Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro > Psych Drugs > Flashcards

Psych Drugs Flashcards

1
Q

Typical antipsychotics

A

Dopamine-2 receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atypical antipsychotics

A

Serotonin-dopamine antagonists

D2 partial agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications of typicals

A 
Psychotic disorders
Mood disorders
Dementia
Psychosis secondary to medical conditions, medications, and drugs of abuse
Personality disorder
Obsessive-compulsive disorder
Autism
Tourette’s disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

dopamine-mediated effects: nigrostriatal pathway

A

EPS (Parkinsonism, Akathisia, Dystonic reactions, Tardive dyskinesia, NMS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

dopamine-mediated effects: mesolimbic pathway

A

dysphoria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

dopamine-mediated effects: mesocortical pathway

A

worsening negative and cognitive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

dopamine-mediated effects: tuberoinfundibular pathway

A

Hyperprolactinemia, and resultant galactorrhea, amenorrhea, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

acute EPS

A

Dystonia – usually within hours
Akathisia – usually within days
Parkinsonism – usually within days to weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

chronic/late set EPS

A

Tardive Dyskinesia usually after 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatment of dystonia (EPS)

A

Anticholinergics – injectable if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment of akathisia

A

beta blockers, anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

treatment of parkinsonism

A

anticholinergics, amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dopamine does what to ACh

A

suppresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dopamine blockade ___ ACh

A

increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

EPS caused by

A

decreased dopamine and increased ACh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

improvement of EPS by

A

anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

mechanism of tardive dyskinesia

A

blockade of receptors in nigrostriatal dopamine pathway causes up-regulation, increased ACh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

increased risk of TD w/

A

age > 50
dose
total exposure
mood disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

anticholinergic side effects (M1)

A

constipation, blurred vision, dry mouth, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

antihistaminergic side effects (H1)

A

weight gain, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

anti-alpha adrenergic side effects

A

dizziness, decreased BP, drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

neuroleptic malignant syndrome

A

life-threatening condition of
hyperpyrexia, autonomic instability, muscle rigidity, and delirium
Death occurs secondary to arrhythmia, rhabdomyolysis or respiratory failure
Discontinue the antipsychotic, aggressive hydration
Mortality rate of 20-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how to increase compliance

A

depot preparations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why was clozapine originally withdrawn

A

agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

benefits of clozapine

A

Much lower incidence of extrapyramidal symptoms and tardive dyskinesia
Improves negative and cognitive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

indications of clozapine

A

Treatment resistant schizophrenia
Schizophrenia with tardive dyskinesia
Schizophrenia or schizoaffective disorder with recurrent suicidal behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

agranulocytosis

A

Life-threatening drop in white blood count
Contraindicated with pre-existing blood disorder
Estimated at 1-2%, about 0.38% with monitoring
Requires continuous monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

adverse effects of atypicals

A

Sedation
Anticholinergic side effects, including dry mouth, constipation, blurry vision, urinary retention, confusion, ECG changes
Myocarditis
Orthostatic hypotension
Weight gain, which can be substantial
Hypersalivation
Seizures, especially with high doses or fast titrations
Metabolic problems, including diabetes and hyperlipidemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

benefits of atypicals

A

Cause fewer EPS, little-to-no TD
Improve positive symptoms
Improve negative and cognitive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

blocking 5HT2A receptor

A

disinhibits DA release and reduces D2 blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

indications of atypical anatipsychotics

A 
Psychotic disorders
Mood disorders
? Dementia
Psychosis secondary to medical conditions, medications, and drugs of abuse
Personality disorder
Obsessive-compulsive disorder
Autism
Tourette’s disorder
**Mania
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

atypical agents

A
  • pine
  • zine
  • done (risperidone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

aripiprazole

A

D2 partial agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

metabolic side effects of atypicals

A 
weight gain
hyperlipidemia
hyperglycemia
diabetes
ketoacidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

metabolic syndrome (Syndrome X)

A

central obesity
high PB high triglycerides
low HDL-cholesterol
insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

CATIE trial

A

atypicals vs. perphenazine.

found to be equally effective

olanzapine more efficacious but worst for weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

mania symptoms

A

Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Attention is easily drawn to unimportant or irrelevant items
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

depression symptoms

A

Depressed mood most of the day, nearly every day,
Markedly diminished interest or pleasure in all, or almost all, activities most of the day
Significant weight loss when not dieting or weight gain or decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Definition of Mood stabilizer

A

efficacy in at least one of the three phases of bipolar disorder (acute mania, acute depression, or prophylaxis), AND it should not cause affective switch to the opposite mood state nor should it worsen the acute episode.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Indications for mood stabilizers

A 
Bipolar Disorder: Mania/Hypomania, Depression, Prophylaxis, Cyclothymia 
Depression Augmentation
Schizoaffective Disorders
Borderline Personality Disorder
Intermittent Explosive Disorder
Post-Traumatic Stress Disorder
Neuropathic Pain
Alcohol Detoxification
Refractory Schizophrenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Lithium formulations

A

Li2CO3
LiCl
LiCitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Lithium mechanism

A

Thought to involve modulation of second messenger systems, particularly in phosphatidyl inositol system
Alteration of G proteins, signal tranduction
Alteration downstream enzymes
Regulation of gene expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Lithium first-line indications

A

Classic euphoric mania
Pure bipolar depression
Bipolar maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Lithium second-line indications

A

Mixed mania

Rapid cycling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Lithium adverse effects

A 
GI
abdominal cramps, nausea, vomiting, diarrhea
Neurologic
cognitive dulling, decreased creativity
tremor
decreased memory and concentration
Metabolic
weight gain
increased thirst and urination
Dermatologic
Psoriasis, acne
Benign leukocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Lithium: medically serious side effects

A 
Hypothyroidism
Renal polyuria and polydipsia (nephrogenic diabetes insipidus
Nephrotoxicity (long-term)
Cardiac arrhythmias
Teratogenicity: Ebstein’s anomaly
Overdose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Lithium therapeutic levels

A

0.8-1.2 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Lithium Toxicity

A

1.5 + mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

lithium management issues

A

requires blood monitoring

significant drug-drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

lithium interactions

A

NSAIDs
Thiazide diuretics
ACE Inhibitors
Calcium channel blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

valproic acid proposed mechanism

A

Proposed: Inhibition of Na+/Ca++ channels, thereby boosting GABA inhibition and decreasing glutamatergic excitation

52
Q

valproic acid first-line indications

A

Mixed (dysphoric) mania

Rapid cycling

53
Q

valproic acid second-line indications

A

Pure depressive states

Classic euphoric mania

54
Q

valproic acid adverse effects

A 
Dyspepsia and diarrhea
Sedation
Dizziness
Increased appetite and weight gain
Tremor
Edema
Neurotoxicity (cognitive blunting, ataxia)
Hair loss
55
Q

valproic acid serious adverse effects

A 
Thrombocytopenia
Hepatotoxicity
Pancreatitis
Polycystic Ovarian Syndrome?
Teratogenicity: Neural tube defects
Overdose
56
Q

carbamazepine mechanism

A

Proposed: Effects at Na+/K+ channels, enhancement of GABA inhibition

57
Q

carbamazepine indications

A

bipolar disorder: mixed mania, rapid cycling

58
Q

carbamazepine indications

A 
Nausea, anorexia, vomiting
Sedation
Dizziness
Cognitive dulling
Electrolyte abnormalities
Anticholinergic effects
59
Q

carbamazepine =

A

tegretol

60
Q

carbamazepine medically serious side effects

A

Hematologic (thrombocytopenia, agranulocytosis, aplastic anemia)
Hepatotoxicity
Allergic reactions, rash
Teratogenicity: Neural tube defects, craniofacial abnormalities
Overdose

61
Q

oxcarbazepine description

A

Metabolite of carbamazepine
Fewer drug-drug interactions, toxicities as compared to carbamazepine
Does not require therapeutic blood monitoring

62
Q

Lamotrigine =

A

lamictal

63
Q

lamotrigine mechanism

A

Inhibits Na+, glutamate

64
Q

lamotrigine indication

A

maintenance (FDA), depression

65
Q

lamotrigine adverse effects

A

Nausea, vomiting, diarrhea
Sedation, lightheadness, tremor
Cognitive blunting
Weight gain less of an issue than with the others

66
Q

lamotrigine serious adverse effects

A

Rash, common, 8-10%, usually benign
but can progress to..
Stevens-Johnson Syndrome, 0.08%, potentially life threatening rash that can lead affect multiple organs

67
Q

Stevens-Johnson rash management

A

Rapid increases in dose correlated with rash
Careful titration
Hold drug, at sign of serious rash
Watch for drug interactions

68
Q

gabapentin =

A

neurontin

69
Q

gabapentin description

A

Mechanism: Unclear; GABA analogue, decreases glutamate
Not effective as monotherapy
Has anxiolytic, analgesic properties
Well tolerated

70
Q

topiramate =

A

topamax

71
Q

topiramate description

A

Mechanism: Unclear; Inhibits Na+ and Ca++ channels, inhibits glutamate and enhances GABA
Not effective as monotherapy
Has weight loss effects
Significant sedation, cognitive dulling

72
Q

other bipolar agents

A 
Atypical Antipsychotics
Typical Antipsychotics
Omega 3 Fatty Acids?
Calcium Channel Blockers?
Benzodiazepines
73
Q

TCA actions

A

antagonism at 5HT and NE presynaptic reuptake pumps

74
Q

why are TCA’s dirty?

A

also block muscarinic, alpha-adrenergic, and histamine receptors

75
Q

how long do TCA’s take to work?

A

3-4 weeks

76
Q

are TCA’s lethal in overdose?

A

yes

77
Q

amitriptyline (elavil)

A

TCA- for pain, headache, insomnia

78
Q

clomipramine (anafranil)

A

highly serotonergic TCA

indicated for OCD

79
Q

nortriptyline (Pamelor)

A 
demethylated imipramine (secondary amine)
least orthostasis of TCA's
80
Q

indications for TCA’s

A 
major depressive disorder
bipolar depression
dysthymia
panic disorder
generalized anxiety disorder
OCD
pain disorder
81
Q

contraindications for TCA’s

A

cardiac conduction delays

arrhythmias

82
Q

adverse effects of TCA’s

A 
anticholinergic
sedation
weight gain
orthostatic hypotension
sexual dysfunction
mania (bipolar)
seizures

serious:
cardiotoxicity
neurotoxicity

83
Q

MAOI mechanism

A

irreversible monoamine oxidase inhibitors

disables monoamine degradation

84
Q

which MAO blockage is necessary for antidepressant effect?

A

MAO A

85
Q

do MAOIs block any other receptors?

A

alpha 1 adrenergic receptors

histamine receptors

86
Q

serious adverse effects of MAOIs

A

tyramine-induced hypertensive crisis

87
Q

SSRI’s mechanism

A

selective antagonism at 5HT reuptake pumps

88
Q

when do SSRI’s take effect?

A

3-4 weeks of administration

89
Q

SSRI major plus

A

well tolerated, widely indicated

90
Q

SSRI contraindications

A

co-administration w/ MAOI’s

91
Q

serotonin syndrome

A

associated w/ hyperthermia, myoclonus, autonomic instability, rigidity, coma, death

need MAOI washout of 2 weeks prior to SSRI treatment

92
Q

serotonergic side effects- 5HT3

A

GI system: diarrhea, nausea, vomiting

93
Q

serotonergic side effects- 5HT2C

A

CNS: anxiety and mental agitation

94
Q

serotonergic side effects- 5HT2A

A

CNS: akathisia, insomnia, myoclonus, sexual dysfunction

95
Q

serotonin discontinuation syndrome

A

headache, dizziness, irritability, fatigue

upon abrupt discontinuation

96
Q

SNRI mechanism

A

selective antagonism at NE and 5HT presynaptic reuptake pumps

97
Q

curvilinear dose response of SNRI

A

additional dopamine reuptake inhibition at higher dosages

98
Q

SNRI contraindications

A

co-administration w/ MAOIs

99
Q

SNRI indications

A

major depressive disorder
generalized anxiety disorder
panic disorder
generalized social phobia

100
Q

NaSSAs mechanism

A

dual mechanism of action

antagonism at central alpha-2 autoreceptors (disinhibition of NE and 5HT release)
stimulation of alpha-1 somatodendritic receptors on serotonin neurons, boosting 5HT release

101
Q

NaSSA agent

A

mirtazapine (Remeron)

102
Q

indications of NaSSA

A

major depressive disorder

103
Q

serious NaSSA adverse effect

A

agranulocytosis and other blood dyscrasias

104
Q

SARIs mechanism

A

selective antagonism at 5HT presynaptic reuptake pumps w/ simultaneous 5HT2A blockade

105
Q

SARI indications

A

major depressive disorder

dysthymia

106
Q

trazodone (type, adverse effect)

A

SARI

priapism (rare)

107
Q

nefazodone (type, adverse effect)

A

SARI

liver toxicity

108
Q

bupropion (wellbutrin, zyban)- type

A

noradrenergic and dopaminergic reuptake inhibitor

109
Q

bupropion indications

A 
major depressive disorder
dysthymia
bipolar depression
ADHD
smoking cessation
110
Q

bupropion contraindications

A

co-administration w/ MAOI’s
anorexia nervosa
bulimia nervosa
seizure disorder

111
Q

bupropion adverse effects

A 
activation
insomnia
nausea
tremor
seizures at higher doses
112
Q

benzodiazepines action

A

increased frequency of GABA receptor open- hyper polarizes cell by Cl influx

113
Q

why are benzo’s used in detoxification in sedative and alcohol addiction?

A

they are cross tolerant with alcohol and barbiturates

114
Q

which benzo’s don’t undergo Phase II glucuronidation

A

lorazepam
oxazepam
temazepam

115
Q

alprazolam (Xanax)

A

perhaps greater addictive potential, but very effective for panic

116
Q

lorazepam (ativan)

A

available in PO, IM, and IV forms

widely used

117
Q

clonezepam (kloponin)

A

long half life, most potent

118
Q

diazepam (valium)

A

fast onset but w/ active metabolite

119
Q

chlordiazepoxide (librium)

A

used for alcohol detox

120
Q

how to counteract benzo overdose

A

flumazenil

121
Q

nonbenzodiazepine anxiolytics

A

various forms and mechanisms, generally non-addictive

122
Q

buspirone

A

5HT1A agonist, effective in anxiety

no sedationor addictive potential of benzos

123
Q

benzo withdrawal toxicity

A

potentially lethal

anxiety, insomnia, restlessness, agitation, irritability, muscle tension

124
Q

nonbenzodiazepine hypnotics

A

indicated for insomnia

125
Q

ramelteon (rozerem)

A

agonist at melatonin receptors, thought to normalize circadian rhythms

Neuro (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions