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Pharmacology > Pharmacology-Psychiatry > Flashcards

Pharmacology-Psychiatry Flashcards

1
Q

CNS stimulants – names

A

methylphenidate, dextroamphetamine, methamphetamine

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2
Q

CNS stimulants – mechanism

A

increase catecholamines (NE + D) at the synaptic cleft

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3
Q

CNS stimulants – use

A

ADHD, narcolepsy, appetite control

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4
Q

Antipsychotics (neuroleptics) – names

A

haloperidol + (trifluoper-, fluphen-, thiorid-, chlorprom-)-AZINE

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5
Q

Antipsychotics (neuroleptics) – mechanism

A

all typical antipsychotics block D2 receptors thus increasing [cAMP]

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6
Q

Antipsychotics (neuroleptics) – stored or excreted

A

highly lipid soluble thus stored in body fat and slow to be removed

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7
Q

Antipsychotics (neuroleptics) - high potency

A

Trifluoperazine, Fluphenazine, Haloperidol

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8
Q

Side effects of high potency Antipsychotics (neuroleptics)

A

neurologic side effects (Extrapyrimidal symptoms)

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9
Q

Explain Extrapyramidal symptoms (EPS)

A
  • 4h - acute dystonia (musc spasm, stifness, oculogyric crisis)
  • 4d - akathisia (restlessness)
  • 4wk- bradykinesia (parkinsonism)
  • 4mo- tardive dyskinesia
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10
Q

Antipsychotics (neuroleptics) - low potency

A

Chlorpromazine, Thioridazine

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11
Q

Side effects of low potency antipsychotics (neuroleptics)

A

non-neurologic:

  • anticholinergic - dry mouth, constipation
  • antihistamine - sedation
  • alpha1 blockade effects - hypotension
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12
Q

Antipsychotics (neuroleptics) - other side effects

A

endocrine effects: dopamine receptor antagonism leads to hyperprolactinemia leads to galactorrhea

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13
Q

Chlorpromazine – side effects

A

corneal deposits

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14
Q

Thioridazine – side effects

A

NAME?

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15
Q

Haloperidol – side effects

A

NMS (neuroleptic malignant syndrome), tardive dyskinesia

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16
Q

What is neuroleptic malignant syndrome?

A

rigidity, myoglobinurea, autohomic instability, hyperpyrexia

think FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigid muscles

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17
Q

What is the treatment of NMS

A
  • dantrolene

- D2 agonists (eg. bromocriptine)

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18
Q

What is tardive dyskinesia

A

oral facial movements as a result of long-term antipsychotic use. irreversible

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19
Q

Atypical Antipsychotics – names

A

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

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20
Q

Atypical Antipsychotics – mechanism

A

effects 5HT2 (not 3), D, alpha and H1 receptors

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21
Q

Atypical Antipsychotics – use

A
  • Schizophrenia – positive and negative symptoms

- Also: Bipolar, OCD, anxiety, depression, mania, tourettes

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22
Q

Atypical Antipsychotics – toxicity

A

fewer extrapyrimidal and anticholinergic side effects than traditional ones

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23
Q

Olanzapine/clozapine – side effects

A

significant weight gain

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24
Q

Clozapine – side effects

A

agranulocytois (requires weekly Wbc count) and seizures

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25
Q

Ziprasidone – side effects

A

prolong QT interval

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26
Q

Lithium – mechanism

A

possibly due to inhibition of phosphoinositol cascade

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27
Q

Lithium – use

A

Bipolar: blocks relapse and acute manic events

SIADH

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28
Q

Lithium – toxicity

A

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antag, causing nephrogenic diabetes insipidus), teratogenesis

“LMNOP: Lithium: Movement, Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy probs”

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29
Q

What effects does lithium have on fetus

A

fetal cardiact defects (ebstein anomaly, malformations of great vessels)

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30
Q

what is the therapeutic window of lithium

A

very narrow

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31
Q

how is lithium excreted

A

kidneys, most reabsorbed at PCT following Na+ reabsorption

32
Q

Buspirone – mechanism

A

(+) 5HT1a receptors

33
Q

Buspirone – use

A

generalized anxiety disorder “i always get anxious if the BUS will be on time so i take buspirone)

34
Q

Buspirone – why is it advantageous

A
  • does not cause sedation, addiction, tolerance and takes 1-2wks
  • does not interact with alcohol (unlike barbs/benzos)
35
Q

Antidepressants – typical types

A

SSRI, SNRI, TCA, MAO inhibitors

36
Q

Antidepressants – time it takes for effect

A

4-8wks

37
Q

SSRI – names

A

Fluoxetine, paroxetine, sertraline, citalopram

38
Q

SSRI – mechanism

A

serotonin specific reuptake inhibitor

39
Q

SSRI – use

A

depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD

40
Q

SSRI – toxicity

A

fewer than TCAs

  • GI distress, sexual dysfunction (decreased libido and anorgasmia)
  • serotonin syndrome
41
Q

What is serotonin syndrome

A
  • occurs w/ any drug which increases serotonin

- hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures

42
Q

Which drugs increase serotonin

A

MAO inhibitors, SNRIs, TCAs, SSRI’s

43
Q

What is the treatment of serotonin syndrome

A

cyproheptadine (5HT2 receptor antagonist)

44
Q

SNRI – names

A

Venlafaxine, Duloxetine

45
Q

SNRI – mechanism

A

inhibit serotonin and NE reuptake

46
Q

SNRI – general use

A

depression

47
Q

Venlafaxine – use

A

depression, generalized anxiety, panic disorder

48
Q

Duloxetine – use

A
  • depression, diabetic peripheral neuropathy

- greater effect on NE

49
Q

SNRI – toxicity

A
  • increased BP most common

- stimulant effects, sedation, nausea

50
Q

TCA – names

A

(Ami, Nor)-triptyline; (Im, Des, Clom)-ipramine; Doxipin, Amoxapine
**All end in -iptyline or -ipramine except last two

51
Q

TCA – mechanism

A

blocks reuptake of NE and S

52
Q

TCA – use

A
  • major depression, fibromyalgia
53
Q

Imipramine – use

A

bedwetting

54
Q

Clomipramine – use

A

OCD

55
Q

TCA – toxicity

A

Tri-C’s: convulsion, coma, cardiotoxicity (arrhythmias),

  • Sedation
  • a1 blocking effects: postural hotn
  • atropine-like (anti-cholinergic): tachycardia, urinary retention, dry mouth
56
Q

TCA – which have more anticholinergic effets

A

tertiary TCAs (amytriptyline) than secondary (nortriptyline)

57
Q

TCA – What is special about desipramine

A

less sedating and has higher seizure threshold

58
Q

TCA – toxicity in elderly

A

confusion, hallucinations due to anticholinergic Sx (use nortriptyline)

59
Q

TCA – treatment of cardiotoxicity

A

NaHCO3

60
Q

MAO inhibitors – names

A

Tranycypromine, phenelzine, isocarboxazid, selegiline

61
Q

What is Selegeline selective for

A

MAO-B

62
Q

MAO inhibitor – mechanism

A

nonselective MAO inhibition increases levels of amine NT’s: ME, S, D

63
Q

MAO inhibitors – use

A

atypical depression, anxiety, hypochondriasis

64
Q

MAO inhibitors – toxicity

A
  • hypertensive crisis (especially w/ ingestion of tyramine from wine/cheese)
  • CNS stimulation
65
Q

MAO inhibitors – contraindications and why

A

contraindicated w/ SSRIs, TCAs, St. Johns wort, meperidine, dextromethorphan to prevent serotonin syndrome

66
Q

Bupropion – use

A

depression, smoking cessation

67
Q

Bupropion – mechanism

A

increase NE and D

68
Q

Bupropion – toxicity

A

stimulant effects – tachycardia, insomnia
headache
seizures in bulimic pts
no sex sx

69
Q

Mirtazapine – mechanism

A

a2 antag (increase release NE and S) and potent 5ht2 and 5ht3 antag

70
Q

Mirtazapine – toxicity and uses

A

sedation (useful in insomniacs)
increased appetite and wt gain (useful in elderly/anorexics)
dry mouth

71
Q

Maprotiline – mechanism

A

blocks NE reuptake

72
Q

Maprotiline – toxicity

A

sedation, orthostatic hOtn

73
Q

Trazodone – mechanism

A

inhibits S reuptake

74
Q

Trazodone – use

A

Primarily for insomnia as high doses are needed for antidepressant effect

75
Q

Trazodone – toxicity

A

sedation, nausea, priaprism, postural hOtn

76
Q

Atypical Antidepressants - Names

A

Bupropion, Mirtazapine, Maprotiline, Trazodone

Pharmacology (12 decks)

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