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Behavioral Sciences > Psychiatric Pharmacology > Flashcards

Psychiatric Pharmacology Flashcards

1
Q

Cyclic Antidepressants drugs

A
  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Desipramine
  • Clomipramine
  • Doxepin
  • Amoxapine
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2
Q

Haloperidol vs Chlorpromazine

Potency, EP symptoms, Anticholinergic effects

A
  • Haloperidol: high potency, high EPS, and low anticholinergic
  • Chlorpromazine: low potency, low EPS, and high anticholinergic
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3
Q

Carbamazepine and Valproic acid

Uses

A
  • Epilepsy
  • Acute mania
  • Rapid cycling bipolar disorder
  • Impulse control
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4
Q

Atomoxetine common uses

A

ADHD

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5
Q

Anti-psychotics mechanism of action

A
  • Dopamine blockage at post-synaptic receptors
  • Alpha-adrenergic blockade
  • Anticholinergic action by blocking muscarinic receptors
  • Blocks both NE and serotonin re-uptake
  • Blocks histamine receptors
    Note: All typicals block dopamine D2 receptors. Most Atypicals are D2 antagonists (except aripiprazole is D2 partial agonist) with varied effects on 5-HT2, dopamine, alpha and H1-receptors
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6
Q

Bupropion mechanism of action

A

Increases NE and dopamine via unknown mechanism

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7
Q

CNS stimulants common uses

A
  • ADHD
  • Narcolepsy
  • Appetite control
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8
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs) mechanism of action

A

Specific re-uptake inhibition of serotonin (5-HT), normally take 4-8 weeks to have an effect

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9
Q

Lithium Adverse effects

A
  • Tremor, thirst, anorexia and GI distress commonly occur at therapeutic levels
  • Life threatening seizures and coma
  • Polyuria and polydipsia
  • Edema
  • Acne
  • Benign leukocytosis
  • Hypothyroidism with goiter (decreased TSH effect and inhibition of 5’-deiodinase)
  • Nephrotoxicity (Thiazide increases toxicity)
  • Nephrogenic Diabetes Insipidus (DI) (decreased ADH effect)
  • Teratogenic (Ebstein anomaly of tricuspid valve)
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10
Q

Benzodiazepines

Uses

A
  • Anxiety
  • Acute and chronic alcohol withdrawal
  • Convulsions
  • Insomnia
  • Restless leg
  • Akathisia
  • Panic disorder
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11
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs) dugs

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram
  • Fluvoxamine (approved for OCD)
  • Escitalopram
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12
Q

Onset of EPS

A
  • Hours to days: Acute dystonia (muscle spasm, stiffness, oculogyric crisis)
  • Days to months: Akathisia (restlessness) and Parkinsonism (bradykinesia)
  • Months to years: TD
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13
Q

Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs) Adverse effects

A
  • Increased blood pressure (most common)
  • Stimulant effects
  • Sedation
  • Nausea
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14
Q 
Tardive Dyskinesia (TD) 
(Causes, Predisposing factors, Treatment)
A
  • Supersensitivity of post-synaptic dopamine receptors
  • Older patients, long-term Rx, smoking and DM
  • No Rx, focus on prevention: pimozide or loxapine has less chance of inducing TD, clozapine not associated with it at all
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15
Q

Clozapine

Specific Adverse effects

A
  • Agranulocytosis (weekly WBC count should be done)
  • Increased salivation (“wet pillow” syndrome)
  • Seizures
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16
Q

Mirtazapine mechanism of action

A
  • Alpha-2 adrenergic antagonist (Stimulates NE and 5-HT release
  • Blocks 5-HT2, 5-HT3 and H1 receptors
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17
Q

Trazodone mechanism of action

A
  • 5-HT receptor antagonist (5-HT2)
  • Alpha-1 adrenergic and H1 receptors blocker
  • Weakly inhibits 5-HT re-uptake
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18
Q

CNS stimulants mechanism of action

A

Increase catecholamines in the synaptic cleft, especially NE and dopamine

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19
Q

Monoamine oxidase inhibitors (MAOIs) drugs

A
  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline (selective MAOb inhibitor)
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20
Q

Typical vs Atypical anti-psychotics

A
  • Typical blocks dopamine, while atypical blocks both dopamine and serotonin
  • Typical treats mostly positive symptoms, while atypical treats positive and negative symptoms
  • Typical has more side effects, while atypical has fewer side effects
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21
Q

Chlorpromazine

Specific Adverse effects

A

Corneal deposits

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22
Q

Risperidone

Specific Adverse effects

A
  • Highest in raising prolactin levels

- Highest risk of movement disorders

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23
Q

Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs) Common uses

A
  • Depression
  • Generalized anxiety disorder
  • Diabetic neuropathy
  • Venlafaxine for social anxiety disorder, panic disorder, PTSD and OCD
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24
Q

Quetiapine

Specific Adverse effects

A

Lowest risk of movement side effects

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25
Q

Atomoxetine adverse effects

A
  • Nausea
  • Xerostomia (dry mouth)
  • Decreased appetite
  • Insomnia
  • Fatigue
  • Headache
  • Cough
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26
Q

Chlorpromazine and Thioridazine vs Haloperidol and Fluphenazine
(M block and Sedation)

A
  • Chlorpromazine and Thioridazine high M block and sedation

- Haloperidol and Fluphenazine low in M block and sedation

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27
Q

Electroconvulsive Therapy (ECT) Important Notes

A
  • Its not a first line treatment but should be considered for
  • Highly suicidal patients
  • Depressed pregnant patients
  • Improvement associated with large increase in slow wave (delta) activity in the prefrontal area; greater increase = greater recovery
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28
Q

Extrapyramidal (EP) reactions Treatment

A
  • Benztropine
  • Trihexyphenidyl
  • Diphenhydramine
  • Benzodiazepines
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29
Q

Cyclic Antidepressants Adverse effects

A
  • Anti-cholinergic effects: nortriptyline has less effects than amitriptyline
  • CNS effects: drowsiness, insomnia and agitation, disorientation and confusion, headache and fine tremor
  • Cardiovascular: most common in elderly and include tachycardia, orthostatic hypotension, and lethal arrhythmias in overdose
  • Sexual:
  • Men: impotence and testicular swelling
  • Women: anorgasmia and breast enlargement (treat with cyproheptadine[5-HT2 receptor antagonist])
  • Metabolic: changes in blood sugar levels
30
Q

Mirtazapine adverse effects

A
  • Somnolence
  • Increased appetite
  • Weight gain
  • Dry mouth
31
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs) Common uses

A
  • Depression
  • Generalized anxiety disorder
  • Panic disorder
  • OCD
  • Bulimia
  • Social anxiety disorder
  • PTSD
  • Premature ejaculation
  • Premenstrual dysphoric disorder
32
Q

Anti-psychotics neurologic adverse effects

A
  • Anticholinergic effects (especially in elderly): dry mouth, blurry vision, constipation, urinary retention and delirium. Also tachycardia and decreased seizure threshold
  • CNS effects from H1 receptors blockage: weight gain, sedation, and impaired memory
  • Extrapyramidal (EP) reactions due to decreasd dopamine
  • Tardive dyskinesia (TD): tongue protrusion, tremors and spasms of the neck, body and limbs. rarely before 3 to 6 month (1 month if older than 60)
33
Q

Extrapyramidal (EP) reactions names and timeline

A
  • Dystonic reactions (jerky movements, trouble speaking): 1 week (younger at more risk)
  • Akinesia: 2 weeks
  • Rigidity: 3 weeks
  • Tremors: 6 weeks
  • Akathisia: 10 weeks
  • Pisa and Rabbit syndromes: 18+ weeks
34
Q

CNS stimulants drugs

A
  • Methylphenidate
  • Dextroamphetamine
  • Methamphetamine
35
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs) Adverse effects

A
  • Anorgasmia and delayed orgasm in 15-20% of patients
  • Anxiety and agitation
  • Bruxism
  • Weight loss
  • SIADH
36
Q

Cyclic Antidepressants Common uses

A
  • Major depression
  • OCD (clomipramine)
  • Phobic and panic anxiety states
  • Peripheral neuropathy
  • Chronic pain with or without depression
  • Enuresis
  • Migraine prophylaxis
37
Q

Buspirone common uses

A

Generalized anxiety disorder

38
Q

Lithium Mechanism of action

A

Prevents recycling of inositol (PIP2) by blocking inositol monophosphate (second messenger) which leads to decrease cAMP

39
Q

Cyclic Antidepressants Toxicity

A

3 Cs

  • Convulsions
  • Coma
  • Cardiotoxicity (arrhythmia due to Na+ channel inhibition) treat with NaHCO3 to prevent arrhythmia
40
Q

Cyclic Antidepressants interactions and cautions

A
  • Hypertensive crisis with MAO inhibitors
  • Serotonin syndrome with SSRIs, MAO inhibitors, and meperidine (pethidine)
  • Prevent antihypertensive action of alpha-2 agonists
  • Potentiate effects of alcohol
  • Manic episodes induced in 50% of bipolars
  • Avoid during the first trimester of pregnancy
41
Q

Cyclic Antidepressants mechanism of action

A
  • Blocking re-uptake of serotonin and NE

- Blocking of alpha-1 adrenergic and muscarinic receptors

42
Q

Monoamine oxidase inhibitors (MAOIs) Interactions

A
  • Hypertensive crisis with SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan (used to prevent serotonin syndrome), alpha-1 agonists and levodopa. Also with tyramine containing foods: aged cheese, dried fish, sauerkraur, sausage, chocolate, avocado and red wine (the safe foods are cottage cheese and white wine). Rx: stop the medications and give phentolamine or chlorpromazine. Wait 2 weeks after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions
  • Serotonin syndrome with SSRIs, TCAs and meperidine
43
Q

Varenicline mechanism of action

A

Partial agonist of nicotinic receptors

44
Q

Anti-psychotics common uses

A
  • Psychotic symptoms: hallucinations, alteration of affect, ideas of reference, delusions, etc. (schizophrenia and bipolar disorder)
  • Tourette’s syndrome
  • Movement disorder: Huntington’s, hemiballism
  • OCD
  • Nausea and vomiting (drug and radiation induced)
  • Intractable hiccups
  • Pruritis
45
Q

Trazodone adverse effects

A
  • Priapism
  • Cardiac arrythmias
  • Sedation
  • Postural hypotension
46
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs) Toxicity and interactions

A
  • Serotonin syndrome
  • With MAO inhibitors, meperidine and TCAs
  • Most inhibit cytochrome P450 (especially fluvoxamine and fluoxetine)
  • Increased levels of benzodiazepines in treatment of anxiety disorder
  • Citalopram is safer for interaction
47
Q

Thioridazine

Specific Adverse effects

A
  • Cardiotoxicity (torsades “quinidine-like”)
  • Retinitis pigmentosa (retinal deposits)
  • Retrograde ejaculation
48
Q

Varenicline adverse effects

A

Sleep disturbances

49
Q

Anti-psychotics non-neurologic adverse effects

A
  • Cardiovascular: orthostatic hypotension (do not use epinephrine; lowers blood pressure further)
  • Particular taste (also dental cavities)
  • Vomiting: common with long term use especially among smokers
  • Sexual effects: due to elevated prolactin
  • Men: decreased libido, inhibition of ejaculation, retrograde ejaculation and gynecomastia
  • Women: breast enlargement and lactation, changes in libido, and dysmenorrhea
  • Altered bodily response to temperature
50
Q

Monoamine oxidase inhibitors (MAOIs) Common uses

A
  • Atypical depression

- Anxiety

51
Q

Monoamine oxidase inhibitors (MAOIs) mechanism of action

A

Inhibit MAOa and MAOb (enzymes that metabolizes serotonin, epinephrine and NE)

52
Q

Typical or First generation anti-psychotics

A
  • Chlorpromazine
  • Thioridazine
  • Fluphenazine
  • Haloperidol
  • Trifluoperazine (high potency)
53
Q

Electroconvulsive Therapy (ECT) Mechanism of action and uses

A
  • Electricity is passed from frontal cortex to the striatum, usually requires 5-10 treatments. and only relative C/I is increased intracranial pressure. 90% show immediate improvement
  • Uses: depression, schizoaffective disorder, and bipolar disorder
54
Q

Olanzapine

Specific Adverse effects

A

Highest incidence of diabetes, weight gain and increase cholesterol

55
Q

Buspirone mechanism of action

A

Stimulates 5-HT1a receptors

56
Q

Neuroleptic Malignant Syndrome (NMS)

Diagnosis and Treatment

A
  • Fever, encephalopathy, vitals unstable, Increased enzymes and rigidity of muscles with myoglobinuria
  • Dantrolene and bromocriptine (D2 agonist)
57
Q

Atypical or Second generation anti-psychotics

A
  • -pines: Clozapine, Olanzapine, Quetiapine, Asenapine
  • -dones: Risperidone, Ziprasidone, Lurasidone, Iloperidone, Paliperidone
  • Others: Aripiprazole
58
Q

Trazodone common uses

A
  • Depression
  • Insomnia
  • Erectile dysfunctio
59
Q

Atomoxetine mechanism of action

A

Selective NE re-uptake inhibitor

60
Q

Ziprasidone

Specific Adverse effects

A

Prolongs QT interval

61
Q

Buspirone adverse effects

A
  • Dizziness
  • Headache
  • Somnolence
  • Premature ejaculation
62
Q

Varenicline common uses

A

Smoking cessation

63
Q

Bupropion adverse effects

A
  • Increased risk of seizures (anorexic/bulimic patients)
  • Appetite suppressant
  • Agitation
  • Insomnia
  • Headache
64
Q

Lithium Common uses

A
  • Long-term control and prophylaxis of bipolar disorder, migraine cluster headache and chronic aggression
  • Combined with TCAs for resistant depression
65
Q

Atypical anti-psychotics which one is highest in alpha block and which one in sedation

A
  • Alpha block is clozapine

- Sedation is risperidone

66
Q

Haloperidol

Specific Adverse effects

A

Most likely cause of neuroleptic malignant syndrome (NMS) and TD

67
Q

Cyclic Antidepressants Withdrawal

A
  • Akathisia, dyskinesia, anxiety, sweating, dizziness, vomiting, cholinergic rebound, and depression rebound
  • After prolonged use, withdraw gradually
68
Q

Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs) drugs

A
  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine
  • Levomilnacipran
  • Milnacipran
69
Q

Bupropion common uses

A
  • Depression

- Smoking cessation

70
Q

Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs) Mechanism of action

A

Inhibit 5-HT and NE re-uptake

Behavioral Sciences (6 decks)

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