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Pharm II > Psych > Flashcards

Psych Flashcards

1
Q

Phenelzine

A 
MAOI
Antidepressant
MOA:
irreversibly blocks monoamine oxidase 
--| metabolizes 5HT,NE, DA
ADR:
Very effective (50+%)
sig side effects, 3rd line tx
sedating, serotonin syndrome
HTN crisis (cheese syndrome from too much tyramine

DDI:
AVOID: SSRI, SNRI, TCA, tramadol, meperidine, dextromethorphan, amphetamines, lethal

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2
Q

Trancycpromine

A 
MAOI
Antidepressant
MOA:
irreversibly blocks monoamine oxidase 
--| metabolizes 5HT,NE, DA
ADR:
Very effective (50+%)
sig side effects, 3rd line tx
sedating, serotonin syndrome
HTN crisis (cheese syndrome from too much tyramine

DDI:
AVOID: SSRI, SNRI, TCA, tramadol, meperidine, dextromethorphan, amphetamines, lethal

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3
Q

Imipramine

A 
TCA (tertiary amine)
Antidepressant (off label ADHD)
MOA:
\+++ serotonergeric reuptake blockade
\++ NE reuptake blockade
also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)

ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating

DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD

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4
Q

Amiptyline

A 
TCA (tertiary amine)
Antidepressant 
MOA:
\+++ serotonergeric reuptake blockade
\++ NE reuptake blockade
also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)

ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating

DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD

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5
Q

Clomipramine

A 
TCA (tertiary amine)
Antidepressant 
MOA:
\+++ serotonergeric reuptake blockade
\++ NE reuptake blockade
also block Histamine, ACh a1, Na channels (class 1 antiarrhythmic)

ADR:
*arrhythmia/heart block,
Weight gain, sedation, antiACh, hypotension, sexual, sweating

DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD

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6
Q

Despramine

A 
TCA (Secondary amine) (ADHD off label)
Antidepressant
MOA:
\+++NE reuptake blockade
\+Serotonergic reuptake blockade

ADR:
Secondary amines; same as tertiary bu weaker
monitor [plasma]

DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD

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7
Q

Nortriptyline

A 
TCA (Secondary amine) (ADHD off label)
Antidepressant
MOA:
\+++NE reuptake blockade
\+Serotonergic reuptake blockade

ADR:
Secondary amines; same as tertiary bu weaker
monitor [plasma]

DDI:
CYP2D6 inhibition
Increases MAOI, TCA, tramaol levels
lethal in OD

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8
Q

Fluoxetine

A 
SSRI
Antidepressant
MOA:
Binds serotonin reuptake pump, 
blocking and prevening reuptake
mostly in the Dorsal Raphe

ADR:
QT prolongation
BBox: increased suicidal ideation

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9
Q

Sertraline

A 
SSRI
Antidepressant
MOA:
Binds serotonin reuptake pump, 
blocking and prevening reuptake
mostly in the Dorsal Raphe

ADR:
QT prolongation
BBox: increased suicidal ideation

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10
Q

Citalopram

A 
SSRI
Antidepressant
MOA:
Binds serotonin reuptake pump, 
blocking and prevening reuptake
mostly in the Dorsal Raphe

ADR:
QT prolongation
BBox: increased suicidal ideation

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11
Q

Escitalopram

A 
SSRI
Antidepressant
MOA:
Binds serotonin reuptake pump, 
blocking and prevening reuptake
mostly in the Dorsal Raphe

ADR:
QT prolongation
BBox: increased suicidal ideation

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12
Q

Paroxetine

A 
SSRI
Antidepressant
MOA:
Binds serotonin reuptake pump, 
blocking and prevening reuptake
mostly in the Dorsal Raphe

ADR:
QT prolongation
BBox: increased suicidal ideation

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13
Q

Venlafaxine

A 
SNRI
Antidepressant (ADHD off label)
MOA:
dual action seratonin and NE reuptake pump
blocks and prevents reuptake
Mostly locus coeruleus
ADR:
Diastolic BP increase
discontinuation sxs terrible
QT prolongation
BBox: increased suicidal ideation
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14
Q

Duloxetine

A 
SNRI
Antidepressant
MOA:
dual action seratonin and NE reuptake pump
blocks and prevents reuptake
Mostly locus coeruleus
ADR:
Diastolic BP increase
discontinuation sxs terrible
QT prolongation
BBox: increased suicidal ideation
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15
Q

Nefazodine

A 
SNRI
Antidepressant
MOA:
dual action seratonin and NE reuptake pump
blocks and prevents reuptake
Mostly locus coeruleus
ADR:
Diastolic BP increase
discontinuation sxs terrible
QT prolongation
BBox: increased suicidal ideation
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16
Q

Trazadone

A

Dual Action
Antidepressant

MOA:
Blocks 5Ht2a/c receptors; 5HT transporter, a1 receptors, H1 antagonism
NERI

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17
Q

Bupropion

A 
NE/DA reuptake inhibitor
Antidepressant (ADHD off label)
MOA:
blocks NE/DA reuptake
reduced sexual side effects vs other ADDs

ADR:
Insomnia, tremor, tinnitus, seizures
avoid in eating disorders (reduces appetitie0
least likely to cause mania

DDI
CYP2D6 inhibition
Increases MAOI, TCA, tramadol, levodopa

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18
Q

Mirtazepine

A

Alpha-2 antagonist
Antidepressant

MOA:
Alpha -2 antagonist
SRI
Histamine receptor antagonist

ADR:
weight gain, sedation
low sexual side effects

DDI:
No CYP450
Don’t combine w/ MAOI

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19
Q

Diazepam

A

Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant

MOA:
non-selective GABA agonist a1-3 and a5
possitive allosteric modulator for GABA
--sleep/anterograde amnestic = a1
--anxiolytic = a2
--muscle relaxant = a3

ADR:
sedation, depression, amnesia, ataxia, dependence, withdrawal
Very long half life 20-50 hrs
metabolite buildup - liver cirrhosis

DDI:

  • EtOH - additive for sedation, resp arrest
  • Opiates, cimetadine
  • flumazenil reverses
  • safe, non- GABA activating
  • addictive a1 effects
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20
Q

Chlordiazepoxide

A

Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant

MOA:
non-selective GABA agonist a1-3 and a5
possitive allosteric modulator for GABA
--sleep/anterograde amnestic = a1
--anxiolytic = a2
--muscle relaxant = a3

ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- Half life 5-30 (metabolite cirrhosis)

DDI:

  • EtOH - additive for sedation, resp arrest
  • Opiates, cimetadine
  • flumazenil reverses
  • safe, non- GABA activating
  • addictive a1 effects
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21
Q

Lorazepam

A

Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant

MOA:
non-selective GABA agonist a1-3 and a5
possitive allosteric modulator for GABA
--sleep/anterograde amnestic = a1
--anxiolytic = a2
--muscle relaxant = a3

ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- renal clearance;
- half life 10-20h

DDI:

  • EtOH - additive for sedation, resp arrest
  • Opiates, cimetadine
  • flumazenil reverses
  • safe, non- GABA activating
  • addictive a1 effects
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22
Q

Alprazolam

A

Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant

MOA:
non-selective GABA agonist a1-3 and a5
possitive allosteric modulator for GABA
--sleep/anterograde amnestic = a1
--anxiolytic = a2
--muscle relaxant = a3
ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- shortest half life 6-12hrs
- most addictive
- strongest

DDI:

  • EtOH - additive for sedation, resp arrest
  • Opiates, cimetadine
  • flumazenil reverses
  • safe, non- GABA activating
  • addictive a1 effects
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23
Q

Clonazepam

A

Benzodiazepam
Anxiolytic, sedative, Amnestic, anticonvulsant

MOA:
non-selective GABA agonist a1-3 and a5
possitive allosteric modulator for GABA
--sleep/anterograde amnestic = a1
--anxiolytic = a2
--muscle relaxant = a3

ADR:
Sedation, depression, amnesia, ataxia, dependence, withdrawal
- popular with psychiatrists
- half life = 18-50 hrs

DDI:

  • EtOH - additive for sedation, resp arrest
  • Opiates, cimetadine
  • flumazenil reverses
  • safe, non- GABA activating
  • addictive a1 effects
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24
Q

Zolpidem

A

Anxiolytic
Non-BZDP

MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia

ADR:
Amnesia

DDI:

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25
Q

Zalaplon

A

Anxiolytic
Non-BZDP

MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia

ADR:
Amnesia

DDI:

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26
Q

Eszopiclone

A

Anxiolytic
Non-BZDP

MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia

ADR:
Amnesia

DDI:

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27
Q

Busprione

A

Anxiolytic
Non-BZDP

GAD
adjuvant for MDD

MOA:
Serotonin receptor partial agonist 5HT-1a

Clin Use:
GAD
non sedating, addictive, tolerancing
1-2 weeks for effect
no EtOH/BZD interactions

ADR:
Dizziness, HA, sedation, nervousness/restlessness
No dependence/withdrawal
4+ weeks for effect

DDI:
MAOI

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28
Q

Lithium

A

Classic Mood stabilizer

MOA:
unknown

PK:
narrow therapeutic range - monitor
urine excretion
Vd = TBW

ADR:
tox: N/V/D, ataxia
SEs: lethargy, weight gain, blurred vision, tremor, polyuria/dipsia, cog slowing

DDI:
diuretics, NSAID, ACEI, CCB

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29
Q

Valproic Acid

A

Anticonvulsant, mood stabilizer

MOA:
increases GABA, inhibits Glu
PO for seizures, mood stabilization, HA prophylaxis

PK:
hepatic metabolism; inhibits some enzymes
T1/2 = 16h
monitor levels, LFTs, ovaries, CBC

ADR:
Hepatotox
teratogenic
pancreatitis

30
Q

Carbamazepine

A

Anticonvulsant, mood stabilizer

MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain

PK:
Hepatic metabolism
enzyme self inducer
T1/2 = 12 hrs

AE:
increase toxic potential of other drugs
Drowsiness, HA, incoordination, decreased EtOH tolerance, weight gain
aplastic anemia
Derm rxns in asians
31
Q

Lamotrigine

A

Anticonvulsant - Mood stabilizer

MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain
Depressed phase

PK:
glucuronidation
T1/2 13h

AE:
serious skin rashes - Stevens-Johnson syndrome
topical epidermal necrolysis

N/V. dizziness visual disturbance, somnelence, ataxia, HA

32
Q

Oxcarbazepine

A

Anticonvulsant, mood stabilizer

MOA:
Na channel blocker in neuronal membrane
slows repeat firing
PO for focal and secondaryily generalized seizures
mood stabilization, neuropathic pain

PK:
Renal
T1/2 ~3hrs

AE:
Dizziness, drowsiness, visual changes, fatigue, HA, N/V, cog impairment, hyponatremia

33
Q

Olanzapine

A

Atypical-Antipsychotic
Dibenzodiazepine

MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
–>Releases DA to PFC –> mesolimbic pathway inhibition

Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette’s

PK:
Hepatic; 
renal/fecal excretion
dissolves rapidly
T1/2 = 21-50h

AE:
Drowsiness, flu-like sx, weigh tgaine, salivation
Tardive dyskinesai, QTc prolongation,
neuroleptic-malignangt syndrome

34
Q

Modafinil

A

Narcolepsy, TBI

MOA unknown

35
Q

Amantadine

A

Cog impairment

non-competitive NMDAr antagonist

36
Q

Memantine

A

Cog impairment
MOA:
non-competitive NMDAr antagonist
DA agonist - improves motivation

Ind:
mod-severe AD

AE:
constipation, dizziness, HA, pain

37
Q

Methylphenidate

A

ADHD
Amphetamine
MOA:
NE/DA reuptake blocker

PK:
rapid PO absorption
short half life
3-4hr effect

Ind:
ADHD, TBI?

AE:
Nervousness, insomnia, shakiness, potential for dependence/abuse

DDI:
MAOI

38
Q

Dextroamphetamine

A

ADHD
Amphetamine
NE/DA reuptake blocker

39
Q

Atomoxetine

A

ADHD
Selective NE reuptake inhibitor

PK:
rapid GI absorption
Hepatic metabolism

Use:
ADHD

AE:
liver tox, Suicidal ideation

40
Q

Duloxetine

A

ADHD

Selective NE reuptake inhibitor

41
Q

Donepezil

A

Alzheimers
Acetylcholinesterase inhibitor

PK:
good PO absorbtion
high protein binding
long half life

Use:
AD treatment

AE:
N/V/D, dizziness, sinus bradycardia, 1st * AV block, Monitor LFTs,

42
Q

Rivastigmine

A

Alzheimers

Acetylcholinesterase inhibitor

43
Q

Galantimine

A

Alzheimer’s

Acetylcholinesterase inhibitor

44
Q

Amphetamine

A

ADHD
Psychostimulant
Indirect adrenergic, stimulates NE, DA, 5HT release

45
Q

Lisdexamfetamine

A

ADHD

Amphetamine prodrug

46
Q

Atomoxetine

A

ADHD non stimulant

SNRI

47
Q

Guanfacine

A 
ADHD non-stimulant
a2 agonist (central acting)
48
Q

clonidine

A 
ADHD non-stimulant
a2 agonist (central)
49
Q

Chlorpromazine

A

Typical antipsychotic
Neuroleptic
low potency

Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes

MOA:
Blocks DA D2 receptors

Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight

Minimal improvement of negative/cog symptoms
limited efficacy because of SEs

SEs:
Low potency, sedation, dry mouth, blurred vision, constipation, urinay retention, weight gain

EPS effects: acute dystonia, Parkinsonism, akaathesia, dyskinesia
Prolactin elevation

50
Q

Haloperidol

A

Typical antipsychotic
Neuroleptic
High potency

MOA:
Blocks DA D2 receptors

Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes

Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight

Minimal improvement of negative/cog symptoms
limited efficacy because of SEs

SEs:
High potency: rigidity stiffness, acute dystonia, Parkinsonism, akasthesia, dyskinesia

51
Q

Fluphenazine

A

Typical antipsychotic
Neuroleptic
High potency

MOA:
Blocks DA D2 receptors

Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes

Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight

Minimal improvement of negative/cog symptoms
limited efficacy because of SEs

SEs:
High potency: rigidity stiffness, acute dystonia, Parkinsonism, akasthesia, dyskinesia

52
Q

Perphenazine

A

Typical antipsychotic
Neuroleptic
mid potency

MOA:
Blocks DA D2 receptors

Clinical Use:
Schizophrenia (positive sx)
psychosis, acute mania, Tourettes

Effects:
Immediate: calm behavior, improved sleep, decrease confusion
Weeks: decrease psychotic sx
Months: improve insight

Minimal improvement of negative/cog symptoms
limited efficacy because of SEs

SEs:
Mid range potency

53
Q

Clozapine

A

Atypical antipsychotic
dibenzodiazepine

MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
–>Releases DA to PFC –> mesolimbic pathway inhibition

Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette’s

Effects:
Most powerful antipsychotic
both +/- sx
only approved refractory tx
decreases suicide/relapse/comorbid SUD
SEs:
SEizures
agranulocytosis (weekly WBC)
myocarditis
Weight gain (significant)
54
Q

Risperidone

A

Atypical antipsychotic
dibenzodiazepine

MOA:

MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
–>Releases DA to PFC –> mesolimbic pathway inhibition

Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette’s

Effects:
fewer relapses

SEs:
EPS symptoms
prolactin elevation

55
Q

Quetiapine

A

Atypical antipsychotic
dibenzodiazepine

MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
–>Releases DA to PFC –> mesolimbic pathway inhibition

Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette’s

Effects

SEs:
minimal EPS/prolactin

56
Q

Aripiprazole

A

Atypical antipsychotic
Dopamine system stabilizer

MOA:
Weak D2 antagonist/potent 5HT/NE a2 antagonist
–>Releases DA to PFC –> mesolimbic pathway inhibition

Clin Use:
Schizophrenia - +/- symptoms
Bipolar DO
OCD, Anxiety, depression, mania, Tourette’s

Effects
Not as good as clozapine/olanzapine but safer

SE:
minimal EPS sx
no prolactin elevation
low weight gain
Early activation,
insomnia
57
Q

D-cycloserine

A

Experimental antipsychotic

58
Q

mGluR

A

Experimental Antipsychotic

59
Q

Buprenorphine

A

Opioid
u partial agonist
combined w/ naloxone in Suboxone

60
Q

Opioids (morphine, codeine)

A

Opium - Poppy fluid
Opiate - derived from opium poppy
Opioid - synthetic/semi-synthetic opioid agonist

Intox:
Euphoria, resp, CNS depression
–v gag reflex, pupillry constriction
Seizures

W/D:
Sweating, dilated pupils, piloerection, ever rhinorrhea, yawning, N/V/D, abd cramps, flu like sx

Tx.
Acute = Naloxone
Chronic = Naltrexone, buprenorphine, methadone

61
Q

Cocaine

A

Stimulant, drug of abuse
Pharm:
IV/ smoked = diminished IN

Intox:
Impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death

W/D:
Hypersomnolence, malaise, severe psychological craving, depression/suicidality

Tx.
Benzos.

62
Q

Heroin

A 
Analgesic drug of abuse
PK:
prodrug - diacetyl morphine
lipid soluble rapid bbb penetration
2x morphine
short acting

W/D:
Early – lacrimation, yawning, rhinorrhea, sweating, sense of anxiety, doom
Middle – restless sleep, dilated pupils, anorexia, gooseflesh, irritability, tremor
Late: increase of early/middle sx + HR/BP, N/V/D, abd cramp, depression, muscle cramps, weakness, bone pain

63
Q

Methadone

A

Opioid abuse
Pk: slow tolerance development (chronic pain)
long half life, high PO availability
delayed onset of action

Neurobio:
Fulll u-opiod receptor agonist
Ideal for addiction treatment

S/Sx use:
warm skin, pruritis, pleasure, relaxation, satisfaction, nodding off, euphoria

S/Sx OD:
Miosis, coma, resp depression, Pulm edema, seizures
Tx- naloxone

W/D:
delayed onsed +3 days
3+ weeks of withdrawal

64
Q

Marijuana

A

Hallucinogen, drug of abuse
RF for psychosis, esp during adolescence

Intox:
stimulates appetite, impairs learning, memory, decrease peripheral sensations, impairs cog function
inhibits N/V
euphoria, tachycardia, conjunctival injection

OD: tachycardia, anxiety, panic, paranoia

W/D:
anxiety, irritability, insomnia, decreased mood/food, physical discomfort

Cannabinomimetics:
‘4-5x potency

65
Q

Methamphetamine

A

stimulant, drug of abuse
sympathomimetic amine

NeuroBio:
Enter DA neurons via reuptake -> DA release

Intox:

  • intense short lasting euphoria(alertness, energy, confidence, increased sexuality)
  • binge till the money runs out

OD:
- hypomania, grandiosity, insomnia, irritability, psychosis, rhabdomyolysis, CV events, bruxism, periodontal disease

W/D:
depression, irritability, suicidal ideation carb craving, relapse

66
Q

Alcohol

A 
Stimulant and Depressant
Intox:
- slurred speech, incoordination, unsteady gait, nystagmus, 
- impaired attention/memory
- stupor/coma

Binge: BAC >0.08

Cogners - additives/byproducts that cause hangovers

BAC vs exam tolerance?

W/D

  • HTN, tachycardia, altered, tremors, N/V, hallucinations, SZs, death,
  • Tx w/ BZDS and taper

Mech:

  • chronic exposure to EtOH - upregulateion of Glu, downregulation of GABA
  • cessation = net excitation

Other:

  • liver
  • dilated cardiomyopathy
  • brain damage
  • FAS
67
Q

Thiamine

A

Alcohol abuse

Vitamin
common deficiency in alcoholics
Beri-beri/Wernickie-Korsakoff

68
Q

Naltrexone

A

Alcohol & Opioid dependence

long term use

~~~don’t confuse w/ naloxone~~~

69
Q

Acamprosate

A

Alcohol abuse

GABA agonist for withdrawal

70
Q

Disulfram

A 
Alcohol abuse (Antabuse)
Aldehyde dehydrogenase inhibitor

Pharm II (3 decks)

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