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USMLE 1 > Psichiatry- Pharmacology > Flashcards

Psichiatry- Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Preferred medications for selectedpsychiatric conditions

  • ADHD
  • Alcohol withdrawal
  • Bipolar disorder
  • Bulimia nervosa
A

Stimulants (methylphenidate, amphetamines)

Benzodiazepines (eg, chlordiazepoxide, lorazepam, diazepam)

Lithium, valproic acid, carbamazepine, lamotrigine, atypical

SSRIs

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2
Q

Preferred medications for selectedpsychiatric conditions

  • Depression
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Panic disorder
A

SSRIs

SSRIs, SNRIs

SSRIs, venlafaxine, clomipramine

SSRIs, venlafaxine, benzodiazepines

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3
Q

Preferred medications for selectedpsychiatric conditions

  • PTSD
  • Schizophrenia
  • Social anxiety disorder
  • Tourette syndrome
A

SSRIs, venlafaxine

Atypical antipsychotics

SSRIs, venlafaxine. Performance only: β-blockers, benzodiazepines

Antipsychotic, tetrabenazine

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4
Q

Central nervous system stimulants

  • Names
  • Mechanism
  • Clinical use
A

Methylphenidate, dextroamphetamine, methamphetamine

Increase catecholamines in the synaptic cleft, especially norepinephrine and dopamine.

ADHD, narcolepsy.

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5
Q

Typical antipsychotics

  • Names
  • Mechanism
  • Clinical use
A

Haloperidol, pimozide, trifluoperazine, fluphenazine, thioridazine, chlorpromazine

Block dopamine D2 receptor

Schizophrenia (1° positive symptoms), psychosis, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD.

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6
Q

Typical antipsychotics

  • High potency
  • Low potency
A

Trifluoperazine, Fluphenazine, Haloperidol (Try to Fly High)

Chlorpromazine, Thioridazine (Cheating Thieves are low).

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7
Q

Typical antipsychotics

- Adverse effects

A 
Endocrine: Hyperprolactinemia
Metabolic: dyslipidemia, weight gain, hyperglycemia.
Antimuscarinic: dry mouth, constipation.
Antihistamine: sedation.
α1-blockade: orthostatic hypotension.
Cardiac: QT prolongation.
Ophthalmologic: Chlorpromazine—Corneal deposits; Thioridazine—reTinal deposits.
Neuroleptic malignant syndrome.
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8
Q

Atypical antipsychotics

- names

A

Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone, risperidone, lurasidone, ziprasidone.

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9
Q

Atypical antipsychotics

  • Mechanism
  • Clinical use
A

Most are D2 antagonists; aripiprazole is D2 partial agonist. Varied effects on 5-HT2, dopamine, and α- and H1-receptors

Schizophrenia, bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.

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10
Q

Atypical antipsychotics

- Adverse effects

A

All—prolonged QT interval, fewer EPS and anticholinergic side effects than typical antipsychotics.

“-pines”—metabolic syndrome (weight gain, diabetes, hyperlipidemia).

Clozapine—agranulocytosis (monitor WBCs frequently) and seizures (dose related).

Risperidone—hyperprolactinemia (amenorrhea,
galactorrhea, gynecomastia).

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11
Q

Lithium

  • Mechanism
  • Clinical use
  • Adverse effects
A

possibly related to inhibition of phosphoinositol cascade.

Mood stabilizer for bipolar disorder

LiTHIUM:
Low Thyroid (hypothyroidism)
Heart (Ebstein anomaly)
Insipidus (nephrogenic diabetes insipidus)
Unwanted Movements (tremor)
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12
Q

Buspirone

  • Mechanism
  • Clinical use
  • Adverse effect
A

Stimulates 5-HT1A receptors.

Generalized anxiety disorder.

Does not cause sedation, addiction, or tolerance. Takes 1–2 weeks to take effect. Does not interact with alcohol

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13
Q

Selective serotonin reuptake inhibitors

  • Names
  • Adverse effects
A

Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram

GI distress, SIADH, sexual dysfunction (anorgasmia,  libido).

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14
Q

Selective serotonin reuptake inhibitors

- Clinical use

A

Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder

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15
Q

Serotonin norepinephrine reuptake inhibitors

  • Names
  • Adverse effects
A

Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran

Increase BP, stimulant effects, sedation, nausea.

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16
Q

Serotonin norepinephrine reuptake inhibitors

- Clinical use

A

Depression, general anxiety disorder, diabetic neuropathy.

Venlafaxine is also indicated for social anxiety disorder, panic disorder, PTSD, OCD.

Duloxetine is also indicated for fibromyalgia.

17
Q

Tricyclic antidepressants

  • Names
  • Mechanism
A

Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

TCAs inhibit 5-HT and NE reuptake.

18
Q

Tricyclic antidepressants

- Adverse effects

A

Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmia due to Na+ channel inhibition); also respiratory depression, hyperpyrexia. Confusion and hallucinations

Treatment: NaHCO3 to prevent arrhythmia.

19
Q

Tricyclic antidepressants

- Clinical use

A

Major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis.

Nocturnal enuresis (imipramine)

20
Q

Monoamine oxidase inhibitors

  • Names and mechanism
  • Clinical use
A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor). (norepinephrine, 5-HT,
dopamine)

Atypical depression, anxiety. Parkinson disease (selegiline).

21
Q

Monoamine oxidase inhibitors

- Adverse effects

A

CNS stimulation; hypertensive crisis (tyramine).

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

22
Q

Atypical antidepressants

A

Pag. 560

Bupropion, Mirtazapine, Trazodone, Varenicline, Vilazodone, Vortioxetine

23
Q

Opioid withdrawal and detoxification

A

Methadone, Buprenorphine + naloxone, Naltrexone

24
Q

Opioid withdrawal and detoxification

- Methadone

A

Long-acting oral opiate used for heroin detoxification or long-term maintenance therapy

25
Q

Opioid withdrawal and detoxification

- Buprenorphine + naloxone

A

Sublingual buprenorphine (partial agonist) is absorbed and used for maintenance therapy.

Naloxone (antagonist, not orally bioavailable) is added to lower IV abuse potential

26
Q

Opioid withdrawal and detoxification

- Naltrexone

A

Long-acting opioid given IM or as nasal spray to treat acute overdose in unconscious individual.

Also used for relapse prevention once detoxified.

USMLE 1 (73 decks)

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