CK3 Flashcards
Psychoactive drug intoxication and withdrawal - depressants - intoxication non-specific synptoms
- mood elevation
- decreased anxiety
- sedation
- behavioural disinhibition
- respiratory depression
Psychoactive drug intoxication and withdrawal - depressants - withdrawal non-specific symptoms
- anxiety
- tremor
- seizures
- insomnia
Alcohol - intoxication
- emotional lability
- slurred speech
- ataxia
- blackouts
- coma
opioid analgesics - toxicity
- addiction
- respiratory depression
- constipation (no tolerance)
- miosis (pinpoint pupils) (no tolerance)
- addictive CNS depression with other drugs
- opioid withdrawal syndrome
- suppressed gag reflex
opioid - withdrawal
- Sweating
- DILATED PUPILS
- piloerection (cold turkey)
- nausea/stomach cramps, diarrhea, fever, rhinorrhea, yawning, nausea (flu like symptoms)
opioid - withdrawal - treatment
long term support, methadone, buprenorphine
barbiturates - toxicity
- respiratory and cardiovascular depression (can be fatal)
- CNS depression (can be exacerbated by alcohol use)
- dependence
- induces of P-450
- withdrawal syndrome
- teratogen
barbiturates - withdrawal
- delirium
2. life threatening cardiovascular (and respiratory) collapse
benzodiazepines - side effects
- dependence
- addictive CNS depression effects with alcohol
- respiratory deppresion less and coma (less risk that barbiturates)
benzodiazepines - overdose treatment (and mechanism of action)
flumazenil (comptetitive antagonist at GABA benzodiazepine receptor)
RARELY USED AS IT CAN PRECIPITATE SEIZURES
benzodiazepines - withdrawal
- sleep disturbances
- depression
- rebound anxiety
- seizures
overdose treatment of 1. opioids 2. benzodiazepines 3. barbiturates
- opioids –> naloxone, naltrexone
- benzodiazepines –> flumazenil
- mechanical respiration, hemodialysis, urine alkalinization
Psychoactive drug intoxication and withdrawal - stimulants - intoxication non-specific synptoms
- mood elevation
- psychomotor agitation
- insomnia
- cardiac arrhytmias
- tachycardia
- anxiety
Psychoactive drug intoxication and withdrawal - withdrawal stimulants non-specific symptoms
post-use “crash” including
- depression
- lethargy
- weight gain
- headache
- Increased appetite
- Sleep disturbances
- Vivid nightmares
Amphetamines intoxication
- euphoria 2. Grandiosity 3. pupillary dilation
- prolonged wakefulness and attention 5. hyperentsion
- tachycardia 7. anorexia 8. paranoia
fever 9. cardiac arrest 10. seizures
Amphetamines withdrawal
- anhedonia
- increased appetite
- hypersomnolence
- existential crisis
nicotine intoxication
restlessness
nicotine withdrawal
- irritability
- anxiety
- craving
nicotine withdrawal - treatment
- nicotine patch/gum/lozenges
- bupropion
- varenicline
caffeine intoxication
- restlessness
- increased diuresis
- muscle twitching
caffeine withdrawal
- lack of concentrations
- headaches
- flu like symptoms
coccaine intoxication
- impaired judgment
- pupillary dilation
- hallucinations (including tactile)
- paranoid ideations
- angina
- sudden cardiac death
coccaine withdrawal
- hypersomnolence
- malaise
- severe psychological craving
- depression/suicidality
coccaine intoxication - treatment
- a-blockers
- benzodiazepines
β blockers are not recommended
Psychoactive drug intoxication and withdrawal - halllucinogens - drugs
- PCP (Phencyclidine)
- LSD (lysergic acid diethylamide)
- Marijuana (cannabinoid)
- MDMA (ecstasy)
PCP - intoxication
- Belligerence
- impislivity
- fever
- analgesia
- vertical and horizontal nystagmus
- tachycardia
- homocidality
- psychosis
- delirium
- seizures
PCP - intoxication - treatment
- benzodiazepines
2. rapid acting antipsychotic
LSD intoxication
- Perceptual distortion (visual auditory)
- depersonalization
- anxiety
- paranoia
- psychosis
- possible flashbacks
Marijuana (cannabinoid) - intoxication
- euphoria
- anxiety
- paranoid delusions
- perceptions of slowed time
- impaired judgement
- social withdrawal
- increased appetite
- dry month
- conjunctival injecton
10 hallucinations
Marijuana (cannabinoid) - clinical use
- antiemetic (chemotherapy)
2. appetite stimulant (AIDS)
Marijuana (cannabinoid) - withdrawal
- irritability
- depression
- insomnia
- nausea
- anorexia
Marijuana (cannabinoid) - course of withdrawal symptoms
Most symptoms peak in 48 hours and last for 5-7 days
Heroin addiction - methadone
long-acting oral opiate used for heroin detoxification or long-term maintenance
Heroin addiction - naloxone + buprenorphine
antagonists + partial agonist. Naloxone is not orally bioavailable, so withdrawal symtpoms occur only if injected (lower abuse potential)
Heroin addiction - naltrexone
long acting opioid antagonists used for relapse prevention once detoxified
Alcoholism - treatment
- disulfiram (to condition the patient to abstain from alcohol use)
- acamprosate
- naltrexone
- supportive care
Delirium tremens
life threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink
Delirium tremens - characterised by
autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
Alcoholic hallucinosis?
visual hallucinations 12-48 hours after last drink
Alcoholic hallucinosis - treatment
long acting benzodiazepines (chlorodiazepoxide, lirazepam , diazepa)
MDMA (ecstasy) - intoxication
- euphoria 2. dishinibition 3. hyperactivity
4. Life threatening effects (hyperentsion, tachycardia, hyperthermia, hyponatriemia, seretonin syndrome)
MDMA (ecstasy) - withdrawal
- depression
- fatigue
- change in appetite
- anxiety
- difficulty concentrating
Bulimia - treatment
SSRIs (+ CBT, nutritional rehabilitation)
social anxiety disorder
SSRIs, venlafaxine
Performance only: β-blockers, benzodiazepines
Tourette syndrome - treatment
- psychoeducation
- behavioral therapy
- for intractable tics –> a. low dose high potency antipsycotics (flyphenazine, pimozide) b. tetrabenazine
c. clonidine d. guanfacine
Narcolepsy - treatment
daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHD)
CNS stimulants - drugs/mechanism/clinical use
- Methylphenidate 2. dextroamphetamine
- methamphetamine
mechanism: increases catecholamines in the synaptic cleft, esp norepinephrine and dopamin
clinical use: 1. ADHD 2. Narcolepsy 3. Appetite control
typical antipsychotics (neuroleptics) - drugs
HALOPERIDOL + “-azine” + pimozide
- haloperidol 2. trifluoperazine 3. fluphenazine
- thioridazine 5. chlorpromazine
typical antipsychotics (neuroleptics) - drug without “-azine”
haloperidol + pimozide
typical antipsychotics (neuroleptics) are divided to … (and which)
high potency –> 1. haloperidol 2. trifluoperazine 3. fluphenazine
low potency –> 1. thioridazine 2. chlorpromazine
typical antipsychotics (neuroleptics) - clinical use
- positive symptoms of schizophrenia
- psychosis
- bipolar disorder
- Turette syndrome
- Huntington (haloperidol)
- OCD
- Delirium
typical antipsychotics (neuroleptics) - side effect
- very slow to be removed from body (highly lipid soluble and stored in fat)
- Extrapyramidal system side effects (parskinsonism, akinesia, akathisia, dyskinesia) - High potency (not exactly)
- Endocrine side effects (hyperprolactinemia) –> galactorrhea and amenorrhea
- long QT
- anticholinergic (dry mount, constipation), anti-a1 (hypotnesion), anti-histamine (sedation) - low potency (not exactly)
- Neuroleptic malignant syndrome
- Tarditve dyskenisia
- corneal deposits (chlorpromazine)
- retinal deposits (thrioridazine)
- metabolic: dyslipidemia, weight gain, hyperglycemia
neuroleptic malignant syndrome - manifestations
mnemonic FEVER Fever (hyperthermia) Encephalopathy Vitals instability (autonomic instability) Enzymes (myoglobinuria) Rigidity of muscles
evolution of extrapyramidal system side effects
4hr acute dystonia (muscle spasm, stiffness oculogyric crisis), can cause laryngospam requiring intubation
4 day akathisia (restlessness)
4 wk bradykinesia (parkinsonism)
4 mo tardive dyskinesia
typical antipsychotics (neuroleptics) - side effects - solution
- Extrapyramidal system side effects –> benzotropine, diphenydramine, benzodiazepine
- Neuroleptic malignant syndrome –> dantrolene, D2 agonists (eg. bromocriptine), stop causative agent
Atipical antipsychotics - drugs
- Olanzapine 2. clozapine 3. quetiapine
- risperidone 5. aripiprazole 6. ziprasidone
- asenapine 8. iloperidone 9. paliperidone
- lurasidone
Atipical antipsychotics - clinical use
- Schizophrenia (both negative and positive symptoms)
- Bipolar disorder
- OCD
- Anxiety disorder
- Depression
- Mania
- Tourette syndrome
Atipical antipsychotics - side effects
- Fewer anti-cholinergic and extrapyramidal side effets than traditional antipsychotics
- Metabolic syndrome - weight gain, diabetes, hyperlipidemia
(-pines) - agranulocytosis (clozapine)
- seizures (clozapine)
- increased prolactin –> lactation and gynecomastia –> decreased GnRH, LH, FSH –> irregular menstruation and fertility issues (risperidone)
- prolonged QT intervals
Atipical antipsychotics - agranulocytosis - management
requires weekly WBC monitoring
use clozapine for
treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia
Lithium - clinical use
- Mood stabilizer for bipolar disorder
- Blocks relapse and acute manic events
- SIADH
Lithium - side effects
- tremor
- hypothyroidism
- polyuria (nephrogenic diabetes insipidus)
- teratogenesis
- NARROW THERAPEUTIC WINDOW (requires close monitoring of serum levels)
causes of lithium toxicity
- change in dosage or health status
- concurrent use of thiazide, ACEi, NSAID, or other nephrotoxic agents
buspirone - everything
stimulates 5-HT1A recetors
general anxiety disorder
TAKES 1-2 WEEKS TO TAKE EFFECTS
- does not cause sedation, addiction, or tolerance
- does not interact with alcohol (vs barbiturates, benzodiazepines)
Anttidepressants - groups
- SSRI
- SNRI
- TCA
- MAOi
- atypical antidepres
SSRIs - drugs
- Fluoxetine
- Paroxetine
- Sertraline
- Citalopram
- fluvoxamine
SSRIs - mechanism
5-HT-specific re-uptake inhibitors
it takes 4-8 weeks for antidepressants to have an effect
SSRIs - clinical use
- Depression
- Generalized anxiety disorder
- panic disorder
- OCD
- Bulimia
- Social phobias
- post-traumatic stress disorder
- premature ejaculation
- premanstrual dysphoric disorder
it takes 4-8 weeks for antidepressants to have an effect
SSRIs - side effects
fewer than TCA
1. GI distress 2. SIADH 3. Sexual dyfunction (anorgasmia, decreased libido) 4. Seretonin syndrome (with other drugs that increase seretonin, eg. MAO inhibitors, SNRIs, TCAs)
Seretonin syndrome manifestations
3A
- neuromascular Activity (clonus, hyperleflexia, hypertonia, tremor, seizures)
- Autonomic stimulation (hyperthermia, diaphoresis, diarrhea
- Agitation
Seretonin syndrome - treatment
cyproheptadine (5-HT-2 receotr antagonist)
SNRIs - drugs
- venlafaxine
- duloxetine
- milnacipran
SNRIs - clinical use
- Depression
- Generalized anxiety disorder
- Panic disorder (venlfaxine)
- post-traumatic stress disorder (venlfaxine)
- Diabetic peripheral neuropathy
- OCD (venlafaxine)
- social anxiety disorder
SNRIs - toxicity
- increased BP (MC)
2. also stimulant effect, sedation, nausea
Tricyclic antidepressants - drugs
- Amitriptyline 2. nortripryline 3. imipramine
- desipramine 5. clomipramine 6. doxepin
- amoxepin
Tricyclic antidepressants - clinical use
- major depression 2. OCD (clomapramine)
- peripheral neuropathy 4. chronic pain
- migraine prophylaxis
Tricyclic antidepressants - toxicity
- Cardiotoxicity (prolong QT) –> due to Na+ channels inhibition
- Respiratory depression
- Hyperpyrexia
- a1 blocking (postural hypertension)
- anticholinergic –> tachycardia, urinary retention, dry month, Confusion, hallucinations
- Coma
- Convulsions
Tricyclic antidepressants - anticholinergic effect
tachycardia, urinary retention, dry month, Confusion, hallucinations 3 TCAs (amitriptyline) have more anticholinergic effects than 2 TCA (nortripyline)
Tricyclic antidepressants - solution of side effects
- NaHCO3 to prevent arrhythmia
- Nortriptyline instead of amytriptyline for anticholinergic effects
- supportive treatment and ECG monitor
- ACTIVATED CHARCOAL
Monoamine oxidase inhibitors - drugs
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Selegiline (selective MAO-B inhibitor)
Monoamine oxidase inhibitors - Clinical use
- atypical depression
- anxiety
- agoraphobia
- Parkinson (only selegiline, with levodopa)
Monoamine oxidase inhibitors - toxicity
- hypertensive crisis (most notably with ingestion of tyramine, which is found in many food such as wine, cheese)
- CNS stimulation
- Contraindicated with SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John’s wort
Monoamine oxidase inhibitors - contraindicated with
SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John’s wort
atypical antidepressants - drugs
- Bupropion
- Mirtazapine
- Trazodone
- varenicline
- Vilazodone
- Vortioxetine
Bupropion - clinical use / mechanism
- depression
- smoking cessation
increases norepinephrine and dopamine via unknown mechanism
Bupropion - toxicity
- stimulants (tachycardia, insomnia)
- headaches
- seizures (in anorexic/bulimic patients, because low threshold of seizures)
NO SEXUAL SIDE EFFECTS
Mirtazapine - mechanism of action
- α2 antagonist –> increases release of norepin and 5-HT
- H1 antagonist
- potent 5-HT2 and 5-HT3 antagonist
Mirtazapine - toxicity
- sedation (may be desirable with depressive patients with insomnia)
- increased appetite
- weight gain (may be desirable in elderly or anorexic patients
- dry month
Trazodone - mechanism of action
Primarily blocks 5-HT2 and a1 adrenergic receptors
Trazodone - clinical use
used primarily for insomnia, as high doses are needed for antidepressants effects
Trazodone - toxicity
- sedation 2. nausea 3. priapism
4. postural hypertension
MAO inhibitors - after?
wait 2 weeks after stopping MAO inhibitors before starting seretonergic drufs or stopping dietary restrictions
Varenicline - mechanism of action / clinical use
Nicotininic ACH receptor partail agonist
- smoking cessation
Varenicline - toxicity
sleep disturbances
depressed mood
Vilazodone - mechanism of action
inhibits 5-HT re-uptake
5-HT1A partial agnostis
vilazodone - clinical use
major depressive disorder
vilazodone - toxicity
headache, diarrhea, nausea, weight gain, anticholinergic effects, Seretonin syndrome (if with other drugs)
Vortioxetine - mechanism of action
- inhibits 5-HT re-uptake
- 5-HT1A agnostis
- 5-HT3 receptor antagonists
Vortioxetine - clinical use
major depressive disorder
Vortioxetine - toxicity
nausea, sexual dysfunction, sleep disturbances (abnormal dreams), anticholinergics, Seretonin syndrome (if with other drugs)