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SFM6 > Psych pharm > Flashcards

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
Q

fluoxetine

A

SSRI
long t1/2
1-2 weeks
Prozac

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26
Q

paroxetine

A

SSRI
short t1/2, rapidly absorbed
<1 day
Paxil

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27
Q

sertraline

A

SSRI
GI side fx
safer in pregnancy/breastfeeding
Zoloft

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28
Q

citalopram/escitalopram

A

SSRI
QTc prolongation
celexa/lexapro

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29
Q

fluvoxamine

A

SSRI
“messy” - many sfx and drug-drug interactions
rarely used
Luvox

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30
Q

SNRI sfx

A 
FFFFFF
Fear
Focus
Fired up
Fasting
Feedback pain inhibition
Full body response
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31
Q

venlafaxine

A 
SNRI
htn at high doses
rapidly metabolized - but long t/12 - fast but takes a long time to go away
discontinuation fx
Effexor
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32
Q

duloxetine

A

SNRI
dual - chronic pain
cymbalta

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33
Q

bupropion

A 
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

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34
Q

mirtazapine

A

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

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35
Q

trazodone

A

atypical antidepressant
sleep aid
sfx: priapism

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36
Q

TCAs suffixes

A
  • triptyline

- ipramine

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37
Q

TCAs OD

A

high overdose toxicity
wide QRS complex - *specific
tx w/ bicarb

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38
Q

imipramine

A

TCA

tx nocturnal enuresis (frequent urination)

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39
Q

clomipramine

A

TCA
gold-standard OCD
but many sfx so generally not 1st line

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40
Q

nortriptyline

A

TCA

less sedation and orthostatic hypotension vs other TCAs

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41
Q

selegiline

A

MAOI
selective for MAO-B
Parkinson’s and MDD

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42
Q

MAOIs

A 
rarely used anymore
atypical depression (mood reactivity, leaden paralysis)

sfx:
htn crisis when +tyramine (aged foods and drinks)
highest risk of serotonin syndrome

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43
Q

MAOIs e.g.

A

phenelzine
tranylcypromine
isocaroxazid
selegiline (MAO-B selective)

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44
Q

tx mania

A

lithium
valproate
carbamazepine
antipsychotics (any)

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45
Q

tx bipolar depression

A

lithium
lamotrigine
antipsychotics (some)

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46
Q

lithium

A

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

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47
Q

valproate

A

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

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48
Q

carbamazepine

A

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

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49
Q

lamotrigine

A

bipolar depression
epilepsy

benign rashes (10%)
SJS (1%)
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50
Q

antidepressants in bipolar disorder

A

standard antidepressants generally don’t work, may cause manic switching

51
Q

antipsychotics moa

A

blocking D2 receptor

also hit MASH of other receptors
Muscarinic
Alpha-1 (NE)
Serotonin
Histamine
52
Q

antipsychotic sfx

A 
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
Q

neuroleptic malignant syx and tx

A

life threatening antipsychotic sfx

FEVER
Fever
Encephalopathy
Vital sign instability
Elevated WBC and CPK
Rigidity

tx:

  • discontinue
  • cooling measures
  • dantrolene or bromocriptine
54
Q

dantrolene

A

reverse neuroleptic malignant syx

55
Q

bromocriptine

A

reverse neuroleptic malignant syx

56
Q

FGAs

A

first gen/typical antipsychotics

haloperidol
chlorpromazine
fluphenazine

57
Q

SGAs

A

second gen/atypical antipsychotics

58
Q

IV haloperidol

A

FGA
QTc prolongation
torsades de pointes

59
Q

chlorpromazine

A

FGA

highly sedating

60
Q

fluphenazine

A

FGA

short and long acting IM injections available

61
Q

-apines

A 
SGAs
fewer extrapyramidal sx
improve mood
sedation
weight gain
62
Q

olanzapine

A

SGA
highly effective
sedation
weight gain

63
Q

quetiapine

A

SGA
weak dopamine blocker
highly sedating

64
Q

clozapine

A

SGA
most effective antipsychotic
agranulocytosis

65
Q

-idones

A

more EPS
other dopamine-related sfx
less sedation and weight gain

66
Q

risperidone

A

SGA
less sedating
hyperprolactinemia
gynecomastia

67
Q

ziprasidone

A

SGA

QTc prolongation

68
Q

lurasidone

A

SGA

tx bipolar depression

69
Q

-ipr- s

A

SGA

dopamine partial agonists

70
Q

aripiprazole

A

SGA
dopamine partial ~30% AGonist
less weight gain
improved mood

abilify

71
Q

brexpiprazole

A

SGA

D partial > ari

72
Q

anxiolytics

A

GABAergics e.g. benzos
serotonergics/noradrenergics
others

73
Q

benzos

A

great in short term
not for long term use
-aze-/-azo- (name)
fx among drugs vary mostly by onset and elimination t1/2

74
Q

short-acting benzos

A

rapid onset
t1/2 <12h

triazolam (halcyon)
oxazepam (serax)
midazolam (versed)

75
Q

long-acting benzos

A

t1/2 >24h
-diaz-

diazepam (valium)
chlordiazepam (librium)

76
Q

intermediate acting benzos

A

t1/2 12-24 h

lorazepam (ativan)
clonazepam (klonapin)
alprazolam (xanax)
temazepam (restoril) - mainly for insomnia

77
Q

benzos in liver dysfunction

A

safe:

  • oxazepam (serax)
  • temazepam (restoril)
  • lorazepam (Ativan)
78
Q

Z-drugs

A

insomnia
differ in t1/2

Zaleplon (4) –> Zolpidem (6) –> Zopiclone (8 hours)

79
Q

sedating serotonergics/noradrenergics

A

trazodone
mirtazapine
others

80
Q

first-line rx for anxiety

A

SSRIs/SNRIs

+CBT

81
Q

buspirone

A

serotonin partial agonist

long-term GAD

82
Q

antihistamines

A

can help anxiety and insomnia - including OTCs
impair sleep cycle
prone to tolerance

e.g.
diphenhydramine (rarely rx for anxiety)
hydroxyzine

83
Q

hydroxyzine

A

H1 receptor antagonist
anxiety
sedation
weak anticholinergic effects (somatic fx)

84
Q

doxylamine

A

antihistamine

moderate anticholinergic effects (somatic fx)

85
Q

gabapentin

A

anticonvulsant
anxiety
pain

86
Q

pregabalin

A

similar to gabapentin

faster onset

87
Q

propranolol

A

beta blocker

performance anxiety

88
Q

prazosin

A

alpha-1 inhibitor

PTSD nightmares

89
Q

MDMA

A

stimulant
oxytocin involvement - connection
oXytocin
bruXism

90
Q

cocaine

A

~1 hour effect time
coronary vasospasm
myocardial ischemia

no medications yet demonstrated reduced risk of relapse

91
Q

methamphetamine

A 
stimulants
monoamine-releasing
psychosis at high doses or in predisposed individuals
- confusion
- paranoia
- hallucinations
>24 h single dose
92
Q

alcohol receptor interactions

A

primary: lipid bilayer alterations surround GABA receptor

secondary

  • serotonin
  • dopamine
  • glutamate
  • ion channels

“mixed bag” of fx

93
Q

disulfiram

A

AUD tx
inhibits conversion of acetaldehyde to acetate –>
induces nausea when drinking alcohol
not very effective as most pts self-d/c

94
Q

naltrexone

A

opioid antagonist
long(er) t1/2
AUD and OUD

reduces amount and frequency of drinking in AUD, opioids OUD

95
Q

acamprosate

A

GABA AGonist

prevents EtOH relapse in AUD

96
Q

flumazenil

A

benzo use disorder / OD
GABA antagonist
little good evidence for use in OD but used anyways

97
Q

naloxone

A

opioid receptor antagonist

opioid OD

98
Q

methadone

A

opioid receptor partial AGonist
long t1/2
OUD

99
Q

buprenorphine

A

opioid receptor partial AGonist

OUD

100
Q

serotonergic hallucinogens

A

vivid sensory experiences
not toxic in OD
little addictive potential

LSD
psilocybin
mescaline
DMT

101
Q

dissociative hallucinogens

A

NMDA-glutamate receptor ANTagonists
dream-like, ethereal
depersonalization, derealization

PCP
ketamine
dextromethorphan

102
Q

cannabis

A 
HASH PIPER
High
Anxiety
Short-term memory loss
Hunger
Pain relief
Impairment
Paranoia
Energy
Red eyes
103
Q

THC

A

active ingredient in cannabis

104
Q

cannabidiol

A

CBD
cannabinoid receptor ANTagonist
“cannabis bringer downer”

105
Q

GHB

A

combined stimulant-depressant

lethal in overdose

106
Q

solvent inhalants

A

head rush
dizzy
temporary elation
significant health problems

risk fx:

  • children w/o fam
  • poor
  • institutionalized
107
Q

anesthetic inhalants

A

immediate euphoria, disinhibition, memory loss, decreased consciousness

less toxic than solvents
highly flammable

nitrous oxide
chloroform
diethyl ether

108
Q

poppers

A

nitrite inhalants
head rush
enhancing sex, esp in MSM

+phosphodiesterase inhibitors (e.g. Viagra) –> hypOtension

109
Q

anabolic steroids

A

increase muscle mass
medical probs
psych probs

110
Q

stimulants and sfx

A

dopamine and NE
ADHD

dopamine = attention
NE = focus
also reduce hyperactivity

RACING
Restlessness
Appetite suppression
CV fx
Insomnia
Narcotic potential 
Growth restriction
111
Q

methylphenidates

A 
stimulant class
NE-dopamine reuptake inhibitors
milder stimulant option

ritalin
concerta

112
Q

amphetamines

A

NE-dopamine releasing agents

more stimulating than methylphenidate

113
Q

non-stimulant ADHD meds

A

atomoxetine
guanfacine
clonidine

less effective but fewer sfx, abuse potential

114
Q

atomoxetine

A

NE reuptake inhibitor

ADHD

115
Q

clonidine

A

alpha-2 receptor AGonist

less effective than stimulants for ADHD
opposite sfx profile:
- fatigue
- weight gain

116
Q

guanfacine

A

alpha-2 receptor AGonist

less effective than stimulants for ADHD
opposite sfx profile:
- fatigue
- weight gain

117
Q

modafinil

A

wakefulness-promoting agent
narcolepsy
shift work sleep disorder

118
Q

acetylcholinesterase inhibitors

A

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
Q

acetylcholinesterase inhibitors e.g.

A 
Relatively Good Dementia Meds:
Rivastigmine
Galantamine
Donepezil
(Memantine)
120
Q

donepezil

A

ACh-ase inhibitor
long t1/2
once-daily dosing

121
Q

rivastigmine

A

ACh-ase inhibitor
shorter t1/2
more sfx
t1/2 and sfx improved w/ slow-release patch

122
Q

galantamine

A

ACh-ase inhibitor
medium t1/2
ER version for 1ce daily

123
Q

memantine

A

NMDA receptor antagonist

improves memory

SFM6 (10 decks)

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