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