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Flashcards in Pysch drugs Deck (36):
1

Depressants

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

Nonspecific: anxiety, tremor, seizures, insomnia - withdrawal

2

Alcohol

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

3

Opiods

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

4

Barbiturates

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

Withdrawal: delirium, CV collapse (life threatening)

5

Benzodiazepines

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

Withdrawal: sleep disturbance, depression, rebound anxiety

6

Stimulants

Amphetamines, Cocaine, Caffeine, Nicotine

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

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

7

amphetamines

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

Withdrawal: Anhedonia, increased appetite, hypersomnolence, existential crisis

8

Cocaine

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

9

Caffeine

Restlessness, increased diuresis, muscle twitching

Withdrawal: lack of concentration, headache

10

Nicotine

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

11

Hallucinogens

PCP, LSD, Marijuana (cannabinoid)

12

PCP

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

13

LSD

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

14

Marijuana

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

15

Heroin addiction

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

16

Alcoholism

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

17

Wernice-Korsakoff syndrome

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

18

Mallory Weiss Syndrome

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

19

Delirium Tremens

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

20

Alcoholic hallucinations

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

21

Meds for pysch condition

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

22

Methyphenidate, Methemphetamine

increase catecholamines in synaptic cleft, especially NE and dopamine

23

Antipsychotics (neuroleptics)

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

24

Neuroleptic malignant syndrome

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

25

Tardive Dyskinesia

Stereotypical oral faicla movement as result of long term antipsychotic use

26

Atypical antipsychotics

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!!!!***

27

Lithium

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

28

Buspirone

Stimulates 5Ht1A receptors

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

29

SSRIs

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)

30

SNRIs

Venlafaxine, duloxetine

Inhibit 5HT and NE reuptake
Use: Depression. Venlafaxine: GAD, panic disorder, PTSD
Duloxetine: diabetic peripheral neuropathy

Toxicity: increased BP; sedation, nausea

31

TCAs

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

32

MAO inhibitors

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

33

Atypical antidepressants

Bupropion, Mirtazapine, Trazodone

34

Bupropion

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

35

Mirtazapine

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

36

Trazodone

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