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Psych pharm Flashcards

1
Q

monoamines

A

serotonin
dopamine
NE

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2
Q

serotonergic meds

A

“broad spectrum” antineurotics

  • depression
  • anxiety
  • OCD
  • etc.

sfx: SPAROW-tonin
- Sleep and energy
- Platelet dysfunction
- Abdominal upset
- Reproductive effects
- Overdose (serotonin syndrome)
- Weight gain

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3
Q

serotonin syndrome

A

Shits and SHIVERS

Shits (diarrhea)
Shivering
Hyperreflexia
Increased temp
Vital sign instability
Encephalopathy
Restlessness
Sweating
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4
Q

where is serotonin produced

A

raphe nuclei

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5
Q

dopaminergic meds

A

increased D:

  • antidepressants
  • stimulants

decreased D:
- antipsychotics

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6
Q

dopamine fx

A

cognition, movement, prolactin inhibition

DOPAMINE:
Drug addiction
Outcomes
Psychosis
Attention
Movement
Inhibition of prolactin
Nausea
Energy
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7
Q

dopamine pathways

positive sx

A

mesolimbic pathway

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8
Q

dopamine pathways

prolactin inhibition

A

TuberoInfundibular Pathway

This Inhibits Prolactin

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9
Q

dopamine pathways

reward

A
  • Ventral Tegmental Area (Very Tiring Addiction)

- nucleus accumbens (want to accumulate)

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10
Q

dopamine pathways

movement

A

NigroStriatal Pathway

  • iNvoluntary movements
  • Stuttering
  • Parkinsonism
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11
Q

noradrenergic meds

A
  • antidepressants
  • anxiolytics
  • stimulants
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12
Q

site of NE production

A

locus ceruleus

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13
Q

alpha 1 adrenergic receptors

A

widely distributed
a-1 a-ll over

generally constriction of smooth muscles

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14
Q

alpha 2 adrenergic receptors

A

inhibit SNS

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15
Q

beta 1 and 2 adrenergic receptors

A 
beta-1 = heart
beta-2 = lungs, bronchiole relaxation

you beta have 1 heart and 2 lungs
beta (better) 2 relax (the bronchioles)

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16
Q

ACh receptors

A 
muscarinic = mostly parasympathetic
nicotinic = voluntary muscle movement and cognition
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17
Q

muscarinic activation

A

SLUDGE BM

Salivation
Lacrimation
Urination
Diaphoresis
Gastrointestinal motility
Emesis
Bradycardia
Miosis (dilated pupils)
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18
Q

atropine

A

anticholinergic

anti-SLUDGE BM

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19
Q

nicotinic activation

A

muscle contraction

cognition

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20
Q

site of ACh production in brain

A

nucleus basalis of Maynert

involved in memory

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21
Q

CNS histamine receptor

A

H1

sleep and allergies

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22
Q

GABA

A

primary inhibitory nt

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23
Q

glutamate

A

primary excitatory nt

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24
Q

antidepressant discontinuation syndrome

A 
FINISH
Flu-like sx
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal
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25
fluoxetine
SSRI long t1/2 1-2 weeks Prozac
26
paroxetine
SSRI short t1/2, rapidly absorbed <1 day Paxil
27
sertraline
SSRI GI side fx safer in pregnancy/breastfeeding Zoloft
28
citalopram/escitalopram
SSRI QTc prolongation celexa/lexapro
29
fluvoxamine
SSRI "messy" - many sfx and drug-drug interactions rarely used Luvox
30
SNRI sfx
``` FFFFFF Fear Focus Fired up Fasting Feedback pain inhibition Full body response ```
31
venlafaxine
``` SNRI htn at high doses rapidly metabolized - but long t/12 - fast but takes a long time to go away discontinuation fx Effexor ```
32
duloxetine
SNRI dual - chronic pain cymbalta
33
bupropion
``` atypical antidepressant +dopamine +NE, no serotonin fx smoking cessation do not use in bulimia/any purging d/t risk of seizures no sex sfx ``` Wellbutrin
34
mirtazapine
atypical antidepressant alpha-2 receptor antagonist (boost SNS - increase NE) increased appetite, weight gain, sedation less likely to cause nausea, sex sfx (SSRIs), tremor (TCAs) helpful in comorbid anxiety, insomnia Remeron
35
trazodone
atypical antidepressant sleep aid sfx: priapism
36
TCAs suffixes
- triptyline | - ipramine
37
TCAs OD
high overdose toxicity wide QRS complex - *specific tx w/ bicarb
38
imipramine
TCA | tx nocturnal enuresis (frequent urination)
39
clomipramine
TCA gold-standard OCD but many sfx so generally not 1st line
40
nortriptyline
TCA | less sedation and orthostatic hypotension vs other TCAs
41
selegiline
MAOI selective for MAO-B Parkinson's and MDD
42
MAOIs
``` rarely used anymore atypical depression (mood reactivity, leaden paralysis) ``` sfx: htn crisis when +tyramine (aged foods and drinks) highest risk of serotonin syndrome
43
MAOIs e.g.
phenelzine tranylcypromine isocaroxazid selegiline (MAO-B selective)
44
tx mania
lithium valproate carbamazepine antipsychotics (any)
45
tx bipolar depression
lithium lamotrigine antipsychotics (some)
46
lithium
tx both mania and depression so still tx of choice in bipolar I despite sfx ``` sfx: LITHIUM SFX Low therapeutic index Intestinal upset Teratogenicity HypOthyroidism Interactions Urination Muscle weakness Skin - acne Fatigue Xtra pounds (weight gain) ``` target blood levels 5 days to ss
47
valproate
mood stabilizer mania only many sfx ``` VALPROIC SFX: Vomiting Alopecia Liver damage Pancreatitis Rebound seizure Ovarian cysts Interactions CBC abnormalities Spina bifida Fatigue Xtra pounds ``` target blood levels 2-3 days to ss
48
carbamazepine
bipolar (mania only) epilepsy trigeminal neuralgia ``` CARB SFX CBC abnormalities Adjustments Rash Baby (neural tube defects) Sodium abnormalities Fatigue Xtra pounds ``` high risk for SJS esp in Asian descent
49
lamotrigine
bipolar depression epilepsy ``` benign rashes (10%) SJS (1%) ```
50
antidepressants in bipolar disorder
standard antidepressants generally don't work, may cause manic switching
51
antipsychotics moa
blocking D2 receptor ``` also hit MASH of other receptors Muscarinic Alpha-1 (NE) Serotonin Histamine ```
52
antipsychotic sfx
``` extrapyramidal: ADAPT Acute Dystonia (hours) Akathisia (days) Parkinsonism (weeks) Tadive dyskinesia (years) ``` ``` neuroleptic malignant syx life threatening FEVER Fever Encephalopathy Vital sign instability Elevated WBC and CPK Rigidity ```
53
neuroleptic malignant syx and tx
life threatening antipsychotic sfx ``` FEVER Fever Encephalopathy Vital sign instability Elevated WBC and CPK Rigidity ``` tx: - discontinue - cooling measures - dantrolene or bromocriptine
54
dantrolene
reverse neuroleptic malignant syx
55
bromocriptine
reverse neuroleptic malignant syx
56
FGAs
first gen/typical antipsychotics haloperidol chlorpromazine fluphenazine
57
SGAs
second gen/atypical antipsychotics
58
IV haloperidol
FGA QTc prolongation torsades de pointes
59
chlorpromazine
FGA | highly sedating
60
fluphenazine
FGA | short and long acting IM injections available
61
-apines
``` SGAs fewer extrapyramidal sx improve mood sedation weight gain ```
62
olanzapine
SGA highly effective sedation weight gain
63
quetiapine
SGA weak dopamine blocker highly sedating
64
clozapine
SGA most effective antipsychotic agranulocytosis
65
-idones
more EPS other dopamine-related sfx less sedation and weight gain
66
risperidone
SGA less sedating hyperprolactinemia gynecomastia
67
ziprasidone
SGA | QTc prolongation
68
lurasidone
SGA | tx bipolar depression
69
-ipr- s
SGA | dopamine partial agonists
70
aripiprazole
SGA dopamine partial ~30% AGonist less weight gain improved mood abilify
71
brexpiprazole
SGA | D partial > ari
72
anxiolytics
GABAergics e.g. benzos serotonergics/noradrenergics others
73
benzos
great in short term not for long term use -aze-/-azo- (name) fx among drugs vary mostly by onset and elimination t1/2
74
short-acting benzos
rapid onset t1/2 <12h triazolam (halcyon) oxazepam (serax) midazolam (versed)
75
long-acting benzos
t1/2 >24h -diaz- diazepam (valium) chlordiazepam (librium)
76
intermediate acting benzos
t1/2 12-24 h lorazepam (ativan) clonazepam (klonapin) alprazolam (xanax) temazepam (restoril) - mainly for insomnia
77
benzos in liver dysfunction
safe: - oxazepam (serax) - temazepam (restoril) - lorazepam (Ativan)
78
Z-drugs
insomnia differ in t1/2 Zaleplon (4) --> Zolpidem (6) --> Zopiclone (8 hours)
79
sedating serotonergics/noradrenergics
trazodone mirtazapine others
80
first-line rx for anxiety
SSRIs/SNRIs | +CBT
81
buspirone
serotonin partial agonist | long-term GAD
82
antihistamines
can help anxiety and insomnia - including OTCs impair sleep cycle prone to tolerance e.g. diphenhydramine (rarely rx for anxiety) hydroxyzine
83
hydroxyzine
H1 receptor antagonist anxiety sedation weak anticholinergic effects (somatic fx)
84
doxylamine
antihistamine | moderate anticholinergic effects (somatic fx)
85
gabapentin
anticonvulsant anxiety pain
86
pregabalin
similar to gabapentin | faster onset
87
propranolol
beta blocker | performance anxiety
88
prazosin
alpha-1 inhibitor | PTSD nightmares
89
MDMA
stimulant oxytocin involvement - connection oXytocin bruXism
90
cocaine
~1 hour effect time coronary vasospasm myocardial ischemia no medications yet demonstrated reduced risk of relapse
91
methamphetamine
``` stimulants monoamine-releasing psychosis at high doses or in predisposed individuals - confusion - paranoia - hallucinations >24 h single dose ```
92
alcohol receptor interactions
primary: lipid bilayer alterations surround GABA receptor secondary - serotonin - dopamine - glutamate - ion channels "mixed bag" of fx
93
disulfiram
AUD tx inhibits conversion of acetaldehyde to acetate --> induces nausea when drinking alcohol not very effective as most pts self-d/c
94
naltrexone
opioid antagonist long(er) t1/2 AUD and OUD reduces amount and frequency of drinking in AUD, opioids OUD
95
acamprosate
GABA AGonist | prevents EtOH relapse in AUD
96
flumazenil
benzo use disorder / OD GABA antagonist little good evidence for use in OD but used anyways
97
naloxone
opioid receptor antagonist | opioid OD
98
methadone
opioid receptor partial AGonist long t1/2 OUD
99
buprenorphine
opioid receptor partial AGonist | OUD
100
serotonergic hallucinogens
vivid sensory experiences not toxic in OD little addictive potential LSD psilocybin mescaline DMT
101
dissociative hallucinogens
NMDA-glutamate receptor ANTagonists dream-like, ethereal depersonalization, derealization PCP ketamine dextromethorphan
102
cannabis
``` HASH PIPER High Anxiety Short-term memory loss Hunger Pain relief Impairment Paranoia Energy Red eyes ```
103
THC
active ingredient in cannabis
104
cannabidiol
CBD cannabinoid receptor ANTagonist "cannabis bringer downer"
105
GHB
combined stimulant-depressant | lethal in overdose
106
solvent inhalants
head rush dizzy temporary elation significant health problems risk fx: - children w/o fam - poor - institutionalized
107
anesthetic inhalants
immediate euphoria, disinhibition, memory loss, decreased consciousness less toxic than solvents highly flammable nitrous oxide chloroform diethyl ether
108
poppers
nitrite inhalants head rush enhancing sex, esp in MSM +phosphodiesterase inhibitors (e.g. Viagra) --> hypOtension
109
anabolic steroids
increase muscle mass medical probs psych probs
110
stimulants and sfx
dopamine and NE ADHD dopamine = attention NE = focus also reduce hyperactivity ``` RACING Restlessness Appetite suppression CV fx Insomnia Narcotic potential Growth restriction ```
111
methylphenidates
``` stimulant class NE-dopamine reuptake inhibitors milder stimulant option ``` ritalin concerta
112
amphetamines
NE-dopamine releasing agents | more stimulating than methylphenidate
113
non-stimulant ADHD meds
atomoxetine guanfacine clonidine less effective but fewer sfx, abuse potential
114
atomoxetine
NE reuptake inhibitor | ADHD
115
clonidine
alpha-2 receptor AGonist less effective than stimulants for ADHD opposite sfx profile: - fatigue - weight gain
116
guanfacine
alpha-2 receptor AGonist less effective than stimulants for ADHD opposite sfx profile: - fatigue - weight gain
117
modafinil
wakefulness-promoting agent narcolepsy shift work sleep disorder
118
acetylcholinesterase inhibitors
Alzheimer's disease, which is associated w/ loss of cholinergic neurons in brain accounts for all but one anti-dementia drugs muscarinic and nicotinic fx Nicotinic: muscle contraction Muscarinic: SLUDGE BM
119
acetylcholinesterase inhibitors e.g.
``` Relatively Good Dementia Meds: Rivastigmine Galantamine Donepezil (Memantine) ```
120
donepezil
ACh-ase inhibitor long t1/2 once-daily dosing
121
rivastigmine
ACh-ase inhibitor shorter t1/2 more sfx t1/2 and sfx improved w/ slow-release patch
122
galantamine
ACh-ase inhibitor medium t1/2 ER version for 1ce daily
123
memantine
NMDA receptor antagonist | improves memory

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