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First Aid STEP 1 - Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What conditions are CNS stimulants used to treat?

A

ADHD, narcolepsy, appetite control

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2
Q

What are examples of antipsychotics (neuroleptics)?

A

haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”)

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3
Q

What is the MOA of typical antipsychotics?

A

all typical antipsychotics blocks dopamine D2 receptors (increase cAMP)

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4
Q

What is the TU of typical antipsychotics?

A

schizophrenia (primarily positive symptoms)
psychosis, acute mania
Tourette Syndrome

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5
Q

What are signs of toxicity of typical antipsychotics and what are their treatments?

A

Because HIGHLY LIPID SOLUBLE –> stored in fat –> very slow to be removed from body

  1. Extrapyramidal system side effects
  2. Endocrine side effects
  3. Dry mouth, constipation (d/t blocking muscarinic receptors)
  4. Hypotension (d/t blocking alpha1 receptors)
  5. Sedation (d/t blocking histamine receptors)
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6
Q

What are the treatments for typical antipsychotic toxicities?

A
  1. Extrapyramidal system side effects –> benztropine or diphenhydramine
  2. Endocrine side effects
  3. Dry mouth, constipation (d/t blocking muscarinic receptors)
  4. Hypotension (d/t blocking alpha1 receptors)
  5. Sedation (d/t blocking histamine receptors)
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7
Q

The major side effect of typical antipsychotic use that includes rigidity, myoglobinuria, autonomic instability, and hyperpyrexia is called what?

A

Neuroleptic Malignant Syndrome (NMS)

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8
Q

What is the treatment for Neuroleptic Malignant Syndrome (NMS)?

A

dantrolene or D2 agonists (e.g. bromocriptine)

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9
Q

The major side effect of typical antipsychotic use that includes stereotypic oral-facial movements as a result of long-term antipsychotic use is called what?

A

Tardive Dyskinesia

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10
Q

What typical antipsychotics have high potency?

A

Trifluoperazine
Fluphenazine
Haloperidol

“Try to Fly High” - neurologic SEs (EPS symptoms)

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11
Q

What typical antipsychotics have low potency?

A

Chlorpromazine
Thioridazine

Non-neurologic side effects (anticholinergic, antihistamine, and alpha1- blockade effects)

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12
Q

What is the evolution of EPS side effects?

A

4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)

4 day akathisia (restlessness)

4 wk bradykinesia (parkinsonism)

4 mo tardive dyskinesia

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13
Q

What are examples of atypical antipsychotics?

A 
Olanzapine
Clozapine
Quetiapine
Resperidone
Aripiprazone
Ziprasidone
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14
Q

What are the TU for atypical antipsychotics?

A 
Schizophrenia (both positive and negative symptoms)
Bipolar disorder
OCD
anxiety disorder
depression
mania
Tourette Syndrome
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15
Q

Which atypical antipsychotics can cause significant weight gain?

A

olanzapine/clozapine

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16
Q

Which is a major side effect of clozapine?

A

agranulocytosis (requires WEEKLY WBC monitoring)

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17
Q

What is a side effect specific to risperidone?

A

increased prolactin –> decreases GnRH, LH, and FSH (causing irregular menstruation and fertility issues)

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18
Q

What is a side effect specific to ziprasidone?

A

prolong QT interval

19
Q

What is the initial treatment for agranulocytosis caused by clozapine?

A

discontinue treatment

Filgrastim (G-CSF) –> recovers bone marrow

20
Q

What is the TU of lithium?

A

“mood stabilizer” for bipolar disorder
blocks relapse and acute manic events
SIADH (because causes nephrogenic diabetes insipidus)

21
Q

What are the side effects of lithium use?

A

LMNOP

Lithium side effects - 
Movement (tremor)
Nephrogenic diabetes insipidus 
hypOthyroidism
Pregnancy problems (teratogenesis including fetal cardiac defects like Ebstein anomaly and malformation of the great vessels)
22
Q

What is the TU for buspirone?

A

generalized anxiety disorder

23
Q

What is the MOA of buspirone?

A

stimulates 5-HT receptors

24
Q

What are examples of SSRIs?

A

Fluoxetine, Paroxetine, Sertraline, and Citalopram

25
Q

What is the MOA of SSRIs?

A

5HT specific repute inhibitor

26
Q

How long does it take an SSRI to normally have an effect?

A

4-8 weeks

27
Q

What are the TUs of SSRIs?

A 
depression
GAD
panic disorder
OCD
bulimia
social phobias
PTSD
28
Q

What are SEs of SSRIs?

A

*fewer than TCAs

GI DISTRESS
SEXUAL DYSFUNCTION (anorgasmia and decreased libido)
SEROTONIN SYNDROME

29
Q

What are signs of Serotonin Syndrome?

A

hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

30
Q

What is the treatment for Serotonin Syndrome?

A

cyproheptadine (5HT2 receptor antagonist)

31
Q

What are examples of SNRIs?

A

venlafaxine

duloxetine

32
Q

What are TUs of SNRIs?

A

depression

venlafaxine: also used in GAD and panic disorders
duloxetine: also used in diabetic peripheral neuropathy

33
Q

What is the MC side effect of SNRIs?

A

increased BP

34
Q

What are examples of TCAs?

A 
amitriptyline
nortriptyline
imipramine
desipramine
clomipramine
doxepine 
amoxapine
35
Q

What are TUs of TCAs?

A

major depression
OCD (clomipramine)
fibromyalgia

36
Q

What are side effects of TCAs?

A

Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrythmias)

other SEs: respiratory depression, hyperpyrexia, confusion and hallucinations in elderly d/t anticholinergic SEs

37
Q

What is the treatment for TCA toxicity?

A

NaHCO3 for CV toxicity

38
Q

What are examples of MAOIs?

A

tranylcypromine
phenelzine
isocarboxazid
selegiline (selective MOA-B inhibitor)

39
Q

What are TUs of MAOIs?

A

atypical depression
anxiety
hypochondriasis

40
Q

What are side effects of MAOIs?

A

HYPERTENSIVE CRISIS (most notably with ingestion of TYRAMINE, which is found in foods such as wine and cheese)

CNS stimulation

*contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

41
Q

Bupropion, Mirtazapine, and Trazodone are in what class of drugs?

A

Atypical Antidepressants

42
Q

What is the MOA, TU, SEs, and contraindications of bupropion?

A

MOA: increase NE and DA via unknown mechanism

TU: smoking cession

SEs: stimulant effects (tachycardia, insomnia), HA, seizure in bulimic patients.

Contraindications: hypochloremia or hypokalemia (e.g. bulimics)

**NO SEXUAL SEs!

43
Q

What is the MOA, TU, SEs, and contraindications of mirtazapine?

A

MOA: alpha2- antagonist (increase release of NE and 5HT) and a potent 5HT2 and 5HT3 receptor antagonist

TU: depression

SEs: sedation, increased appetite, weight gain, dry mouth

44
Q

What is the MOA, TU, SEs, and contraindications of trazodone?

A

MOA: primarily blocks 5HT2 and alpha1-adrenergic receptors

TU: primarily for INSOMNIA

SEs: sedation, nausea, priapism, postural HOTN

*called trazoBONE d/t male-specific side effects

First Aid STEP 1 - Psychiatry (4 decks)

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