Pharm-Psych Flashcards
What are some non specific symptoms of depressant intoxication?
Mood elevation Decr. anxiety Sedation Behavioral disinhibition respiratory depression
What are some non specific symptoms of depressant withdrawal
anxiety
tremor
seizures
insomnia
What are some depressants?
Alcohol
Opioids
Barbituates
Benzodiazepines
Intoxication of alcohol? Lab values?
Emotional lability, slurred speech ataxia coma blackouts
Serum Gamma glutamyltransferase (sensitive indicator of alcohol use)
AST value is twice ALT
Alcohol withdrawal? Treatment?
Mild: Similar to other depressants
Severe: autonomic hyperactivity
DTs
Treatment: Benzos
opioid intoxication? Treatment?
Euphoria, respiratory and CNS depression Decr. gag reflex pupillary constriction seizures (overdose)
Treatment: Naloxone, naltrexone
opioid withdrawal
Sweating Dilated pupils Piloerection Fever Rhinorrhea Yawning Nausea Stomach cramps Diarrhea
Treatment: Long term support, methadone, buprenorphine
barbituate intox? Treatment?
Low safety margin
Marked resp. depression
Treatment: Symptom management
barbituate withdraw
Delirium
Life threatening CV collapse
benzo intox
Greater safety margin
Ataxia
Minor resp. depression
Treatment: Flumenazil (benzo receptor antagonist, but can precipitate seizures)
benzo withdraw
Sleep disturbance
depression
Rebound anxiety
Seizure
Stimulant intox non spec?
Mood elevation psychomotor agitation INsomnia Arrythmias tachycardia Anxiety
Stimulant withdraw non spec?
“Post use crash”–>
depression
lethargy
weight gain
headache
Examples of stimulants?
Amphetamines
Cocaine
Caffeine
Nicotine
Amphetamine Intox?
Euphoria Grandiosity Pupillary dilation prolonged wakefulness and attention hypertension tachycardia anorexia paranoia fever
severe: cardiac arrest, seizure
Amphet with?
Anhedonia
Incr. appetite
hypersomnolence
existential crisis
Cocaine intox? Treatment?
Impaired judgment pupillary dilation hallucinations (including tactile) paranoid ideation angina sudden cardiac death
Alpha blockers, benzos
Never beta blockers
Cocaine with?
Hypersomnolence
Malaise
severe psych craving
depression/suicidality
Caffeine intox?
restlessness
Incr. diuresis
muscle twitching
Caffeine with?
Lack of concentration
Headache
Nicotine intox?
Restlessness
Nicotine withdraw? Treatment?
Irritability
Anxiety
Craving
Nicotine patch
gum
lozenges
bupropion/verenicline
Hallucinogens?
PCP
LSD
Marijuana
PCP Intx? Treatment?
belligerence impulsivity fever psychomotor agitation analgesia vertical and horizontal nystagmus tachycardia homicidality psychosis delirium seizures
Treatment: Benzos, rapid acting antipsychotic
PCP withdraw?
Depression Anxiety Irritability Restlessness Anergia Disturbances of thought and sleep
LSD intox?
Perceptual distortion (visual, auditory) Depersonalization Anxiety Paranoia Psychosis Possible flashbacks
LSD withdraw?
No withdrawal symptoms
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
Marijuana withdraw? Timeline?
Irritability Depression Insomnia Nausea anorexia
Peak at 48 hours and last for 5-7 days
In urine for 1 month
What are heroin users at incr. risk for? How are they treated?
Hepatitis, HIV, abscesses, bacteremia, right heart endocarditis
Methadone
Naloxone + buprenorphine
Naltrexone
What is the the mechanism of methadone? How is it used?
Long acting oral opiate used for heroin detox or long term maintenance
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
What is the mechanism/use of naltrexone?
Long acting opioid antag.
Relapse prevention after detox
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
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
CNS Stimulants
Incr. catecholamines in the synaptic cleft, especially NE and DA
ADHD, Narcolepsy, appetite control
methylphenidate, dextroamphetamine, and methamphetamine
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)
Dantrolene, D2 agonists (bromocriptene)
FEVER
Fever Encephalopathy Vitals Unstable Enzymes incr. (myoglobinuria) Rigidity of muscles
NMS
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
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
Stimulates 5-HT1A receptors
GAD
No sedation, addiction, or tolerance.
1-2 weeks
Does not interact with alcohol
buspirone
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?
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
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)
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
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)
Bupropion
Mirtazapine
Trazodone
atypical antidepressants
Depression
Smoking cessation
Incr. NE and DA via unknown mechanism
Stimulant effects (tachy, insomnia)
headache
Seizures in anorexic/bulimic
No sexual Sx
bupropion
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
Blocks 5-HT2 and Alpha 1 receptors
Used mainly for insomnia (high doses needed to be antidepressant)
Sedation, nausea, priapism, post. hypotension
Trazodone
