Psych Flashcards
Stimulants
Drug names
Methylphenidate
Dextroamphetamine
Methamphetamine
Stimulants
MOA
Inc. catecholamines in synaptic cleft (NE, Dopa).
Also blocks NE/Dopa reuptake.
Stimulants
Clinical use
ADHD, narcolepsy, appetite control
Typical antipsychotics (neuroleptics)
Drug names
(Try to Fly High)
(Cheating Thieves are low)
> High potency: Trifluoperazine, Fluphenazine, Haloperidol
Low potency: Chlorpromazine, Thioridazine
(Haloperidol + -azines)
Typical antipsychotics
MOA
Block D2 receptors in nigrostriatal pathway – inc. cAMP.
(Normally inhibited D2 effects are balanced by excitatory M1 effects – blocked D2 means inc. M1 cholinergic activity).
Highly lipid soluble – stored in fat – slow to be removed.
Typical antipsychotics
Clinical use
Schizophrenia
Psychosis, Acute mania
Tourette syndrome
Typical antipsychotics
Toxicity (High potency)
Neuro SE (Huntington dse, delirium, EPS sx).
EPS sx evolution:
- 4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
- 4 day: akathisia (restlessness)
- 4 wk: bradykinesia (parkinsonism)
- 4 mo: tardive dyskinesia
Typical antipsychotics
Toxicity (Low potency)
Anticholinergic, antihistamine, a1-blockade effects.
Dry mouth, constipation; sedation; hypotension, possible QT prolonged.
Neuroleptic malignant syndrome
Disordered thermoregulation and skeletal muscle metabolism (rigidity, myoglobinuria, autonomic instability, hyperpyrexia).
*Mnem. FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes inc., Rigidity
>Tx: Dantrolene, D2 agonist (bromocriptine).
Tardive dyskinesia
Stereotypic oral-facial movements due to chronic antipsychotic use.
Lipsmacking, choreoathetoid movements.
Can persist ff. meds discontinuation.
Atypical antipsychotics
Drug names
Olanzapine, Clozapine, Quetiapine
Risperidone, Aripiprazole, Ziprasidone
Atypical antipsychotics
MOA
Varied effects on 5HT2-receptors, D-receptors, a-receptors, H1-receptors.
Atypical antipsychotics
Clinical use
Schizophrenia.
Bipolar d/o (mood-stabilizing).
OCD, anxiety, depression, mania, Tourette syndrome.
Tx-resistant schizophrenia (clozapine).
Atypical antipsychotics
Toxicity
Fewer EPS and anticholinergic effects vs. typical antipsychotics.
All may prolong QT interval.
>Clozapine: agranulocytosis, wt. gain, seizures, sialorrhea.
>Olanzapine: wt. gain.
>Risperidone: inc. prolactin (lactation, gynecomastia).
Lithium
MOA, clinical use
May be related to inhibition of phosphoinositol pathway.
Mood stabilizer for bipolar – blocks relapse and acute manic events.
SIADH.
Lithium
Toxicity
Movement (tremor). Nephrogenic DI (polyuria), Hypothyroidism -- close monitoring of TFT, creatinine. Pregnancy problems (ebstein anomaly). CI w/ ACEi -- deplete Na, dec. GFR. *Tx for lithium toxicity: Thiazide
Buspirone
MOA, clinical use
Anxiolytic (non-BZ) – not muscle relaxant or anticonvulsant.
Stimulates 5HT1A-receptors.
For generalized anxiety d/o.
*Takes 1-2 wks for effect
SSRIs
Drug names
Fluoxetine, Paroxetine, Sertraline
Citalopram
SSRIs
MOA
5HT-specific reuptake inhibitors. Antidepressant.
*Takes 4-8 wks for effect – take BZ during initiation period.
SSRIs
Clinical use
Depression, Generalized anxiety d/o, panic d/o, OCD, bulimia, social phobias, PTSD
SSRIs
Toxicity
Sexual dysfunction, GI distress, SIADH
Serotonin syndrome
Serotonin syndrome
Caused by any drug that inc. 5HT (MAOi, SNRI, TCA) – uncommon in pts taking a single serotonergic drug.
Hyperthermia, confusion, myoclonus, CVS instability, flushing, diarrhea, seizures.
Tx: cyproheptadine (5HT2-receptor antagonist).
SNRIs
Drug names
Venlafaxine, Duloxetine
SNRIs
MOA, clinical use
Inhibit 5HT, NE reuptake, antidepressants.
For depression.
>Venlafaxine: GAD, panic d/o, PTSD.
>Duloxetine: diabetic peripheral neuropathy.
Tricyclic antidepressants
Drug names
Amitriptyline, Nortriptyline
Imipramine, Desipramine, Clomipramine, Amoxapine
Doxepin
Tricyclic antidepressants
MOA
Block NE, 5HT reuptake
Tricyclic antidepressants
Clinical use
Major depression.
Peripheral neuropathy, chronic pain.
Migraine prophylaxis.
OCD (clomipramine).
Tricyclic antidepressants
Toxicity
Tri-C’s: Convulsions, Coma, Cardiotoxicty (Tx w/ NaHCO3 to prevent arrhythmia).
Respi depression, hyperpyrexia
Sedation, anticholinergic effects, sexual dysfunction.
MAO inhibitors
Drug names
Tranylcypromine, Phenelzine, Isocarboxacid
Selegiline (selective MAO-B inhibitor)
MAO inhibitors
MOA
Antidepressant.
Irreversible binding of MAO, w/c normally breaks down amine neurotransmitters.
Inc. NE, 5HT, Dopa.
MAO inhibitors
Clinical use
Atypical depression
Anxiety
MAO inhibitors
Toxicity
HTN crisis (esp. w/ ingestion of Tyramine, like in wine and cheese). CI w/ SSRI, TCA, St. John's wort, dextromethorphan, meperidine -- prevent Serotonin syndrome.
Bupropion
Clinical use
NE/Dopa reuptake inhibitor.
1st line for antidepressant w/o causing sexual dysfunction.
Also for smoking cessation.
May worsen GAD due to stimulating effects.
Mirtazapine
Clinical use
Atypical antidepressant.
a2-antagonist (inc. NE, 5HT release).
Potent 5HT2, 5HT3 receptor antagonist.
Trazodone
Clinical use, toxicity
Atypical antidepressant. Blocks 5HT2 and a1-adrenergic receptors. For insomnia. High doses needed for antidepressant effects. Toxicity: priapism, sedation, nausea.
