Psychopharmacology Flashcards
1
Q
Drug side effect:
confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdo, renal fialure, death
A
Serotonin Syndrome
2
Q
Drug side effect:
hypertension, headache, sweating, nausea, vomiting, photophobia, autonomic instability, chest pain, arrhythmia, death
A
Hypertensive crisis, caused by ingestion of MAOi w/tyramine rich foods, also known as Tyramine Hypertensive Crisis
3
Q
Drug side effects:
- Mask-like face, cogwheel rigidity, bradykinesia, pill-rolling tremor
- Sense of inner restlessness, need to move
- painful sustained contraction of muscle
A
- Parkinsonian
- Akathisia
- Dystonia
All occur primarily with high-potency antipsychotics, reversible
4
Q
Drug side effects:
Choreoathetoid muscle movements of face, mouth, tongue
A
Tardive dyskinesia
- develops after many years of antipsychotic use
- usually NOT reversible, 50% may spontaneously remit
- Risk factors: older age, possibly women and affective disorder
5
Q
Drug side effects:
Hyperprolactinemia
A
Occurs with high-potency antipsychotics AND risperidone
6
Q
Drug side effects:
fever, tachycardia, hypertension, tremor, elevated CPK, lead pipe rigidity, leukocytosis, diaphoresis, delirium, autonomic instability
A
Neuroleptic malignant syndrome
- mostly high-potency antipsychotics
- 20% mortality rate
7
Q
CYP450 Inducers (4)
A
- Tobacco
- Carbamazepine
- Barbituates
- St. John’s Wort
8
Q
CYP450 Inhibitors (5)
A
- Fluvoxamine (SSRI)
- Fluoxetine (SSRI)
- Paroxetine (SSRI)
- Sertraline (SSRI)
- Duloxetine (SNRI)
9
Q
SSRI Drug:
- Longest half-life w/active metabolites (don’t need to taper)
- safe in pregnancy, approved in children
- insomnia, anxiety, sexual dysfunction
- elevate levels of antipsychotics (Cyp450 inhibitor)
A
Fluoxetine
10
Q
SSRI Drug:
- higher risk for GI disturbance
- few drug interactions
- insomnia, anxiety, sexual dysfunction
A
Sertraline
11
Q
SSRI Drug:
- Highly protein bound (several drug interactions)
- Most anticholinergic
- Sexual dysfunction
- Short half-life (need to taper), withdrawal phenomena
A
Paroxetine
12
Q
SSRI Drug:
- Approved only for OCD
- Nausea and vomiting
- Cyp450 inhibitor, many interactions
A
Fluvoxamine
13
Q
SSRI Drug:
- geriatric-friendly
- fewest drug-drug interactions
- dose-dependent QTc prolongation
A
Citalopram
14
Q
SSRI Drug:
- geriatric-friendly
- few drug-drug interactions
- dose-dependent QTc prolongation
- enantiomer of another drug
A
Escitalopram
15
Q
SSRI Side effects that resolve
A
- GI disturbance
- Insomnia, vivid dreams
Headache
Anorexia, weight loss
16
Q
SSRI side effects that do NOT resolve
A
- Sexual dysfunction (decreased libido, anorgasmia, delayed ejaculation)
- Akathisia-like state
17
Q
Other SSRI side effects
A
- Rare hyponatremia
- 0.2% seizures
- Rare SIADH
18
Q
Misc. Antidepressant:
- used for depression, GAD, neuropathic pain
- few drug interactions
- Incr. BP in high doses
A
Venlafaxine (SNRI)
19
Q
Misc. Antidepressant:
- used for depression, neuropathic pain, fibromyalgia
- NE effects: dry mouth, constipation
- Hepatotoxicity in vulnerable patients
A
Duloxetine (SNRI)
20
Q
Misc. Antidepressant:
- Lack of sexual side effects compared to SSRI
- Used for depression, smoking cessation, adult ADHD
- Increased anxiety possible
- Decreases seizure threshold, especially in eating disorders
- Psychosis at high doses
- Contraindicated in MAOi (also seizures and eating disorder)
A
Bupropion (NDRI)
21
Q
Misc. Antidepressant(2)
- Used for depression, depression with anxiety, insomnia
- Lack of sexual side effects
- Do not affect REM sleep
- Nausea, dizziness, hypotension
- Rare but serious liver failure for one drug
A
(Serotonin agonist/antagonist)
- Trazodone
- Nefazodone (liver injury)
22
Q
Misc. Antidepressant
- used for MDD, esp. w/weight loss or insomnia
- sedation, weight gain, dizziness, tremor, dry mouth, constipation, agranulocytosis (rare)
- few sexual side effects
- few drug interactions
A
(Alpha2 adrenergic receptor antagonist)
Mirtazapine
23
Q
Heterocyclic Antidepressant:
- used for depression, chronic pain, migraines, insomnia
A
Amitriptyline (TCA, tertiary amine)
24
Q
Heterocyclic Antidepressant:
- Used for depression, enuresis, panic disorder
A
Imipramine (TCA, tertiary amine)
25
Heterocyclic Antidepressant:
- Used for OCD and depression
- Most serotonin-specific
Clomipramine (TCA, tertiary amine)
26
Heterocyclic Antidepressant:
- Used for depression, chronic pain
- Can use as sleep aid at low dose
Doxepin (TCA, tertiary amine)
27
Heterocyclic Antidepressant:
- Less anti-cholinergic/histaminic/adrenergic
- Least likely to cause orthostatic hypotension
- Used for depression and chronic pain
- Useful therapeutic blood levels
Nortriptyline (TCA, secondary amine)
28
Heterocyclic Antidepressant:
- Less anti-cholinergic/histaminic/adrenergic
- Least anticholinergic
- More activating/Least sedating
Desipramine (TCA, secondary amine
29
Heterocyclic Antidepressant:
- metabolite of loxapine
- can cause EPS
- similar side effects to typical antipsychotics
Amoxapine (Tetracyclic antidepressant)
30
TCA Mechanism:
General TCA side effects:
- Drug interactions, distribution
- Anti-histaminic (2)
- Anti-adrenergic (5)
- Anti-muscarinic (6)
- Serotonergic (2)
- Protein-bound, lipid soluble, drug interactions
TCA Mechanism: inhibit reuptake of NE, 5-HT, increase monoamine availability in synapse
Side Effects:
- Antihistaminic: sedatin and weight gain (suppress satiety)
- Antiadrenergic: orthostatic hypoTN, dizziness, reflex tachycardia, arrhythmias (block cardiac sodium channel), ECG changes (widened QRS, QT, PR intervals)
- Avoid in patients with conduction abnormalities or recent MI
- Antimuscarinic: dry mouth, constipation, urinary retention, blurred vision, tachycardia, glaucoma
- Serotonergic: ED, ejaculatoru dysfunction in males, anorgasmia in females
31
Drug Side Effect:
- Agitation, tremors, ataxia, arrhythmia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizure, coma
TCA overdose
32
MAOI Mechanism:
Prevent inactivation of NE, 5-HT, DA, tyramine (intermediate in conversion of tyrosine to NE) by irreversibly inhibiting MAO-a and MAO-b
- MAOa deactivates 5-HT and NE, and DA and tyramine
- MAOb deactivates phenethylamine, and DA and tyramine
33
MAOI Drug Names:
Drug Names: Phenelzine, Tranylcypromine, Isocarboxazid
34
Side Effects:
orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction
- numbness or paresthesias in B6 deficiency
- rare liver toxicity, edema, seizures
MAOi side effects in addition to hypertensive crisis and serotonin syndrome
35
Antipsycotic class:
- Higher doses
- Higher anti-(a1)adrenergic/cholinergic/histaminic side effects
- Lower EPS and NLMS
- QTc prolongation, potential for heartblock and v-tach causing lethality in overdose
- Rare agranulocytosis
- Increased seizure risk
Low-potency typical antipsychotics
36
Antipsychotic Drug:
- orthostatic hypotension
- blue-gray skin discoloration
- photosensitivity
- deposits in lens and cornea
- also used to treat nausea, vomiting, hiccups
Chlorpromazine (Low potency typical)
37
Antipsychotic Drug:
| - associated with retinitis pigmentosa
Thioridazine (Low potency typical)
38
Antipsychotic Drug:
- higher risk for seizures
- metabolite is antidepressant
Loxapine (Mid-potency typical)
39
Antipsychotic Drug:
| - ocular pigment changes
Thiothixene (Mid-potency typical)
40
Midpotency Antipsychotic Drugs (4):
Loxapine
Thiothixene
Molindone
Perphenazine
41
Antipsychotic Class:
- Lower Doses
- less anti-cholinergic/(a1)adrenergic/histaminic effects
- more risk for EPS and TD
High-potency typical antispychotics
42
Antipsychotic Drug:
- can be given PO/IM/IV
- depot form available
Haloperidol (High-potency typical)
43
Antipsychotic Drug:
| - Depot form available
Fluphenazine (High potency typical)
44
Antipsychotic Drug:
| - used also for nonpsychotic anxiety
Trifluoperazine (High potency typical)
45
Antipsychotic Drug:
| - QTc prolongation and v-tach
Pimozide (High-potency typical)
46
Mesolimbic dopamine pathways is responsible for
Positive symptoms of schizophrenia
47
Mesolimbic pathway (4 parts)
nucleus accumbens
fornix
amygdala
hippocampus
48
Mesocortical pathway is responsible for
Negative symptoms of schizophrenia (decreased DA action)
49
EPS occurs due to:
blockade of DA pathways in nigrostriatal pathway
50
Treatment for NLMS:
- discontinue medications
- supportive care including cooling, hydration, etc
- dantrolene, bromocriptine, amantadine may be used
- MAY restart antipsychotic carefully in future, but higher risk of recurrent episode
51
Antipsychotic drug class:
- less likely to cause EPS, TD, NLMS
- may be more effective in tx of negative symptoms
- also used to tx acute mania, bipolar disorder, as adjuctive meds in depression, borderline personality, PTSD, tic disorders of childhood
- risk for metabolic syndrome
Atypical antipsychotics
52
Antipsychotic Drug:
- more efficacious in treatment-refractory schizophrenia
- tachycardia and hypersalivaton
- more anticholinergic than atypical or high potency typical
- Rare myocarditis, agranulocytosis
- 4% seizure incidence
- decrease suicide risk
Clozapine (atypical)
53
Antipsychotic Drug:
- hyperprolactinemai
- orthostatic hypotension and reflex tachycardia
- depot form
Risperidone (atypical antipsychotic)
54
Antipsychotic Drug:
- much less likely to cause EPS
- sedation and orthostatic hypotension
Quetiapine (atypical antipsychotic)
55
Antipsychotic Drug:
| - weight gain and sedation
Olanzapine (atypical antipsychotic)
56
Antipsychotic Drug:
- less likely to cause weight gain
- QTc prolongation
- take with food (reduced absorption w/o)
Ziprazidone (atypical antipsychotic)
57
Antipsychotic Drug:
- partial D2 agonism
- more activating (akathisia), less sedating
- less weight gain
Aripiprazole (atypical antipsychotic)
58
Antipsychotic Drug:
- metabolite of risperidone
- depot form available
Paliperidone (atypical antipsychotic)
59
Antipsychotic Drug:
| - Orally disolving tablet
Arsenapine
60
Antipsychotic Drug:
- take with food
- use for bipolar depression
Lurasidone
61
Drug Side Effect:
| - Weight gain, hyperlipidemia (triglycerides mostly), hyperglycemia, rare DKA
Metabolic syndrome, seen primarily with atypical antipsychotics
62
Mood Stabilizer Uses (5):
- treating acute mania and preventing relapse in BD
- augment antidepressants
- potentiate antipsychotics in schizoprenia/schizoaffective disorder
- treatment of aggression/impulsivity
- enhance abstinence in alcoholism
63
Mood Stabilizer Drug:
- Used for acute mania/prophylaxis, cyclothymic disorder, unipolar depression
- Metabolized by kidney
- Takes 5-7 days for onset
- Blood levels correlate with clinical efficacy
- Narrow therapeutic index 0.6-1.2
- inhibits synthesis of T3/4 and release from thyroid
- benign leukocytosis
Lithium
64
Drug Side Effect:
| - altered mental status, coarse tremors, convulsions, delirium, coma, death
Toxic Lithium Levels
65
Mood Stabilizer Drug:
- tremor
- nephrogenic DI
- GI disturbance
- Wt. gain
- Sedation
- Thyroid enlargement/hypothyroidism
- ECG changes
- Leukocytosis
Lithium
66
Ebstein anomaly
Lithium
67
Mood Stabilizer Drug:
- Used for mania with mixed features, rapid cycling BD, less effective for depression
- Takes 5-7 days for onset
- GI and CNS side effects (drowsiness, ataxia, sedation, confusion)
- LFT elevation, hepatitis
- Drug interactions with CYP450 drugs (induces)
- Teratogenic (NTD)
- leukopenia, aplastic anemia, thrombocytopenia, agranulocytosis
- hyponatremia
- SJS
Carbamezapine
- blocks sodium channels and inhibits action potentials
68
Drug Side Effects:
| - confusion, stupor, motor restlessness, ataxia, tremor, nystagmus, twitching, vomiting
Carbamezapine toxicity
69
Mood Stabilizer Drug:
- used for acute mania, mixed features, rapid cycling
- therapeutic range 50-150
- teratogenic (NTD)
- monitor LFT and CBC
Valproic acid
- blocks sodium channels
- increases GABA concentrations in the brain
70
Mood Stabilizer Drug:
- used for bipolar depression, not useful for mania
- dizziness, sedation, headache, ataxia
- SJS, decreased by slowly tapering
- concurrent use of valproate results in increased levels of drug, decreases valproate levels
Lamotrigine
71
Mood Stabilizer Drug:
- as effective as carbamezapine but beter toleratied
- lower SJS risk
- lower hepatotoxicity
- monitor for hyponatremia
Oxcarbazepine
72
Mood Stabilizer Drug:
- used to help with anxiety, sleep, neuropathic pain
- not effective in bipolar disorder
Gabapentin
73
Mood Stabilizer Drug:
- used in GAD, fibromyalgia
- not effective in bipolar disorder
Pregabalin
74
Mood Stabilizer Drug: (2)
- helpful with impulse control disorders
- weight loss
- hypochloremic metabolic acidosis
- kidney stones
- cognitive slowing
Tiagabine
| Topiramate
75
BDZ:
- rapid onset
- alcohol or sedative hypnotic detox
- seizure termination
- muscle spasm termination
- sometimes used for anxiety
- long-acting
Diazepam
76
BDZ:
- anxiety and panic attacks
- avoid with renal dysfunction
- 1-2x daily dosing (long-acting)
Clonazepam
77
BDZ:
- tx of anxiety, and panic attacks
- intermediate action
- short onset of action, euphoria with abuse potential
Alprazolam
78
BDZ:
- panic attacks, alcohol and sedative hypnotic detox, agitation
- intermediate action
- not metabolized by liver
Lorazepam
79
BDZ:
- alcohol and sedative hypnotic detox
- intermediate action
- not metabolized by liver
Oxazepam
80
BDZ:
- insomnia, though decreasing due to dependence risk
- not metabolized by liver
- inermediate actinv
Temazepam
81
BDZ:
- insomnia
- anterograde amnesia, sleep related activities
- short acting
Triazolam
82
BDZ
- VERY SHORT half-life
- medical and surgical settings
Midazolam
83
Zolpidem/Zaleplon/Eszopiclone
- Mechanism
- Half-lives
- AE
- bind to omega1 receptor on GABA-A receptor
| - Zaleplon
84
Ramelteon
| - mechanism
selective MT1 and MT2 agonist
85
Non-BDZ Anxiolytic:
- partial 5HT1a receptor agonist
- not as effective as other option
- does not potentiate alcohol or BDZ
Buspirone
86
Non-BDZ Anxiolytic:
- antihistamine
- dry mouth, sedation, constipation, urinary retention, blurry vision
- fast acting, useful in people who cannot take BDZ
Hydroxyzine
87
Non-BDZ Anxiolytic:
- useful for autonomic effects of panic attacks or social phobia, palpitations sweating, tachycardia
- useful for akathisia
Propranolol
88
Psychostimulant:
- Schedule II due to high abuse potential
- monitor BP, weight loss
- can cause insomnia, exacerbation of tics, decreased seizure threshold
Dextroamphetamine and amphetamines
89
Psychostimulant:
- Schedule II
- Leukopenia or anemia
- Watch BP and CBC
- Weight loss, insomnia, exacerbation of tics, decreased seizure threshold
Methylphenidate
90
Psychostimulant:
- Inhibits presynaptic NE reuptake, resulting in increased synaptic NE and DA
- not controlled
- less appetite suppression and insomnia
- lower abuse potential, but less effective
- rare liver toxicity
- possible incr. SI in children
Atomoxetine
91
Psychostimulant:
| - used in narcolepsy
Modafinil
92
Cognitive Enhancer:
- acetylcholinesterase inhibitor
- once daily
- GI side effects
- mild to moderate NCD
Donepezil
93
Cognitive Enhancer:
- acetylcholinesterase inhibitor
- twice daily
- GI side effects
- mild to moderate NCD
Galantamine
94
Cognitive Enhancer:
- acetylcholinesterase inhibitor
- twice daily, patch form with fewer side effects
- mild to moderate NCD
Rivastigmine
95
Cognitive Enhancer:
- NMDA receptor antagonist
- fewer side effects
- use with cholinesterase inhibitor
- more severe NCD
Memantine
96
Drug: _______
| - Nonstimulant norepinephrine reuptake inhibitor used to treat ______
Atomoxetine
| Childhood and Adult ADHD
97
Stimulants help ___% of patients with ADHD
70
98
DDAVP Side effects:
Headache
| Nausea
99
Treatment for DT and reasoning
Oxazepam or lorazepam
| - not reliant on liver function for metabolism
100
Drug Side Effects:
- polyuria
- polydipsia
- tremor
- mental confusion
Lithium
101
Phenelzine is a __
MAOi (MAO A and B) irreversible inhibitor
102
MAO A and B irreversible inhibitors
phenelzine, tranylcypromine, isocarboxazid
103
MAO B inhibitor
selegiline, but nonselective at high doses
104
Cyproheptadine
5-HT2A antagonist sometimes used in severe cases of serotonin syndrome
105
Contraindicated with MAOi's (8)
```
meperidine
stimulant
decongestants
amine precrsors
l-dopa and l-tryptophan
antihypertensives
methyldopa
guanethidine
reserpine
```
106
use for atypical depression
MAOi's
107
tremor, nausea, diarrhea, ataxia
then seizures
then acute renal failure
then coma and death
lithium toxicity
108
akathisia treatment
propranolol, then benzodiazepine as second line
109
```
order the bdz's according to strength:
alprazolam
chlordiazepoxide
clonazepam
deiazepam
oxazepam
```
```
clonazepam
alprazolam
diazepam
oxazepam
chlordiazepoxide
```
110
test to doe before starting divalproex
lft's due to rare hepatotoxicity, sometimes ammonia can increase
111
nsaids safe to use with lithium
aspirin
| sulindac
112
atypical antipsychotics- 8
```
clozapine
risperidone
quetiapine
ziprasidone
aripiprazole
paliperadone
arsenapine
lurasidone
```
113
low potency antipsychotics- 2
chlorpromazine
| thioridazine
114
high potency- 4
haloperidol
fluphenazine
trifluoperazine
pimozide
