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Pharmacology > Psychiatry Pharmacology > Flashcards

Psychiatry Pharmacology Flashcards

1
Q

Psychiatry Pharmacology

Preferred treatment of ADHD

A

Stimulants (methylphenidate, amphetamines)

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2
Q

Psychiatry Pharmacology

Preferred treatment of alcohol withdrawal

A

Benzodiazepines (eg. chlordiazepoxide, lorazepam, diazepam)

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3
Q

Psychiatry Pharmacology

Preferred treatment of bipolar disorder

A

Lithium, valproic acid, atypical antipsychotics

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4
Q

Psychiatry Pharmacology

Preferred treatment of bulimia nervosa

A

SSRIs

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5
Q

Psychiatry Pharmacology

Preferred treatment of depression

A

SSRIs

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6
Q

Psychiatry Pharmacology

Preferred treatment of generalized anxiety disorder

A

SSRIs, SNRIs

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7
Q

Psychiatry Pharmacology

Preferred treatment of obsessive-compulsive disorder

A

SSRIs, venlafaxine, clomipramine

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8
Q

Psychiatry Pharmacology

Preferred treatment of panic disorder

A

SSRIs, venlafaxine, benzodiazepines

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9
Q

Psychiatry Pharmacology

Preferred treatment of PTSD

A

SSRIs, venlafaxine

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10
Q

Psychiatry Pharmacology

Preferred treatment of schizophrenia

A

Atypical antipsychotics

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11
Q

Psychiatry Pharmacology

Preferred treatment of social anxiety disorder

A

SSRIs, venlafaxine

Performance only: β-blockers, benzodiazepines

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12
Q

Psychiatry Pharmacology

Preferred treatment of Tourette syndrome

A

Antipsychotics (eg. fluphenazine, pimozidde), tetrabenzine

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13
Q

Psychiatry Pharmacology

Methylphenidate, dextroamphetamine, methamphetamine

A

MOA: CNS stimulants. ↑ catecholamines in the synaptic cleft, especially norepinephrine and dopamine.

Use: ADHD, narcolepsy, appetite control.

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14
Q

Psychiatry Pharmacology

Neuroleptics (haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine)

A

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.

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15
Q

Psychiatry Pharmacology

What are the high potency neuroleptics and their side effects?

A

Trifluoperazine, fluphenazine, haloperidol (Try to Fly High)

Adverse Effects: Neurologic side effects (eg. extrapyramidal symptoms)

Haloperidol: NMS, tardive dyskinesia

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16
Q

Psychiatry Pharmacology

What are the low potency neuroleptics and their side effects?

A

Chlorpromazine, thioridazine

Adverse Effects: Non-neurologic side effecs (anicholinergic, anthistamine, α1-blockade effects)

Chlorpromazine - corneal deposits
Thioridazine - retinal deposits

17
Q

Psychiatry Pharmacology

What is the onset of EPS?

A

Hours to days: Acute dystonia (muscle spasm, stiffness, oculogyric crisis)

Days to months: Akathasia (restlessness) and parkinsonism (bradykinesia)

Months to years: Tardive dyskinesia

18
Q

Psychiatry Pharmacology

What are the symptoms & treatment of neuroleptic malignant syndrome?

A

Symptoms: FEVER (Fever, Encephalopathy, Vitals unstable, Enzymes ↑, Rigidity of muscles)
Also myoglobinuria

Treatment: Dantrolene, D2 agonists (eg. bromocriptine)

19
Q

Psychiatry Pharmacology

What are the symptoms of tardive dyskinesia?

A

Orofacial chorea as a result of long-term antipsychotic use

20
Q

Psychiatry Pharmacology

Atypical antipsychotics

A

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)

21
Q

Psychiatry Pharmacology

Lithium

A

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

22
Q

Psychiatry Pharmacology

Buspirone

A

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)

23
Q

Psychiatry Pharmacology

SSRIs

A

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)

24
Q

Psychiatry Pharmacology

SNRIs

A

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

25
Q

Psychiatry Pharmacology

What is serotonin syndrome? How is it treated?

A

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)

26
Q

Psychiatry Pharmacology

TCAs

A

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)

27
Q

Psychiatry Pharmacology

MAOIs

A

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.

28
Q

Psychiatry Pharmacology

Bupropion

A

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

29
Q

Psychiatry Pharmacology

Mirtazapine

A

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.

30
Q

Psychiatry Pharmacology

Trazodone

A

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.

31
Q

Psychiatry Pharmacology

Varenicline.

A

MOA: Nicotinic ACh receptor partial agonist.

Use: Depression, smoking cessation.

Toxicity: Sleep disturbance.

Pharmacology (17 decks)

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