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Psychiatry > drug > Flashcards

drug Flashcards

1
Q

what are the first gen antipsychotics or the typicals and what are their mechanisms of action

A

haloperidol, perphenazine, chlorpromazine, fluphenazine

primarily D2 antagonists.

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2
Q

What do the typical antipsychotics treat

A

the positive symptoms mainly. not good at the negatives

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3
Q

what are the side effects of the typicals

A

extrapyramidals, neuroleptic malignant syndrome, and tardive dyskinesia.

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4
Q

what is another name for the typical antipsychotics

A

neuroleptics

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5
Q

what are the atypical or second generation antipsychotics

and the mechanism of action

A

aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, quetiapine, risperidone, ziprasidone.
these are D4>2 antagonists. they also antagonize the serotonin HT2 receptors. j

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6
Q

what are the benefits of the second gens

A

lower incidence of extrapyramidal symptoms, there is an increased risk for metabolic syndrome.

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7
Q

what is the worst antipsychotic and what are the risks and why is it used?

A

clozapine. this is last ditch for people who are refractory. there is a risk of agranulocytosis

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8
Q

what are the important SE of antipsychotics in general?

A

extrapyramidal symptoms, anticholinergic symptoms, metabolic syndrome, tardive dyskinesia and neuroleptic malignant syndrome. prolonged QT syndrome. watch for hyperprolactinemia and gynecomastia

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9
Q

what are the anticholinergic SE of the antipsychotics

A

dry mouth, constipation, blurred vision, hyperthermia.

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10
Q

what is tardive dyskinesia

A

(more likely to be caused by first gen antipsychotics) choreoathetoid movements usually of the face, tongue, and head.

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11
Q

what do we use to treat specific phobias or acute anxiety

A

Benzos.

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12
Q

what do we use to treat public speaking

A

nonselective beta-blockers, such as propanolol, atenolol, nadolol

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13
Q

what does the withdrawal of Benzos look like

A

alcohol.

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14
Q

how do we treat chronic anxiety such as OCD, PTSD, GAD

A

SSRI/SNRI

psychotherapy.

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15
Q

how do we treat Benzodiazepines withdrawal

A

with long acting Benzos such as diazepam and chlordiazepoxide

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16
Q

what causes the positive symptoms of schizophrenia

A

mesolimbic D2c receptors

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17
Q

what causes the negative symptoms of schizophrenia

A

serotonin receptors and mesocortical hypo function

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18
Q

what does blocking the tubuloinfundibular path do?

A

gynecomastia in men

amenorrhea and galactorrhea in women

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19
Q

what are the potent typical antipsychotics

A

haloperidol, trifluoptazine and fluphenazine

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20
Q

what are the lower potency typical antipsychiotics

A

thioridizine and chlorpromazine

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21
Q

what other SE are caused by the typical antipsychotics

A

anticholinergic effects: dry mouth, urinary retention

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22
Q

what are the atypical antipsychotics

A

quetiapine, clozapine, rispiradone, olanzapine, aripiprazole, zaprasidone

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23
Q

most likely SE of quetiapine

A

somnolence. also used to treat insomnia and a mood stabilizer.

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24
Q

most likely SE of olanzapine

A

metabolic syndrome

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25
Q

most likely SE of risperadone

A

highest risk for EPS

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26
Q

what do all of the atypicals have for SE

A

QTc prolongation and anticholinergic effects

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27
Q

what drugs do we use to help people quit drinking

A

naltrexone, acamprosate and disulfiram

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28
Q

when do we use naltrexone

A

can still be drinking. used to achieve sobriety

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29
Q

what are the contraindications for using naltrexone in alcohol abuse treatment

A

if the person is not taking opioids, has poor liver function or hepatitis.

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30
Q

when is acamprosate used for alcohol abuse treatment

A

used to decrease cravings, but the person has to achieve sobriety first.

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31
Q

what is acute dystonia and what to treat

A

sudden, sustained contraction of the neck, mouth, tongue and eye muscles. treat with benztropine and diphenhydramine

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32
Q

what is akathisia and how to treat

A

subjective restlessness and inability to sit still treat with beta blocker, benztropine and Benzodiazepines (lorazepam).

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33
Q

how do we treat drug induced Parkinson’s

A

benztropine and amantidine

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34
Q

what is tardive dyskinesia and how to treat

A

gradual onset after prolonged therapy, dyskinesia of the mouth face and truck treat with valbenazine

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35
Q

what is the first line therapy for major depressive disorder with psychotic features

A

antidepressants and antipsychotics or ECT

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36
Q

what is the treatment of choice for specific phobia

A

CBT. short acting benzos can also be used.

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37
Q

what are the short acting benzos

A

oxelapram, midazolam, triazolam

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38
Q

what are the intermediate benzos

A

Alprazolam (Xanax), lorazepam (Ativan), estazolam (Prosom), and temazepam (Restoril)

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39
Q

what are the long acting benzos

A

diazepam and chlordiazoxide

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40
Q

what are the long term treatments for people with panic disorder

A

CBT and SSRIs/SNRI

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41
Q

what is pseudo dementia and what to treat

A

dementia secondary to MDD, treat with SSRIs.

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42
Q

what is the MSE for someone with pseudodementia

A

≤25

43
Q

what is the first and second-line therapy for OCD

A

SSRI -1

clompiramine -2

44
Q

what is clomipramine and why is it second line therapy for OCD

A

TCA and has a nasty SE profile.

45
Q

what is the SE profile for aripiprazole

A

metabolic. low
EPS. low
QTc. low

46
Q

what is the SE profile for quetiapine

A

metabolic. high
EPS. low
QTc. low

47
Q

what is the SE profile for clozapine

A

metabolic. Very high
EPS. low
QTc. low

48
Q

what is the SE profile for risperidone

A

metabolic. high
EPS. high
QTc. high

49
Q

what is the SEprofile for olanzapine

A

metabolic. very high
EPS. low
QTc. low
same as clozapine

50
Q

what is the SE profile for ziprasidone

A

metabolic. low
EPS. low
QTc. high

51
Q

what is delirium

A

insomnia, fluctuating level of consciousness, agitation and paranoid delusions

52
Q

what is the treatment of choice for catatonia

A

1-benzo

2-ECT

53
Q

how does catatonia present

A

patient with a long history of bipolar that presents with immobility, resistance to movement and mutism.
treat with Benzodiazepines (lorazepam) or ECT

54
Q

when is a person supposed to be on lifetime antidepressants

A

> 3 lifetime depressive episodes, suicide attempts or episodes >2 years

55
Q

which atypical antipsychotics have the least risk of hyperprolactinemia

A

aripiprazole and quetiapine

56
Q

which two atypical antipsychotics have the least SE

A

aripiprazole and quetiapine

57
Q

what pathway is involved in the prolactinemia path?

A

Think the EPS pathway or the niagrostriatal path.

58
Q

what class should you use in a patient with depression and diabetic neuropathy

A

SNRIs or TCAs.

59
Q

what is the SE profile for lurasidone

A

metabolic. low
EPS. medium
QTc. low

60
Q

what are the first line treatments for acute bipolar depression

A

quetiapine, lurasidone, lamotrigine, lithium, valproate, and the combination of olanzipine and fluoxetine.

61
Q

what drugs treat akathisia

A

beta blockers, benztropine and Benzodiazepines

62
Q

what drugs treat acute dystonia

A

anticholinergics benztropine and diphenhydramine

remember that acute dystonia can be muscle spasms and result in random movement of a limb.

63
Q

what is the treatment for intractable hiccups

A

chlorpromazine

64
Q

what is the treatment for acute mania in a pregnant woman?

A

depends on the date of the pregnancy but ECT works

65
Q

what are the symptoms of opioid withdrawal

A

The withdrawal sequalae can include dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, nausea/vomiting, fever, dilated pupils, abdominal cramps, athralgia, myalgia, hypertension, tachycardia, and craving.

66
Q

what drug should be avoided in a patient in opioid withdrawal f they have a QTc prolongation

A

methadone. this can cause arrhythmia

67
Q

what drug is given to avoid the withdrawal symptoms of opiates

A

clonidine

68
Q

what are the side effects for verenicline

A

nausea, suicidal ideation, constipation.

69
Q

what sleep aid do you use for an elderly man? with insomnia

A

zolpidem

do not use trazodone due to postural hypotension, priapism.

70
Q

what are the best choices for antipsychotics in acute mania

A

olanzapine, haloperidol, risperadone

71
Q

what the drug used for dyspareunia

A

ospemifine this is a ZSERM.

72
Q

SE of ospemifine

A

Side effects associated with ospemifene include vaginal discharge, hot flashes, and diaphoresis.

73
Q

what is a phsyiological argument against using imipramine for enuresis

A

cardiac arrhtythimia

74
Q

what are some of the criteria for avoidant and restrictive food intake disorder

A

avoiding food based on its texture and having nutritional definciency

75
Q

what is the most common cardiac arrhythmia for psychiatry

A

torsades.

76
Q

what does torsades look like on an ekg?

A

like a twisting of peaks

77
Q

what is the treatment for torsades

A

magnesium sulfate

78
Q

What treatment can be used for bipolar disorder maintenance in the second trimester

A

lamotrigine can be used during the second and third trimester

79
Q

What treatment is used for acute mania in pregnancy and what is used for maintenance therapy

A

1st trimester: maintenance therapy –NONE.
2-3 trimester maintenance –lamotrigine
acute mania: ECT

80
Q

what is first line pharm for ADHD with tourettes

A

atomoxetine. do not use methylphenidate because it worsens the symptoms of Tourettes

81
Q

what drug can be used to augment SSRI therapy —what drugs should not be used

A

lithium

Do not add another SSRI or SNRI never add a MOAi or st johns wort as there is a risk of serotonin syndrome

82
Q

what are the only treatments FDA approved for hyperactivity and irritability in autism

A

risperidone and aripiprazole

83
Q

what are the best choices for Benzodiazepines in alcohol withdrawal

A

ChLOT chlordiazepoxide, lorazepam (first line), oxezepam and temazepam

84
Q

is cocaine a teratogen

A

no. but it can cause placental abruption including low birth weight, preterm delivery and intra-uterine growth restriction.

85
Q

what is a lesser known SE of carbamazepine toxicity

A

ataxia

86
Q

what are the treatments for anorexia

A

family and psychotherapy are the best, but if these fail use olanzapine

87
Q

what mood stabilizer can cause hypercalcemia

A

lithium

88
Q

what are the SE of lithium

A

hypercalcemia via hyperparathyroidism, nephrogenic diabetes insipidus, chronic kidney disease, thyroid dysfunction.
watch for teratogenic effects

89
Q

is clozapine used for acute management of agitation

A

NO

90
Q

what are the indications for SSRIs

A

major depression, OCD, bulimia, anxiety, PTSD and premature ejaculation

91
Q

what are the causes of U waves and inverted T waves on an EKG

A

hypokalemia from lithium toxicity

92
Q

what pathway do the atypical antipsychotics inhibit which can cause sexual dysfunction?

A

tubloinfundibular

93
Q

what pathway do the atypical antipsychotics inhibit which can cause gynecomastia

A

tubuloinunfdibular

94
Q

what pathway do the atypical antipsychotics inhibit which can cause infertility

A

tubuloinunfdibular

95
Q

what drugs inhibit the reuiptake of serotonin

A

SSRIs, SNRIs, TCAs, trazodone

96
Q

what drugs inhibit the reuptake of norepinephrine

A

TCAs and SNRIs

97
Q

what drugs increase the release of NE

A

bupropion

98
Q

what drug inhibits the inhibition of NE release

A

mirtazapine

99
Q

what are the pharmacological treatments for insomnia

A

Remember that the best treatments are sleep hygiene and CBT

1) Benzos –short term
2) Non-benzos zolpidem, eszopiclone, zaleplon
3) antidepressants like trazodone, amitriptyline, and doxepin

100
Q

what are the treatments for narcolepsy

A 
sleep hygiene
scheduled day time naps. 
avoidance of shift work 
amphetamines for daytime sleepiness 
sodium oxybate for day time sleepiness and cataplexy \
101
Q

what are the treatments for cataplexy

A

sodium oxybate 0–drug of choice.

imipramine, despiramine, clomipramine SSRIs are also used.

102
Q

what class do milnacepram and levomilnacepram belong

A

SNRIs

103
Q

why don’t we give beta blockers to cocaine overdose

A

because that would cause unopposed alpha and cause severe hypertension

Psychiatry (11 decks)

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