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Psychopharmacology > Antipsychotics and Antidepressants > Flashcards

Antipsychotics and Antidepressants Flashcards

1
Q

Antidepressants

a patient with major depressive disorder is most likely to develop antidepressant poop-out during maintenance treatment when she is taking which antidepressant?

A

sertraline

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2
Q

Antidepressants

secondary amines OR tertiary amines have less side effects?

A

secondary amines

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3
Q

Antidepressants

secondary amines OR tertiary amines have greater uptake of norepinephrine?

A

secondary amines

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4
Q

Antidepressants

advantage of SSRIs over TCAs?

A

SSRIs are less cardiotoxic

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5
Q

Antidepressants

which antidepressant is least likely to have an adverse impact on sexual functioning?

A

bupropion

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6
Q

First Generation Antipsychotics

side effect of long-term use of FGAs?

A

tardive dyskinesia

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7
Q

Antipsychotics

term for side effect that begins with involuntary movements of the tongue, face, and jaw

A

tardive dyskinesia

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8
Q

Antidepressants

taking both an SSRI and an MAOI togather may cause this side effect, characterized by agitations, hyperthermia, & autonomic instability

A

serotonin syndrome

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9
Q

Antidepressants

this antidepressant (generic name) increases norepinephrine and dopamine levels, resulting in an energizing (stimulating) effect

A

buproprion (Wellbutrin)

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10
Q

First Generation Antipsychotics

side effects of first-generation antipsychotics

A

extrapyramidal side effects (EPS), such as tardive dyskinesia, parkinsonism, dystonia, and akathisia

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11
Q

Second Generation Antipsychotics

side effects of SGAs

A

metabolic (weight gain)

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12
Q

First Generation Antipsychotics

what sxs of schizophrenia are targeted by FGA?

A

only positive sxs (hallucinations & delusions)

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13
Q

Second Generation Antipsychotics**

what sxs of schizophrenia are targeted by SGA?

A

positive and negative sxs

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14
Q

Antipsychotics

main difference between FGAs and SGAs

A

FGAs block dopamine receptors
SGAs block dopamine AND serotonin receptors

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15
Q

First Generation Antipsychotics

generic name for 4 FGAs

A
  • chlorpromazine (Thorazine)
  • haloperidol (Haldol)
  • thioridazine (Mellaril)
  • fluphenazine (Prolixin)
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16
Q

First Generation Antipsychotics

major side effects of FGAs

A

extrapyramidal side effects (EPS)
& neuroleptic malignant syndrome
* agranulocytosis
* cardiotoxic

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17
Q

Symptoms of anticholinergic side effects of first-gen antipsychotics & which meds are are low potency & more likely to cause these side effects?

A

1) dry mouth, blurred vision, urinary retention, constipation, & tachycardia
2) chlorpromazine & thioridazine

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18
Q

First Generation Antipsychotics

generic names for 2 FGAs that are high potency & more likely to cause extrapyramidal side effects

A

haloperidol & fluphenazine

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19
Q

First Generation Antipsychotics

__________ is potentially life threatening, begins after long-term drug use, and is more common in women and older adults.

A

Tardive dyskinesia

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20
Q

Symptoms of tardive dyskensia

A
  • involuntary, rhythmic movements of the tongue, face, and jaw
  • may also affect the limbs and trunk
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21
Q

First Generation Antipsychotics

treatment for tardive dyskinesia

A

(A) irreversible
(B) gradually withdrawing & administering a benzo or switching to second-gen antipsychotic

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22
Q

First Generation Antipsychotics

symptoms of neuroleptic malignant syndrome

A

autonomic dysfunction
- unstable blood pressure
- tachycardia
- excessive sweating
an altered mental state
- confusion
- combativeness

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23
Q

First Generation Antipsychotics

treatment for neuroleptic malignant syndrome

A
  • stop taking drug at first sign of symptoms
  • providing hydration & cooling
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24
Q

Second Generation Antipsychotics

Generic name for the 5 second-gen antipsychotics (SGAs)

A

1) clozapine (Clozaril)
2) risperidone (Risperdal)
3) olanzapine (Zyprexa)
4) quetiapine (Seroquel)
5) aripiprazole (Abilify)

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25
Q

Second Generation Antipsychotics

SGAs are used to treat these disorders

A

schizophrenia & MDD

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26
Q

Antipsychotics

generic name for antipsychotic used for treatment-resistant schizophrenia

A

clozapine (Clozaril)

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27
Q

Second Generation Antipsychotics

Second-gen antipsychotics alleviate positive symptoms of schizophrenia by blocking _______ receptors and alleviate negative & cognitive symptoms of schizophrenia by blocking ______ receptors.

A

dopamine (D3 & D4); serotonin

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28
Q

Second Generation Antipsychotics

most common side effect of SGAs

A

metabolic syndrome

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29
Q

Second Generation Antipsychotics

symptoms of metabolic syndrome

A
  • substantial weight gain
  • high blood pressure
  • insulin resistance
  • hyperglycemia
  • increased risk for diabetes & heart disease
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30
Q

Which second-gen antipsychotic is most likely to cause neutropenia & agranulocytosis?

A

clozapine (Clozril)

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31
Q

neutropenia, including agranulocytosis, is potentially ______ and involve dangerously low levels of this type of blood cell that is an essential part of the body’s immune system

A

life-threatening; white blood cells

32
Q

=Antipsychotics

patients taking clozapine must have regular blood tests and, when neutrophil levels are too low, treatment may include what action(s)?

A
  • blood tests
  • discontinuing the drug, prescribing an antibiotic for infections & other meds to improve body’s ability to produce neutrophils more quickly
33
Q

Antidepressants

5 types of antidepressants

A
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • norepinephrine dopamine reuptake inhibitors (NDRIs)
  • tricyclic antidepressants (TCAs)
  • monoamine oxidase inhibitors (MAOIs)
34
Q

Antidepressants

generic names for 5 SSRI’s

A

1) fluoxetine (Prozac, Sarafem)
2) fluvoxamine (Luvox)
3) paroxetine (Paxil)
4) sertraline (Zoloft)
5) citalopram (Celexa)

35
Q

Most frequently prescribed antidepressants & generally considered first-line pharmacological treatment for MDD and PDD

A

SSRIs

36
Q

SSRIs are used to treat what disorders?

A
  • MDD & PDD
  • PMDD
  • OCD
  • panic disorder
  • GAD
  • PTSD
  • bulimia nervosa
  • premature ejaculation
37
Q

SSRIs are classified as ___(A)____ or indirect agonists and exert their therapeutic effects by increasing the availability of serotonin, which is done by blocking the ___(B)___, thereby increasing its availability in the ___(C)___. Because they increase the availability of serotonin.

A

(A) serotonin agonists
(B) presynaptic reuptake of serotonin
(C) synaptic cleft

38
Q

Advantages of SSRIs

A
  • fewer side effects
  • safer in overdose/ less cardiotoxic
  • safer for older adults
39
Q

Side effects of SSRIs

A
  • mild anticholinergic effects
  • GI disturbances
  • insomnia
  • anxiety
  • sexual dysfunction
40
Q

Abruptly stopping an SSRI can cause ________, characterized by what symptoms?

A

discontinuation syndrome
- headaches, dizziness, mood lability, impaired concentration, sleep disturbances, flu-like symptoms

41
Q

Combining SSRIs with what other meds increases likelihood of serotonin syndrome?

A

MAOIs, lithium, and other serotonergic drugs

42
Q

_______ is potentially fatal and involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium.

A

Serotonin syndrome

43
Q

Treatment for serotonin syndrome requires… ?

A
  • immediate withdrawal of serotonergic drugs
  • treat symptoms w/ appropriate medical interventions
44
Q

Taking an SSRI (or MAOI) can cause tachyphylaxis, also known as antidepressant tolerance and antidepressant poop-out, and occurs when a person with depression loses a previously antidepressant treatment response despite…?

A

tachyphylaxis; staying on same drug and dosage

45
Q

Common signs of tachyphylaxis

A
  • apathy
  • fatigue
  • dulled cognitive functioning
  • sleep disturbance
  • sexual dysfunction
46
Q

Treatment strategies for tachyphylaxis

A
  • increasing current drug dosage
  • switching to a different SSRI
  • switching to an SNRI (e.g., venlafaxaine) or a TCA (e.g., clomipramine)
  • augmenting current SSRI w/ another med
  • depression-focused therapy
47
Q

Common meds used in the treatment of tachyphylaxis to augment current SSRI

A
  • TCAs
  • bupropion
  • lithium
  • atypical antipsychotic
48
Q

SSRIs have a delayed onset with Initial therapeutic effects occurring ____weeks, with full effects not being achieved until ______

A

2 to 4 weeks; 6 to 8 weeks

49
Q

Generic names for the 3 SNRIs

A

1) venlafaxine (Effexor
2) duloxetine (Cymbalta)
3) desvenlafaxine (Pristiq)

50
Q

SNRIs are used to treat what disorders?

A
  • MDD
  • social anxiety disorder
  • neuropathic pain & other pain disorders
51
Q

Some evidence that SNRIs may be more effective than SSRIs for what disorder?

A

severe depression

52
Q

SNRIs therapeutic effects are due to ______ of the reuptake of serotonin and norephinephrine at _______.

A

inhibition; synapses

53
Q

SNRIs can cause _______ when stopped abruptly and ________ when combined with other serotonergic drugs

A

discontinuation syndrome; serotonin syndrome

54
Q

Due to SNRIs effects on norepinephrine, SNRIs can cause what side effects and are contraindicated for people with what pre-existing health issues?

A
  • same as SSRIs
  • elevated blood pressure
  • hypertension & heart problems
55
Q

Generic name for 1 NDRI and what disorders this med treats

A
  • bupropion (Wellbutrin, Zyban)
  • MDD
  • smoking cessation
56
Q

NDRIs exert their therapeutic effects by _______ the reuptake of norepinephrine and dopamine at synapses

A

inhibiting

57
Q

Side effects of NDRIs

A
  • skin rash
  • decreased appetite and weight loss
  • agitation
  • insomnia
  • dizziness
  • seizures
58
Q

Advantages of bupropion

A
  • causes few anticholinergic effects
  • does not cause sexual dysfunction
  • not cardiotoxix
59
Q

Bupropion and other antidepressants that increase levels of norepinephrine and dopamine have an ___(A)___ effect, which means they’re useful for patients who have ___(B)___ and ___(C)___ but not for those who have ___(D)___ or are ___(E)___.

A

(A) energizing
(B) low energy
(C) low motivation
(D) insomnia
(E) very anxious

60
Q

_______ are categorized as tertiary or secondary amines based on their chemical structure.

A

TCAs

61
Q

Generic names for 4 tertiary amines (TCAs)

A

1) amitriptyline (Elavil)
2) imipramine (Tofranil)
3) clomipramine (Anafranil)
4) doxepin (Sinequan)

62
Q

Tertiary amines exert their effects by ______ the reuptake of both serotonin and norepinephrine, with some having a ______effect on serotonin

A

inhibiting; stronger

63
Q

Generic names for 2 secondary amines (TCAs)

A

1) nortriptyline (Pamelor)
2) desipramine (Norpramin)

64
Q

________ are more potent at inhibiting the reuptake of norepinephrine than serotonin.

A

secondary amines

65
Q

TCAs are used to treat what disorders?

A
  • MDD
  • panic disorder
  • OCD
  • neuropathic pain
66
Q

What TCA(s) is primarily used to treat OCD?

A

clomipramine (Anafranil)

67
Q

What TCA(s) are primarily used to treat neuropathic pain?

A

nortiptyline (Pamelor) & amitriptyline (Elavil)

68
Q

Side effects of TCAs

A
  • cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension)
  • anticholinergic effects
  • sedation
  • weight gain
  • sexual dysfunction
69
Q

________ amines are less likely to cause sedation and anticholinergic effects.

A

Secondary

70
Q

Which type of antidepressant is most likely to induce a manic or hypomanic episode when used to treat bipolar disorder?

A

TCAs

71
Q

Which antidepressants must be prescribed with caution for people who have heart disease or are suicidal because they are cardiotoxic?

A

TCAs

72
Q

Generic names for 3 MAOIs

A

1) phenelzine (Nardil)
2) isocarboxazid (Marplan)
3) tranylcypromine (Parnate)

73
Q

Type of antidepressant most useful for treatment-resistant depression or atypical depression

A

MAOIs

74
Q

Symptoms of atypical depression

A

reversed vegetative symptoms
- hypersomnia
- increased appetite
- reactive dyphoria

75
Q

The enzyme monoamine oxidase ________ norepinephrine, serotonin, and dopamine, and the MAOIs increase the levels of these neurotransmitters by ________ the activity of this enzyme.

A

deactivates; inhibiting

76
Q

Side effects of MAOIs

A
  • anticholinergic effets
  • orthostatic hypotension
  • sedation
  • sexual dysfunction
77
Q

Combining MAOIs and amphetamines, antihistamines or foods containing tyramine (e.g., aged cheese and meat, soy products, beer, red wine, sauerkraut, fava beans, ripe bananas can produce _________, characterized by what symptoms

A

hypertensive crisis
- severe, throbbing headache
- neck pain or stiffness
- rapid heart rate
- nausea & vomiting
- sweating
- sensitivity to light
- confusion & delirium

Psychopharmacology (2 decks)

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