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Step 1 Drugs > Psychiatry > Flashcards

Psychiatry Flashcards

0
Q

Opioids

A

Intoxication: euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction, seizures

Treatment: naloxone, naltrexone

Withdrawal: sweating, dilated pupils, lacrimation, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea

Treatment: long term suppport, mehodone, buprenoprhine

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1
Q

Benzodiazepines

A

Intoxification: greater safety margin. Ataxia, minor respiratory depression.

Treatment: supportive care, consider flumazenil

Withdrawal: sleep disturbance, depression, rebound anxiety, seizure, tachycardia palpitations, psychosis

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2
Q

Caffeine

A

Intoxication: Restlessness, increased diuresis, muscle twitching

Withdrawal: lack of concentration, headache

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3
Q

Nicotine

A

Intoxication: Restlessness

Withdrawal: irritability, anxiety, craving, increased appetite, dysphoria

CYP 450 inducer

Treatment: nicotine patch, gum, or lozenges
Buproprion/varenicline

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4
Q

Venlafaxine

A

SNRI
MOA: inhibit 5-HT and NE reuptake

Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN

Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea, increased intraocular pressure

Withdrawal effects: flu, electric shocks

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5
Q

Methadone

A

MOA: LONG ACTING oral opiate, mu receptor agonist

Used for heroin detoxification to suppress withdrawal symptoms

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6
Q

Fluphenazine

A

MOA: block dopamine receptors (increase cAMP)
High potency
Can be given in bi-monthly injection

Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS

Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures

galactorrhea

Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)

Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements

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7
Q

Alcohol

A

Intoxication: emotional liability, slurred speech, ataxia, coma, blackouts,
Serum y-glutamyltransfersase-sensitive indicator of alcohol use
Lab AST value is 2x ALT value
Chronic: Down regulates GABA receptors, up regulates NMDA receptors

Withdrawal:
Mild-symptoms similar to other depressants
Severe alcohol withdrawal can cause autonomic hyperactivity (increased temp and RR, insomnia) and Delirum tremens
Seziures, tachycardia, palpitatons
First manifestation is the shakes (tremors)

Treatment for Delirum tremens: benzodiazepines

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8
Q

Marijuana (cannabinoid)

A

MOA: Active ingredient in THC which stimulates canniboid receptors CB1 and CB2

Intoxication: euphoria, paranoid delusions, perception of slowed time, slowed reflexes, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injection, rapid heart rate, hallucinatons, short term memory loss

Prescription: dronabinol uses as antiemetic in chemo and appetite stimulant in AIDS

Withdrawal: irritability, depression, insomnia, nausea, anorexia
Symptoms peak in 48 hours
detectable in urine for 4-10 days but up to 30
stored in lipophilic tissues

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9
Q

Naloxone + buprenorphine

A

MOA: partial agonist
Long acting with fewer withdrawal symptoms than methadone

Naloxone not active if taken orally

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10
Q

Quetiapine

A

Atypical antipsychotic

MOA: Dopamine and sertonin antagonist

Clinical: schizophrenia positive and negative symptoms
MDD, PTSD

Toxicity: Least likely extrapyramidal, less anticholinergic side effects than traditional antipsychotics

increase glucose, lipids, weight gain, orthostasis, esophageal dysmotility,

SEDATING, CATARACTS, PARKINSON’s

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11
Q

PCP (phencyclidine)

A

MOA: antagnozies NMDA receptors

Intoxication: belligerence, impulsivness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, ataxia, psychosis, delirium, seizures
Death due to trauma

Treatment: benzodiazpeines, rapid-acting antipsychotic

Withdrawal: depression, anxiety, irritability, restlessness, anergia (lack of energy), distrubances of thought and sleep

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12
Q

Naltrexone

A

Long acting opioid antagnosist used for relapse prevention once detoxified

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13
Q

Haloperidol

A

MOA: block dopamine receptors (increase cAMP)
High potency

Clinical: Schizophrenia positive symptoms, psychosis, acute mania, acute psychosis, Tourette syndrome AND HUNTINGTONS

Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures

galactorrhea

Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)

Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements

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14
Q

Thioridazine

A

MOA: block dopamine receptors (increase cAMP)
Low potency

Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS

Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures

galactorrhea

Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)

Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements

RETINAL DEPOSITS

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15
Q

Mirtazapine

A

Atypical antidepressant

MOA: alpha2 antagonist (increases release of NE and 5HT) and potent 5HT2 and 5HT3 receptor antagonist

Toxicity: sedation (insomnia patients), increased appetite, weight gain (elderly, cancer or anorexic patients), dry mouth, agranulocytosis

Use in elderly

NO sexual and little GI side effects!

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16
Q

Olanzapine

A

Atypical antipsychotic

MOA: Dopmain and sertonin antagonist

Clinical: Schizophrenia positive and negative symptoms
Bipolar disorder,

Toxicity: Fewer EPS and anticholinergic side effects than traditional antipsychotics
Orthostasis, esophageal dysmotility

Weight gain-increased lipids and LFTS

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17
Q

Fluoxetine (Prozac)

A

MOA:Serotonin reuptake inhibitors
Take 4-8 weeks to have an effect use BDZs temporarily

Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose

CYP450 inhibitor
Longest half life-no need to taper

Safe in pregnancy and with children

Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim

Toxicity: Fewer side effects than TCAs
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, weight loss, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Can cause weight loss

Watch with cough supprsesant for serotonin syndrome

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18
Q

Aripiprazole

A

Atypical antipsychotic

MOA: dopamine and serotonin antagonist, partial dopamine agonist

Clinical: schizophrenia positive and negative symptoms
Bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome

Toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotcs
incresaed glucose, lipids, weight, orthostatsis, esophageal dysmotility

SEIZURES, MANIA, AKATHESIA

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19
Q

Serotonin syndrome

A

Occurs with any drug that increases serotonin
Linezolid, TCAs, MAO inhibitors, SNRIs, triptans, tramadol, SSRIs

Symptoms: hyperthermia confusion, myoclonus, cardiovascular collapse, tachycardia, flushing, diarrhea, seizures, diaphoresis, rhabdomyolysis, renal failure, and death

Treatment: cyproheptadine (5HT Receptor antagonist) and stop medications

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20
Q

Modafinil

A

Non amphetamine stimulant

1st line for narcolepsy

CYP-450 inducer

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21
Q

Amphetamines

A

Intoxication: euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia,fever, diaphroresis, choreiform movements, tooth decay

Severe: cardiac arrest, seizure

Withdrawal: anhedonia (can’t experience pleasure from activities), increased appetite, hypersomnolence, existential crisis (question life)

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22
Q

Buspirone

A

MOA: stimulates 5-HT receptors

Clinical: generalized anxiety disorder
Does not cause sedation, addiction or tolerance
Does not interact with alcohol-useful in abuse patients

Takes 1-2 weeks to take effect

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23
Q

Lithium

A

MOA: not established

Clinical: mood stabilizer for bipolar disorder, blocks relapse and acute manic events, SIADH, Alcohol dependency, aggression

Toxicity: tremor, sedation, edema, heart block, ataxia, delirium, hypothyroidism, polyuria, n/v, slurred speech, hyperreflexia, metal taste, weight gain, seizures

CAN CAUSE NEPHRONGENIC DIABETES INSIPIDUS

Ebstein anomaly and malformation of great vessels

Thiazide diuretics, ACE inhibitors and NSAIDS increase lithium levels

MNOP: movement (tremor), nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy probs

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24
Q

Methylphenidate, dextroampheatmine, metamphetamine, phentermine

A

MOA: increase catecholamines at the synaptic cleft, especially NE and dopamine

Treat: ADHD, narcolepsy, appetite control

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25
Q

Buproprion

A

Atypical antidperessant

MOA: increase NE and dopamine by inhibiting presynpatic uptake

Clinical: atypical depression and smoking cessation, migraines, depression in bipolar, adult ADHD

Toxicity: stimulant effects (tacchycardia, insomnia), headache, nausea
DON’T USE IN PATIENTS WITH EATING DISORDERS, EPILEPSY, OR ALCOHOL ABUSE DUE TO INCREASE RISK OF SEIZURES and psychosis or on MAOI

No sexual side effects!!!

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26
Q

Trazodone

A

MOA: blocks 5Ht2 and alpha1 adrenergic receptors

Clinical: primarily insomnia, high doses needed for antidepressant

Toxicity: sedation, nausea, priapism (constant boner), postural hypotension, hepatotoxicity, dizziness, orthostatsis, cardiac arrhythmias

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27
Q

Ziprasidone

A

Atypical antipsychotic-

MOA: Dopamine and serotonin antagonist

Clinical: Schizophrenia positive and negative symptoms,
Bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome

Toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotics
May prolong QT interval should obtain ECGs
Less metabolic side effects

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28
Q

Akathisia

A

reslessnes and agiation

Treatment: B-Blocker

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29
Q

Cocaine

A

MOA: Blocks reuptake of monoamines

Intoxication: impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death (coronary artery vasospasm), stroke, intracranial hemorrhage, seizures, sympathetic stimulation-tachycardia

Treatment: benzodiazepines

Withdrawal: hypersomonlence, malaise, severe psychological craving, depression/suicidality, increased appetite, psychomotor retardation, MI (increased demand and decreased perfusion)

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30
Q

Resperidone

A

Atypical antipsychotic

MOA: Dopamine and Serotonin antagonists
Fast acting

Clinical: Schizophrenia positive and negative symptoms
Bipolar disorder OCD, anxiety disorder, depression, mania, Tourette syndrome/tics

toxicity: fewer EPS and anticholinergic side effects than traditional antipsychotics (however most likely atypical antipsychotic to cause EPS)
Increases prolactin leading to lactation and gynecomastia
Decreases GnRH, LH and FSH causing irregular menstruation and fertility issues

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31
Q

Varenicline

A

MOA: reinforces effects of nicotine that lead to dependene through partial agonistic acitivity on a4B2 nicotinic acetylcholin recpetor in CNS

Decreases symptoms of withdrawal and attenuating rewards

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32
Q

Clozapine

A

Atypical antipsychotics

MOA: Dopamine and serotonin antagonist
Acts on D4 receptors

Clinical: schizophrenia positive and negative symptoms (treatment resistant Schizo)

Toxicity: NO EPS and anticholinergic side effects than traditional antipsychotics (least likely atypical antipsychotic to cause EPS)
weight gain
AGRANULOCYTOSIS-requires weekly WBC monitoring
Seizures
MYOCARDITIS

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33
Q

LSD (Lysergic Acid Diethylamide)

A

Intoxication: perceptual distortion (visual auditory), visual hallucinations, depersonalization, anxiety, paranoia, psychosis, possible flashback

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34
Q

Phenelzine

A

MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off

Clinical: atypical depression, anxiety, hypochondriasis

Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine

Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome

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35
Q

Barbituates

A

intoxication: Low safety margin, marked respiratory depression

CYP450 Inducers

Treatment: symptom management-assist respiration, increase BP

Withdrawal: delirium, life threatening cardiovascular collapse

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36
Q

Electro convulsive therapy

A

Produced painless seizure in anesthetized patient

Treatment for major depressive disorder refractory to other treatments or pregnant women with depression

Or when immediate response is necessary (suicide)

Depression with psychotic features and Catatonia are also indications

AE: disorientation, temporary headache, and partial anterograde/retrograde amnesia fully resolving in 6 months

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37
Q

Psychoanalysis

A

Goal is to resolve unconscious conflicts by bringing repressed experiences and feelings into awareness

Insight oriented

Patients: under the age of 40, not psychotic, intelligent, in stable relationships and function daily

Useful in: Cluster C, Anxiety Disorders, OCD, Problems coping with life events, anorexia nervosa, sexual disorders, dysthymic disorder

Focus: unconscious conflicts cause symptoms, explore positive relationships, break down defense mechanisms , talk about problems

38
Q

Behavioral Therapy

A

Helping patients change behaviors that contribute to their symptoms
Extinguishes maladaptive behaviors by replacing htem with healthy alternatives

Classical and operant conditioning
flooding: phobic disorders
Systemic desensitization: phobic disorders
Aversion therapy: paraphilias, substance abuse
Token economy: showering, shaving
Biofeedback: migraines, agoraphobia, fecal incontinence, tension headache, asthma, hypertension, chronic pain

39
Q

Fluvoxamine (Luvox)

A

MOA:Serotonin reuptake inhibitors

CYP450 inhibitor
Lots of drug interactions

Clinical: ONLY OCD

Toxicity:
Nausea and vomiting more common
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Watch with cough supprsesant for sserotonin syndrome

40
Q

Cognitive Behavioral Therapy

A

Combines cognitive therapy and behavior therapy
patient learns how behaviors is influenced by thoughts

used in: depression, anxiety, and substance abuse

41
Q

Hyperprolactinemia

A

Seen with high potency traditional anti-psychotics (haloperidol and trifluoperazine) and risperidone

42
Q

Hypertensive Crisis

A

Caused by builldup of stored catecholamines (NE)
MAOIs + foods with tyramine (red wine, cheese, chicken liver, cured meats) or plus sympathomimetics

Treat with: Phentolamine

42
Q

Dystonia

A

Sustained contraction of muscles of neck, tongue, eyes, diaphragm

within days

High potency traditional antipsychotics (haloperidol and trifluoperazine)

Treat with: benedryl/cogentin

43
Q

Group Therapy

A

Patients with similar problem or pathology meet together with a therapist for group sessions

Treat: substance abuse, adjustment disorder, eating disorder and personality disorders

Advantages: patients get immediate feedback and support from peers and may gain insight

Universilization: patient is not alone in their suffering
Group cohesion: group working towards same goal

44
Q

Parkinsonism

A

Masklike face, cogwheel rigidiity, pill rolling tremor

Occur with high potency traditonal antipsychotics (haloperidiol and trifluoperazine)

Happens within months

Treat with benztropine

45
Q

Cognitive Therapy

A

Corrects faulty assumptions and negative feelings that exacerbate psychiatric symptoms

Treats: depression and anxiety
paranoid personality disorder, OCD, somatoform disorder, and eating disorders

46
Q

Tardive Dyskinesia

A

Choreoatetoid muscle movements usually of mouth and tongue

Occur after years of antipsychotic use particularly high potency traditional antipsychotics (haloperidol, trifluoperazine)

Can be irreversible

Treat with benztropine

47
Q

Neuroleptic maligant syndrome

A

Fever, tachycardia, hypertension, tremor, elevated CPK, lead pipe rigidity, leukocytosis,

Can be caused by all antipsychotics after short or long time (increased risk with high potency traditional antipsychotics-haloperidol and trifluoperazine)

Treatment: stop drug, benedryl, dantrolene/bromocriptine/amantadine

49
Q

Amitriptyline

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
also for pain

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

50
Q

Sertraline (Zoloft)

A

MOA:Serotonin reuptake inhibitors

Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose

CYP450 inhibitor

Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim

Toxicity: Fewer side effects than TCAs
highest risk of GI distress (N/V/D), sedation

sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, weight loss, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Watch with cough supprsesant for sserotonin syndrome

51
Q

Withdrawal phenomenom of antidpressants

A

dizziness, headaches, nausea, insomnia and malaise

May need to be tapered

52
Q

Paroxetine (Paxil)

A

MOA:Serotonin reuptake inhibitors-stimulant

Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose

CYP450 inhibitor
Short half life can lead to withdrawal phenomena

Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim

Toxicity: Fewer side effects than TCAs
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety,
More anticholinergic SE: sedation, constipation, weight gain, headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Worse for sexual sdie efects and weight gain
Late night sedation

Several Drug interactions
Watch with cough supprsesant for sserotonin syndrome

54
Q

Dialectical Behavior Thearpy

A

Diminishes self destructive behaviors and hospitalizations
Incorporates cognitive and supportive techniques, improve emotion and regulation, distress tolerance, mindful awareness

Treats: Borderline personality disorder, self injury

54
Q

Citalopram (Celexa)

A

MOA:Serotonin reuptake inhibitors

Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose

Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim

Toxicity: Fewer side effects than TCAs
LEAST Sexual side effects
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Can increase QTc interveal

FEWEST Drug interactions
Watch with cough supprsesant for sserotonin syndrome

55
Q

Desvenlafaxine

A

SNRI
MOA: inhibit 5-HT and NE reuptake

Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN

Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea

56
Q

Duloxetine

A

SNRI
MOA: inhibit 5-HT and NE reuptake

Clinical: depression, generalized anxiety and panic disorders, fibromylagia, diabetic neuropathy, female stress incontinence
Depression WITH PAIN

Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea, hepatatoxicity, bleeding

57
Q

Milnacipran

A

SNRI
MOA: inhibit 5-HT and NE reuptake

Clinical: Only fibromyalgia

Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea

58
Q

Nefazodone

A

MOA: blocks 5Ht2 and alpha1 adrenergic receptors

Clinical: primarily insomnia, high doses needed for antidepressant

Toxicity: sedation, nausea, postural hypotension, hepatotoxicity, dizziness, orthostatsis
Liver failure-black box warning

60
Q

Levomilnacipran

A

SNRI
MOA: inhibit 5-HT and NE reuptake

Clinical: depression with pain

Toxicity: increase BP, stimulant effects, sedation, nausea, vomiting, diarrhea

60
Q

Clomipramine

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)

OCD-clomipramine

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QRS prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

61
Q

Escitalopram (Lexapro)

A

MOA:Serotonin reuptake inhibitors
Much like citalopram but more expensive!

Used commonly due to low incidence of side effects which resolve with time, no food restrictions, much safer in overdose

Clinical: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, IBS, migraines, autsim

Toxicity: Fewer side effects than TCAs
LEAST Sexual side effects
GI distress, sexual dysfunction, serotonin syndrome, nausea, diarrhea, anxiety, insomnia (vivid dreams), headaches, restlessness, seizures (low risk)
can elevate levels of neuroleptics increasing side effects

Fewest Drug interactions
Watch with cough supprsesant for sserotonin syndrome

62
Q

Imipramine

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
also enuresis and pain

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

63
Q

Nortriptyline

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)
Also for enuresis

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

63
Q

Doxepin

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

64
Q

Trimipramine

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

65
Q

Isocarboxazid

A

MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off

Clinical: atypical depression, anxiety, hypochondriasis

Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine

Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome

67
Q

Tranylcypromine

A

MOA: Increase levels of amine NTs-NE, 5HT, and dopamine
Takes 2 weeks to re synthesize MAO- watch for serotonin syndrome-wait two weeks to switch to (fluoxetine 5 weeks), 2 weeks to come off

Clinical: atypical depression, anxiety, hypochondriasis

Toxicity: hypertensive crisis (ingestion of tyramine-wine and cheese), CNS stimulation, edema, orthostasis, weight gain, sexual, headache
Treat with phentolamine

Contraindicated: SSRIs, TCAs, St. John’s wort, meperidine, and dextromehtorphan-prevents serotonin syndrome

68
Q

Clonazepam

A

MOA: increases GABA by increasing frequency of Cl- channel opening

Intermediate acting

Uses: seizures, insomnia, GAD, Alcohol withdrawal
PANIC ATTACKS

Lethal with alcohol

Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

69
Q

Clonidine

A

a2 agonists

Used for opioid detoxification, tourrettes/tics

70
Q

Propanolol

A

Used for panic attacks, social phobia, akathesia

Helps with sweating and tachycardia

71
Q

Donepezil

A

Cholinesterase inhibitor

slows progression of Alzheimers

72
Q

Zolpidem

A

For sleep
Not a BDZ
But binds to same receptor
No addiction and no withdrawal

74
Q

Alprazolam

A

MOA: increases GABA by increasing frequency of Cl- channel opening

Short acting

Uses: seizures, insomnia, GAD, Alcohol withdrawal
PANIC ATTACKS

Lethal with alcohol

Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

75
Q

Interpersonal Therapy

A

For: relationship conflicts, life role transitions, grief

Focus current relationships and conflicts

76
Q

memantine

A

NMDA antagonist

Used in alzheimers

77
Q

Perphenazine

A

MOA: block dopamine receptors (increase cAMP)
Low potency

Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS

Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures

galactorrhea

Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)

Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements

78
Q

Chlropromazine

A

MOA: block dopamine receptors (increase cAMP)
Low potency

Clinical: Schizophrenia positive symptoms, psychosis, acute mania, AND HUNTINGTONS

Toxicity: EPS-acute dystonia (sustained muscle contractions), akathisia (restlessness-treat with Beta blockers), Parkinsonism (tremor rigidity, bradykinesia-treat with anticholinergics (benztropine or diphenyhydramine) , increased LFTs, seizures

BLUE SKIN, CORNEAL DEPOSITS

galactorrhea

Neuroleptic malignant syndrome: rigidity, myoglobinuria, autonomic instability, hyperpyrexia,
Treat with dantrolene, D2 agonists (brmocriptine)

Tardive dyskinesia: sterotpic oral-facial movements, lip smacking, chroathetoid movements

79
Q

Lorazepam

A

MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep

Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY

Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal

Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration

Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

80
Q

Supportive therapy

A

For: lower functioning patient, psychotic, cognitively impaired, acute life crisis

Focus: reinforce coping skills, build up adaptive defense mechanisms

81
Q

Carbamazepine

A

blocks Na-voltage gated channels, increases GABA

used for bipolar rapid cycling, mixed episodes

Side effects: increased LFTs, teratogenic, hyponatremia, aplastic anemia

82
Q

Lamotrigine

A

No acute use, used for mood stabilization

Side effects: rash, cytopenias, multi-organ hypersensivity

83
Q

Oxazepam

A

MOA: increases GABA by increasing frequency of Cl- channel opening

Short acting

Uses: seizures, insomnia, GAD, Alcohol withdrawal

Lethal with alcohol

Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

84
Q

Triazolam

A

MOA: increases GABA by increasing frequency of Cl- channel opening

Short acting

Uses: seizures, GAD, Alcohol withdrawal
INSOMNIA

Lethal with alcohol

Toxicity: dependence, additive CNS depression with alcohol, less respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly), decreased memory and concentration
LESS DROWSINESS
SEVERE WITHDRAWAL SYMPTOMS AND HIGHER ADDICTIVE POTENTIAL

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

85
Q

Chlrodiazepam

A

MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep

Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY

Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal

Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration

Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

86
Q

Valproic Acid

A

Increases GABA
Used: bipolar disorder, alcohol dependenc, psychosis, agression, rapid cycling bipolar

Side effects: teratogenic, hepatotoxic, thrombocytopenia, nausea, sedation, alopecia, pancreatitis

86
Q

Diazepam

A

MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep

Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)

Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal

Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration

Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

87
Q

Tacrine

A

Cholinesterase inhibitor

Slows progression of Alzheimers

88
Q

Zaleplon

A

For sleep
Not a BDZ
But binds to same receptor
No addiction and no withdrawal

88
Q

Motivational therapy

A

Used in substance abuse

Address ambivalence to change, non judgmental, enhance motivation to change

89
Q

Temazepam

A

MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep

Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)
GOOD FOR ALCOHOL WITHDRAWAL, PRESURGERY ANXIETY

Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal

Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration

Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

91
Q

Despramine

A

MOA: block reuptake of NE and 5HT
Also block Na channels, Ach channels, alpha adrenergic, block histamine

Clinical: major depression, fibromyalgia, painful diabetic neuropahty (insomnia with depression)

LEAST SIDE EFFECTS, LEAST SEDATING

Toxicity: Sedation
alpha blocking: postural hypotension
Anticholinergic: dry mouth, tachycardia, urinary retention, Confusion and hallucinations in elderly, hyperthermia, dilated pupils
Na block: cardiotoxcity leads to death treat with NaHCO3, QT prolongation and cardiac dysrhthymias
NaHCO3 can correct QRS prolongation, reverse hypotension and treat ventricular dysrhthymias

Tri-Cs: convulsion, coma, cardiotoxicity
Respiratory depression, hyperpyrexia (high fever)

CAUTION in BPH

92
Q

Biofeedback therapy

A

For: prominent physical symptoms that accompany psych symptoms

Focus: improve awareness and control over physiological reactions
Lower stress levels
Integrate mind and body

93
Q

Flurazepam

A

MOA: Facilitate GABA by increasing frequency of Cl- channel opening
Decreases REM sleep

Clinical: anxiety, spasticity, status epilepticus (diazepam), detoxification from alcohol delirum tremens, general anesthetic (amnesia muscle relaxation), hypnotic (insomnia)

Diazepam and chlrodizepoxide are first line treatment for seizures assoicated with alcohol withdrawal

Toxicity: Less dependence (due to slower clearance), Higher daytime drowsiness (increased chance of falls), additive CNS ddepression effects with alcohol, less risk of respiratory depression and coma than barbiturates, sedation impairs coordination and balance (avoid in elderly) decreased memory and concentration

Avoid with alcohol, barbituates, neuroleptics and 1st gen antihistamines

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)

Step 1 Drugs (15 decks)

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