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USMLE Pharmacology > Psychiatry > Flashcards

Psychiatry Flashcards

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USMLE® Step 1 flashcards
1
Q

ADHD

A

Methylphenidate

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2
Q

Alcohol withdrawal

A

Benzodiazepines

Specifically DTs

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3
Q

Anxiety

A

SSRIs, SNRIs, buspirone

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4
Q

Bipolar disorder

A

“Mood stabilizers” = lithium, valproic acid, carbamazepine

Atypical antipsychotics

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5
Q

Bulimia

A

SSRIs

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6
Q

Depression

A

SSRIs, SNRIs, TCAs, bupropion (Wellbutrin; increase NE and Da), mirtazepine (especially with insomnia; a2 antagoinst and potent 5HT2 and 5HT3 receptor antagonist)

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7
Q

Obsessive-compulsive disorder

A

SSRIs, clomipramine (TCA)

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8
Q

Panic disorder

A

SSRIs, venlafaxine (SNRI), benzos

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9
Q

PTSD

A

SSRIs

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10
Q

Schizophrenia

A

Antipsychotics

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11
Q

Social phobias

A

SSRIs, B-blockers

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12
Q

Tourette syndrome

A

Antipsychotics (haloperidol, risperidone)

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13
Q

CNS stimulants

A

Methylphenidate, dextroamphetamine, methamphetamine, phentermine
Increase NE and Da at synaptic cleft
ADHD, narcolepsy, appetite control

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14
Q

Typical antipsychotics

A 
Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine
("azines" + Haloperidol)

Block D2 receptors = increase cAMP

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15
Q

Typical antipsychotic toxicity/side effects

A

Extrapyramidal system side effects (dyskinesias)
Endocrine side effects (hyperprolactinemia –> galactorrhea)
Muscarinic, a1, and histamine blockade

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16
Q

Evolution of EPS side effects

A

4 hr acute dystonia = muscle spasm, stiffness, oculogyric crisis
4 day akathisia = restlessness
4 wk bradykinesia = parkinsonism
4 mo tardive dyskinesia

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17
Q

Haloperidol side effects

A

Neuroleptic malignant syndrome

Tardive dyskinesia

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18
Q

Neuroleptic malignant syndrome

Treatment?

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia

Treatment = dantrolene, D2 agonists (bromocriptine)

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19
Q

Tardive dyskinesia

A

Stereotypic oral-facial movements as a result of long-term antipsychotic use
Potentially irreversible

20
Q

NMS symptoms

“FEVER”

A 
Fever
Encephalopathy
Vitals unstable
Enzymes increased (CK)
Rigidity of muscles/Rhabdomyolysis
21
Q

Atypical antipsychotics

“Old Closets Quietly Risper from A to Z”

A 
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
22
Q

Atypical antipsychotics

A

Varied effects on 5HT2, dopamine, a receptors, H1 preceptors

Fever extrapyramidal and anticholinergic side effects

23
Q

Antipsychotics causing significant weight gain/metabolic syndrome

A

Olanzapine

Clozapine

24
Q

Antipsychotic causing agranulocytosis (requires weekly WBC monitor) and seizure?

A

Clozapine

25
Q

Antipsychotic causing gynecomastia (male) and lactation/irregular menstruation (female)?

A

Risperidone

26
Q

Antipsychotic that prolongs QT interval?

A

Ziprasidone

27
Q

Lithium toxicity/side effects?

A

Movement (tremor)
Nephrogenic diabetes insipidus
Hypothyroidism
Pregnancy problems

Tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antag causing nephrogenic DI)

Narrow therapeutic window = excreted by kidneys
Most reabsorbed at PCT following Na reabsorption

28
Q

Fetal cardiac defects due to lithium use?

A

Ebstein anomaly and malformation of the great vessels

29
Q

Buspirone

A

Stimulates 5HT1A receptors (partial agonist)
GAD
Does not cause sedation, addiction, or tolerance
Does not interact with alcohol

30
Q

SSRIs

A 
Fluoxetine = Prozac
Paroxetine = Paxil
Sertraline = Zoloft
Citalopram = Celexa

5HT reuptake inhibitors

31
Q

SSRI side effects

A

GI distress
SEXUAL DYSFUNCTION (anorgasmia and decreased libido)
Serotonin syndrome with any drug that increases 5HT

32
Q

Serotonin syndrome sx

A

Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
Treatment = cyproheptadine (5HT2 receptor antagonist)

33
Q

Serotonin syndrome antidote?

A

Cyproheptadine = 5HT2 receptor antagonist

34
Q

SNRIs

A

Tx depression
Venlafaxine = GAD, panic
Duloxetine = diabetic peripheral neuropathy

Inhibit 5HT and NE reuptake

35
Q

SNRI toxicity

A

Increased BP
Stimulant effects
Sedation
Nausea

36
Q

TCAs

A 
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine (OCD)
Doxepin
Amoxapine (depression in elderly with psychotic features)

Block reuptake of NE and 5HT
Major depression, OCD, fibromyalgia

37
Q

TCA toxicity

A

Sedation, a1 blocking (postural hypotension), anticholinergic (tachycardia, urinary retention, dry mouth)
Desipramine = less sedating but higher incidence seizures
Tri-C’s:
—Convulsions
—Coma
—Cardiotoxicity (arrhythmias) = tx with NaHCO3
Respiratory depression, hyperpyrexia
Confusion, hallucination

38
Q

Tri-C’s

A

Convulsions
Coma
Cardiotoxicity

39
Q

Treatment for TCA induced cardiotoxicity?

A

NaHCO3

40
Q

MAOIs

A

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)

Increase levels of amine neurotransmitters (NE, 5HT, Da)
Atypical depression, anxiety, hypochondriasis

41
Q

MAOI toxicity

A 
HTN crisis (with ingestion of tyramine = wine and cheese)
CNS stimulation
42
Q

MAOI contraindications

A 
SSRIs
TCAs
St. John's wort
Meperidine
Dextromethorphan
(To prevent serotonin syndrome)
43
Q

Atypical antidepressants (3)

A

Bupropion (Wellbutrin)
Mirtazapine
Trazodone

44
Q

Bupropion (Wellbutrin)

MOA? Toxicity?

A

Increased NE and 5HT via unknown MOA

Toxicity = stimulant effects (tachycardia, insomnia), headache, seizure in bulimics

45
Q

Mirtazapine

MOA? Toxicity?

A 
a2 antagonist (increase release of NE and 5HT) and potent 5HT2 and 5HT3 receptor antagonist
Toxicity = sedation (desirable with concurrent insomnia), increased appetite, weight gain (desirable in anorexic patients), dry mouth
46
Q

Trazodone

MOA? Toxicity?

A

Blocks 5HT2 and a1 adrenergic receptors
Uses = insomnia (high doses needed for antidepressant effects)
Toxicity = sedation, nausea, PRIAPISM, postural hypotension
“TrazoBONE”

USMLE Pharmacology (15 decks)

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