAOIs are taken together. initially characterized by lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks. may progress to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, and death.
27
Hypertensive crisis
risk when MAOIs are taken with tyramine-rich foods or sympathomimetics. foods with tyramine (red chianti wine, cheese, chicken liver, fava beans, cured meats) case a build up of stored catecholamines.
28
SSRIs (examples)
fluoxetine (prozac), sertraline (zoloft), paroxetine (paxil), fluvoxamine (luvox), citalopram (celexa), escitalopram (lexapro)
29
fluoxetine
prozac. longest half life with active metabolites. do not need to taper
30
sertraline
zoloft. highest risk of GI disturbances
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paroxetine
paxil. most serotonin specific, most activating
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fluvoxamine
luvox. only for OCD
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citalopram
celexa.
34
escitalopram
lexapro. similar to cialopram/celexa, more expensive
35
side effects of SSRIs
Sexual dysfunction (25-30%), GI disturbance, insomnia, headache, anorexia, weight loss, serotonin syndrome when used with MAOIs
36
Venlafaxine
SNRI. effexor. treats refractory depression and CAP. can increase BP. withdrawal symptoms with 1-3 missed doses not life threatening but very uncomfortable
37
Bupropion
Wellbutrin. NDRI. commonly used to aid in smoking cessation and seasonal affective disorder, and adult ADHD. lack of sexual side effects compared to SSRIs. dopaminergic effect can exacerbate psychosis. side effects: increase sweating and increased risk of seizures and psychosis at high doses.
38
serzone and trazodone
especially useful in treatment of refractory major depression
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Mirtazapine
Remeron. NASA. refractory major depression, especially if weight gain is needed. side effects are sedation, weight gain, dizziness, somnolence, tremor, and agranulocytosis.
40
low potency antipsychotics
lower affinity for dopamine receptors, higher dose required. chlorpromazine (thorazine), thioridazine (mellaril). higher incidence of anticholinergic and antihistaminic side effects than high potency traditional antipsychotics. lower incidence of EPSE and NMS
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high potency antipsychotics
higher affinity for dopamine receptors, and therefore a relatively low dose is needed to achieve effect. Haloperidol, fluphenazine, trifluoperazine, perphenazine, pimozide
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treatment of EPSEs
reduce dose of antipsychotic and administer antiparkinsonian, anticholinergic, or antihistaminic meds like amantadine, benadryl, or benztropine
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other SEs of antidepressants
weight gain, elevated LFTs, jaundice, chlorpromazine- deposits in lens and cornea), dermatologic problems- rashes and photosensitivity (blue gray skin discoloration with chlorpromazine), seizures,
44
Neuroleptic malignant syndrome
FALTER: Fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigidity
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treatment of NMS
discontinue current meds, hydration, cooling etc. sodium dantrolene, bromocriptine, and amantadine are useful. you CAN start the same neuroleptic at a later time. NOT an allergy
46
two atypical antipsychotics approved to treat mania
quetiapine and ziprasidone
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atypical antipsychotics
clozapine, risperidone, quetiapine, olanzapine, ziprasidone
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olanzapine side effects
hyperlipidemia, glucose intolerance, weight gain, and liver toxicity (monitor LFTs)
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Quetiapine side effects
less propensity for weigh gain, but has beens hown to cause cataracts in beagle dogs, so periodic slit lamp examination is recommended.
50
Three mood stabilizers
lithium, carbamazepine and valproic acid
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Therapeutic range of lithium
0.7-1.2
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Factors that affect lithium levels
NSAIDs decrease it, aspirin, dehydration, salt deprivation, impaired renal function, diuretics
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side effects of lithium
fine tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, GI problems, benign leukocytosis, thyroid enlargement, hypothyroidism, and nephrogenic diabetes insipidus
54
carbamazepine
tegretol. anticonvulsant that is especially useful in treating mixed episodes and rapid cycling bipolar disorder. used in the management of trigeminal neuralgia.
55
carbamazepine side effects
skin rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, and agranulocytosis.
56
valproic acid
anticonvulsant that is especially useful in treating mixed manic episodes and rapid cycling bipolar disorder. its mechanism of action is unknown, but it has been shown to increase CNS levels of GABA.
57
side effects of valproic acid
sedation, weight gain, alopecia, hemorrhagic pancreatitis, hepatotoxicity, and thrombocytopenia.
58
categories of anxiolytics
benzos, barbiturates, and buspirone
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advantage of benzos over barbiturates
safety at high doses
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limitation of using benzos
duration of BDZ use due to potential for tolerance and dependence. works by potentiating effects of GABA
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long acting benzodiazepines
Chlordiazepoxide, diazepam, flurazepam
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intermediate acting benzodiazepines
alprazolam, clonazepam, lorazepam, temazepam
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short acting benzodiazepam
oxazepam, triazolam
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zolpidem, zaleplon
short term treatment of insomnia. selectively bind to benzodiazepine binding site on GABA receptor. no withdrawal, minimal rebound insomnia, little or no tolerance/dependance occurs with prolonged use.
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Buspirone (indication, kinetics, receptor, advantage)
alternative to benzo or venlafaxine for treating generalized anxiety disorder. slower onset than benzos (takes 1-2 weeks to take effect), anxiolytic action is at the 5HT-1A receptor (partial agonist). does not potentiate the CNS depression of alcohol. low potential for abuse/addiction
66
what two drug classes have HAM side effects
TCAs and low potency antipsychotics
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symptoms of serotonin syndrome
confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, and death
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akathisia
restlessness and agitation
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parkinsonism
masklike face, cogwheel rigity, pill rolling tremor
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dystonia
sustained contraction of muscles of neck, tongue, eyes. occurs with high potency traditional antipsychotics, reversible (occurs within days), can be life threatening (example- dystonia of the diaphragm causing asphyxiation)
71
NMS
fever, tachycardia, HTN, tremor, elevated CPK, lead pipe rigidity
72
medications that can cause psychosis
sympathomimetics, analgesics, antibiotics, anticholinergis, anticonvulsants, antihistamines, corticosteroids, and antiparkinsonian agents
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medications that can cause agitation/confusion/delirium
antipsychotics, antidepressants, antiarrhythmics, antineoplastics, corticosteroids, cardiac glycosides, NSAIDs, antiasthmatics, antibiotics, anti-HTN, antiparkinsonian agents, and thyroid
74
medications that can cause depression
may be caused by anti-HTN, antiparkinsonian agents, corticosteroids, CCBs, NSAIDs, abx, and peptic ulcer drugs
75
medications that can cause anxiety
sympathomimetics, antiasthmatics, antiparkinsonian agents, hypoglycemics, NSAIDs, and thyroid hormones
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medications that can cause sedation/poor concentration
antianxiety agents/hypnotics, anticholinergics, antibiotics, and antihistamines
