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CNS Pharmacology > Neuropsychopharmacology > Flashcards

Neuropsychopharmacology Flashcards

1
Q

Alternative to Lithium

A

Carbamazepine- blocks sodium channel at therapeutic concentrations; CNS side effects like sedation, confusion, ataxia
Valproic Acid and Divalproex- first line drug in bipolar disorder and is sedating
Warning on suicidal ideation
Haloperidol- for initial control of manic symptoms

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2
Q

Carbamazepine

A

Blocks Na channels without interacting with GABA
Pharmacokinetics: unpredictable absorption, hepatic enzyme induction
Clinical use: drug of choice for partial seizures
Toxicity: dose related (Diplopia, ataxia, GI upset, drowsiness, rare blood dyscasias)

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3
Q

Valproic Acid

A

Block Na, Ca and increase GABA concentration
Pharmacokinetics: bound to plasma proteins and distributes in EC fluid
Clinical use: absence seizures, tonic-clinic seizures and partial seizures
Toxicity: GI upset, weight gain, hair loss, idiosyncratic hepato toxicity and teratogenic causing spinal bifida (not dose related)

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4
Q

Treatment of Anxiety and Insomnia

A 
Benzodiazepines
SSRI
Buspirone
Classical antihistamine 
Alcohol, cannabis, opiates 
Barbiturates
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5
Q

Diazepam

A

Agonist of the benzodiazepine receptor
Fast onset of action (orally taken)
High lipid solubility- rapid absorption and entry into the brain
Rapid redistribution after single dose
Active metabolites change this in multiple dose situation
GABAergic agents: action in reducing spasticity in the spinal cord, and used in patients with muscle spasm of any origin, produces sedation in most patients at the dose required to stop spasms

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6
Q

Zolpidem (ambien)

A

Agonist of benzodiazepines receptor

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7
Q

Flumazenil

A

Antagonist of benzodiazepines receptor

Use: overcome overdose with sleeping pills, or wake up quickly after surgery

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8
Q

Buspirone

A

Not as effective as anti anxiety
Partial agonist for 5-HT 1A- inhibit adenylate cyclase and opens K channels
Also binds to dopamine receptor (not important)
Less sedating benzodiazepines and no cross- tolerance
Does not potentiate other sedative-hypnotics and depressants nor suppress symptoms of their withdrawal
Used to treat generalized anxiety syndrome
Therapeutic effects may take 1 to 2 weeks to occur

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9
Q

Benzodiazepines as antianxiety

A

Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Primarily treat anxiety and decrease anxiety before causing sleep

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10
Q

Benzodiazepines for Hypnotics

A

Flurazepam- rapid onset of action and long duration
Triazolam- rapid onset of action but ultrashort duration
Lorazepam
Zolpidem (newer “Z” drugs)
Affect on sleep: decreased latency to sleep (quicker and more in stage 1 and 2 sleep), decreased in stage 3, 4 and REM, rebound insomnia upon withdrawal
Adverse effects: daytime sedation (flurazepam), ataxia, rebound insomnia, tolerance and dependence, occasional idiosyncratic excitement and stimulation (in children)

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11
Q

Lorazepam

A

Anti Anxiety
Less lipophilic than diazepam
Absorption and onset of action are slower
Longer duration of action after single dose- better for sleep
No active metabolites

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12
Q

Benzodiazepines

A

CNS effects: decreased anxiety, sedation, hypnosis, muscle relaxation, anterograde amnesia (IV admin), anticonvulsant, minimal CV and respiratory actions at therapeutic doses
Drug interaction: produce additive CNS depression with most other depressant drugs like ethanol, other sedative hypnotics and sedating antihistamines
Also problems with drugs that affect hepatic metabolism (cimetidine)
Clinical uses: anxiety states, muscle relaxant (diazepam), sleep disorder, seizure treatment, intravenous sedation and anesthesia, alcohol withdrawal
Withdrawal: anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures
Use gradual dose reduction

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13
Q

Anxiety Treatments

A

Benzodiazepines
SSRI and SNRI for panic attacks and generalized anxiety
Beta-blockers (performance anxiety)
Other sedatives (rarely)

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14
Q

Zolpidem

A

Non-benzodiazepines
Bind to BDZ receptor on GABA receptor complex
Weak anxiolytics, muscle relaxant and anticonvulsant
Stage 3 and 4 sleep preserved with minor effects on REM
Duration of action 5-6 hours
Antagonized by Flumazenil
Low abuse liability

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15
Q

Barbiturate

A

Metabolism: rapidly absorbed and distributed and highly lipid soluble compounds such as thiopental distribute rapidly to brain, induce their own metabolism
Action: Act at GABA site but increased enhanced action
Can cause CNS depression to point of death and respiratory depression

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16
Q

Baclofen

A

GABAergic agents
GABA mimetic agent that works on GABA B receptors
Results in hyperpolarization causing presynaptic inhibition
Decreased release of excitatory transmitter like glutamate
As effective as diazepam in reducing spasticity with much less sedation

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17
Q

Tizanidine

A

Alpha 2 adrenergic agonist related to clonidine and enhance presynaptic and postsynaptic inhibition
Same efficacy as Baclofen and diazepam for muscle spasms
Side effects: drowsiness, hypotension, dry mouth and asthenia

18
Q

Lithium

A

Mono aren’t cation of the lightest alkali metal
First treatment for bipolar disorder
Blocks manic behavior
No behavioral effects in “normals”
Action: Acts by blcoking enzymes involved in neurotransmission
Therapeutic concentrations-> blocks conversion of IP2 to IP1 and blocks IP1 to inositol (blocks recycling so no second messenger system)
Also affects glycogen synthase kinase (GSK)
Pharmacokinetics: absorbed from oral admin and peak in 2 to 4 hours, half life is 18-24 hours, unbound to plasma proteins
Eliminate in urine 95% with extensive tubular reabsorption
Na affects Li levels (increase Na excretion then increase Li levels in blood so with diuretics)
Narrow therapeutic window (monitor levels)
ACE inhibitors and Ang 2 receptor blockers can raise Li levels
Side Effects: fatigue, tremor, GI symptoms, slurred speech with ataxia, serious toxicity with 2-3 times level (impaired consciousness, rigidity and hyperactive deep reflex, coma), caution with pregnant women
Clinical Uses: treat mania and prevent recurrences of bipolar (only approved use), prevent recurrence of unipolar depression, schizoaffective disorder, cluster headache

19
Q

Tricyclic Antidepressants

A

Blockade of transmitter uptake (NE and serotonin)
Pharmacokinetics: rapidly absorbed after parenteral or oral administration and relatively high concentrations found in brain and heart
Side effects: elevation of mood in depressed patients, decreased REM and stage 4, prominent anticholinergic effects, sedation, cardiac abnormality
Overdose: acute toxicity (hyperpyrexia, hyper or hypotension, seizures, coma, cardiac conduction defects)
Drug interaction: guanethidine, sympathomimetic drugs, effects on absorption and metabolism of other drugs
Therapeutic use: major depression, chronic pain (amitryptyline), OcD

20
Q

Selective Serotonin Re-uptake Inhibitors (SSRI)

A

Most commonly used anti-depressants
Pharmacokinetics: long and short half life
Side effects: nausea vomiting, insomnia, nervousness, sexual dysfunction
Less risk of overdose
If used with MAO inhibits- hyperthermia, muslce rigidity, cardiovascular collapse
SSRI discontinuing syndrome with shorter acting drugs- dizziness, light headedness, vertigo, anxiety, fatigue, headache, tremor, visual disturbance
Clinical use: major depressive disorder, OCD, panic disorder, generalized anxiety

21
Q

Fluoxetine

A

SSRI
Active metabolite with long half life
Sustained release product

22
Q

Sertraline

A

Similar in action to fluoxetine with less effects on drug metabolism
Shorter half-life

23
Q

Serotonin and norepinephrine reuptake inhibitor

A

Duloxetine

24
Q

Bupropion

A

Atypical anti-depressant
Affective disorder treatment, nicotine withdrawal and seasonal affective disorder
Blocks NE and dopamine uptake

25
Q

Duloxetine

A 
Block serotonin and NE uptake 
12-18 hours half life 
Caution in patients with liver disease 
Approved in fibromyalgia, diabetic neuropathy, back pain, and osteoarthritis pain 
Affective disorder
26
Q

Mirtazapine

A

ATypical Anti-depressant
Blocks presynaptic alpha 2 receptors in brain
So no inhibition and continue making neurotransmitter
Increase appetite

27
Q

Amitryptyline

A

Tricyclics Antidepressants

Used for Chronic pain

28
Q

Monoamine OXidase Inhibitors

A

Block oxidative deaminatin of NE, dopamine, and serotonin
MAO A and B and anti-depressant action is inhibition of A
Takes about 2 weeks for actions
Mood elevation in depressed patients and may cause hypo mania
Acute toxicity: agitation, hallucination, hyperpyrexia, convulsions, change in blood pressure
Interactions: Tyramine cause hypertensive crisis
Therapeutic use: Major depression (not first choice)

29
Q

Phenelzine

A

Irreversible MAO inhibitor

Anti-depressant actions

30
Q

Psychosis

A

General term for major mental disorders characterized by derangement of the personality and loss of contact with reality as evidenced by delusions and hallucinations
Prototype: schizophrenia

31
Q

Antipsychotic Drugs Actions

A 
Decrease in psychotic behavior 
Sedation 
Extra pyramidal actions- dopamine receptor blockade and include Parkinsonism and akathsisia
Neuroendocrine effects 
Orthostatic hypotension (alpha adrenergic receptor blockade)
Cardiac effects 
Weight gain 
Neuroleptic malignant syndrome
32
Q

Chlorpromazine

A

Antipsychotic
Low to medium potency
Sedative
Pronounced anticholinergic actions

33
Q

Thioridazine

A 
Piperidine side chains 
Antipsychotic 
Low potency 
Sedative 
Less extra pyramidal actions 
Anticholinergic
34
Q

Fluphenazine

A 
Antipsychotic 
High potency 
Less sedative 
Less anticholinergic 
More extra pyramidal reactions
35
Q

Haloperidol

A

Not related to phenothiazines but similar to the high potency piperazine derivatives

36
Q

Atypical Antipsychotic

A

Dopamine and serotonin actions (5-HT2)
Uses: acute psychotic episodes, manic episodes, chronic schizophrenia, augmentation of anti-depressants, Tourette’s, antiemetic

37
Q

Clozapine

A 
Atypical antipsychotic 
Less extra pyramidal symptoms 
Serious agranulocytosis or other blood dyscrasias 
Weight gain
Effects on negative symptoms
38
Q

Olanazapine

A 
Atypical antipsychotic 
More potent as 5-HT2 antagonist 
Few extra pyramidal symptoms 
No agranulocytosis 
Weight gain and diabetic risk
39
Q

Quetiapine

A

Atypical antipsychotic
Structurally related to clozapine with effects on D2 and 5-HT2 receptors
Abuse potential

40
Q

Aripipazole

A

D2 partial agonist

Approved as adjunct in treatment of depression

41
Q

Risperidone

A

Combined dopamine and serotonin receptor antagonist

Low incidence of extra pyramidal side effects

CNS Pharmacology (5 decks)

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