Flashcards in Reverse Pharm Psych Deck (49):
Non spec depressant intox
non spec depressant with
Serum Gamma glutamyltransferase (sensitive indicator)
AST value is twice ALT
Mild: Similar to other depressants
Severe: autonomic hyperactivity
respiratory and CNS depression
Decr. gag reflex
Long term support, methadone, buprenorphine
Low safety margin
Marked resp. depression
Life threatening CV collapse
Greater safety margin
Minor resp. depression
Flumenazil (benzo receptor antagonist, but can precipitate seizures)
stim intox NS
"Post use crash"-->
Stim with. NS
prolonged wakefulness and attention
severe: cardiac arrest, seizure
hallucinations (including tactile)
sudden cardiac death
Alpha blockers, benzos
Never beta blockers
severe psych craving
Lack of concentration
vertical and horizontal nystagmus
Benzos, rapid acting antipsychotic
Disturbances of thought and sleep
Perceptual distortion (visual, auditory)
No withdrawal symptoms
perception of slowed time
Long acting oral opiate used for heroin detox or long term maintenance
Antagonist (1) and partial agonist.
(1) is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential)
naloxone (1) and buprenorphine
Long acting opioid antag.
Relapse prevention after detox
Long acting benzos (chlordiazepoxide, lorazepam, diazepam)
Lithium, valproid acid, atypical antipsychotics
SSRIs, venlafaxine, benzos
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
GAD: SSRIs, SNRIs
OCD: SSRIs, clomipramine
Panic disorder: SSRIs, venlafaxine, benzos
PTSD: SSRIs, venlafaxine
Social Phobias: SSRIs, beta blockers
tourette syndrome: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine
What are the mechanism of methylphenidate, dextroamphetamine, and methamphetamine? Drug class? clinical use?
Incr. catecholamines in the synaptic cleft, especially NE and DA
ADHD, Narcolepsy, appetite control
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)
4: Retinal deposits
1: NMS, tardive dyskinesia
Schizophrenia (positive symptoms)
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
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
What are the symptoms in NMS? Treatment? What is tardive dyskinesia?
Enzymes incr. (myoglobinuria)
Rigidity of muscles
Dantrolene, D2 agonists (bromocriptene)
Stereotypical oral-facial movements due to long term psychotic use
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?
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)
Fewer EPS Sx and Antichol Sx than traditional antipsychotics.
1/2: Significant weight gain
2: Agranulocytosis and seizure
4: Incr. prolactin (lactation and gynecomastia) decr. GnRH leading to irregular menstruation and fertility issues?
What is the mechanism of lithium? Clinical uses? Toxicity?
Not established; related to inhibition of phosphoinositol cascade
Nephrogenic Diabetes Insipidus
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
Mechanism of buspirone? Clinical use? Timeline? Why is it favorable?
Stimulates 5-HT1A receptors
No sedation, addiction, or tolerance.
Does not interact with alcohol
What is the mechanism of fluoxetine, paroxetine, sertraline, and citalopram? Timeline? Clinical use? Toxicity?
5-HT specific reuptake inhibitors
Depression, GAD, Panic disorder, OCD, bulimia, social phobias, PTSD
4-8 weeks to take effect
Fewer than TCAs.
When does serotonin syndrome occur? Symptoms? Treatment?
Any drug that incr. 5-HT (SSRIs, MAOIs, TCAs, SNRIs)
Cyproheptadine (5-HT2 receptor antag)
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?
Inhibit 5-HT and NE reuptake
1=GAD, panic disorder, PTSD
2=Diabetic peri Neuro
Incr BP most common
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?
Block reuptake of NE and 5-HT
Major Depression, OCD (3), peripheral neuro, chronic pain, migraine prophylaxis
alpha 1 blocking (post hypotension)
Antichol (tachycardia, urinary retention, dry mouth)=1 more than 2
Confusion and hallucinations in elderly
To prevent arrhythmia, used NaHCO3
What is the drug class of Tranylcypromine, phenelzine, isocarboxazid, selegiline (1)? Mechanism? Mechanism of just 1? Clinical use? Toxicity? Contraindications? Why?
Non selective MAO inhibition leads to incr. levels of NE, 5-Ht, DA
1=MAO-B selective inhibitor
Hypertensive crisis (with ingestion of tyramine, which is found in many foods such as wine and cheese)
CI with SSRIs, TCAs, St jOhns wort, meperidine, dextromethorphan (to prevent serotonin syndrome)
What are the atypical antidepressants?
What is the clinical use of bupropion? Mechanism? Toxicity?
Incr. NE and DA via unknown mechanism
Stimulant effects (tachy, insomnia)
Seizures in anorexic/bulimic
No sexual Sx
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)
Weight gain (desirable in elderly or anorexic)