Psychiatry Flashcards
ADHD
Methylphenidate
Alcohol withdrawal
Benzodiazepines
Specifically DTs
Anxiety
SSRIs, SNRIs, buspirone
Bipolar disorder
“Mood stabilizers” = lithium, valproic acid, carbamazepine
Atypical antipsychotics
Bulimia
SSRIs
Depression
SSRIs, SNRIs, TCAs, bupropion (Wellbutrin; increase NE and Da), mirtazepine (especially with insomnia; a2 antagoinst and potent 5HT2 and 5HT3 receptor antagonist)
Obsessive-compulsive disorder
SSRIs, clomipramine (TCA)
Panic disorder
SSRIs, venlafaxine (SNRI), benzos
PTSD
SSRIs
Schizophrenia
Antipsychotics
Social phobias
SSRIs, B-blockers
Tourette syndrome
Antipsychotics (haloperidol, risperidone)
CNS stimulants
Methylphenidate, dextroamphetamine, methamphetamine, phentermine
Increase NE and Da at synaptic cleft
ADHD, narcolepsy, appetite control
Typical antipsychotics
Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine
("azines" + Haloperidol)
Block D2 receptors = increase cAMP
Typical antipsychotic toxicity/side effects
Extrapyramidal system side effects (dyskinesias)
Endocrine side effects (hyperprolactinemia –> galactorrhea)
Muscarinic, a1, and histamine blockade
Evolution of EPS side effects
4 hr acute dystonia = muscle spasm, stiffness, oculogyric crisis
4 day akathisia = restlessness
4 wk bradykinesia = parkinsonism
4 mo tardive dyskinesia
Haloperidol side effects
Neuroleptic malignant syndrome
Tardive dyskinesia
Neuroleptic malignant syndrome
Treatment?
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia
Treatment = dantrolene, D2 agonists (bromocriptine)
Tardive dyskinesia
Stereotypic oral-facial movements as a result of long-term antipsychotic use
Potentially irreversible
NMS symptoms
“FEVER”
Fever Encephalopathy Vitals unstable Enzymes increased (CK) Rigidity of muscles/Rhabdomyolysis
Atypical antipsychotics
“Old Closets Quietly Risper from A to Z”
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
Atypical antipsychotics
Varied effects on 5HT2, dopamine, a receptors, H1 preceptors
Fever extrapyramidal and anticholinergic side effects
Antipsychotics causing significant weight gain/metabolic syndrome
Olanzapine
Clozapine
Antipsychotic causing agranulocytosis (requires weekly WBC monitor) and seizure?
Clozapine
Antipsychotic causing gynecomastia (male) and lactation/irregular menstruation (female)?
Risperidone
Antipsychotic that prolongs QT interval?
Ziprasidone
Lithium toxicity/side effects?
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
Fetal cardiac defects due to lithium use?
Ebstein anomaly and malformation of the great vessels
Buspirone
Stimulates 5HT1A receptors (partial agonist)
GAD
Does not cause sedation, addiction, or tolerance
Does not interact with alcohol
SSRIs
Fluoxetine = Prozac Paroxetine = Paxil Sertraline = Zoloft Citalopram = Celexa
5HT reuptake inhibitors
SSRI side effects
GI distress
SEXUAL DYSFUNCTION (anorgasmia and decreased libido)
Serotonin syndrome with any drug that increases 5HT
Serotonin syndrome sx
Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
Treatment = cyproheptadine (5HT2 receptor antagonist)
Serotonin syndrome antidote?
Cyproheptadine = 5HT2 receptor antagonist
SNRIs
Tx depression
Venlafaxine = GAD, panic
Duloxetine = diabetic peripheral neuropathy
Inhibit 5HT and NE reuptake
SNRI toxicity
Increased BP
Stimulant effects
Sedation
Nausea
TCAs
Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine (OCD) Doxepin Amoxapine (depression in elderly with psychotic features)
Block reuptake of NE and 5HT
Major depression, OCD, fibromyalgia
TCA toxicity
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
Tri-C’s
Convulsions
Coma
Cardiotoxicity
Treatment for TCA induced cardiotoxicity?
NaHCO3
MAOIs
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)
Increase levels of amine neurotransmitters (NE, 5HT, Da)
Atypical depression, anxiety, hypochondriasis
MAOI toxicity
HTN crisis (with ingestion of tyramine = wine and cheese) CNS stimulation
MAOI contraindications
SSRIs TCAs St. John's wort Meperidine Dextromethorphan (To prevent serotonin syndrome)
Atypical antidepressants (3)
Bupropion (Wellbutrin)
Mirtazapine
Trazodone
Bupropion (Wellbutrin)
MOA? Toxicity?
Increased NE and 5HT via unknown MOA
Toxicity = stimulant effects (tachycardia, insomnia), headache, seizure in bulimics
Mirtazapine
MOA? Toxicity?
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
Trazodone
MOA? Toxicity?
Blocks 5HT2 and a1 adrenergic receptors
Uses = insomnia (high doses needed for antidepressant effects)
Toxicity = sedation, nausea, PRIAPISM, postural hypotension
“TrazoBONE”
