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USMLE Step 1 > Psych Drugs > Flashcards

Psych Drugs Flashcards

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USMLE® Step 1 flashcards
1
Q

Rx for Alcohol Withdrawal

A

Benzodiazpines

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2
Q

Tx: Anxiety

A

SSRIs, SNRIs, buspirone

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3
Q

Tx for ADHD

A

Methylphenidate, amphetimines

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4
Q

Tx for Bipolar Disorder

A

“Mood stabilizers” (e.g. lithium, valproic acid, carbamazepine), atypical antipsychotics

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5
Q

Tx for Bulimia

A

SSRIs

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6
Q

Tx for Depression

A

SSRIs, SNRIs, TCAs, buspirone, mirtazapine (especially with insomnia)

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7
Q

Tx for OCD

A

SSRIs, clomipramine

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8
Q

Tx for Panic Disorder

A

SSRIs, venlafaxine, benzodiazepines

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9
Q

Tx for PTSD

A

SSRIs

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10
Q

Tx for PTSD

A

SSRIs

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11
Q

Tx for Schizophrenia

A

Antipsychotics

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12
Q

Tx for Social Phobia

A

SSRIs

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13
Q

Tx for Tourette’s Syndrome

A

Antipsychotics (e.g haloperidol)

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14
Q

CNS Stimulants

A

Methylphenidate, Dextroamphetamine, Methamphetamine

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15
Q

CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Mechanism

A

Increase catecholamines at synaptic cleft, especially NE and dopamine

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16
Q

CNS Stimulants (methylphenidate, dextroamphetamine, methamphetamine): Clinical Use

A

ADHD, narcolepsy, appetite control

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17
Q

Antipsychotics (typical)

A

Haloperidol, Trifluoperazine, Fluphenazine, Thioridazine, Chlorpromazine,

Haloperidol + (“-azines”)

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18
Q

Typical Antipsychotics (“-azines”+ haloperidol) : Mechanism

A

Block D2 receptors (increase cAMP)

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19
Q

High potency typical antipsychotics

A

Trifluoperazine, Fluphenazine, Haloperidol

Try to Flying High
* associated with extrapyramidal effects

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20
Q

Typical Antipsychotics (“-azines + haloperidol): Clinical Use

A

Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette’s syndrome

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21
Q

Low potency antipsychotics

A

Chlopromazine, Thioridazine

(Cheating Leaves are low)
* associated with non-neurological side effects (anti-cholinergic, antihistamine, and alpha-1 blockade)

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22
Q

Typical antipsychotics (“-azines”+ haloperidol): Toxicity

A

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

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23
Q

Extrapyramidal effects associated with which typical antipsychotics?

A

Trifluoperazine, Fluphenazine, Haloperidol

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24
Q

Specific side effect for Chlorpromazine (typical antipsychotics)?

A

Corneal deposits

“C”hlorpromazine – “C”orneal deposits

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25
Q

Specific side effect for Thioridazine (typical antipsychotic)?

A

retinal deposits

“T”hioridazine - re”T”inal deposits

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26
Q

Haloperidol side effects

A

Neuroleptic Malignant Syndrome, tardive dyskinesia

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27
Q

Evolution of EPS side effects

A

4 HOUR acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 DAY akathisia (restlessness)
4 WEEK bradykinesia (parkisonism)
4 MONTH tardive dyskinesia

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28
Q

Neuroleptic Malignant Syndrome

A

Associated with typical antipsychotics

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

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29
Q

Tx for Neuroleptic Malignant Syndrome

A

Dantrolene, D2 agonists (e.g. bromocriptine)

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30
Q

Tardive dyskinesia

A

Stereotypic oral-facial movements as a result of long-term antipsychotic use. Often irreversible

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31
Q

Mneumonic for NMS symptoms

A 
Think "FEVERS"
F-ever
E-ncephalopathy
V-itals unstable
E-levated enzymes
R-igidity of muscles
32
Q

Atypical antipsychotics

A

Olanzapine, Clozapine, Quetiapine, Risperidone, Apiprazole, Ziprasidone

33
Q

Atypical antipsychotics: Mechanism

A

Not completely understood. Varied effects on 5-HT2, dopamine, alpha and H1 receptors

34
Q

Atypical antipsychotics: Clinical Use

A

Schizophrenia - both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette’s syndrome

35
Q

Atypical antipsychotics: Toxicity

A

Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics

36
Q

Side effects for Olanzapine/Clozapine

A

May cause significant weight gain

37
Q

Side effects for clozapine

A

May cause agranulocytosis (requires weekly WBC monitoring) and seizure

38
Q

Side effect for Ziprasidone

A

May prolong the QT interval

39
Q

Lithium: Mechanism

A

Not established; possible related to inhibition of phosphoinositol cascade

40
Q

Lithium: Clinical Use

A

Mood stabilizer for bipolar disorder; blocks relapse and acute maniac events. Also SIADH.

41
Q

Mneumonic for Lithium

A 
LMNOP
L-ithium side effects
M-ovements
N-ephrogenic diabetes insipidus
O- HypOthyroidism (constipation, dry skin, hair loss, weight gain)
P-regnancy problems
42
Q

Lithium Toxicity

A

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis

43
Q

Teratogenic effects for lithium

A

Fetal cardiac defects

  • Ebstein’s anomaly (atrialized right ventricle)
  • Malformation of great vessels
44
Q

Excretion of Lithium

A

Almost excreted exclusively by the kidneys; most is reabsorbed at the proximal convoluted tubules following Na reabsorption

45
Q

Buspirone: Mechanism

A

Stimulates 5-HT1A receptors

46
Q

Buspirone: Clinical Use

A

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)

47
Q

SSRIs

A

Fluoxetine, Paroxetine, Sertaline, Citalopram

“Fl”ashbacks “Par”alyze “Se”nior “Cit”izens

48
Q

SSRIs: Mechanism

A

Serotonin-specific reuptake inhibitors

49
Q

SSRIs: Clinical Use

A

Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD

*It normally takes 4-8 weeks for antidepressants to have an effect”

50
Q

SSRIs: Toxicity

A

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)
51
Q

Serotonin syndrome

A

Combination of drugs that raise serotonin levels (e.g. SSRIs, MOAis, SNRIs) - can cause hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures

52
Q

Treatment for SSRI Toxicity

A

Cyproheptadine (5-HT2 receptor antagonist)

53
Q

SNRIs

A

Venlafaxine, duloxetine

54
Q

SNRIs: Mechanism

A

Inhibit serotonin and NE reuptake

55
Q

SNRIs: Clinical Use

A

Depression. Venlafaxine is also used in generalized anxiety and panic disorder

56
Q

Aside from depression, duloxetine is used to treat what?

A

Duloxetine is indicated for diabetic peripheral neuropathy. It has greater effect on NE.

57
Q

SNRIs: Toxicity

A

Increase in BP in most common; Also stimulant effects, sedation, nausea

58
Q

Tricyclic Antidepressants:

A

Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine

(Except for doxepin, amoxapine, TCAs end in “-yline” and “-mine”)

59
Q

TCAs (“-iptyline” and “-amine”): Mechanism

A

Block reuptake of NE and serotonin

60
Q

TCAs (“-iptyline” and “-amine”): Clinical Use

A

Major depression. Bedwetting (imipramine), OCD (clomipramine), fibromyalgia

61
Q

TCAs (-itpyline and -amine): Toxicity

A

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.

62
Q

Desmipramine: Side effects

A

Is less sedating than other TCAs and has higher seizure threshold

63
Q

TCAs Toxicity (Mneumonic)

A

“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)

64
Q

Treatment for TCA toxicity

A

Sodium bicarbonate for cardiotoxicity

65
Q

Monoamine Oxidates (MAO) inhibitors

A

Trancyclopromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).

“MAO” “T”akes “P”ride “I”n “S”hanghai

66
Q

MAO Inhibitors

A

Non-selective MAO inhibition increases levels of amine neurotransmitters (NE, serotonin, dopamine)

67
Q

MAO Inhibitors: Clinical Use

A

Atypical depression, anxiety, hypochrondriasis

68
Q

MAO Inhibitors: Toxicity

A

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

69
Q

Atypical antidepressants

A

Buproprion, Mirtazapine, Maprotiline, Trazodone

70
Q

Bupropion: Clinical Use

A

Also used

for smoking cessation. Increases NE and dopamine via unknown mechanism

71
Q

Bupropion: Toxicity

A 
Stimulant effects (tachycardia, insomnia) headache, seizure in bulimic patients.
No sexual side effects
72
Q

Mirtazapine: Mechanism

A

A-2 antagonist (increase release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist

73
Q

Mirtazapine: Toxicity

A

Sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may desirable in elderly or anorexic patients), dry mouth

74
Q

Maprotiline

A

Blocks NE reuptake

75
Q

Maprotilline: Toxicity

A

Sedation, Orthostatic Hypotension

76
Q

Trazodone: Mechanism

A

Primarily inhibits serotonin reuptake. Primarly used for insomnia, as high doses are needed for antidepressant effects

77
Q

Trazodone: Toxicity

A

Sedation, nausea, priapism, postural hypotension

Called trazo”bone”due to male-specific side effects

USMLE Step 1 (34 decks)

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