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c. pharm exam 3 (w13) > psych meds 3/25 > Flashcards

psych meds 3/25 Flashcards

1
Q

what are the main categories of psychotropic drugs:

A
  1. antianxiety drugs
  2. antidepressants
  3. antipsychotropics
  4. mood stablilzers
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2
Q

TCAs (tricyclic antidepressants):

what is it treatment for?

A

first line treatment in major depression

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3
Q

TCAs:

action:

A

-blocks pre-synaptic serotonin and NE reuptake

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4
Q

TCAs:

route, onset and max effect:

A
  • well absorbed orally,
  • onset=1hr to 3 weeks;
  • max effect 2-6 weeks.
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5
Q

TCAs:

how long should it take you to reach max dose?

A

2-3 weeks

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6
Q 
TCAs:
name 4 (out of the 6) tricyclic antidepressants:
A
  1. amitryptiline (elavil)
  2. clomipramine (anafranil)
  3. imipramine (tipramine)
  4. nortriptyline (aventyl)
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7
Q

TCAs

drug interactions:

A
  1. CNS depressants: alcohol, antidepressants, psychotropics
  2. sympathomimetics: epinephrine
  3. anticholinergics: scopolamine, atropine
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8
Q

TCAs:

-what are 4 categories of adverse affects?

A

1-antihisthamine: block histhamine so cause sedation,
2-anticholinergic: muscarenic anticholinergic effects (dry mouth, constipation, urine retention).
3-cardiac: cardiotoxicity (causes dysrhythmias, tachycardia) , orthostatic hypotension
4-neuro: extrapyrimadal side effects (increased head, face and neck motor activity), tremors, insomina, blurred vision

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9
Q

TCAs:
Precautions should be used in patients with what conditions?
why?

A
  1. heart disease (risk of conduction abnormalities)

2. epilepsy (lowers seizure threshold)

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10
Q

TCAs:
Overdose: what are effects?
- what is the treatment for the first 2 effects of overdose?

A
  1. life threatening cardiac arrhythmias
  2. prolonged QRS (treatment IV sodium bicarb).
  3. Marked hypotension
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11
Q

SSRIs:

  1. where does serotonin have high concentrations in the body?
  2. what is it responsible for?
A
  1. hypothalaums, limbic system, medulla, spinal cord

2. regulate REM sleep, pain perception, emotional states

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14
Q

hallucinations

A

when somthing is seen that is not there

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15
Q

SSRIs:

- pharmacodynamics (onset, peak,duration..how long for all of it in general?)

A
  • well abosorbed orally, onset, peak and duration up to 1-4 weeks
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16
Q

SSRIs

- how long for max effect?

A

-may take 12 weeks for complete effect

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17
Q

illusions

A

when one sees somthing as somthing else (ex. person thinks a bush is a man crouching and spying on them)

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18
Q

what is the pathophysiology of psychosis:

  1. which neurotransmitter is linked to psychosis?
  2. what does cocaine and amphetamines do?
  3. what is another theory? what chemicals affect this?
A
  1. Dopamine
  2. elevate central levels of Dopamine
  3. glutamine/NDMA receptor theory; (ketamine & PCP)
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19
Q

SSRIs (aka…)

- action:

A

selective serotonin uptake/reuptake inhibitors

- block serotonin reuptake with weak affinity for dopa, epi and norepi reuptake inhibition

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20
Q

positive:
negative:
cognitive

A
  1. add symptoms
  2. loss of normal behaviors
    3.
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21
Q

what change in receptors may be cause of schizophrenia

A

upregulation (they have higher dopamine receptor density)

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22
Q

what are 9 causes of psychiatric disorders?

A
  1. neurodevelopmental disease
  2. brain tumors
  3. encephalopathies
  4. psychiatric disorders
  5. epileptic disorders
  6. trauma
  7. recreational drugs
  8. poisons (sarin gas etc.)
  9. electrolyte imbalance
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23
Q 
SSRIs:
side effects:
1. cardiac:
2. sexual:
3. what (mouth) side effect is it associated with?
4. what syndrome?
A
  1. QT prolongation
  2. sexual dysfunction/ failure to achieve orgasm/ impotence
  3. bruxism (teeth grinding)
  4. serotonin syndrome
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24
Q

SSRIs:

what is serotonin syndrome?

A

Serotonin syndrome is a potentially life-threatening drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. TOO MUCH SYNAPTIC SEROTONIN!

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25
Q

SSRIs:

what are s/s effects of serotonin syndrome (6 major S/Ss)?

A
  1. confusion
  2. anxiety
  3. hypertension
  4. sweating
  5. hyperpyrexia
  6. ataxia/ hyper-reflexia/ myoclonus
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26
Q

what are the phenothiazines?

A 
chlopromazine
thoridazine
fluphenazine
perphenazine
trifluoperazine
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27
Q

what are the dibenzodiazepines

A

clozapine
loxapine
olanzapine

28
Q 
SSRIs:
what are the brand names for these?
1. citalopram: what is special about this one?
2. fluoxetine:
3. sertaline:
4. paroxetine:
A
  1. citalopram=celexa; (most potent)
  2. fluoxetine=prozac
  3. sertaline=zoloft
  4. paroxetine=Paxil
29
Q

what are the butyrophenones

A

haldoperidol

droperidol

30
Q

2 causes of encephalopathies?

A

malaria, tuberculosis

31
Q

SSRIs:
indications:(6 conditions it is used for):

A
  1. Depression
  2. Eating disorders: anorexia and bulimia
  3. anxiety disorder: panic, phobias, OCD
  4. fibromyalgia
  5. autism
  6. premenstrual syndrome
32
Q

SSRIs:

drug interactions:

A
  1. MAO inhibitors
  2. Lithium
  3. CNS depressants (benzos, dilantin, tegretol)
33
Q

which illness makes up the majority of mental conditions

A

schizophrenia

34
Q

SSRIs:

name 4 major SSRIs (chemical names):

A
  1. citalopram
  2. fluoxetine
  3. sertaline
  4. paroxetine
35
Q

what is the Benzisoxazole

A

Respirdone

37
Q

what is dysthmia

A

a psyhcological disorder requiring sadness that is characterized by chronic sadness

38
Q
  1. what is endogenous depression?
  2. what is etiology?
  3. what is its clinical name?
A
  1. heredity mood disorder characterized by lack of energy, feeling of worthness and guilt, low self esteem, loss of pleasure or interest in activities, difficulty sleeping and concentrating.
  2. unknown etiology
  3. aka Major depression
39
Q
  1. what is somatostatin?
  2. what is its other name?
  3. where is it produced?
A
  1. blocks growth hormone
  2. GHIH (growth hormone inhibiting hormone)
  3. delta cells
40
Q

TCAs:

-what is tricyclic antidepressants MOA?

A

-block pre synaptic reuptake of NE, dopa and serotinin at the synapse so that there is higher chance for pick up by post synaptic neuron.

41
Q

SSRIs:

mode of action:

A

selectively block serotonin re-uptake by pre synaptic neuron leaving more of a concentration for use by post synaptic neuron (DOES NOT inhibit NE reuptake)

42
Q

SNRIs

  1. what is it?
  2. what is major adverse effect? why?
  3. what are lesser adverse affects?
A
  1. serotonin-norepi reuptake inhibitor
  2. may increase BP (d/t more NE at the synapse)
  3. also cause dry mouth, drowziness, dizziness, loss of appetite, and nausea.
43
Q

what is the diphenylbutylpiperidine drug?

A

pimozide

44
Q

what can happen during surgery that can lead to PTSD?

A

intra-op awareness

45
Q

SSRIs:

1. what concurrent disease patients are SSRIs good for?

A
  1. cardiac/ heart disease because it lacks the cardiotoxicity of TCAs
46
Q
  1. withdrawl syndromes aka:
  2. caused by?
  3. occurs within __ days of discontinuation?
A
  1. antipsychotic discontinuation syndrome
  2. sudden discontinuation
  3. 7
47
Q

MAO-Is (mono-amine oxidase inhibitors):

  1. what breaks down serotonin and NE?
  2. what is the action of an MAO-I?
A
  1. monoamine oxidase breaks down the monoamines: serotonin and norepinephrine at the synapse, to be reabsorbed by pre-synaptic neuron (leaving less of it for use).
  2. less serotnin and NE= depression; MAO-I’s block MAO from breaking them down.
48
Q

MAO-I:

1. what is MAO inhibitors claim to fame?

A
  1. first drug approved to treat depression (1950s)
49
Q

MAO-I:
side effects:
5 major things

A
  1. orthostatic hypotension (d/t vasodilation)
  2. headache (d/t vasodilation
  3. insomnia
  4. hypertensive crisis when mixed with tyramine
  5. sudden increased sympathiomimetic activity (headache, stiff neck, flushing, palpitations, diaphoresis).
50
Q

MAOI

name the major ones:

A
  1. bupropion (zyban) or wellbutrin
  2. chantix
  3. trazadone
51
Q

MAO-I
wellbutrin/ bup-ro-pion (zyban):
1. what is the action/class?
2. metabolite (y/n)

A
  1. norepinephrine/ dopamine reuptake inhibitor

2. has an active metabolite which may be more potent than parent drug

52
Q

MAO-I

side effects:

A

few anticholinergic

rare cardiovascular or sexual

53
Q

MAO-I
wellbutrin/ bupropion
uses:

A

depression/ bipolar

smoking cessation

54
Q

SSRIs

what is significant about SSRIs in treating depression?

A

drug of choice

55
Q 
MAO-I
trazadone:
1. action:
2. pros:
3. cons:
A
  1. selectively inhibits serotonin reuptake
  2. pros: minimal anticholinergic and cardiac effects
  3. cons: considerable sedation and orthostatic hypotension
56
Q

lithium:

  1. what is lithium used for?
  2. what symptoms is it most effective against?
A
  1. mood stabilizer in bipolar disorder; reduces mania and depressive symptoms
  2. has greater activity on mania than on depression
57
Q

pharmacology of lithium:

  1. mechanism of action #1
  2. mechanism of action #2
  3. mechanism of action #3
A
  1. affects electrolytes on ion transport chain
  2. affects neurotransmitter receptor binding
  3. affects signaling pathways following NT receptor binding by suppressing IP3 (insitol triphosphate) and DAG (diacylglycerol) which are important in amine neurotransmission
58
Q

Lithium:

  1. what happens during mania?
  2. what does lithium do?
A

a. during mania there is an increased activity of NTs utilizing of DAG & IP3 secondary messengers
b. Lithium reduces the resonse produced by these overactive NTs

59
Q 
Lithium:
pharmakokinetics:
1. absorption:
2. distribution:
3. metabolism:
A
  1. highly absorbed (95-100%)
  2. widely distributed (ffound in thyroid, bone and brain)
  3. not metabolized (it is an element); half life is 24 hours
    - –remember what you know; lithium is a salt so it doesnt break down and goes wherever salt goes!!!
60
Q

Lithium:
pharmacology:
1. excretion:
2. what happens to clearance during pregnancy?
3. what does it compete with in the kidneys (where in the kidney)?
4. what is theraputic window (large or small)?

A
  1. excreted in urine, extensively reabsorbed
  2. clearance increases with pregnancy
  3. competes with sodium for renal tuble reabsorption
  4. narrow theraputic window
61
Q

Lithium:

  1. what type of kinetics for lithium?
  2. how long does it take to become theraputic?
  3. what else is needed with lithium initially
  4. what is needed once theraputic?
A
  1. first order kinetics (like alcohol) initially, then switches to 2nd order
  2. takes several days or weeks to become theraputic
  3. during early phase, patient needs other medications like neuroleptics or benzos
  4. drug monitoring is needed once treatment has become theraputic
62
Q

Lithium:

  1. what is desired effect?
  2. what may be required?
A
  1. decreases severity of mania and decreases the frequency and magnitude of mood swings
  2. antidepressants may be required for adunct maintainance
63
Q

lithium:

  1. theraputic overdose:
  2. what are s/s of toxic overdose?
A
  1. d/t narrow theraputic index; happens accidentally very frequently; usually d/t acculmulation
  2. neurotoxicity and cardiotoxicity; N/V (early signs) , diarrhea, tremors, confusion, arrhythmias, seizures
64
Q

Lithium:

adverse affects:

A
  1. drowsines,
  2. weight gain,
  3. fine hand tremor (controlled with beta adrenergic antagonist), 4. polyuria (blocks antidiuretic hormone-kidney cannot concentrate urine),
  4. thyroid enlargement- causes hypothyroidism by blocking thyroid hormone release
  5. salivary gland dysfunction
65
Q 
name the drug class:
dibenzodiazepine; SSRI; TCA; Phenothiazine; Benzoisoxazole; butryphenones; MAO-I
1. chlopromazine
2. amitryptaline
3. citalopram
4. trazadone
5. clozapine
6. respirdone
7. fluoxitine
8. fluphenazine
9. wellbutrin
10. haldoperidol
11. loxapine
12. sertaline
13. nortriptyline
14. thoridizine
15. paroxitine
16. imipramine
17. olanzipine
18. droperidol
19. chantix
20. clemipramine
21. perphenazine
A 
name the drug class:
dibenzodiazepine; SSRI; TCA; Phenothiazine; Benzoisoxazole; butryphenones; MAO-I
1. chlopromazine-phenothiazine
2. amitryptaline-TCA
3. citalopram-SSRI
4. trazadone-MAO
5. clozapine-dibenzodiazepine
6. respirdone-benzisoxazole
7. fluoxitine-SSRI
8. fluphenazine-phenothiazine
9. wellbutrin-MAO-I
10. haldoperidol-butryphenone
11. loxapine-dibenzodiazepines
12. sertaline-SSRI
13. nortriptyline-TCA
14. thoridizine-phenothiazines
15. paroxitine-SSRI
16. imipramine-TCA
17. olanzipine-dibenzodiazepines
18. droperidol-butryphenone
19. chantix-MOA-I
20. clemipramine-TCA
21. perphenazine-phenothiazine

c. pharm exam 3 (w13) (6 decks)

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