Psychopharmacology Flashcards
effects of psychoactive drugs
agonists –> produces effect similar to neurotrans
—direct agonist: mimics the effect of neurotrans
–indirect agonist: attach to receptor site to facilitate action of the neurotrans
inverse agonists –> produces opposite effect of neurotrans
partial agonists –> produces similar but lesser effect
antagonists –> reduce or block effects of neurotrans
–direct antagonist: attach to receptor site to block
–indirect antagonist: attach to site and interfere with action of neurotrans
Traditional/conventional vs atypical/novel antipsychotics
traditional = effective for + Sx, less effective for -
used for: schizophrenia, acute mania, delusions/hallucinations from MDD, organic psychoses
atypical= effective for both + and - Sx
used for: schizophrenia, Clozapine used for bipolar not responding to mood stabilizer, depression and suicidality, addiction, hostility, motor Sx of Huntington’s and Parkinson’s
side effects of traditional antipsychotics
1) extrapyramidal effects: due to effects on dopamine receptors in caudate nucleus
e.g., tardive dyskinesia (late-occuring, more in females and older patients)
TD can be relieved by discontinuing drug, adding a benzo or other GABA agonist.
Haloperidol = most severe side effects
2) anticholinergic effects: “dry” Sx, tachycardia
3) neuroleptic malignant syndrome (NMS): rapid onset of motor, mental and autonomic Sx
conventional/typical antipsychotics
holperidol (Haldol)
thiothixene (Narvane)
fluphenazine (Prolixin)
chlorpromazine (Thorazine)
atypical antipsychotics
clozapine (Clozaril)
resperidone (Risperdal)
olanzapine (Zyprexa)
quetiapine (Seroquel)
traditional antipsychotics exert effects by ______
blocking dopamine receptors (at D2 receptors)
atypical/novel antipsychotics exert effects by _____
blocking D4 dopamine receptors AND receptors for serotonin and glutamate
side effects of atypical antipsychotics
anticholinergic effects lowered seizure threshold sedation less common extrapyramidal side effects (except for akathisia) agranulocytosis neuroleptic malignant syndrome (NMS)
Tricyclic antidepressants
amitriptyline (Elavil, Endep) nortriptyline (Pamelor) doxepin (Sinequan, Adapin) imipramine (Trofanil) clomipramine (Anafranil)
TCAs most effective for ______
depression with vegetative, somatic Sx Panic Disorder Agoraphobia Bulimia OCD (esp chlomipramine) enuresis (imipramine) neuropathic pain (amitriptyline, nortriptyline)
mode of action of TCAs
block reuptake of norepi, serotonin, and/or dopamine
catecholamine hypothesis
depression caused by deficiency of norepinephrine
side effects of TCAs
***CARDIOTOXIC*** anticholinergic effects confusion drowsiness fatigue weight gain fine tremor paresthesia blood dyscrasia
SSRIs
fluoxetine (Prozac)
fluvoxamine (Faverin, Luvox)
paroxetine (Paxil)
setraline (Zoloft)
SSRIs most effective for _____
melancholic depressions OCD Bulimia Panic Disorder PTSD
Side effects of SSRIs
GI disturbance insomnia anxiety headache sissiness anorexia tremor frequent urination sexual dysfunction
advantages of SSRIs over TCIs
less cardiotoxic
safer in overdose
cognitive impairment less likely
serotonin syndrome
neurological effects (headache, nystagmus, tremor, dizziness, unsteady gait)
cardiac arrhythmia
coma/death
MAOIs
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
MAOIs best for treating _____
atypical depressions involving anxiety, reversed vegetative Sx, interpersonal sensitivity
MAOIs side effects
hypertensive crisis -- when taken with tyramine foods anticholinergic effects insomnia agitation confusion skin rash weight gain edema headache dizziness tremor blood dycrasia
tyramine-rich foods
aged cheeses and meats, beer, red wine, chicken liver, avocados, bananas, lava beans, soy sauce
Sx of hypertensive crisis
severe headache stiff neck rapid heart rate nausea/vomiting sweating sensitivity to light
NDRIs (norepi dopamine reuptake inhibitor)
buproprion (Wellbutrin)
used for MDD, depressive phase of BP
used under name Zyban for smoking cessation
can aggregate preexisting psychosis and seizures
SNRIs (serotonin norepi reuptake inhibitor)
venlafaxine (Effexor)
duloxetine (Cymbalta)
used of MDD, GAD, social anxiety, OCD
some pain syndromes (fibromyalgia, mixed headaches, back pain, peripheral nueropathic pain)
Modd stabilizers
lithium
carbamazepine
lithium best for ____
“classic” BP with manic episodes with elevated mood and without rapid cycling
reduces or eliminates manic symptoms and suppresses mood swings
lithium toxicity
diarrhea ataxia drowsiness slurred speech confusion coarse tremor can result in seizures, coma and death must regulate serum lithium levels in blood
if taking lithium, must avoid ____
fluctuations in salt intake caffeine alcohol other diuretics contraindicated for: cardiovascular, thyroid, kidney, liver and GI problems
Carbamazepine (Tegretol)
was anticonvulsant drug
also effective for mania
“rapid cycling” BP + dysphoric mania
also valproic acid (Depakote) and clonazepam (Klonopin)
side effects of carbamazepine
dizziness ataxia visual disturbances anorexia nausea rash bad for cardio conduction patients slight risk for agranulocytosis and aplastic anemia
sedative-hypnotics include _____
barbiturates
anxiolytics
alcohol
withdrawal Sx of sedative-hypnotics
tremors anxiety nausea/vomiting paranoia extreme cases: hallucinations, delirium, convulsive seizures
barbiturates exert effect by ____
interrupting impulses to the RAS
benzodiazepines
diazepam (Valium) alprazolam (Xanax) oxapam (Serax) triazolam (Halcion) chlordiazepoxide (Librium) lorazepam (Ativan)
benzodiazepines work by ____
stimulating inhibitory action of GABA
side effects of benzodiazepines
drowsiness dizziness lethargy slurred speech ataxia impaired psychomotor ability ---------- irritability, hostility, paradoxical agitation, increased disorientation, sleep disturbance (reduced REM), ante grade amnesia, depression
azapirone (buspirone)
first anxiolytic without sedation
need to take for several weeks before effective
Beta-Blockers used for ____
high blood pressure angina/cardiovascular disorders tremors migraines glaucoma reducing palpitations, tremor and excessive sweating from anxiety
beta-blockers work by _____
blocking beta-andrenergic receptors (which respond to epinephrine and norepinephrine)
Propranolol (Inderal)
side effects of propranolol
bradycardia shortness of breath arterial insufficiency (like Raynaud's) nausea diarrhea depression dizziness sexual dysfunction trouble sleeping numbness/tingling in fingers/toes
propranolol is potentially lethal for people with ____
respiratory issues
obstructive pulmonary disease
narcotics-analgesics (opiods)
natural opiods (opium, morphine, codeine) semi-synthetics of morphine (heroin, Percodan, Dilaudid) pure synthetics (Demerol, Darvon, methadone)
narcotics-analgesics (opiods) work by ____
opiod receptors in the spinal cord and amygdala, thalamus and hypothalamus
enkephalins are ____
beta-endorphins
signs of narcotic use are:
constricted pupils decreased visual acuity increased perspiration constipation nausea/vomiting respiratory depression
narcotics overdose:
slow/shallow breathing muscle rigidity catalepsy clammy skin decreased blood pressure and pulse rate convulsions coma/death
narcotics/opiod withdrawal symptoms
flu-like Sx stomach cramps nausea/vomiting weakness fever muscle and joint pain sweating insomnia
psychostimulants
amphetamines (dexamphetamine sulphate) - for narcolepsy and ADHD
methylphenidate (Ritalin, Concerta, Metadate) for ADHD
psychostimulants work by ___
potentiating the release of norephinephrine and dopamine and block their reuptake
side effects of amphetamines
restlessness insomnia poor appetite tremor palpitations cardia arrhythmia
side effects of methyphenidate
decreased appetite insomnia dysphoria abdominal pain tachycardia
anti-alcohol drugs
disulfiram (Antabuse) – inhibits alcohol metabolism, causing accumulation of acetaldehyde and unpleasant reactions (nausea, vomiting, seating, headache, tachycardia, hypotension)
naltrexone (ReVia, Vivitrol) – opiod receptor antagonist - blocks craving for alcohol
side effects of disulfam (Antabuse)
drowsiness depression disorientation headache restlessness impotence blood dyscrasia
side effects of naltrexone
abdominal cramping nausea/vomiting insomnia nervousness headache joint and muscle pain
