Chapter 10 ( Psychopharmacology ) Flashcards by Ahmed Safwat

Side effects of antihistamincs ?

Sedation

Weight gain

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Side effects of anticholinergics ?

Dry mouth
Blurry vision
Constipation
Confusion

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Mechanism of action of antipsychotic drugs ?

Dopamine blockade at postsynaptic receptors

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Side effects of antipsychotic drugs ? Peak ? Ttt ?

1- Dystonic reaction - hours to days - ttt: anticholinergics
2- Rigidity - 3 weeks - ttt: lower dose or anticholinergics
3- Tremors - 6 weeks - ttt: lower dose or anticholinergics
4- Akathisia - 10 weeks - ttt: B-blockers , benzodiazepines , lower dose or switch to atypical antipsychotics
5- Tardive dyskinesia - >3-6 months - ttt: switch to atypical antipsychotics
6- Neuroleptic malignant syndrome - anytime - ttt: dantrolene or bromocriptine

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Typical antipsychotics?

Haloperidol 
Fluphenazine 
Chlorpromazine
Mesoridazine 
Thioridazine

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Thioridazine has an increased risk for ?

Retinitis pigmentosa

Retrograde ejaculation

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Atypical antipsychotics ?

ZOP CLARQ :

Ziprasidone 
Olanzapine 
Paliperidone 
Clozapine 
Lurasidone 
Aripiprazole 
Risperidone 
Quetiapine

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Clozapine has increased risk for ?

Agranulocytosis
Seizures
Drooling

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Atypical antipsychotics that is partial dopamine agonist at low doses ?

Aripiprazole

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Tricyclic antidepressants mechanism of action ?

Blocks :
Reuptake of serotonin and norepinephrine
Alpha 1 receptors
Muscarinic receptors

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TCAs ?

DANCI :
Desipramine 
Amitriptyline 
Nortriptyline 
Clomipramine 
Imipramine

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The ttt pf choice for major depressive disorders with atypical features ?

Monoamine oxidase inhibitors

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Function of monoamine oxidase ?

Metabolizes :
Serotonin
Epinephrine
Norepinephrine

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MAOIs ?

TIP :

Tranylcypromine
Isocarboxazide
Phenelzine

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Signs of hypertensive crisis ?

Occipital headache 
Stiff neck 
Nausea vomiting 
Chest pain 
Dilated pupils
Nosebleed

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Foods containing Tyramine that causes hypertensive crisis with MAOIs ?

Aged cheese
Dried fish 
Sauerkraut 
Sausage 
Chocolate 
Avocados 
Red wine

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SSRIs ?

F SPaCE F :

Fluoxetine 
Sertraline 
Paroxetine 
Citalopram 
Escitalipram 
Fluvoxamine

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Serotonin syndrome causes ? Symptoms ? Ttt ?

High doses
MAOIs/SSRIs combo
MAOIs/synthetic narcotics combo

General restlessness , insomnia
Nausea , diarrhea , cramps
Delirium
Myoclonus

Ttt:
Removal the causative agent
Stopping SSRIs
Cyproheptadine

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Serotonin norepinephrine reuptake inhibitors ?

Venlafaxine
Desvenlafaxine
Duloxetine

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Mechanism of action of Trazodone ? Side effects ?

Serotonin receptor antagonist and alpha 1 blocker

Priapism and sedation

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Mirtazapine mechanism of action ?

Stimulates norepinephrine and serotonin release

Blocks 5-HT2 and 5-HT3 receptors

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Bupropion mechanism ? Side effects ?

Relatively weak inhibitor of neuronal reuptake of norepinephrine and dopamine ( dose not inhibit reuptake of serotonin )

Increased risk of seizures

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The drug of choice for bipolar disorders ?

Lithium

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Ttt of choice for lithium > 2,5 meq/L ?

Dialysis

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Side effects of lithium ?

``` Tremors Anorexia , git disturbances Polyuria , polydipsia , edema Acne Hypothyroidism Nephrotoxicity Teratogenicity ( Ebstein’s anomaly of the tricuspid valve ) DI Ataxia , seizures, confusion ( if toxic ) ```

Mechanism of action of valproic acid ?

Augmentation of GABA in CNS

Toxicity of valproic acid causes ?

Liver damage ( hepatotoxic )

Carbamazepine mechanism ? Side effects ? Toxicity ?

Blocking Na channels in neurons with action potential , it alters central GABA receptors . Rash GI distress Mild leucopenia , agranulocytosis , aplastic anemia Hypotension , tachycardia , respiratory depression , coma

Lamotrigine is associaed with ?

Steven Johnson syndrome

Benzodiazepines mechanism ? Side effects ?

Depression of the CNS at the limbic system , RAS and cortex by binding to GABA-Chloride receptors facilitating the action of GABA ``` Sedation Insomnia Addiction Falls Confusion Disinhibition ```

Amittriptyline uses in addition to depression ?

Depression with insomnia | Chronic pain

Clomipramine uses in addition to depression ?

Obsessive compulsive disorder

Doxepin uses in addition to depression ?

Peptic ulcer | Pruritis

Imipramine uses in addition to depression ?

Panic disorder with agoraphobia Enuresis Eating disorders The

Maprotiline uses in addition to depression ?

Anxiety with depressive features

Nortriptyline uses in addition to depression ?

Depression in elderly Pruritis Patients with cardiac diseases

Protriptyline uses in addition to depression ?

ADHD | Narcolepsy

Citalopram uses in addition to depression ?

OCD | Panic disorder

Escitalopram uses in addition to depression ?

Chronic pain Paraphilia Generalized anxiety disorder

Fluoxetine uses in addition to depression ?

Social anxiety disorder Premenstrual dysphoria PTSD

Flucoxamine uses in addition to depression ?

Bulimia nervosa

Paroxetine uses in addition to depression ?

Premature ejaculation Body dysmorphic disorder Hot flashes

Vortioxetine indicated only for ?

Major depressive disorder

Duloxetine uses in addition to depression ?

Generalized anxiety disorder | Social anxiety disorder

Venlafaxine and desvenlafaxine uses in addition to depression ?

Panic disorder | Chronic pain

Levomilnacipran is indicated only in ?

Major depressive disorder

Isocarboxazid uses in addition to depression ?

Geriatric depression

Tranylcypromine uses in addition to depression ?

Atypical depression

Phenelzine uses in addition to depression ?

Pain disorders Eating disorders Panic disorders

Selegiline uses in addition to depression ?

Social anxiety disorder

Amoxapine uses in addition to depression ?

Depression with psychotic features

Bupropion uses in addition to depression ?

``` Smoking cessation Major depressive disorder with seasonal pattern SSRI induced sexual dysfunction Adult ADHD Obesity ```

Mitrazapine uses in addition to depression ?

Insomnia

Trazodone uses in addition to depression ?

Insomnia

Vilazodone indicated only for ?

Major depressive disorder

Clorazepate uses in addition to anxiety ?

Partial seizures

Triazolam uses in addition to anxiety ?

Insomnia

Alprazolam uses in addition to anxiety ?

Depression Panic disorder Social anxiety disorder

Lorazepam uses in addition to anxiety ?

Psychotic agitation Alcohol withdrawal Acute control of seizures

Temazepam uses in addition to anxiety ?

Insomnia

Chlordiazepoxide uses in addition to anxiety ?

Alcohol withdrawal

Clonazepam uses in addition to anxiety ?

``` Seizures Mania Social anxiety disorder Panic disorder Obsessive compulsive disorder ```

Diazepam uses in addition to anxiety ?

Muscle relaxation Analgesia Seizures Alcohol withdrawal

Flurazepam uses in addition to anxiety ?

Insomnia