Psych Flashcards
Phenelzine
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
Trancycpromine
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
Imipramine
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
Amiptyline
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
Clomipramine
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
Despramine
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
Nortriptyline
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
Fluoxetine
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
Sertraline
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
Citalopram
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
Escitalopram
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
Paroxetine
SSRI Antidepressant MOA: Binds serotonin reuptake pump, blocking and prevening reuptake mostly in the Dorsal Raphe
ADR:
QT prolongation
BBox: increased suicidal ideation
Venlafaxine
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
Duloxetine
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
Nefazodine
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
Trazadone
Dual Action
Antidepressant
MOA:
Blocks 5Ht2a/c receptors; 5HT transporter, a1 receptors, H1 antagonism
NERI
Bupropion
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
Mirtazepine
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
Diazepam
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
Chlordiazepoxide
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
Lorazepam
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
Alprazolam
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
Clonazepam
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
Zolpidem
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
Zalaplon
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
Eszopiclone
Anxiolytic
Non-BZDP
MOA:
Selective GABA agonist against a1 receptor
Sedative hypnotics, specifically mediate sleep/amnesia
ADR:
Amnesia
DDI:
Busprione
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
Lithium
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
Valproic Acid
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
Carbamazepine
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
Lamotrigine
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
Oxcarbazepine
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
Olanzapine
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
Modafinil
Narcolepsy, TBI
MOA unknown
Amantadine
Cog impairment
non-competitive NMDAr antagonist
Memantine
Cog impairment
MOA:
non-competitive NMDAr antagonist
DA agonist - improves motivation
Ind:
mod-severe AD
AE:
constipation, dizziness, HA, pain
Methylphenidate
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
Dextroamphetamine
ADHD
Amphetamine
NE/DA reuptake blocker
Atomoxetine
ADHD
Selective NE reuptake inhibitor
PK:
rapid GI absorption
Hepatic metabolism
Use:
ADHD
AE:
liver tox, Suicidal ideation
Duloxetine
ADHD
Selective NE reuptake inhibitor
Donepezil
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,
Rivastigmine
Alzheimers
Acetylcholinesterase inhibitor
Galantimine
Alzheimer’s
Acetylcholinesterase inhibitor
Amphetamine
ADHD
Psychostimulant
Indirect adrenergic, stimulates NE, DA, 5HT release
Lisdexamfetamine
ADHD
Amphetamine prodrug
Atomoxetine
ADHD non stimulant
SNRI
Guanfacine
ADHD non-stimulant a2 agonist (central acting)
clonidine
ADHD non-stimulant a2 agonist (central)
Chlorpromazine
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
Haloperidol
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
Fluphenazine
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
Perphenazine
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
Clozapine
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)
Risperidone
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
Quetiapine
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
Aripiprazole
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
D-cycloserine
Experimental antipsychotic
mGluR
Experimental Antipsychotic
Buprenorphine
Opioid
u partial agonist
combined w/ naloxone in Suboxone
Opioids (morphine, codeine)
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
Cocaine
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.
Heroin
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
Methadone
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
Marijuana
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
Methamphetamine
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
Alcohol
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
Thiamine
Alcohol abuse
Vitamin
common deficiency in alcoholics
Beri-beri/Wernickie-Korsakoff
Naltrexone
Alcohol & Opioid dependence
long term use
~~~don’t confuse w/ naloxone~~~
Acamprosate
Alcohol abuse
GABA agonist for withdrawal
Disulfram
Alcohol abuse (Antabuse) Aldehyde dehydrogenase inhibitor
