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PSYCH - Pharm Flashcards

1
Q

Typical Antipsychotics

A

High potency: trifluoperazine, fluphenazine, haloperidol

Low Potency: Chlorpromazapine, Thioridazine

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2
Q

Typical Antipsychotics MOA

A

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Block D2-Rs to increase cAMP

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3
Q

Typical Antipsychotics use

A

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Schizophrenia (+ symptoms)
Psychosis
Acute mania
Tourettes

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4
Q

Typical Antipsychotic toxicities

A

High potency: trifluoperazine, fluphenazine, haloperidol
Low Potency: Chlorpromazapine, Thioridazine

Lipid soluble - stored in fat for long time
EPS
Hyperprolactinemia
Anti-muscarinic (dry mouth, constipation)
Anti-a1 (hypotension)
Anti-histamine (sedation)
QT prolongation 
NMS
Tardive Dyskinesia
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5
Q

EPS =

A

Extrapyramidal symptoms
MC with high-potency: trifluoperazine, fluphenazine, haloperidol

4h = dystonia (muscle spasms, stiff, oculogyric crisis)
4d-4w = akathisia (restless)
4w = bradykinesia (parkinsonian, "haldol shuffle"
4m = tardive dyskinesia (stereotypes oral/facial movements)
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6
Q

EPS Rx

A

Benztropine (anti-muscarinic)

Diphenhydramine (H1G1 blocker)

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7
Q

NMS =

A 
Neuroleptic malignant syndrome
"FEVER"
Fever
Encephalopathy
Vitals unstable (autonomic instability)
Enzymes elevated (myoglobinuria)
Rigidity
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8
Q

NMS Rx

A 
Dantrolene (prevents Ca++ release from SR)
D2 agonists (bromocriptine)
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9
Q

Tardive dyskinesia

A

Stereotypes oral-facial movements from long-term antipsychotic use

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10
Q

High potency vs. low potency typical antipsychotics

A

High potency: trifluoperazine, fluphenazine, haloperidol
= neurological AE (huntingtons, delerium, EPS)

Low Potency: Chlorpromazapine, Thioridazine
= non-neurological AE (anti-cholinergic, anti-a1, anti-histamine)

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11
Q

Atypical Antipsychotics

A

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

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12
Q

Atypical antipsychotics MOA

A

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Not well known, alter 5HT2, DA, a, and H1 receptors

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13
Q

Atypical antipsychotics use

A

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Schizophrenia (+ and -)
Bipolar
mania
depression
anxiety
OCD
Tourette's
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14
Q

Atypical Antipsychotic toxicities - general

A

Quetiapine, Olanzapine, Risperidone, Aripiprazole, Clozapine, Zipreasidone

Fewer EPS and anti-cholinergic s/s than typicals
All may prolong QT (except aripiprazole)

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15
Q

Antipsychotics causing weight gain

A

clonzapine and olanzapine

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16
Q

Clozapine AE

A

weight gain, agranulocytosis, seizures

*requires weekly WBC counts

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17
Q

Antipsychotic causing agranulocytosis

A

clozapine

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18
Q

antipsychotic causing seizures

A

clozapine

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19
Q

Olanzapine AE

A

weight gain

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20
Q

Risperidone AE

A

prolactinemia

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21
Q

Lithium mechanism

A

unknown, related to PIP pathway

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22
Q

Lithium use

A

Mood stabilizer for bipolar! blocks their relapse and acute manic events
SIADH (SSRIs cause SIADH)

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23
Q

Lithium toxicity

A

Tremor
Hypothyroidism
Nephrogenic DI (increase with thiazides via increase Na co-transport in PCT from dehydration)
Teratogen (Ebstein anomaly = low tricuspid)

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24
Q

Buspirone mechanism

A

stimulates 5HT1A-Rs

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25
Buspirone use
GAD
26
Buspirone profile
No sedation, addiction, or tolerance. Does not interact with alcohol. Good for old addicts. BUT takes 1-2 weeks to start working
27
SSRIs
Paroxetine, sertraline, flluoxetine, citalopram
28
SSRI use
Paroxetine, sertraline, flluoxetine, citalopram ``` Depression GAD Panic disorder OCD Bulemia social phobia PTSD ```
29
SSRI toxicity
Paroxetine, sertraline, flluoxetine, citalopram GI SIADH (lithium treated SIADH) SEXUAL DYSFUNCTION SEROTONIN SYNDROME *less AE than TCAs
30
Serotonin syndrome: causes, s/s, Rx
Seen with any drug that increases 5HT: TCA, SSRI, SNRI, MAO-I; Ondansetron, detromethorphan, meperidine, tramadol, trypans, linezolid ``` Hyperthermia Confusion Myoclonus CV instability Flushing diarrhea seizures ``` Rx = cyproheptadine (5HT-2 antagonist)
31
Serotonin syndrome causes
Any drug that increases 5HT: TCA, SSRI, SNRI, MAO-I
32
Serotonin syndrome s/s
``` Hyperthermia Confusion Myoclonus CV instability Flushing diarrhea seizures ```
33
Serotonin syndrome rx
Rx = cyproheptadine (5HT-2 antagonist)
34
SNRIs
Venlafaxine and duloxetine
35
SNRI mechanism
Venlafaxine and duloxetine inhibits 5-HT and NE uptake
36
SNRI use
Venlafaxine and duloxetine Depression Venlafaxine - GAD, panic, PTSD Duloxetine - diabetic peripheral neuropathy
37
Venlafaxine use
Depression GAD Panic disorder PTSD
38
Duloxetine use
Depression | Diabetic peripheral neuropathy
39
SNRI toxicity
Venlafaxine and duloxetine INCREASE BP stimulant sedation nausea
40
TCAs
Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine
41
TCA mechanism
Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine Inhibit 5HT and NE reuptake
42
TCA use
Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine ``` Major depression OCD (clomipramine) Peripheral neuropathy Chronic pain Migraine prophylaxis ```
43
TCA toxicity
Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine ``` Anti-muscarinic (3' amitriptlyine is worse than 2' nortriptyline); causes confusion and hallucinations in the elderly Anti-a1 --> Orthostatic hypotension anti-histamine --> sedation Prolong QT Convulsions Coma Prolong Cardiac Fast Na+ channels --> Cardiotoxicity (arrhythmias) - prevent with NaHCO3 Respiratory depression Fever inc. NE/5HT --> Tremor, insomnia ```
44
TCA to use in elderly
Nortriptyline because 2' so less anticholinergics
45
NaHCO3
prevents arrhythmias with TCAs
46
MAO-I
Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)
47
MAO-I mechanism
Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only) Causes increased amine NTs (NE, 5HT, DA)
48
MAO-I use
Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only) ATYPICAL depression, anxiety
49
MAO-I toxicity
Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only) CHEESE REACTION - hypertensive crisis with tyramine-rich foods (wine, cheese, beer, smoked meats) CNS stimulation ``` Contraindicated with: (to prevent serotonin syndrome) SSRI TCA St. John's Wort Meperidine (opioid) Dextromethorphan (opioid) ```
50
Cheese reaction mechanism
Hypertensive crisis with tyramine-rich foods while on MAO-Is MAO normally breaks down tyramine in GIT MAO blocked, so tyramine absorbed Tyramine causes displacement of NE from its vesicles, and thus increases NE release excess NE causes hypertensive crisis
51
Bupropion mechanism
increase NE and DA (don't know how)
52
Bupropion use
ATYPICAL depression | Smoking cessation
53
Bupropion toxicity
stimulant HA SEIZURES IN ANOREXIC/BULEMICS *NO sexual AE (SSRIs do)
54
Mirtazapine mechanism
a2-antagonist - increases NE and 5HT release | 5HT-2 and 5HT-3 - R Antagonists
55
Mirtazapine use/AE
ATYPICAL depression Sedation (good for insomnia) Increased appetite and weight gain (good for elderly/AIDS)
56
Trazadone mechanism
Blocks 5HT-2 and a1-Rs Weakly inhibits presynaptic reuptake of serotonin Blocks postsynaptic H1 receptors
57
Trazodone use
MC = insomnia (because very high doses needed for atypical depression treatment)
58
Trazodone AE
PRIAPISM sedation (obviously) nausea postural hypotension
59
CNS stimulants
Methylphanidate, dextroamphetamine, methampnetamine
60
CNS stimulant mechanism
Methylphanidate, dextroamphetamine, methampnetamine Increase catecholamines in the synaptic cleft (especially NE and DA)
61
CNS simulant use
Methylphanidate, dextroamphetamine, methampnetamine ADHD, narcolepsy, appetite control
62
Methylphenidate
CNS Stimulant
63
Dextroamphetamine
CNS stimulant
64
Methamphetamine
CNS stimulant
65
Haloperidol
Typical antipsychotic - high potency
66
Trifluoperazine
Typical antipsychotic - high potency
67
Fluphenazine
Typical antipsychotic - high potency
68
Chlorpromazine
Typical antipsychotic - low potency
69
Thioridazine
Typical antipsychotic - low potency
70
Antipsychotics name general
haloperidol + ___azine
71
Quetiapine
Atypical antipsychotic
72
Olanzapine
Atypical antipsychotic
73
Risperidone
Atypical antipsychotic
74
Aripirazole
Atypical antipsychotic
75
Clozapine
Atypical antipsychotic
76
Ziprasidone
Atypical antipsychotic
77
Paroxetine
SSRI
78
Fluoxetine
SSRI
79
Fluoxetine vs. fluphenadine
``` fluoxetine = SSRI fluphenazine = typical antipsychotic ```
80
Citalopram
SSRI
81
Sertraline
SSRI
82
Venlafaxine
SNRI
83
Duloxetine
SNRI
84
Amitriptyline
TCA - 3'
85
Noramitriptyline
TCA - 2'
86
Imipramine
TCA
87
Desipramine
TCA
88
Clomipramine
TCA
89
Doxepin
TCA
90
Amoxapine
TCA
91
Tranylcypromine
MAO-I
92
Phenelzine
MAO-I
93
Selegiline
MAO-I (B selective)
94
Isocarboxazid
MAO-I

DRUGS (41 decks)

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