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Psych First Aid Pharm Flashcards

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1
Q

Treatment for ADHD?

A

Methylphenidate

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2
Q

Treatment for Alcohol withdrawal?

A

Benzodiazepines

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3
Q

Treatment for Anxiety?

A

SSRI, SNRI, Buspirone

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4
Q

Treatment for Bipolar Disorder?

A

“Mood stabilizers” (Lithium, valproic acid, carbamazepine), Atypicals

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5
Q

Treatment for Bulimia?

A

SSRI (Fluoxetine)

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6
Q

Treatment for Depression?

A

SSRI, SNRI, TCA,Bupropion, Mirtazapine (especially with insomnia)

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7
Q

Treatment for OCD?

A

SSRI, Clomipramine

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8
Q

Treatment for Panic Disorder?

A

SSRI, venlafaxane, benzodiazepines

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9
Q

Treatment for PTSD?

A

SSRI

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10
Q

Treatment for Schizophrenia?

A

Antipsychotics

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11
Q

Treatment for Social Phobias?

A

SSRI, B-blockers (propanolol for social speaking, don’t forget, if they have asthma/COPD, give them a cardioselective = A-M)

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12
Q

Treatment for Tourette syndrome?

A

Antipsychotics (haloperidol, risperidone) (DIT said Fluphenazine, Pinozide, and Tetrabenazine

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13
Q

What are the CNS Stimulants?

A

Methylphenidate, dextroamphetamine, methamphetamine, phentermine

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14
Q

MOA CNS stimulants?

A

Increase catecholamines at the synaptic cleft, especially NE and Dopa

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15
Q

Clinical use CNS stimulants?

A

ADHD, narcolepsy, appetite control

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16
Q

What are the antipsychotics (neuroleptics)?

A

Haloperidol, Trifluoperazine, fluphenazine, thioridazine, chlorpromazine (Group of Haloperidol + azines)

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17
Q

What is the mechanism of all the typical antipsychotics (Haloperidol + Azines)?

A

Block Dopamine D2 Receptors (Increases cAMP)

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18
Q

What are the high potency antipsychotics and side effects?

A

Try to Fly High = High potency (Trifluoperazine, Fluphenazine, Haloperidol)
Neurologic, EPS symptoms

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19
Q

What are the low potency antipsychotics and side effects?

A

Cheating Thieves are Low = Low potency (Chlorpromazine, Thioridazine)
Non-neurologic side effects like anticholinergic, antihistamine, and alpha1 blockade

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20
Q

What are the antipsychotics used for? (4 uses listed)

A

Psychosis
Acute Mania
Tourette Syndrome
Schizophrenia (primarily positive symptoms)
(Spells PATS if you’re interested in that… PATS down Dopamine? work with me here)

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21
Q

What are the general toxicities of Antipsychotics?

A

They are highly lipid soluble so stored in body fat, and are slowly removed from body
EPS from high potency
Non-neurologic side effects (antichol, antirust, anti alpha 1 from low potency
Endocrine side effects (remember dopamine antagonism = hyperprolactinemia and all that good shit)

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22
Q

What are the side effects of Chorpromazine, Thioridazine, and Haloperidol?

A

Chlorpromazine - Corneal Deposits (C’s)
Thioridazine - reTinal deposits
Haloperidol - NMS (dantrolene), Tardive dyskinesia

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23
Q

What is the evolution of EPS side effects? (4 hours, days, weeks, months)

A

4 hours - acute dystonia = muscle spasm, stiffness, oculogyric crisis
4 days - akathisia = restlessness
4 weeks - bradykinesia = parkinsonism
4 mo - tardive diskinesia

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24
Q

What is NMS?

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

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25
What is the FEVER mnemonic for NMS?
``` Fever Encephalopathy Vitals unstable Enzymes increased Rigidity of muscle (leads to myoglobinuria) ```
26
What is the treatment for NMS?
Dantrolene, D2 agonists (bromocriptine)
27
What is tardive diskinesia?
Stereotypic oral-facial movements as a result of long term-psychotic use (maybe irreversible)
28
What are the atypical antipsychotics?
Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone (FA Mnemonic: It is Atypical for Old CLOZets to QUIETly RISPER from A to Z)
29
What is the MOA of atypical antipsychotics?
Not 100% known, but varied effects on 5-HT2, dopamine, alpha and H1 receptors
30
What are the atypical antipsychotics used for?
Schizo - both the positive and negative symptoms Bipolar, OCD, anxiety, depression, mania, Tourette DIT = Olanzapine - OCD and Anxiety
31
What are the toxicities of atypical antipsychotics?
Fewer EPS and anticholinergic than traditionals.
32
What can Olanzapine/Clozapine cause? What additional for Clozapine?
Olanzapine/Clozapine - Weight gain! | Clozapine - Agranulocytosis and seizures
33
What does Risperidone cause?
Increased prolactin --> GnRH, LH, and FSH (irregularity in menstruation/fertility)
34
What does Ziprasidone cause?
Prolong QT interval
35
What is the MOA of lithium?
Who the fuck knows, who the fuck cares? Something about a phosphoinositol cascade
36
What is Lithium used for?
Mood stabilizer for bipolar disorder and mania; blocks relapse and acute manic events, Also SIADH.
37
What is the Lithium side effects mnemonic?
``` LMNOP! (not therapy for CHF....) L - Lithium Side Effects M - Movement (tremor) N - Nephrogenic DI (polyuria) O - hypOthyroidism P - Pregnancy problems ```
38
What are some other notable side effects of Lithium?
Fetal cardiac defects including Ebstein anomaly and malformation of great vessels, narrow therapeutic window, almost exclusively excreted by kidneys (most reabs at PCT following Na reabsorption)
39
What is Busiprone's MOA?
Stimulate 5-HT1A receptors
40
What are the uses of Busiprone?
ONLY FOR GENERALIZED ANXIETY DISORDER: Does NOT cause sedation, addiction, or tolerance. Takes a few weeks to take effect and does NOT interact with alcohol (vs barbs and benzos)
41
Mnemonic for Busiprone?
Im always anxious if the BUS will be ON time, so I take BUSpirONE
42
What are the SSRI's?
Fluoxetine, Paroxetine, Setraline, Citalopram (FLashbacks PARalyze SEnior CITizens)
43
What is the MOA of SSRIs......
5-HT specific reuptake inhibitors
44
What is the clinical use of SSRI's?
Depression, GAD, panic, OCD, bulimia, social phobias, PTSD; generally take 4-8 weeks to work
45
What is the long acting vs short acting SSRI?
``` Fluoxetine = long Paroxetine = short ```
46
What are the toxicities of SSRI's?
Less than TCAs (TCA's suck). Gi distress, sexual disfunction (anorgasmia and decreased libido). Serotonin Syndrome!
47
What is Serotonin Syndrome?
Looks like carcinoid but from a drug; It is from any drug that increases 5-HT, causes hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
48
Treatment of SS?
Cyproheptadine (5-HT2 receptor antagonist), cooling, benzos.
49
What don't you give SSRI's with?
SNRI or MAOI
50
What can cause SS?
SSRI, SNRI, MAOI, St. Johns Wort, Kava Kava, Sibutramine, L-Tryptophan, Cocaine, Amphetamines (DIT)
51
What are the SNRI's?
Venlafaxane and Duloxetine
52
What do SNRI's do?
Inhibit 5-HT and NE reuptake
53
SNRI Uses?
Depression; Venlafaxane for GAD and panic disorder; Duloxetine is for diabetic peripheral neuropathy
54
SNRI tox?
Increased BP MC; also stimulant effects, sedation, nausea
55
What are the TCA's
Any -triptyline/ipramine + doxepin + amoxapine
56
MOA TCA?
Block reuptake of NE and 5-HT, they are older with 3 ring structure
57
Use of TCAs?
Major Depression, OCD (Clomipramine), Fibromyalgia (amytriptyline)
58
TCA Tox?
Sedation, alpha 1 blocking effects including postural hTN + atropine like (antichoinergic) side effects (mad was a hatter, dry as a bone... etc.)
59
What TCA's have more AntiACh effects?
3 TCA's (amitryptiline) have more than 2 TCA (nortriptyine)
60
Which is the least sedating TCA? What consequence?
Desipramine is less sedating but has higher seizure incidence
61
What are the Tri-C's of TCA?
Convulsions, Coma, Cardiotox (+resp depression, hyperpyrexia)
62
What can happen in elderly with TCA?
Confusion and hallucinations due to anticholinergic side effects
63
What TCA do you use in elderly to avoid hallucinations?
Nortriptyline
64
What is the treatment for TCA cardiotox?
NaHCO3
65
What are the MAOI's?
Trancylcypromine, Phenelzine, Isocarboxazid, Selegiline (MAO Takes Pride In Shanghai)
66
MOA MAOI's?
NS MAO inhibition to increase levels of amine NT's (NE, 5-HT, Dopamine)
67
Use of MAOI's?
Atypical depression, anxiety, hypochondriacs
68
MAOI Tox?
Hypertensive crisis most notably with the ingestion of Tyramine (stimulates NE release from nerve terminals) = AGED FOODS (Brown bananas, wine, beer, cheese, beef, etc, etc, etc, etc) CNS Stimulation. HTN crisis can occur w/ Beta agonist too.
69
Why does tyramine ingestion on an MAOI cause toxicity?
MAOI usually is found in gut and prevents tyramine from acting, but it's not there anymore, so NE is released
70
What are MAOI's CI'd with?
SSRI, TCA, St. Johns Wort, meperidine, Dextromethorphan (all to prevent SS)
71
What is the MAO-B inhibitor?
Selegiline
72
What is Selegiline used for?
Not depression, used for parkinsonism
73
What are the Atypical Antidepressants?
Bupropion, Mirtazapoine, Trazodone
74
What is Bupropion used for?
Smoking cessation
75
Bupropion MOA?
Increase NE/D via unknown mech
76
Bupropion Tox?
Stimulant effects (tachycardia/insomnia), H/A, seizure in bulimic patients, NO SEXUAL SIDE EFFECTS YAY!
77
What class of drugs does Bupropion work well with?
SSRI or SNRI
78
What is Mirtazapine (MOA)?
Alpha2 antagonist (increase release of NE and 5-HT), patent 5-HT2 and 5-HT3 receptor antagonist
79
Mirtazapine tox?
Sedation (may be desirable in depressed insomniacs), appetite, weight gain (may be desirable in elderly/anorexics), dry mouth, antihistamine AEs
80
What is Trazodone (MOA)? What is it used for and why?
Blocks 5-HT2 and alpha1 adrenergics; used for insomnia because high doses are needed for antidepressant effects
81
Trazodone tox?
TrazoBONE b/c priaprism; sedation, nausea, postural hTN
82
If trazodone is combined with SSRI or SNRI what can happen for sleep?
Increased REM sleep

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