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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
List the preferred drug for alcohol withdrawal
long-acting benzodiazepines (chlordiazepoxide, lorazepam, diazepam)
26
List the preferred drug for bipolar disorder
lithium -mech not understood valproic acid -increases Na+ channel inactivation atypical anti-psychotics -varied effects on 5-HT2, dopamine, alpha, and H1-receptors
27
List the preferred drug for bulimia
SSRIs
28
List the preferred drug for depression
SSRIs
29
List the preferred drug for generalized anxiety disorder
SSRIs, SNRIs
30
List the preferred drug for OCD
SSRIs, clomipramine (TCA)
31
List the preferred drug for panic disorder
SSRIs, venlafaxine (SNRIs), benzodiazepine
32
List the preferred drug for PTSD
SSRIs, venlafaxine (SNRIs)
33
List the preferred drug for schizophrenia
atypical anti-psychotics (2nd generation: clozapine, olanzapine, quietapine, risperidone, aripiprazole, ziprasidone)
34
List the preferred drug for social phobias
SSRIs, beta blockers
35
List the preferred drug for tourette syndrome
antipsychotics (pinozide, fluphenazine), tetrabenazine, clonidine
36
List the 3 CNS stimulants. List mech of action and the 3 clinical uses.
-methylphenidate, dextroamphetamine, methamphetamine MECH: increase catecholamines in the synaptic cleft, esp NE and dopamine Clinical uses: ADHD, narcolepsy and appetite control
37
All typical antipsychotics work via?
block dopamine D2 receptors (increase [cAMP] b/c D2 receptors = Gi)
38
List the 4 clinical conditions typical antipsychotics can be used to treat
- schizophrenia (primarily positive symptoms) - psychosis - acute mania - tourette syndrome
39
typical antipsychotics are lipid soluble or insoluble?
-highly lipid soluble and stored in body fat: thus very slow to be removed from body!!!
40
List all the side effects assoc with typical antipsychotics
- 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
Explain the evolution of EPS side effects in ppl who take typical antipsychotics
- 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
Separate the typical anti-psychotics into high potency and low potency.
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
Neuroleptic malignant syndrome can occur in people taking anti-psychotics, typically the high potency typical anti-psychotics. List symptoms and treatment
``` 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
What is the mech of atypical (2nd) generation anti-psychotics?
-varied effects on 5-HT2, dopamine, alpha and H1-recetpors
45
What is the clinical use of atypical anti-psychotics?
Schizophrenia (both positive and negative symptoms) Also used for bipolar disorder, OCD, anxiety, disorder, depression, mania, Tourette.
46
Compare EPS and anti-cholinergic side effects of typical vs atypical.
Typical -has more EPS side effects due to d2 receptor antagonism Atypical -fewer EPS and fewer anticholinergic side sides
47
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)
True
48
List the 6 atypical anti-psychotics
- clozapine - olanzapine - quetiapine - risperidone - ziprasidone - aripiprazole
49
Which 2 atypical anti-psychotics can cause significant weight gain
- olanzapine | - clozapine
50
Which atypical anti-psychotic can cause agranulocytosis and seizures
clozapine (can also cause toxic megacolon)
51
Which atypical can cause increase prolactin?
risperidone can cause increase prolactin
52
Of all the atypicals, which one is most likely to cause tardive dyskinesia? Which one is least likely?
most likely -> risperidone | least likely -> clozapine
53
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?
- 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
How is lithium excreted? What drugs can cause lithium toxicity based on how lithium is handled by the kidneys?
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
What's the best way to manage lithium toxicity?
hemodialysis is most effective way of acutely decreasing lithium effects
56
What is buspirone? Used for?
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
List the 4 SSRIs
- Fluoxetine - Paroxetine - Sertraline - Citalopram
58
What's the mech of action of SSRIs? Used for?
mechanism: 5-HT-specific reuptake inhibitors | clinical use: depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD
59
What are some side effects of SSRIs? What's the one that's of main concern?
GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido) **sexual dysfunction is of main concern.
60
What is serotonin syndrome? Treatment?
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
List the 2 SNRIs and their mech of action and clinical uses as well as side effects
- 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
List the 7 TCAs
- Amitriptyline - nortriptyline - imipramine - desipramine - clomipramine - doxepin - amoxapine
63
List the mech of actions of TCA
- block reuptake of NE and 5-HT - Na+ channel blockade *this is what kills - anti-cholinergic - alpha-adreneric blocker --> hypotension - GABA antagonists --> seizures
64
What can TCAs be used for?
- major depression - OCD (clomipramine) - peripheral neuropathy - chronic pain - migraine ppx
65
T/F: atypical antipsychotics, typical antipsychotics and TCAs can prolong QT interval and may lead to torsades.
True
66
List side effects of TCAs
- 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
Which TCA has less anti-cholinergic side effects?
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
What can you use to treat TCA overdose?
Na+ bicarb to prevent the arrhythmias b/c that is what kills
69
List the 4 MAO inhibitors. Which one is specifically MAO-B inhibitor
- Tranylcypromine - Phenelzine - Isocarboxazid - Selegiline (MAO-B inhibitor)
70
How do MAO inhibitors work? Normally use for?
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
What are some side effects of MAO inhibitors?
- 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
List the 3 atypical anti-depressants.
Bupropion Mirtazapine Trazodone
73
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?
- smoking cessation | - hypoactive sexual disorder
74
What are some side effects of bupropion? What is one thing that actually makes someone choose bupropion over SSRI as their antidepressant?
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
Mirtazapine is an atypical antidepressant. What is its mech of action? Side effects?
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
Trazodone is an atypical antidepressant. What is its mech of action? Side effects?
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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