Drugs Flashcards
1
Q
HAM se’s
A
antiHistamine - sedation, w/g
antiAdrenergic - hypotension
antiMuscarinic - dry mouth, blurred vision, urinary retention
2
Q
Serotonin syndrome
A
seen with SSRI’s and MAOIs combined (or triptan + SSRI)
confusion, flushing, tremor, myoclonic jerks, hypertonicity, rhabdomyolysis, renal failure death, shivering
- should wait TWO WEEKS, before giving SSRI + MAOI
- if suspect, discontinue med, try CCB (nifedipine) or chlopromazine/phentolamine
3
Q
Hypertensive crisis
A
seen with buildup of catecholamines d/t MAOIs + tyramine
4
Q
akathisia
A
restlessness/agitation - unable to sit still (days to months) - seen after using high dose typical antipsychotics
tx: benzos
5
Q
dystonia
A
sustained contraction of mm of neck, tongue, eyes, diaphragm (hours to days)
- haloperidol, fluphenazine
tx of dystonia: anticholinergics- diphenhydramine, benztropine, trihexphenydyl
6
Q
tardive dyskinesia
A
grimacing and writhing tongue protrusion, mvmt of fingers and toes
- occurs after YEARS of use of haloperidol or fluphenazine
- can be permanent
7
Q
acute dystonia
A
twisting and abnormal postures (hours to days)
8
Q
hyperprolactinemia
A
seen with haloperidol, fluphenazine, ** risperidone **
9
Q
NMS
A
neuroleptic malignant syndrome = fever, tachycardia, HTN, tremor, elevated CPK, “lead pipe” rigidity
- increased risk in haloperidol and fluphenazine
tx: supportive - discontinuiation of current medications, hydration and cooling
1. dantrolene
2. bromocriptine
3. amantadine
10
Q
SSRI’s
A
Fluoxetine - longest half life Paroxetine, Sertraline - GI probs Citalopram - fewest DDIs Escitalopram, Fluvoxamine - OCD tx
common SE’s:
- sexual dysfunction
- Gi problems
- insomnia, anorexia,
** increased suicidal thinking and behavior
11
Q
OCD?
A
fluvoxamine (SSRI) - or fluoxetine, sertraline
clomipramine (TCA)
d/t pts having low levels of serotonin
12
Q
no sexual SE’s for depression?
A
buproprion - NE and dopamine reuptake inhibitor
** increased risk of SEIZURES **
no sexual SE’s
CI in eating disorders!
13
Q
SNRI’s
A
Venlafaxine - used for depression, anxiety, disorder
Duloxetine (cymbalta) - depression + neuropathic pain tx
14
Q
Seratonin receptor antagonis/agonist
A
Trazodone - useful in tx of refractory major depression WITH INSOMNIA!!!
- no sexual SE’s
- SE: sedation, priapism
15
Q
alpha-2 antagonist
A
Mirtazapine - useful for refractory major depression, WEIGHT GAIN
16
Q
HETEROCYCLIC ANITDEPRESSANTS, TCA’S
A
- Tertiary amines: highly anticholinergic (blurry eyes, pupillary dilation, more sedating, higher risk of OD)
1. Amitriptyline - chronic pain/ migraines
2. Imipramine - tx panic disorder
3. Clomipramine - tx OCD
4. Doxepin - Secondary amines: less anticholinergic, less sedating
1. nortriptyline - least likely to cause OT hypoTN
2. Despiramine
SE’s:
- highly protein bound and lipid soluble
- cardiotoxic: orthostatic hypoTN, dizziness, tachycardia, arrhtymias, ECG changes
- sedation (antihistamine)
- anticholinergic: dry mouth, constipation, urinary retention, blurred vision,
17
Q
tx of TCA OD?
A
sodium bicarbonate IV
18
Q
major complications of TCA’s?
A
three C’s: cardiotoxicity, convlusions, coma
anticholinergic: dry mouth, retention, fatigue, blurry vision
19
Q
MAOIs
A
monoamine oxidase inhibitors “Phen is a tran”
- Phenelzine
- Tranylcypromine
- Isocarboxazid
MOA: prevent inactivation of amines such as NE, serotonin and dopamine and tyramine
** tx of refractory depression
** CI: people with heart problems
SE’s:
- serotonin syndrome: hyperthermia, hypertonic, rhabdo, renal problems, convulsions, coma death
- wait two weeks to switch
- hypertensive crisis
20
Q
tx of enuresis?
A
TCA’s = imipramine
21
Q
smoking cessation?
A
buproprion - also used for alcohol w/drawal
22
Q
insomnia + depression tx?
A
** trazodone**, amitriptyline, mirtazapine
23
Q
what to monitor when prescribe lithium?
A
Lithium levels, creatinine, thyroid levels
24
Q
typical vs atypical antipsychotics?
A
typical - blocks dopamine receptors
* increased risk of mortality with elderly pts
atypical - block dopamine and serotonin
- better at tx negative sx
- lower risk of EPS sx, increased risk of metabolic syndrome
25
low potency typical antipsychotics
chlorpromazine - bluish skin discoloration
thioridazine
anti-HAM effects: histaminic, adrenergic, muscarinic receptors
- weight gain, hypoTN, dry mouth, tachycardia, urinary retention, blurry vision
26
mid potency typical atipsychotics
trifluoperazine
27
high potency typical antipsychotic
- haloperidol
- fluphenazine
* * increased action at dopamine receptors **
* * less sedation, orthostatic hypoTN, anticholinergic effects
* * greater effect at dopamine receptors thus increased EPS effects
Antidopaminergic effects:
1. Parkinsonism - bradykinesia
2. Akathisia - restlessness
3. Dystonia - sustained painful contraction of mm in neck
* * hyperprolactinemia ** decreased libido, galactorrhea, gynecomastia, impotence, amenorrhea
28
tx of EPS?
```
benztropine (anticholinergic medication)
diphenhydramine (antihistaminergic)
amantadine
benzodiazepines
beta blockers
```
** decreased dopaminergic tone is d/t antipsychotics, by decreasing anticholinergic and anithistamine tone then they are balanced
EPS sx: dystonia (spasms), parkinsonism, akathisia
29
atypical antipsychotics
block both dopamine and serotonin - less likely to cause EPS, tardive diskinesia or NMS
** more effective in tx of negative sx
its atypical for closets to risper quietly from a to z
30
clozapine
bad:
weight gain and agranulocytosis! seizures!!
** must stop if absolute neutrophil count drops below 1500 - must have weekly blood draws for first six months
** more likely to cause DM and hypercholesterolemia as well
good:
- decreased risk of suicide, more efficacious
- less likely to cause TD
** usually reserved for pts who have failed multiple antipsychotic trials before d/t increased risk of agranulocytosis
31
Risperidone
increased prolactin
| increased akathisia risk
32
quietiapine
- lowest EPS sx
| bad: sedation, orthostatic hypoTN
33
olanzapine
weight gain is problem!
34
ziprasidone
no weight gain!
bad: increased QT prolongation
35
aripiprazole
less potential for weight gain, less sedating!
36
typical antipsychotics less likely to cause w/g?
aripiprazole or ziprasidone
37
Lithium
USE: BPD, schizoaffective disorder, major depression, schizophrenia, tx of aggression and impulsivity
- therapeutic range; 0.6-1.2 (lethal >2.0)
- should have ECG, basic chemistry, thyroid function, CBC, pregnancy test
- metabolized by kidneys: check renal function
SE's: altered mental status, coarse tremors, convulsions, nephrogenic DI, GI disturbance, w/g, sedation, hypothyroidism
- Ebstein's anomaly
38
mood stabilizers for BPD?
lithium, anticonvulsants (valproic acid, lamotrigine, carbmazepine)
39
carbamazepine
mixed episodes, rapid-cycling bipolar disorder
SE's: skin rash, SJS, GI sx, drowsiness, sedation, confusion
40
Valproic acid
tx: mixed episodes, bipolar disorder
SE: hepatotoxicity, w/g, alopecia, teratogenic NT defects
41
gabapentin
used to help with anxiety and sleep as an adjunvtive with biplar disorder
42
pregabalin
used for GAD and fibromyalgia
43
long acting benzos
Diazepam (Valium) - used for detox from alcohol or for seizures
Clonazepam (Klonopin) - tx of anxiety, including panic attacks
** note: benzos can cause confusion, disinhibition, amnesia and blackouts in ederly population
44
intermediate benzos
Alprazolam (Xanax) - tx of anxiety, panic attacks
| Lorazepam (Ativan) - tx of anxiety, panic attacks
45
Short acting benozs
Triazolam - used to tx insomnia
midazolam -
both primarily used in medical/surgical setting
46
tx for benzo OD? benzo w/drawal?
flumazenil, but can cause w/drawal if used too quickly
* * benzo w/drawal can be life threatening and cause seizures
* * can have respiratory depressin OD
benzo w/drawal sx: anxiety, diaphoresis, irritability, fatigue, h/a, myalgias, "skin crawling", tremor, seizures
47
Zolpidem, Zaleplon, Eszopiclone
Ambient, Sonata, Lunesta - used for short term tx of insomnia
48
diphenhydramine
"benadryl" - antihistamine - SE includes sedation, dry mouth, constipation, urinary retention, blurry vision
49
Buspirone
anxiolytic that has action at serotonin receptor
| slower onset than benzos, does not cause CNS depression
50
hydroxyzine
antihistamine used to tx anxiety - sedation, dry mouth, constipation, urinary retentio, blurry vision
51
propanolol
beta blocker used to tx panic attacks or performance anxiety
52
dextroamphetamine
Adderall, dexedrine
| D isomer of amphetamine, schedule II
53
methylphenidate
Ritalin, schedule II, watch out for leukopenia, anemia, increased LFTs
54
atomoxetine
straterra - presynaptic NE inhibitor- used to tx ADHD
55
CI with seizures?
buproprion - can also cause hypersomnia, hyperphagia, reactive mood, leaden paralysis
56
PTSD tx?
sertraline (or other SSRIs)
57
the difft schizos
brief psychotic disorder: 1 day-1 mos
schizophreniform: 1 mos - 6 mos
schizophrenia: > 6 mos
schizoaffective disorder: schizophrenia + mood disorder: have continuous delusions or hallucinations for two weeks in absence of mood disorders and (meet criteria for MDD, manic or mixed episode when schizophrenia criteria are met as well) --> have mood sx present for a substantial portion of psychotic illness
mood disorder with psychotic features: have mood disorder with psychotic features, have times when psychotic features are not present, but mood disorder is
schizotypal: personality disorder: paranoid with odd magical beliefs, eccentric, lack friends
schizoid: personality disorder: w/drawn, lack of enjoyment from social interactions, emotionally restricted
best to worst: mood disorder > brief psychotic disorder> schizoaffective disorder > schizophreniform disorder > schizophrenia
58
normal pressure hydrocephalus
NPH = shuffling gait, unable to hold urine, dementia
- CT shows increased ventricles
LP has normal opening pressure
59
tx of bulemia?
SSRI: fluoxetine
don't use buproprion!
can't use SSRIs for anorexia
60
cataplexy
sudden loss of mm tone
tx: sodium oxybate
61
negativism
motiveless resistance to attempts to being moved (part of catotonic schizophrenia - stupor, negativism, rigidity, posturing, mutism)
62
anticholinergic delerium
caused by anticholinergics or TCAs - OD causes clouding of consciousness, constipation, urinary retention, dry mouth, increased temp, dry flushed skin
tx: bethanechol
note: physostigmine, increases cholinergic stimulation by inhibiting cholinesterase - good for decreasing CNS sx of anticholinergics like delerium and confusion
63
somatization disorder
pain in >4 sites, 1 neuro problem, 1 sexual problem, 1 GI problem
64
atypical depression
eat and sleep in excess, "leaden paralysis"
65
tx of PCP agitation
diazepam, midazolam, lorazepam
66
tx of opioid detox?
naltrexone
67
dysthmia
mild depression, lasting more than 2 years of depressed mood
68
cyclothymia
more than 2 years of hypomania and depressed mood
69
adjustment vs acute stress disorder
adjustment: behavior change as a result of stressor
70
worse schizo prognosis
single, male, early age of onset, negative sx, family hx of schizo, poor inter functioning
note: quick onset of sx is a better prognosis, along with + sx, female and married
71
tx of heroin w/drawal sx?
mm. aches, ab cramping, loose stools, chills, clear nasal discharge, dilated pupils (use anticholinergics i.e. diphenhydramine)
72
tx of narcolepsy
non amphetamine stimulants: modafinil, sodium oxybate, methylphenidate
73
circumstantiality
over inclusion of details, wanders off but eventually reaches the point
74
loose associations
disconnected ideas
75
tangentiality
never reaches the point
76
PTSD
sx must be present for >1 mos ; sx are d/t life-threatening experience
vs. Acute stress disorder: like PTSD but only have sx for a short period of time sx occur for
77
schizophrenia pathophysiology
```
increased dopamine
(possibly also increased serotonin, elevated NE, decreased GABA, decreased glutamate)
```
sx present >6 mos
1. paranoid type: higher functioning, later onset - preoccupation w/ delusions and hallucinations
2. disorganized type: poor functioning, earlier onset - disorganized speech/behavior
3. catatonic type: motor immobility, extreme negativism/mutism or posturing
4. residual type: prominent negative sx
78
schizophrenia vs. delusional disorder:
schizo:
- bizarre delusions, daily functioning impaired, hallucinations, disorganized speeech/behavior, negative sx
delusional disorder:
- nonbizarre delusions, daily functioning not significantly impaired
```
types of delusional disorders:
- erotomanic: delusions around love
grandiose: inflated self worth
somatic: physical delusions
persecutory
jealous delusions
mixed type delusions
```
79
MDD
sx present for at least a 2 week period:
- depressed mood
- anhedonia
- change in weight
- feelings of worthlessness/guilt
- insomnia/hypersomnia
- psychomotor agitation/retardation
- fatigue
- recurrent thoughts of death/suicide
SIG E CAPS
sleep, interest, guilt, energy, concentration, appetite, psychomotor activity, suicide
pathophys: low serotonin, NE, and dopamine
* usually lasts 6-13 mos untreated
types of depression:
1. melancholic: 40-60%: anhedonia, early morning awakening, psychomotor problems, excessive guilt, anorexia
2. atypical: hypersomnia, hyperphagia, reactive mood, leaden paralysis
3. catatonic: catalepsy (immobility), purposeless, extreme negativism, bizarre postures
4. psychotic:
80
BPD
manic episode: present for at least one week of distractibility, inflated self esteem, increased activity, decreased need for sleep, flight of ideas, pressured speech, risky activities
mixed episode: criteria for mania and MDD present every day for one week (irritibility is major mood state)
hypomanic episode: elevated, expansive mood that doesn't cause impaired social functioning, lasts at least 4 days
BPD I: mania and major depression
BPD II: hypomania with MDD episodes
81
bereavment vs. adjustment disorder
"simple grief" as a reaction to a major loss: lasts for two months (usually goes away in 6 mos) illusions can be common
- denial, anger, bargaining, depression, acceptance
"complicated grief" - lasts at least 6 months w/ feelings of numbness, bitterness, emptiness, trouble accepting loss, agitation
vs. depression where suicidal thoughts are present, sx last >2 mos
adjustment disorder: sx begin w/in 3 mos after event and end w/in 6 mos - have severe distress in excess and impairs daily functioning. Sx are not of bereavment. In adjustment disorder the the event is not life threatening such as divorce, loss of job, death of loved one (In PTSD or acute stress disorder, the problem is life threatening)
82
dysthymic disorder
chronic mild depression most of the time with no discrete episodes : depressed mood for >2 years
CHASES: poor concentration, hoplessness, poor appetite/overeating, insomnia, low energy, low self-esteem
83
cyclothymic disorder
alternating periods of hypomania and periods with mild/moderate depressive sx for >2 years
84
pathophysiology of anxiety
increased NE, decreased GABA
85
tx for social phobia?
paroxetine or beta blockers for performance anxiety
86
egodystonic vs. egosyntonic
ego-dystonic: distressed by by their sx
87
personality disorders
A: schizoid, schizotypal, paranoid (paranoid and schizotypal have increased schizo in families)
B: borderline, antisocial, historionic, narcisistic
C: avoidant, dependent, OCD
88
tx of borderline?
psycotherapy DBT is best option and pharmacotherapy of depressive sx
89
drugs for alcohol abuse?
disulfiram: blocks aldehyde dehydrogenase --> flushing, h/a, vomiting, SOB
Naltrexone: opoid blocker, works by decreasing craving
Acamprosate: similar to GABA
90
cocaine
blocks dopa reuptake
- euphoria, nausea, HR changes, dilated pupils, w/l, chills, sweating
- w/drawal not life threatening: depression, malaise, fatigue, constricted pupils, vivid dreams
91
amphetamines
block reuptake of dopa and NE (ex meth, ritalin, ecstasy)
sx: dilated pupils, perspiration, resp depression, chest pain
chronic use causes tooth decay "meth mouth"
92
PCP
NMDA glutamate antagonist - can cause nystagmus, memory problems, **violence, HTN, mm. rigidity, coma, death
use lorazepam and haloperidol to tx agitation
tactile and visual hallucinations are seen in both PCP and cocaine use
93
sedatives/hypnotics
benzos: increased GABA frequency
barbs: increased GABA duration
- barb w/drawal can be deadly (w/drawal from sedatives can be deadly, where as stimulants often isn't): signs of w/drawal is tonic-clonic seizures, tremors, anxiety, irritibility, HTN, hyperactivity
94
opiods
heroin, oxycodone, codeine, detromethorphan, morphine
* constricted pupils, slurred speech, drowsiness, nausea, vomiting, seizures, resp depression, decreased pain perception
tx: naloxone or naltrexone (can cause bad w/drawal sx)
w/drawal is not deadly: sx are insomnia, rhinorrhea, ywaning, weakness, sweating, piloerection, dilated pupils, abdominal cramps, myalgia, tachycardia
- Methadone: long acting opioid agonist - administered once daily - can cause QTC prolongation
- Buprenorphine: partial opioid receptor agonist: sublingual administration "suboxone" when combined with naloxone
- naltrexone: competitive antagonist
95
LBD vs FTD
lewy body disease: similar to PD, caused by lew bodies, aggregation of alpha synuclein --> waxing and waning of cognition, visual hallucinations/delusions, parkinsonism
pick disease/FTD: social/personality changes, disinhibition of verbal, physical and sexual behavior, lacking empathy, poor insight, memory well preserved: d/t marked atrophy of frontal and temporal lobes
note: HD caused by atrophy of caudate
PD caused by loss of cells in substantia nigra of basal ganglia
96
pseudodementia vs. true dementia
pseudodementia = sx of depression in elderly
- onset acute, sundowning uncommon, often answer questions" i don't know" but can eventually answer correctly, patient is aware of their problems and worried about them, deficits improve with antidepressants
dementia = often confabulate answers (guess at them), onset is insidious, sundowning and increased confusion at night, pt is unaware of problems, cognitivie problems don't improve with SSRIs
97
tx of ADHD
must be present more than six months, before age 12
```
methylphenidate = ritalin, focalin, concerta
dextroamphetamine = dexedrine
amphetamine salts = adderall
alpha-2 agonists: clonidine, guanfacine
atomoxetine = non-stimulant
```
98
asperger disorder
unlike autistic disorder children have normal language acquisition and cognitive development - but just have problems with social interactions
99
rett disorder vs childhood disintegrative disorder
decreased rate of head growth and loss of learned purposeful hand skills b/w ages 5 mos - 30 mos
* seen more in girls
- associated with MECP2 gene mutation on x chromosome
- "hand wringing" hand washing
- cognitive development never goes past that of first year of life
CDD: normal develop. in first two years but loss of social skills/language/bowel skills/motor skills before age 10 - have repetitive stereotyped behaviors and impaired social interaction - more common in boys* - high rates of EEG and seizure disorders.
- Note unlike Rett head growth oesn't slow and there are no hand mvmts present
100
tourette disorder
```
coprolalia = obscene words repeated
echolalia = exact repetition of words
```
* onset before 18 years, occur almost every day for >1 year
- sx peak around 8-12 years and often go away by adulthood
- comorbid w/ ADHD and OCD
- impaired dopamine regulation (maybe d/t group A beta hemolytic infection...)
tx:
- neuroleptics: risperidone, alpha 2 agonists (guanfacine, clonidine), haloperidol, pimozide
101
enuresis
involuntary voiding of urine after age 5 - must rule out infectionsk diabetes, seizures
tx: behavior modification, antidiuretics (DDAVP), TCA's (imipramine)
encopresis = passage of feces in inapprorpriate places by age 4
tx: bowel catharsis, stool softeners
102
stranger anxiety
peaks around 8-12 mos
103
dissociative amnesia
"disruption in continuity of person's memory" - report gaps in memory of an event, especially traumatic one-
- often unable to recall important personal infeormation: usually d/t stressful event or trauma
- sx cause distress and impairement in functioning
- often acute and abruptly return after minutes to days
104
dissociative fugue
- sudden, unexpected travel away from home, and inability to recall one's id or past ... think "fugitive"
- unaware of amnesia and new identity, show low anxiety despite confusion
- onset assoc. with stressful event or alcohol/head trauma
** unlike amnesia, fugue are not aware they have forgotten anything **
105
dissociative identity disorder
- two or more personalities; memories, habits and skills can differ.
- more common in women; increased with severe stress
106
depersonalization disorder
- persistent/recurrent feelings of detachment from one's self or environment ; common in normal people during times of stress; more common in adolescents
107
somataform disorder differences
primary gain: internal conflicts (facitious disorder, muchausen)
secondary gain: external benefits (malingering)
- -> Not intentionally produced: Somatoform disorders
1. Somatization disorder: multiple nonspecific physical sx; 4 pain, 2 GI, 1 sexual, 1 neuro; sx NOT intentionally produced
2. Conversion disorder: neurologic sx that can't be explained; calm and unconcerned (blindness, paralysis, paresthesia)
3. Hypochondriasis: fear of having a serious disease, persists >6 mos
4. Body dysmorphic disorder: preoccupied with body parts they perceive as "flawed"
5. Pain disorder: prolonged, severe discomfort w/out medical explanation; not intentionally produced. pain can be present in multiple sites - often pain in xs of the disease pathology
--> Intentionally produced sx:
1. Factitious disorder: intentionally produce sx to assume role of "sick pt" for primary gain (Note: munchausen is primarily physical complains)
2. Malingering: feigning physical sx to acheive personal gain
108
pathophys behind explosive disorder/aggression?
low levels of serotonin
109
refeeding syndrome after anorexia tx
can cause decreased levels of phosphorus, magnesium and calcium
110
harmful sx of anorexia/bulemia
amenorrhea, cold intolerance, hypoTN, bradycardia, arrhythmia, MVP, constipation, lanugo hair, hypoTH, osteoporosis, hypo natremia/kalemia, chloremia, elevated BUN, anemia, increased GH
for bulemia see salivary gland enlargement, erosions, abrasions on dorsum of hand, petechiae, elevated bicarb, hypochloremic hypokalemic alkalosis, metabolic acidosis d/t laxative abuse
tx of anorexia: behavioral therapy, supervised w/g (SSRIs not helpful d/t low levels of tryptan)
bulemia tx: SSRIs - fluoxetine!
111
zolpidem
sleep aid that can cause increased risk of falls in elderly
112
narcolepsy
excessive daytime sleepiness, falling asleep at inappropriate times
* caused by low levels of hypocretin, allowing REM phenomenon to enter into wakefullness
cataplexy: sudden b/l loss of mm. tone d/t intense emotion
(vs catalepsy, unprovoked mm. rigidity)
hypnagogic hallucination: upon sleeping
hypnopompic hallucination; upon waking
tx: amphetamines, methylphenidate, modafinil, sodium oxybate
tx for cataplexy: sodium oxybate
