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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

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2
Q

Chlorpromazine

Haloperidol

A

Typical antipsychotics

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3
Q 
Olanzapine
Quetipain
Risperidone
Clozapine
Aripiprazole
Ziprasidone
A

Atypical antipsychotics

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4
Q

Long term side effect of chronic treatment with typical antipsychotics? What drug is most common cause?

A

1) Tardive dyskinesia

2) Haloperidol

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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

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6
Q 
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles
A

Neuroleptic malignant syndrome

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7
Q

Most common cause of Tardive dyskinesia

A

Haloperidol

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8
Q

Stereotypical, repetitive, involuntary movement of the lateral jaw and lip smacking; may have twisting and protrusion of the tongue

A

Tardive dyskinesia

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9
Q

What are the side effects of atypical antipsychotics?

A

1) Weight gain

2) Hyperglycemia and Type II DM

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10
Q

What is the most efficacious antipsychotic against the negative sypmtoms of schizophrenia?

A

1) Clozapine

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11
Q

What must be monitored when using Clozapine?

A

1) Blood

2) Increased risk for agranulocytosis

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12
Q

What atypical antipsychotic is at greatest risk for extrapyramidal side effects

A

Risperidone

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13
Q

Atypical antipsychotic that is a partial dopamine agonist and a partial 5-HT2 antagonist

A

Aripiprazole

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14
Q

What is the only atypical anti-psychotic that does not increase the changes of diabetes or weight gain?

A

Aripiprazole

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15
Q

MOA of Tricyclic antidepressants

A

1) Block monoamine (NE and 5HT) reuptake by down regulating monoamine receptors

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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

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17
Q

What are TCAs also used for?

A

1) Treatment of the emotional side of pain

2) Amytriptyline most commonly used

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18
Q

Amyitriptyline
DoxepinImipramine
Clomipramine
Desipramine

A

Tricyclic antidepressants

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19
Q 
Bupropion
Mirtazapine
Maprotiline
Trazodone
Venlafaxine
A

Atypical antidepressants

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20
Q

MOA of Bupropion

A

Inhibitor of dopamine uptake site

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21
Q

MOA of Mirtazpine

A

Alpha-2 antagonist that increases NE and serotonin

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22
Q

Atypical antidepressant that cause little to no sexual dysfunction; also used for smoking cessation

A

Bupropion

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23
Q

Antidepressant that may cause priapism

A

Trazodone

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24
Q

Adverse effect of Mirtazapine

A

1) Significant sedation

2) Increased appetite/weight gain

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25
Q 
Fluoxetine
Paroxetine
Setraline
Citalopram
Fluvoxamine
Escitalopram
A

SSRI (Selective Serotonin Reuptake inhibitors)

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26
Q

Adverse effects of SSRI

A

1) Sexual dysfunction
2) GI disturbances
3) Initial agitation
4) Initial insomnia

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27
Q

What SSRI has the most pronounced discontinuation syndrome?

A

Paroxetine

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28
Q

Flu like syndrome that occurs with abrupt halt of chronic SSRI treatment

A

Discontinuation Syndrome

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29
Q

What two antidepressant classes if given together is fatal?

A

1) SSRI with an MAOI

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30
Q

What is important to know about fluoxetine if you plan on changing drugs?

A

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

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31
Q

What SSRI is most likely to cause GI distrubances

A

Sertraline

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32
Q

Most Serotonin selective of the SSRIs

A

Escitalopram

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33
Q

SSRI specifically used for OCD

A

Fluvoxamine

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34
Q

Phenelzine

Tranylcyrpomine

A

MAO inhibitors

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35
Q

What is a common adverse effect in all antidepressants?

A

Sexual dysfunction

1) Decreased libido
2) Decreased arousal
3) Anorgasmia

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36
Q

Why must pt. on an MAO avoid foods with tyramine (aged cheese, wine, liver, ect.)?

A

1) MAO prevents the deamination of dietary tyramine

2) Build up of tyramine results in increased release of NE causing hypertensive crisis

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37
Q

What are MAOIs contraindicated with?

A

1) SSRIs
2) TCAs
3) St. John’s Wort

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38
Q

What antidepressant has the highest incident of sexual dysfunction?

A

1) Paroxetine

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39
Q

What antidepressant has a potential for seizure at high doses

A

Bupropion

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40
Q

What initially occurs in fluoxetine treatment?

A

Insomnia

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41
Q

What antidepressant most commonly causes increase in blood pressure?

A

Venlafaxine (atypical antidepressant)

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42
Q

What are drug interactions that occur with lithium?

A

1) Diuretics and NSAIDs decrease clearance of Lithium

2) Pure D2 antagonists enhance extrapyramidal syndromes

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43
Q

What are the drug toxicities of lithium?

A

1) Tremors
2) Decreased thyroid function (HYPOTHYROIDISM)
3) Mild cognitive impairment
4) Transient acne eruption
5) Leukocytosis
6) Renal dysfunction

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44
Q

What drugs besides lithium are mood stabilizers?

A

1) Lamotrigine
2) Carbamazepine and Oxcarbazepine
3) Divalproex sodium (valproate)
4) Antipsychotics

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45
Q

What drug that can be used to treat bipolar disorder is both an antidepressant and an antipsychotic?

A

Lurasidone

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46
Q

What are the contraindications of methylphenidate?

A

1) Hypertension
2) Glaucoma
3) Anxiety
4) Seizure disorder

47
Q

What are the adverse effects of methylphenidate

A

1) Insomnia
2) Anorexia
3) Weight loss
4) Growth retardation

48
Q

What are the adverse effects of Atomoxetine

A

1) Nausea
2) Dry mouth
3) Appetite suppression
4) Insomnia

49
Q

What are contraindications for atomoxetine?

A

1) BPH (has anticholingeric effects)

50
Q

What is the MOA of Guanfacine?

A

1) alpha-2 agonist

51
Q

What are the adverse effects of guanfacine?

A

1) Sleepiness

2) Low BP

52
Q

ADHD pro-drug

A

Lisdexamphetamine (bound to lysine and causes prolonged release)

53
Q

What must benzodiazepines never be given with?

A

1) Alcohol or Barbiturates

2) Causes respiration depression

54
Q

Water soluble, short acting beznodiazepine used IV pre-op

A

Midazolam

55
Q 
Diazepam
Alprazolam
Lorazepam
Oxazepam
Midazolam
A

Benzodiazepine agonist

56
Q

What does cimetidine (H2 blocker) effect in treatment with a benzodiazepine?

A

1) Inhibits liver mixed function oxidase prolonging the action of BZDs

57
Q

MOA of Buspirone

A

1) 5-HT1A agonist
2) Anxiolytic
3) No cross reaction with BZDs
4) No dependence or tolerance

58
Q

What drug is used to cause withdrawal of a benzodiazepine?

A

Flumazenil

59
Q

Need of immediate efficacy to alleviate anxiety

A

Aprazolam (more rapid oral absorption than other benzodiazepine)

60
Q

What are the adverse effects of amphetamine related anorexiants?

A

1) Dental problems
2) Insomnia
3) Increased BP
4) Anxiety
5) Tremor

61
Q

What can occur with a amphetamine related anorexiant overdose?

A

1) Arrhythmia
2) Confusion
3) Diarrhea
4) Fever
5) Assualtive behavior
6) Circulatory collapse

62
Q

Contraindications for amphetamine related anorexiant?

A

1) CVD
2) Moderate to severe HTN
3) Hyperthyroidism
4) Glaucoma
5) Alcoholism
6) Psychosis
7) History of drug abuse

63
Q

Benzphetamine
Diethylpropion
Phentermine

A

Amphetamine related anorexiants

64
Q

Derivative of lipstatin that binds covalently and inhibits gastric/pancreatic lipases

A

Orlistat

65
Q

What is the MOA of Lorcaserin?

A

1) 5-HT2c agonist

2 Obesity drug

66
Q

What is the criteria for amphetamine related anorexants and Lorcaserin?

A

1) BMI >30 OR BMI >27 with condition

67
Q

What adverse effect can occur with diethylpropion

A

Blood dyscrasias

68
Q

What are problematic of long acting benzodiazepines for hypnotic effect?

A

1) Long acting BZDs have a hangover effect

69
Q

What are problematic of short acting benzodiazepines for hypnotic effect?

A

1) Rebound insomnia

2) Early morning awakening

70
Q

Short half life BZD that has no hangover, but rebound insomnia and withdrawal signs; may have amnesia; used for hypnotic effects

A

Triazolam

71
Q

Zolpidem

Zaleplon

A

BZD Receptor Subtype Selective Drugs

1) Bind to GABA receptors containing alpha-1 subunit

72
Q

What is used for treatment of awakening during mid-sleep cycle

A

Zaleplon

73
Q

What is a contraindication for the use of melatonin?

A

1) Depression or Hx of depression

74
Q

MOA of Ramelteon

A

1) Binds to melatonin receptor

2) Does not bind to GABA receptors

75
Q

What are the adverse effects of barbiturates?

A

1) Dependance
2) Hangover
3) Profound depression
4) Respiratory depression

76
Q

In comparison to Triazolam, Zolpidem is:

A

1) not found to have rebound insomnia
2) found to have lower dependence
3) Less anxiolytic, anticonvulsatn, and muscle relaxant effects

77
Q

BZD1 Receptor drug that is approved for long term basis with no rebound insomnia

A

Eszopiclone

78
Q

Promoted for PRN use; requires 4 hours

A

Zaleplon

79
Q

Used for “Jet-Lag” and “shift changes”

A

Melatonin

80
Q

What drug inhibits alcohol dehydrogenase? When would this drug be useful?

A

1) Fomepizole
2) Methanol consumption
3) Prevents the formation of formaldehyde

81
Q

What is the primary route of alcohol metabolism? Where does this occur?

A

1) Formation of acetaldehyde via alcohol dehydrogenase
2) NAD is used in reaction
3) Occurs in the cytoplasm

82
Q

What is the secondary route of alcohol metabolism? Where does it occur?

A

1) Formation of acetaldehyde via Microsomal Ethanol Oxidizing sytem
2) Uses NADP
3) Occurs in smooth ER

83
Q

What occurs after alcohol is metabolized to acetaldehyde?

A

1) Acetaldehyde is converted to acetate via acetaldehyde dehydrogenase
2) Occurs in the cytoplasm and mitochondria

84
Q

What causes the hangover effect of alcohol?

A

Excessive acetaldehyde

85
Q

What occurs with excessive acetate in alcoholics?

A

1) Acetate is converted to acetoacetate

2) Contributes to ketosis

86
Q

What does excessive alcohol metabolism produce besides increased amounts of acetate?

A

1) Excessive amounts of reducing agents (NADH and NADPH)

87
Q

What are the metabolic disorders that are found with excessive alcohol metabolism?

A

1) Decreased gluconeogenesis
2) Hypoglycemia
3) Ketoacidosis
4) Increased triglyceride synthesis from free fatty acids

88
Q

What are the acute effects of ethanol on ion channels?

A

1) Inhibits glutamate Ca channel

2) Facilitates GABA Cl channels

89
Q

What are the acute effects of ethanol on the cardiovasculature?

A

1) Vasodilation

2) Depression of myocardial contractility

90
Q

What is the acute effect of ethanol on the endocrine system?

A

1) Causes inhibition of ADH

2) Diuresis occurs

91
Q

What CNS effects occur at a BEC of 50-100?

A

1) Sedation
2) Subjective “high”
3) Increased time to react

92
Q

What CNS effects occur at BEC of 100-200

A

1) Impaired motor function
2) Slurred speech
3) Ataxia

93
Q

What CNS effects occur at BEC of 200-300?

A

1) Stupor

2) Emesis

94
Q

When is intoxication more pronounced? Why?

A

1) During the rise of BEC

2) Due to the release of dopamine

95
Q

How do you treat an intoxicated pt. with hypoglycemia?

A

1) Give thiamine (give first to prevent lactic acidosis and Wernicke’s encephalopathy)
2) Give glucose

96
Q

MOA of naltrexone?

A

1) Opioid antagonisst

2) Reduces cravings in alcoholics

97
Q

What is naltrexone contraindicated in?

A

1) Impaired liver function

98
Q

What do you give in replacement of naltrexone? Why?

A

1) Acamprosate

2) Acamprosate is not metabolized

99
Q

MOA of Disulfiram

A

1) Blocks aldehyde dehydrogenase

100
Q

What are the effects of alcholol on the liver?

A

1) Alcoholic steatosis
2) Alcoholic hepatitis
3) Cirrhosis and liver failure

101
Q

Pt. comes in with euphoria, respiratory and CNS depression with pinpoint pupils

A

Opioid intoxication

102
Q

Treatment for opioid overdose?

A

1) Naloxone or naltrexone

103
Q

Pt. comes in with impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina

A

Cocaine intoxication

104
Q

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?

A

1) Delirium tremens

2) 2-3 days

105
Q

What is the adverse effect of Varenicline?

A

1) Changes in behavior
2) Hostility
3) Suicidal behavior

106
Q

MOA of Varenicline

A

1) Partial nicotine agonist

2) Decreases cravings of nicotine

107
Q

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?

A

1) Lithium

2) Pt. has hypothyroidism due to the thyrotoxic effects of lithium

108
Q

What drugs can interact with SSRIs to cause Serotonin syndrome?

A

1) MOA inhibitors
2) Tramadol
3) 5-HT3 receptor antagonist
4) Linezolid
5) Triptans (5-HT agonist)

109
Q

Symptoms of serotonin syndrome

A

1) Hyperreflexia, clonus, myoclonus, rigidity
2) Autonomic stimulation
3) Altered mental status

110
Q

What drugs can complicate the use of benzodiazepines that are normally not used antipsychotic purposes

A

1) First generation Anti-histamines (H1)

2) Have antimuscarinic effects, sedation, and anti alpha adrenergic activity

111
Q

What should never be given with lithium?

A

1) Thiazides, ACE inhibitors, NSAIDs

2) Causes Increased reabsorption of Na which leads to Lithium reabsorption

112
Q

Atomoxetine
Methylphenidate
Amphetamine salts (adderall)
Lisdexamphetamine

A

Drugs for treatment of ADHD

113
Q

MOA of Benzodiazepines

A

Think: Frenzodiazepine

1) Increase the Frequency of the opening of Cl channels; facilitate GABA

114
Q

MOA of Barbitruates

A

Think: BarbiDurates

1) Decrease closing of Cl channels; increase duration; facilitate GABA

Drugs (13 decks)

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