FA Psychiatry Flashcards
ADHD Treatment
Methylphenidate
Alcohol Withdrawal Treatment
Benzodiazepines
Anxiety Treatment
SSRIs, SNRIs, buspirone
Bipolar Disorder Treatment
“Mood stabilizers” (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics
Bulimia Treatment
SSRIs
Depression Treatment
SSRIs, SNRIs, TCAs, bupropion, mirtazapine (especially with insomnia)
Obsessive-Compulsive Disorder Treatment
SSRIs, clomipramine
Panic Disorder Treatment
SSRIs, venlafaxine, benzodiazepines
PTSD Treatment
SSRIs
Schizophrenia Treatment
Antipsychotics
Social Phobia Treatment
SSRIs, β-blockers
Tourette Syndrome Treatment
Antipsychotics (e.g. haloperidol, risperidone)
CNS Stimulants
Methylphenidate, dextroamphetamine, methamphetamine, phentermine
CNS Stimulant Mechanism
↑ catecholamines at the synaptic cleft, especially norepinephrine and dopamine
CNS Stimulant Use
ADHD, narcolepsy, appetite control
Typical Antipsychotics
High potency: haloperidol, trifluoperazine, fluphenazine
Low potency: thioridazine, chlorpromazine
(haloperidol + “-azines)
Typical Antipsychotic Mechanism
Block dopamine D2 receptors (↑ [cAMP])
Typical Antipsychotic Use
Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette syndrome
Typical Antipsychotic Toxicity
Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.
Extrapyramidal system side effects (e.g., dyskinesias). Treatment: benztropine or diphenhydramine.
Endocrine (e.g., dopamine receptor antagonism → hyperprolactinemia → galactorrhea).
Blockage of muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors.
Neuroleptic malignant syndrome - rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (bromocriptine). Think FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes ↑, Rigidity of Muscles
Tardive Dyskinesia - stereotypical oral-facial movements as a result of long-term antipsychotic use. Potentially irreversible.
Evolution of EPS side effects: 4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis), 4 day akathisia (restlessness), 4 wk bradykinesia (parkinsonism), 4 mo tardive dyskinesia
Chlorpromazine Toxicity
Corneal deposits
Thioridazine Toxicity
Retinal deposits
Haloperidol Toxicity
Neuroleptic malignant syndrome, tardive dyskinesia
Atypical Antipsychotics
Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
Atypical Antipsychotic Mechanism
Not completely understood. Varied effecs on 5-HT2, dopamine, and α and H1-receptors.
Atypical Antipsychotic Use
Schizophrenia - both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.
Atypical Antipsychotic Toxicity
Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics. Olanzapine/clozapine may cause significant weight gain. Clozapine may cause agranulocytosis (requires weekly WBC monitoring) and seizure. Risperidone may increase prolactin (lactation and gynecomastia) → ↓ GnRH, LH, FSH (irregular menstruation and fertility issues). Ziprasidone may prolong QT interval.
Lithium Mechanism
Not established; possibly related to inhibition of phosphoinositol cascade.
Lithium Use
Mood stabilizer for bipolar disorder; blocks relaps and acute manic events. Also SIADH.
Lithium Toxicity
Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis. Fetal cardiac defects include Ebstein anomaly and malformation of great vessels. Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by kidneys; most is reabsorbed at PCT following Na+ reabsorption.
LMNOP: Lithium side effects - Movement, Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems
Buspirone Mechanism
Stimulates 5-HT1A receptors
Buspirone Use
Generalized anxiety disorder. Does not cause sedation, addiction, or tolerance. Takes 1-2 weeks to take effect. Does not interact with alcohol (vs. barbiturates, benzodiazepines).
Antidepressants
MAOIs, Buproprion, Mirtazapine, TCAs, SSRIs, SNRIs, Trazodone
SSRIs
Fluoxetine, paroxetine, sertraline, citalopram
SSRI Mechanism
5-HT specific reuptake inhibitors
SSRI Use
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD. Usually takes 4-8 weeks for antidepressants to have an effect.
SSRI Toxicity
Fewer than TCAs. GI distress, sexual dysfunction (anorgasmia and ↓ libido). Serotonin syndrome with any drug that ↑ 5-HT (MAOIs, SNRIs, TCAs) - hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures. Treatment: cyproheptadine (5-HT2 receptor antagonist).
SNRIs
Venlafaxine, duloxetine
SNRI Mechanism
Inhibit 5-HT and norepinephrine reuptake
SNRI Use
Depression. Venlafaxine is also used in generalized anxiety and panic disorders; duloxetine is also indicated for diabetic peripheral neuropathy.
SNRI Toxicity
↑ BP most common; also stimulant effects, sedation, nausea.
Tricyclic Antidepressants (TCAs)
Amitryptiline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
Tricyclic Antidepressant Mechanism
Block reuptake of norepinephrine and 5-HT
Tricyclic Antidepressant Use
Major depression, OCD (clomipramine), fibromyalgia
Tricyclic Antidepressant Toxicity
Sedation, α1-blocking effects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth). 3° TCAs (amitriptyline) have more anticholinergic effects than 2° TCAs (nortriptyline) have. Desipramine is less sedating, but has higher seizure incidence.
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline). Treatment: NaHCO3 for cardiovascular toxicity.
Monoamine Oxidase (MAO) Inhibitors
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)
Monoamine Oxidase Inhibitor Mechanism
Nonselective MAO inhibition ↑ levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine)
Monoamine Oxidase Inhibitor Use
Atypical depression, anxiety, hypochondriasis
Monoamine Oxidase Inhibitor Toxicity
Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese); CNS stimulation. Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome).
Atypical Antidepressants
Buproprion, mirtazapine, trazodone
Bupropion Use
Atypical depression, smoking cessation
Bupropion Mechanism
↑ norepinephrine and dopamine via unknown mechanism.
Bupropion Toxicity
Stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. No sexual side effects.
Mirtazapine Mechanism
α2-antagonist (↑ release of norepinephrine and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.
Mirtazapine Toxicity
Sedation (which may be desirable in depressed patients with insomnia), ↑ appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth.
Trazodone Mechanism
Primarily blocks 5-HT2 and α1-adrenergic receptors.
Trazodone Use
Used primarily for insomnia, as high doses are needed for antidepressant effects.
Trazodone Toxicity
Sedation, nausea, priapism, postural hypotension.
