Psychopharm 2 Flashcards
Phase 1 vs phase 2 transformation (steps)
Phase I: oxidation, reduction, hydrolysis
(CYP 450)
Phase II: conjugation, acetylation
(liver, kidney, small intestine)
Name drugs that are phase II metabolism (conjugation)
Lorazepam, oxazepam, temazepam
Desvenlafaxine, paliperidone
Name drugs exclusively renally excreted
MNEMONIC: The Pee Leaves a Perfectly Moist Golden Drain
Topiramate
Paliperidone (50%)
Lithium
Acamprosate
Pregabalin
Memantine
Gabapentin
Desvenlafaxine
Also: duloxetine, mirtazapine (30-50% dose reduc), paliperidone (50% dose reduc)
Hunter decision rules for Serotonin Syndrome
-Spontaneous clonus
-Inducible clonus
-Ocular clonus
-Tremor and hyperreflexia
-Hypertonia, temperature >38F, and ocular or inducible clonus
NMS
FARM
-Fever
-Autonomic Instability
-Rigidity
-Mental status changes
Sertraline MoA
(-) SERT (-) DAT, sigma
Fluvoxamine MoA
(-) SERT (-) sigma
Fluoxetine MoA
(-) SERT (-) 5HT2C, NET
Paroxetine MoA
(-) SERT (-) M1, NET, NO synthase
Citalopram MoA
Escitalopram MoA
Citalopram: (-) SERT (-) H
Escitalopram: (-) SERT
Naltrexone MoA
(-) u and k
V weak partial agonist, effectively an antagonist
Methadone MoA
(+) u, less NMDA
Lumateperone MoA
(-) 5HT2A, more than D2, D1, a1, SERT
Cariprazine MoA
partial agonist, More D3 than D2
Brexpripazole MoA
Less D2, more 5HT?
Same as abilify but less D2 therefore less akathisia
Aripiprazole MoA
D2, (+) 5HT1A (-) 5HT2A 2C 5HT7
Lurasidone MoA
(-) D4 more than D2, (-) 5HT7 more than 5HT2A
Carbamazepine MoA
(-) Na channels
Lamotrigine MoA
(-) VGSC when overexcited
Epival MoA
(+) GABA (-) Na channels, T-type Ca channels
Z-drugs MoA
a1 subunit of GABA receptor
Bzds MoA
GABA receptor is a voltage sensitive channel to Cl-, subunit a1 sedates, subunits a2 a3 anxiolysis
