CHAPTER 6 PSYCH3 Flashcards
irreversibly inhibit monoamine
oxidase, blocking metabolism of monoamine
neurotransmitters
MAOIs:
Indications of MAOI
atypical depression, panic disorder, social
phobia, posttraumatic stress disorder, OCD, bulimia
nervosa, pain management
Severe hypertension and complications of malignant hypertension if taking MAOIs and _____
tyramine-containing substance or food is ingested
___________ if MAOIs taken in combination
with SSRIs or other antidepressants, over-the-counter
medications, meperidine, stimulants, sympathomimetics
Serotonin syndrome
MAOI
better than SSRIs for ______
also used for insomnia, pain, obsessive-compulsive
disorder, panic, anxiety
melancholic depression,
Contraindications of MAOI:
recent myocardial infarction, bundle branch block, widened QRS, narrow-angle glaucoma, cardiac disease, prostatic hypertrophy,
Mixed-mechanism antidepressants:
bupropion, duloxetine,
mirtazapine, nefazodone, trazodone, venlafaxine
Mechanism of Bupropion
Dopamine-NE reuptake inhibitor: preferentially
increases dopamine (weak inhibitor of dopamine
reuptake)
Clinical use of Buproprion
FDA-approved for depression,
smoking cessation;
non-FDA–approved—attention
Buproprion Can increase seizure risk at doses more than ________
450 mg/day
Contraindications of Buproprion: patients with ___ and _______
seizure disorders,
eating disorders
Duloxetine (Cymbalta) clinical use
Clinical uses: FDA-approved for depression, diabetic
peripheral neuropathic
Enhances release of NE and 5HT, inhibits 5HT2 and
5HT3 receptors, also potent histamine antagonist,
moderate α2-adrenergic antagonist
Mirtazapine (Remeron)
Indications for Mirtazapine (Remeron)
FDA-approved for depression; non-
FDA–approved—improves appetite and sleep
SE of Mirtazapine
early sedation, weight gain, possible
agranulocytosis
Serotonin (5HT2) receptor-antagonist, weak
inhibitor of 5HT reuptake (5HT2 antagonist/reuptake
inhibitor
What anti-depressant
Nefazodone (Serzone)
Serotonin (5HT2) receptor-antagonist, weak inhibitor
of 5HT reuptake (5HT2 antagonist/reuptake inhibitor
Clinical uses: FDA-approved for depression; non-
FDA–approved—insomnia
Trazodone (Desyrel)
Inhibits 5HT reuptake at lower doses, inhibits NE
reuptake at moderate doses, and dopamine reuptake
at higher doses
Venlafaxine (Effexor)
Examples of Typical anti-psychotics
chlorpromazine (Thorazine), mesoridazine
(Serentil), thioridazine (Mellaril), fluphenazine
(Prolixin), perphenazine (Trilafon), trifluoperazine
(Stelazine), thiothixene (Navane), loxapine (Loxitane),
haloperidol (Haldol), molindone (Moban)
1) Favorable side-effect profile (useful in emergency
settings)
2) Useful for positive symptoms but not negative symptomsof schizophrenia
3) High potential for dose-dependent acute extrapyramidalside effects and sexual dysfunction
Haloperidol: high-potency agent
_________ also has potential to cause retinitis pigmentosa, retrograde ejaculation, QTc prolongation
Thioridazine
1) Effective for positive symptoms, less effective for negative symptoms of schizophrenia
2) Has a relatively favorable risk versus benefit ratio, so is
widely used
Thiothixene, perphenazine, trifluoperazine: medium
potency agents
Atypicals: _____________
clozapine, risperidone, olanzapine, quetiapine,
aripiprazole, ziprasidone
Clozapine (Clozaril): low-potency agent, for _____
1) Choice for patient with______ and ____
2) Effective for ____ and _____ symptoms of
schizophrenia
3) Should have had at least three failed trials of antipsychotics from different classes and at least one depot formulation trial
refractory schizophrenia
tardive dyskinesia or at high risk for tardive dyskinesia
positive and negative
Serious side effects of Clozapine:
agranulocytosis, seizures
Risperidone (Risperdal): high-potency agent
1) Effective for ______ and ______ symptoms of
schizophrenia
2) Reduced potential for acute or chronic extrapyramidal
side effects
3) Can significantly increase serum _______, more
_________ is possible
positive and negative
prolactin levels
sexual dysfunction
1) Is structurally similar to and acts like clozapine but
with less risk for agranulocytosis and seizures
2) Acute extrapyramidal side effects no more frequent
than reported for placebo, low chance for chronic
extrapyramidal side effects
Olanzapine (Zyprexa): medium- to high-potency agent
SE of Olanzapine
weight gain, hypertriglyceridemia, sedation,
diabetes (?) , elevated liver function enzymes
low potency, few EPS, less
sexual dysfunction, no prolactin increase antipsychotic
Quetiapine (Seroquel)
Antipsychotics
Typicals bind to _______, blocking dopamine at the
site, more prone to extrapyramidal side effects
D2 receptors
Antipsychotics
Atypicals are weaker D2 receptor antagonists but are
potent ______ receptor antagonists and also have ______ and ______
5HT2A
anticholinergic
and antihistaminic activity
______ and _____dopaminergic pathways
are affected by antipsychotics
Mesocortical and mesolimbic
Adverse effects of anti-psychotics
_____________- abnormal involuntary movements
(usually mouth and/or tongue) after long-term use
-Elderly, women, and those with mood disorders more
susceptible
Tardive dyskinesia:
Adverse effects of anti-psychotics
__________ (tremor, rigidity, hypokinesia): treat by
lowering dose of antipsychotic or adding antiparkinsonian
agent
Parkinsonism
Adverse effects of anti-psychotics
______ (subjective feelings of anxiety, tension, agitation):
treat by lowering dose of antipsychotic, try β-
blocker, clonidine, amantadine, or benzodiazepine
Akathisia
Adverse effects of anti-psychotics
sustained contraction of muscles of neck, mouth, tongue): treat with intravenous benztropine
or diphenhydramine
Acute dystonic reaction
Adverse effects of anti-psychotics
________ (dry mouth, urinary retention,
blurry vision, constipation, exacerbation of narrowangle
glaucoma): treat by reducing dose or change to
more potent antipsychotic or to atypical antipsychotic
Anticholinergic side effects
Adverse effects of anti-psychotics
Agranulocytosis (associated with low-potency antipsychotics and especially clozapine; potentially fatal):
requires weekly blood counts for_____ and ____
first 6 months, then
every 2 weeks thereafter
Adverse effects of anti-psychotics
rigidity, high fever, delirium, autonomic instability,
increased serum levels of creatine kinase and liver
enzymes): treat by stopping offending drug, supportive
care, try dantrolene or bromocriptine, ECT for severe
cases
Neuroleptic malignant syndrome
Rapid removal of medications with dopaminergic
properties such as those used to treat _______
can also cause neuroleptic malignant-like syndrome
Parkinson’s disease
________: most often prescribed psychotropic
medications
Anxiolytics
BZD with long half life
chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), flurazepam (Dalmane
BZD with Medium half-life:
estazolam (ProSom), lorazepam
Ativan), temazepam (Restoril
BZD with Short half-life:
alprazolam (Xanax), oxazepam (Serax),
triazolam (Halcion)
Preferred benzodiazepines for the elderly:
oxazepam,
lorazepam, temazepam (“out the liver”)
anxiolytics, sedative-hypnotics
1) Used for generalized anxiety disorder: effects seen
after 1 to 2 weeks
2) Relatively nonsedating, no abuse potential
Buspirone (BuSpar)
Electric current applied across scalp electrodes, producing a grand mal seizure
ECT
ECT may improve both mood and motor symptoms of patients with _______, but effects may be short-lived from days to weeks to 6 months, according to various
studies
advanced Parkinson’s disease
MOA of Lithium
inhibits inositol-1-phosphatase
Indications of Lithium therapy
mania, augmentation of antidepressants,
prophylaxis of mania/depression,
schizoaffective disorder, aggression, impulsivity
Concerns for Lithium:
thyroid/kidney, pregnancy (Ebstein’s
anomaly
Clinical indications for Amphetamine:
1) Narcolepsy and other sleep disorders, attentiondeficit/
hyperactivity disorder in children, obesity
2) Has also been used for depression by augmenting
antidepressant effects, neurasthenia, AIDS dementia,
encephalopathy from brain injury
MOA of Amphetamine
1) Causes direct release of dopamine and NE from
neurons
2) Blocks reuptake of catecholamines
3) Peak plasma levels in 1 to 3 hours
___________ related to
amphetamine, but milder stimulant (little or no abuse
potential)
Methylphenidate (Concerta, Ritalin):
________ novel stimulant for narcolepsy
Modafinil (Provigil):
Sympathomimetics decrease efficacy of many antihypertensive
agents, especially ______ and _______
guanethidine (Ismelin) and
guanethidine-hydrochlorothiazide (Esimil)
Techniques for behavioral therapy
classic conditioning, operant conditioning,
positive reinforcers, negative reinforcers, relaxation training,
systematic desensitization, flooding, behavioral
modification
a person’s evaluation of a perceived adverse
event largely determines the degree and type of
emotional state experienced
Cognitive-behavioral therapy:
