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PLAB Pharmacology > Psychiatry Pharmacology > Flashcards

Psychiatry Pharmacology Flashcards

1
Q

preferred medications for ADHD

A
  • stimulants
    • methylphenidate
    • amphetamines
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2
Q

preferred medications for alcohol withdrawal

A
  • benzodiazepines
    • chlordiazepoxide
    • lorazepam
    • diazepam
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3
Q

preferred medications for Bipolar disorder

A
  • lithium
  • valproic acid
  • atypical antipsychotics
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4
Q

preferred medications for bulimia nervosa

A
  • SSRIs
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5
Q

preferred medications for depression

A
  • SSRIs
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6
Q

preferred medications for generalized anxiety disorder

A
  • SSRIs
  • SNRIs
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7
Q

preferred medications for obsessive compulsive disorder

A
  • SSRIs
  • venlafaxine
  • clomipramine
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8
Q

preferred medications for panic disorder

A
  • SSRIs
  • venlafaxine
  • benzodiazepines
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9
Q

preferred medications for PTSD

A
  • SSRIs
  • venlafaxine
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10
Q

preferred medications for schizophrenia

A
  • atypical antipsychotics
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11
Q

preferred medications for social anxiety disorder

A
  • SSRIs
  • venlafaxine
  • performance only
    • beta blockers
    • benzodiazepines
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12
Q

preferred medications for Tourette syndrome

A
  • antipsychotics
    • fluphenazine
    • pimozide
  • tetrabenazine
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13
Q

name the CNS stimulants

A
  • methylphenidate
  • dextroamphetamine
  • methamphetamine
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14
Q

CNS stimulants–mechanism

A
  • increase catecholamines in the synaptic cleft
    • especially norepinephrine and dopamine
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15
Q

CNS stimulants–use

A
  • ADHD
  • narcolepsy
  • appetite control
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16
Q

name the antipsychotics (neuroleptics)

A
  • haloperidol
  • trigluoperazine
  • fluphenazine
  • thioridazine
  • chlorpromazine
    • “haloperidol + ‘-azines’”
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17
Q

antipsychotics (neuroleptics)–mechanism

A
  • alltypical antipsychotics block dopamine D2 receptors
    • increase [cAMP]
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18
Q

antipsychotics (neuroleptics)–stored or excreted?

A
  • highly lipid soluble, so stored in body fat and slow to be removed
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19
Q

antipsychotics (neuroleptics)–high potency drugs

A
  • Trifluoperazine
  • Fluphenazine
  • Haloperidol
    • “Try to Fly High”
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20
Q

antipsychotics (neuroleptics)–high potency drug side effects

A

neurologic side effects, including extrapyramidal symptoms (EPS)

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21
Q

explain the onset of extrapyramidal symptoms (EPS)

A
  • ​ADAPT
    • ​hours to days: Acute Dystonia–muscle spasm, stiffness, oxulogyric crisis
    • days to months: Akathisia (restlessness) and Parkinsonism (bradykinesia)
    • months to years: Tardive dyskinesia
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22
Q

antipsychotics (neuroleptics)–low potency drugs

A
  • chloropromazine
  • thioridazine
    • “Cheating Thieves are low”
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23
Q

antipsychotics (neuroleptics)–low potency drug side effects

A
  • non neurologic side effects
    • anticholinergic
    • antihistamine
    • alpha 1 blockade effects
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24
Q

Chlorpromazine–side effects

A
  • (antipsychotic)
  • ​Corneal deposits
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25
**T**hioridazine--side effects
* (antipsychotic) * re**T**inal deposits
26
haloperidol--side effects
* (antipsychotics) * NMS * tardive dyskinesia
27
Neuroleptic Malignant Syndrome (NMS)
* rigidity * myoglobinuria * autonomic instability * hyperpyrexia * **"FEVER"** * **​F**ever * **E**ncephalopathy * **V**itals unstable * **E**nzymes increase * **R**igidity of muscles * treatment: dantrolene, D2 agonists (bromocriptine)
28
treatment for extrapyramidal system side effects
* caused by antipsychotics * treatment: * benztropine * diphenhydramine * benzodiazepines
29
antipsychotics (neuroleptics)--toxicity
* EPS side effects * endocrine side effects * side effects arising from: * blocking muscarinic Rs--dry mouth, constipation * blocking alpha 1 Rs--orthostatic hypotension * blocking histamine Rs--sedation * may cause QT prolongation * Neuroleptic Malignant Syndrome (NMS) * Tardive Dyskinesia
30
explain endocrine side effects that may result from taking antipsychotics (neuroleptics)
* dopamine receptor antagonism --\> hyperprolactinemia --\> galactorrhea, oligomenorrhea, gynecomastia
31
Tardive Dyskinesia
* orofacial chorea as a result of long term antpsychotic use
32
name the antypical antipsychotics
* aripiprazole * asenapine * clozapine * iloperidone * lurasidone * olanzapine * paliperidone * quetiapine * risperidone * ziprasidone
33
atypical antipsychotics--mechanism
* not completely understood * most are D2 antagonists * aripiprazole is a D2 partial agonist * varied effects on 5-HT2, dopamine, and alpha and H2 receptors
34
atypical antipsychotics--use
* schizophrenia--both positive and negative symptoms * also used for: * bipolar disorder * OCD * anxiety disorder * depression * mania * Tourette syndrome
35
atypical antipsychotics--toxicity
* prolonged QT interval * fewer EPS and anticholinergic side effects than typical antipsychotics
36
what is a possible adverse effect of asenapine, clozapine, **o**lanzapine, quetiapine?
* (atypical antipsychotics) * metabolic syndrome * weight gain * diabetes * hyperlipidemia * "**O**lanzapine --\> **O**besity"
37
clozapine--toxicity
* (atypical antipsychotics) * agranulocytosis * have to monitor WBC weekly * "Must watch bone marrow **cloz**ely with **cloz**apine"
38
risperidone--toxicity
* (atypical antipsychotic) * hyperprolactinemia * amenorrhea * galactorrhea * gynecomastia
39
lithium--mechanism
* not established * possibly related to inhibition of phosphoinositol cascade
40
lithium--use
* mood stabilizer for bipolar disorder * blocks relapse and acute manic events
41
lithium--toxicity
* tremor * hypothyroidism * polyuria * causes nephrogenic diabetes insipidus * teratogenesis * **LMNOP--L**ithium Side Effects * **M**ovement (tremor) * **N**ephrogenic diabetes insipidus * Hyp**O**thyroidism * **P**regnancy problems
42
what effects does lithium have on a fetus if taken by a pregnant mother?
* cardiac defects * causes Ebstein anomaly in newborn--malformations of great vessels
43
therapeutic window of lithium
* therapeutic window is very narrow and requires close monitoring of serum levels
44
how is lithium excreted?
* almost exclusively excreted by the kidneys * most is reabsorbed at PCT with Na+
45
what has been implicated in lithium toxicity in bipolar patients?
* thiazide use
46
buspirone--mechanism
* stimulates 5-HT1A receptors
47
buspirone--use
* generalized anxiety disorder * "I'm always anxious if the **bus** will be **on** time, so I take **bus**pir**on**e" * does not cause sedation, addiction, or tolerance * takes 1-2 weeks to take effect * does not interact with alcohol (vs. barbiturate, benzodiazepines)
48
name the selective serotonin reuptake inhibitors (SSRIs)
* **Fl**uoxetine * **Par**oxetine * **Se**rtraline * **Cit**alopram * "**Fl**ashbacks **par**alyze **se**nior **cit**izens."
49
SSRIs--mechanism
* 5-HT specific reuptake inhibitors * normally takes 4-8 weeks for antidepressants to have an effect
50
SSRIs--use
* depression * generalized anxiety disorder * panic disorder * OCD * bulimia * social anxiety disorder * PTSD * premature ejaculation * premenstrual dysphoric disorder
51
SSRIs--toxicity
* fewer than TCAs * GI distress * SIADH * sexual dysfunction * anorgasmia * decreased libido
52
name the serotonin-norepinephrine reuptake inhibitors
* venlafaxine * desvenlafaxine * duloxetine * levomilnacipran * milnacipran
53
serotonin-norepinephrine reuptake inhibitors--mechanism
* inhibit 5-HT and norepinephrine reuptake
54
serotonin-norepinephrine reuptake inhibitors--use
* depression * general anxiety disorder * diabetic neuropathy * Venlafaxine is also indicated for: * social anxiety disorder * panic disorder * PTSD * OCD
55
serotonin-norepinephrine reuptake inhibitors--toxicity
* increase BP is the most common problem * stimulant effects * sedation * nausea
56
serotonin syndrome
* can occur with any drug that increases 5-HT (ie. MAO inhibitors, SNRIs, TCAs) * characterized by 3 **A**'s: * neuromuscular **A**ctivity--clonus, hyperreflexia, hypertonia, tremor, seizure * **A**utonomic stimulation--hyperthermia, diaphoresis, diarrhea * **A**gitation * treatment: cyproheptadine--5-HT2 receptor antagonist
57
name the tricyclic antidepressants
* amitriptyline * nortriptyline * imipramine * desipramine * comipramine * doxepin * amoxapine
58
tricyclic antidepressants--mechanism
* block reuptake of norepinephrine and 5-HT
59
tricyclic antidepressants--use
* major depression * OCD (clomipramine) * peripheral neuropathy * chronic pain * migraine prophylaxis
60
tricyclic antidepressants--toxicity
* sedation * alpha 1 blocking effects including postural hypotension * atropine like (anticholinergic) side effects * tachycardia * urinary retention * dry mouth * prolong QT interval * **Tri-C's**: **C**onvulsions, **C**oma, **C**ardiotoxicity--arrhythmia due to Na channel inhibition * respiratory depression * hyperpyrexia
61
why are the elderly at risk for confusion and hallucinations as a result of taking tricyclic antidepressants?
* b/c of the anticholinergic side effects
62
how would you prevent an arrhythmia that may result from taking tricyclic antidepressants?
* administer NaHCO3
63
tertiary tricyclic antidepressants (amitriptyline) vs. secondary tricyclic antidepressants (nortriptyline)
* tertiary tricyclic antidepressants have more anticholinergic effects than secondary TCAs
64
name the monoamine oxidase inhibitors
* **T**ranylcypromine * **P**henelzine * **I**socarboxazid * **S**elegiline * selective **MAO**-B inhibitor * "**MAO T**akes **P**ride **I**n **S**hanghai"
65
monoamine oxidase inhibitors--mechanism
* nonselective MAO inhibition increase levels of amine neurotransmitters, like norepinephrine, 5-HT, dopamine
66
monoamine oxidase inhibitors--use
* atypical depression * anxiety
67
monoamine oxidase inhibitors--toxicity
* hypertensive crisis--most notably with ingestion of tyramine, which is found in many foods such as aged cheese and wine * CNS stimulation
68
what are contraindications for monoamine oxidase inhibitors?
* SSRIs * TCAs * St. John's wort * meperidine * dextromethorphan (to prevent serotonin syndrome)
69
what do you need to wait to take 2 weeks after stopping MAO inhibitors?
* wait 2 weeks after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions
70
what are the 4 atypical antidepressants?
* bupropion * mirtazapine * trazodone * varenicline
71
buproprion--mechanism
* inc norepinephrine and dopamine * mechanism unknown
72
bupropion--use
* depression * smoking cessation
73
bupropion--toxicity
* stimulant effects * tachycardia * insomnia * headache * seizures in anorexic/bulimic patients * no sexual side effects
74
mirtazapine--mechanism
* alpha 2 antagonist--inc release of NE and 5-HT * potent 5-HT2 and 5-HT3 receptor antagonist * H1 antagonist
75
mirtazapine--toxicity
* sedation * may be desirable in depressed patients with insomnia * increased appetite * weight gain * may be desirable in elderly or anorexic patients * dry mouth
76
trazodone--mechanism
* primarily blocks 5-HT2, alpha 1 adrenergic, and H2 receptors * also weakly inhibits 5-HT reuptake
77
trazodone--use
* primarily for insomnia * high doses needed for antidepressant effects
78
trazodone--toxicity
* sedation * nausea * priapism * postural hypotension * called tra**ZZZ**o**bone** due to sedative and male specific side effects
79
varenicline--mechanism
* nicotinic ACh receptor partial agonist
80
varenicline--use
* depression * smoking
81
varenicline--toxicity
* sleep disturbance

PLAB Pharmacology (17 decks)

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