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USLME Pharmacology > Psych Pharm > Flashcards

Psych Pharm Flashcards

1
Q

List symptoms of intoxication and withdrawal: In general for depressants

A

Intoxication: nonspecific: mood elevation, decrease anxiety, sedation, behavioral inhibition, respiratory depression

Withdrawal: Nonspecific: anxiety, tremor, seizures, insomnia

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2
Q

List symptoms of intoxication and withdrawal: alcohol

A

Intoxication: emotional lability, slurred speech, ataxia, coma, blackouts.

Withdrawal:

mild: symptoms similiar to other depressants.
severe: autonomic hyperactivity and delirium tremens (5-15% mortality rate) –treatment: chlordiazepoxide (unless liver failure –> lorazepam)

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3
Q

What is a sensitive indicator of alcohol use detected in serum?

A

serum y-glutamyltransferase (GGT)

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4
Q

In alcohol toxicity, both AST and ALT are elevated. Are they elevated to the same degree?

A

AST > ALT

almost twice the value

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5
Q

List symptoms of intoxication and withdrawal: opiods (heroin, methadone, morphine) -depressants

A

intoxication: euphoria, respiratory and CNS depression, decrease gag reflex, pupillary constriction (pinpoint pupils), seziures (overdose) -treatment: Naloxone, naltrexone
withdrawal: sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu-like symptoms) -treatment long-term support, methadone, buprenorphine

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6
Q

Describe symptoms of acute neonatal narcotic withdrawal. What to treat?

A

Acute neonatal narcotic withdrawal: pupillary dilation, rhinorrhea, sneezing, nasal stuffiness, diarrhea, N/V, chills, tremors, jittery movements, can progress to seizures

treat with tincture of opium

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7
Q

List symptoms of intoxication and withdrawal: barbiturates (depressants)

A

intoxication: low safety margin, marked respiratory depression -treatment: symptom management (assist respiration, increase BP)
withdrawal: delirium, LIFE-THREATENING cardiovascular collapse

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8
Q

List symptoms of intoxication and withdrawal: benzodiazepines (depressants)

A

intoxication: greater safety margin, ataxia, minor respiratory depression -treatment-flumazenil -BZ-receptor antagonist but rarely used as it can precipitate seizures
withdrawal: sleep disturbance, depression, rebound anxiety, seizure

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9
Q

List the 4 groups of psychoactive drugs that are considered depressants:

General side effects of this class for:
Intoxication: mood elevation, decrease anxiety, sedation, behavioral disinhibition, resp depression
Withdrawal: anxiety, tremor, seizures, insomnia

A
  • alcohol
  • opioids
  • barbiturates
  • benzodiazepines
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10
Q

List general symptoms of intoxication and withdrawal belonging to the class of stimulants (amphetamines, cocaine, caffeine, nicotine)

A

intoxication: mood elevation, psychomotor agitation, insomnia, cardiac arrythmias, tachycardia, anxiety
withdrawal: post-use crash, including depression, lethargy, weight gain, headache

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11
Q

List symptoms of intoxication and withdrawal: amphetamines

A

intoxication: euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attn, hypertension, tachycardia, anorexia, paranoia, fever; severe enough can cause cardiac arrest and seizures
withdrawal: anhedonia (inability to exp pleasures with activities usu found enjoyable), increase appetite, hypersomnolence, existential crisis

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12
Q

List symptoms of intoxication and withdrawal: cocaine

A

intoxication: impaired judgement, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death -treatment: alpha blockers, benzodiazepines (BETA BLOCKERS NOT RECOMMENDED)

Withdrawal: hypersomnolence, malaise, severe psychological craving, depression/suicidality

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13
Q

List symptoms of intoxication and withdrawal: caffeine

A

intoxication: restlessness, increase diuresis, muscle twitching
withdrawal: lack of concentration, headache

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14
Q

List symptoms of intoxication and withdrawal: nicotine

A

intoxiciation: restlessness
withdrawal: irritability anxiety, craving -treatment: nicotine patch, gum, or lozenges; bupropion/varenicline

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15
Q

List symptoms of intoxication and withdrawal: PCP -a hallucinogen

A

intoxication: belligerence, impulsivity, fever, psychomotor agitation, analgesia, verticaland horizontal nystagmus, tachy, homicidality, psychosis, delirium, seizures -treatment: benzo, rapid-acting anti-psychotics
withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

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16
Q

List symptoms of intoxication and withdrawal: LSD -a hallucinogen

A

intoxication: perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashblacks
withdrawal: n/a

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17
Q

List symptoms of intoxication and withdrawal: marijuana -a hallucinogen

A

intoxication: euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increase appetite, dry mouth, conjunctival injection, hallucinations
withdrawal: irritability, depression, insomnia, nausea, anorexia. most symptoms peak in 48hrs and last for 5-7 days. generally detectable in urine for up to 1 month.

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18
Q

What’s the pharm form of marijuana? Used in?

A

dronabinol (a THC isomer): used as antiemetic (in chemo) and appetite stimulant in AIDS

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19
Q

heroin addicts are at increased risk for? Outline the 3 possible treatments

A

Heroin addicts are at increase risk for hepatitis, HIV, abscesses, bacteremia, right-heart endocarditis (usu. s aureus)

1) Methadone -long-acting oral opiate used for heroin detox or long-term maintenance
2) naloxone + buprenorphine: antagonist + partial agonist
3) naltrexone: long-acting opioid antagonist used for relapse prevention once detoxified

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20
Q

What’s the treatment for alcoholism in that it conditions pts to abstain?

A

disulfiram -inhibits acetylaldehyde dehydrogenase to increase the bad symptoms of alcohol

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21
Q

List the 3 drugs that can be used to treat alcoholism

A

1) disulfiram
2) acamprosate
3) naltrexone

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22
Q

What is Wernicke-korsakoff syndrome caused by? What’s the triad? How to treat?

A

Vitamin B1 deficiency (thiamine)
triad: confusion, opthalmoplegia, ataxia
may progress to irreversible memory loss, confabulation, personality change (korsakoff psychosis)
*imaging: periventricular hemorrhage/necrosis of mammillary bodies

treatment: IV vitamin B1

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23
Q

Explain the differences btw delirium tremens and alcoholic hallucinosis

A
  • Delirium tremens is a life-threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink characterized by tachycardia, tremors, anxiety, seixures; it classically occurs in hospital setting (2-4 days postsurgery)
  • alcoholic hallucinosis: distinct condition characterized by visual hallucinations 12-48 hours after last drink -also treats with long-acting benzos (chlordiazepoxide, lorazepam, diazepam)
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24
Q

List the preferred drug for ADHD

A

Stimulants (e.g methylphenidate increases catecholamines in the synaptic cleft)

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25
Q

List the preferred drug for alcohol withdrawal

A

long-acting benzodiazepines (chlordiazepoxide, lorazepam, diazepam)

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26
Q

List the preferred drug for bipolar disorder

A

lithium -mech not understood
valproic acid -increases Na+ channel inactivation
atypical anti-psychotics -varied effects on 5-HT2, dopamine, alpha, and H1-receptors

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27
Q

List the preferred drug for bulimia

A

SSRIs

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28
Q

List the preferred drug for depression

A

SSRIs

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29
Q

List the preferred drug for generalized anxiety disorder

A

SSRIs, SNRIs

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30
Q

List the preferred drug for OCD

A

SSRIs, clomipramine (TCA)

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31
Q

List the preferred drug for panic disorder

A

SSRIs, venlafaxine (SNRIs), benzodiazepine

32
Q

List the preferred drug for PTSD

A

SSRIs, venlafaxine (SNRIs)

33
Q

List the preferred drug for schizophrenia

A

atypical anti-psychotics (2nd generation: clozapine, olanzapine, quietapine, risperidone, aripiprazole, ziprasidone)

34
Q

List the preferred drug for social phobias

A

SSRIs, beta blockers

35
Q

List the preferred drug for tourette syndrome

A

antipsychotics (pinozide, fluphenazine), tetrabenazine, clonidine

36
Q

List the 3 CNS stimulants. List mech of action and the 3 clinical uses.

A

-methylphenidate, dextroamphetamine, methamphetamine
MECH: increase catecholamines in the synaptic cleft, esp NE and dopamine

Clinical uses: ADHD, narcolepsy and appetite control

37
Q

All typical antipsychotics work via?

A

block dopamine D2 receptors (increase [cAMP] b/c D2 receptors = Gi)

38
Q

List the 4 clinical conditions typical antipsychotics can be used to treat

A
  • schizophrenia (primarily positive symptoms)
  • psychosis
  • acute mania
  • tourette syndrome
39
Q

typical antipsychotics are lipid soluble or insoluble?

A

-highly lipid soluble and stored in body fat: thus very slow to be removed from body!!!

40
Q

List all the side effects assoc with typical antipsychotics

A
  • Extrapyramidal system side effects -due to blockade of dopamine in nigrostriatal pathway) ***treatment: benztropine/anti-muscarinic; diphenydramine (H1 receptor blocker)
  • Endocrine side effects due to dopamine antagonism –> hyperprolactinemia –> galactorrhea
  • Neuroleptic malignant syndrome
  • Tardive dyskinesia
  • blocking muscarinic receptors –> dry, mouth, constipation
  • blocking a1 –> hypotension
  • blocking histamine receptors –> sedation
  • can cause QT prolongation (risk for torsades)
41
Q

Explain the evolution of EPS side effects in ppl who take typical antipsychotics

A
  • 4 hrs: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
  • 4 days: akathisia (restlessness)
  • 4 weeks: bradykinesia (parkinsonism)
  • 4 months: tardive dyskinesia **more common in high potency
42
Q

Separate the typical anti-psychotics into high potency and low potency.

A

high potency: “Try to Fly High”; neuro side effects

  • Trifluoperazine
  • Fluphenazine
  • haloperidol

low potency: “cheating thieves are low”: non-neuro side effects; mainly anticholinergic, antihistamine and a1 blockade side effects)

  • Chlorpromazine –unique side effect = Corneal deposits
  • Thioridazine –unique side effect reTinal deposits
43
Q

Neuroleptic malignant syndrome can occur in people taking anti-psychotics, typically the high potency typical anti-psychotics. List symptoms and treatment

A 
For NMS symptoms, think FEVER:
Fever
Encephalopathy
Vitals unstable
Enzymes increase (CK due to rhabomyolsis --> myoglobinuria)
Rigidity of muscles

Treatment: Dantrolene (muscle relaxant that inhibits Ca2+ channels), D2 agonists (bromocriptine)

44
Q

What is the mech of atypical (2nd) generation anti-psychotics?

A

-varied effects on 5-HT2, dopamine, alpha and H1-recetpors

45
Q

What is the clinical use of atypical anti-psychotics?

A

Schizophrenia (both positive and negative symptoms)

Also used for bipolar disorder, OCD, anxiety, disorder, depression, mania, Tourette.

46
Q

Compare EPS and anti-cholinergic side effects of typical vs atypical.

A

Typical -has more EPS side effects due to d2 receptor antagonism

Atypical -fewer EPS and fewer anticholinergic side sides

47
Q

T/F: Both typical (trifluoperazine, fluphenazine, haloperidol, chlopromazine, thioridazine) and atypical (olanzapine, clozapine, quetipine, risperidone, aripiprazole, ziprasidone) can produce QT prolongation, which is a risk factor for developing torsades (a ventricular arryhtmia)

48
Q

List the 6 atypical anti-psychotics

A
  • clozapine
  • olanzapine
  • quetiapine
  • risperidone
  • ziprasidone
  • aripiprazole
49
Q

Which 2 atypical anti-psychotics can cause significant weight gain

A
  • olanzapine

- clozapine

50
Q

Which atypical anti-psychotic can cause agranulocytosis and seizures

A

clozapine (can also cause toxic megacolon)

51
Q

Which atypical can cause increase prolactin?

A

risperidone can cause increase prolactin

52
Q

Of all the atypicals, which one is most likely to cause tardive dyskinesia? Which one is least likely?

A

most likely -> risperidone

least likely -> clozapine

53
Q

Lithium’s mech of action is not very clear although it might involve inhibiting phosphoinositol cascade. It is often used as a mood stabilizer for bipolar disorders, blocks relapse and acute manic events, can also use for SIADH (b/c it can cause nephrogenic diabetes insipidis)

However, it has a VERY narrow therapeutic window so requires close monitoring. What are some side effects?

A
  • Tremor
  • hypothyroidism
  • polyuria (causes nephrogenic diabetes insipidus)
  • teratogenesis –> causes Ebstein anomaly: tricuspid valve is downwardly/apically displaced making the RV have an atrialized thin part)

*can also have vision changes.

54
Q

How is lithium excreted? What drugs can cause lithium toxicity based on how lithium is handled by the kidneys?

A

Lithium is almost exclusively excreted by kidneys; most is reabsorbed at PCT with Na+.

Renal injury, toxins, drugs that lead to increase PCT absorption of Na+ can also increase lithium levels b/c lithium is handled like Na+

Drugs that cause increase PCT reabsorption = thiazide, NSAIDs, ACEI

55
Q

What’s the best way to manage lithium toxicity?

A

hemodialysis is most effective way of acutely decreasing lithium effects

56
Q

What is buspirone? Used for?

A

Buspirone stimulates 5-HT1A receptors used in generalized anxiety disorder.

  • does not cause sedation, addiction, or tolerance
  • takes 1-2 weeks to take effect
  • does not interact with alcohol
57
Q

List the 4 SSRIs

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
58
Q

What’s the mech of action of SSRIs? Used for?

A

mechanism: 5-HT-specific reuptake inhibitors

clinical use: depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD

59
Q

What are some side effects of SSRIs? What’s the one that’s of main concern?

A

GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido)

**sexual dysfunction is of main concern.

60
Q

What is serotonin syndrome? Treatment?

A

combining SSRIs w/ any other drugs that increase 5-HT (e.g. MAO inhibitors, SNRIs, TCAs) ***SSRI or TCA should be d/c at least 14d prior to starting a MAOI vice versa

  • hyperthermia
  • confusion
  • myoclonus
  • cardiovascular instability
  • flushing
  • diarrhea
  • seizures

Treat with cyproheptadine (5-HT2 receptor antagonist)

61
Q

List the 2 SNRIs and their mech of action and clinical uses as well as side effects

A
  • venlaxafine
  • duloxetine

MOA: inhibit 5-HT and NE reuptake
clinical use: depression
velaxafine: GAD, panic disorder, PTSD
duloxetine: diabetic peripheral neuropathy

side effect: most commonly: increase BP; also stimulant effects, sedation, nausea

62
Q

List the 7 TCAs

A
  • Amitriptyline
  • nortriptyline
  • imipramine
  • desipramine
  • clomipramine
  • doxepin
  • amoxapine
63
Q

List the mech of actions of TCA

A
  • block reuptake of NE and 5-HT
  • Na+ channel blockade *this is what kills
  • anti-cholinergic
  • alpha-adreneric blocker –> hypotension
  • GABA antagonists –> seizures
64
Q

What can TCAs be used for?

A
  • major depression
  • OCD (clomipramine)
  • peripheral neuropathy
  • chronic pain
  • migraine ppx
65
Q

T/F: atypical antipsychotics, typical antipsychotics and TCAs can prolong QT interval and may lead to torsades.

66
Q

List side effects of TCAs

A
  • sedation
  • a1 adrenergic blockade —> hypotension
  • anticholinergic –> dry, flushing, tachy, mydriasis, urinary retention
  • can prolong QT interval
  • convulsions, coma, cardiotoxicty (arrhytmias)
  • respiratory depression, hyperpyrexia
  • confusion and hallucinations in elderly
  • can cause mixed metabolic/resp acidosis
67
Q

Which TCA has less anti-cholinergic side effects?

A

nortriptyline (second generation TCA) has less side effects than third (like amitriptyline) so if an elderly needs TCA, use nortriptyline to prevent confusion and hallucinations than using amitriptyline

68
Q

What can you use to treat TCA overdose?

A

Na+ bicarb to prevent the arrhythmias b/c that is what kills

69
Q

List the 4 MAO inhibitors. Which one is specifically MAO-B inhibitor

A
  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline (MAO-B inhibitor)
70
Q

How do MAO inhibitors work? Normally use for?

A

MAO inhibitors can increase levels of NE, 5-HT, and DA used in atypical depression (mood reactivity, arms and legs feeling heavy/leaden fatigue, rejection sensitivity -overly sensitive to criticisms, increase sleep and appetitie), and anxiety

Selegiline -specific MAO-B inhibitor can be used to delay progression of Parkinsons

71
Q

What are some side effects of MAO inhibitors?

A
  • Hypertensive crisis (most notably with tyramine found in wine, cheese, chocolate, soy sauce, aged meats)
  • CNS stimulation

contraindicated with SSRIs, TCAs, St. Johns Wort, meperidine, dextromethorphan, = to prevent serotonin syndrome

72
Q

List the 3 atypical anti-depressants.

A

Bupropion
Mirtazapine
Trazodone

73
Q

Bupropion is an atypical anti-depressant that increases NE and DA via unknown mechanism. What else can bupropion be used for in addition as an antidepressant?

A
  • smoking cessation

- hypoactive sexual disorder

74
Q

What are some side effects of bupropion? What is one thing that actually makes someone choose bupropion over SSRI as their antidepressant?

A

Side effects: stimulant effects (tachy, insomnia), headache, SEIZURES in anorexic/bulimic patients

NO sexual side effects, which is one reason why pts will choose this over SSRI

75
Q

Mirtazapine is an atypical antidepressant. What is its mech of action? Side effects?

A

Mirtazapine is an a2-antagonist (increase release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.

Toxicity: sedation, increase appetite, weight gain, dry mouth

76
Q

Trazodone is an atypical antidepressant. What is its mech of action? Side effects?

A

MOA: primarily blocks 5-HT2 and a1-adrenergic receptors
-used primarily for insomnia, not really for depression b/c very high doses are needed

toxicity: sedation, nausea, priapism, postural hypotension

USLME Pharmacology (15 decks)

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