Psychiatry Flashcards
Atomoxetine
Norepinephrine reuptake inhibit used to treat ADHD
Haloperidol, Fluphenazine, Trifluoperazine
High potency typical antipsychotics (block D2 receptors –> increase cAMP)
- increased risk of EPS side effects (e.g. dystonia, akathisia, bradykinesia, tardive dyskinesia); treat EPS side effects with anticholinergics (e.g. benztropine, diphenhydramine)
- Haloperidol increases risk of NMS
Neuroleptic malginant syndrome (NMS)
Associated with haloperidol use.
Characterized by “FEVER”: Fever, Encephalopathy, Vitals unstable, Enzymes increase (myoglobinuria), Rigidity of muscles
Tx: dantrolene, D2 agonists (bromocriptine)
Chlorpromazine, Thioridazine
Low potency typical antipsychotics (block D2 receptors –> increase cAMP)
- increased risk of non-neurologic side effects (anticholinergic, antihistamine, alpha1-blockade)
- Chlorpromazine increases risk of cornea deposits
- Thioridazine inreases risk of retinal deposits
Olanzapine
Atypical antipsychotic
Associated with weight gain
Clozapine
Atypical antipsychotic
Associated with weight gain, granulocytosis (requires weekly WBC monitoring) and seizures
Risperidone
Atypical antipsychotic
Associated with increased prolactin, which leads to decreased GnRH, LH, and FSH (causing irregular menstruation)
Ziprasidone
Atypical antipsychotic
May prolong QT interval
Atypical antipsychotics
Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone
Varied effect on 5-HT2, dopamine, and alpha and H1 receptors
Treats positive and negative symptoms of schizophrenia, bipolar disorder, OCD
Lithium side effects
“LMNOP”: Lithium side effects
- Movement (tremor)
- Nephrogenic diabetic insipidus (ADH antagonist)
- HypOthyroidism
- Pregnancy problems (Ebstein anomaly and malformation oif great vessels)
Buspirone
Treats generalized anxiety disorder. Stimulates 5-HT1a receptor.
Fluoxetine, paroxetine, sertraline, citalopram
SSRIs. Treat depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD.
Risk of serotonin syndrome with concomitant use of any drug that increases 5-HT (e.g. MAO inhibitors, SNRIs, TCAs). Treat with cyprohepatadine (5-HT2 receptor antagonist)
Venlafaxine, duloxetine
SNRIs. Treat depression. Venlafaxine also treats GAD and panic disorder. Duloxetine also treats diabetic peripheral neuropathy.
Amitriptyline, nortriptyline, imipramine, desipramine, doxepin, amoxapine
TCAs. Block reuptake of norepinephrine and 5-HT (like SNRIs). Treat major depression, OCD (clomipramine), and fibromyalgia.
Toxicity: histamine antagonism (sedation), alpha1-blocking effects (orthostatic hypotension), anticholinergic side effects (intestinal ileus, urinary retention, sinus tach)
Complications (“Tri-C’s”): Convulsions, Coma, Cardiotoxicity (treat with NaHCO3)
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline
MAO inhibitors. All are non-selective except for selegiline (selective MAO-B inhibitor). Increase levels of amine NTs (norepinephrine, 5-HT, dopamine). Treat atypical depression, anxiety, hypochondriasis.
Toxicity:
- Hypertensive crisis (due to ingestion of tyramine in wine and cheese).
- Serotonine syndrome due to concomitant use with SSRIs, TCAs, St. John’s wort, meperidine (opioid), or dextromethorphan
Bupropion
Used for smoking cessation. Also used for depression with associated psychomotor retardation or hypersomnia.
MoA: Increases norepinephrine and dopamine.
No sexual side effects.
Toxicity: agitation, insomnia, seizures in bulimic patients
Mirtazapine
Treats depression in thin old depressed patients (increases appetite/weight gain).
MoA: alpha2-antagonist (increases release of norepinephrine and 5-HT) and 5-HT2 and 5-HT3 receptor antagonist
Trazodone
Treats insomnia. MoA: blocks 5-HT2 and alpha1 receptors.
May cause priapism (“trazobone”)
Triazolam
Short-acting benzo (< 6 hours)
“Try” it for a little bit
Lorazepam
Intermediate-acting benzo
Lasts One Relaxing Day (LOR)
Diazepam, Flurazepam, Chlordiazepoxide
Long-acting benzo (> 24 hours)
Cyprohepatadine
First-generation histamine antagonist with non-specific 5-HT1 and 5-HT2 receptor antagonistic properties.
Used in treatment of serotonin syndrome.
Varenicicline
Partial agonist of nicotinic ACh receptors.
Used in smoking cessation because it decreases nicotinic cravings and attenuates the rewarding effects of nicotine.
