Psichiatry- Pharmacology Flashcards
Preferred medications for selectedpsychiatric conditions
- ADHD
- Alcohol withdrawal
- Bipolar disorder
- Bulimia nervosa
Stimulants (methylphenidate, amphetamines)
Benzodiazepines (eg, chlordiazepoxide, lorazepam, diazepam)
Lithium, valproic acid, carbamazepine, lamotrigine, atypical
SSRIs
Preferred medications for selectedpsychiatric conditions
- Depression
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Panic disorder
SSRIs
SSRIs, SNRIs
SSRIs, venlafaxine, clomipramine
SSRIs, venlafaxine, benzodiazepines
Preferred medications for selectedpsychiatric conditions
- PTSD
- Schizophrenia
- Social anxiety disorder
- Tourette syndrome
SSRIs, venlafaxine
Atypical antipsychotics
SSRIs, venlafaxine. Performance only: β-blockers, benzodiazepines
Antipsychotic, tetrabenazine
Central nervous system stimulants
- Names
- Mechanism
- Clinical use
Methylphenidate, dextroamphetamine, methamphetamine
Increase catecholamines in the synaptic cleft, especially norepinephrine and dopamine.
ADHD, narcolepsy.
Typical antipsychotics
- Names
- Mechanism
- Clinical use
Haloperidol, pimozide, trifluoperazine, fluphenazine, thioridazine, chlorpromazine
Block dopamine D2 receptor
Schizophrenia (1° positive symptoms), psychosis, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD.
Typical antipsychotics
- High potency
- Low potency
Trifluoperazine, Fluphenazine, Haloperidol (Try to Fly High)
Chlorpromazine, Thioridazine (Cheating Thieves are low).
Typical antipsychotics
- Adverse effects
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.
Atypical antipsychotics
- names
Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone, risperidone, lurasidone, ziprasidone.
Atypical antipsychotics
- Mechanism
- Clinical use
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.
Atypical antipsychotics
- Adverse effects
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).
Lithium
- Mechanism
- Clinical use
- Adverse effects
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)
Buspirone
- Mechanism
- Clinical use
- Adverse effect
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
Selective serotonin reuptake inhibitors
- Names
- Adverse effects
Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram
GI distress, SIADH, sexual dysfunction (anorgasmia, libido).
Selective serotonin reuptake inhibitors
- Clinical use
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder
Serotonin norepinephrine reuptake inhibitors
- Names
- Adverse effects
Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran
Increase BP, stimulant effects, sedation, nausea.
Serotonin norepinephrine reuptake inhibitors
- Clinical use
Depression, general anxiety disorder, diabetic neuropathy.
Venlafaxine is also indicated for social anxiety disorder, panic disorder, PTSD, OCD.
Duloxetine is also indicated for fibromyalgia.
Tricyclic antidepressants
- Names
- Mechanism
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
TCAs inhibit 5-HT and NE reuptake.
Tricyclic antidepressants
- Adverse effects
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmia due to Na+ channel inhibition); also respiratory depression, hyperpyrexia. Confusion and hallucinations
Treatment: NaHCO3 to prevent arrhythmia.
Tricyclic antidepressants
- Clinical use
Major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis.
Nocturnal enuresis (imipramine)
Monoamine oxidase inhibitors
- Names and mechanism
- Clinical use
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor). (norepinephrine, 5-HT,
dopamine)
Atypical depression, anxiety. Parkinson disease (selegiline).
Monoamine oxidase inhibitors
- Adverse effects
CNS stimulation; hypertensive crisis (tyramine).
Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan (to prevent serotonin
syndrome).
Atypical antidepressants
Pag. 560
Bupropion, Mirtazapine, Trazodone, Varenicline, Vilazodone, Vortioxetine
Opioid withdrawal and detoxification
Methadone, Buprenorphine + naloxone, Naltrexone
Opioid withdrawal and detoxification
- Methadone
Long-acting oral opiate used for heroin detoxification or long-term maintenance therapy
Opioid withdrawal and detoxification
- Buprenorphine + naloxone
Sublingual buprenorphine (partial agonist) is absorbed and used for maintenance therapy.
Naloxone (antagonist, not orally bioavailable) is added to lower IV abuse potential
Opioid withdrawal and detoxification
- Naltrexone
Long-acting opioid given IM or as nasal spray to treat acute overdose in unconscious individual.
Also used for relapse prevention once detoxified.
