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psychopharm3 Flashcards

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1
Q

amitryptaline

A

Elavil; TCA (tertiary amine); useful in chronic pain, migraines, and insomnia

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2
Q

imipramine

A

tofranil; TCA (tertiary amine); has IM form; useful in enuresis and panic disorder

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3
Q

clomipramine

A

anafranil; TCA (tertiary amine); most seratonin specific, useful in treatment of OCD

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4
Q

doxepin

A

sinequin; TCA (tertiary amine); useful in treatment of chronic pain; emerging use as a sleep aid in low doses

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5
Q

examples of secondary amine type of TCA

A

metabolites of tertiary amines (less anticholinergic, less sedating); nortryptline, desipramine

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6
Q

nortryptaline

A

pemlor, aventyl; secondary amine TCA; least likely to cause orthostatic hypotension; useful in treating chronic pain

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7
Q

desipramine

A

norpramin; TCA secondary amine; more activating, least sedating; least anticholinergic

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8
Q

what are the tetracyclic antidepressants

A

amoxapine, maprotiline

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9
Q

amoxapine

A

tetracyclic antidepressant; Ascendin; metabolite of antipsych loxapin; may case EPS and has similar side effect profile to typical antipsychotics

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10
Q

maprotiline

A

tetracyclic antidepressant; ludiomil; higher rates of seizure, arrhythmia, and fatality in overdose;

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11
Q

why do TCAs have so many side effects?

A

they are highly protein bound and lipid soluble, and therefore can interact with other meds that have high protein binding ability

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12
Q

what are the TCA side effects?

A

antihistamine (sedation); antiagrenergic (cardiovascular, incl ECG changes); antimuscarinic (aka anticholinergic); weight gain; seizures; seratonergive effects

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13
Q

TCAs should be avoided in what patients

A

those with cardiac abnormalities or recent MI

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14
Q

what happens when you OD on TCAs

A

agitation, tremors, ataxia, delirium, hypoventalation from CNS depression, myoclonus, hyperreflexia, seizures, and coma

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15
Q

seizures and TCAs

A

more common with clomipramine and tetracyclics

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16
Q

what are the seratonergic side effects of TCAs

A

erectile/ejaculatory dysfunction; anorgasmia in females

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17
Q

how do MAOIs work?

A

prevent th einactivation of norepi, serotonin, dopamine, and tyramine

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18
Q

what is tyramine

A

intermediate in the conversion of tyrosine to norepi

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19
Q

difference between MAOI-A and B

A

A preferentially deactivates seratonin, and MAO-B preferentially deactivates norepi and epi; both types also act on dopamine and tyramine

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20
Q

examples of MAOIs

A

phenelzine (nardil); tranylcypromine (parnate); isocarboxazid (marplan)

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21
Q

side effects of MAOIs

A

seratonin syndrome when SSRIs and MAOIs are taken together; hypertensive crisis when MAOIs are taken with tyramine-rich foods or sympathomimetics

22
Q

seratonin syndrome

A

initially lethargy, restlessness, confsion, flushing, sweating, tremor, and myoclonic jerks; may progress to hyperthermia, hypertonicity, rhabdo, renal failure, convuslions, coma, death

23
Q

how to avoid seratonin syndrome

A

wait at least 2 weejs before switching from SSRI to MAOI and at least 5-6 weeks with fluoxeitne

24
Q

foods with tyramine

A

red wine, cheese, chicken liver, fava beans, cured meats

25
Q

features of hypertensive crisis

A

incr BP, headache, sweating, n/v, photophobia, autonomic instability, chest pain, arrythmias, and death

26
Q

other side effects of MAOIs

A

orhostatic hypotension (most common SE); drowsiness, weight gain, sex dysfucntion, dry mouth, sleep disturbance

27
Q

people with pyridoxine def who take MAOIs

A

can have paresthesias, treated with B6

28
Q

rare side effects of TCAs

A

liver toxicity, seizures, and edema

29
Q

antidepressants used in OCD

A

SSRIs in high doses, TCAs (clomipramine)

30
Q

antidepressants used in panic disorder

A

SSRIs, TCAs (imipramine), MAOIs

31
Q

antidepressants used in eating disorder

A

SSRIs in high doses, TCAs, and MAOIs

32
Q

antidepressants used in social phobia

A

SSRIs, TCAs, MAOIs

33
Q

antidepressants used in GAD

A

SSRIs, SNRIs (venlafaxine), TCAs

34
Q

antidepressants used in PTSD

A

SSRIs

35
Q

antidepressants used in enuresis

A

TCAs (imipramine)

36
Q

antidepressants used in neuropathic pain

A

TCAs (amitriptyline and nortriptyline), duloxetine

37
Q

antidepressants used in chronic pain

A

SSRIs, and TCAs

38
Q

antidepressants in fibromyalgia

A

SSRI

39
Q

antidepressant used in migraine headache

A

TCAs (amitryptiline), SSRIs

40
Q

antidepressant used in smoking cessation

A

bupropion

41
Q

antidepressant used in premenstrual dysphoric disorder

A

SSRIs

42
Q

antidepressant used in depressive phase of manic depression

A

SSRIs

43
Q

antidepressants used in insomnia

A

mirtazapine, TCAs (amitryptaline)

44
Q

difference between typical (first gen) and atypical (second gen) antipsychotics

A

first gen block the D2 receptors and second gen block both D2 and 2A (serotonin)

45
Q

why are atypical antipsychotics better?

A

more effective in treating neg sx such as flat affect and social withdrawal

46
Q

low potency typical antipsychoitcs

A

lower affinity for dopamine receptors and therefore higher dose is reqd; higher incidence of anticholinergic and antihistaminic SE than high potency traditional antipsych

47
Q

low potency typical antipsychotics

A

lower incidence of EPS and neuroleptic malig syndrome; more lethality in overdose due to QTC prolongation and the potential for heart block and vtach

48
Q

low potency typical antipsychoitcs

A

rare risk of agranulocytosis and they have a slightly higher seizure risk than higher potency meds

49
Q

examples of low potency, typical psychotics

A

chlorpromazine (thorazine); thioridazine (Mellaril)

50
Q

chlorpromazine

A

Thorazine; low pot typical antipsych; commonly causes orthostatic hypotension, bluish skin discoloration, can lead to photosensitivity; can treat n/v and intractable hiccups

Psych (23 decks)

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