Psych Meds Flashcards
1
Q
Ach fx
A
affects sleep, arousal, pain perception and modulation and coordination of movement, memory acquisition and retention
2
Q
Ach category
A
Cholinergic
3
Q
Ach decrease
A
results in parkinson’s, huntington’s, alzheimer’s
4
Q
norep category
A
monamine
5
Q
NE fx in ANS
A
produces activity in sympathetic post synaptic n. affects ANS resulting in fight or flight.
6
Q
MAO
A
monamine oxidase - metabolizes and inactivates NE; inactivates DA; catabolizes 5HT and histamine
7
Q
COMT
A
catechol O methyl transferase - metabolizes and inactivates NE; inactivates DA
8
Q
NE fx
A
regulates mood, cognition, perception, locomotion, CV functioning and sleep and arousal
9
Q
NE increase
A
implicated in mania, anxiety, schizo
10
Q
DA fx
A
regulations of movement, coordination, emotion, voluntary decision making ability, inhibits the release of prolactin (pituitary)
11
Q
DA increase
A
mania and schizoprenia
12
Q
Ach increase
A
depression
13
Q
NE decrease
A
depression
14
Q
DA decrease
A
parkinson’s, depression
15
Q
5HT (Serotonin) fx
A
sleep, arousal, libido, appetite, mood, aggression, pain, perception, coordination, judgement
16
Q
5HT decrease
A
depression
17
Q
5HT increase
A
anxiety
18
Q
Histamine fx
A
wakefulness, pain sensation, inflammation response
19
Q
Histamine decrease
A
depression
20
Q
GABA fx
A
slowdown of body activity, inhibitory neurotransmitter
21
Q
GABA decrease
A
huntington’s, anxiety, schizo, epilepsy (some forms)
22
Q
Glycine fx
A
recurrent inhibition of motor neurons
23
Q
Glycine toxicity
A
encephalophathy
24
Q
glycine decrease
A
spastic motor movement
25
Glutamate, aspartate
relay sensory info and regulation of various motor and spinal reflex
26
glutamate and aspartate decrease
schizo
27
glutamate and aspartate increase
huntington's, temporal lobe epilepsy, spinal cerebellar degeneration, anxiety, depressive disorders
28
endorphins and enkephalins
modulates pain and reduces peristalsis
29
endorphin dysfx
modulates DA and may link to schizo sx
30
substance P
regulates pain
31
substance P decrease
huntington's and alzheimer's
32
substance P increase
depression
33
somatostatin fx
releases DA, 5HT, NE, Ach; inhibits NE, histamine, glutamate; modulator for 5HT in hypothalamus
34
SSRI s/e
nausea, agitation, h/a, sex dysfx
35
SSRI fx
reduces depression
controls anxiety
controls obsessions
36
TCA fx
reduces depression
relief of severe pain
prevent panic attacks
37
TCA action
inhibit reuptake of 5HT and NE
| block NE, Ach, H1 receptor
38
TCA s/e
sex dysfx (NE, 5HT)
sedation, weight gain (H1)
dry mouth, constipation, blurred vision, urine retention (Ach)
postural hypotension, tachycard (alpha 1)
39
MAOI action
increase NE and 5HT by inhibiting MAO -A (enzyme that degrades them)
40
MAOI fx
reduce depression
| control anxiety
41
MAOI s/e
sedation, dizziness
sex dysfx
HTN crisis - with tyramine
42
trazodone and nefazodone action
5HT reuptake blocker
5HT 2 receptor antagonist
andrenergic receptor blockade
43
trazodone and nefazodone fx
reduce depression and anxiety
44
trazodone and nefazodone s/e
nausea
sedation
orthostasis
priapism
45
SSNRIs
venlafaxine
desvenlafaxine
duloxetine
levomilnacipran
46
SSNRI action
inhibitor of 5HT and NE reuptake
| weak inhibitor of D reuptake
47
SSNRI action
reduces depression
relieves pain of neuropathy (duloxetine)
relieves anxiety (venlafaxine)
48
SSNRI s/e
```
nausea 5HT
diaphoresis
insomnia
tremors
sex dysfx 5HT
```
49
Bupropion action
inhibits reuptake of NE and DA
50
Bupropion fx
reduce depression
smoking cessation
decrease ADHD sx
51
Bupropion s/e
insomnia
dry mouth
tremor
seizures
52
antipsychotics: action
phenothiazine
haloperidol
strong DA receptor blockade
| weaker blockade of Ach, H1, alpha adrenergic, 5HT2 receptors
53
phenothiazine, haloperidol fx
relief of psychosis, anxiety, some n/v and intractable hiccups
54
phenothiazine, haloperidol s/e
```
blurred vision, dry mouth, decreased sweating constipation, urine retention, tachycard (Ach)
EPS, increased plasma prolactin (DA)
sedation, weight gain H1
ejaculation difficulty (5HT)
postural hypotension alpha, H1
```
55
novel antipsychotics
```
apriprazole
asenapine
clozapine
iloperidone
lurasidone
olanzepine
paliperidone
quetiapine
risperdone
ziprasidone
```
56
Novel antipsych action
```
receptor antagonism of 5HT
D1-D5
H1
alpha adrenergic
muscarinic
```
57
Novel antipsych fx
relief of psychosis with minimal or no EPS, anxiety, acute mania
58
Novel antipsych s/e
potential for mild EPS
sedation, weight gain
orthostasis, dizziness
blurred vision, dry mouth, decreased sweating, constipation, urinary retention, tachycard
59
benzodiazepine action
binds to receptor sites on GABA receptor
| increases receptor affinity for GABA
60
benzodiazepine fx
relief of anxiety
| sedation
61
benzodiazepine s/e
dependence - long term use
| confusion, memory impairment, motor incoordination
62
buspirone action
5HT agonist
| D agonist
63
buspirone fx
relief of anxiety
64
buspirone s/e
n, h/a, dizziness, restlessness
65
positive schizo sx
excess hallucinations
delusions
agitation
treated by 1st gen
66
1st generation antipsych
```
haloperidol
trifluoperazine
thiothixene
fluphenazine
chlorpromazine
loxapine
molindone
perphenazine
prochlorperazine
```
67
1st gen s/e
```
EPS
orthostatic hypoTN
avoid in elderly
skin rash - no sun
sex dysfx, amenorrhea
```
68
deconate route
IM, stay under observation for at least 3 hrs after
lasts 2-4 weeks for stabilization
test with oral for effectiveness
69
long acting deconate forms
prolixin, haloperidol, riperdal consta, zyprexa
70
2nd gen action
tx both pos and neg sx of schizo
increases DA by antagonizing 5HT
toxicity with ETOH
71
neg sx of schizo
deficit w/d, lack of energy/interest, flat affect, alogia, avolition
72
posterior pituitary hormones
ADH, oxytocin
73
ADH fx
conserve H2O, maintain BP; stimulated by pain, emotional stress, dehydration, increase plasma concentration, decrease blood volume. may be related to polydipsia.
74
oxytocin fx
stimulates contraction of uterus and release of milk. also release in response to stress and sex arousal. may stimulate release of ACTH (related to stress)
75
GH (somatotropin)
growth in children, protein synthesis. releases fat from fat tissues for energy. can increase blood glucose due to stress. may be associated with anorexia
76
TSH (thyrotropin)
stimulates secretion of T3 and T4. metabolism of food and regulation of temp.
hyper - irrit, insomnia, anxiety, restless, weight loss, emotional labile.
hypo - fatigue, decreased libido, memory impair, depression, suicidal,
77
ACTH
stimulates adrenal cortex to secret cortisol;
hypo - addison's result in mood changes, apathy, social w/d, impaired sleep, decreased concentration, fatigue.
hyper - cushings with depression, mania, psychosis, suicidal, cognitive impairement
78
prolactin
stimulates milk production
| hyper - depression, decreased libido, stress intolerance, anxiety and increase irrit
79
FSH
maturation of follicles in ova, secretion of estrogen
80
LH
ovulation, secretion of progesterone from corpus luteum
81
MSH (melanocyte stim hormone)
stim pineal gland to secrete melatonin. implicated in SAD
82
TCA's
```
amitriptyline
amoxapine
imipramine
desipramine
doxepin
clomipramine
nortriptyline
protriptline
trimipramine
```
83
MAOI's action
increase dopamine and tyramine
| long acting metabolites - must wait 2 weeks before starting new antidepressant
84
MAOI s/e
```
ortho HTN
insomnia
sex dysfx
drug and food interactions
palpitations
HA
HTN crisis, LV necrosis - toxicity; caused by eating foods high in tyramine
```
85
HTN crisis sx
h/a
stiff neck
n/v
increased BP
86
MAOI c/i
foods with tyramine - aged, pickled, fermented, smoked. cheese wine beer sauerkraut soy sauce liver yogurt sardines pizza
caffeine, tylenol, opiates, antihistamines, antiHTN, beta2 agonists, decongestants, nasal sprays, stimulants, sudafed, chocolate
cold and cough meds, antihistamines, decongestants, gen anesthetics
NO DEMEROL
87
MAOI's
```
isocarboxazid
phenelzine
tranylcypromine
moclamine
selegiline patch - no diet restrictions
```
88
SSRI actions
decrease depression and suicide
decrease sx of OCD, PTSD, eating DO, enuresis, gen anxiety disorder (GAD)
NOT LETHAL
lowest risk of birth defects
89
SSRI teaching
lag time 2-4 weeks
do not stop abruptly - taper
c/i combo with MAOI - fatal
90
SSRI s/e
agitation, stimulation, n, weight loss, insomnia, seizure
| TOXICITY - increase risk of seizure
91
which SSRI is approved for children
Serafem (Fluoxetine) - Prozac for kids
92
which SSRI has most potential for sexual s/e
Paroxetine (Paxil)
93
which SSRI is for social anxiety DO
Fluvoxamine (Luvox)
94
which MAOI has no dietary restrictions?
Selegiline Transdermal patch (EMsam)
95
MAOI and Demerol together cause what s/e
Serotonin syndrome
96
s/s serotonin syndrome
```
restlessness
unstable VS
increase BP
diarrhea
seizure
hyperthermia
myoclonus, loss of consciousness, collapse of CV systems
death
```
97
causes of serotonin syndrome
1. SSRI with MAOI
2. Lithium or Ltroptophan with SSRI
3. some antibiotics
4. INH
98
which SNRI decreases pain DO sx
venlafaxine (Effexor)
99
NRI - NE reuptake inhibitor
REboxetine (vestra)
100
NDRI - norep DA reuptake inhibitors
| what are they not good for
not good for eating DO
| Buproprion (Wellbutrin)
101
which NDRI is for smoking cessation
Zyban - does not cause sex dysfx
102
heterocyclics
mirtazpine (remeron), Tazodone
103
what is a s/e of giving any antidepressant to a bipolar
manic switch
104
what are s/s of manic switch
sleeplessness, agitation, loss of inhibitions (social, financial, sexual) and sometimes delusional thinking
105
action of mood stabilizers
decrease mania
| antimanic agents
106
lithium teaching
```
EKG first
take with food
monitor salt and water intake due to Na lost in sweating or diarrhea - can lead to Lithium conservation -> toxicity.
IBU can increase levels
serum Cr levels prior to starting
best for decreasing suicidal ideations
```
107
s/s of lithium toxicity
vomiting, diarrhea, lethargy, ataxia, loss of coordination, tremor or muscle weakness, drowsiness, seizure
108
s/e of lithium
nausea, polyuria, polydipsia, fine hand tremor, weight gain, dry mouth.
109
long term s/e of lithium
hypothyroid, leukocytosis (reversible when d/c), acne, psoriasis, kd damage
110
c/i for lithium
renal and cardiac dz, severe dehydration, Na depletion, brain damage, preg/lactation
caution with elderly, thyroid DO, urinary retention, seizures
111
what labs are useful for Lithium
TSH
BUN
Cr
EKG
112
what can cause Li level increase
fluoxetine
ACE inhibitor
diuretics
NSAIDS
113
what can cause Li level decrease
theophylline
osmotic diuretic
urinary alkalinizers
114
Li therapeutic window
```
NARROW
2-3 weeks to reach effective level
1.5 can be toxic and therapeutic - no more than 1.5mEq/L
1-1.5 - therapeutic range
0.5 - 1.0 - maintanence
```
115
anticonvulsant teaching/priority
TAPER!! DO NOT STOP ABRUPTLY
| take with food and report bruising
116
anticonvulsant action
mood stabilizer
block sodium from entering cell
decrease likelyhood of neuron firing
increases GABA
117
Carbamazepine (tegretol) interactions
monitor blood levels
not with Li (Li toxicity increases)
not with clozaril (clozapine) - toxicity of both increases
118
s/e of valproic acid (depakote, depakene, valproate)
GI, dizziness, confusion, diplopia, edema, tremor, weight gain, anxiety, alopecia, jaundice
119
toxic effect of valproic acid
LV dysfx/failure
blood dyscrasias (thrombocytopenia)
DO NOT CUT TAB - irritation
120
s/e of carbamazepine (tegretol)
dizziness, n/v, drowsiness, ataxia, confusion, disturbed vision, memory impairment, skin rash, weight gain
121
toxic effects of carbamazepine (tegretol)
agranulocytosis
| aplastic anemia
122
gabapentin (neurotin)
oxcarbazepine (trileptal)
Clonazepam (Klonipin)
what category of drug
benzodiazepines
anxiolytic and anticonvulsant
muscle relaxant
hypnotic properties
123
topiramat (topamax) is used for?
used for binge eating
can cause weight loss, hypotension, ataxia
take with food
124
what is s/e of lamotrigine (lamictal)
rash that can lead to stevens johnson syndrom
125
anxiolytic action
increase GABA
| decrease anxiety, induce sleep, treat withdrawal and detox, decrease n/v from chemo, decrease movement DO
126
anxiolytic s/e
disinhibition, sedation, drowsiness, confusion, n/v, dizziness, ataxia, hypotension
TOXICITY - respiratory depression
127
anxiolytic c/i
other CNS depressants
renal, hepatic dysfx
hx of subst abuse
depression, suicidal tendencies
128
benzodiazepines
```
Alprazolam (Xanax)
Lorazepam (Ativan)
Chlodiazepoxide (Librium)
Diazepam (Valium)
Clonazepam (Klonopin)
```
129
benzodiazepine teaching
MUST TAPER - stopping abruptly leads to convulsions
not good for elderly
increase confusion and memory impairment
decreased effects with caffeine and cigarettes
130
which drug can be used to overcome OD on benzo and ETOH
Flumaxenil (Romazicon)
can see effect in one minute
Do not use if TCA is suspected part of OD cardiac prob
131
which non benzo anxiolytic has less potential for dependence
Buspirone (Buspar)
132
Buspirone Buspar teaching
2-4 weeks to take effect
133
action of sedative/hypnotics
potentiate effect of GABA
sedate in low doses
sleep in large doses
134
which system is responsible for arousal, wakefulness, and sleep regulation
reticular activating system
135
s/e of hypnotic/sedatives
```
lapse in memory
drowsiness
ataxia
weight loss
dizziness
mood swings
```
136
toxic effects of hypnotic/sedatives
respiratory depression
| abrupt w/d causes depression, paranoia, delirium, seizure
137
c/i of hypnotics/sedatives
```
ETOH
addiction
CNS depressants
cardiac disease
preg/lactation
```
138
hypnotic/sedative teaching
for short term use
no driving
can cause dependence
139
non barbs
Flurazepam (Dalmane)
| Temazepam (Restoril)
140
barbiturates
Secobarbital (Seconal)
| Pentobarbital (Nembutal)
141
Non Benzodiazepines
Zolpidem (Ambien)
| Zaleplon (Sonata)
142
ACH inhibitors function
used to treat dementia - thought to be imbalance between DA and Ach
blocks ACHesterase
143
which patients have deficit in Ach
Alzheimers
144
Function of cholinergic system
```
logical thinking
memory
prob solving
recognition
executive functioning
```
145
Ach inhibitors
```
Donepezil (Aricept)
Tacrine (Cognex)
Memantine (Namenda)
Galantamine (Reminyl)
Revastigmine (exelon)
```
146
function of stimulants
improve attention
decrease distractibility, hyperactivity and impulsivity
used for ADHD
147
s/e of stimulants
weight loss, anorexia, growth delay, insomnia, h/a, tachycardia, tic DO
148
c/i of stimulants
subst abuse
anorexia
MAOIs
149
toxic effects of stimulants
```
abuse or OD
arrhythmia
HTN
hyperpyrexia
seizure
```
150
stimulant teaching
do not take after 4 pm
take with food
and parental supervision of meds
151
stimulants
```
Methylphenidate (Ritalin)
Detroamphetamine (Dexedrine)
Pemoline (Cylert)
Detroamphetamine/Amphetamine (adderal)
Lisdexamfetamine (vyvanse)
Guanfacine (Intuniv)
```
152
non stimulant with MOA as Ne reuptake inhibitor
Atomoxetine (strattera)
