Psych Pharm 2 Flashcards
Methylphenidate, amphetamines
- Cause increase in NE and DA release
- Used to treat ADHD (Targets frontal lobe secretion and function)
- Also can be used to supress apetite for a short time and can be used in narcolepsy
Neuroleptics
- D2 blockers. D2 is Gi therefore blocking will increase cAMP and function
- Used for psychosis, acute mania, tourettes
- Significant side effect profile
- High potency: Haloperidol, trifluoropirazine, fluphenalzine
- Low potency: Chlorpromazine, Thioridazine
Non Extrapyramidal Side effects
- Have alpha 1, muscarinin, and histamine blocking leading to dry mouth, hypotension, cardiac arrythmias
- Also block D2 receptors in prolactin cells of AP leading to prolactinemia
- Very high volume of distrubution
Pyramindal Symptoms
- Blockage of D2 receptor leads to increase in DA receptor number and sesitivity
- at first dose, 4 hours leads to dystonia, torticollis, oculogyric crisis (upward devation of eyes caused by spasmotic contraction), Treat with benztropine (Ach blocker)
- withing a week (4 days) onset of akasthesia or restlessness from increase in receptor sensitivity
- At four weeks there is bradykinesia and pseudoparkinsonism
- At 4 months there can be permanent increase in receptor number and sensitivity leading to tardive dyskinesia (often seen with steretyped lip smacking)
Neuroleptic malignant syndrome
Massive rigidity and rhabdomyolyisis leading to myoglobinria. Also hyperthermia and autonomic instability
-Tx: Bromocriptine, a dopamine agonist and dantrolene (block Ca channels)
Haloperidol, fluphenaline,trifluoreprazine
-Increased extrapuramidal side effect risk
Chlorpromazine, Thioridazine
- Decreased extrapyramidal symptoms, but incresed AchR blocker symtoms
- Chlorpromazine also has corneal deposits
- Thioridzaine has retinal deposits
Atypical Antpsychotics
- Mechanism unclear, decreased or absent extrapyramidal symptoms
- Major side effect is weight gain
Cloazapine
-Agranulocytosis, need WBC checked frequently
Olanzapine
-Wieght gain
Ziprisadone, risperadone, apiprazole etc
-Atypical Antipsychotics
Lithium
- Decreases G protein signalling??? Leads to mood stabilization
- Give before SSRI in patients with mania or may precipitate suicide
- Purey excreted by kidney, and resorbed with Na
- S/E: Hypothyroidism, Ebsteins anomaly, Nephrogenic DI, tremors, seizures
Busprione
- Partial 5HT agonist
- Used to treat generalized anxiety and has a very mild side effect profile with limited drug drug interactions
SSRI
- Inhibit Seretonin Reuptake
- First line in a number of diseases
- Depression, PTSD, Anxiety, OCD, Bulemia, Panic
- S/E: Sexual dysfunction (can use buproprion)
- Seretonin syndrome
Seretonin Syndrome
- Elevated seretonin, generally seen when there is increased seretonin from a number of drugs on board with an MAOI
- Siezures, Hypertension, flushing, myoclonus, hyperthermia
Cyprophetadine
-Seretonin Antagonist, used to treat seretonin syndrome
Drugs that are SSRI
-Fluoxetine, paroxetine, sertaline, citalopram
SNRI
Venlafaxine, duloxetine
-Most common is increased BP (increase NE)
Venlafaxine
- Anxiety
- pani disorders
Duloxetine
-Can be used to treat diabetic peripheral neuropathy
TCA
- Block the reputake of seretonin and NE, can have seretonin syndrome or hypertensive crisis
- CCC due to blocking of cholinergic effects, and alpha effects. Cardiotox (Torsades), Convulsions, Coma
- Other indications, but most are replaced by SSRI
- Strong anticholinergic effects (urinary retension, dry mouth, confusion and hallucinations (especially in elderly)
- Treat overdose with NaHCO3 to alkalanize the urine and increase clearance
- Can also be incdicated for bedwetting, OCD, and fibromylagia
TCA Drugs
- End in ine/line except doxepin
- Amitryptaline, nortryptaline, imipramine, despiramine, clomimpramine, doxepin, amoxapine
MAOI
- MAO degrades caetacholamines, increase Caethacholamines
- Used to treat atyical depression, anxiety, hypochondriasis
- Selegeline is specific for MAOB and is used to decrease DA degredation in parkinsons
- phenylzine, tranlycipromine, isocarbazoxide
- Hypertensive Crisis with tyramine (leads to increased release of NE and 5HT from cleft)
- Seretonin syndrome with any drug or herb that will increased sretonin
Buprorion
- Mechanism unkown, but increase NE and 5HT
- Used to treat depression and has minimal sexual side effects
- Can also be used in smoking cessation
Mirtazapine
- Centrally acting alpha 2 antagonist and also has seretonin antagonism activity
- Causes weight gain and sedation
- Use in anorexic patients and in depressed patients with insomnia
Maprotiline
-sepecific for NE reuptake blockage
Trazadone
- Main indication is to treat insomnia and pain associated with insomnia
- Blocks seretonin reuptake and also blocks alpha 1
- Causes priaprism and hypoyension
