Psych Drugs- GOOD Flashcards
Gold standard ADHD tx?
-stimulants
methylphenidate, amphetamines
DOC for alcoholic withdraw?
Benzos
Bipolar:
What are your three treatment options?
- lithium
- valproic acid
- atypical antipsychotics
…NOT SSRIs (one of the few psych things you cannot use this for.)
DOC for schizophrenia
atypical antipsychotics
Two treatment options for tourettes:
- atypical antipsychotics (fluphenazine, pimozide)
- tetrabenazine and clonidine
Bulimia, Depression, GAD, OCD, panic disorder, social anxiety disorder & PTSD can all be treated with?
-SSRIs
may also us sNri’s except in bulimia and depression= SSRI only
Performance Social Anxiety Disorder may be treated with? (2)
- BBers
- Benzos
CNS stimulants (i.e. methylphenidate):
MOA
3 conditions for which these may be useful
^^ Dopa/ NE at synaptic cleft
-ADHD, narcolepsy, appetite control
Haloperidol + psych drugs that end in –azine are of what class?
-CLASSIC antipsychotics (neuroleptics)
Neuroleptics:
- MOA
- lipophilic or hydrophilic?
- aside from desired MOA, what other receptors in body may be targeted?
- block D2 receptors, ^^ cAMP
- lipophilic, long t1/2
- muscarinic, H1, a1 all blocked.
What are three high potency neuroleptics?
What neuroleptic ADR is highly likely when taking these drugs?
- Try to Fly High
- Trifluoperazine, fluphenazine, haloperidol = HIGH potency
- assc with extrapyramidal ADRs (i.e. parkinsonism, tardice dyskinesia)
Endocrine effects assc with neuroleptics?
Cardio?
Neuro?
- endo = gynecomastia due to ^^ PRL
- cardio= orthostatic hypoTN (a1 block), QT prolongation
- neuro= tardive dyskinesia, parkinsonism, NMS, sedation (H1 antagonism)
Chlopromazine: strange ADR
Thioridazine: strange ADR
Chlorpromazine: “C”orneal deposits
Thioridazine: re”T”inal deposits
Signs of NMS (neuroleptic malignant syndrome)?
WHAT DRUG REVERSES?
(If you don’t know this by now, you’re doomed.)
- fever, encephalopathy, rigid muscle contractures
- give them some DANTROLENE. Inhibits Ca release from SARCOPLASMIC RETICULUM.
Describe tardive kinesia assc with haloperidol and the –azine drugs (neurolpetics)
orofacial chorea
looks like bunny twitching nose
What receptors are effected by ATYPICAL antipsychotics?
-D2, 5HT2, a, H1
Which symptoms of schizo can atypical antipsychotics treat? Which can typical psychotics treat?
- atypical: positive + neg sx
- typical: positive symptoms only
What effect can all antipsychotics have on the heart? (both typical and atypical?)
QT prolongation
What do atypical anti-psychotics ending in –pine cause?
-metabolic syndrome
Special ADR assc with clozapine? olanzapine?
What kind of drugs are these and how do we know?
- end in –pine, do NOT end in –azine= atypical antipsych
- clozapine= agranulocytosis, must watch marrow CLOZEly
- all –pines can cause metabolic syndrome, but “O”lanzapine is esp known for causing “O”besity
Risperidone:
What ADR is it most known for?
What kind of psych drug is this?
How do you know?
- known for hyperprolactinemia
- you know its ATYPICAL antipsych because it sounds like one of those crazy drugs you learned in psych and it isn’t haloperidol/ doesnt end in –azine.
- also, they probably gave it to someone with psych issues in the question stem!
Lithium:
- mechanism unkown
- classically used to treat what disorder?
- Key ADRs (4)
-bipolar
-LMNOP
Lithium = Movement (tremor), Nephrogenic di, hypOthyroid, Preg problems.
**Please note: lithium +thiazide combo will ^^^ risk nephrogenic DI
Where is lithium reabsorbed in the kidney?
-PCT with Na
What birth defect is lithium assc with?
-Ebstein anomaly (tricuspid anomaly)
Buspirone: MOA Use Benefit over other treatments? Downfall?
- stimulates 5HT1a receptors
- treats GAD
- no sedation/ addiction/ tolerance/ alcohol/benzo interaction (= good choice for addicts)
- will take 1-2 weeks to begin working
List the four SSRIs
- Flashbacks Paralyze Senior Citizens
- Fluoxetine
- Paroxetine
- Sertraline
- Citalopram
How long does it take for SSRIs to begin working?
What are three ADRs worth mentioning?
- 4-8 weeks
- 3 S’s: SIADH (tx with demeclocycline), sex prob (decreased libido), & serotonin storm (MAOi, SNRI, TCA)
Desvenlafaxine, levomilnacipran, milnacipran are what kind of drugs?
What are two BETTER KNOWN drugs in this class, whose names are worth being able to regurgitate?
- SNRIs
- venlafazine, duloxetine
Of the SNRIs, which has the most DIVERSE use?
-venlafaxine
choose THIS to treat most psych conditions– other SNRIs may be limited to depression/ pain/ diabetic neuropathy.
Most common ADR assc with SNRIs?
HTN
Serotonin storm:
What does this look like?
- Hyperthermia, flushing
- Myoclonus/ Seizures
- Cardiovascular instability
- Diarrhea
Treatment for serotonin storm?
-cyproheptadine (5HT2 antagonist)
Amitryptyline, nortryptyline are what kind of psych drugs?
-TCAs
*others worth reading:
imipramine, desipramine, clomipramine (notice the pramine trend), doxepine, amoxapine
MOA for TCAs
-block NE/5HT reuptake
TCA commonly used in OCD?
-clomipramine
What are three non-psych indications for TCA use?
- migraine px
- chronic pain
- peripheral neuropathy
ADRs for TCA are very similar to what other psych drug class?
- typical antipsychtoics (without the parkinsonism)
- blocks a1/ has atropine like ADRs, prolongs QT
What are the “three C’s” of TCA overdose?
Whats the most common cause of death in TCA overdose? How do you prevent it?
- cardiotox, coma, convulsions
- #1 COD is fast Na channel block –> arrhythmia, give NaHCO3
Anticholinergic symptoms assc with TCAs may cause confusion or hallucination in the elderly.
Which of the TCAs is LEAST likely to have this effect?
-nortyptilline
What are the four MAOis?
Which is MAO-B specific?
- MAO Takes Pride In Shanghai
- trancyclopromine
- phenelzine
- isocarboxazaid
- selegiline (MAO-B only, parkinsons)
What are two most noteworthy ADRs assc with MAOis?
- serotonin storm with any drug that also causes ^^^ 5HT
- stop this drug TWO WEEKS before starting another that will ^^5HT
- hypertensive crisis w/ tyramine (wine, cheese)
What three NTs are ^^^ in response to MAOis?
-^^ NE,Dopa, 5HT
Buproprion:
MOA
Special benefit
Use
- ^^NE, Dopa only– not 5HT
- no sexual ADRs
- used for depression and also smoking cessation
Varenicline: MOA
Use, ADR
- nicotinic Ach receptor partial agonist
- used for smoking cessation
- causes sleep changes
Mirtazapine, a weird antidepressant, has several MOAs. List them. Sorry, Just try.
- a1 antagonist –> ^^ NE, 5HT
- 5HT2/3 antagonist
- H1 antagonist
Trazadone MOA + use
- blocks 5HT2, a1, H1 receptors + weakly blocks 5HT reuptake
- treats insomnia + ED (traZZZZaBONE)
