Pharmacology-Psychiatry Flashcards
CNS stimulants – names
methylphenidate, dextroamphetamine, methamphetamine
CNS stimulants – mechanism
increase catecholamines (NE + D) at the synaptic cleft
CNS stimulants – use
ADHD, narcolepsy, appetite control
Antipsychotics (neuroleptics) – names
haloperidol + (trifluoper-, fluphen-, thiorid-, chlorprom-)-AZINE
Antipsychotics (neuroleptics) – mechanism
all typical antipsychotics block D2 receptors thus increasing [cAMP]
Antipsychotics (neuroleptics) – stored or excreted
highly lipid soluble thus stored in body fat and slow to be removed
Antipsychotics (neuroleptics) - high potency
Trifluoperazine, Fluphenazine, Haloperidol
Side effects of high potency Antipsychotics (neuroleptics)
neurologic side effects (Extrapyrimidal symptoms)
Explain Extrapyramidal symptoms (EPS)
- 4h - acute dystonia (musc spasm, stifness, oculogyric crisis)
- 4d - akathisia (restlessness)
- 4wk- bradykinesia (parkinsonism)
- 4mo- tardive dyskinesia
Antipsychotics (neuroleptics) - low potency
Chlorpromazine, Thioridazine
Side effects of low potency antipsychotics (neuroleptics)
non-neurologic:
- anticholinergic - dry mouth, constipation
- antihistamine - sedation
- alpha1 blockade effects - hypotension
Antipsychotics (neuroleptics) - other side effects
endocrine effects: dopamine receptor antagonism leads to hyperprolactinemia leads to galactorrhea
Chlorpromazine – side effects
corneal deposits
Thioridazine – side effects
NAME?
Haloperidol – side effects
NMS (neuroleptic malignant syndrome), tardive dyskinesia
What is neuroleptic malignant syndrome?
rigidity, myoglobinurea, autohomic instability, hyperpyrexia
think FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigid muscles
What is the treatment of NMS
- dantrolene
- D2 agonists (eg. bromocriptine)
What is tardive dyskinesia
oral facial movements as a result of long-term antipsychotic use. irreversible
Atypical Antipsychotics – names
Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone
Atypical Antipsychotics – mechanism
effects 5HT2 (not 3), D, alpha and H1 receptors
Atypical Antipsychotics – use
- Schizophrenia – positive and negative symptoms
- Also: Bipolar, OCD, anxiety, depression, mania, tourettes
Atypical Antipsychotics – toxicity
fewer extrapyrimidal and anticholinergic side effects than traditional ones
Olanzapine/clozapine – side effects
significant weight gain
Clozapine – side effects
agranulocytois (requires weekly Wbc count) and seizures
Ziprasidone – side effects
prolong QT interval
Lithium – mechanism
possibly due to inhibition of phosphoinositol cascade
Lithium – use
Bipolar: blocks relapse and acute manic events
SIADH
Lithium – toxicity
Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antag, causing nephrogenic diabetes insipidus), teratogenesis
“LMNOP: Lithium: Movement, Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy probs”
What effects does lithium have on fetus
fetal cardiact defects (ebstein anomaly, malformations of great vessels)
what is the therapeutic window of lithium
very narrow
how is lithium excreted
kidneys, most reabsorbed at PCT following Na+ reabsorption
Buspirone – mechanism
(+) 5HT1a receptors
Buspirone – use
generalized anxiety disorder “i always get anxious if the BUS will be on time so i take buspirone)
Buspirone – why is it advantageous
- does not cause sedation, addiction, tolerance and takes 1-2wks
- does not interact with alcohol (unlike barbs/benzos)
Antidepressants – typical types
SSRI, SNRI, TCA, MAO inhibitors
Antidepressants – time it takes for effect
4-8wks
SSRI – names
Fluoxetine, paroxetine, sertraline, citalopram
SSRI – mechanism
serotonin specific reuptake inhibitor
SSRI – use
depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD
SSRI – toxicity
fewer than TCAs
- GI distress, sexual dysfunction (decreased libido and anorgasmia)
- serotonin syndrome
What is serotonin syndrome
- occurs w/ any drug which increases serotonin
- hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures
Which drugs increase serotonin
MAO inhibitors, SNRIs, TCAs, SSRI’s
What is the treatment of serotonin syndrome
cyproheptadine (5HT2 receptor antagonist)
SNRI – names
Venlafaxine, Duloxetine
SNRI – mechanism
inhibit serotonin and NE reuptake
SNRI – general use
depression
Venlafaxine – use
depression, generalized anxiety, panic disorder
Duloxetine – use
- depression, diabetic peripheral neuropathy
- greater effect on NE
SNRI – toxicity
- increased BP most common
- stimulant effects, sedation, nausea
TCA – names
(Ami, Nor)-triptyline; (Im, Des, Clom)-ipramine; Doxipin, Amoxapine
**All end in -iptyline or -ipramine except last two
TCA – mechanism
blocks reuptake of NE and S
TCA – use
- major depression, fibromyalgia
Imipramine – use
bedwetting
Clomipramine – use
OCD
TCA – toxicity
Tri-C’s: convulsion, coma, cardiotoxicity (arrhythmias),
- Sedation
- a1 blocking effects: postural hotn
- atropine-like (anti-cholinergic): tachycardia, urinary retention, dry mouth
TCA – which have more anticholinergic effets
tertiary TCAs (amytriptyline) than secondary (nortriptyline)
TCA – What is special about desipramine
less sedating and has higher seizure threshold
TCA – toxicity in elderly
confusion, hallucinations due to anticholinergic Sx (use nortriptyline)
TCA – treatment of cardiotoxicity
NaHCO3
MAO inhibitors – names
Tranycypromine, phenelzine, isocarboxazid, selegiline
What is Selegeline selective for
MAO-B
MAO inhibitor – mechanism
nonselective MAO inhibition increases levels of amine NT’s: ME, S, D
MAO inhibitors – use
atypical depression, anxiety, hypochondriasis
MAO inhibitors – toxicity
- hypertensive crisis (especially w/ ingestion of tyramine from wine/cheese)
- CNS stimulation
MAO inhibitors – contraindications and why
contraindicated w/ SSRIs, TCAs, St. Johns wort, meperidine, dextromethorphan to prevent serotonin syndrome
Bupropion – use
depression, smoking cessation
Bupropion – mechanism
increase NE and D
Bupropion – toxicity
stimulant effects – tachycardia, insomnia
headache
seizures in bulimic pts
no sex sx
Mirtazapine – mechanism
a2 antag (increase release NE and S) and potent 5ht2 and 5ht3 antag
Mirtazapine – toxicity and uses
sedation (useful in insomniacs)
increased appetite and wt gain (useful in elderly/anorexics)
dry mouth
Maprotiline – mechanism
blocks NE reuptake
Maprotiline – toxicity
sedation, orthostatic hOtn
Trazodone – mechanism
inhibits S reuptake
Trazodone – use
Primarily for insomnia as high doses are needed for antidepressant effect
Trazodone – toxicity
sedation, nausea, priaprism, postural hOtn
Atypical Antidepressants - Names
Bupropion, Mirtazapine, Maprotiline, Trazodone