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Flashcards in Reverse Pharm Psych Deck (49):
1

Mood elevation
Decr. anxiety
Sedation
Behavioral disinhibition
respiratory depression

Non spec depressant intox

2

anxiety
tremor
seizures
insomnia

non spec depressant with

3

Alcohol
Opioids
Barbituates
Benzodiazepines

depressants

4

Emotional lability,
slurred speech
ataxia
coma
blackouts

Lab values?

alcohol intox

Serum Gamma glutamyltransferase (sensitive indicator)
AST value is twice ALT

5

Mild: Similar to other depressants
Severe: autonomic hyperactivity
DTs

Treatment?

Alcohol withdraw

Treatment: Benzos

6

Euphoria,
respiratory and CNS depression
Decr. gag reflex
pupillary constriction
seizures (overdose)

Treatment:

Opiod intox

Naloxone, naltrexone

7

Sweating
Dilated pupils
Piloerection
Fever
Rhinorrhea
Yawning
Nausea
Stomach cramps
Diarrhea

Treatment:

Opiod with.

Long term support, methadone, buprenorphine

8

Low safety margin
Marked resp. depression

Treatment:

Barbituate intox

Symptom management

9

Delirium
Life threatening CV collapse

Barbituate withdraw.

10

Greater safety margin
Ataxia
Minor resp. depression

Treatment:

Benzo intox

Flumenazil (benzo receptor antagonist, but can precipitate seizures)

11

Sleep disturbance
depression
Rebound anxiety
Seizure

Benzo withdrawal

12

Mood elevation
psychomotor agitation
INsomnia
Arrythmias
tachycardia
Anxiety

stim intox NS

13

"Post use crash"-->

depression
lethargy
weight gain
headache

Stim with. NS

14

Amphetamines
Cocaine
Caffeine
Nicotine

Stimulants

15

Euphoria
Grandiosity
Pupillary dilation
prolonged wakefulness and attention
hypertension
tachycardia
anorexia
paranoia
fever

severe: cardiac arrest, seizure

Amphet intox

16

Anhedonia
Incr. appetite
hypersomnolence
existential crisis

Amphet with

17

Impaired judgment
pupillary dilation
hallucinations (including tactile)
paranoid ideation
angina
sudden cardiac death

Treatment?

Cocaine intox

Alpha blockers, benzos
Never beta blockers

18

Hypersomnolence
Malaise
severe psych craving
depression/suicidality

Cocaine withdraw

19

restlessness
Incr. diuresis
muscle twitching

Caffeine intox

20

Lack of concentration
Headache

caffeine withdraw

21

Restlessness

nicotine intox

22

Irritability
Anxiety
Craving

Treatment?

Nicotine withdraw

Nicotine patch
gum
lozenges
bupropion/verenicline

23

PCP
LSD
Marijuana

Hallucinogens

24

belligerence
impulsivity
fever
psychomotor agitation
analgesia
vertical and horizontal nystagmus
tachycardia
homicidality
psychosis
delirium
seizures

Treatment:

PCP intox

Benzos, rapid acting antipsychotic

25

Depression
Anxiety
Irritability
Restlessness
Anergia
Disturbances of thought and sleep

PCP Withdrawal

26

Perceptual distortion (visual, auditory)
Depersonalization
Anxiety
Paranoia
Psychosis
Possible flashbacks

LSD Intox

27

No withdrawal symptoms

LSD withdrawal

28

Euphoria
Anxiety
paranoid delusions
perception of slowed time
impaired judgment
social withdrawal
incr. appetite
dry mouth
conjuctival injection
hallucinations

Mari INtox

29

Irritability
Depression
Insomnia
Nausea
anorexia

Mari withdraw

30

Long acting oral opiate used for heroin detox or long term maintenance

methadone

31

Antagonist (1) and partial agonist.

(1) is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential)

naloxone (1) and buprenorphine

32

Long acting opioid antag.

Relapse prevention after detox

naltrexone

33

Stimulatants (methylphenidate)

Long acting benzos (chlordiazepoxide, lorazepam, diazepam)

Lithium, valproid acid, atypical antipsychotics

SSRIs

SSRIs

SSRIs, SNRIs

SSRIs, clomipramine

SSRIs, venlafaxine, benzos

SSRIs, venlafaxine

Atypicals

SSRIs, beta blockers

Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine

ADHD: Stimulatants (methylphenidate)

Alcohol Withdrawal: Long acting benzos (chlordiazepoxide, lorazepam, diazepam)

bipolar disorder: Lithium, valproid acid, atypical antipsychotics

Bulimia: SSRIs

Depression: SSRIs

GAD: SSRIs, SNRIs

OCD: SSRIs, clomipramine

Panic disorder: SSRIs, venlafaxine, benzos

PTSD: SSRIs, venlafaxine

Schizophrenia: Atypicals

Social Phobias: SSRIs, beta blockers

tourette syndrome: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine

34

What are the mechanism of methylphenidate, dextroamphetamine, and methamphetamine? Drug class? clinical use?

CNS Stimulants

Incr. catecholamines in the synaptic cleft, especially NE and DA

ADHD, Narcolepsy, appetite control

35

What type of drug are haloperidol (1), trifluoperazine (2), fluphenazine (3), thioridazine (4), and chlorpromazine (5)?
What type are 4 and 5? Kinds of Side effects? What type are 1, 2, and 3? Kinds of Side effects? Side effects of 5? Side effects of 4? Side effects of 1? Mechanism? Clinical use? Toxicity? Mechanisms of toxicity?

Antipsychotics (neuroleptics) (5)

High potency: Trifluoperazine, fluphenazine, haloperidol (Try to Fly High); Neuro side effects (huntington, delirium, EPS symptoms)

Low Potency: Chlorpromazine, Thioridazine (Cheating Thieves are Low); Non neuro side effects (antichol, antihist, alpha 1 blockade)

5:Corneal deposits
4: Retinal deposits
1: NMS, tardive dyskinesia

Schizophrenia (positive symptoms)
Psychosis
Acute mania
Tourette syndrome

Highly lipid soluble, slow to be excreted
EPS side effects
Endocrine side effects (less dopamine leads to more prolactin leading to galactorhea)
Block musc (dry mouth, constipation), alpha 1 (hypotension), histamine (sedation) receptors
QT prolongation

36

What is the evolution of EPS side effects with antipsychotics? Treatment?

4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)

4 day: akathisia (restlessness)

4 week: bradykinesia (parkinsonism)

4 months: tardive dyskinesia

Benztropine or diphenhydramine

37

What are the symptoms in NMS? Treatment? What is tardive dyskinesia?

FEVER

Fever
Encephalopathy
Vitals Unstable
Enzymes incr. (myoglobinuria)
Rigidity of muscles

Dantrolene, D2 agonists (bromocriptene)

Stereotypical oral-facial movements due to long term psychotic use

38

What type of drugs are olanzapine (1), clozapine (2), quetiapine (3), risperidone (4), aripiprazole (5), ziprasidone (6)? Mechanism? Clinical use? Toxicity? Side effect of 1/2? Side effect of 2? Side effect of 4?

Atypical antipsychotics

It's atypical for old closets to quietly risper from A to Z

Mechanism not entirely understood. Varied effects on 5-HT2, DA, and alpha and H1 receptors

Schizophrenia (pos and neg symptoms)
Bipolar Disorder
OCD
Anxiety disorder
depression
mania
Tourettes

Fewer EPS Sx and Antichol Sx than traditional antipsychotics.
QT prolongation

1/2: Significant weight gain
2: Agranulocytosis and seizure
4: Incr. prolactin (lactation and gynecomastia) decr. GnRH leading to irregular menstruation and fertility issues?

39

What is the mechanism of lithium? Clinical uses? Toxicity?

Not established; related to inhibition of phosphoinositol cascade

LMNOP

Lithium Sx
Movement (tremor)
Nephrogenic Diabetes Insipidus
hypOthyroidism
Pregnancy problems (Ebstein anamoly)

Narrow therapeutic window; close monitoring of serum levels.
Excreted in kidneys
Most reabsorbed in PCT with Na
Thiazide use implicated in lithium toxicity

40

Mechanism of buspirone? Clinical use? Timeline? Why is it favorable?

Stimulates 5-HT1A receptors

GAD

No sedation, addiction, or tolerance.
1-2 weeks
Does not interact with alcohol

41

What is the mechanism of fluoxetine, paroxetine, sertraline, and citalopram? Timeline? Clinical use? Toxicity?

SSRIs (4)

5-HT specific reuptake inhibitors

Depression, GAD, Panic disorder, OCD, bulimia, social phobias, PTSD

4-8 weeks to take effect

Fewer than TCAs.
GI distress
SIADH
Sexual dysfuntion
Serotonin syndrome

42

When does serotonin syndrome occur? Symptoms? Treatment?

Any drug that incr. 5-HT (SSRIs, MAOIs, TCAs, SNRIs)

Hyperthermia
confusion
Myoclonus
CV instability
Flushing
Diarrhea
Seizures

Cyproheptadine (5-HT2 receptor antag)

43

What type of drugs are Venlafaxine (1) and Duloxetine (2)? Mechanism? Clinical use of both? Of just 1? Of just 2? Most common Toxicity? Others?

SNRIs

Inhibit 5-HT and NE reuptake

Depression

1=GAD, panic disorder, PTSD
2=Diabetic peri Neuro

Incr BP most common
Stimulant effects
Sedation
Nausea

44

What type of drugs are amitriptyline (1), nortriptyline (2), imipramine, desipramine, clomipramine (3), doxepin, and amoxapine? Mechanism? Clinical use? of just 3? Toxicity? How do 1 and 2 differ in toxicity? Treatment of toxicities?

TCAs

Block reuptake of NE and 5-HT

Major Depression, OCD (3), peripheral neuro, chronic pain, migraine prophylaxis

Sedation
alpha 1 blocking (post hypotension)
Antichol (tachycardia, urinary retention, dry mouth)=1 more than 2
QT prolongation
Convulsions
Coma
Cardiotoxicity (arrhythmias)
Resp. Depressin
Hyperpyrexia
Confusion and hallucinations in elderly

To prevent arrhythmia, used NaHCO3

45

What is the drug class of Tranylcypromine, phenelzine, isocarboxazid, selegiline (1)? Mechanism? Mechanism of just 1? Clinical use? Toxicity? Contraindications? Why?

MAOIs

Non selective MAO inhibition leads to incr. levels of NE, 5-Ht, DA

1=MAO-B selective inhibitor

Atypical depression
Anxiety

Hypertensive crisis (with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS stim

CI with SSRIs, TCAs, St jOhns wort, meperidine, dextromethorphan (to prevent serotonin syndrome)

46

What are the atypical antidepressants?

Bupropion
Mirtazapine
Trazodone

47

What is the clinical use of bupropion? Mechanism? Toxicity?

Depression
Smoking cessation

Incr. NE and DA via unknown mechanism

Stimulant effects (tachy, insomnia)
headache
Seizures in anorexic/bulimic
No sexual Sx

48

What is the mechanism of Mirtazapine? Toxicity?

alpha 2 antagonist (decr. inhibition of release of NE and 5-HT).
Potent 5-HT2 and 3 receptor antagonist

Sedation (desirable insomnia)
Incr. appetite
Weight gain (desirable in elderly or anorexic)
Dry mouth

49

What is the mechanism of Trazodone? clinical use? Toxicity?

Blocks 5-HT2 and Alpha 1 receptors

Used mainly for insomnia (high doses needed to be antidepressant)

Sedation, nausea, priapism, post. hypotension