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Step One > Pharm-Psych > Flashcards

Pharm-Psych Flashcards

1
Q

What are some non specific symptoms of depressant intoxication?

A 
Mood elevation
Decr. anxiety
Sedation
Behavioral disinhibition
respiratory depression
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2
Q

What are some non specific symptoms of depressant withdrawal

A

anxiety
tremor
seizures
insomnia

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3
Q

What are some depressants?

A

Alcohol
Opioids
Barbituates
Benzodiazepines

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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

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5
Q

Alcohol withdrawal? Treatment?

A

Mild: Similar to other depressants
Severe: autonomic hyperactivity
DTs

Treatment: Benzos

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6
Q

opioid intoxication? Treatment?

A 
Euphoria, 
respiratory and CNS depression
Decr. gag reflex
pupillary constriction
seizures (overdose)

Treatment: Naloxone, naltrexone

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7
Q

opioid withdrawal

A 
Sweating
Dilated pupils
Piloerection
Fever
Rhinorrhea
Yawning
Nausea
Stomach cramps
Diarrhea

Treatment: Long term support, methadone, buprenorphine

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8
Q

barbituate intox? Treatment?

A

Low safety margin
Marked resp. depression

Treatment: Symptom management

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9
Q

barbituate withdraw

A

Delirium

Life threatening CV collapse

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10
Q

benzo intox

A

Greater safety margin
Ataxia
Minor resp. depression

Treatment: Flumenazil (benzo receptor antagonist, but can precipitate seizures)

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11
Q

benzo withdraw

A

Sleep disturbance
depression
Rebound anxiety
Seizure

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12
Q

Stimulant intox non spec?

A 
Mood elevation
psychomotor agitation
INsomnia
Arrythmias
tachycardia
Anxiety
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13
Q

Stimulant withdraw non spec?

A

“Post use crash”–>

depression
lethargy
weight gain
headache

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14
Q

Examples of stimulants?

A

Amphetamines
Cocaine
Caffeine
Nicotine

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15
Q

Amphetamine Intox?

A 
Euphoria
Grandiosity
Pupillary dilation
prolonged wakefulness and attention
hypertension
tachycardia
anorexia
paranoia
fever

severe: cardiac arrest, seizure

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16
Q

Amphet with?

A

Anhedonia
Incr. appetite
hypersomnolence
existential crisis

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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

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18
Q

Cocaine with?

A

Hypersomnolence
Malaise
severe psych craving
depression/suicidality

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19
Q

Caffeine intox?

A

restlessness
Incr. diuresis
muscle twitching

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20
Q

Caffeine with?

A

Lack of concentration

Headache

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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
Q

PCP withdraw?

A 
Depression
Anxiety
Irritability
Restlessness
Anergia
Disturbances of thought and sleep
26
Q

LSD intox?

A 
Perceptual distortion (visual, auditory)
Depersonalization
Anxiety
Paranoia
Psychosis
Possible flashbacks
27
Q

LSD withdraw?

A

No withdrawal symptoms

28
Q

Marijuana intox? How is it used clinically?

A 
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
Q

Marijuana withdraw? Timeline?

A 
Irritability
Depression
Insomnia
Nausea
anorexia

Peak at 48 hours and last for 5-7 days
In urine for 1 month

30
Q

What are heroin users at incr. risk for? How are they treated?

A

Hepatitis, HIV, abscesses, bacteremia, right heart endocarditis

Methadone
Naloxone + buprenorphine
Naltrexone

31
Q

What is the the mechanism of methadone? How is it used?

A

Long acting oral opiate used for heroin detox or long term maintenance

32
Q

What is the mechanism of naloxone (1) and buprenorphine? What advantage does naloxone have?

A

Antagonist (1) and partial agonist.

1) is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential

33
Q

What is the mechanism/use of naltrexone?

A

Long acting opioid antag.

Relapse prevention after detox

34
Q

What is delirium tremens? Timline? How is it characterized? Treatment? What is alcohlic hallucinosis? timeline? Treatment?

A

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
Q

What is the preferred medication for:

ADHD:
Alcohol Withdrawal:
bipolar disorder:
Bulimia:
Depression:
GAD: 
OCD:
Panic disorder:
PTSD:
Schizophrenia:
Social Phobias:
tourette syndrome:
A

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
Q

CNS Stimulants

Incr. catecholamines in the synaptic cleft, especially NE and DA

ADHD, Narcolepsy, appetite control

A

methylphenidate, dextroamphetamine, and methamphetamine

37
Q

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

A

haloperidol (1), trifluoperazine (2), fluphenazine (3), thioridazine (4), and chlorpromazine (5)

38
Q

Dantrolene, D2 agonists (bromocriptene)

FEVER

Fever
Encephalopathy
Vitals Unstable
Enzymes incr. (myoglobinuria)
Rigidity of muscles
A

NMS

39
Q

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?

A

olanzapine (1), clozapine (2), quetiapine (3), risperidone (4), aripiprazole (5), ziprasidone (6)?

Old closets quietly risper form a-z

40
Q

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

A

Lithium

41
Q

Stimulates 5-HT1A receptors

GAD

No sedation, addiction, or tolerance.
1-2 weeks
Does not interact with alcohol

A

buspirone

42
Q

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
A

fluoxetine, paroxetine, sertraline, and citalopram?

43
Q

Any drug that incr. 5-HT (SSRIs, MAOIs, TCAs, SNRIs)

Hyperthermia
confusion
Myoclonus
CV instability
Flushing
Diarrhea
Seizures

Cyproheptadine (5-HT2 receptor antag)

A

serotonin syndrome

44
Q

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

A

Venlafaxine (1) and Duloxetine (2)

45
Q

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

A

amitriptyline (1), nortriptyline (2), imipramine, desipramine, clomipramine (3), doxepin, and amoxapine

46
Q

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)

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline (1)

47
Q

Bupropion
Mirtazapine
Trazodone

A

atypical antidepressants

48
Q

Depression
Smoking cessation

Incr. NE and DA via unknown mechanism

Stimulant effects (tachy, insomnia)
headache
Seizures in anorexic/bulimic
No sexual Sx

A

bupropion

49
Q

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

A

Mirtazapine

50
Q

Blocks 5-HT2 and Alpha 1 receptors

Used mainly for insomnia (high doses needed to be antidepressant)

Sedation, nausea, priapism, post. hypotension

A

Trazodone

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