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Pharmacology Decks > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

Drug side effect:

confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdo, renal fialure, death

A

Serotonin Syndrome

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2
Q

Drug side effect:

hypertension, headache, sweating, nausea, vomiting, photophobia, autonomic instability, chest pain, arrhythmia, death

A

Hypertensive crisis, caused by ingestion of MAOi w/tyramine rich foods, also known as Tyramine Hypertensive Crisis

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3
Q

Drug side effects:

  • Mask-like face, cogwheel rigidity, bradykinesia, pill-rolling tremor
  • Sense of inner restlessness, need to move
  • painful sustained contraction of muscle
A
  • Parkinsonian
  • Akathisia
  • Dystonia

All occur primarily with high-potency antipsychotics, reversible

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4
Q

Drug side effects:

Choreoathetoid muscle movements of face, mouth, tongue

A

Tardive dyskinesia

  • develops after many years of antipsychotic use
  • usually NOT reversible, 50% may spontaneously remit
  • Risk factors: older age, possibly women and affective disorder
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5
Q

Drug side effects:

Hyperprolactinemia

A

Occurs with high-potency antipsychotics AND risperidone

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6
Q

Drug side effects:
fever, tachycardia, hypertension, tremor, elevated CPK, lead pipe rigidity, leukocytosis, diaphoresis, delirium, autonomic instability

A

Neuroleptic malignant syndrome

  • mostly high-potency antipsychotics
  • 20% mortality rate
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7
Q

CYP450 Inducers (4)

A
  • Tobacco
  • Carbamazepine
  • Barbituates
  • St. John’s Wort
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8
Q

CYP450 Inhibitors (5)

A
  • Fluvoxamine (SSRI)
  • Fluoxetine (SSRI)
  • Paroxetine (SSRI)
  • Sertraline (SSRI)
  • Duloxetine (SNRI)
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9
Q

SSRI Drug:

  • Longest half-life w/active metabolites (don’t need to taper)
  • safe in pregnancy, approved in children
  • insomnia, anxiety, sexual dysfunction
  • elevate levels of antipsychotics (Cyp450 inhibitor)
A

Fluoxetine

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10
Q

SSRI Drug:

  • higher risk for GI disturbance
  • few drug interactions
  • insomnia, anxiety, sexual dysfunction
A

Sertraline

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11
Q

SSRI Drug:

  • Highly protein bound (several drug interactions)
  • Most anticholinergic
  • Sexual dysfunction
  • Short half-life (need to taper), withdrawal phenomena
A

Paroxetine

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12
Q

SSRI Drug:

  • Approved only for OCD
  • Nausea and vomiting
  • Cyp450 inhibitor, many interactions
A

Fluvoxamine

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13
Q

SSRI Drug:

  • geriatric-friendly
  • fewest drug-drug interactions
  • dose-dependent QTc prolongation
A

Citalopram

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14
Q

SSRI Drug:

  • geriatric-friendly
  • few drug-drug interactions
  • dose-dependent QTc prolongation
  • enantiomer of another drug
A

Escitalopram

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15
Q

SSRI Side effects that resolve

A
  • GI disturbance
  • Insomnia, vivid dreams
    Headache
    Anorexia, weight loss
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16
Q

SSRI side effects that do NOT resolve

A
  • Sexual dysfunction (decreased libido, anorgasmia, delayed ejaculation)
  • Akathisia-like state
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17
Q

Other SSRI side effects

A
  • Rare hyponatremia
  • 0.2% seizures
  • Rare SIADH
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18
Q

Misc. Antidepressant:

  • used for depression, GAD, neuropathic pain
  • few drug interactions
  • Incr. BP in high doses
A

Venlafaxine (SNRI)

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19
Q

Misc. Antidepressant:

  • used for depression, neuropathic pain, fibromyalgia
  • NE effects: dry mouth, constipation
  • Hepatotoxicity in vulnerable patients
A

Duloxetine (SNRI)

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20
Q

Misc. Antidepressant:

  • Lack of sexual side effects compared to SSRI
  • Used for depression, smoking cessation, adult ADHD
  • Increased anxiety possible
  • Decreases seizure threshold, especially in eating disorders
  • Psychosis at high doses
  • Contraindicated in MAOi (also seizures and eating disorder)
A

Bupropion (NDRI)

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21
Q

Misc. Antidepressant(2)

  • Used for depression, depression with anxiety, insomnia
  • Lack of sexual side effects
  • Do not affect REM sleep
  • Nausea, dizziness, hypotension
  • Rare but serious liver failure for one drug
A

(Serotonin agonist/antagonist)

  • Trazodone
  • Nefazodone (liver injury)
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22
Q

Misc. Antidepressant

  • used for MDD, esp. w/weight loss or insomnia
  • sedation, weight gain, dizziness, tremor, dry mouth, constipation, agranulocytosis (rare)
  • few sexual side effects
  • few drug interactions
A

(Alpha2 adrenergic receptor antagonist)

Mirtazapine

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23
Q

Heterocyclic Antidepressant:

- used for depression, chronic pain, migraines, insomnia

A

Amitriptyline (TCA, tertiary amine)

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24
Q

Heterocyclic Antidepressant:

- Used for depression, enuresis, panic disorder

A

Imipramine (TCA, tertiary amine)

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25
Q

Heterocyclic Antidepressant:

  • Used for OCD and depression
  • Most serotonin-specific
A

Clomipramine (TCA, tertiary amine)

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26
Q

Heterocyclic Antidepressant:

  • Used for depression, chronic pain
  • Can use as sleep aid at low dose
A

Doxepin (TCA, tertiary amine)

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27
Q

Heterocyclic Antidepressant:

  • Less anti-cholinergic/histaminic/adrenergic
  • Least likely to cause orthostatic hypotension
  • Used for depression and chronic pain
  • Useful therapeutic blood levels
A

Nortriptyline (TCA, secondary amine)

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28
Q

Heterocyclic Antidepressant:

  • Less anti-cholinergic/histaminic/adrenergic
  • Least anticholinergic
  • More activating/Least sedating
A

Desipramine (TCA, secondary amine

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29
Q

Heterocyclic Antidepressant:

  • metabolite of loxapine
  • can cause EPS
  • similar side effects to typical antipsychotics
A

Amoxapine (Tetracyclic antidepressant)

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30
Q

TCA Mechanism:

General TCA side effects:

  • Drug interactions, distribution
  • Anti-histaminic (2)
  • Anti-adrenergic (5)
  • Anti-muscarinic (6)
  • Serotonergic (2)
A
  • Protein-bound, lipid soluble, drug interactions
    TCA Mechanism: inhibit reuptake of NE, 5-HT, increase monoamine availability in synapse

Side Effects:

  • Antihistaminic: sedatin and weight gain (suppress satiety)
  • Antiadrenergic: orthostatic hypoTN, dizziness, reflex tachycardia, arrhythmias (block cardiac sodium channel), ECG changes (widened QRS, QT, PR intervals)
  • Avoid in patients with conduction abnormalities or recent MI
  • Antimuscarinic: dry mouth, constipation, urinary retention, blurred vision, tachycardia, glaucoma
  • Serotonergic: ED, ejaculatoru dysfunction in males, anorgasmia in females
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31
Q

Drug Side Effect:
- Agitation, tremors, ataxia, arrhythmia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizure, coma

A

TCA overdose

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32
Q

MAOI Mechanism:

A

Prevent inactivation of NE, 5-HT, DA, tyramine (intermediate in conversion of tyrosine to NE) by irreversibly inhibiting MAO-a and MAO-b

  • MAOa deactivates 5-HT and NE, and DA and tyramine
  • MAOb deactivates phenethylamine, and DA and tyramine
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33
Q

MAOI Drug Names:

A

Drug Names: Phenelzine, Tranylcypromine, Isocarboxazid

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34
Q

Side Effects:
orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction
- numbness or paresthesias in B6 deficiency
- rare liver toxicity, edema, seizures

A

MAOi side effects in addition to hypertensive crisis and serotonin syndrome

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35
Q

Antipsycotic class:

  • Higher doses
  • Higher anti-(a1)adrenergic/cholinergic/histaminic side effects
  • Lower EPS and NLMS
  • QTc prolongation, potential for heartblock and v-tach causing lethality in overdose
  • Rare agranulocytosis
  • Increased seizure risk
A

Low-potency typical antipsychotics

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36
Q

Antipsychotic Drug:

  • orthostatic hypotension
  • blue-gray skin discoloration
  • photosensitivity
  • deposits in lens and cornea
  • also used to treat nausea, vomiting, hiccups
A

Chlorpromazine (Low potency typical)

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37
Q

Antipsychotic Drug:

- associated with retinitis pigmentosa

A

Thioridazine (Low potency typical)

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38
Q

Antipsychotic Drug:

  • higher risk for seizures
  • metabolite is antidepressant
A

Loxapine (Mid-potency typical)

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39
Q

Antipsychotic Drug:

- ocular pigment changes

A

Thiothixene (Mid-potency typical)

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40
Q

Midpotency Antipsychotic Drugs (4):

A

Loxapine
Thiothixene
Molindone
Perphenazine

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41
Q

Antipsychotic Class:

  • Lower Doses
  • less anti-cholinergic/(a1)adrenergic/histaminic effects
  • more risk for EPS and TD
A

High-potency typical antispychotics

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42
Q

Antipsychotic Drug:

  • can be given PO/IM/IV
  • depot form available
A

Haloperidol (High-potency typical)

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43
Q

Antipsychotic Drug:

- Depot form available

A

Fluphenazine (High potency typical)

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44
Q

Antipsychotic Drug:

- used also for nonpsychotic anxiety

A

Trifluoperazine (High potency typical)

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45
Q

Antipsychotic Drug:

- QTc prolongation and v-tach

A

Pimozide (High-potency typical)

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46
Q

Mesolimbic dopamine pathways is responsible for

A

Positive symptoms of schizophrenia

47
Q

Mesolimbic pathway (4 parts)

A

nucleus accumbens
fornix
amygdala
hippocampus

48
Q

Mesocortical pathway is responsible for

A

Negative symptoms of schizophrenia (decreased DA action)

49
Q

EPS occurs due to:

A

blockade of DA pathways in nigrostriatal pathway

50
Q

Treatment for NLMS:

A
  • discontinue medications
  • supportive care including cooling, hydration, etc
  • dantrolene, bromocriptine, amantadine may be used
  • MAY restart antipsychotic carefully in future, but higher risk of recurrent episode
51
Q

Antipsychotic drug class:

  • less likely to cause EPS, TD, NLMS
  • may be more effective in tx of negative symptoms
  • also used to tx acute mania, bipolar disorder, as adjuctive meds in depression, borderline personality, PTSD, tic disorders of childhood
  • risk for metabolic syndrome
A

Atypical antipsychotics

52
Q

Antipsychotic Drug:

  • more efficacious in treatment-refractory schizophrenia
  • tachycardia and hypersalivaton
  • more anticholinergic than atypical or high potency typical
  • Rare myocarditis, agranulocytosis
  • 4% seizure incidence
  • decrease suicide risk
A

Clozapine (atypical)

53
Q

Antipsychotic Drug:

  • hyperprolactinemai
  • orthostatic hypotension and reflex tachycardia
  • depot form
A

Risperidone (atypical antipsychotic)

54
Q

Antipsychotic Drug:

  • much less likely to cause EPS
  • sedation and orthostatic hypotension
A

Quetiapine (atypical antipsychotic)

55
Q

Antipsychotic Drug:

- weight gain and sedation

A

Olanzapine (atypical antipsychotic)

56
Q

Antipsychotic Drug:

  • less likely to cause weight gain
  • QTc prolongation
  • take with food (reduced absorption w/o)
A

Ziprazidone (atypical antipsychotic)

57
Q

Antipsychotic Drug:

  • partial D2 agonism
  • more activating (akathisia), less sedating
  • less weight gain
A

Aripiprazole (atypical antipsychotic)

58
Q

Antipsychotic Drug:

  • metabolite of risperidone
  • depot form available
A

Paliperidone (atypical antipsychotic)

59
Q

Antipsychotic Drug:

- Orally disolving tablet

A

Arsenapine

60
Q

Antipsychotic Drug:

  • take with food
  • use for bipolar depression
A

Lurasidone

61
Q

Drug Side Effect:

- Weight gain, hyperlipidemia (triglycerides mostly), hyperglycemia, rare DKA

A

Metabolic syndrome, seen primarily with atypical antipsychotics

62
Q

Mood Stabilizer Uses (5):

A
  • treating acute mania and preventing relapse in BD
  • augment antidepressants
  • potentiate antipsychotics in schizoprenia/schizoaffective disorder
  • treatment of aggression/impulsivity
  • enhance abstinence in alcoholism
63
Q

Mood Stabilizer Drug:

  • Used for acute mania/prophylaxis, cyclothymic disorder, unipolar depression
  • Metabolized by kidney
  • Takes 5-7 days for onset
  • Blood levels correlate with clinical efficacy
  • Narrow therapeutic index 0.6-1.2
  • inhibits synthesis of T3/4 and release from thyroid
  • benign leukocytosis
A

Lithium

64
Q

Drug Side Effect:

- altered mental status, coarse tremors, convulsions, delirium, coma, death

A

Toxic Lithium Levels

65
Q

Mood Stabilizer Drug:

  • tremor
  • nephrogenic DI
  • GI disturbance
  • Wt. gain
  • Sedation
  • Thyroid enlargement/hypothyroidism
  • ECG changes
  • Leukocytosis
A

Lithium

66
Q

Ebstein anomaly

A

Lithium

67
Q

Mood Stabilizer Drug:

  • Used for mania with mixed features, rapid cycling BD, less effective for depression
  • Takes 5-7 days for onset
  • GI and CNS side effects (drowsiness, ataxia, sedation, confusion)
  • LFT elevation, hepatitis
  • Drug interactions with CYP450 drugs (induces)
  • Teratogenic (NTD)
  • leukopenia, aplastic anemia, thrombocytopenia, agranulocytosis
  • hyponatremia
  • SJS
A

Carbamezapine

  • blocks sodium channels and inhibits action potentials
68
Q

Drug Side Effects:

- confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting

A

Carbamezapine toxicity

69
Q

Mood Stabilizer Drug:

  • used for acute mania, mixed features, rapid cycling
  • therapeutic range 50-150
  • teratogenic (NTD)
  • monitor LFT and CBC
A

Valproic acid

  • blocks sodium channels
  • increases GABA concentrations in the brain
70
Q

Mood Stabilizer Drug:

  • used for bipolar depression, not useful for mania
  • dizziness, sedation, headache, ataxia
  • SJS, decreased by slowly tapering
  • concurrent use of valproate results in increased levels of drug, decreases valproate levels
A

Lamotrigine

71
Q

Mood Stabilizer Drug:

  • as effective as carbamezapine but beter toleratied
  • lower SJS risk
  • lower hepatotoxicity
  • monitor for hyponatremia
A

Oxcarbazepine

72
Q

Mood Stabilizer Drug:

  • used to help with anxiety, sleep, neuropathic pain
  • not effective in bipolar disorder
A

Gabapentin

73
Q

Mood Stabilizer Drug:

  • used in GAD, fibromyalgia
  • not effective in bipolar disorder
A

Pregabalin

74
Q

Mood Stabilizer Drug: (2)

  • helpful with impulse control disorders
  • weight loss
  • hypochloremic metabolic acidosis
  • kidney stones
  • cognitive slowing
A

Tiagabine

Topiramate

75
Q

BDZ:

  • rapid onset
  • alcohol or sedative hypnotic detox
  • seizure termination
  • muscle spasm termination
  • sometimes used for anxiety
  • long-acting
A

Diazepam

76
Q

BDZ:

  • anxiety and panic attacks
  • avoid with renal dysfunction
  • 1-2x daily dosing (long-acting)
A

Clonazepam

77
Q

BDZ:

  • tx of anxiety, and panic attacks
  • intermediate action
  • short onset of action, euphoria with abuse potential
A

Alprazolam

78
Q

BDZ:

  • panic attacks, alcohol and sedative hypnotic detox, agitation
  • intermediate action
  • not metabolized by liver
A

Lorazepam

79
Q

BDZ:

  • alcohol and sedative hypnotic detox
  • intermediate action
  • not metabolized by liver
A

Oxazepam

80
Q

BDZ:

  • insomnia, though decreasing due to dependence risk
  • not metabolized by liver
  • inermediate actinv
A

Temazepam

81
Q

BDZ:

  • insomnia
  • anterograde amnesia, sleep related activities
  • short acting
A

Triazolam

82
Q

BDZ

  • VERY SHORT half-life
  • medical and surgical settings
A

Midazolam

83
Q

Zolpidem/Zaleplon/Eszopiclone

  • Mechanism
  • Half-lives
  • AE
A
  • bind to omega1 receptor on GABA-A receptor

- Zaleplon

84
Q

Ramelteon

- mechanism

A

selective MT1 and MT2 agonist

85
Q

Non-BDZ Anxiolytic:

  • partial 5HT1a receptor agonist
  • not as effective as other option
  • does not potentiate alcohol or BDZ
A

Buspirone

86
Q

Non-BDZ Anxiolytic:

  • antihistamine
  • dry mouth, sedation, constipation, urinary retention, blurry vision
  • fast acting, useful in people who cannot take BDZ
A

Hydroxyzine

87
Q

Non-BDZ Anxiolytic:

  • useful for autonomic effects of panic attacks or social phobia, palpitations sweating, tachycardia
  • useful for akathisia
A

Propranolol

88
Q

Psychostimulant:

  • Schedule II due to high abuse potential
  • monitor BP, weight loss
  • can cause insomnia, exacerbation of tics, decreased seizure threshold
A

Dextroamphetamine and amphetamines

89
Q

Psychostimulant:

  • Schedule II
  • Leukopenia or anemia
  • Watch BP and CBC
  • Weight loss, insomnia, exacerbation of tics, decreased seizure threshold
A

Methylphenidate

90
Q

Psychostimulant:

  • Inhibits presynaptic NE reuptake, resulting in increased synaptic NE and DA
  • not controlled
  • less appetite suppression and insomnia
  • lower abuse potential, but less effective
  • rare liver toxicity
  • possible incr. SI in children
A

Atomoxetine

91
Q

Psychostimulant:

- used in narcolepsy

A

Modafinil

92
Q

Cognitive Enhancer:

  • acetylcholinesterase inhibitor
  • once daily
  • GI side effects
  • mild to moderate NCD
A

Donepezil

93
Q

Cognitive Enhancer:

  • acetylcholinesterase inhibitor
  • twice daily
  • GI side effects
  • mild to moderate NCD
A

Galantamine

94
Q

Cognitive Enhancer:

  • acetylcholinesterase inhibitor
  • twice daily, patch form with fewer side effects
  • mild to moderate NCD
A

Rivastigmine

95
Q

Cognitive Enhancer:

  • NMDA receptor antagonist
  • fewer side effects
  • use with cholinesterase inhibitor
  • more severe NCD
A

Memantine

96
Q

Drug: _______

- Nonstimulant norepinephrine reuptake inhibitor used to treat ______

A

Atomoxetine

Childhood and Adult ADHD

97
Q

Stimulants help ___% of patients with ADHD

A

70

98
Q

DDAVP Side effects:

A

Headache

Nausea

99
Q

Treatment for DT and reasoning

A

Oxazepam or lorazepam

- not reliant on liver function for metabolism

100
Q

Drug Side Effects:

  • polyuria
  • polydipsia
  • tremor
  • mental confusion
A

Lithium

101
Q

Phenelzine is a __

A

MAOi (MAO A and B) irreversible inhibitor

102
Q

MAO A and B irreversible inhibitors

A

phenelzine, tranylcypromine, isocarboxazid

103
Q

MAO B inhibitor

A

selegiline, but nonselective at high doses

104
Q

Cyproheptadine

A

5-HT2A antagonist sometimes used in severe cases of serotonin syndrome

105
Q

Contraindicated with MAOi’s (8)

A 
meperidine
stimulant
decongestants
amine precrsors
l-dopa and l-tryptophan
antihypertensives
methyldopa
guanethidine
reserpine
106
Q

use for atypical depression

A

MAOi’s

107
Q

tremor, nausea, diarrhea, ataxia

then seizures

then acute renal failure

then coma and death

A

lithium toxicity

108
Q

akathisia treatment

A

propranolol, then benzodiazepine as second line

109
Q 
order the bdz's according to strength:
alprazolam
chlordiazepoxide
clonazepam
deiazepam
oxazepam
A 
clonazepam
alprazolam
diazepam
oxazepam
chlordiazepoxide
110
Q

test to doe before starting divalproex

A

lft’s due to rare hepatotoxicity, sometimes ammonia can increase

111
Q

nsaids safe to use with lithium

A

aspirin

sulindac

112
Q

atypical antipsychotics- 8

A 
clozapine
risperidone
quetiapine
ziprasidone
aripiprazole
paliperadone
arsenapine
lurasidone
113
Q

low potency antipsychotics- 2

A

chlorpromazine

thioridazine

114
Q

high potency- 4

A

haloperidol
fluphenazine
trifluoperazine
pimozide

Pharmacology Decks (4 decks)

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