Psychopharmacology Flashcards
Aricept (donepezil hydrochloride)
can be used in mild to moderate dementia to slow and temporarily reverse some of the cognitive decline associated with Dementia of the Alzheimer’s type
Antipsychotics
typical/traditional or atypical/novel; many end in “azine”; traditional treat positive symptoms more effectively than negative symptoms; novel generally effective for both positive and negative; all are to some extent dopamine antagonists
Neurolpetics
antipsychotic medications; block dopamine receptors
Thorazine
Typical/traditional antipsychotic
Chlorpromazine
Typical/traditional antipsychotic
Prolixin
Typical/traditional antipsychotic
Fluphenazine
Typical/traditional antipsychotic
Haldol
Typical/traditional antipsychotic
Haloperidol
Typical/traditional antipsychotic
Clozaril
atypical/novel antipsychotic; increased risk of agranulocytosis; usually only administered to those who have failed trials of others
Clozapine
atypical/novel antipsychotic; increased risk of agranulocytosis; usually only administered to those who have failed trials of others
Risperdal
atypical/novel antipsychotic
Risperidone
atypical/novel antipsychotic
Zyprexa
atypical/novel antipsychotic
Olanzapine
atypical/novel antipsychotic
Positive symptoms (schizophrenia)
hallucination, disorganized thinking, delusions
Negative symptoms (schizophrenia)
affective flattening, lack of motivation, poverty of speech
Depot neuroleptics
antipsychotics administered intramuscularly in doses that last 2-4 weeks; helpful for inconsistent compliance
Decanoate
added to antipsychotic name to indicate it was administered in depot form
Schizophrenia factors that correlate with better treatment outcome
-later age of onset
-acute onset
-good premorbid functioning
-anxiety or other affective symptoms (as opposed to emotional blunting)
-systematized and focused delusions
-precipitating factors
-married status
-family history of affective disorders
-no family history of schizophrenia
Other disorders antipsychotics are used to manage
Delusional Disorder; sometimes Delirium, Brief Psychotic Disorder, Tourette’s Disorder, and Autism/Pervasive Developmental Disabilities (to decrease oppositional behavior, emotional lability, and irritability); sometimes adjunct in PTSD or MDD; not first choice for dementia but can be used to reduce agitation, confusion, and sleep problems
Lower potency antipsychotic side effects
sedation, anticholinergic effects (confusion, memory loss, worsening mental function), orthostatic hypotension, and a lowering of the seizure threshold; weight gain (increased appetite, decreased activity), sexual dysfunction
Higher potency antipsychotic side effects
extrapyramidal symptoms; weight gain (increased appetite, decreased activity), sexual dysfunction
Anticholinergic effects
dry mouth, constipation, urinary hesitancy or retention, blurred vision, dry eyes, photophobia (sensitivity to light), nasal congestion, and confusion and decreased memory; antipsychotic side effect, typically diminish but do not completely disappear within first month of use
Orthostatic hypotension
dizziness and lightheadedness when standing up
Extrapyramidal symptoms (EPS)
movement-related symptoms; potentially most damaging side effects of antipsychotics; include dystonia, parkinsonism, akathisia; some treated with anticholinergic agents (ACAs), such as Cogentin (benztropine) and Artane (trihexy - phenidyl)
Dystonia
acute and painful muscle spasms of the neck, back, tongue, eyes, and/or larynx; usually pass within two weeks; extrapyramidal symptom
Parkinsonism
also called pseudoparkinsonism; mask-like face, shuffling gait, drooling, resting tremor, rigidity, and akinesia; persist through treatment; treated by lowering dose, switching drugs, or using an anticholinergic agent; extrapyramidal symptom
Akathasia
most prevalent side effect of antipsychotics; dysphoria as well as an internal sense of restlessness or agitation, a feeling of the “ jitters” or “fidgeting,” tapping of the feet, rocking backward or forward, and shifting weight when standing; may persist throughout treatment; helped by using propranolol (a beta-blocker), a benzodiazepine, or an anticholinergic agent
Neuroleptic malignant syndrome (NMS)
affects 1% of patients treated with antipsychotics, potentially lethal; severe muscle rigidity, altered consciousness, autonomic instability (heart rate, blood pressure), high fever; requires emergency medical treatment
Tardive dyskinesia
typical/traditional antipsychotics can cause; abnormal movements of the lips, tongue, jaw (e.g., frowning, blinking, rolling and protruding the tongue), limbs (rapid purposeless movements, tremors, knee tapping), and trunk (rocking, twisting, pelvic gyrations); generally arises after 6+ months, plateaus at 3-6 years; may be reversible; sometimes seen when dosage is lowered or terminated; best treated through prevention; neuroleptics most effective short-term treatment for TD; anticholinergic agents typically exacerbate; not associated with Clozaril
Agranulocytosis
potentially lethal side effect of Clozaril; a sudden drop in the granulocyte count, usually occurring within hours to 12 weeks of initial administration, and manifesting as a sore throat and high fever
Antipsychotic dependence/withdrawal/overdose
do not cause addiction, dependence, or tolerance; only withdrawal if immediately stop high dosage (GI distress, headaches, insomnia, nightmares); overdoses not lethal unless take 30-60 day supply at once, but more lethal in combination with other medications
Antidepressants
include tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine-oxidase inhibitors (MAOIs), and others; primary mechanism of action usually blocking reuptake of norepinephrine and/or serotonin
Elavil
tricyclic antidepressant
Amitryptyline
tricyclic antidepressant
Anafranil
tricyclic antidepressant
Clomipramine
tricyclic antidepressant
Tofranil
tricyclic antidepressant
Imipramine
tricyclic antidepressant
Prozac
SSRI antidepressant; fluoxetine
fluoxetine
SSRI antidepressant
Zoloft
SSRI antidepressant; sertraline
sertraline
SSRI antidepressant
Paxil
SSRI antidepressant
Paroxetine
SSRI antidepressant
Treatment for “typical depressions”
SSRIs typically have fewer and less distressing side effects and are first choice; all classes of antidepressants equally effective in treating “typical depressions”
Treatment for psychotic depression
best treated by tricyclics (TCAs) in combination with antipsychotic
Treatment for inpatient depression
severe inpatient depression usually best treated with tricyclics (TCAs)
Treatment for melancholic depression
usually best treated with tricyclics (TCAs)
Treatment for geriatric depression
usually best treated with tricyclics (TCAs)
Atypical depression
symptoms of hypersomnia, increased appetite, rejection sensitivity, and profound lack of energy
Treatment for atypical depression
usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective
Treatment for treatment-resistant depression
usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective
Treatment for depression with panic disorder
usually best treated with monoamine-oxidase inhibitors (MAOIs); SSRIs may be shown to be equally effective
Treatment for mild depression
first line is psychotherapy since placebos and psychotherapy as effective as drug treatment
Treatment for bipolar disorder
lithium treatment of choice; long time to take effect (1-3 weeks for mania, 6-8 for depression), so often combined with antipsychotic/antidepressant; after several months, prophylactic (preventive) effect;; must be treated carefully if using antidepressants; tricyclics induce mania in 10-15%; SSRIs also induce mania but at lower rate
Treatment for depression with sleep problems
frequently helped by Desyrel (trazadone; other) or Sinequan (doxepin; TCA), both of which have hypnotic effects
Treatment for panic disorder
in addition to antianxiety agents Xanax (alprazolam) and Klonopin (clonazepam), commonly treated with antidepressants: Tofranil (imipramine; TCA), Paxil (paroxetine, SSRI) or Prozac (fluoxetine, SSRI)
Treatment for OCD
often responds to the TCA Anafranil (clomipramine), and appears to respond to any of the SSRIs, especially Prozac (fluoxetine)
Chronic pain disorders
respond well to TCAs, particularly Elavil (amitryptiline), Norpramin (desipramine), and Sinequan (doxepin). It is less clear if the SSRIs help
Treatment for bulimia
antidepressants most typical pharmacological treatment; tricyclic antidepressants frequently used, including Norpramin (desipramine) and Tofranil (imipramine); SSRIs more common now, particularly Prozac (fluoxetine)
Treatment for premature ejaculation
tricyclic Anafranil (clomipramine) and the SSRI Paxil (paroxetine)
Other antidepressant uses
severe bereavement, anorexia nervosa, premenstrual phase dysphoric syndrome, enuresis, childhood sleepwalking or night terrors, dysthymia, and borderline personality disorder
Tricyclic side effects
can trigger manic episodes in bipolar patients; more severe anticholinergic effects than antipsychotics; sedation, orthostatic hypotension, weight gain, nausea, and sexual dysfunction; contraindicated for patients with heart conditions, high blood pressure, or seizures
SSRI side effects
lower side effect profile than the TCAs (no anticholinergic effects, less sedation); headaches, nervousness, restlessness, insomnia, sedation, gastrointestinal distress, and sexual dysfunction
MAOI side effects
frequently cause orthostatic hypotension, weight gain, edema, sexual dysfunction, and insomnia; most serious side effect is tyramine-induced hypertensive crisis (must be warned not to eat foods high in tyramine; symptoms include severe headache, stiff neck, palpitations, sweating, nausea, and vomiting); contraindicated for variety of medical conditions; can be dangerous in conjunction with other meds
Antidepressant dependence/withdrawal/overdose
no dependence, tolerance, addiction; non-life-threatening withdrawal symptoms with abrupt stop; TCAs and MAOIs lethal, increased if combined with alcohol; SSRIs and atypical antidepressants not very lethal
Types of anti-anxiety drugs
benzodiazepines (anxiolytics and sedatives/hypnotics), non-benzodiazepine sedatives/hypnotics
Anxiolytics
benzodiazepines whose major function is anxiety reduction
Sedatives/hypnotics
benzodiazepines whose major function is sedation and sleep improvement
Xanax
anxiolytic benzodiazepine; disadvantage of triggering “mini withdrawals” between doses, may make patients feel worse and more dependent on the drug; alprazolam
alprazolam
anxiolytic benzodiazepine; disadvantage of triggering “mini withdrawals” between doses, may make patients feel worse and more dependent on the drug; Xanax
Klonopin
anxiolytic benzodiazepine
Clonazepam
anxiolytic benzodiazepine
Valium
anxiolytic benzodiazepine; daizepam
Diazepam
anxiolytic benzodiazepine; Valium
Ativan
anxiolytic benzodiazepine
Lorazepam
anxiolytic benzodiazepine
Restoril
sedative/hypnotic benzodiazepine
Temazepam
sedative/hypnotic benzodiazepine
Halcion
sedative/hypnotic benzodiazepine
Triazolam
sedative/hypnotic benzodiazepine
Ambien
non-benzodiazepine sedative/hypnotic
Zolpidem
non-benzodiazepine sedative/hypnotic
Benzodiazepine mechanism of action
facilitate GABA’s ability to bind to its receptor site; increasing GABA results in reduced anxiety, increased sedation, muscle relaxation, and reduction in seizures
Benzodiazepine use
limited and short-term because of potential for abuse; first consider possible secondary causes of anxiety (medical illness, illicit drugs, withdrawals from CNS depressants (benzodiazepines, alcohol, opiates, and barbiturates), medications (SSRIs, tricyclics, antipsychotics, etc)
Adjustment disorder treatment
benzodiazepines appropriate when response to particular stressor that meets criteria for adjustment disorder with anxiety; limited to 1-2 weeks
Panic disorder treatment
symptoms sometimes helped by benzodiazepines, particularly Xanax (alprazolam) or Klonopin (clonazepam); antidepressants first choice for treating on longer-term basis
GAD treatment
often treated with benzodiazepines as-needed to forestall acute anxiety or on-going while psychotherapeutic approaches are being initiated; problems: high rates of failure to respond, tolerance, dependence; Buspar and antidepressants often used instead
Other anxiety disorder treatment
BZs can have a minor role in the treatment of Social and Specific Phobias, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder
Sleep problem treatment
benzodiazepines best for short-term problems; problems: tolerance, dependence, rebound insomnia, disrupt sleep cycle, suppress REM sleep; when discontinued, REM rebound can cause vivid, disturbing dreams
Other disorders treated by benzodiazepines
occasionally treat depression; Klonopin (clonazepam) sometimes for Acute Mania; sometimes for akathisia and Alcohol Withdrawal; occasionally play a role as anticonvulsants (particularly Klonopin), muscle relaxants, and as adjuncts in anesthesia
Benzodiazepine side effects
more benign than barbiturates; most common are sedation and drowsiness; mild cognitive impairment and some amnesia; Ataxia (incoordination) and depression can occur when dosages are high; if taken with alcohol or other CNS depressants, severe drowsiness, paradoxical disinhibition, and respiratory problems that can be fatal
Benzodiazepine dependence/withdrawal/overdose
both physical and psychological dependence; most addictive are those with rapid onset and short half-life; can acquire dependence requiring larger doses for similar effects; BZs and alcohol cross-tolerant; withdrawal syndrome is serious and can be fatal, need to taper; safer in overdose, rarely fatal when taken alone; can be fatal with alcohol or other CNS depressants; chronic overdose: drowsiness, ataxia, slurred speech, and vertigo; acute overdose: lethargy and confusion, coma, and on rare occasions, heart attack or death
Benzodiazepine withdrawal symptoms
stage 1: tremors, sweating, agitation, and increased autonomic reactions; stage 2: hallucinations and panic; stage 3: single or multiple grand mal seizures
Who should avoid benzodiazepines
elderly, those with liver problems, patients with a history of alcohol dependence or any drug dependence, and patients who do not comply well with prescription directions
Buspar
non-Benzodiazepine anxiolytic; does not cause sedation, cognitive impairment, or withdrawal; low potential for abuse and dependence; may take 2-4 weeks for response, cannot be taken as needed; used primarily for GAD, not effective for panic disorder; side effects of headaches, nausea, dizziness
Buspirone
non-Benzodiazepine anxiolytic; does not cause sedation, cognitive impairment, or withdrawal; low potential for abuse and dependence; may take 2-4 weeks for response, cannot be taken as needed; used primarily for GAD, not effective for panic disorder; side effects of headaches, nausea, dizziness
Inderal
beta blocker
Propanolol
beta blocker
Beta blockers
frequently prescribed for the somatic manifestation of anxiety, especially in social and performance anxiety; sometimes prescribed for drug-induced akathisia, lithium- induced tremor, and alcohol withdrawal; prescribed for heart and blood problems; side effects: sexual dysfunction, dizziness, drowsiness, shortness of breath, angina, cold hands and feet, difficulty sleeping, and nightmares; less common side effects: depression, anxiety, sleep disturbance; non-additive, do not cause withdrawal, problematic in overdoses
Antihistamines
sometimes used to treat mild insomnia and extrapyramidal symptoms; common side effects: sedation, dizziness, and low blood pressure; examples: Atarax (hydroxyzine chloride), Vistaril (hydroxyzine pamoate), and Benadryl (diphenhydramine)
Barbiturates
rarely used; strong sedating effects; more likely than BZs to cause addiction and lethal in overdose; also not as good therapeutic effects
Lithium mechanism
theorized that functions as cell membrane stabilizer, affects variety of neurotransmitters; largely speculative
Other lithium uses
Schizoaffective Disorder, Bipolar Type; treatment-resistant depression when antidepressants alone have not been effective; sometimes combined with antipsychotics for schizophrenia; impulse disorders, such as Intermittent Explosive Disorder; occasionally part of treatment for Cyclothymia and Borderline Personality Disorder
Lithium side effects
frequently causes a fine hand tremor, gastric distress, weight gain, polyuria (urine) and polydipsia (thirst), fatigue, and mild cognitive impairment; negative effects on the kidneys, thyroid, heart, and skin; lithium toxicity
Lithium toxicity
potentially fatal, always medical emergency; symptoms initially mimic flu (vomiting, abdominal pain, and severe diarrhea); other symptoms severe tremor, ataxia, coma, seizures, confusion, and irregular heart beat; can occur when on stable dose and complying
Lithium dependence/withdrawal/overdose
does not cause tolerance, addiction, dependence, or withdrawal; non-compliance major problem because of side effects; Contraindications for its use include pre-existing heart disease, thyroid disease, renal damage, and pregnancy; requires close medical supervision
Zyprexa
mood stabilizer for maintenance treatment of bipolar disorder
Olanzipine
mood stabilizer for maintenance treatment of bipolar disorder
Klonopin
mood stabilizer for acute mania
Clonazepam
mood stabilizer for acute mania
Risperidal
mood stabilizer for acute mania
Resperidone
mood stabilizer for acute mania
Anti-convulsants
typically used when bipolar disorder does not respond to lithium or lithium is contra-indicated; also used to treat impulse control disorders; occasionally helpful for depression; do not cause withdrawal
Tegretol
anti-convulsant; may be more effective than lithium in cases of rapid cycling or dysphoric manic episodes; drug of choice for certain neurological chronic pain disorders, such as trigeminal neuralgia; side effects mimic alcohol intoxication
Carbamazepine
anti-convulsant; may be more effective than lithium in cases of rapid cycling or dysphoric manic episodes; drug of choice for certain neurological chronic pain disorders, such as trigeminal neuralgia; side effects mimic alcohol intoxication
Depakene
anti-convulsant; side effects include gastrointestinal distress, sedation, and tremor
Valproic acid
anti-convulsant; side effects include gastrointestinal distress, sedation, and tremor
Ritalin
stimulant
Methylphenidate
stimulant; Ritalin, Concerta
Adderall
stimulant
Amphetamine
stimulant; Adderall
Concerta
stimulant
Psychostimulant mechanism
increase level and effect of catecholamines
Disorders treated with stimulants
primarily treat ADHD in children, response typically in the first two days; sometimes used for adult ADHD, treatment-resistant depression, treatment-resistant obesity, narcolepsy, and chronic medically debilitating conditions (e.g., AIDS, Cancer)
Stimulant side effects
loss of appetite, insomnia, headaches, and gastrointestinal distress (stomach aches or nausea); may temporarily suppress growth in children, drug holidays recommended; anxiety, irritability, insomnia, and dysphoria, as well as increases in heart rate and blood pressure; occasionally bring about movement disorders; Decreased appetite, fatigue, and stomach fullness may be signs of liver damage after several months
Stimulant dependence/withdrawal/overdose
can cause psychological dependence and drug abuse; physical dependence, tolerance (especially when used for Narcolepsy), addiction, and physical withdrawal; Withdrawal symptoms include increased appetite, weight gain, increased sleep, decreased energy, and, uncommonly, paranoid symptoms; overdose rarely lethal because not strong enough; overdose symptoms include agitation, suicidal ideation, chest pain, hallucinations, confusion, dysphoria, and delusions
