Psych Flashcards
Mesolimbic (+) SS
- Hallucinations
- Delusions
- Disorganized speech, Behavior, Thought
- Poor Attention
Mesocortical (-) SS
- Loss of interest, motivation, emotion
- Poor Hygiene
- Social withdrawal
- Lack of speech, flat affect
- Feeling blue
Schizophrenia Tx
- 2GA x2 (except Clozapine)
- 1GA
- CLOZAPINE
- ECT
Antipsychotics MOA
- Blocks DOPAMINE Receptors
- 2GA also blocks SEROTONIN Receptors
- Blocks ALPHA, HISTAMINE, and PROLACTIN receptors
What does the Mesolimbic dopamine tract do?
Arousal, Memory, Stimulus, Processing (sensations)
What does the Mesocortical dopamine tract do?
cognition, communication, social fn
What does the Nigrostriatal dopamine tract do?
Motor Mvmnt
What does the Tuberoinfundibular dopamine tract do?
Regulates Prolactin release
i think incr dopamine = decr PRL release
Antipsychotics effect on the dopamine tracts
- Mesolimbic
- Mesocortical
- Nigrostriatal
- Tuberinfundibular
- Mesolimbic -> DECR (+) SS
- Mesocortical -> (-) SS not often improved. 2GA may help a lil
- Nigrostriatal -> EPS
- Tuberinfundibular -> INCR PRL Release
ALL ______ may cause death in elderly pts with dementia-related psychosis
what class of meds?
Antipsychotics
Antipsychotics that may also be used as Antidepressants have a high risk of _______
SUICIDE
Are SE more common in LOW or HIGH Potency 1st Gen Antipsychotics?
Typicals
LOW Potency 1GA
1GA: LOW Potency SE
- Sedation
- Orthostatic HypoTN
- Tachy
- Anticholinergic (dry, constipated)
1GA: HIGH Potency SE
EPS
- Tardive Dyskinesia -> Jerky
- Dystonia -> Continuous muscle spasms
- Bradykinesia -> SLOW Mvmnts
- Parkinsonism -> RIGIDITY, Tremors
- Akathisia -> inner RESTLESSNESS
2 LOW Potency 1GA
- Chlorpromazine (Thorazine) -> also used for intractable hiccups
- Thioridazine (Mellaril) -> highest QTc prolongation risk
Which Antipsychotic may also be used for intractable hiccups?
Chlorpromazine (Thorazine)
LOW Potency
Which 1GA has the highest QTc prolongation risk?
Thioridazine (Mellaril)
LOW Potency
8 HIGH Potency 1GA
- Fluphenazine (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Loxitane)
- Molindone (Moban)
- Perphenazine (Trilaphon)
- Prochlorperazine (Compazine)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
Which antipsychotic has a LOW risk of Wt Gain, has a LAI option, and is also used for Tourettes?
Haloperidol (Haldol)
HIGH Potency 1GA
Which Antipsychotic causes WT LOSS
Molindone (Moban)
HIGH Potency 1GA
Which Antipsychotics is also used for N/V and also comes as IM or a suppository?
Prochlorperazine (Compazine)
2GA SE
- METABOLIC -> WT Gain, Incr Lipids, Incr Blood Sugar
- INCR PRL -> Gynecomastia, Galactorrhea
- LOWER, but poss risk of EPS
Which 2GA carries the HIGHEST RISK OF SE
CLOZAPINE
- AGRANULOCYTOSIS (MONITOR NEUTROPHILS/ANC)
- MYOCARDITIS
- GI HYPERMOBILITY
- WT GAIN
- REMS PROGRAM
Which 2GA are for Bipolar Mania
- Ziprasidone (Geodon)
- Cariprazine (Vraylar)
- Olanzapine (Zyprexa)
Risperidone (Risperdal) - Bipolar Maintenance
Which 2GA are for adjunct Depression
- Ariprazole (Abilify)
- Brexiprazole (Rexulti)
- Quetapine (Seroquel)
Which 2GAs increase PRL Release?
- Papilleridone (Invega)
- Risperdone (Risperdal)
Which 2GA must you take with food to ensure absorption (350cal+)
Lurasidone (Latuda)
Which 2GA?
* must monitor for 3Hr after injection
* causes WT GAIN
* used for bipolar mania
Olanzapine (zyprexa)
Which 2GA?
* WT GAIN
* LOWEST RISK OF EPS
* Adjunct for Depression
* Bipolar Depression
Quetapine (Seroquel)
Which 2GA?
- NO food/drink 10-15min after dose
- MOUTH NUMBESS
- HEPATIC FAILURE
- Sublingual and patch avail
Asensapine (Saphris)
Major Depressive DO Tx
- 1st line
- 2nd line
- 3rd line
- SSRI/SNRI, Bupropion (Welbutrin), Mirtazapine (Remeron)
- SWITCH SSRI/SNRI, ADD Diff antidepress, ADD 2GA
- SWITCH SSRI/SNRI, TCA, MAOI, Esketamine, ECT
MDD Med Therapy Timeline
- ___ - ____ Wks -> PHYSICAL SS improve
- ____ - _____ Wks -> EMOTIONAL improvement
- ____ - ____ Wks -> FULL EFFECTS SEEN
- 1-2 Wks -> PHYSICAL
- 3-4 Wks -> EMOTIONAL
- 6-8 Wks -> FULL EFFECTS
6 SSRIs
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertaline (Zoloft)
Which 2 SSRIs can cause QTc Prolongation
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Which SSRI has the longest half-life (~50Hr)
Fluoxetine (Prozac)
Which SSRI is ONLY used for OCD (Off-label for depression)
Fluvoxamine (Luvox)
Which SSRI causes the MOST SE -> SLEEPY, WT GAIN, Anticholinergic
Paroxetine (Paxil)
Whcih SSRI?
- FOOD increases absorption
- HIGHEST GI (DIARRHEA)
- Slightly sedating
Sertaline (Zoloft)
3 Serotonin Modulators
- Trazodone (Desyrel) -> Priapism risk, Sleepy
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
Which Serotonin Modulator has a risk of PRIAPISM & SLEEPY
Trazodone (Desyrel)
Serotonergic SE
- Hyponatremia
- GI
- Weak, Fatigue
- Sleep disturb
- Incr Risk BLEEDING (effect on PLT)
- Sexual Dysfn
- Wt Changes
5 SNRIs
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristia)
- Duloxetine (Cymbalta)
- Levomilnacipran (Fitizima)
- Viloxazine (Qelbree)
_______ is also great for neuroathy
SSRI or SNRI?
SNRI
Venlafaxine (Effexor) is an SSRI at ______ doses & an SNRI at ______ doses
LOW or HIGH?
LOW Dose = SSRI
HIGH Dose = SNRI
Which SNRI?
* BAD For LIVER
* Risk of Acute Angle Glaucoma
Duloxetine *Cymbalta)
Which SNRI is for ADHD, NOT Depression
Viloxazine (Qelbree)
Noradrenergic SE
- Tremors, Jittery
- Tachy, HTN
- Sweating, Urinary Retention
True or False?
SSRIs & SNRIs cause Hyponatremia and are CI with MAOIs
TRUE
Bupropion (Welbutrin) MOA
Blocks Dopamine & Norepi reuptake
Bupropion (Welbutrin) Contraindications
- Hz Sz or ETOH abuse -> SEIZURE RISK
- Anorexia /Bulemia
- Acute Angle Glaucoma
Which Bupropion formulation is for SMOKING CESSATION?
Bupropion SR (Zyban)
NOT Welbutrin
Dopaminergic SE
- EUPHORIA
- Nightmares/Odd dreams
- Seizures
- Psychosis aggrivation
True or False: Bupropion has a LOWER RISK OF SEXUAL DYSFN and is CI with MAOIs
TRUE
TCAs MOA
- Blocks Serotonin and Norepi Reuptake
- Blocks Alpha-adrenergic, Histamine, Muscarinic receptors
TCAs -> 2ndary vs Tertiary Amines
* Amitriptyline (Elavil
* Doxepin (Sinequan)
* Desipramine (Norpramin)
* Imipramine (Tofranil)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)
SECONDARY AMINES (DNP)
* Desipramine (Norpramin)
* Nortriptyline (Pamelor)
* Protriptyline (Vivactil)
TERTIARY AMINES (AID)
* Amitriptyline (Elavil
* Imipramine (Tofranil)
* Doxepin (Sinequan)
- Secondary amines -> more selective for norepi reuptake block -> LOWER RISK FOR SE
- Tertiary amines -> more selective for serotonin reuptake block, Histamine block, Ach block -> MORE SE
Which TCA is also used for
- HA prevention
- Pain syndromes
Amitriptyline (Elavil)
Which TCA is also used for Insomnia
Doxepin (Sinequan)
TCAs -> ___ Amines have MORE SE
Secondary or Tertiary?
TERTIARY
True or False -> TCAs incr QTc prolongation risk and DECR Seizure threshold
TRUE
do TCAs cause anticholinergic or cholinergic SE?
ANTICHOLINERGIC (DRY)
Anti-histamine SE
- Sedation
- WT gain
- Confusion
Alpha-1 blcoker SE
- HypoTN
- Dizzy
Mirtazapine (Remeron) MOA
blocks alpha-2 adrenergic receptors -> inhibits (-) feedback -> allows for more SEROTONIN & NOREPI to be secreted and avail
Which antidepressant is best for MDD if ELDERLY & WANT WT GAIN
Mirtazapine (Remeron) SE:
* ** Decr anxiety
* INCR APPETITE**
* Insomnia
* GI upset
* Sexual dysn
LESS bad SE than in SSRIs
MAOIs MOA
blocks the MAO enzyme -> more neurotransmitters avail
normally, the MOA enzyme metabolizes Dopamine, Serotonin, Norepi
4 MAOIs
- Tranylcypromine (Parnate)
- Phenelzine (Nardil)
- Isocarboxazid (Marplan)
- Selegiline (Emsan)
Which Low-dose MAOI is used for Parkinson’s?
Selegiline (Emsan)
Selefiline at LOW doses is selective for MAOB = Dopamine
MAOIs Considerations
HUGE HTN RISK
* AVOID TYRAMINE-Rich diet (aged cheese, smoked meats, pickled foods, red wine, craft beer, soy sauce, fava beans, yeast extract)
* DO NOT TAKE IF Heart prob or have HAs
SSRIs, SNRIs, and TCAs need a ___wk washout period before transitioning to/from MAOIs
2
to prevent Serotonin Syndrome
Which meds have a HTN risk **bc they incr Norepi & Dopamine
- SNRIs, TCAs, Bupropion (Welbutrin)
- Stimulants
- OTC Pseudophedrine
Serotonin Syndrme Tx
Benzos
Cyprohepatadine
Neuroepileptic Malignant Syndrome
- ET?
- SS?
- Tx?
- ET: Antipsychotics (1GA>2GA), Nausea meds that incr Dopamine (Metoclopramide, Promethazine)
- SS: LONG onset & Resolution -> Bradyflexia, Muscle rigidity, Hyperthermia, Flunctuating BP
- Tx: Bromocriptine (Dopamine agonist)
Tx for Bipolar Acute mania or mixed episode
- Lithium
- Valproic acid
- Carbamazepine
- 2GA
- SEVERE -> Lithium or Valproate + 2GA
Bipolar Depression Tx
- Lithium or Lamotrigine
- +/- Antidepressant (NO TCAs & NEVERE AS MONOTHERAPY)
Bipolar Maintenance Tx
- used what worked best in the past
- only consider antipsychotics when in psychosis or trying to prevent psychosis relapse
BREAKTHROUGH SS -> ADD ANY
1. Lithium, Valproic acid
2. Lamotritigine, Carbamazepine
3. 2GA
4. Antidepressant
