Psychiatry Drugs Flashcards
Typical Antipsychotics Overview (“Ant-Tie Psychiatrist”)
Indication: schizophrenia (“sketchy fern”), psychosis, acute mania, Tourette syndrome (“torn rat”).
Mechanism: D2 receptor antagonist (“block guy blocking doberman).
Properties: lipid soluable (“lips”, long half life).
Side Effects: galactorrhea; see high and low potency drugs.
High Potency Antipsychotics (“High Pot Ant-Tie Psychiatrist”)
Drugs: trifluorperazine (“truffle-purse”); fluphenazine (“fluffy-nazi”); haloperidol (“halo-poodle”).
Side Effects: neurologic EPS symptoms (“X-pyramid”) including dystonia (“dice-stone”, muscle spasm), akathisia (restlessness), parkinsonism (“park-in-sun garage”, bradykinesia), and tardive dykinesia (“tar-dive disc-kite”, oral-facial movements).
Haloperidol (“Halo-Poodle”)
Class: high-potency antipsychotic (“high pot ant-tie psychiatrist”).
Side Effects: EPS symptoms (“X-pyramid).
Fluphenazine (“Fluffy-Nazi”)
Class: high-potency antipsychotic (“high pot ant-tie psychiatrist”).
Side Effects: EPS symptoms (“X-pyramid).
Trifluoperazine (“Truffle-Purse”)
Class: high-potency antipsychotic (“high pot ant-tie psychiatrist”).
Side Effects: EPS symptoms (“X-pyramid).
Low Potency Antipsychotics (“Low Pot Ant-Tie Psychiatrist”)
Drugs: chlorpromazine (“color-pro”); thioridizine (“thor-diasy”).
Side Effects: non-neurologic symtoms including anticholinergic (“ant-tie cola”, dry mouth and costipation), antihistamine (sedation), and alpha-1 blockade (“anti-tie-afro-1-wand”, hypotension).
Chlorpromazine (“Color-Pro”)
Class: low potency antipsychotic (“low pot ant-tie psychiatrist”).
Side Effects: corneal deposits (“corn-eyes”); non-neurologic symtoms.
Thioridazine (“Thor-Diasy”)
Class: low potency antipsychotic (“low pot ant-tie psychiatrist”).
Side Effects: retinal deposits (“red-tin”); non-neurologic symtoms.
Atypical Antipsychotics (“A-Tipi Ant-Tie Psychiatrist”)
Drugs: olanzapine; clozapine; quetiapine; rispiridone; aripiprazole; ziprasidone.
Indication: schizophrenia (“stetchy-fern”, both positive and negative symptoms); bipolar disorder; OCD; anxiety disorder; depression; mania; Tourette syndrome.
Mechanism: unknown; effects upon 5-HT2, dopamine, alpha, and H1 receptors.
Side Effects: fewer EPS (“X-pyramid falling off cliff”) and anticholinergic (“ant-tie-cola falling off cliff”) symptoms than traditional antipsychotics.
Olanzapine
Class: atypical antipsychotic.
Side effects: weight gain (“up-arrow scale”)
Clozapine
Class: atypical antipsychotic.
Side effects: weight gain (“up-arrow scale”); agranulocytosis (“a-granny-side-toe”); siezure (“Caesar”).
MOST EFFECTIVE DRUG, BUT MANY SIDE EFFECTS!
Quetiapine
Class: atypical antipsychotic.
Risperidone
Class: atypical antipsychotic.
Side effects: hyperprolactinemia and subsequent effects.
Aripiprazole
Class: atypical antipsychotic.
Ziprasidone
Class: atypical antipsychotic.
Side effects: long QT (“stretched QT-heart”).
Lithium (“Lithium Battery”)
Indication: mood stabilization (“mood-mask stabalized”) in bipolar disorder (“bi-polar bear”); SIADH.
Mechanism: unknown (“question-mark mechanism”).
Side Effects: tremor (“trimmer”); hypothyroidism (“hippo-thigh-droid”); nephrogenic DI (“kidney with dyed beads and sippy cup”); teratogen (“pregnant woman with caution tape”) = Ebstein enomaly (“Einstein heart”); heart block (“block in heart”); sedation; edema.
Elimination: KIDNEYS; contraindicated in renal failure; increased serum lithium in dehydration and salt-wasting diuretics; decreased serum lithium in increased salt intake.
NARROW THERAPEUTIC WINDOW!
Buspirone (“Bus-Piranha”)
Mechanism: 5-HT1 agonist (“turning on 5-HT1 silver tonic receptors”); causes release of dopamine (“doberman on bus”) and norepinephrine (“north-epi-pen on bus”).
Indication: generalized anxiety disorder (“general with anxiety-bag”).
Side effects: very few (“low side-FX sign”); does not interact with alcohol (“martini ignored”, vs. barbiturates and benzos).
Other: takes 1-2 weeks to take effect.
SSRIs (“Selective Silver-Tonic Reuptake Tube with Inhibiting Chains”)
Drugs: fluoxetine (“flute-ox”); paroxetine (“pear-rockets”); sertraline (“search-light”); escitalopram (“Easter-ram”).
Mechanism: 5-HT specific reuptake inhibitors.
Indication: depression (“depressed emo playing claw machine”); gereralized anxiety disorder (“emo using anxiety-bag and general on search light”); panic disorder; OCD; bulimia; social phobias; PTSD.
Side effects: sexual dysfunction (“limp weiner in bun”); serotonin syndrome (“silver-tonic savage”); can initially cause anxiety; can cause mania in biopolar patients; do not combine fluoxetine or paroxetine with tamoxifen; escitalopram can cause long QT.
Other: can take 4-8 weeks to have effect.
Serotonin Syndrome (“Silver-Tonic Savage”)
Cause: use of SSRI along with MAO-I, SNRI, TCA or linezolid.
Signs/symptoms: hyperthermia; confusion; myoclonus; CV collapse; flushing; diarrhea; seizures.
Treatment: cyrpoheptadine (“zipper-head”)
SNRIs (“Silver-Tonic and North-Epi-Pen Reuptake Tube with Inhibiting Chains in SNRI Factory”)
Drugs: venlafaxine (“vanilla-fax”); duloxetine (“doll-ox”).
Mechanism: inhibits 5-HT and NE reuptake.
Indication: depression (“depressed emo working at factory”); generalized anxiety and panic disorders (“manager with anxiety bag and panic button”, venlafaxine); diabetic peripheral neuropathy (“dyed-bead pancrease with wavy-nerve-arms”; duloxetine).
Side effects: hypertension (“hiker-BP escaping from factory”); insomnia (“woman with eyes taped open”); decreased libido (“down-arrow libido-limbo guy escaping”); nausua (“woman vomitting”); sedation.
Venlafaxine (“Vanilla-Fax”)
Class: SNRI.
Indication: depression (“depressed emo”); generalized anxiety and panic disorder (“manager with anxiety bag and panic button”).
Duloxetine (“Doll-Ox”)
Class: SNRI.
Indication: depression (“depressed emo”); diabetic peripheral neuropathy (“dyed-bead pancrease with wavy-neuron arms being saved by doll-ox”).
TCAs (“Tricycle Ant-Tie Depressed Emo”)
Drugs (think about “tiling” for -iptyline and “ramen” for -ipramine): amitriptyline (“amish-trip-tiling”); nortriptyline (“north-trip-tiling”); imipramine (“i-map-ramen”); desipramine (“daisy-ramen”); clomipramine (“clam-map-ramen”); doxepin; amoxapine.
Mechanism: blocks reuptake of NE and 5-HT (“block in north-epi-pen and silver-tonic reuptake tube”).
Indication: major depression (“major-league depressed emo”); bed wetting (“bed with urine beneath i-map-ramen bowl”); fibromyalgia (“Fabio with mayo-algae causing the amish-trip-tiling”).
Side effects: anti-histamine (“ant-tie historian”); alpha-1 blocker (“block man with 1-wand blocking triceratops receptor”, postural hypertension); anticholinergic (“ant-tie-cola dumping cola on CNS brain); CNS effects (“attacked CNS brain”, sedation, siezure); respiratory depression; hyperpyrexia; **Tri-Cs **(“triceratops”) = convulsions (“Converse sneakers”), coma (“comb in brain”), cardiotoxicity (“toxic green heart”, arrhythmias, treat with NaHCO3).
Amitriptyline (“Amish-Trip-Tiling”)
Class: TCA (“tricycle ant-tie depressed emo”).
Indication: depression; fibromyalgia (“fabio-mayo-algae”); chronic pain.
Side effects: more anticholinergic symptoms.
Nortriptyline (“North-Trip-Tiling”)
Class: TCA (“tricycle ant-tie depressed emo”).
Indication: depression.
Side effects: less anticholinergic symptoms.
Imipramine (“I-Map-Ramen”)
Class: TCA (“tricycle ant-tie depressed emo”).
Indication: bed wetting (“urine on bed coming out of i-map-ramen pot”).
Desipramine (“Daisy-Ramen”)
Class: TCA (“tricycle ant-tie depressed emo”).
Indication: depression.
Other: less sedating; narrow therapeutic window.
Clomipramine (“Clam-Map-Ramen”)
Class: TCA (“tricycle ant-tie depressed emo”).
Indication: OCD.
MAO-Inhibitors (“Mao with Inhibiting Chains”)
Drugs (“take pride in shanghai”): tranylcypromine (“train-zipper”); phenelzine (“funnel-Z on train”); isocarboxazid (“ice-car-box”); selegiline (“sledge-lion smashing ice-car-box”).
Mechanism: increases levels of amines NE, 5-HT, and dopamine (“up-arrow A-mines from emo’s hand”).
Indication: atypical depression (“A-tipi with emo”); anxiety; hypochondriasis.
Side effects: hypertensive crisis (“hiker-BP crying”); hypertensive crisis precipitated by eating tyramine containing foods such as wine and cheese (“wine and cheese party with Mao in caution tape”); serotonin syndrome when combined with SSRIs (“silver-tonic savage pulling table cloth while eating silver-tonic pills”).
Medication Contraindications: SSRIs, TCAs, St. John’s wort, meperidine and dextromethorphan.
Tranylcypromine (“Train-Zipper”)
Class: MAO-I (“Mao in inhibiting chains”).
Phenelzine (“Funnel-Z”)
Class: MAO-I (“Mao in inhibiting chains”).
Isocarboxazid (“Ice-Car-Box”)
Class: MAO-I (“Mao in inhibiting chains”).
Selegiline (“Sledge-Lion”)
Class: MAO-I (“Mao in inhibiting chains”).
Buproprion (“Butt-propane”)
Class: atypical antidepressant (“emo smoking cigarette”).
Mechanism: unknown; increases NE (“north-epi-pen exploding upward”) and dopamine (“doberman exploding upward”).
Indication: depression (“emo”), especially if SSRI caused sexual dysfunction; smoking cessation (“emo smoking cigarette and no smoking sign”).
Side effects: stimulant side effects (“Caesar with red bull can”) including tachycardia and insomnia; seizure (“Caesar”) in bulimic patients.
Mirtazapine (“Martha-Pine”)
Class: alpha-2 blocker (“afro-tutu block guy”).
Mechanism: increase release of NE and 5-HT via alpha-2 blockade; 5-HT receptor antagonist (“ant-toga blocking 5-HT receptor from Marth pouring silver tonic”).
Indication: depression (“fat depressed emo”).
Side effects: sedation (“sedating dart in emo”); increased appetite and weight gain (“fat emo sitting on up-arrow scale”); increase serum cholesterol (“emo eating burger”); dry mouth.
Trazodone (“Tarzan-Bone”)
Class: atypical antidepressant.
Mechanism: 5-HT reuptake inhibitor (“inhibiting chains on silver-tonic reuptake tube”); block 5-HT and alpha-1 receptors.
Indication: insomnia (“Jane with eyes taped open”); depression.
Side effects: sedation (“sedation dart”); priapism (“Tarzan pitching a tent”, traza-bone); orthostatic hypertension (“oar-hippo-BP”).
Benzodiazepines (“Benz-Dice”)
Drugs (think about “Z-Pam Anderson” for -zepam and “Z-lamb” for -zolam): diazepam; lorazepam; triazolam; temazepam; oxazepam; midazolam; chlordiazepoxide; alprazolam.
Mechanism: facilitate GABA action by increasing the frequency of chloride channel opening (“up-arrow revolving door on chloride-dispenser channel”).
Indication: anxiety (“pregnant woman with axiety bag”); spasticity; status epilecticus (“statue-Caesar”, first line); detoxification (“D-tux”, especially DTs); night terrors and sleep walking; induction of general anesthesia (“A-nest induction-duck”); insomnia.
Side effects: decreased REM sleep (“down-arrow sleeping rum bottle”); CNS depression (“deflated CNS-brain”); dependence (“dependence ball-and-chain on CNS-brain”); treat overdose with flumazenil (“flute-mace-nail”), a competative antagonist at GABA receptor.
Short Acting Benzodiazepines (“Benz-Dice”)
Drugs: triazolam; oxazepam; midazolam.
Properties: higher addictive potential; decreased daytime fatigue and impaired judgement compared to long acting.
Donepezil (“Donut-Puzzle”)
Class: acetylcholinesterase inhibitor (“a-seagull-cola-nest with inhibiting chains”).
Indication: Alzheimer’s disease (“old-timer clock being lead home by puzzle pieces”, slows decline in cognition and functional independence).
Side effects: nausua/vomitting (“seagull vomitting”); dizziness (“dizzy seagull”); insomnia; bradycardia.
Memantine (“Mummy-Tin”)
Class: NMDA receptor antagonist (“NMDA receptor ant-toga”).
Mechanism: slows intracellular calcium influx and attenuates exictotoxic neuronal damage (“mummy-tin’s wrapping blocking excited-x-nerves”).
Indication: Alzheimer’s disease (“mummy-tin leading the old-timer home with his wrapping”).
Side effects: confusion (“Confucious”); hallucinations (“Halloween hallucination pumpkin”); dizziness (“dizzy-eyed pumpkin”)
Methylphenidate (“Metal-Pheonix”)
Class: CNS stimulant (“CNS-brain with red bull can”)
Mechanism: increases catecholamines in synaptic cleft (“cat-cola in synaptic cleft”); increases NE and dopamine (“up-arrow north-epi-pen and doberman”).
Indications: ADHD (“AD-HeaD guy with multiple heads”).
Side effects: potential for abuse (“guy abusing red bull”); decreased appitite; decreased sleep; weight loss; growth retardation; tics; irritability; “zombie-like”; sudden death and cardiac toxicity (rare).
Atomoxetine
Class: NE-reuptake inhibitor.
Indication: ADHD in youth and adults.
Advantages: single daily dosing; not a controlled substance.
Side effects: GI upset; loss of appitite; erectile dysfunction; insomnia; liver toxicity (rare).
Fluoxetine (“Flute-Ox”)
Class: SSRI (“selective silver-tonic reuptake-tube with inhibiting chains”).
Notes: long half-life; do not combine with tamoxifin; appears safe in pregnancy.
Sertraline (“Search-Light”)
Class: SSRI (“selective silver-tonic reuptake-tube with inhibiting chains”).
Notes: causes diarrhea.
Paroxetine (“Pear-Rocket”)
Class: SSRI (“selective silver-tonic reuptake-tube with inhibiting chains”).
Notes: short half-life; do not combine with tamoxifen.
Citalopram/Escitalopram (“Easter-Ram”)
Class: SSRI (“selective silver-tonic reuptake-tube with inhibiting chains”).
Notes: can cause long-QT at high doses.
