Psych Drugs Flashcards
1
Q
MOA of atypical antipsychotics
A
1) Block D2 receptors and 5-HT2 receptors
2) Good for both positive and negative symptoms of schizophrenia
2
Q
Chlorpromazine
Haloperidol
A
Typical antipsychotics
3
Q
Olanzapine Quetipain Risperidone Clozapine Aripiprazole Ziprasidone
A
Atypical antipsychotics
4
Q
Long term side effect of chronic treatment with typical antipsychotics? What drug is most common cause?
A
1) Tardive dyskinesia
2) Haloperidol
5
Q
Side effects of typical antipsychotics
A
1) Extrapyramidal problems (dystonias, parkonsinisms, and neuroleptic malignant syndrome)
2) Dsyphoria
3) Increased prolactin release
4) Weight gain
5) Hypotension
6) Poikilothermia
7) Tardive dyskinesia
6
Q
Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles
A
Neuroleptic malignant syndrome
7
Q
Most common cause of Tardive dyskinesia
A
Haloperidol
8
Q
Stereotypical, repetitive, involuntary movement of the lateral jaw and lip smacking; may have twisting and protrusion of the tongue
A
Tardive dyskinesia
9
Q
What are the side effects of atypical antipsychotics?
A
1) Weight gain
2) Hyperglycemia and Type II DM
10
Q
What is the most efficacious antipsychotic against the negative sypmtoms of schizophrenia?
A
1) Clozapine
11
Q
What must be monitored when using Clozapine?
A
1) Blood
2) Increased risk for agranulocytosis
12
Q
What atypical antipsychotic is at greatest risk for extrapyramidal side effects
A
Risperidone
13
Q
Atypical antipsychotic that is a partial dopamine agonist and a partial 5-HT2 antagonist
A
Aripiprazole
14
Q
What is the only atypical anti-psychotic that does not increase the changes of diabetes or weight gain?
A
Aripiprazole
15
Q
MOA of Tricyclic antidepressants
A
1) Block monoamine (NE and 5HT) reuptake by down regulating monoamine receptors
16
Q
Adverse effects of Tricyclic antidepressants
A
1) Antimuscarinic effects
2) Metabolic (weight gain and sexual distrubance)
3) Sedation
4) Tremors and insomnia
5) Orthostatic hypotension
17
Q
What are TCAs also used for?
A
1) Treatment of the emotional side of pain
2) Amytriptyline most commonly used
18
Q
Amyitriptyline
DoxepinImipramine
Clomipramine
Desipramine
A
Tricyclic antidepressants
19
Q
Bupropion Mirtazapine Maprotiline Trazodone Venlafaxine
A
Atypical antidepressants
20
Q
MOA of Bupropion
A
Inhibitor of dopamine uptake site
21
Q
MOA of Mirtazpine
A
Alpha-2 antagonist that increases NE and serotonin
22
Q
Atypical antidepressant that cause little to no sexual dysfunction; also used for smoking cessation
A
Bupropion
23
Q
Antidepressant that may cause priapism
A
Trazodone
24
Q
Adverse effect of Mirtazapine
A
1) Significant sedation
2) Increased appetite/weight gain
25
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Fluoxetine
Paroxetine
Setraline
Citalopram
Fluvoxamine
Escitalopram
```
SSRI (Selective Serotonin Reuptake inhibitors)
26
Adverse effects of SSRI
1) Sexual dysfunction
2) GI disturbances
3) Initial agitation
4) Initial insomnia
27
What SSRI has the most pronounced discontinuation syndrome?
Paroxetine
28
Flu like syndrome that occurs with abrupt halt of chronic SSRI treatment
Discontinuation Syndrome
29
What two antidepressant classes if given together is fatal?
1) SSRI with an MAOI
30
What is important to know about fluoxetine if you plan on changing drugs?
1) Floxetine has the longest half life of all SSRIs
2) 48 hour half life after 1 dose
3) 80-120 hour half life after multiple doses
31
What SSRI is most likely to cause GI distrubances
Sertraline
32
Most Serotonin selective of the SSRIs
Escitalopram
33
SSRI specifically used for OCD
Fluvoxamine
34
Phenelzine
| Tranylcyrpomine
MAO inhibitors
35
What is a common adverse effect in all antidepressants?
Sexual dysfunction
1) Decreased libido
2) Decreased arousal
3) Anorgasmia
36
Why must pt. on an MAO avoid foods with tyramine (aged cheese, wine, liver, ect.)?
1) MAO prevents the deamination of dietary tyramine
| 2) Build up of tyramine results in increased release of NE causing hypertensive crisis
37
What are MAOIs contraindicated with?
1) SSRIs
2) TCAs
3) St. John's Wort
38
What antidepressant has the highest incident of sexual dysfunction?
1) Paroxetine
39
What antidepressant has a potential for seizure at high doses
Bupropion
40
What initially occurs in fluoxetine treatment?
Insomnia
41
What antidepressant most commonly causes increase in blood pressure?
Venlafaxine (atypical antidepressant)
42
What are drug interactions that occur with lithium?
1) Diuretics and NSAIDs decrease clearance of Lithium
| 2) Pure D2 antagonists enhance extrapyramidal syndromes
43
What are the drug toxicities of lithium?
1) Tremors
2) Decreased thyroid function (HYPOTHYROIDISM)
3) Mild cognitive impairment
4) Transient acne eruption
5) Leukocytosis
6) Renal dysfunction
44
What drugs besides lithium are mood stabilizers?
1) Lamotrigine
2) Carbamazepine and Oxcarbazepine
3) Divalproex sodium (valproate)
4) Antipsychotics
45
What drug that can be used to treat bipolar disorder is both an antidepressant and an antipsychotic?
Lurasidone
46
What are the contraindications of methylphenidate?
1) Hypertension
2) Glaucoma
3) Anxiety
4) Seizure disorder
47
What are the adverse effects of methylphenidate
1) Insomnia
2) Anorexia
3) Weight loss
4) Growth retardation
48
What are the adverse effects of Atomoxetine
1) Nausea
2) Dry mouth
3) Appetite suppression
4) Insomnia
49
What are contraindications for atomoxetine?
1) BPH (has anticholingeric effects)
50
What is the MOA of Guanfacine?
1) alpha-2 agonist
51
What are the adverse effects of guanfacine?
1) Sleepiness
| 2) Low BP
52
ADHD pro-drug
Lisdexamphetamine (bound to lysine and causes prolonged release)
53
What must benzodiazepines never be given with?
1) Alcohol or Barbiturates
| 2) Causes respiration depression
54
Water soluble, short acting beznodiazepine used IV pre-op
Midazolam
55
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Diazepam
Alprazolam
Lorazepam
Oxazepam
Midazolam
```
Benzodiazepine agonist
56
What does cimetidine (H2 blocker) effect in treatment with a benzodiazepine?
1) Inhibits liver mixed function oxidase prolonging the action of BZDs
57
MOA of Buspirone
1) 5-HT1A agonist
2) Anxiolytic
3) No cross reaction with BZDs
4) No dependence or tolerance
58
What drug is used to cause withdrawal of a benzodiazepine?
Flumazenil
59
Need of immediate efficacy to alleviate anxiety
Aprazolam (more rapid oral absorption than other benzodiazepine)
60
What are the adverse effects of amphetamine related anorexiants?
1) Dental problems
2) Insomnia
3) Increased BP
4) Anxiety
5) Tremor
61
What can occur with a amphetamine related anorexiant overdose?
1) Arrhythmia
2) Confusion
3) Diarrhea
4) Fever
5) Assualtive behavior
6) Circulatory collapse
62
Contraindications for amphetamine related anorexiant?
1) CVD
2) Moderate to severe HTN
3) Hyperthyroidism
4) Glaucoma
5) Alcoholism
6) Psychosis
7) History of drug abuse
63
Benzphetamine
Diethylpropion
Phentermine
Amphetamine related anorexiants
64
Derivative of lipstatin that binds covalently and inhibits gastric/pancreatic lipases
Orlistat
65
What is the MOA of Lorcaserin?
1) 5-HT2c agonist
| 2 Obesity drug
66
What is the criteria for amphetamine related anorexants and Lorcaserin?
1) BMI >30 OR BMI >27 with condition
67
What adverse effect can occur with diethylpropion
Blood dyscrasias
68
What are problematic of long acting benzodiazepines for hypnotic effect?
1) Long acting BZDs have a hangover effect
69
What are problematic of short acting benzodiazepines for hypnotic effect?
1) Rebound insomnia
| 2) Early morning awakening
70
Short half life BZD that has no hangover, but rebound insomnia and withdrawal signs; may have amnesia; used for hypnotic effects
Triazolam
71
Zolpidem
| Zaleplon
BZD Receptor Subtype Selective Drugs
| 1) Bind to GABA receptors containing alpha-1 subunit
72
What is used for treatment of awakening during mid-sleep cycle
Zaleplon
73
What is a contraindication for the use of melatonin?
1) Depression or Hx of depression
74
MOA of Ramelteon
1) Binds to melatonin receptor
| 2) Does not bind to GABA receptors
75
What are the adverse effects of barbiturates?
1) Dependance
2) Hangover
3) Profound depression
4) Respiratory depression
76
In comparison to Triazolam, Zolpidem is:
1) not found to have rebound insomnia
2) found to have lower dependence
3) Less anxiolytic, anticonvulsatn, and muscle relaxant effects
77
BZD1 Receptor drug that is approved for long term basis with no rebound insomnia
Eszopiclone
78
Promoted for PRN use; requires 4 hours
Zaleplon
79
Used for "Jet-Lag" and "shift changes"
Melatonin
80
What drug inhibits alcohol dehydrogenase? When would this drug be useful?
1) Fomepizole
2) Methanol consumption
3) Prevents the formation of formaldehyde
81
What is the primary route of alcohol metabolism? Where does this occur?
1) Formation of acetaldehyde via alcohol dehydrogenase
2) NAD is used in reaction
3) Occurs in the cytoplasm
82
What is the secondary route of alcohol metabolism? Where does it occur?
1) Formation of acetaldehyde via Microsomal Ethanol Oxidizing sytem
2) Uses NADP
3) Occurs in smooth ER
83
What occurs after alcohol is metabolized to acetaldehyde?
1) Acetaldehyde is converted to acetate via acetaldehyde dehydrogenase
2) Occurs in the cytoplasm and mitochondria
84
What causes the hangover effect of alcohol?
Excessive acetaldehyde
85
What occurs with excessive acetate in alcoholics?
1) Acetate is converted to acetoacetate
| 2) Contributes to ketosis
86
What does excessive alcohol metabolism produce besides increased amounts of acetate?
1) Excessive amounts of reducing agents (NADH and NADPH)
87
What are the metabolic disorders that are found with excessive alcohol metabolism?
1) Decreased gluconeogenesis
2) Hypoglycemia
3) Ketoacidosis
4) Increased triglyceride synthesis from free fatty acids
88
What are the acute effects of ethanol on ion channels?
1) Inhibits glutamate Ca channel
| 2) Facilitates GABA Cl channels
89
What are the acute effects of ethanol on the cardiovasculature?
1) Vasodilation
| 2) Depression of myocardial contractility
90
What is the acute effect of ethanol on the endocrine system?
1) Causes inhibition of ADH
| 2) Diuresis occurs
91
What CNS effects occur at a BEC of 50-100?
1) Sedation
2) Subjective "high"
3) Increased time to react
92
What CNS effects occur at BEC of 100-200
1) Impaired motor function
2) Slurred speech
3) Ataxia
93
What CNS effects occur at BEC of 200-300?
1) Stupor
| 2) Emesis
94
When is intoxication more pronounced? Why?
1) During the rise of BEC
| 2) Due to the release of dopamine
95
How do you treat an intoxicated pt. with hypoglycemia?
1) Give thiamine (give first to prevent lactic acidosis and Wernicke's encephalopathy)
2) Give glucose
96
MOA of naltrexone?
1) Opioid antagonisst
| 2) Reduces cravings in alcoholics
97
What is naltrexone contraindicated in?
1) Impaired liver function
98
What do you give in replacement of naltrexone? Why?
1) Acamprosate
| 2) Acamprosate is not metabolized
99
MOA of Disulfiram
1) Blocks aldehyde dehydrogenase
100
What are the effects of alcholol on the liver?
1) Alcoholic steatosis
2) Alcoholic hepatitis
3) Cirrhosis and liver failure
101
Pt. comes in with euphoria, respiratory and CNS depression with pinpoint pupils
Opioid intoxication
102
Treatment for opioid overdose?
1) Naloxone or naltrexone
103
Pt. comes in with impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina
Cocaine intoxication
104
Known alcoholic is retained in prison and begins to have mental confusions with fluctuating levels of consciousness, tremor, agitation, and autonomic activity. What is this pt. experiencing? How long has he been in prison?
1) Delirium tremens
| 2) 2-3 days
105
What is the adverse effect of Varenicline?
1) Changes in behavior
2) Hostility
3) Suicidal behavior
106
MOA of Varenicline
1) Partial nicotine agonist
| 2) Decreases cravings of nicotine
107
Pt. using mood stabilize presents wtih constipation, dry skin, hair loss, and weight gain. They are tired and have low bp and heart rate. What is the drug and why is it causing these symptoms?
1) Lithium
| 2) Pt. has hypothyroidism due to the thyrotoxic effects of lithium
108
What drugs can interact with SSRIs to cause Serotonin syndrome?
1) MOA inhibitors
2) Tramadol
3) 5-HT3 receptor antagonist
4) Linezolid
5) Triptans (5-HT agonist)
109
Symptoms of serotonin syndrome
1) Hyperreflexia, clonus, myoclonus, rigidity
2) Autonomic stimulation
3) Altered mental status
110
What drugs can complicate the use of benzodiazepines that are normally not used antipsychotic purposes
1) First generation Anti-histamines (H1)
| 2) Have antimuscarinic effects, sedation, and anti alpha adrenergic activity
111
What should never be given with lithium?
1) Thiazides, ACE inhibitors, NSAIDs
| 2) Causes Increased reabsorption of Na which leads to Lithium reabsorption
112
Atomoxetine
Methylphenidate
Amphetamine salts (adderall)
Lisdexamphetamine
Drugs for treatment of ADHD
113
MOA of Benzodiazepines
Think: Frenzodiazepine
| 1) Increase the Frequency of the opening of Cl channels; facilitate GABA
114
MOA of Barbitruates
Think: BarbiDurates
| 1) Decrease closing of Cl channels; increase duration; facilitate GABA
