Pschyopharmacology Flashcards
which drug is ass with no tardive dyskinesia
clozapine
pimozide and loxapine less
extrapyramidal reactions sequence of antisychotics
DARTAR dystonic(jerky mov,trouble speaking) akinesia tremor rigidity akithisia pisa and rabbit syn (1,2,3wks,1.5,2.5,4.5mth)
tardive dyskinesia occurs after
3-6 months
cause of tardive dyskinesia
supersenitivity to postsynaptic DA recep
i.e why may persisit even after drug termination
EP and tardive dyskinesia tt
1.acuteEP:antimuscurinic drugs (benztropine,diphenhydramine,trihexyphenidyl)
2.chronic EP(TD only)
should prevent by giving drug holiday on onset of symptoms i.e.discontinuation
switch to atypical
receptors on which antipsychotics act
block
- dopamine (EP,Tardive dyskinesia,prolactin inc)
- alpha-adrenergic(hypotension)
- H1(wt gain,sedation,impaired memory)
- muscuranic(dry mouth,blurry vision, constipation)
are the followinf se of antipsychotics
- particular taste(dental caries)
- altered bodily response to temp
yes
among typicals max EPS(D acting)
haloperidol
fluphenazine
(chlorpromazine, thio- more on M,H1,alpha)
peculiar side effects of thioridazine
retrograde ejaculation
retinitis pigmentosa
cardiotoxicity(torsades-quinidine like)
antispychotics given vua inj
fluphenazine
ziprasidone
which antipsychotic will be most likely caustive of malignant neuroleptic syn and TD
haloperidol
main side effect of clozapine
agranulocytosis
seizure(high dose)
increased salivation
name 5 typical Antipsychotics
haloperidol fluphenazinr thioridazine chlorpromazine loxapinr
wet pillow syn caused by
clozapine
if acute symptoms(agressiveness etc) which class to be used
typicals-more likely to act
for maintaince can shift to atypicals if they work
which class treats both + and - schizophrenic symptoms
atypical
if fear of EP symptoms ..which atypical not to use
haloperidol like
highest incidence of dibetrs,chol,wt gain
olanzapine
name atypicals
cloza resperidone olanza quetiapinr aripiprazole ziprasidone
uses of antipsychotics
schizophrenia psyhotic symptoms-hallu,delusions movement disorder-toureytr,huntingtons n/v intractable hiccups pruritis
uses of antidepressants
depression anxiety chronic pain with/without depression OCD panic enuresis
window of suicide risk
- for all antidepressants
- motor activity incresese before depression is affected so increased risk of suicide
moa of TCA
blockage of 5HT and NE reuptake
also block alpa adrrnergic and muscrinic rep
adr of TCA
- anticholinergic
- alpha blokade: CVS -orthostatic hyptsn, tachcardia
- CNS:drowsiness, insomnia, agitation, headache , fine tremor
- sexual:men(erectile dysfxn) and women
- metabolic:changrs in blood sugar
exclusion of bipolar necessary for giving antidepressant
these can ppt maniac phase
fewest side effects of which class of antidepresant
SSRI
side effects of SSRI
sexual :anorgasmia ,delayed orgasm
serotonin syndrome
git
symptoms of Serotonin syn
(due to inc serotonin) general restlessness sweating, hyperthermia insomnia nause diarrhoea cramps, rigidity,myoclonus delerium
cause of serotonin syn
high dose SSRI
SSRI+MAOI
MAOI+ synthetic narcotics
tt of serotonin syn
stop drug
give cyproheptadine if req
moa enzyme action
metabolizes epi,NE, serotonin
major adr of MOAI
hypertensive crisis(MAOI + tyramine) occipetal headache stiff neck n/v chest pain dilated pupils nosebleed elevated blood pressure
tt of hypertensive crisis due to MAOI
stop drug
phrntolamine/chlorpromazine
tyramine containing foods
cheese chocolates dried fish avocado sausage sauerkraut (sage foods:cottage cheese and only some wines)
use of ECT
Mainly depression
scizoaffective disorder, bipolar
c/i for ECT
Increased ICP(tumor)
t/f
ECT used to treat episodrs not prophylaxis
yes
side effects of ECT
memory losd and headache
returns to normal in several weeks
ECT is especially considered for
highly suicidal patients
depressed pregnent women
how do we get to know about the recovry after ECT
increasr in slow wave (delta)activity
antidepressant used for smoking cessation
bupropion
main se of trazodone
priapism
mitrazepine se
increased sleep,increased appetite,wt gain
anorexia nervosa with concomitant depression
mitrazepine se
increased sleep,increased appetite,wt gain
(anorexia nervosa with concomitant depression)
bupropion opposite in se(appetite suppresant, agitation, insomnia)
depression + pain
duloxetine
use of lithium
bipolar(control, prophylaxis)
migraine cluster headaches
chronic aggression
combined with TCA for resistant depression
Li has very narrow safety margin .How?
requires reaching plasma levels very close to toxic levels for effect
therapeutic level for Li
0.8- 1.5 mEq/L
toxic-1.4 mEq/L may be toxic
frank toxixity: 2
hemodialysis: above 2.5
se of lithium
therapeutic- tremor, thirst, anorexia, git
seisures coma
DI:polyuria and polydypsia( dec ADH effect)
acne
benign leukocytosis
hypothyroidism(dec TSH effect)
nephrotoxic
teratogenic effect of lithium
ebstein anomaly of tricuspid valve
other drugs used for bipolar
valproic(rapid action)
carbamezipine
OCP and BZD should not be used together
yes
OCP inc BZD level
buspirone
antianxiety drus moa- effects serotonin not gaba no anticonvulsant , m relaxing properties no abuse potential not potentiated by alcohol(others are)
moa of mirtazipine
bupropion
stimulates 5HT and NE release
weak inhibitor of dopamine, modest effect on NE,no effect on 5 Ht reuptake
use of SSRI
Major depression OCD bulimia anxiety ds- chronic( for acute- BDZ) premenstrual dysphoric syn
irreversible inhibitor of both mao enz
tranylcypromine
phenelzine
drugs used in ADHD
methylphenidate -amphetamine like
atomoxetine- selective NE reuptake inhibitor
