PSYCHIATRY Flashcards
General drugs for alcohol withdrawal
Benzodiazepines
What level of potency do trifluoperazine, fluphenazine, and haloperidol have as typical antipsychotics?
high
A schizophrenic pt that has weekly CBC monitoring is most likely taking what drug?
clozapine because it causes agranulocytosis
Which SNRI can be used to treat the neuropathic pain of diabetic neuropathy?
Duloxetine
Which TCA can be used to Tx bedwetting?
Imipramine
Which TCA can be used to Tx OCD?
Clomipramine
Name 4 MAOI antidepressants
Tranylcypromine, Isocarboxazid, Selegiline, and Phenelzine
Name 5 typical antipsychotics
Haloperidol, trifluoperazine, fluphenazine, thioridazine, and chlorpromazine (haloperidol and the zines)
Which drug is known to cause the Ebstein anomaly?
lithium
What is the Tx for serotonin syndrome? MOA?
Cyproheptadine (5HT2 antagonist)
Which drugs are best for Tourette’s syndrome?
antipsychotics (haloperidol and risperidone)
In general, which generation of antipscyhotics is known to 1) Cause EPS and tardive dyskinesia 2) cause weight gain?
1) typicals (1st gen) 2) atypicals (2nd gen)
What is the MOA of the typical antipsychotics?
Blocks D2 and therefore increases cAMP
Clozapine and Olanzapine are atypical antipsychotics most notorious for causing ______-
weight gain (clozapine also causes agranulocytosis)
NaHCO3 is the antidote to OD of which antidepressant?
TCA’s–esp to prevent cardiotoxicity
What kind of drug is tranylcypromine?
MAO-I antidepressant
What are the major AE of trazodone (4)
PRIAPISM (trazoBONE), sedation, nausea, and postural hypotension
2 types of drugs for ADHD
amphetamines and methylphenidate
What is the primary endocrine AE of typical antipsychotics?
galactorrhea because they block DA and DA is aka prolactin-inhibiting factor
Which drug is a selective MAOB inhibitor?
Selegiline
Which drug is an alpha-2 antagonist, and 5HT2 and 5HT3 antagonist?
mirtazapine
What is the Tx for TCA overdose?
NaHCO3 (alkalinize urine)
What drugs are best for PTSD?
SSRIs
What kind of drug is ziprasidone? Major AE?
Atypical antipsychotic, QT prolongation
Where can you find tyramine? With which class of drug is it an issue? What happens?
Wine and cheese; MAOI’s; HTN crisis
High potency typical antipsychotics primarily have what AE?
neurological AE (i.e. EPS and tardive dyskinesia)
What is buspirone used to Tx?
Generalized anxiety disorder
Which population is most at risk for seizure on bupropion?
Bulimics
What may provoke a HTN crisis in a patient on an MAOI?
Tyramine
Which class of drugs can cause HTN crisis if taken with tyramine containing foods?
MAOIs
What other indication does bupropion have aside from depression?
smoking cessation
What sexual AE are present in bupropion?
NONE
Name 2 SNRI’s
venlafaxine, duloxetine
Which atypical antidepressant is an alpha-2 antagonist?
mirtazapine
Why is mirtazapine preferrable in depressed pts with insomnia?
one of its AE is sedation
What is the major AE of clozapine (2)
agranulocytosis (weekly CBC monitoring) and weight gain
What atypical antidepressant primarily inhibits serotonin reuptake and is used for insomnia?
Trazodone
What is the Tx of neuroleptic malignant syndrome (2)
Bromocriptine and Dantrolene
What is the MOA of mirtazapine?
Atypical antidepressant that is an alpha-2 antagonist that increases release of NE and serotonin; it also inhibits 5HT2 and 5HT3
What kind of drugs are sertraline and citalopram?
SSRIs
What class of drug has a similar MOA to tricyclic antidepressants?
SNRI’s, both block reuptake of serotonin and NE
Dantrolene and Bromocriptine are important for the Tx of what?
Neuroleptic malignant syndrome (dantrolene for muscle rigidity, and bromocriptine to agonize the antagonized D2 receptors)
MOA of lithium
unknown but likely affects the phosphoinositol cascade
Which drugs are best for OCD? (2)
SSRI and clomipramine (a TCA)
7 indications for SSRI’s
Depression, Generalized Anxiety Disorder, Panic Disorder, OCD, bulimia, social phobias, and PTSD
DOC class for bulimia
SSRI
What are 4 AE of mirtazapine?
sedation (good for insomnia), increase appetite, wieght gain (good for anorexia), and dry mouth
Which drugs MOA are not completely understood but block 5HT2, D2, and alpha 1 and H1?
atypical antipsychotics (2nd Gen)
Why do typical antipsychotics take so long to leave the body?
They are highly fat soluble
Which drugs are best for social phobias?
SSRIs
What is the MOA of the CNS stimulants: methylphenidate, dextroamphetamine, and methamphetamine?
increase catecholamines at the synaptic cleft (NE and DA, in particular)
What is the MOA of MAOI’s?
Block monoamine oxidase so increase concentration of amine neurotransmitters (NE, DA, and 5HT)
What is the MOA of maprotiline?
blocks NE reuptake
What kind of drugs are olanzapine, clozapine, quetiapine, risperidone, aripiprazole, and ziparasidone?
atypical antipsychotics
What kind of drugs are fluoxetine, paroxetine, sertraline, and citalopram?
SSRIs
Which typical antipsychotic causes corneal deposits? Retinal deposits?
Chlorpromazine, thioridazine
What 5 drugs are CI with MAOIs as it may provoke serotonin syndrome?
Meperidine, Dextromethorphan, SSRI, TCA, and St. John’s Wort
What 3 disorders can be Tx’d by methylphenidate, dextroamphetamine
Narcolepsy, ADHD, and appetite control
What atypical antipsychotic causes weight gain and agranulocytosis which requires weekly CBC monitoring?
clozapine
Which atypical antidepressant increases NE and DA via an unknown mechanism and may cause seizures in bulimics?
Buproprion
Why do TCAs sometimes cause postural hypotension?
alpha-1 blockade
Which anxiolytic does NOT interact with alcohol?
Buspirone because it is not GABAergic, rather it stimulates 5HT-1A
What kind of drug is phenelzine?
MAOI antidepressant
Which atypical antipsychotic is most likely to cause QT prolongation?
Ziprasidone
Which sexual dysfunctions may arise with SSRI’s?
Anorgasmia and decreased libido
What SNRI is also approved for Tx of generalized anxiety and panic disorder?
Venlafaxine
What is the MOA of the SNRI’s?
Block reuptake of BOTH serotonin and norepi
What kind of drugs are duloxetine and venlafaxine?
SNRI’s
What is the MOA of 1) Buspirone and 2) Bupropion
1) anxiolytic that stimulates 5HT-1A 2) Atypical antidepressant that increases NE and DA via unknown mechanism
Which AE of typical antipsychotics is typically irreversible?
Tardive dyskinesia
What level potency typical antipsychotics generally have non-neurologic side effects? i.e. anticholinergic, antihistaminergic, and alpha-1 blockade?
low potency typical antipsychotics (i.e. chlorpromazine and thioridazine)
Name 7 TCA’s
Amitryptaline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, and Amoxapine
What are the Tri-C’s of TCA toxicity?
Convulsions, Comas, and Cardiotoxicity
What is the least sedating TCA with the highest seizure threshold?
Desipramine
What are the low potency typical antipsychotics?
Chlorpromazine and thioridazine
Which 2 MAOI’s do NOT end in iptyaline or impramine?
Doxepin and Amoxapine
What kind of drug is selegiline?
MAOI antidepressant; also used for Parkinsons (it is a SELECTIVE MAO-B INHIBITOR)
How long does it take for antidepressants to have an effect?
4-8 weeks
What is the caution for using bupropion in bulimics?
Can cause seizure; in general it lowers seizure threshold
How long does buspirone take to take effect?
1-2 weeks (would not use for panic disorder)
What are the special uses of the TCA’s: 1) Imipramine and 2) Clomipramine
1) Bedwetting (anticholinergic effect) 2) OCD
Which psychiatric med has an unestablished MOA but likely affects the phosphoinositol cascade?
lithium
Which antipsychotics can Tx both positive and negative Sx of schizophrenia
2nd gen
What receptors do typical antipsychotics block to cause 1) dry mouth and constipation 2) drowsiness 3) hypotension
1) muscarinic 2) histaminergic (H1) and 3) alpha 1
Which drugs block the D2 receptors (only) and increase cAMP?
typical antipsychotics (neuroleptics)
Which typical antipsychotic causes corneal deposits?
Chlorpromazine
MOA of atypical antipsychotics
not completely understood but affect 5HT-2, DA, and alpha and H1 receptors
Which SNRI has the greatest effect on NE?
Duloxetine
What kind of drug is isocarboxazid? Isoniazid?
MAOI antidepressant; anti-TB drug that blocks mycolic acid synthesis
What other indication aside from depression is duloxetine used for?
Diabetic peripheral neuropathy (neuropathic pain)
Why would you want an EKG for 1 )Lithium 2) Ziprasidone
1) Causes heart block (CI in sick sinus syndrome) 2) causes QT prolongation
What drugs are indicated for atypical depression, anxiety, and hypochondriasis
MAOI
Name 4 SSRIs
Fluoxetine, paroxetine, sertraline, and citalopram
4 signs and symptoms of neuroleptic malignant syndrome
rigidity, autonomic instability, hyperpyrexia, and myoglobinuria
What fetal cardiac defects are associated with maternal use of lithium when pregnant?
Ebstein anomaly and great vessel defects
Which drug is best for depression with insomnia?
mirtazapine
What level of potency do chlorpromazine and thioridazine have as typical antipsychotics?
low
Which 2 atypical antipsychotics are most likely to cause weight gain?
clozapine (and agranulocytosis) and olanzapine
What is the most severe AE of SSRI’s?
serotonin syndrome
Which level of potency typical antipsychotics display primarily neurologic AE?
High potency (trifluoperazine, fluphenazine, and haloperidol)
Which type of drug causes neuroleptic malignant syndrome?
Typical antipsychotics
What kind of drugs are tranylcypromine, phenelzine, selegiline, and isocarboxazid?
MAOI antidepressants
Which atypical antidepressant can cause priapism?
trazodone (recall from Rohrbach, the one thing he actually taught us)
Which typical antipsychotic causes retinal deposits?
Thioridazine
With which opioids (2) are MAOI’s contraindicated because it may lead to serotonin syndrome?
Meperidine and dextromethorphan
What is the major psych use of cyproheptadine?
To treat serotonin syndrome
What syndrome involves hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea and seizures?
Serotonin syndrome
What can imipramine be used to Tx aside from major depression?
Nocturnal enuresis due to anticholinergic effect
What else can clomipramine be used to Tx aside from major depression?
OCD
Indications for MAOI’s (3)
Atypical depression, anxiety, and hypochondriasis
What is the most common AE of SNRI’s? Most severe?
HTN; serotonin syndrome
What are the most common AE of SSRI’s? Most severe?
GI distress and Sexual dysfunction (anorgasmia and decreased libido); Serotonin syndrome
What is the Tx for neuroleptic malignant syndrome? Serotonin syndrome?
NMS = Bromocriptine and Dantrolne; SS = Cyproheptadine
What are 4 major AE of lithium?
Hypothyroidism, Nephrogenic DI, teratogenic (ebstein anomaly), tremor, and heart block (sick sinus syndrome)
Where in the kidney is lithium reabsorbed?
PCT (follows Na)
Name 6 atypical antipsychotics
Quetiapine, olanzapine, clozapine, risperidone, aripiprazole (ablify), ziprasidone
What are the AE of TCA’s?
Antimuscarinic, Anticholinergic, and Antihistaminergic (Convulsions, Coma, and Cardiotoxicity (Tri-C’s))
Which drug, approved for generalized anxiety disorder stimulates 5HT-1A receptors?
Buspirone
What non-psychiatric condition can lithium be used to Tx?
SIADH (because it causes nephrogenic DI)
