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DRUGS > PSYCH - Pharm > Flashcards

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
Q

Buspirone use

A

GAD

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26
Q

Buspirone profile

A

No sedation, addiction, or tolerance. Does not interact with alcohol. Good for old addicts.

BUT takes 1-2 weeks to start working

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27
Q

SSRIs

A

Paroxetine, sertraline, flluoxetine, citalopram

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28
Q

SSRI use

A

Paroxetine, sertraline, flluoxetine, citalopram

Depression
GAD
Panic disorder
OCD
Bulemia
social phobia
PTSD
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29
Q

SSRI toxicity

A

Paroxetine, sertraline, flluoxetine, citalopram

GI
SIADH (lithium treated SIADH)
SEXUAL DYSFUNCTION
SEROTONIN SYNDROME

*less AE than TCAs

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30
Q

Serotonin syndrome: causes, s/s, Rx

A

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)

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31
Q

Serotonin syndrome causes

A

Any drug that increases 5HT: TCA, SSRI, SNRI, MAO-I

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32
Q

Serotonin syndrome s/s

A 
Hyperthermia
Confusion
Myoclonus
CV instability
Flushing
diarrhea
seizures
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33
Q

Serotonin syndrome rx

A

Rx = cyproheptadine (5HT-2 antagonist)

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34
Q

SNRIs

A

Venlafaxine and duloxetine

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35
Q

SNRI mechanism

A

Venlafaxine and duloxetine

inhibits 5-HT and NE uptake

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36
Q

SNRI use

A

Venlafaxine and duloxetine

Depression

Venlafaxine - GAD, panic, PTSD
Duloxetine - diabetic peripheral neuropathy

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37
Q

Venlafaxine use

A

Depression
GAD
Panic disorder
PTSD

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38
Q

Duloxetine use

A

Depression

Diabetic peripheral neuropathy

39
Q

SNRI toxicity

A

Venlafaxine and duloxetine

INCREASE BP
stimulant
sedation
nausea

40
Q

TCAs

A

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

41
Q

TCA mechanism

A

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

Inhibit 5HT and NE reuptake

42
Q

TCA use

A

Amitryptiline, nortryptiline, imipramine, deipramine, clomipramine, dozepin, amoxapine

Major depression
OCD (clomipramine)
Peripheral neuropathy
Chronic pain
Migraine prophylaxis
43
Q

TCA toxicity

A

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
Q

TCA to use in elderly

A

Nortriptyline because 2’ so less anticholinergics

45
Q

NaHCO3

A

prevents arrhythmias with TCAs

46
Q

MAO-I

A

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

47
Q

MAO-I mechanism

A

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

Causes increased amine NTs (NE, 5HT, DA)

48
Q

MAO-I use

A

Isocarboxazid, Tranylcypromine, Phenelzine, Selegiline (MAO-B only)

ATYPICAL depression, anxiety

49
Q

MAO-I toxicity

A

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
Q

Cheese reaction mechanism

A

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
Q

Bupropion mechanism

A

increase NE and DA (don’t know how)

52
Q

Bupropion use

A

ATYPICAL depression

Smoking cessation

53
Q

Bupropion toxicity

A

stimulant
HA
SEIZURES IN ANOREXIC/BULEMICS

*NO sexual AE (SSRIs do)

54
Q

Mirtazapine mechanism

A

a2-antagonist - increases NE and 5HT release

5HT-2 and 5HT-3 - R Antagonists

55
Q

Mirtazapine use/AE

A

ATYPICAL depression
Sedation (good for insomnia)
Increased appetite and weight gain (good for elderly/AIDS)

56
Q

Trazadone mechanism

A

Blocks 5HT-2 and a1-Rs
Weakly inhibits presynaptic reuptake of serotonin
Blocks postsynaptic H1 receptors

57
Q

Trazodone use

A

MC = insomnia (because very high doses needed for atypical depression treatment)

58
Q

Trazodone AE

A

PRIAPISM
sedation (obviously)
nausea
postural hypotension

59
Q

CNS stimulants

A

Methylphanidate, dextroamphetamine, methampnetamine

60
Q

CNS stimulant mechanism

A

Methylphanidate, dextroamphetamine, methampnetamine

Increase catecholamines in the synaptic cleft (especially NE and DA)

61
Q

CNS simulant use

A

Methylphanidate, dextroamphetamine, methampnetamine

ADHD, narcolepsy, appetite control

62
Q

Methylphenidate

A

CNS Stimulant

63
Q

Dextroamphetamine

A

CNS stimulant

64
Q

Methamphetamine

A

CNS stimulant

65
Q

Haloperidol

A

Typical antipsychotic - high potency

66
Q

Trifluoperazine

A

Typical antipsychotic - high potency

67
Q

Fluphenazine

A

Typical antipsychotic - high potency

68
Q

Chlorpromazine

A

Typical antipsychotic - low potency

69
Q

Thioridazine

A

Typical antipsychotic - low potency

70
Q

Antipsychotics name general

A

haloperidol + ___azine

71
Q

Quetiapine

A

Atypical antipsychotic

72
Q

Olanzapine

A

Atypical antipsychotic

73
Q

Risperidone

A

Atypical antipsychotic

74
Q

Aripirazole

A

Atypical antipsychotic

75
Q

Clozapine

A

Atypical antipsychotic

76
Q

Ziprasidone

A

Atypical antipsychotic

77
Q

Paroxetine

78
Q

Fluoxetine

79
Q

Fluoxetine vs. fluphenadine

A 
fluoxetine = SSRI
fluphenazine = typical antipsychotic
80
Q

Citalopram

81
Q

Sertraline

82
Q

Venlafaxine

83
Q

Duloxetine

84
Q

Amitriptyline

A

TCA - 3’

85
Q

Noramitriptyline

A

TCA - 2’

86
Q

Imipramine

87
Q

Desipramine

88
Q

Clomipramine

89
Q

Doxepin

90
Q

Amoxapine

91
Q

Tranylcypromine

92
Q

Phenelzine

93
Q

Selegiline

A

MAO-I (B selective)

94
Q

Isocarboxazid

DRUGS (41 decks)

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