Psych pharmacology Flashcards
Emotional lability, slurred speech, ataxia, GGT elevation and AST > ALT indicates
Alcohol intoxication
CNS and respiratory depression, euphoria, miosis, seizures and euphoria indicate
Opioid intoxication
4 Symptoms of mild alcohol withdrawal
anxiety, tremor, seizures and insomnia
Symptoms of opioid withdrawal
sweating, mydriasis, goosebumps, cramps, diarrhea, rhinorrhea, yawning
Methadone and buprenorphine treat withdrawal from
opioids
Delirium, life-threatening cardiovascular collapse can occur due to withdrawal from
Barbiturates
Sleep depression, depression, seizures and rebound anxiety indicates withdrawal from
Benzodiazepines
Headache, difficulty concentrating and flu-like symptoms occur from withdrawal of
caffeine
Nicotine withdrawal symptoms include
anxiety, irritability, restlnessness and difficulty concenrtrating
Euphoria, grandiosity, pupil dilation and prolonged attention and wakefulness, hypertension, anorexia, fever and tachycardia indicate toxicity of
Amphatemies
Alpha-blockers, benzodiazepines treat intoxication of which substance
cocaine
Symptoms of cocaine intoxication
Impaired judgment, pupillary dilation, hallucination (including tactile), paranoid ideations, angina, sudden cardiac death
What are symptoms of stimulant withdrawal?
lethargy, increased appetite, vivid nightmares, depression
What is delirium tremens?
Life-threatening alcohol withdrawal syndrome that peaks 2-4 days after last drink
Presentation of delirium tremens
tachycardia, tremors, anxiety and seizures
Treatment for delirium tremens
benzodiazepines
Violence, nystagmus, hypertension, delirium, seizures, trauma are common signs of intoxication from
Phencyclidine
Treatment for phencyclidine toxicity
benzodiazepines, rapid acting antipsychotic
Perceptual distortion, depersonalization, psychosis, possible flashbacks indicate intoxication from
LSD (Lysergic acid diethylamide)
increased appetite, dry mouth, impaired judgment, euphoria, slowed perception of time indicate intoxication from
marijuana
What are three symptoms of MDMA intoxication
euphoria, disinhibition, hyperactivity
Hyperthermia, hyponatremia and serotonin syndrome are life-threatening complications in which substance?
MDMA
Which opioid antagonist is used for relapse after detox
Naltrexone
How does Methadone treat heroin addiction
It is long-acting opiate so less withdrawal symptoms and lower abuse potential, good for long-term maintenance
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
