Psychiatry Flashcards
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
Use, mechanism, side effects, metabolism?
Selective Serotonin Reuptake Inhibitors (SSRIs)
Antidepressants
FLashbacks PARalyze SEnior CITizens
Use:
- Depression
- Generalized Anxiety Disorders
- Panic Disorder
- OCD
- Bulimia
- Social Phobias
- PTSD
Mechanism of Action:
- 5-HT specific reuptake inhibitors, increasing serotonin in the synapse
- Takes 4-8 weeks to have an effect
Side Effects:
- Sexual dysfunction (anorgasmia, decreased libido)
- rarely serotonin syndrome
- hyponatremia (worse w fluoxetine and paroxetine)
Metabolism:
- P450 system, lots of drug interactions. Escitalopram has fewest interactions
Cyproheptadine
- 5-HT2 receptor antagonist
- Treats Serotonin syndrome
- Also used in migraine treatment
Serotonin Syndrome
Serotonin Syndrome occurs in any drugs that affect serotonin (MAO inhibitors, SSRIs, SNRIs, TCAs)
- Hyperthermia
- Confusion
- Myoclonus
- Cardiovascular collapse
- Flushing
- Diarrhea
- Seizures
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxipine
Use, Mechanism, Side effects?
Tricyclic Antidepressants
-iptyline, -ipramine (except doxepin and amoxipine)
Use:
- Major Depression
- OCD (clomipramine)
- Fibromyalgia
Mechanism of Action:
- Block reuptake of NE and serotonin (same as SNRIs)
- Also has effects on muscarinic, histaminergic, and alpha1-adrenergic receptors
Side Effects:
- Sedation
- α1 - blocking effects (postural hypotension)
- Anticholinergic (atropine-like) effects = tachycardia, urinary retention, dry mouth. Worse in 3° TCAs (amitriptyline). These effects can cause confusion and hallucinations in the elderly (use nortriptyline)
- Desipramine has less sedation, more seizures
- Respiratory depression
- Hyperpyrexia
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrythmias)
Use NaHCO3 for cardiotoxicity
Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine
Use, Mechanism, Side effects?
Typical Antipsychotics (Neuroleptics)
-azines (+ haloperidol)
Use:
- Schizophrenia (positive symptoms)
- Psychosis
- Acute mania
- Tourette’s Syndrome
Mechanism of Action:
- All typical antipsychotics block D2 dopamine receptors
Side Effects:
- Highly lipid soluble and stored in body fat, so very slowly removed from body
- Corneal Deposits = Chlorpromazine
- Retinal Deposits = Thioridazine
- NMS, Tardive dyskinesia = Haloperidol
Extrapyramidal system side effects
- Seen most in high potency drugs: (Try to Fly HIGH)
Trifluoperazine, Fluphenazine, Haloperidol
- dyskinesias, NMS
- treated with Benztropine, diphenhydramine
- Evolution of EPS effects:
4 hr = acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 d = akathisia (restlessness)
4 wks = Bradykinesia (Parkinsonism)
4 mo = Tardive dyskinesia
ANS Effects
- seen most in low potency drugs: Cheating Thieves are LOW
Chlorpromazine, Thioridazine
- dry mouth, constipation (blocked muscarinic receptors)
- Orthostatic hypotension (blocked α1 receptors)
- Male sexual dysfucntion (blocked α receptors)
- Visual problems (blocked muscarinic receptors)
- Sedation (blocked histamine receptors)
Endocrine Effects
- hyperprolactinemia → galactorrhea (block of D2 in pituitary)
Buspirone
Use, Mechanism, Side effects?
Anti-Anxiety
I’m anxious that the BUS wont be ON time, so I take BUSpirONe
Use:
- Generalized Anxiety Disorders
Action:
- Stimulates 5-HT1A receptors
- Takes 1-2 weeks to take effect, use short-term benzodiazepines initially
Side Effects:
- No sedation, tolerance, or dependence
- Does no interact with alcohol (unlike barbiturates, benzodiazepines)
Venlafaxine
Duloxetine
Use. mechanism, Side effects
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Antidepressants
Use:
- Depression
- Generalized anxiety and panic disorders (Venlafaxine)
- Diabetic peripheral neuropathy (Duloxetine), pain disorders
Action:
- inhibit reuptake of both serotonin and NE
Side Effects:
- increased BP
- Stimulant effects: sedation, nausea
Mirtazapine
Use, Mechanism, Side effects?
Atypical Antidepressant
Use:
- Depression
Action:
- α2 - antagonist (increases release of NE, 5-HT)
- Potent 5-HT2 and 5-HT3 receptor antagonists
- Potent antagonist at histamine receptors
Side Effects:
- Sedation (may be desirable in depression w/ insomnia)
- Increased appetite and weight gain (may be desirable in eldery/annorexic)
- Dry mouth
Buproprion
Atypical Antidepressants
Use:
- Depression
- Smoking cessation
Action:
- Increases NE and dopamine via unkown mechanism
Side Effects:
- Stimulant effects (insomnia, tachycardia)
- Headache
- Seizure in bulimic patients
- No sexual side effects
Trazadone
Use, Mechanism, Side effects?
Atypical Antidepressant
Use:
- Usually for insomnia (need high doses for anti-depressive effects)
Action:
- Blocks α1-adrenergic and 5-HT2 receptors
Side Effects:
- Significant sedation
- Nausea
- Priapism (Trazo-bone)
- Postural Hypotension
Tranylcypramine
Phenelzine
Isocarboxazid
Monoamine Oxidase Inhibitors (MAOs)
Antidepressants
MAO Takes Pride In Shanghai
Use: Rarely used anymore due to side effects
- Atypical depression
- Anxiety
- Hypochondriasis
Action:
- nonselective MAO inhibition increases amine NTs (NE, 5-HT, dopamine)
Side Effects:
- Hypertensive Crisis. Occurs most notably after ingestion of tyramine, found in many foods (alcohol, cheese)
- CNS stimulation
Contraindications:
- SSRIs, TCAs, St. John’s Wort, meperidine, dextromethorphan (prevent seratonin syndrome)
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
Use, Mechanism, Side Effects?
Atypical Antipsychotics
It’s atypical for old clozets to quetily risper from A to Z.
Use:
- Schizophrenia (both positive and negative symptoms)
- Bipolar disorder
- OCD
- Anxiety disorders
- Depression
- Mania
- Tourette’s Syndrome (Risperidone)
Action:
- varied effects on 5-HT, dopamine, α- and H1 receptors
Side Effects:
- fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics
- Weight gain = Olanzapine/Clozapine
- Agranulocytosis (requires weekly RBC count) and seizure = Clozapine (Watch clozely)
- Prolactinemia (lactation, gynecomastia), ↓GnRH, LH, FSH (irregular menstruation, fertility issues) = Risperidone
- Prolonged QT interval = Ziprasidone
Lithium
Use, action, side effects, metabolism?
Use:
- Mood Stabilizer for Bipolar Disorder (blocks relapse and acute manic events)
- Can also be used in SIADH (acts as an ADH antagonist)
Action:
- unsure. May block phosphoinositol cascade, altering sodium transport
- Very narrow therapeutic window, serum levels must be watched closely
Side Effects:
LMNOP: Lithium causes:
- Movement (tremors)
- Nephrogenic diabetes insipidus (ADH antagonist) and thus polyuria (reversible)
- HypOthyroidism with goiter
- Pregnancy Problems = Fetal cardiac defects include Ebstein anomaly (defect in tricuspid valve) and malformation of great vessels
Metabolism:
- almost exclusively excreted by kidneys. Much is reabsorbed in the proximal tubule following sodium
Manage NDI with amiloride
