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CK3 Flashcards

1
Q

Psychoactive drug intoxication and withdrawal - depressants - intoxication non-specific synptoms

A
  1. mood elevation
  2. decreased anxiety
  3. sedation
  4. behavioural disinhibition
  5. respiratory depression
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2
Q

Psychoactive drug intoxication and withdrawal - depressants - withdrawal non-specific symptoms

A
  1. anxiety
  2. tremor
  3. seizures
  4. insomnia
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3
Q

Alcohol - intoxication

A
  1. emotional lability
  2. slurred speech
  3. ataxia
  4. blackouts
  5. coma
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4
Q

opioid analgesics - toxicity

A
  1. addiction
  2. respiratory depression
  3. constipation (no tolerance)
  4. miosis (pinpoint pupils) (no tolerance)
  5. addictive CNS depression with other drugs
  6. opioid withdrawal syndrome
  7. suppressed gag reflex
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5
Q

opioid - withdrawal

A
  1. Sweating
  2. DILATED PUPILS
  3. piloerection (cold turkey)
  4. nausea/stomach cramps, diarrhea, fever, rhinorrhea, yawning, nausea (flu like symptoms)
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6
Q

opioid - withdrawal - treatment

A

long term support, methadone, buprenorphine

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7
Q

barbiturates - toxicity

A
  1. respiratory and cardiovascular depression (can be fatal)
  2. CNS depression (can be exacerbated by alcohol use)
  3. dependence
  4. induces of P-450
  5. withdrawal syndrome
  6. teratogen
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8
Q

barbiturates - withdrawal

A
  1. delirium

2. life threatening cardiovascular (and respiratory) collapse

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9
Q

benzodiazepines - side effects

A
  1. dependence
  2. addictive CNS depression effects with alcohol
  3. respiratory deppresion less and coma (less risk that barbiturates)
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10
Q

benzodiazepines - overdose treatment (and mechanism of action)

A

flumazenil (comptetitive antagonist at GABA benzodiazepine receptor)
RARELY USED AS IT CAN PRECIPITATE SEIZURES

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11
Q

benzodiazepines - withdrawal

A
  1. sleep disturbances
  2. depression
  3. rebound anxiety
  4. seizures
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12
Q

overdose treatment of 1. opioids 2. benzodiazepines 3. barbiturates

A
  1. opioids –> naloxone, naltrexone
  2. benzodiazepines –> flumazenil
  3. mechanical respiration, hemodialysis, urine alkalinization
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13
Q

Psychoactive drug intoxication and withdrawal - stimulants - intoxication non-specific synptoms

A
  1. mood elevation
  2. psychomotor agitation
  3. insomnia
  4. cardiac arrhytmias
  5. tachycardia
  6. anxiety
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14
Q

Psychoactive drug intoxication and withdrawal - withdrawal stimulants non-specific symptoms

A

post-use “crash” including

  1. depression
  2. lethargy
  3. weight gain
  4. headache
  5. Increased appetite
  6. Sleep disturbances
  7. Vivid nightmares
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15
Q

Amphetamines intoxication

A
  1. euphoria 2. Grandiosity 3. pupillary dilation
  2. prolonged wakefulness and attention 5. hyperentsion
  3. tachycardia 7. anorexia 8. paranoia
    fever 9. cardiac arrest 10. seizures
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16
Q

Amphetamines withdrawal

A
  1. anhedonia
  2. increased appetite
  3. hypersomnolence
  4. existential crisis
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17
Q

nicotine intoxication

A

restlessness

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18
Q

nicotine withdrawal

A
  1. irritability
  2. anxiety
  3. craving
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19
Q

nicotine withdrawal - treatment

A
  1. nicotine patch/gum/lozenges
  2. bupropion
  3. varenicline
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20
Q

caffeine intoxication

A
  1. restlessness
  2. increased diuresis
  3. muscle twitching
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21
Q

caffeine withdrawal

A
  1. lack of concentrations
  2. headaches
  3. flu like symptoms
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22
Q

coccaine intoxication

A
  1. impaired judgment
  2. pupillary dilation
  3. hallucinations (including tactile)
  4. paranoid ideations
  5. angina
  6. sudden cardiac death
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23
Q

coccaine withdrawal

A
  1. hypersomnolence
  2. malaise
  3. severe psychological craving
  4. depression/suicidality
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24
Q

coccaine intoxication - treatment

A
  1. a-blockers
  2. benzodiazepines
    β blockers are not recommended
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25
Q

Psychoactive drug intoxication and withdrawal - halllucinogens - drugs

A
  1. PCP (Phencyclidine)
  2. LSD (lysergic acid diethylamide)
  3. Marijuana (cannabinoid)
  4. MDMA (ecstasy)
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26
Q

PCP - intoxication

A
  1. Belligerence
  2. impislivity
  3. fever
  4. analgesia
  5. vertical and horizontal nystagmus
  6. tachycardia
  7. homocidality
  8. psychosis
  9. delirium
  10. seizures
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27
Q

PCP - intoxication - treatment

A
  1. benzodiazepines

2. rapid acting antipsychotic

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28
Q

LSD intoxication

A
  1. Perceptual distortion (visual auditory)
  2. depersonalization
  3. anxiety
  4. paranoia
  5. psychosis
  6. possible flashbacks
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29
Q

Marijuana (cannabinoid) - intoxication

A
  1. euphoria
  2. anxiety
  3. paranoid delusions
  4. perceptions of slowed time
  5. impaired judgement
  6. social withdrawal
  7. increased appetite
  8. dry month
  9. conjunctival injecton
    10 hallucinations
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30
Q

Marijuana (cannabinoid) - clinical use

A
  1. antiemetic (chemotherapy)

2. appetite stimulant (AIDS)

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31
Q

Marijuana (cannabinoid) - withdrawal

A
  1. irritability
  2. depression
  3. insomnia
  4. nausea
  5. anorexia
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32
Q

Marijuana (cannabinoid) - course of withdrawal symptoms

A

Most symptoms peak in 48 hours and last for 5-7 days

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33
Q

Heroin addiction - methadone

A

long-acting oral opiate used for heroin detoxification or long-term maintenance

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34
Q

Heroin addiction - naloxone + buprenorphine

A

antagonists + partial agonist. Naloxone is not orally bioavailable, so withdrawal symtpoms occur only if injected (lower abuse potential)

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35
Q

Heroin addiction - naltrexone

A

long acting opioid antagonists used for relapse prevention once detoxified

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36
Q

Alcoholism - treatment

A
  1. disulfiram (to condition the patient to abstain from alcohol use)
  2. acamprosate
  3. naltrexone
  4. supportive care
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37
Q

Delirium tremens

A

life threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink

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38
Q

Delirium tremens - characterised by

A

autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)

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39
Q

Alcoholic hallucinosis?

A

visual hallucinations 12-48 hours after last drink

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40
Q

Alcoholic hallucinosis - treatment

A

long acting benzodiazepines (chlorodiazepoxide, lirazepam , diazepa)

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41
Q

MDMA (ecstasy) - intoxication

A
  1. euphoria 2. dishinibition 3. hyperactivity

4. Life threatening effects (hyperentsion, tachycardia, hyperthermia, hyponatriemia, seretonin syndrome)

42
Q

MDMA (ecstasy) - withdrawal

A
  1. depression
  2. fatigue
  3. change in appetite
  4. anxiety
  5. difficulty concentrating
43
Q

Bulimia - treatment

A

SSRIs (+ CBT, nutritional rehabilitation)

44
Q

social anxiety disorder

A

SSRIs, venlafaxine

Performance only: β-blockers, benzodiazepines

45
Q

Tourette syndrome - treatment

A
  1. psychoeducation
  2. behavioral therapy
  3. for intractable tics –> a. low dose high potency antipsycotics (flyphenazine, pimozide) b. tetrabenazine
    c. clonidine d. guanfacine
46
Q

Narcolepsy - treatment

A

daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHD)

47
Q

CNS stimulants - drugs/mechanism/clinical use

A
  1. Methylphenidate 2. dextroamphetamine
  2. methamphetamine
    mechanism: increases catecholamines in the synaptic cleft, esp norepinephrine and dopamin
    clinical use: 1. ADHD 2. Narcolepsy 3. Appetite control
48
Q

typical antipsychotics (neuroleptics) - drugs

A

HALOPERIDOL + “-azine” + pimozide

  1. haloperidol 2. trifluoperazine 3. fluphenazine
  2. thioridazine 5. chlorpromazine
49
Q

typical antipsychotics (neuroleptics) - drug without “-azine”

A

haloperidol + pimozide

50
Q

typical antipsychotics (neuroleptics) are divided to … (and which)

A

high potency –> 1. haloperidol 2. trifluoperazine 3. fluphenazine
low potency –> 1. thioridazine 2. chlorpromazine

51
Q

typical antipsychotics (neuroleptics) - clinical use

A
  1. positive symptoms of schizophrenia
  2. psychosis
  3. bipolar disorder
  4. Turette syndrome
  5. Huntington (haloperidol)
  6. OCD
  7. Delirium
52
Q

typical antipsychotics (neuroleptics) - side effect

A
  1. very slow to be removed from body (highly lipid soluble and stored in fat)
  2. Extrapyramidal system side effects (parskinsonism, akinesia, akathisia, dyskinesia) - High potency (not exactly)
  3. Endocrine side effects (hyperprolactinemia) –> galactorrhea and amenorrhea
  4. long QT
  5. anticholinergic (dry mount, constipation), anti-a1 (hypotnesion), anti-histamine (sedation) - low potency (not exactly)
  6. Neuroleptic malignant syndrome
  7. Tarditve dyskenisia
  8. corneal deposits (chlorpromazine)
  9. retinal deposits (thrioridazine)
  10. metabolic: dyslipidemia, weight gain, hyperglycemia
53
Q

neuroleptic malignant syndrome - manifestations

A 
mnemonic FEVER
Fever (hyperthermia) 
Encephalopathy 
Vitals instability (autonomic instability) 
Enzymes (myoglobinuria) 
Rigidity of muscles
54
Q

evolution of extrapyramidal system side effects

A

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

55
Q

typical antipsychotics (neuroleptics) - side effects - solution

A
  1. Extrapyramidal system side effects –> benzotropine, diphenydramine, benzodiazepine
  2. Neuroleptic malignant syndrome –> dantrolene, D2 agonists (eg. bromocriptine), stop causative agent
56
Q

Atipical antipsychotics - drugs

A
  1. Olanzapine 2. clozapine 3. quetiapine
  2. risperidone 5. aripiprazole 6. ziprasidone
  3. asenapine 8. iloperidone 9. paliperidone
  4. lurasidone
57
Q

Atipical antipsychotics - clinical use

A
  1. Schizophrenia (both negative and positive symptoms)
  2. Bipolar disorder
  3. OCD
  4. Anxiety disorder
  5. Depression
  6. Mania
  7. Tourette syndrome
58
Q

Atipical antipsychotics - side effects

A
  1. Fewer anti-cholinergic and extrapyramidal side effets than traditional antipsychotics
  2. Metabolic syndrome - weight gain, diabetes, hyperlipidemia
    (-pines)
  3. agranulocytosis (clozapine)
  4. seizures (clozapine)
  5. increased prolactin –> lactation and gynecomastia –> decreased GnRH, LH, FSH –> irregular menstruation and fertility issues (risperidone)
  6. prolonged QT intervals
59
Q

Atipical antipsychotics - agranulocytosis - management

A

requires weekly WBC monitoring

60
Q

use clozapine for

A

treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia

61
Q

Lithium - clinical use

A
  1. Mood stabilizer for bipolar disorder
  2. Blocks relapse and acute manic events
  3. SIADH
62
Q

Lithium - side effects

A
  1. tremor
  2. hypothyroidism
  3. polyuria (nephrogenic diabetes insipidus)
  4. teratogenesis
  5. NARROW THERAPEUTIC WINDOW (requires close monitoring of serum levels)
63
Q

causes of lithium toxicity

A
  • change in dosage or health status

- concurrent use of thiazide, ACEi, NSAID, or other nephrotoxic agents

64
Q

buspirone - everything

A

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)

65
Q

Anttidepressants - groups

A
  1. SSRI
  2. SNRI
  3. TCA
  4. MAOi
  5. atypical antidepres
66
Q

SSRIs - drugs

A
  1. Fluoxetine
  2. Paroxetine
  3. Sertraline
  4. Citalopram
  5. fluvoxamine
67
Q

SSRIs - mechanism

A

5-HT-specific re-uptake inhibitors

it takes 4-8 weeks for antidepressants to have an effect

68
Q

SSRIs - clinical use

A
  1. Depression
  2. Generalized anxiety disorder
  3. panic disorder
  4. OCD
  5. Bulimia
  6. Social phobias
  7. post-traumatic stress disorder
  8. premature ejaculation
  9. premanstrual dysphoric disorder
    it takes 4-8 weeks for antidepressants to have an effect
69
Q

SSRIs - side effects

A

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)

70
Q

Seretonin syndrome manifestations

A

3A

  • neuromascular Activity (clonus, hyperleflexia, hypertonia, tremor, seizures)
  • Autonomic stimulation (hyperthermia, diaphoresis, diarrhea
  • Agitation
71
Q

Seretonin syndrome - treatment

A

cyproheptadine (5-HT-2 receotr antagonist)

72
Q

SNRIs - drugs

A
  1. venlafaxine
  2. duloxetine
  3. milnacipran
73
Q

SNRIs - clinical use

A
  1. Depression
  2. Generalized anxiety disorder
  3. Panic disorder (venlfaxine)
  4. post-traumatic stress disorder (venlfaxine)
  5. Diabetic peripheral neuropathy
  6. OCD (venlafaxine)
  7. social anxiety disorder
74
Q

SNRIs - toxicity

A
  1. increased BP (MC)

2. also stimulant effect, sedation, nausea

75
Q

Tricyclic antidepressants - drugs

A
  1. Amitriptyline 2. nortripryline 3. imipramine
  2. desipramine 5. clomipramine 6. doxepin
  3. amoxepin
76
Q

Tricyclic antidepressants - clinical use

A
  1. major depression 2. OCD (clomapramine)
  2. peripheral neuropathy 4. chronic pain
  3. migraine prophylaxis
77
Q

Tricyclic antidepressants - toxicity

A
  1. Cardiotoxicity (prolong QT) –> due to Na+ channels inhibition
  2. Respiratory depression
  3. Hyperpyrexia
  4. a1 blocking (postural hypertension)
  5. anticholinergic –> tachycardia, urinary retention, dry month, Confusion, hallucinations
  6. Coma
  7. Convulsions
78
Q

Tricyclic antidepressants - anticholinergic effect

A 
tachycardia, urinary retention, dry month, Confusion, hallucinations 
3 TCAs (amitriptyline) have more anticholinergic effects than 2 TCA (nortripyline)
79
Q

Tricyclic antidepressants - solution of side effects

A
  1. NaHCO3 to prevent arrhythmia
  2. Nortriptyline instead of amytriptyline for anticholinergic effects
  3. supportive treatment and ECG monitor
  4. ACTIVATED CHARCOAL
80
Q

Monoamine oxidase inhibitors - drugs

A
  1. Tranylcypromine
  2. Phenelzine
  3. Isocarboxazid
  4. Selegiline (selective MAO-B inhibitor)
81
Q

Monoamine oxidase inhibitors - Clinical use

A
  1. atypical depression
  2. anxiety
  3. agoraphobia
  4. Parkinson (only selegiline, with levodopa)
82
Q

Monoamine oxidase inhibitors - toxicity

A
  1. hypertensive crisis (most notably with ingestion of tyramine, which is found in many food such as wine, cheese)
  2. CNS stimulation
  3. Contraindicated with SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John’s wort
83
Q

Monoamine oxidase inhibitors - contraindicated with

A

SSRIs, TCAs, ST. meperidine, dextromethrophan, St. John’s wort

84
Q

atypical antidepressants - drugs

A
  1. Bupropion
  2. Mirtazapine
  3. Trazodone
  4. varenicline
  5. Vilazodone
  6. Vortioxetine
85
Q

Bupropion - clinical use / mechanism

A
  1. depression
  2. smoking cessation
    increases norepinephrine and dopamine via unknown mechanism
86
Q

Bupropion - toxicity

A
  1. stimulants (tachycardia, insomnia)
  2. headaches
  3. seizures (in anorexic/bulimic patients, because low threshold of seizures)
    NO SEXUAL SIDE EFFECTS
87
Q

Mirtazapine - mechanism of action

A
  • α2 antagonist –> increases release of norepin and 5-HT
  • H1 antagonist
  • potent 5-HT2 and 5-HT3 antagonist
88
Q

Mirtazapine - toxicity

A
  1. sedation (may be desirable with depressive patients with insomnia)
  2. increased appetite
  3. weight gain (may be desirable in elderly or anorexic patients
  4. dry month
89
Q

Trazodone - mechanism of action

A

Primarily blocks 5-HT2 and a1 adrenergic receptors

90
Q

Trazodone - clinical use

A

used primarily for insomnia, as high doses are needed for antidepressants effects

91
Q

Trazodone - toxicity

A
  1. sedation 2. nausea 3. priapism

4. postural hypertension

92
Q

MAO inhibitors - after?

A

wait 2 weeks after stopping MAO inhibitors before starting seretonergic drufs or stopping dietary restrictions

93
Q

Varenicline - mechanism of action / clinical use

A

Nicotininic ACH receptor partail agonist

- smoking cessation

94
Q

Varenicline - toxicity

A

sleep disturbances

depressed mood

95
Q

Vilazodone - mechanism of action

A

inhibits 5-HT re-uptake

5-HT1A partial agnostis

96
Q

vilazodone - clinical use

A

major depressive disorder

97
Q

vilazodone - toxicity

A

headache, diarrhea, nausea, weight gain, anticholinergic effects, Seretonin syndrome (if with other drugs)

98
Q

Vortioxetine - mechanism of action

A
  • inhibits 5-HT re-uptake
  • 5-HT1A agnostis
  • 5-HT3 receptor antagonists
99
Q

Vortioxetine - clinical use

A

major depressive disorder

100
Q

Vortioxetine - toxicity

A

nausea, sexual dysfunction, sleep disturbances (abnormal dreams), anticholinergics, Seretonin syndrome (if with other drugs)

psychiatry (6 decks)

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