Psychiatry Pharmacology Flashcards
Psychiatry Pharmacology
Preferred treatment of ADHD
Stimulants (methylphenidate, amphetamines)
Psychiatry Pharmacology
Preferred treatment of alcohol withdrawal
Benzodiazepines (eg. chlordiazepoxide, lorazepam, diazepam)
Psychiatry Pharmacology
Preferred treatment of bipolar disorder
Lithium, valproic acid, atypical antipsychotics
Psychiatry Pharmacology
Preferred treatment of bulimia nervosa
SSRIs
Psychiatry Pharmacology
Preferred treatment of depression
SSRIs
Psychiatry Pharmacology
Preferred treatment of generalized anxiety disorder
SSRIs, SNRIs
Psychiatry Pharmacology
Preferred treatment of obsessive-compulsive disorder
SSRIs, venlafaxine, clomipramine
Psychiatry Pharmacology
Preferred treatment of panic disorder
SSRIs, venlafaxine, benzodiazepines
Psychiatry Pharmacology
Preferred treatment of PTSD
SSRIs, venlafaxine
Psychiatry Pharmacology
Preferred treatment of schizophrenia
Atypical antipsychotics
Psychiatry Pharmacology
Preferred treatment of social anxiety disorder
SSRIs, venlafaxine
Performance only: β-blockers, benzodiazepines
Psychiatry Pharmacology
Preferred treatment of Tourette syndrome
Antipsychotics (eg. fluphenazine, pimozidde), tetrabenzine
Psychiatry Pharmacology
Methylphenidate, dextroamphetamine, methamphetamine
MOA: CNS stimulants. ↑ catecholamines in the synaptic cleft, especially norepinephrine and dopamine.
Use: ADHD, narcolepsy, appetite control.
Psychiatry Pharmacology
Neuroleptics (haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine)
MOA: Block dopamine D2 receptors (↑ [CAMP]
Use: Schizophrenia (primarily positive symptoms), psychosis, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD.
Adverse Effects: Highly lipid soluble and stored in body fat; thus, very slow to be removed from the body.
Extrapyramidal system side effects (treatment: benztropine, diphenhydramine, benzodiazepines).
Endocrine side effects (eg. dopamine receptor antagonism → hyperprolactinemia → galactorrhea, oligomenorrhea, gynecomastia.
Side effects arising from blocking muscarinic (dry mouth, constipation), α1 (orthostatic hypotension), and histamine (sedation) receptors
Can cause QT prolongation.
Psychiatry Pharmacology
What are the high potency neuroleptics and their side effects?
Trifluoperazine, fluphenazine, haloperidol (Try to Fly High)
Adverse Effects: Neurologic side effects (eg. extrapyramidal symptoms)
Haloperidol: NMS, tardive dyskinesia
Psychiatry Pharmacology
What are the low potency neuroleptics and their side effects?
Chlorpromazine, thioridazine
Adverse Effects: Non-neurologic side effecs (anicholinergic, anthistamine, α1-blockade effects)
Chlorpromazine - corneal deposits
Thioridazine - retinal deposits
Psychiatry Pharmacology
What is the onset of EPS?
Hours to days: Acute dystonia (muscle spasm, stiffness, oculogyric crisis)
Days to months: Akathasia (restlessness) and parkinsonism (bradykinesia)
Months to years: Tardive dyskinesia
Psychiatry Pharmacology
What are the symptoms & treatment of neuroleptic malignant syndrome?
Symptoms: FEVER (Fever, Encephalopathy, Vitals unstable, Enzymes ↑, Rigidity of muscles)
Also myoglobinuria
Treatment: Dantrolene, D2 agonists (eg. bromocriptine)
Psychiatry Pharmacology
What are the symptoms of tardive dyskinesia?
Orofacial chorea as a result of long-term antipsychotic use
Psychiatry Pharmacology
Atypical antipsychotics
Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone
MOA: Not completely understood. Most are D2 antagonists; aripiprazole is a D2 partial agonist. Varied effects on 5-HT2, dopamine, and α- and H1-receptors.
Use: Schizophrenia (both positive and negative symptoms). Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome
Adverse Effects:
All: Prolonged QT interval, fewer EPS and anticholinergic side effects than typical antipsychotics.
“-pines”: Metabolic syndrome (weight gain, diabetes, hyperlipidemia, hyperglycemia)
Clozapine: Agranulocytosis (check WBC weekly)
Risperidone: hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)
Psychiatry Pharmacology
Lithium
MOA: Not established; possibly related to inhibition of phosphoinositol cascade.
Use: Mood stabilizer for bipolar disorder; blocks relapse and acute manic events.
Adverse Effects: Tremor, hypothyroidism, polyuria (causes nephrogenic diabetes insipidus), teratogenesis (causes Ebstein anomaly). Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by kidneys; most is reabsorbed at PCT with Na+.
LMNOP: Lithium causes Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy problems
Psychiatry Pharmacology
Buspirone
MOA: Stimulates 5-HT1a receptors
Use: Generalized anxiety disorder. Does not cause sedation, addiction, or tolerance. Takes 1-2 weeks to take effect. Does not interact with alcohol (vs barbiturates, benzodiazepines)
Psychiatry Pharmacology
SSRIs
Fluoxetine, paroxetine, sertraline, citalopram
MOA: 5-HT-specific reuptake inhibitors
Use: Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder
Adverse Effects: Fewer than TCAs. GI distress, SIADH, sexual dysfunction (anorgasmia, ↓ libido)
Psychiatry Pharmacology
SNRIs
Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran
MOA: Inhibit 5-HT and norepinephrine reuptake
Use: Depression, general anxeity disorder, diabetic neuropathy. Venlafaxine is also indicated for social anxiety disorder, panic disorder, PTSD, OCD.
Adverse Effects: ↑ BP most common, also stimulant effects, sedation, nausea
Psychiatry Pharmacology
What is serotonin syndrome? How is it treated?
Can occur with any drug that ↑ 5-HT (eg. MAOIs, SNRIs, TCAs). Characterized by neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure), autonomic stimulation (hyperthermia, diaphoresis, diarrhea), and agitation.
3 As: neuromuscular Activity, Autonomic stimulation, Agitation
Treatment: cyproheptadine (5-HT2 receptor antagonist)
Psychiatry Pharmacology
TCAs
Amitriptyline, nortriptyline, imipramine, desipramine, comipramine, doxepin, amoxapine
MOA: Block reuptake of norepinephrine and 5-HT
Use: Major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis
Adverse Effects: Sedation, α1-blocking effects including postural hypotension, and atropine-like side effects (tachycardia, urinary retention, dry mouth). 3° TCAs (amitriptyline) have more anticholinergic effects than 2* TCAs (nortriptyline). Can prolong QT interval.
Toxicity: Convulsions, coma, cardiotoxicity (Treatment: NaHCO3)
Psychiatry Pharmacology
MAOIs
Tranylcypromine, phenelzine, isocarboxazid, seligiline
MOA: Nonselective inhibition ↑ levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine). Seligiline is a selective MAO-B inhibitor.
Use: Atypical depression, anxiety.
Adverse Effects: Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as aged cheese and wine); CNS stimulation. Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan ( to prevent serotonin syndrome). Wait 2 weeks after stopping MAOIs before starting serotonergic drugs or stopping dietary restrictions.
Psychiatry Pharmacology
Bupropion
MOA: Atypical antidepressant. ↑ norepinephrine and dopamine via unknown mechanism
Use: Depression, smoking cessation.
Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures in anorexic/bulimic patients. No sexual side effects
Psychiatry Pharmacology
Mirtazapine
MOA: α2-antagonist (↑ release of NE and 5-HT), potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist.
Use: Depression
Toxicity: Sedation, ↑ appetite, weight gain, dry mouth.
Psychiatry Pharmacology
Trazodone
MOA: Primarily blocks 5-HT2, α1-adrenergic, and H1 receptors; also weakly inhibits 5-HT reuptake.
Use: Insomnia (high doses needed for antidepressant effects)
Toxicity: sedation, nausea, priapism, postural hypotension.
Psychiatry Pharmacology
Varenicline.
MOA: Nicotinic ACh receptor partial agonist.
Use: Depression, smoking cessation.
Toxicity: Sleep disturbance.
