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Intro to Psychiatry > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

What type of drug is fluoxetine? What are its pearls?

A

SSRI. Has a long half-life, has an active metabolite (norfluoxetine). Relatively more drug-drug interactions

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2
Q

What type of drug is paroxetine? What are its pearls?

A

SSRI. Is the most anticholinergic of the SSRIs, relatively more drug-drug interactions

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3
Q

What type of drug is sertraline? What are its pearls?

A

SSRI. Less potent, but well tolerated with few drug-drug interactions

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4
Q

What type of drug is fluvoxamine? What are its pearls?

A

SSRI. Notorious for many drug/drug interactions, so it is rarely used in elderly.

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5
Q

What type of drug is citalopram? What are its pearls?

A

SSRI. Well tolerated. Few drug interactions. Some concern about QT prolongation

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6
Q

What type of drug is escitalopram? What are its pearls?

A

Is the S enantiomer of the racemic mixture citalopram. Fewer side effects.

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7
Q

Which SSRI has the most drug-drug interactions?

A

Fluvoxamine

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8
Q

Which SSRIs are the most well-tolerated due to few drug-drug interactions?

A

Sertraline and escitalopram (or citalopram)

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9
Q

What are the 6 main SSRIs?

A

Fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

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10
Q

What is the mechanism of bupropion?

A

It is an NDRI (norepinephrine and dopamine reuptake inhibitor). Commonly used as an add-on to SSRIs. Also, is a smoking cessation agent

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11
Q

Why should bupropion not be used in psychosis patients?

A

Because of its dopamine reuptake blocking activity, it may worsen psychosis symptoms

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12
Q

What are the 3 SNRIs to know?

A

Venlafaxine, desvenlafaxine, duloxetine

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13
Q

What can venlafaxine cause in some patients?

A

Hypertension

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14
Q

What kind of drug is duloxetine and what is it approved for other than depression?

A

Is an SNRI, also approved for treatment of neuropathic pain in diabetes

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15
Q

What kind of drug is mirtazapine?

A

Is a ‘NASA’ norepinephrine and serotonin antidepressant . stimulates appetite

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16
Q

What are 5 TCA drugs?

A

Desipramine, nortriptyline, amitriptyline, imipramine, clomipramine

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17
Q

What is the mechanism of action of TCA drugs?

A

Dual agents that block both serotonin and norepinephrine reuptake.

18
Q

What is the major downside of TCAs?

A

Need to be continually monitored because it can cause cardiac arrhythmias. Much more likely to cause death in a fatal overdose due to torsades de pointes (elongation of QT interval)

19
Q

What are the 3 monoamine oxidase inhibitors?

A

Phenelzine, tranylcypromine, and selegiline.

20
Q

What is the mechanism of action of MAOIs?

A

Inhibit the enzyme responsible for breaking down monoamines (serotonin, dopamine, norepinephrine)

21
Q

What causes hypertensive crisis in patients with MAOIs?

A

Too much dietary tyramine (from aged cheeses and wine)

22
Q

Why does HTN crisis result in patients on MAOIs?

A

Too much dietary tyramine displaces norepinephrine in the synapse which causes increase in pulse and blood pressure. The NE is in the synapse and is not broken down by MAOs.

23
Q

What other antidepressant can be prescribed with MAOIs?

A

NONE. Never mix MAOIs with other antidepressants. Otherwise can cause high levels of serotonin and serotonin syndrome

24
Q 
In patients with schizophrenia, what is the dopamine concentration for:
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular
A 
Mesolimbic = Elevated
Mesocortical = Reduced
Nigrostriatal = Normal
Tuberoinfundibular = Normal
25
Q

What causes hyperprolactinemia in patients on antipsychotics?

A

Reduction in dopamine in the tuberoinfundibular pathway which causes release of prolactin

26
Q

What are two common typical antipsychotics?

A

Haloperidol and fluphenazine

27
Q

What type of antipsychotics can be given as a depot injection?

A

The typicals, haloperidol and fluphenazine

28
Q

What is the mechanism difference between typical antipsychotics and atypicals?

A

Both block D2 receptors, but atypicals also block serotonin receptors. Atypicals cause fewer neuromuscular side effects

29
Q

What are the 7 atypical antipsychotics?

A
  1. Risperidone
  2. Olanzapine
  3. Clozapine
  4. Quetiapine
  5. Ziprasidone
  6. Aripiprazole
  7. Paliperidone (active metabolite of risperidone)
30
Q

What 2 atypical antipsychotics are associated with the most weight gain?

A

Olanzapine and clozapine (quetiapine also has weight gain)

31
Q

What atypical antipsychotic is associated with the most extrapyramidal symptoms?

A

Risperidone

32
Q

What atypical antipsychotic is a weight neutral antipsychotic?

A

Ziprasidone (Geodon) as well as aripiprazole (Abilify)

33
Q

What atypical antipsychotic can cause agranulocytosis rarely?

A

Clozapine

34
Q

Which atypical antipsychotic is a partial dopamine receptor agonist?

A

Aripiprazole

35
Q

What are the 4 common side effects of typical antipsychotics that are less common in atypicals?

A
  1. Extrapyramidal symptoms
  2. Tardive dyskinesia
  3. Neuroleptic malignant syndrome
  4. Acute dystonic reaction
36
Q

What are extrapyramidal symptoms and how are they treated?

A

Temporary slowness of movement, tremor, mild muscle rigidity. Treated by daily administration of anticholinergic medicine (like benadryl or cogentin; diphenhydramine or benztropine)

37
Q

What is tardive dyskinesia and how is it treated?

A

A sometimes permanent writhing movement often in mouth or tongue, but sometimes extremities and trunk) induced by long-term exposure to antipsychotics. Treated by switching to atypical antipsychotic. Anticholinergic medicines will not help

38
Q

What is neuroleptic malignant syndrome, what is measured to assess for it, and how is it treated?

A

It is a catastrophic all over muscle rigidity. Measure creatinine kinase in the blood, due to the muscles breaking down. Can cause death by the muscle breakdown releasing proteins that cause renal failure. Treated by removing the antipsychotic, flush with IV fluids, and give muscle relaxants.

39
Q

What is acute dystonic reaction and how is it treated?

A

One muscle group suddenly contracts that is painful. Treated with a single IM injection of an anticholinergic such as benadryl or cogentin

40
Q

What are the 3 findings of metabolic syndrome of atypical antipsychotics?

A
  1. elevated serum glucose
  2. elevated serum triglycerides
  3. elevated body weight

Intro to Psychiatry (9 decks)

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