Pysch drugs

Question 1

Depressants

Answer 1

Alcohol, Opiods (morphine, heroin, methadone), Barbiturates, BZDs
Mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression - intoxication

Nonspecific: anxiety, tremor, seizures, insomnia - withdrawal

Question 2

Alcohol

Answer 2

emotional labilty, slurred speech, ataxia, coma, blackouts. Serum GGT. AST twice ALT value
Withdrawal: mild: anxiety, tremor, seizures, insomnia
Severe alcohol withdrawal: autonomic hyperactivity and DTs (delirium tremens). Tx: BZD

Question 3

Opiods

Answer 3

Morphine, Methadone, heroin

Euphoria, resp and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose),
Tx: naoloxone, naltrexone

Withdrawal: Sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea, flu like symptoms
Tx: long term support, methadone, buprenorphine

Question 4

Barbiturates

Answer 4

Marked resp depression. low safety margin
Tx: symptom management, assist resp and increase BP

Withdrawal: delirium, CV collapse (life threatening)

Question 5

Benzodiazepines

Answer 5

Greater safety margin. Ataxia, minor resp depression.
Tx: Flumazenil (BZD antagonist); can precipitate seizures

Withdrawal: sleep disturbance, depression, rebound anxiety

Question 6

Stimulants

Answer 6

Amphetamines, Cocaine, Caffeine, Nicotine

Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhythmia, tachycardia, anxiety

Withdrawal: post use crash, depression, lethargy, weight gain, headache

Question 7

amphetamines

Answer 7

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever; Severe: cardiact arrest, seizure

Withdrawal: Anhedonia, increased appetite, hypersomnolence, existential crisis

Question 8

Cocaine

Answer 8

impaired judgment, pupillary dilation, hallucinations (also tactile), paranoid ideations, angina, sudden cardiac death
Tx: alpha blockers, BZS. NO beta blockers

Withdrawal: Hypersomnolence, malaise, severe psychological craving, depression/suicidality

Question 9

Caffeine

Answer 9

Restlessness, increased diuresis, muscle twitching

Withdrawal: lack of concentration, headache

Question 10

Nicotine

Answer 10

Restlessness
Withdrawal: irritability, anxiety, craving
Tx: nicotine patch, gum; bupropion

Question 11

Hallucinogens

Answer 11

PCP, LSD, Marijuana (cannabinoid)

Question 12

PCP

Answer 12

Belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tahcycardia, psychosis, delirium, seizures
Tx: BZD, rapid acting antipsychotic

Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

Question 13

LSD

Answer 13

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, flashbacks

Question 14

Marijuana

Answer 14

Euphoria, anziety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations.
Pharm form: dronabinol used as antiemetic and appetite stimulant in AIDs patients

Withdrawal: Irritability, depression, insomnia, nausea, anorexia
Peak in 48 hours and last for 5-7 days
Detectable in urine for 1 month

Question 15

Heroin addiction

Answer 15

users at increased risk for hepatitis, HIV, abscesses, bacteremia, right heart endocarditis
Tx: Methadone - long acting oral opiate for heroin detox or long term maintenance
Naloxone + Buprenorphine: Antagonist + partial agonist. Naloxone not orally available so withdrawal only in injected - aka lower abuse potential

Naltrexone - long acting antagonist for relapse prevention

Question 16

Alcoholism

Answer 16

Tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, HTN, malaise, nausea, DTs) when intake interrupted
Complications: Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

Treatment: Disulfirum (to abstain from alcohol use), naltrezone, supportive care.

Alcoholics Anonymous for sustaining abstinence and supporting patient and family

Question 17

Wernice-Korsakoff syndrome

Answer 17

Caused by Vitamin B1 defiency (thiamine)
Triad: confusion, ataxia, opthalmoplegia. can be irreversible memory loss, confabulation, personality change (korsakoff psychosis)
A/w periventricular hemorrhage/necrosis of mamillary bodies.

Tx: IV vitamin B1

Question 18

Mallory Weiss Syndrome

Answer 18

Partial thickness tear at GE junction by excessive vomiting. Hematemesis and misdiagnosed as ruptured esophageal varices

Question 19

Delirium Tremens

Answer 19

Life threatening alcohol syndrome peaks 2-4 days after last drink

Autonomic hyperactivity: tachycardia, tremors, anxiety, seizures)
Occurs in hospital (2-4 postsurgery) in alcoholics not able to drink

Tx: BZD

Question 20

Alcoholic hallucinations

Answer 20

Visual hallucinations 12-48 hours after last drink. different from DTs
Tx: long acting BZD: chlordiazepoxide, lorazepam, diazepam

Question 21

Meds for pysch condition

Answer 21

ADHD: stimulants - methylphenidate
Alcohol withdrawal: Long acting BZDs
Bipolar: Lithium, valproic acid, atypical antipsychotics
SSRIs: Bulimia, Depression, GAD, OCD (clomipramine), Panic, PTSD, Social phobias

Panic: SSRIs, venlaxafine, BZD
PTSD: SSRI, Venlafaxine
Schizophrenia: Atypical antipsychotics
Social: SSRIs, B blockers
Tourette: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine

Question 22

Methyphenidate, Methemphetamine

Answer 22

increase catecholamines in synaptic cleft, especially NE and dopamine

Question 23

Antipsychotics (neuroleptics)

Answer 23

Haloperidol, Fluphenazine, chlorpromazine, thioridazine

Block Dopamine D2 receptor (increase cAMP)

Use: Schizophrenia - positive symtoms, psychosis, acute mania, tourette syndrome

Toxicity: highly lipid soluble and stored in body fat; very slow to remove from body
1) Extrapyramidal side effects: dyskinesia, Tx: Benztropine (anticholinergic) or Diphenhydramine

2) Endocrine effects: Dopamine antagonism-> hyperprolactinoma -> galactorrhea
3) block of muscarinic (dry mouth, constipation), alpha1 receptor (hypotension), and histamine (sedation)

Other toxicities: NMS, Tardive dyskinesia

Question 24

Neuroleptic malignant syndrome

Answer 24

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia: Fever, Encephalopathy, Vital unstable, Enzymes increase (myoglobinuria), rigidity of muscles
Tx: Dantrolene, D2 agonists (Bromocriptine)

Question 25

Tardive Dyskinesia

Answer 25

Stereotypical oral faicla movement as result of long term antipsychotic use

Question 26

Atypical antipsychotics

Answer 26

Olanzapine, Clozapine, Quietapine, Risperidone, Arpiprazole, Ziprasidone Effects of 5HT2, Dopamine, alpha and H1 receptors Schizophrenia - both positive and negative symptoms. Also for Bipolar, OCD, anxiety, depression, mania, Tourette syndrome Toxicity: Fewer extrapyramidal effects and anticholinergic effects Olanzapine/clozapine - weight gain Clozapine -agranulocytosis - WBC check Risperidone - increase prolactin -> galactorrhea and gynecomastia Decrease GnRH-> decreased FSH, LH -> amenorrhea Prolong QT interval!!!!***

Question 27

Lithium

Answer 27

Mood stabilizer for biplarl disorer Blocks relapse and acute manic events Also, SIADH Toxicity: Tremor, Hypothyroidism, Polyuria (nephrogenic DI), teratogenesis Causes Ebstein anomaly in newborn; Excreted by kideys, most reabsorbed at PCT with Na. If Li toxicity in Bipolar patients: thiazide use implicated Side effects: LMNOP: Movement (tremor), Nephrogenic DI, HypOthyroidism, Preggo problems

Question 28

Buspirone

Answer 28

Stimulates 5Ht1A receptors GAD. does not cause sedation, addiction or tolerance. 1-2 weeks for effect. Does not interact with alcohol (v. barbiturates, BZD)

Question 29

SSRIs

Answer 29

Fluoxetine, paroxetine, sertraline, citalopram 5-HT specific reuptake inhibitors use: Depression, GAD, panic, OCD, bulimia, social phobias, PTSD Toxicity: Fewer TCSs. GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido) Serotonin Syndrome: with drug that increases 5-HT (ex: MAO inhibitors, SNRIs, TCAs) - hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures Tx: Cryoheptadine (5HT2 receptor antagonist)

Question 30

SNRIs

Answer 30

Venlafaxine, duloxetine Inhibit 5HT and NE reuptake Use: Depression. Venlafaxine: GAD, panic disorder, PTSD Duloxetine: diabetic peripheral neuropathy Toxicity: increased BP; sedation, nausea

Question 31

TCAs

Answer 31

Amitryptiline, nortryptiline, imipramine, desipramine, clomipramine, doxepin, amoxapine Block NE and 5HT reuptake Use: Major depression, OCD (Clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis ``` Toxicity: sedation, postural hypotension due to alpha 1 blocing, atropine like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth) Tertiary TCAs (amitryptiline) - anticholinergic effects than secondary TCA (nortryptiline) Prolong QT interval ``` Tri C's - convulsion, coma, cardiotoxicity (arrhythmias); resp depression, hyperpyrexia. Confusion and hallucinations - anticholinergic effects Tx: NaHCO3 prevent arrhythmias

Question 32

MAO inhibitors

Answer 32

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAOB inhibitor) Non selective MAO inhibition -> increases amine neurotransmitters (NE, 5HT, dopamine) use: atypical depression, anxiety Toxicity: Hypertensive crisis esp wit Tyramine intake - wine and cheese; CNS stimulant CI with SSRIs, TCAs, St John's wort, meperidine, Dextromethorphan to prevent Serotonin syndrome

Question 33

Atypical antidepressants

Answer 33

Bupropion, Mirtazapine, Trazodone

Question 34

Bupropion

Answer 34

Also for smoking cessation, increase NE and dopamine Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures anorexic/bulimic patients. No sexual side effects

Question 35

Mirtazapine

Answer 35

Alpha2 antagonists (Increase NE and 5HT) and potent 5HT2 and 5HT3 antagonist. Toxicity: Sedation - needed in depressed patient with insomnia increase appetite, weight gain - desirable in elderly or anorexic patients, dry mouth

Question 36

Trazodone

Answer 36

Blocks 5HT2 and alpha1 adrenergic receptors Used mainly for insomnia. High dose usage as anti-depressant Toxicity: sedation, nausea PRIAPISM, postural hypotension