Psych pharmacology Flashcards by geet baghel

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

Alcohol intoxication

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

Opioid intoxication

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4 Symptoms of mild alcohol withdrawal

anxiety, tremor, seizures and insomnia

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Symptoms of opioid withdrawal

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

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Methadone and buprenorphine treat withdrawal from

opioids

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

Barbiturates

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

Benzodiazepines

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

caffeine

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Nicotine withdrawal symptoms include

anxiety, irritability, restlnessness and difficulty concenrtrating

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

Amphatemies

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Alpha-blockers, benzodiazepines treat intoxication of which substance

cocaine

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Symptoms of cocaine intoxication

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

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What are symptoms of stimulant withdrawal?

lethargy, increased appetite, vivid nightmares, depression

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What is delirium tremens?

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

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Presentation of delirium tremens

tachycardia, tremors, anxiety and seizures

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Treatment for delirium tremens

benzodiazepines

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

Phencyclidine

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Treatment for phencyclidine toxicity

benzodiazepines, rapid acting antipsychotic

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

LSD (Lysergic acid diethylamide)

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

marijuana

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What are three symptoms of MDMA intoxication

euphoria, disinhibition, hyperactivity

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

MDMA

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Which opioid antagonist is used for relapse after detox

Naltrexone

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How does Methadone treat heroin addiction

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

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Name three therapeutic CNS stimulants

Methylphenidate, dextroamphetamine, methamphetamine

Three clinical uses for stimulants

ADHD, narcolepsy, appetite control

Mechanism of stimulants

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

What is the mechanism of antipsychotics (neuroleptics)

Block dopamine D2 receptors (increase cAMP)

What are the main clinical uses of neuroleptics (antipsychotics)

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

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

Trifluoperazine, Fluphenazine, Haloperidol

What are the side effects of high potency neuroleptics?

tremors, dystonia, rigidity, tardive dyskinesia, restlessness

Name two low-potency neuroleptics

Chlorpromazine, Thioridazine

What are the side effects of antipsychotics

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

Acute dystonia occurs how long after taking high-potency neuroleptics

Hours to days

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

Days to months

Tardive dyskinesia occurs how long after taking high potency neuroleptics

Months to years

What are the 4 symptoms of Neuroleptic malignant syndrome

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

Treatment for neuroleptic malignant syndome

Dantrolene or bromocriptine

Presentation of Neuroleptic malignant syndrome

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

How to ID neuroleptics

Haloperidol + -azines

What is the mechanism of aripiprazole

partial D2 agonist

Mechanism of atypical (second generation)) antipsychotics

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

Name the "pine" atypical antipsychotics

Clozapine, asenapine, olanzapine, quietiapine

Name the "idone" atypical antipsychotics

Ilooperidone, Lurasidone, Risperidone, Ziprasidone, Paliperidone

What type of medication is Aripiprazole

Atypical antipsychotic

What is the cliinical use of atypical antipsychotics

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

What are adverse effects of clozapine

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

What is an adverse effect of risperidone

hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)

Side effect of olanzazpine

obesity

Adverse effect of atypical antipsychotics

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

What is Lithium used for

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

side effects of lithium (L MNOP)

Movement tremor Nephrogenic diabetes insipdus Hypothyroidism Pregnancy problems

What is the mechanism of Buspirone

Stimulates 5HT1a receptors

What is the clinical use of Buspirone

Generalized Anxiety Disorder

What are the benefits of Buspirone

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

How long does Buspirone take to work

1-2 weeks

Name four major categories of antidepressants

SSRIs, SNRIs, TCAs, MAOIs

Tranylycypromine

MAOI

Isocarboxazid

MAOI

Phenelzine

MAOI

Selegline

MAOI

Name 4 MAOIs

Tranylycopromine, Isocarboxazid, Phenelzine, Selegline

Clinical use of MAOIs

Atypical depression, anxiety

Mechanism of MAOIs

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

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

interaction with Tyramine

side effects of MAOIs

CNS stimulation, Serotonin syndrome

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

2 weeks

Interaction of MAOIs with which drugs leads to Serotonin syndrome

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

Name 4 Atypical antidepressants

Bupropion, Mirtazapine, Trazodone, Varenicline

Mechanism of Bupropion

Stimulates NE and DA release

Use of Bupropion

depression, smoking cessation

side effects of Bupropion

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

Mechanism of Mirtazapine

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

side effects of Mirtazapine

weight gain, increased appetite, sedation, dry mouth

Mechanism of Trazodone

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

Use of Trazodone

Primarily for insomnia

Side effects of Trazadone

nausea, sedation, prolonged penile erection, postural hypotension

Varenicline mechanism

Nicotinic ACh receptor partial agonist

Use of Varenicline

Smoking cessation

Side effect of Varenicline

Sleep disturbance

List 4 SSRI

Fluoxetine, Paroxetine, Sertraline, Citalopram

Mechanism of SSRI

5HT reuptake inhibitor

How long do SSRIs take to work

4-8 weeks

Clinical use of SSRIs

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

Adverse effects

GI distress, SIADH, decreased libido

Name 5 SNRIs

Venlaxafine, Desvenlaxafine, Duloxetine, Levomilnacipran, Milnacipran

Mechanism of SNRIs

Inhibit 5HT and NE reuptake

Clinical use of SNRIs

Depression, GAD, diabetic neuropathy

Uses of Venlaxafine

Social anxiety disorder, panic disorder, PTSD, OCD

Adverse effects of SNRIs

Increased BP, tachycardia, sedation, nausea

Symptoms of Serotonin Syndrome

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

Treamtent of serotonin syndrome

Cyproheptadine

Amitriptyline

Tertiary TCA, more anticholinergic effects

Nortriptyline

Secondary TCA

Imipramine

TCA

Desipramine

TCA

Clomipramine

TCA, used for OCD

Doxepin

TCA

Amoxapine

TCA

Mechanism of TCAs

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

Clinical use of TCAs

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

Side effects of TCAs

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

Major adverse effects of TCAs

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

Treatment for TCA toxicity

NaHCO3 to prevent arrhythmia

Which antipsychotic is used for treatment-resistant schizophrenia?

Clozapine

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

MAOIs

MAOIs are optimal for use in

Treatment-resistant and atypical depression

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

Fall

List three first-line medications for bipolar disorder

Lithium, Valproate, Quetiapine

Why are antidepressants contraindicated in patients with bipolar disorder?

Can precipitate manic episodes

Which benzodiazepine is used for treatment of acute mania?

Lorazepam

Mechanism of benzodiazepines

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

Mechanism of barbiturates

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

Which psychiatric medications can induce mania in susceptible patients?

Antidepressants

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

Clozapine

Thyroid function tests and creatinine should be monitored in patients taking

Lithium

Second-generation antipsychotic that prolongs QT interval

Ziprasidone

Side effects include diabetes insipidus and hypothyroidism

Lithium