Psych Drugs Flashcards
Rx for Alcohol Withdrawal
Benzodiazpines
Tx: Anxiety
SSRIs, SNRIs, buspirone
Tx for ADHD
Methylphenidate, amphetimines
Tx for Bipolar Disorder
“Mood stabilizers” (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics
Tx for Bulimia
SSRIs
Tx for Depression
SSRIs, SNRIs, TCAs, buspirone, mirtazapine (especially with insomnia)
Tx for OCD
SSRIs, clomipramine
Tx for Panic Disorder
SSRIs, venlafaxine, benzodiazepines
Tx for PTSD
SSRIs
Tx for PTSD
SSRIs
Tx for Schizophrenia
Antipsychotics
Tx for Social Phobia
SSRIs
Tx for Tourette’s Syndrome
Antipsychotics (e.g haloperidol)
CNS Stimulants
Methylphenidate, Dextroamphetamine, Methamphetamine
CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Mechanism
Increase catecholamines at synaptic cleft, especially NE and dopamine
CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Clinical Use
ADHD, narcolepsy, appetite control
Antipsychotics (typical)
Haloperidol, Trifluoperazine, Fluphenazine, Thioridazine, Chlorpromazine,
Haloperidol + (“-azines”)
Typical Antipsychotics (“-azines”+ haloperidol) : Mechanism
Block D2 receptors (increase cAMP)
High potency typical antipsychotics
Trifluoperazine, Fluphenazine, Haloperidol
Try to Flying High
* associated with extrapyramidal effects
Typical Antipsychotics (“-azines + haloperidol): Clinical Use
Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette’s syndrome
Low potency antipsychotics
Chlopromazine, Thioridazine
(Cheating Leaves are low)
* associated with non-neurological side effects (anti-cholinergic, antihistamine, and alpha-1 blockade)
Typical antipsychotics (“-azines”+ haloperidol): Toxicity
Highly lipid soluble and stored in body fats; thus very slow to be removed from body
Endocrine side effects (e.g. dopamine receptor antagonism –> hyperprolactinemia –> galactorrhea)
Side effects arising from muscarinic blockage (dry mouth, constipation); alpha-1 blockade (hypotension) and histamine (sedation) receptors
Extrapyramidal effects associated with which typical antipsychotics?
Trifluoperazine, Fluphenazine, Haloperidol
Specific side effect for Chlorpromazine (typical antipsychotics)?
Corneal deposits
“C”hlorpromazine – “C”orneal deposits
Specific side effect for Thioridazine (typical antipsychotic)?
retinal deposits
“T”hioridazine - re”T”inal deposits
Haloperidol side effects
Neuroleptic Malignant Syndrome, tardive dyskinesia
Evolution of EPS side effects
4 HOUR acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 DAY akathisia (restlessness)
4 WEEK bradykinesia (parkisonism)
4 MONTH tardive dyskinesia
Neuroleptic Malignant Syndrome
Associated with typical antipsychotics
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia
Tx for Neuroleptic Malignant Syndrome
Dantrolene, D2 agonists (e.g. bromocriptine)
Tardive dyskinesia
Stereotypic oral-facial movements as a result of long-term antipsychotic use. Often irreversible
Mneumonic for NMS symptoms
Think "FEVERS" F-ever E-ncephalopathy V-itals unstable E-levated enzymes R-igidity of muscles
Atypical antipsychotics
Olanzapine, Clozapine, Quetiapine, Risperidone, Apiprazole, Ziprasidone
Atypical antipsychotics: Mechanism
Not completely understood. Varied effects on 5-HT2, dopamine, alpha and H1 receptors
Atypical antipsychotics: Clinical Use
Schizophrenia - both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette’s syndrome
Atypical antipsychotics: Toxicity
Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics
Side effects for Olanzapine/Clozapine
May cause significant weight gain
Side effects for clozapine
May cause agranulocytosis (requires weekly WBC monitoring) and seizure
Side effect for Ziprasidone
May prolong the QT interval
Lithium: Mechanism
Not established; possible related to inhibition of phosphoinositol cascade
Lithium: Clinical Use
Mood stabilizer for bipolar disorder; blocks relapse and acute maniac events. Also SIADH.
Mneumonic for Lithium
LMNOP L-ithium side effects M-ovements N-ephrogenic diabetes insipidus O- HypOthyroidism (constipation, dry skin, hair loss, weight gain) P-regnancy problems
Lithium Toxicity
Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis
Teratogenic effects for lithium
Fetal cardiac defects
- Ebstein’s anomaly (atrialized right ventricle)
- Malformation of great vessels
Excretion of Lithium
Almost excreted exclusively by the kidneys; most is reabsorbed at the proximal convoluted tubules following Na reabsorption
Buspirone: Mechanism
Stimulates 5-HT1A receptors
Buspirone: Clinical Use
Generalized anxiety disorder.
Does not cause sedation, addiction, or tolerance.
Takes 1-2 weeks to take effect.
Does not interact with alcohol (vs. barbituates, benzodiazepines)
SSRIs
Fluoxetine, Paroxetine, Sertaline, Citalopram
“Fl”ashbacks “Par”alyze “Se”nior “Cit”izens
SSRIs: Mechanism
Serotonin-specific reuptake inhibitors
SSRIs: Clinical Use
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD
*It normally takes 4-8 weeks for antidepressants to have an effect”
SSRIs: Toxicity
Fewer than TCAs, GI distress, sexual dysfunction (anorgasmia and decreased libido)
- When combined with SNRIs, MOA inhibitors - drugs that can raise serotonin levels can cause serotonin syndrome)
Serotonin syndrome
Combination of drugs that raise serotonin levels (e.g. SSRIs, MOAis, SNRIs) - can cause hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures
Treatment for SSRI Toxicity
Cyproheptadine (5-HT2 receptor antagonist)
SNRIs
Venlafaxine, duloxetine
SNRIs: Mechanism
Inhibit serotonin and NE reuptake
SNRIs: Clinical Use
Depression. Venlafaxine is also used in generalized anxiety and panic disorder
Aside from depression, duloxetine is used to treat what?
Duloxetine is indicated for diabetic peripheral neuropathy. It has greater effect on NE.
SNRIs: Toxicity
Increase in BP in most common; Also stimulant effects, sedation, nausea
Tricyclic Antidepressants:
Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine
(Except for doxepin, amoxapine, TCAs end in “-yline” and “-mine”)
TCAs (“-iptyline” and “-amine”): Mechanism
Block reuptake of NE and serotonin
TCAs (“-iptyline” and “-amine”): Clinical Use
Major depression. Bedwetting (imipramine), OCD (clomipramine), fibromyalgia
TCAs (-itpyline and -amine): Toxicity
Sedation, alpha-1 blocking effects including postural hypotension and atropine/anti-cholinergic side effects (tachycardia, urinary retention, dry mouth).
Tertiary TCAs (amitiptyline) have more anticholinegic effects than secondary TCAs (nortryptilline) have.
Desmipramine: Side effects
Is less sedating than other TCAs and has higher seizure threshold
TCAs Toxicity (Mneumonic)
“Tri-C’s”- “C”onvulsions, “C”omas, “C”ardiotoxicity (arrhythmias),
Also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic effects (use nortriptyline)
Treatment for TCA toxicity
Sodium bicarbonate for cardiotoxicity
Monoamine Oxidates (MAO) inhibitors
Trancyclopromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
“MAO” “T”akes “P”ride “I”n “S”hanghai
MAO Inhibitors
Non-selective MAO inhibition increases levels of amine neurotransmitters (NE, serotonin, dopamine)
MAO Inhibitors: Clinical Use
Atypical depression, anxiety, hypochrondriasis
MAO Inhibitors: Toxicity
Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS Stimulation
Contrainidicated with SSRIs, SNRIs, TCAs, St. John’s Wort, Meripirine, Dextromethorphan - to precent serotonin syndrome
Atypical antidepressants
Buproprion, Mirtazapine, Maprotiline, Trazodone
Bupropion: Clinical Use
Also used
for smoking cessation. Increases NE and dopamine via unknown mechanism
Bupropion: Toxicity
Stimulant effects (tachycardia, insomnia) headache, seizure in bulimic patients. No sexual side effects
Mirtazapine: Mechanism
A-2 antagonist (increase release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist
Mirtazapine: Toxicity
Sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may desirable in elderly or anorexic patients), dry mouth
Maprotiline
Blocks NE reuptake
Maprotilline: Toxicity
Sedation, Orthostatic Hypotension
Trazodone: Mechanism
Primarily inhibits serotonin reuptake. Primarly used for insomnia, as high doses are needed for antidepressant effects
Trazodone: Toxicity
Sedation, nausea, priapism, postural hypotension
Called trazo”bone”due to male-specific side effects
