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Pharmacology > Psych drugs > Flashcards

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
Q

Oxazepam

A

Short acting benzodiazepine (higher addiction potential)

Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism

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26
Q

Midazolam

A

Short acting benzodiazepine (higher addiction potential)

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27
Q

Alprazolam

A

Short acting benzodiazepine (higher addiction potential)

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28
Q

Triazolam

A

Short acting benzodiazepine (higher addiction potential)

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29
Q

Temazepam

A

Benzodiazepine

Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism

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30
Q

Lorazepam

A

Benzodiazepine

Can be used to treat alcohol withdrawal in patients with liver disease because minimal first pass metabolism

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31
Q

Zolpidem
Zaleplon
eszopiclone (mechanism, use, adverse effects)

A

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

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32
Q

Ramelton
Tasimelton
(mechanism, use, adverse effects)

A

melatonin receptor agonists (binds MT1 and MT2 in suprachiasmatic)
Clinical use: insomnia
Adverse effects: dizziness, nausea, fatigue, headache
No dependence

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33
Q

Suvorexant

mechanism, use, adverse effects

A

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

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34
Q

Buspirone

A

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

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35
Q

Pregabalin

A

+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

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36
Q

Hydroxyzine

A

H1 antihistamine
5-HT antagonist
Use: GAD
Adverse effects: Antihistamine, anticholinergic, antidopaminerigic →solmnolence, dry mouth, GI disturbances, blurred vision, dyskinesias

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37
Q

Fluoxetine

A

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)

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38
Q

Fluvoxamine

A

SSRI

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39
Q

Paroxetine

A 
SSRI
Cyp inhibitor (affects TCAs and haloperidol, risperidone, codeine, beta blockers)
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40
Q

sertraline

A

SSRI

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41
Q

escitalopram

A

SSRI

42
Q

Citralopram

A

SSRI

43
Q

SSRI mechanism

A

Block 5-HT reuptake

44
Q

SSRI indications

A

Depression, GAD, OCD, PD, OCD, PTSD, SAD, bulimia, PMDD, premature ejaculation

45
Q

SSRI adverse effects

A

insomnia, sexual dysfunction (anorgasmia, low libido), SIADH, extrapyramidal effects (early in treatment), seizures (Overdose)
Serotonin syndrome when combine with MAOIs,

46
Q

Venlafaxine

A

SNRI

Additional indications: OCD, PD, PTSD, SAD

47
Q

Duloxetine

A

SNRI

Additional indications: fibromyalgia

48
Q

desvenlafaxine

A

SNRI

49
Q

Levomilnacipran

A

SNRI

50
Q

Milnacipran

A

SNRI

51
Q

SNRI mechanism of action

A

inhibit 5-HT and NE reuptake

52
Q

Clinical indications of SNRIs

A 
MDD, Chronic pain, GAD
menopausal symptoms
Diabetic Neuropathy
Ven: SAD, PD, PTSD, OCD
Dul: fibromyalgia
53
Q

SNRI side effects

A

Same as SSRIs + increased BP, stimulant effects, sedation, anticholinergic effects

54
Q

TCA mechanism

A

Block 5-HT and NE reuptake

Post-synaptic alpha1 antagonist

55
Q

TCA clinical use

A

MDD, peripheral neuropathy, chronic pain, migraine prophylaxis
Imipramine: mocturnal enuresis
Clomipramine: OCD

56
Q

Amitriptyline

A

TCA (tertiary)

anticholinergic effects - can be used for insomnia

57
Q

Adverse effects of TCAs

A

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
Q

nortriptyline

A

TCA (secondary)

less anticholinergic effects so better tolerated in the elderly

59
Q

imipramine

A

TCA
Additional use: nocturnal enuresis
(ima pee)

60
Q

Desipramine

A

TCA

61
Q

Clomipramine

A

TCA

62
Q

Doxepin

A

TCA

H1 antagonist effects –>also used for insomnia

63
Q

Amoxapine

A

TCA

64
Q

MAOI mechanism

A

nonselective MAO inhibition leading to decreased breakdown of NE, 5-HT, and DA

65
Q

MAOI clinical use

A

atypical depression, anxiety

Selegiline: parkinsons

66
Q

Transcyclopromine

A

MAOI

reversible

67
Q

Phenelzine

A

MAOI

irreversible

68
Q

Isocarboxazid

A

MAOI

69
Q

Selegiline

A

MAOI (MAO-B selective)

Treats parkinsons as well because MAO-B specific for DA

70
Q

MAOI adverse effects

A

hypertensive crisis with tyramine containing foods, CNS stimulation - agitation, convulsions, hyperthermia, orthostatic hypotension
serotonin syndrome

71
Q

MAOI contraindications

A

SSRIs TCAs, st. johns wort, meperidine, dextromethorphan

can lead to serotonin syndrome

72
Q

Trazodone

A

Atypical antidepressant
blocks 5HT2, alpha1, and H1 receptors
Use: mainly insomnia (traZZZodone), high dose for MDD
Adverse effects: priapism (tazoBONE), postural hypotension, sedation

73
Q

Nefazodone

A

Atypical antidepressant
blocks 5HT2, alpha1, and H1 receptors
Use: depression, insomnia
Adverse effects: black box warning for hepatotoxicity

74
Q

Bupropion

A

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
Q

Mirtazapine

A

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
Q

Varenicline

A

Atypical antidepressant
Nicotinic ACh-R partial agonist
Use: smoking cessation
Toxicity: sleep disturbance, depressed mood (Nicline - nicotine craving decline)

77
Q

Vilazodone

A

Atypical anti-depressant
inhibit 5-HT reuptake, 5-HT1a partial agonist
Use: MDD
Adverse effects: weight gain, anticholinergic, serotonin syndrome

78
Q

Vortioxetine

A

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
Q

Lithium (mechanism,clinical use, adverse effects)

A

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
Q

Methadone -use and pharmacokinetics

A

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
Q

Buprenorphine

A

Sublingual partial mu agonist of (opioid receptor).
Use: maintenance therapy
Often combined with naloxone to prevent abuse if injected

82
Q

Naltrexone

A

IM/nasal spray Long acting opioid

Use: acute overdose in unconscious individual, relapse prevention post-detox

83
Q

Morphine

A

mu agonist
Use: acute pain, MI, angina, pulmonary edema, cancer patients
Pharm: slow onset, long duration
CI: head injury

84
Q

Fentanyl

A 
mu agonist
regional anesthesia (spinal/epidural), cancer patients, labor pain
Pharm: fast onset, short duration. 100x more potent than morphine
85
Q

Oxycodone/hydrocodone

A

oral mu agonist
use: moderate/chronic pain
can be combined with acetiminophen (warn patients about toxicity)

86
Q

Codeine/ Dextromorphan

A 
mu agonist (D-isomer)
cough supressant
87
Q

Heroin

A

pain management in some countries

Associated morbidity: HIV, endocarditis, syphilis, osteomyelitis, hepatitis

88
Q

Methylphenidate

A

Stimulant
blocks DA and NE reuptake
Use: ADHD (Ritalin), narcolepsy

89
Q

Nonstimulant ADHD medications

A

atomoxetine, guanfacine, clonidine

90
Q

Dextroamphetamine

A

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
Q

Atomoxetine

A

NE reuptake inhibitor

Use: ADHD (in adults because 2+ week lag for effects to appear)

92
Q

Guanfacine

A

alpha2 agonist
Use: ADHD
stimulates receptors in prefrontal cortex to enhance executive functions, attentiveness, and working memory

93
Q

Clonidine

A

alpha2 agonist
Use: ADHD
stimulates receptors in prefrontal cortex to enhance executive functions, attentiveness, and working memory

94
Q

Nitrous Oxide

A 
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
Q

Isoflurane

A 
Inhaled anesthetic
volatile
used for maintenance
induction in pediatrics
highest solubility, so slowest onset
96
Q

Sevoflurane

A 
Inhaled anesthetic
volatile
used for maintenance
induction in pediatrics
fastest metabolism, but little effect on emergence
97
Q

Desflurne

A

Inhaled anesthetic
volatile
used for maintenance
induction in pediatrics

98
Q

Propofol

A

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
Q

Etomidate

A

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
Q

Ketamine

A

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
Q

Dexmedetomidine

A 
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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