Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

N550 Pharm > Psych Meds > Flashcards

Psych Meds Flashcards

0
Q

Where is alpha-1 found and what are the effects?

A

Postsynaptic
Found in vasculature, heart, glands, gut
Activation causes vasoconstriction and relaxation of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What is the order of potency between norepi, epi, and isoproterenol for alpha and beta receptors?

A

Alpha: Norepi>epi>isoproterenol
Beta: Isoproterenol>epi>norepi
Note: a1/b1/dop1 are found post-synaptically, a2/b2/dop2 are found pre- and post-synaptically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is alpha-2 found and what are the effects?

A

Presynaptic found in peripheral vascular smooth muscle, coronaries, brain, CNS. Activation presynaptically causes inhibition of norepi release and inhibition of sympathetic outflow leading to decreased BP and decreased HR, inhibition of CNS activity
Postsynaptic found in coronaries, CNS. Activation causes constriction and sedation and analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is beta-1 found and what are the effects?

A

(post synaptic??) Myocardium, SA node, ventricular conduction system, coronaries, kidney. Activation causes increase in inotropy, chronotropy, myocardial conduction velocity, coronary relaxation, and renin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the beta-2 effects and where are they found?

A

(pre and post synaptic??) Found in vascular, bronchial, skin, and uterine smooth muscle, coronaries, kidneys, GI tract. Activation causes vasodilation, bronchodilation, uterine relaxation, gluconeogenesis, insulin release, potassium uptake by the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What catecholamines do dopamine receptors interact with?

A

Dopamine ONLY (no other catecholamines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does dopaminergic-1 work and what are the effects?

A

Postsynaptic, found on renal mesenteric, splenic, and coronary vessels and renal tubules, causes vasodilation (increases urine output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does dopaminergic-2 work and what effects?

A

Presynaptic causes inhibition of norepi release

Postsynaptic may promote constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is serotonin and where is it concentrated?

A

Serotonin is 5-HT (hydroxytryptamine), a neurotransmitter and local hormone
Highest concentration in wall of intestine, blood, and CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SSRI uses?

A

Mild- moderate depression, panic disorder, OCD, PTSD, social phobia, bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SSRI mechanism of action?

A

Block reuptake of serotonin
New SSRI’s act on serotonin, norepinephrine, and/or dopamine
Some produce alpha-2 receptor blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which SSRI’s work only on serotonin?

A

Fluoxetine (prozac), sertraline (zoloft), paroxatine (paxil), fluvoxamine (luvox), escitalopram (lexapro)
Note: Prozac has the longest half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which Atypical SSRIs work on serotonin and norepi?

A

Bupropion (wellbutrin), trazadone (desyrel), nefazodone (serzone), venlafaxine (effexor), duloxetine (cymbalta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SSRI side effects?

A

Insomnia, fatigue, agitation, orthostatic hypotension, headache, N/V, sexual dysfunction, increased appetite
Note: SSRIs have a higher index of safety than other antidepressants (minimal BP effects, cardiac conduction, changes in seizure threshold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anesthetic Considerations: What do SSRIs do to CP-450 and platelet activity?

A

INHIBITS CP-450 enzymes which may increase plasma concentration of certain drugs
Antiplatelet activity, increased risk of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is serotonin syndrome?

A

It can be medication induced for patients taking SSRIs

s/s: confusion, fever, shivering, ataxia, diaphoresis, hyperreflexia, muscle rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are uses and mechanism of action of TCAs (tricyclic antidepressants)?

A

Uses: depression and chronic pain in lower doses (TCAs have a similar chemical structure to LAs, inhibit overactive inflammatory response)
MOA: blocks reuptake of serotonin and/or NE at presynaptic terminals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the MOA of tertiary amines vs secondary amines and name specific drugs?

A

Tertiary amines- inhibit serotonin and NE reuptake. Amytriptyline (elavil), imipramine (tofranil), and clomipramine (anafranil)
Secondary amines- inhibit NE reuptake. Desipramine (norpramin), nortriptyline (pamelor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

TCA pharmacokinetics? (lipid/water soluble, protein bound or not, E1/2t, metabolize)

A

Highly lipid soluble, strongly protein bound
LONG e1/2t (10-80 hours).. especially elderly population
Metabolized in liver and has ACTIVE metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TCA side effects?

A

Anticholinergic- dry mouth, tachycardia, urinary retention, ileus
CV- orthostatic hypotension, tachycardia, depressed conduction
CNS- lower seizure threshold, weakness, fatigue
With overdose, cardiotoxicity, seizure, CNS depressant effects can be fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can happen if someone is taking TCAs and MAOI’s?

A

CNS toxicity: hyperthermia, seizure, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are drug interactions/considerations for people taking TCAs? (list the class of drugs)

A

Sympathomimetics, inhaled anesthetics, anticholinergics, antihypertensives, opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the anesthetic consideration with a patient taking TCAs and giving sympathomimetics?

A

Unpredictable because it is indirect acting, there will be exaggerated responses due to longer amounts of NE available to receptors
Use low dosages of sympathomimetics (ephedrine) OR use a potent direct acting drug (phenlyephrine will directly effect the receptor to increase BP)
Note: Someone just started TCA will react stronger than someone who has been on TCAs for a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the anesthetic consideration for patients on TCAs using… volatile anesthetics agents? Opioids? Barbiturates?

A

Higher mac of volatile anesthetic agents
Decrease dose of opioids
Decrease dose of barbiturates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
What is the anesthetic consideration for patients on TCAs using anticholinergics?
More likely to have post op delirium and confusion (central anticholinergic syndrome) s/s of anticholinergic toxicity or central anticholinergic syndrome- flushing, dry mouth and skin, mydriasis Note: Use glycopyrrolate instead of atropine because atropine crosses BBB
25
What are s/s of TCA overdose? What will they die from?
s/s- agitation, excitement/delirium, progresses to coma, respiratory depression, and cardiac dysrhythmias and sudden death, hypotensive, anticholinergic effects With TCA will die from myocardial depression or ventricular dysrhythmias
26
What inactivates MAO enzyme system?
Dopamine, epinephrine, norepinephrine, and serotonin inactivate MAOs Note: MAOs found in the outer mitochondrial membranes
27
MAOI (monoamine oxidase inhibitors) mechanism of action?
Blocks the enzyme that metabolizes biogenic amines, forms a stable irreversible complex with MAO enzyme (breaks down amine) which increases amount of neurotransmitter available in the brain/CNS and peripheral nervous system
28
Why aren't MAOIs used often?
Side effects Lethal in overdose Difficult dosing Tyramine free diet
29
List MAOIs
Phenelzine (nardil) Tranylcypromine (parnate) Isocarboxaxid (marplan) Selegiline (eldepryl) - also used for parkinson's
30
What neurotransmitters do MAO A vs. MAO B work on?
MAO A: serotonin, norepinephrine, epinephrine (dopamine, tyramine too) MAO B: phenylethylamine (also dopamine)
31
MAOI side effects?
``` Orthostatic hypotension (especially elderly) Anticholinergic Impotence/anorgasmy Weight gain Sedation or stimulant effects ```
32
What dietary restrictions are there for MAOIs? Why?
Tyramine! Cheese, fava beans, wine, avocado, liver, cured meats Dietary tyramine can cause a massive release of endogenous catecholamines leading to hypertensive crisis, hyperpyrexia, CVA (symptoms of headache, vomiting, or chest pain must be reported) Note: MAO enzyme is present in the liver, GI tract, kidneys, lungs (MAO A in GI and liver)
33
List of drug cautions with MAOIs
TCAs, opioid (NO meperidine!), cold/allergy drugs, sympathomimetics (NO ephedrine!), nasal decongestants, SSRIs May need higher mac with volatile agents
34
What is the MAOI interaction with demerol (meperidine)- an opioid?
``` Excitatory response (type I) is agitation, skeletal muscle rigidity, hyperpyrexia Depressive response (type II) is hypotension, respiratory depression, coma ```
35
What is the interaction between MAOIs and sympathomimetics?
May get exaggerated response from indirect acting drugs (DONT give ephedrine), use direct acting agents if indicated, decrease dose by 1/3 and titrate to effect
36
What are the s/s of MAOI overdose?
Excessive sympathetic discharge: tachycardia, hyperthermia, mydriasis, seizure to coma
37
Why should Antidepressants be tapered when discontinued?
Discontinuation syndromes: dizziness, myalgia, paresthesia, irritability, insomnia, visual disturbances, tremors, lethargy, N/V/D
38
Benzodiazepine mechanism of action?
``` Facilitates GABA (the major inhibitory neurotransmitter of the CNS) Binds to GABA receptors in the brain and potentiates GABA mediated neuronal inhibition by increasing chloride permeability, cellular hyperpolarization, and inhibition of neuronal firing ```
39
Benzodiazepine 5 pharmacological effects?
``` Sedation Anxiolysis Anticonvulsant actions Anterograde amnesia Muscle relaxation (at spinal level, NOT neuromuscular junction) ```
40
Benzodiazepine pharmacokinetics? (protein bound, lipid/water soluble, metabolism, elimination?)
Highly protein bound High lipid solubility Hepatic metabolism by CP-450 system Eliminated by the kidneys
41
How do benzodiazepines effect the CNS?
Decrease CBF and CMRO2 Preserves cerebrovascular response to CO2 Does NOT attenuate ICP response to laryngoscopy Anticonvulsant, amnestic Paradoxical excitement is rare
42
What is the respiratory effect of benzodiazepines?
Dose dependent decrease in ventilation Hypoxemia and hypoventilation enhanced in presence of opioid!! Depress reflex deglutition (decreased esophageal motility) CO2 response curve flattens (does not shift)
43
Benzodiazepine effect on CV?
Decreases SVR at induction dosage (rarely used for induction) BP consequently decreases CO unchanged
44
How does Midazolam (versed) compare to diazepam (which is more potent, which has a longer duration of time)?
Versed is 2-3 x more potent than diazepam Both are highly protein bound Versed has a rapid redistribution and short duration of action, prepared in water soluble mix Diazepam (valium) is highly lipid soluble with prolonged duration of action, prepared in propylene glycol/ benzyl alcohol, low pH (Painful IV/IM injection!!), rapidly absorbed form GI
45
What are the usages and dosages of versed? | Pediatrics vs. adults vs. induction dosages
Premedication/pediatrics: 0.5 mg/kg po IV sedation/adults: 1-2.5 mg IV up to 5 mg as needed Induction: 0.1-0.2 mg/kg over 30-60 sec
46
What is diazepam's E1/2t compared to desmethyldiazepam?
Diazepam: 21-37 hours Desmethyldiazepam: 48-96 hours **Desmethyldiazepam is diazepam's active metabolite. So this is unique to have the active metabolite last so much longer than the drug
47
What are uses and dosages of diazepam?
Premedication/oral: 10-15 mg Premedication/IV: 0.2 mg/kg (reduces mac) Induction: 0.5-1 mg/kg IV Anticonvulsant: 0.1 mg/kg IV
48
What are the classes of antipsychotic/ neuroleptic drugs?
Phenothiazines, thioxantheses, butyrophenones
49
List phenothiazines and thioxanthenes
``` Chlorpromazine (thorazine) Thioridazine (mellaril) Pherphenazine (trilafon) Trifluoperazine (stelazine) Thiothixene (navane) ```
50
Phenothiazine and thioxanthene mechanism of action?
Blockade of dopamine receptors in the basal ganglia and limbic portions of the brain Interfering with dopamine will cause extrapyramidal side effects Blocking dopamine receptors in chemoreceptor trigger zone of the medulla will cause antiemetic effects
51
What is absorption and E1/2t of phenothiazines and thioxanthenes?
Although highly lipid soluble and protein bound, erratic patterns of absorption from po administration E1/2t 10-20 hours
52
Side effects of phenothiazines and thioxanthenes?
Extrapyramidal effects: tardive dyskinesia (permanent, in the first year in 20% of patients) Acute dystonic reactions (in the first few weeks of therapy), rigidity, respiratory distress (treat with diphenhydramine 25-50mg IV) CV: decreases BP (depresses vasomotor alphas, relaxes smooth muscle), prolong QT CNS: sedation (tolerance develops with chronic therapy) due to tolerance of alpha1/muscarinic/histamine receptors, seizure threshold is decreased, skeletal muscle relaxation of CNS Antiemetic (effective against opioid N/V) Neuroleptic malignant syndrome Note: overdose is rarely fatal
53
What is neuroleptic malignant syndrome?
Side effect of phenothiazine and thioxanthenes Develops over 24-72 hours usually in young men Hyperthermia, hypertonicity of skeletal muscles, instability of autonomic NS, fluctuating LOC
54
What anesthetic considerations are there for phenothiazines and thioxanthenes?
Potentiation of opioids: sedative effects, ventilatory depression, analgesic properties
55
List 2 butyrophenones
Droperidol (inapsine): used for neurolept analgesia with fentanyl, also used as antiemetic Haloperidol (haldol): similar to structure and side effects of phenothiazines
56
Is Droperidol's clearance perfusion dependent?
Clearance is perfusion dependent, hepatic metabolism opposed to hepatic enzyme activity, so accumulation will occur with decreased hepatic flow
57
Droperidol side effects? | Note: Haldol's side effects are similar to phenothyazine side effects
CNS: extrapyramidal, cerebral vasoconstriction (decreased flow but not consumption), dysphoria CV: decrease BP from alpha blockade (minimal), protects against epi-inducced dysrhythmias (large doses will decrease conduction for tachy-dysrhythmias/ WPW syndrome), prolonged QT, Torsades de pointes (Block Box Warning!)
58
Due to the black box warning on Droperidol, what is required?
12-lead EKG prior to administration, monitor 2-3 hours after administration This is why it isn't used as a common antiemetic used for surgery anymore
59
What is lithium used for? How does it work?
Mood stabilizer, treatment of bipolar (gold standard), Competes with Na, Ca, and Mg affecting cell membranes, H2O, and neurotransmitters (but not well enough understood to know exactly how it works)
60
What are lithium's pharmacokinetics? | A patient with low levels of ______ will absorb MORE lithium
Filtered by glomerulus and reabsorbed by proximal tubules Proximal reabsorption of lithium and Na is competitive, so a pt with low sodium will absorb more lithium E1/2t is 24 hours Steady state is 4-5 E1/2t (blood draw is important to monitor)
61
Lithium side effects?
Kidneys- evaluate renal function every 6 months for polyuria/polydipsia EKG- T wave changes, flattening or inversion (for OR pt we need baseline EKG and electrolytes) Other- hypothyroidism, psoriasis, acne, tremor, sedation, memory disturbances/cognitive slowing
62
What are s/s of lithium toxicity?
Mild- sedation, nausea, weakness, wide QRS, AV block, hypotension, dysrhythmia, seizure Significant toxicity- emergency! hemodialysis, osmotic diuresis and IV bicarb
63
Lithium anesthetic considerations
Prolonged neuromuscular blocking agents, anesthetic requirements may be decreased Get EKG and labs (electrolytes)
64
Antiepileptic mechanism of action?
Decrease neuronal excitability or enhance inhibition of neurotransmission by altering intrinsic membrane ion currents (sodium, potassium, and calcium) or enhancing GABA
65
Antiepileptic pharmacokinetics
Slow absorption from GI tract, protein binding varies Most are metabolized by liver and excreted by kidneys E1/t from hours to days Monitor plasma concentration to determine compliance with drug and pharmacokinetic interactions
66
Dangerous side effects of antiepileptics?
Life threatening bone marrow suppression and hepatoxicity | This is why labs (liver function tests and hematologic studies) are done to monitor.
67
List antiepileptics
Phenobarbital, phenytoid (dilantin), fosphenytoin (cerebyx), primidone (mysoline), carbamazepine (tegretol), valproate (depakote), levetiracetam (keppra)
68
Phenytoin uses and mechanism of action?
Effective for partial and generalized seizures MOA: regulates neuronal excitability and spread of seizure activity from a seizure focus by regulating Na and Ca transport across neuronal membranes
69
Phenytoin pharmacokinetics
pH of 12, precipitates in solutions with pH 10 mcg/ml for zero order
70
Phenytoin side effects?
CNS toxicity- nystagmus, ataxia, diplopia, vertigo, peripheral neuropathy Acne, facial coarsening Allergic rash ( SJS) GI irritation Hepatotoxicity, induces hepatic enzyme system
71
Fosphenytoin: how does it work? Pharmakodynamics?
Acts on Na ion channel blockade Highly protein bound, water soluble phenytoin pro drug Used in hospitals for status epilepticus and in neurosurgery to prevent seizures
72
What is the dose of fosphenytoin when used for status epilepticus or in surgery to prevent seizures?
10-20 mg/kg IV loading dose
73
What is the mechanism of action of phenobarbital? Pharmacokinetics?
``` Modulates post synaptic actions of GABA and glutamate Enhances CP450 (dilantin and phenobarbital both do this, meaning you need to give more doses) ```
74
Phenobarbital side effects?
Long acting, cognitive and behavior side effects limit its usefulness Sedation in adults, hyperactivity in children Depression Confusion in elderly

N550 Pharm (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions