Pharm-Psych Flashcards
1
Q
What are some non specific symptoms of depressant intoxication?
A
Mood elevation Decr. anxiety Sedation Behavioral disinhibition respiratory depression
2
Q
What are some non specific symptoms of depressant withdrawal
A
anxiety
tremor
seizures
insomnia
3
Q
What are some depressants?
A
Alcohol
Opioids
Barbituates
Benzodiazepines
4
Q
Intoxication of alcohol? Lab values?
A
Emotional lability, slurred speech ataxia coma blackouts
Serum Gamma glutamyltransferase (sensitive indicator of alcohol use)
AST value is twice ALT
5
Q
Alcohol withdrawal? Treatment?
A
Mild: Similar to other depressants
Severe: autonomic hyperactivity
DTs
Treatment: Benzos
6
Q
opioid intoxication? Treatment?
A
Euphoria, respiratory and CNS depression Decr. gag reflex pupillary constriction seizures (overdose)
Treatment: Naloxone, naltrexone
7
Q
opioid withdrawal
A
Sweating Dilated pupils Piloerection Fever Rhinorrhea Yawning Nausea Stomach cramps Diarrhea
Treatment: Long term support, methadone, buprenorphine
8
Q
barbituate intox? Treatment?
A
Low safety margin
Marked resp. depression
Treatment: Symptom management
9
Q
barbituate withdraw
A
Delirium
Life threatening CV collapse
10
Q
benzo intox
A
Greater safety margin
Ataxia
Minor resp. depression
Treatment: Flumenazil (benzo receptor antagonist, but can precipitate seizures)
11
Q
benzo withdraw
A
Sleep disturbance
depression
Rebound anxiety
Seizure
12
Q
Stimulant intox non spec?
A
Mood elevation psychomotor agitation INsomnia Arrythmias tachycardia Anxiety
13
Q
Stimulant withdraw non spec?
A
“Post use crash”–>
depression
lethargy
weight gain
headache
14
Q
Examples of stimulants?
A
Amphetamines
Cocaine
Caffeine
Nicotine
15
Q
Amphetamine Intox?
A
Euphoria Grandiosity Pupillary dilation prolonged wakefulness and attention hypertension tachycardia anorexia paranoia fever
severe: cardiac arrest, seizure
16
Q
Amphet with?
A
Anhedonia
Incr. appetite
hypersomnolence
existential crisis
17
Q
Cocaine intox? Treatment?
A
Impaired judgment pupillary dilation hallucinations (including tactile) paranoid ideation angina sudden cardiac death
Alpha blockers, benzos
Never beta blockers
18
Q
Cocaine with?
A
Hypersomnolence
Malaise
severe psych craving
depression/suicidality
19
Q
Caffeine intox?
A
restlessness
Incr. diuresis
muscle twitching
20
Q
Caffeine with?
A
Lack of concentration
Headache
21
Q
Nicotine intox?
A
Restlessness
22
Q
Nicotine withdraw? Treatment?
A
Irritability
Anxiety
Craving
Nicotine patch
gum
lozenges
bupropion/verenicline
23
Q
Hallucinogens?
A
PCP
LSD
Marijuana
24
Q
PCP Intx? Treatment?
A
belligerence impulsivity fever psychomotor agitation analgesia vertical and horizontal nystagmus tachycardia homicidality psychosis delirium seizures
Treatment: Benzos, rapid acting antipsychotic
25
PCP withdraw?
```
Depression
Anxiety
Irritability
Restlessness
Anergia
Disturbances of thought and sleep
```
26
LSD intox?
```
Perceptual distortion (visual, auditory)
Depersonalization
Anxiety
Paranoia
Psychosis
Possible flashbacks
```
27
LSD withdraw?
No withdrawal symptoms
28
Marijuana intox? How is it used clinically?
```
Euphoria
Anxiety
paranoid delusions
perception of slowed time
impaired judgment
social withdrawal
incr. appetite
dry mouth
conjuctival injection
hallucinations
```
Dronabinol (THC isomer) used as antiemetic in chemo and appetite stimulant in AIDS
29
Marijuana withdraw? Timeline?
```
Irritability
Depression
Insomnia
Nausea
anorexia
```
Peak at 48 hours and last for 5-7 days
In urine for 1 month
30
What are heroin users at incr. risk for? How are they treated?
Hepatitis, HIV, abscesses, bacteremia, right heart endocarditis
Methadone
Naloxone + buprenorphine
Naltrexone
31
What is the the mechanism of methadone? How is it used?
Long acting oral opiate used for heroin detox or long term maintenance
32
What is the mechanism of naloxone (1) and buprenorphine? What advantage does naloxone have?
Antagonist (1) and partial agonist.
| 1) is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential
33
What is the mechanism/use of naltrexone?
Long acting opioid antag.
Relapse prevention after detox
34
What is delirium tremens? Timline? How is it characterized? Treatment? What is alcohlic hallucinosis? timeline? Treatment?
Life threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink.
Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
Benzos
Visual hallucinations 12-48 hours after last drink
Long acting benzos
35
What is the preferred medication for:
```
ADHD:
Alcohol Withdrawal:
bipolar disorder:
Bulimia:
Depression:
GAD:
OCD:
Panic disorder:
PTSD:
Schizophrenia:
Social Phobias:
tourette syndrome:
```
ADHD: Stimulatants (methylphenidate)
Alcohol Withdrawal: Long acting benzos (chlordiazepoxide, lorazepam, diazepam)
bipolar disorder: Lithium, valproid acid, atypical antipsychotics
Bulimia: SSRIs
Depression: SSRIs
GAD: SSRIs, SNRIs
OCD: SSRIs, clomipramine
Panic disorder: SSRIs, venlafaxine, benzos
PTSD: SSRIs, venlafaxine
Schizophrenia: Atypicals
Social Phobias: SSRIs, beta blockers
tourette syndrome: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine
36
CNS Stimulants
Incr. catecholamines in the synaptic cleft, especially NE and DA
ADHD, Narcolepsy, appetite control
methylphenidate, dextroamphetamine, and methamphetamine
37
Antipsychotics (neuroleptics) (5)
High potency: 1,2,3 ; Neuro side effects (huntington, delirium, EPS symptoms)
Low Potency: 4,5 (Cheating Thieves are Low); Non neuro side effects (antichol, antihist, alpha 1 blockade)
5: Corneal deposits
4: Retinal deposits
1: NMS, tardive dyskinesia
Schizophrenia (positive symptoms)
Psychosis
Acute mania
Tourette syndrome
Highly lipid soluble, slow to be excreted
EPS side effects
Endocrine side effects (less dopamine leads to more prolactin leading to galactorhea)
Block musc (dry mouth, constipation), alpha 1 (hypotension), histamine (sedation) receptors
QT prolongation
haloperidol (1), trifluoperazine (2), fluphenazine (3), thioridazine (4), and chlorpromazine (5)
38
Dantrolene, D2 agonists (bromocriptene)
FEVER
```
Fever
Encephalopathy
Vitals Unstable
Enzymes incr. (myoglobinuria)
Rigidity of muscles
```
NMS
39
Atypical antipsychotics
Mechanism not entirely understood. Varied effects on 5-HT2, DA, and alpha and H1 receptors
```
Schizophrenia (pos and neg symptoms)
Bipolar Disorder
OCD
Anxiety disorder
depression
mania
Tourettes
```
Fewer EPS Sx and Antichol Sx than traditional antipsychotics.
QT prolongation
1/2: Significant weight gain
2: Agranulocytosis and seizure
4: Incr. prolactin (lactation and gynecomastia) decr. GnRH leading to irregular menstruation and fertility issues?
olanzapine (1), clozapine (2), quetiapine (3), risperidone (4), aripiprazole (5), ziprasidone (6)?
Old closets quietly risper form a-z
40
Not established; related to inhibition of phosphoinositol cascade
Movement (tremor)
Nephrogenic Diabetes Insipidus
hypOthyroidism
Pregnancy problems (Ebstein anamoly)
Narrow therapeutic window; close monitoring of serum levels.
Excreted in kidneys
Most reabsorbed in PCT with Na
Thiazide use implicated in lithium toxicity
Lithium
41
Stimulates 5-HT1A receptors
GAD
No sedation, addiction, or tolerance.
1-2 weeks
Does not interact with alcohol
buspirone
42
SSRIs (4)
5-HT specific reuptake inhibitors
Depression, GAD, Panic disorder, OCD, bulimia, social phobias, PTSD
4-8 weeks to take effect
```
Fewer than TCAs.
GI distress
SIADH
Sexual dysfuntion
Serotonin syndrome
```
fluoxetine, paroxetine, sertraline, and citalopram?
43
Any drug that incr. 5-HT (SSRIs, MAOIs, TCAs, SNRIs)
```
Hyperthermia
confusion
Myoclonus
CV instability
Flushing
Diarrhea
Seizures
```
Cyproheptadine (5-HT2 receptor antag)
serotonin syndrome
44
SNRIs
Inhibit 5-HT and NE reuptake
Depression
1=GAD, panic disorder, PTSD
2=Diabetic peri Neuro
Incr BP most common
Stimulant effects
Sedation
Nausea
Venlafaxine (1) and Duloxetine (2)
45
TCAs
Block reuptake of NE and 5-HT
Major Depression, OCD (3), peripheral neuro, chronic pain, migraine prophylaxis
```
Sedation
alpha 1 blocking (post hypotension)
Antichol (tachycardia, urinary retention, dry mouth)=1 more than 2
QT prolongation
Convulsions
Coma
Cardiotoxicity (arrhythmias)
Resp. Depressin
Hyperpyrexia
Confusion and hallucinations in elderly
```
To prevent arrhythmia, used NaHCO3
amitriptyline (1), nortriptyline (2), imipramine, desipramine, clomipramine (3), doxepin, and amoxapine
46
MAOIs
Non selective MAO inhibition leads to incr. levels of NE, 5-Ht, DA
1=MAO-B selective inhibitor
Atypical depression
Anxiety
```
Hypertensive crisis (with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS stim
```
CI with SSRIs, TCAs, St jOhns wort, meperidine, dextromethorphan (to prevent serotonin syndrome)
Tranylcypromine, phenelzine, isocarboxazid, selegiline (1)
47
Bupropion
Mirtazapine
Trazodone
atypical antidepressants
48
Depression
Smoking cessation
Incr. NE and DA via unknown mechanism
Stimulant effects (tachy, insomnia)
headache
Seizures in anorexic/bulimic
No sexual Sx
bupropion
49
alpha 2 antagonist (decr. inhibition of release of NE and 5-HT).
Potent 5-HT2 and 3 receptor antagonist
Sedation (desirable insomnia)
Incr. appetite
Weight gain (desirable in elderly or anorexic)
Dry mouth
Mirtazapine
50
Blocks 5-HT2 and Alpha 1 receptors
Used mainly for insomnia (high doses needed to be antidepressant)
Sedation, nausea, priapism, post. hypotension
Trazodone
