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USMLE > Psych pharmacology > Flashcards

Psych pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Emotional lability, slurred speech, ataxia, GGT elevation and AST > ALT indicates

A

Alcohol intoxication

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2
Q

CNS and respiratory depression, euphoria, miosis, seizures and euphoria indicate

A

Opioid intoxication

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3
Q

4 Symptoms of mild alcohol withdrawal

A

anxiety, tremor, seizures and insomnia

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4
Q

Symptoms of opioid withdrawal

A

sweating, mydriasis, goosebumps, cramps, diarrhea, rhinorrhea, yawning

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5
Q

Methadone and buprenorphine treat withdrawal from

A

opioids

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6
Q

Delirium, life-threatening cardiovascular collapse can occur due to withdrawal from

A

Barbiturates

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7
Q

Sleep depression, depression, seizures and rebound anxiety indicates withdrawal from

A

Benzodiazepines

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8
Q

Headache, difficulty concentrating and flu-like symptoms occur from withdrawal of

A

caffeine

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9
Q

Nicotine withdrawal symptoms include

A

anxiety, irritability, restlnessness and difficulty concenrtrating

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10
Q

Euphoria, grandiosity, pupil dilation and prolonged attention and wakefulness, hypertension, anorexia, fever and tachycardia indicate toxicity of

A

Amphatemies

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11
Q

Alpha-blockers, benzodiazepines treat intoxication of which substance

A

cocaine

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12
Q

Symptoms of cocaine intoxication

A

Impaired judgment, pupillary dilation, hallucination (including tactile), paranoid ideations, angina, sudden cardiac death

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13
Q

What are symptoms of stimulant withdrawal?

A

lethargy, increased appetite, vivid nightmares, depression

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14
Q

What is delirium tremens?

A

Life-threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink

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15
Q

Presentation of delirium tremens

A

tachycardia, tremors, anxiety and seizures

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16
Q

Treatment for delirium tremens

A

benzodiazepines

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17
Q

Violence, nystagmus, hypertension, delirium, seizures, trauma are common signs of intoxication from

A

Phencyclidine

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18
Q

Treatment for phencyclidine toxicity

A

benzodiazepines, rapid acting antipsychotic

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19
Q

Perceptual distortion, depersonalization, psychosis, possible flashbacks indicate intoxication from

A

LSD (Lysergic acid diethylamide)

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20
Q

increased appetite, dry mouth, impaired judgment, euphoria, slowed perception of time indicate intoxication from

A

marijuana

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21
Q

What are three symptoms of MDMA intoxication

A

euphoria, disinhibition, hyperactivity

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22
Q

Hyperthermia, hyponatremia and serotonin syndrome are life-threatening complications in which substance?

A

MDMA

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23
Q

Which opioid antagonist is used for relapse after detox

A

Naltrexone

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24
Q

How does Methadone treat heroin addiction

A

It is long-acting opiate so less withdrawal symptoms and lower abuse potential, good for long-term maintenance

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25
Q

Name three therapeutic CNS stimulants

A

Methylphenidate, dextroamphetamine, methamphetamine

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26
Q

Three clinical uses for stimulants

A

ADHD, narcolepsy, appetite control

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27
Q

Mechanism of stimulants

A

Increase catecholamines in synaptic cleft by blocking reuptake or degradation (by MAO)

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28
Q

What is the mechanism of antipsychotics (neuroleptics)

A

Block dopamine D2 receptors (increase cAMP)

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29
Q

What are the main clinical uses of neuroleptics (antipsychotics)

A

Positive symptoms of schizophrenia, psychosis, bipolar disorder, delirium, Tourettes, Huntington, OCD

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30
Q

Name the three high-potency neuroleptics (antipsychotics) (Try to Fly High)

A

Trifluoperazine, Fluphenazine, Haloperidol

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31
Q

What are the side effects of high potency neuroleptics?

A

tremors, dystonia, rigidity, tardive dyskinesia, restlessness

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32
Q

Name two low-potency neuroleptics

A

Chlorpromazine, Thioridazine

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33
Q

What are the side effects of antipsychotics

A

Dry mouth, sedation, orthostatic hypotension
dyskinesias
Galactorrhea, oligomenorrhea, gynecomastia
QT prolongation

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34
Q

Acute dystonia occurs how long after taking high-potency neuroleptics

A

Hours to days

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35
Q

Akathisia (restlessness) and Parkinsonism occur how long after taking high potency neuroleptics

A

Days to months

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36
Q

Tardive dyskinesia occurs how long after taking high potency neuroleptics

A

Months to years

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37
Q

What are the 4 symptoms of Neuroleptic malignant syndrome

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

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38
Q

Treatment for neuroleptic malignant syndome

A

Dantrolene or bromocriptine

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39
Q

Presentation of Neuroleptic malignant syndrome

A

Fever, encephalopathy, vitals unstable, enzymes increased, rigidity of muscles

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40
Q

How to ID neuroleptics

A

Haloperidol + -azines

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41
Q

What is the mechanism of aripiprazole

A

partial D2 agonist

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42
Q

Mechanism of atypical (second generation)) antipsychotics

A

varied effects on 5HT2, dopamine and alpha and H1 receptors. Most are D2 antagonists

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43
Q

Name the “pine” atypical antipsychotics

A

Clozapine, asenapine, olanzapine, quietiapine

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44
Q

Name the “idone” atypical antipsychotics

A

Ilooperidone, Lurasidone, Risperidone, Ziprasidone, Paliperidone

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45
Q

What type of medication is Aripiprazole

A

Atypical antipsychotic

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46
Q

What is the cliinical use of atypical antipsychotics

A

positive and negative sx of schizophrenia; bipolar disorder, OCD, anxiety disorder, depression, mania and tourette

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47
Q

What are adverse effects of clozapine

A

Agranulocytosis (monitor weekly WBC), seizures, myocarditis, metabolic syndrome

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48
Q

What is an adverse effect of risperidone

A

hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)

49
Q

Side effect of olanzazpine

A

obesity

50
Q

Adverse effect of atypical antipsychotics

A

prolonged QT interval, fewer EPS and anticholinergic effects than typicals though

51
Q

What is Lithium used for

A

Stabilizes mood in bipolar disorder and blocks relapse and acute manic events

52
Q

side effects of lithium (L MNOP)

A

Movement tremor
Nephrogenic diabetes insipdus
Hypothyroidism
Pregnancy problems

53
Q

What is the mechanism of Buspirone

A

Stimulates 5HT1a receptors

54
Q

What is the clinical use of Buspirone

A

Generalized Anxiety Disorder

55
Q

What are the benefits of Buspirone

A

Does not cause sedation, addiction or tolerance and does not interact with alcohol

56
Q

How long does Buspirone take to work

A

1-2 weeks

57
Q

Name four major categories of antidepressants

A

SSRIs, SNRIs, TCAs, MAOIs

58
Q

Tranylycypromine

A

MAOI

59
Q

Isocarboxazid

A

MAOI

60
Q

Phenelzine

A

MAOI

61
Q

Selegline

A

MAOI

62
Q

Name 4 MAOIs

A

Tranylycopromine, Isocarboxazid, Phenelzine, Selegline

63
Q

Clinical use of MAOIs

A

Atypical depression, anxiety

64
Q

Mechanism of MAOIs

A

Inhibit serotonin and NE degrdation by inhibiting IC MAOI (increase NE and 5HT levels)

65
Q

Aged cheese and wine with MAOIs can cause hypertensive crisis due to

A

interaction with Tyramine

66
Q

side effects of MAOIs

A

CNS stimulation, Serotonin syndrome

67
Q

How long to wait after stopping MAOIs before starting serotonergic drugs or changing diet

A

2 weeks

68
Q

Interaction of MAOIs with which drugs leads to Serotonin syndrome

A

St. John’s wort, SSRIs, TCAs detromethorphan and meperidine

69
Q

Name 4 Atypical antidepressants

A

Bupropion, Mirtazapine, Trazodone, Varenicline

70
Q

Mechanism of Bupropion

A

Stimulates NE and DA release

71
Q

Use of Bupropion

A

depression, smoking cessation

72
Q

side effects of Bupropion

A

tachycardia, insomnia, headache, seizures in anorexic/bulemic pts

73
Q

Mechanism of Mirtazapine

A

Inhibits alpha-2 autorceptor to increase NE and 5HT release, potent 5HT2 and 3 Receptor antagonist and H1 antagonist

74
Q

side effects of Mirtazapine

A

weight gain, increased appetite, sedation, dry mouth

75
Q

Mechanism of Trazodone

A

blocks 5HT2, alpha1 and H1 receptors; weakly inhibits 4HT reuptake

76
Q

Use of Trazodone

A

Primarily for insomnia

77
Q

Side effects of Trazadone

A

nausea, sedation, prolonged penile erection, postural hypotension

78
Q

Varenicline mechanism

A

Nicotinic ACh receptor partial agonist

79
Q

Use of Varenicline

A

Smoking cessation

80
Q

Side effect of Varenicline

A

Sleep disturbance

81
Q

List 4 SSRI

A

Fluoxetine, Paroxetine, Sertraline, Citalopram

82
Q

Mechanism of SSRI

A

5HT reuptake inhibitor

83
Q

How long do SSRIs take to work

A

4-8 weeks

84
Q

Clinical use of SSRIs

A

Depression, GAD, Panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premajure ejaculation, premenstrual dysphoric disorder

85
Q

Adverse effects

A

GI distress, SIADH, decreased libido

86
Q

Name 5 SNRIs

A

Venlaxafine, Desvenlaxafine, Duloxetine, Levomilnacipran, Milnacipran

87
Q

Mechanism of SNRIs

A

Inhibit 5HT and NE reuptake

88
Q

Clinical use of SNRIs

A

Depression, GAD, diabetic neuropathy

89
Q

Uses of Venlaxafine

A

Social anxiety disorder, panic disorder, PTSD, OCD

90
Q

Adverse effects of SNRIs

A

Increased BP, tachycardia, sedation, nausea

91
Q

Symptoms of Serotonin Syndrome

A

Clonus/hyperreflexia/hypotonia/tremor/seizure, hyperthermia, diaphoresis, diarrhea; agitation

92
Q

Treamtent of serotonin syndrome

A

Cyproheptadine

93
Q

Amitriptyline

A

Tertiary TCA, more anticholinergic effects

94
Q

Nortriptyline

A

Secondary TCA

95
Q

Imipramine

A

TCA

96
Q

Desipramine

A

TCA

97
Q

Clomipramine

A

TCA, used for OCD

98
Q

Doxepin

A

TCA

99
Q

Amoxapine

A

TCA

100
Q

Mechanism of TCAs

A

Block reuptake of NE and 5HT and block cardiac fast sodium channels

101
Q

Clinical use of TCAs

A

Major depression, OCD, peripheral neuropathy, chronic pain, migraine prophylaxis

102
Q

Side effects of TCAs

A

Sedation, tachycardia, diaphoresis, dry mouth, urinary retention, prolong QT interval

103
Q

Major adverse effects of TCAs

A

Convulsions, Coma, cardiotoxicity (arrhythmia due to Na+ channel inhibition), confusion and hallucinations in elderly, respiratory depression, hyperpyrexia, prolonged QRS and QT, dry mouth and flushing

104
Q

Treatment for TCA toxicity

A

NaHCO3 to prevent arrhythmia

105
Q

Which antipsychotic is used for treatment-resistant schizophrenia?

A

Clozapine

106
Q

Mood reactivity, heaviness in arms and legs, rejection sensitivity and increased sleep and appetite can be treated with which type of antidepressants

A

MAOIs

107
Q

MAOIs are optimal for use in

A

Treatment-resistant and atypical depression

108
Q

Antipsychotics, antidepressants, benzodiazepines are most commonly associated with what risk in the elderly

A

Fall

109
Q

List three first-line medications for bipolar disorder

A

Lithium, Valproate, Quetiapine

110
Q

Why are antidepressants contraindicated in patients with bipolar disorder?

A

Can precipitate manic episodes

111
Q

Which benzodiazepine is used for treatment of acute mania?

A

Lorazepam

112
Q

Mechanism of benzodiazepines

A

Allosterically bind GABAa Receptor to allow ain increased frequency of chloride channel opening

113
Q

Mechanism of barbiturates

A

Allosterically bind GABAa receptor and increase duration of channel opening to increase Cl- influx and hyperpolarization

114
Q

Which psychiatric medications can induce mania in susceptible patients?

A

Antidepressants

115
Q

Second-generation antipsychotic with superior efficacy in managing treatment-resistant schizophrenia and suicidality

A

Clozapine

116
Q

Thyroid function tests and creatinine should be monitored in patients taking

A

Lithium

117
Q

Second-generation antipsychotic that prolongs QT interval

A

Ziprasidone

118
Q

Side effects include diabetes insipidus and hypothyroidism

A

Lithium

USMLE (36 decks)

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