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Psychopharmacology Flashcards

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1
Q

4 categories of major antidepressants

A

TCAs, MAOIs, SSRIs, atypicals

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2
Q

OCD treatment

A

SSRIs, TCAs

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3
Q

Panic disorder tx

A

SSRIs, TCAs, MAOIs

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4
Q

eating disorder tx (pharm)

A

SSRIs, TCAs, MAOIs

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5
Q

dysthymia tx

A

SSRI

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6
Q

social phobia tx

A

MAOI and SSRI

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7
Q

PTSD tx

A

SSRI, TCA

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8
Q

IBS tx

A

SSRI, TCA

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9
Q

Enuresis tx

A

TCA

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10
Q

neuropathic pain tx

A

TCA

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11
Q

migraine headaches tx

A

TCA, SSRI, bupropion

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12
Q

smoking cessation tx

A

bupropion

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13
Q

TCAs MOA

A

inhibit reuptake of NE and serotonin, increasing availability in synapse

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14
Q

hallmark of TCA toxicity

A

widened QRS (>100msec) used as threshold to treatment

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15
Q

TCA used for OCD

A

clomipramine

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16
Q

mainstay of treatment for TCA overdose is

A

IV sodium bicarbonate

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17
Q

antihistaminic property of TCAs

A

sedation

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18
Q

antiadrenergic properties of TCAs

A

CV side effects- orthostatic hypotension, tachycardia, arrhythmias

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19
Q

antimuscarinic effects of TCAs

A

dry mouth, constipation, urinary retention, blurred vision, tachycardia

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20
Q

MAOI MOA

A

prevent the inactivation of biogenic amines such as NE, serotonin, dopamine, and tyramine

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21
Q

MAO-A preferentially deactivates what?

A

serotonin

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22
Q

MAO-B preferentially deactivates what?

A

NE/Epi

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23
Q

MAO A and B both act on which neurotransmitters

A

dopamine and tyramine

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24
Q

Three MAOIs

A

phenelzine (Nardil), tranylcypromine (parnate), isocarboxazid (marplan)

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25
Q

side effects of MAOIs

A

orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction

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26
Q

serotonin syndrome

A

SSRIs and MAOIs are taken together. initially characterized by lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks. may progress to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, and death.

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27
Q

Hypertensive crisis

A

risk when MAOIs are taken with tyramine-rich foods or sympathomimetics. foods with tyramine (red chianti wine, cheese, chicken liver, fava beans, cured meats) case a build up of stored catecholamines.

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28
Q

SSRIs (examples)

A

fluoxetine (prozac), sertraline (zoloft), paroxetine (paxil), fluvoxamine (luvox), citalopram (celexa), escitalopram (lexapro)

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29
Q

fluoxetine

A

prozac. longest half life with active metabolites. do not need to taper

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30
Q

sertraline

A

zoloft. highest risk of GI disturbances

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31
Q

paroxetine

A

paxil. most serotonin specific, most activating

32
Q

fluvoxamine

A

luvox. only for OCD

33
Q

citalopram

A

celexa.

34
Q

escitalopram

A

lexapro. similar to cialopram/celexa, more expensive

35
Q

side effects of SSRIs

A

Sexual dysfunction (25-30%), GI disturbance, insomnia, headache, anorexia, weight loss, serotonin syndrome when used with MAOIs

36
Q

Venlafaxine

A

SNRI. effexor. treats refractory depression and CAP. can increase BP. withdrawal symptoms with 1-3 missed doses not life threatening but very uncomfortable

37
Q

Bupropion

A

Wellbutrin. NDRI. commonly used to aid in smoking cessation and seasonal affective disorder, and adult ADHD. lack of sexual side effects compared to SSRIs. dopaminergic effect can exacerbate psychosis. side effects: increase sweating and increased risk of seizures and psychosis at high doses.

38
Q

serzone and trazodone

A

especially useful in treatment of refractory major depression

39
Q

Mirtazapine

A

Remeron. NASA. refractory major depression, especially if weight gain is needed. side effects are sedation, weight gain, dizziness, somnolence, tremor, and agranulocytosis.

40
Q

low potency antipsychotics

A

lower affinity for dopamine receptors, higher dose required. chlorpromazine (thorazine), thioridazine (mellaril). higher incidence of anticholinergic and antihistaminic side effects than high potency traditional antipsychotics. lower incidence of EPSE and NMS

41
Q

high potency antipsychotics

A

higher affinity for dopamine receptors, and therefore a relatively low dose is needed to achieve effect. Haloperidol, fluphenazine, trifluoperazine, perphenazine, pimozide

42
Q

treatment of EPSEs

A

reduce dose of antipsychotic and administer antiparkinsonian, anticholinergic, or antihistaminic meds like amantadine, benadryl, or benztropine

43
Q

other SEs of antidepressants

A

weight gain, elevated LFTs, jaundice, chlorpromazine- deposits in lens and cornea), dermatologic problems- rashes and photosensitivity (blue gray skin discoloration with chlorpromazine), seizures,

44
Q

Neuroleptic malignant syndrome

A

FALTER: Fever, autonomic instability, leukocytosis, tremor, elevated CPK, rigidity

45
Q

treatment of NMS

A

discontinue current meds, hydration, cooling etc. sodium dantrolene, bromocriptine, and amantadine are useful. you CAN start the same neuroleptic at a later time. NOT an allergy

46
Q

two atypical antipsychotics approved to treat mania

A

quetiapine and ziprasidone

47
Q

atypical antipsychotics

A

clozapine, risperidone, quetiapine, olanzapine, ziprasidone

48
Q

olanzapine side effects

A

hyperlipidemia, glucose intolerance, weight gain, and liver toxicity (monitor LFTs)

49
Q

Quetiapine side effects

A

less propensity for weigh gain, but has beens hown to cause cataracts in beagle dogs, so periodic slit lamp examination is recommended.

50
Q

Three mood stabilizers

A

lithium, carbamazepine and valproic acid

51
Q

Therapeutic range of lithium

A

0.7-1.2

52
Q

Factors that affect lithium levels

A

NSAIDs decrease it, aspirin, dehydration, salt deprivation, impaired renal function, diuretics

53
Q

side effects of lithium

A

fine tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, weight gain, GI problems, benign leukocytosis, thyroid enlargement, hypothyroidism, and nephrogenic diabetes insipidus

54
Q

carbamazepine

A

tegretol. anticonvulsant that is especially useful in treating mixed episodes and rapid cycling bipolar disorder. used in the management of trigeminal neuralgia.

55
Q

carbamazepine side effects

A

skin rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, and agranulocytosis.

56
Q

valproic acid

A

anticonvulsant that is especially useful in treating mixed manic episodes and rapid cycling bipolar disorder. its mechanism of action is unknown, but it has been shown to increase CNS levels of GABA.

57
Q

side effects of valproic acid

A

sedation, weight gain, alopecia, hemorrhagic pancreatitis, hepatotoxicity, and thrombocytopenia.

58
Q

categories of anxiolytics

A

benzos, barbiturates, and buspirone

59
Q

advantage of benzos over barbiturates

A

safety at high doses

60
Q

limitation of using benzos

A

duration of BDZ use due to potential for tolerance and dependence. works by potentiating effects of GABA

61
Q

long acting benzodiazepines

A

Chlordiazepoxide, diazepam, flurazepam

62
Q

intermediate acting benzodiazepines

A

alprazolam, clonazepam, lorazepam, temazepam

63
Q

short acting benzodiazepam

A

oxazepam, triazolam

64
Q

zolpidem, zaleplon

A

short term treatment of insomnia. selectively bind to benzodiazepine binding site on GABA receptor. no withdrawal, minimal rebound insomnia, little or no tolerance/dependance occurs with prolonged use.

65
Q

Buspirone (indication, kinetics, receptor, advantage)

A

alternative to benzo or venlafaxine for treating generalized anxiety disorder. slower onset than benzos (takes 1-2 weeks to take effect), anxiolytic action is at the 5HT-1A receptor (partial agonist). does not potentiate the CNS depression of alcohol. low potential for abuse/addiction

66
Q

what two drug classes have HAM side effects

A

TCAs and low potency antipsychotics

67
Q

symptoms of serotonin syndrome

A

confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, and death

68
Q

akathisia

A

restlessness and agitation

69
Q

parkinsonism

A

masklike face, cogwheel rigity, pill rolling tremor

70
Q

dystonia

A

sustained contraction of muscles of neck, tongue, eyes. occurs with high potency traditional antipsychotics, reversible (occurs within days), can be life threatening (example- dystonia of the diaphragm causing asphyxiation)

71
Q

NMS

A

fever, tachycardia, HTN, tremor, elevated CPK, lead pipe rigidity

72
Q

medications that can cause psychosis

A

sympathomimetics, analgesics, antibiotics, anticholinergis, anticonvulsants, antihistamines, corticosteroids, and antiparkinsonian agents

73
Q

medications that can cause agitation/confusion/delirium

A

antipsychotics, antidepressants, antiarrhythmics, antineoplastics, corticosteroids, cardiac glycosides, NSAIDs, antiasthmatics, antibiotics, anti-HTN, antiparkinsonian agents, and thyroid

74
Q

medications that can cause depression

A

may be caused by anti-HTN, antiparkinsonian agents, corticosteroids, CCBs, NSAIDs, abx, and peptic ulcer drugs

75
Q

medications that can cause anxiety

A

sympathomimetics, antiasthmatics, antiparkinsonian agents, hypoglycemics, NSAIDs, and thyroid hormones

76
Q

medications that can cause sedation/poor concentration

A

antianxiety agents/hypnotics, anticholinergics, antibiotics, and antihistamines

Psych (3 decks)

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