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psychiatry yu > psychopharm 2 > Flashcards

psychopharm 2 Flashcards

1
Q

TRICYCLIC ANTIDEPRESSANTS
MOA:

A

1-Block serotonin and norepinephrine reuptake from presynaptic receptor,
so increase their concentration in the synaptic cleft.
2) Blocking of other receptors causes side effects

  • H1-receptor (histaminic) ,
  • α-receptors (adrenergic) ,
  • M-receptors (muscarinic receptors)
  • voltage-sensitive sodium channels.
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2
Q

Old generation: Tricyclic Antidepressants: ———–
New greneration: Tetracyclic antidepressants:
Maprotiline and Amoxapine

A

Imipramine, desipramine,
clomipramine,
amitriptyline, nortriptyline, protriptyline, and doxepinE

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3
Q

Major Depressive Disorder
* OCD : ——- is only approved in the United States for the treatment of OCD.
* Panic Disorder with Agoraphobia: ——-
* Generalized Anxiety Disorder: ———–
* chronic neuropathic pain and in prophylaxis of migraine
headache :————
* Childhood enuresis : often treated with ———-.
CHILD IN FEAR NEED HIS IMI

A

clomipramine
Imipramine
doxepin
Amitriptyline
imipramine

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4
Q

Psychiatric Effects OF TCA
Anticholinergic Effects
Cardiac Effects
Hepatic Effects

A

-induce a switch to mania or hypomania
-SEDATION
*****-tachycardia, flattened T waves, prolonged QT intervals, and
depressed ST segments in the electrocardiographic (EKG) recording{IN CASE OF INTOXICATION }
–TCAs can also produce a fulminant acute hepatitis in 0.1 to 1
percent of persons.

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5
Q

Autonomic Effects OF TCA

A

Orthostatic hypotension is the most common cardiovascular
autonomic adverse effect and the most common reason TCAs are
discontinued.
- Orthostatic hypotension is treated with avoidance of caffeine,
intake of at least 2 L of fluid per day and addition of salt to the diet
unless the person is being treated for hypertension. In persons taking
antihypertensive agents, reduction of the dosage may reduce the risk
of orthostatic hypotension.

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6
Q

Neurologic Effects

A

–lower the seizure threshold espically (Clomipramine and
amoxapine)
{-Amoxapine}}} is unique in causing parkinsonian symptoms, akathisia,
and even dyskinesia because of the dopaminergic blocking activity of
one of its metabolites

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7
Q

DRUG INTERACTIONS

(((Birth control))) pills may decrease TCA plasma concentrations through the induction of hepatic
enzymes.
(((( Nicotine ))))may reduce TCA concentrations.

A
  • The TCAs should not be taken within 14 days of administration of an MAOI.
  • The antihypertensive effects of the
    beta-adrenergic receptor antagonists (e.g.,
    propranolol and clonidine) may be blocked by the
    TCAs
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8
Q

TCAs

  • Contraindications:
    1- Absolute contraindications:
    3
    2- Relative contraindications: 2
A

MI (until 6 months after the MI)
* Narrow-angle glaucoma
* Contraindication in epileptic patients because it lowers
threshold of seizure
========================
Cardiac disease ( a baseline ECG is recommended).
* Prostatic hypertrophy or other obstructive uropathy (
secondary to anti-cholinergic side effects).

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9
Q

MAO enzymes are found on the outer membranes*
of mitochondria,

A

where they degrade cytoplasmic and
extraneuronal monoamine neurotransmitters such as
norepinephrine, serotonin, dopamine, epinephrine,
.and tyramine

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10
Q

Defined by systolic Bp is >180 mmhg & diastolic *
.blood pressure > 120 mmHg
:Potentially fatal reaction characterized by <
.Occipital headache that may radiate frontally *
. Palpitation *
.Neck stiffness or soreness *
.Nausea & Vomiting *
. Sweating (sometimes with fever) *
. Dilated pupils, photophobia *
Tachycardia or bradycardia, which can be *
.associated with constricting chest pain

A

Hypertensive crisis

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11
Q

treated with ———-
These drugs lower blood pressure within 5 MIN

A

alpha adrenergic anatagonist (phentolamine or chlorpromazine

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12
Q

Bupropion indications::
{.The risk of seizure is dose dependent *
( contraindicated in epileptic patients)}

A

Depression with seasonal pattern -
Smoking cessation -
:Attention-Deficit/Hyperactivity Disorder -
Bupropion is used as a second-line agent after
the sympathomimetics
Hypoactive Sexual Desire Disorder: Bupropion -
is often added to drugs such as SSRIs to
counteract** sexual side effects

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13
Q

Bupropion

MOA

A

inhibits the reuptake of norepinephrine and *
.dopamine

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14
Q

mood stabilizers are :

A
  1. Lithium
  2. Carbamazepine
  3. Lamotrigine
  4. Valproate
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15
Q

Lithium Cardiac Effects

A

-T-wave flattening or inversion.
-contraindicated in
persons with sick sinus syndrome.
-potentially teratogenic (pregnancy risk category
D): Ebstein’s anomaly of tricuspid valve

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16
Q

Neurological Effects lithium

hypothyroidism pt

A

Tremor
-is most notable in outstretched hands
- The tremor can be reduced by dividing the daily dosage, using a sustained-release formulation and reducing caffeine intake
* Cognitive Effect:
* -Lithium use has been associated with dysphoria, lack of spontaneity, slowed reaction times, and impaired memory.
* - The differential diagnosis

17
Q

lithium Renal Effect
ur Mx :check
their serum creatinine concentration, urine
chemistries, and 24-hour urine volume at
6-month intervals.

A

is polyuria with secondary polydipsia called lithium-induced nephrogenic diabetes
insipidus.
nephrotic syndrome and features of distal
renal tubular acidosis.
nonspecific interstitial fibrosis

18
Q

lithium-treated persons, TSH concentrations should be measured every 6-12 mths
Tx :include adding a thyroid
medication.
and its reversible once lithium is stopped

A

as its can cause hypothyroidism in 1st 2 y of TX

19
Q

Dermatological Effects lithium :
Therapeutic blood level range is 0.6-1.2 mEq/L.
and if used with tetracycline those levels should be monitored

A

Alopecia,acneiform, follicular, and maculopapular eruptions; pretibial ulcerations;

20
Q

lithium intoxication:
o mild to moderate:(
o moderate to severe lithium toxicity (serum
l
o severe lithium intoxication (lithium level

A

lithium level=1.5–2.0mEq/ L)
evel=2.1–2.5 mEq/L)
more than
2.5 mEq/L)

21
Q

lithium toxicity management

A

sodium polystyrene sulfonate or polyethyleneglycol solution but not activated charcoal.
hemodialysis if lithium >2 mmol/L, coma, shock, severe
dehydration, failure

22
Q

lithium Drug interaction /Contraindication :Safe to take aspirin or paracetamol

A

*NSAIDS
*Diuretics except osmotic and loop diuretics

23
Q

relapses are ——–times more likely after
lithium use is discontinued.

A

28

24
Q

valproic acid (Depakene )

  • THERAPEUTIC INDICATIONS
A
  • Acute Mania of Bipolar I Disorder
    (About two-thirds of persons with
    acute mania respond to valproate.(
  • seizures
  • prophylaxis of migraine
25
Q

Risk factors for potentially fatal hepatotoxicity
hepatitis +pancreatitis

A

-include young age (younger than 3 years);
-concurrent use of phenobarbital; and the
-presence of neurologic disorders, especially
inborn errors of metabolism

26
Q

Valproate side effcet

A

also associated with
teratogenicity, most notably neural tube
defects (e.g., spina bifida(
* aplastic anemia
* Stevens-Johnson syndrome.
* Polycystic ovarian syndrome ( PCOS(
* Agranulocytosis.
* Platelet dysfunction.

27
Q

Valproate doubles lamotrigine concentrations,
which lead to

A

increasing the risk of a serious rash (Stevens-
Johnson syndrome, and toxic epidermal

necrolysis)

28
Q

the treatment of manic and
mixed episodes of bipolar I disorder.
as extended-release
formulation

A

carbamazepine

29
Q

MOST COMMON-side effect

A

CNS depression ((ataxia, drowsiness)) –

30
Q

carbamazepine Pregnancy side effect:

A

potentially teratogenic:
* 0.5% - 1 % incidence of spina bifida.
* Craniofacial defects.
* developmental delay in the neonate.

31
Q

:effects Potentially serious or life-threatening side*

A

4-Stevens-Johnson syndrome and toxic epidermal necrolysis especially
during the first 2-8 weeks of treatment.

1-Hepatitis or hepatic failure.+cholestasis
2-Agranulocytosis or aplastic anemia (1 in 20,000; black box warning).
3-Syndrome of inappropriate antidiuretic hormone (SIADH) due to
vasopressin release.
5-aplastic anemia

32
Q

Carbamazepine inhibit OCP and it is
teratogenic.
its enhances metabolism of all draug so watch for what they are used AS TX
* Carbamazepine cause no weight gain

A

PHENOTOIN&raquo_space;»SEAZIURES
OCP»SPOTTING
DOXYCYCLINE»INFECTION

33
Q

Drugs that cause agranulocytosis

A

(carbamazepine, valporate ,
mitrazepine)🡪 contraindicated to given
togeth

34
Q

DRUGS CAUSE SIADH 🡪by SSRI and carbamazepine

A
35
Q

USED AS mood stabilizer for bipolar
depression as maintenance therapy

A

lamotrigine

36
Q

lamotrigine Common Side effects include:

A
  1. headache (the most common)
  2. skin rash (approximately 10% of patients)

psychiatry yu (6 decks)

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