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Psych drugs Flashcards

1
Q

Haloperidol

A

Typical antipsychotic - block D2 receptors
-Treat schiozphrenia, psychosis, bipolar, delirium, etc.
High potency –> EPS

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2
Q

pimozide

A

Typical antipsychotic - block D2 receptors

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3
Q

Trifluoperazine

A

Typical antipsychotic - block D2 receptors

-High potentcy –> EPS

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4
Q

Fluphenazine

A

Typical antipsychotic - block D2 receptors

  • High potentcy –> EPS
  • tourette syndrome
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5
Q

Thioridazine

A

Typical antipsychotic - block D2 receptors

-low potency so more anticholinergic, antihistamine, and alpha 1 blockade effects

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6
Q

Chlorpromazine

A

Typical antipsychotic - block D2 receptors

-low potency so more anticholinergic, antihistamine, and alpha 1 blockade effects

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7
Q

Atypical antipsychotics uses

A

schizophrenia, psychosis, bipolar, delirium, tourette syndrome, huntington disease, OCD

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8
Q

Atypical antipsychotics adverse effects

A

EPS - ADAPT (acute dystonia, akathsia, parkinsonism, Tardive dyskinesia
NMS - neuroleptic malignant syndrome
Endocrine: galactorrhea, oligomenorrhea, gynecomastia
Metabolic: dyslipidemia, weight gain, hyperglycemia
Antimuscarinic: dry mouth, constipation, urinary retention
Antihistamine: sedation
Alpha 1 block: orthostatic hypotension

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9
Q

Neuroleptic malignant syndrome: presentation and treatment

A

cause= typical anti-psychotics
Presentation: muscle rigidity, diaphoresis, hyperpyrexia, ANS instability, SEVERE (10% fatal)
Treat: dantrolene (muscle relaxor) + bromocriptine (DA agonist)

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10
Q

Aripiprazole

A

Atypical antipsychotic
-Partial D2 agonist
reduce positive and negative symtpoms

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11
Q

Asenapine

A

Atypical antipsychotic
-D2 antagonist, effects on 5HT2, H1, alpha
Adverse effects: metabolic syndrome (pines)

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12
Q

Clozapine

A

Atypical antipsychotic

  • D2 antagonist, effects on 5HT2, H1, alpha
  • used for treatment resistant schizophrenia or schizoaffective d/o and suicidality in schizophrenia
  • Adverse effects: agranulocytosis (must monitor WBCs), and seizures (dose related), obesity
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13
Q

Olanzapine

A

Atypical antipsychotic
-D2 antagonist, effects on 5HT2, H1, alpha
Adverse effects: metabolic syndrome (pines), obesity

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14
Q

Quetiapine

A

Atypical antipsychotic
-D2 antagonist, effects on 5HT2, H1, alpha
Adverse effects: metabolic syndrome (pines)

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15
Q

Iloperidone

A

Atypical antipsychotic

-D2 antagonist, effects on 5HT2, H1, alpha

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16
Q

paliperidone

A

Atypical antipsychotic

-D2 antagonist, effects on 5HT2, H1, alpha

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17
Q

risperidone

A

Atypical antipsychotic
-D2 antagonist, effects on 5HT2, H1, alpha
Adverse affects: hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)
-tourette syndrome

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18
Q

Lurasidone

A

Atypical antipsychotic

-D2 antagonist, effects on 5HT2, H1, alpha

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19
Q

Atypical antipsychotic clinical uses

A

Schizophrenia (+/- symtpoms)

Bipolar Disorder, OCD, anxiety disorder, depression, maina, tourette syndrome

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20
Q

Atypical antispychotic adverse effect profile

A

prolonged QT interval, fewer EPS and anticholinergic effects compared to typicals
Pines: metbaolic syndrome
clozapine: agranulocytosis, seizures
Risperidone: hyperprolactinemia

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21
Q

Benzodiazepines mechanism of action

A

facilitate GABAa action by increasing frequency of CL- channel opening. leads to increased GABAergic inhibition

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22
Q

Clinical uses of benzodiazepines

A

Anxiety, spasticity, status epilepticus, insomnia, muscle relaxant, sedation for minor procedures, eclampsia, delirum tremens/alcohol withdrawal trt., night terrors, sleep walking,

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23
Q

Benzodiazepine adverse effects

A

dependence, CNS depression with alcohol

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24
Q

Flumazenil

A

Competitive Antagonist of GABA-R
antagonizes BZs and ZZZ drugs
Treats benzo overdose
Can precipitate seizure froma cute benzo withdrawal

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25
Oxazepam
Short acting benzodiazepine (higher addiction potential) | Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism
26
Midazolam
Short acting benzodiazepine (higher addiction potential)
27
Alprazolam
Short acting benzodiazepine (higher addiction potential)
28
Triazolam
Short acting benzodiazepine (higher addiction potential)
29
Temazepam
Benzodiazepine | Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism
30
Lorazepam
Benzodiazepine | Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism
31
Zolpidem Zaleplon eszopiclone (mechanism, use, adverse effects)
Act via BZ1 GABA receptor subtype. used to treat Use: insomnia Adverse effects: ataxia, headaches, confusion. rebound insomnia at high doses (zol+zal) . few amnestic effects and lower risk of dependency than benzos. short acting because rapid metabolism by liver enzymes
32
Ramelton Tasimelton (mechanism, use, adverse effects)
melatonin receptor agonists (binds MT1 and MT2 in suprachiasmatic) Clinical use: insomnia Adverse effects: dizziness, nausea, fatigue, headache No dependence
33
Suvorexant | mechanism, use, adverse effects
Orexin receptor antagonist (OX1, OX2) - orexin involved in wake pathway “Sleep driving”, amnestic effects solmolence, headache, dizziness, abnormal dreams, URTI contraindications: narcolepsy, strong CYP3A4 inhibitors
34
Buspirone
Partial 5-HT agonist 2nd line for GAD Adverse effects: Nausea, abdominal pain, drowsiness, dizziness Inconsistent long term efficacy takes 2 weeks to exert effect → NOT for acute anxiety
35
Pregabalin
+presynaptic GABA release by binding voltage gated Ca channels leading to Ca influx +GABA biosynthesis Adverse effects: Lower dependence risk than BZs Abrupt discontinuation → withdrawal → anxiety, nervousness, irritability
36
Hydroxyzine
H1 antihistamine 5-HT antagonist Use: GAD Adverse effects: Antihistamine, anticholinergic, antidopaminerigic →solmnolence, dry mouth, GI disturbances, blurred vision, dyskinesias
37
Fluoxetine
SSRI Additional use: ADHD (adults), bulimia nervosa active metabolite has long 1/2 life (7-9 days) so wait a bit before switching to MAOIs to prevent serotonin syndrome Cyp inhibitor (affects TCAs and haloperidol, risperidone, codeine, beta blockers)
38
Fluvoxamine
SSRI
39
Paroxetine
``` SSRI Cyp inhibitor (affects TCAs and haloperidol, risperidone, codeine, beta blockers) ```
40
sertraline
SSRI
41
escitalopram
SSRI
42
Citralopram
SSRI
43
SSRI mechanism
Block 5-HT reuptake
44
SSRI indications
Depression, GAD, OCD, PD, OCD, PTSD, SAD, bulimia, PMDD, premature ejaculation
45
SSRI adverse effects
insomnia, sexual dysfunction (anorgasmia, low libido), SIADH, extrapyramidal effects (early in treatment), seizures (Overdose) Serotonin syndrome when combine with MAOIs,
46
Venlafaxine
SNRI | Additional indications: OCD, PD, PTSD, SAD
47
Duloxetine
SNRI | Additional indications: fibromyalgia
48
desvenlafaxine
SNRI
49
Levomilnacipran
SNRI
50
Milnacipran
SNRI
51
SNRI mechanism of action
inhibit 5-HT and NE reuptake
52
Clinical indications of SNRIs
``` MDD, Chronic pain, GAD menopausal symptoms Diabetic Neuropathy Ven: SAD, PD, PTSD, OCD Dul: fibromyalgia ```
53
SNRI side effects
Same as SSRIs + increased BP, stimulant effects, sedation, anticholinergic effects
54
TCA mechanism
Block 5-HT and NE reuptake Post-synaptic alpha1 antagonist
55
TCA clinical use
MDD, peripheral neuropathy, chronic pain, migraine prophylaxis Imipramine: mocturnal enuresis Clomipramine: OCD
56
Amitriptyline
TCA (tertiary) | anticholinergic effects - can be used for insomnia
57
Adverse effects of TCAs
orthostatic hypotension (alpha), muscarinic block (tachycardia, urinary retention, dry mouth), sedation, weight gain, prolonged QT interval, arrhythmias (treat with NaHCO3), seizures, respiratory depression, hyperpyrexia Confusion and hallucinations in elderly patients “Tri-Cs → convulsion, coma, cardiotoxicity”
58
nortriptyline
TCA (secondary) | less anticholinergic effects so better tolerated in the elderly
59
imipramine
TCA Additional use: nocturnal enuresis (ima pee)
60
Desipramine
TCA
61
Clomipramine
TCA
62
Doxepin
TCA | H1 antagonist effects -->also used for insomnia
63
Amoxapine
TCA
64
MAOI mechanism
nonselective MAO inhibition leading to decreased breakdown of NE, 5-HT, and DA
65
MAOI clinical use
atypical depression, anxiety | Selegiline: parkinsons
66
Transcyclopromine
MAOI | reversible
67
Phenelzine
MAOI | irreversible
68
Isocarboxazid
MAOI
69
Selegiline
MAOI (MAO-B selective) | Treats parkinsons as well because MAO-B specific for DA
70
MAOI adverse effects
hypertensive crisis with tyramine containing foods, CNS stimulation - agitation, convulsions, hyperthermia, orthostatic hypotension serotonin syndrome
71
MAOI contraindications
SSRIs TCAs, st. johns wort, meperidine, dextromethorphan | can lead to serotonin syndrome
72
Trazodone
Atypical antidepressant blocks 5HT2, alpha1, and H1 receptors Use: mainly insomnia (traZZZodone), high dose for MDD Adverse effects: priapism (tazoBONE), postural hypotension, sedation
73
Nefazodone
Atypical antidepressant blocks 5HT2, alpha1, and H1 receptors Use: depression, insomnia Adverse effects: black box warning for hepatotoxicity
74
Bupropion
Atypical antidepressant Inhibits DA and NE reuptake Uses: smoking cessation, depression, ADHD (adults) Adverse effects: stimulant effects (tachycardia, insomnia), headache, seizures (in bulimia/anorexic patients or overdose) favorable sexual effect profile
75
Mirtazapine
atypical antidepressant presynaptic a2 autoreceptor antagonist→ increased NE and 5-HT release. Also 5-HT2, 5-HT3, H1 antagonist Use: Depressed patients (with insomnia, or anorexia) Adverse effects: Sedation, increased appetite, weight gain, dry mouth (open your eyes and look in the mirror)
76
Varenicline
Atypical antidepressant Nicotinic ACh-R partial agonist Use: smoking cessation Toxicity: sleep disturbance, depressed mood (Nicline - nicotine craving decline)
77
Vilazodone
Atypical anti-depressant inhibit 5-HT reuptake, 5-HT1a partial agonist Use: MDD Adverse effects: weight gain, anticholinergic, serotonin syndrome
78
Vortioxetine
Atypical anti-depressant inhibit 5-HT reuptake, 5-HT1a partial agonist, 5-HT3 antagonist Use: MDD Adverse effects: sleep disturbance,s exual dysfunction, serotonin syndrome
79
Lithium (mechanism,clinical use, adverse effects)
Mechanism: not established but possibly from phosphoinositol cascade inhibition. Use: mood stabilizer - bipolar disorder, acute manic episodes Adverse effects: Low Thyroid Heart (ebstein anomaly) Insipidus (nephrogenic diabetes insipidus) Unwanted Movement (tremor) Monitor - narrow therapeutic window Almost exclusively excreted by kidneys, reabsorption in PCT - thiazides can cause toxicity
80
Methadone -use and pharmacokinetics
long acting oral opiate Use: heroin detox/ long term maintenance therapy, NOWS treatment, opiate addicted pregnant women Pharm: longer duration of action with blunted peak effect. less severe withdrawal effects
81
Buprenorphine
Sublingual partial mu agonist of (opioid receptor). Use: maintenance therapy Often combined with naloxone to prevent abuse if injected
82
Naltrexone
IM/nasal spray Long acting opioid | Use: acute overdose in unconscious individual, relapse prevention post-detox
83
Morphine
mu agonist Use: acute pain, MI, angina, pulmonary edema, cancer patients Pharm: slow onset, long duration CI: head injury
84
Fentanyl
``` mu agonist regional anesthesia (spinal/epidural), cancer patients, labor pain Pharm: fast onset, short duration. 100x more potent than morphine ```
85
Oxycodone/hydrocodone
oral mu agonist use: moderate/chronic pain can be combined with acetiminophen (warn patients about toxicity)
86
Codeine/ Dextromorphan
``` mu agonist (D-isomer) cough supressant ```
87
Heroin
pain management in some countries | Associated morbidity: HIV, endocarditis, syphilis, osteomyelitis, hepatitis
88
Methylphenidate
Stimulant blocks DA and NE reuptake Use: ADHD (Ritalin), narcolepsy
89
Nonstimulant ADHD medications
atomoxetine, guanfacine, clonidine
90
Dextroamphetamine
stimulant - mixed amphetamine salts (adderall) block DA reuptake. also acts as DA transporter substrate to thenblock VMAT storage vesicles which leads to increased release of presynaptic DA and NE Use: ADHD, narcolepsy, wt. control
91
Atomoxetine
NE reuptake inhibitor | Use: ADHD (in adults because 2+ week lag for effects to appear)
92
Guanfacine
alpha2 agonist Use: ADHD stimulates receptors in prefrontal cortex to enhance executive functions, attentiveness, and working memory
93
Clonidine
alpha2 agonist Use: ADHD stimulates receptors in prefrontal cortex to enhance executive functions, attentiveness, and working memory
94
Nitrous Oxide
``` Inhaled anesthetic only gaseous agent low potentcy and usually used in addition to other agents good amnestic and analgesic actions Lowest solubility, so fastest onset ```
95
Isoflurane
``` Inhaled anesthetic volatile used for maintenance induction in pediatrics highest solubility, so slowest onset ```
96
Sevoflurane
``` Inhaled anesthetic volatile used for maintenance induction in pediatrics fastest metabolism, but little effect on emergence ```
97
Desflurne
Inhaled anesthetic volatile used for maintenance induction in pediatrics
98
Propofol
IV anesthetics lipophilic, partitions into highly perfused lipophilic tissues (brain, spinal cord), rapid onset + elimination rapid elimination -induction and maintenance of GA. also sedation -Use within 8 hours of dispensing because bacterial contamination -GABA agonist, Non-analgesic, amnestic, antiemetic in small doses Adverse effects: vasodilation, negative inotropy, decreased Vt, RR, minute volume, and upper airway refleces
99
Etomidate
IV anesthetics lipophilic, partitions into highly perfused lipophilic tissues (brain, spinal cord), rapid onset+ elimination Use: induction and short sedation MINIMAL hemodynamic effects GABA agonist, non-analgesic Adverse effects: potential endocrine effects (negative effect on cortisol production) which prevents prolonged sedation use, respiratory depression burns on injection, and asosciated with post operative N/V
100
Ketamine
IV anesthetics lipophilic, partitions into highly perfused lipophilic tissues (brain, spinal cord), rapid onset+ elimination -causes dissociative amnesia w/ nystagmus (how you know its working) NMDA receptor antagonist ANALGESIC INCREASES HR, BP, CO increased lacrimation and secretions Minimal respiratory depression Co-administration with benzos suggested to prevent subanalgesic doses can assit opioid tolerance and treatment resistant depression
101
Dexmedetomidine
``` IV anesthetics sedation or adjunct to GA sedative and analgesic Alpha 2 agonist (target locus cereleus and spinal cord) preserves respiratory drive DECREASES BP and HR ```

Pharmacology (7 decks)

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