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Pharm > Pysch drugs > Flashcards

Pysch drugs Flashcards

1
Q

Depressants

A

Alcohol, Opiods (morphine, heroin, methadone), Barbiturates, BZDs
Mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression - intoxication

Nonspecific: anxiety, tremor, seizures, insomnia - withdrawal

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2
Q

Alcohol

A

emotional labilty, slurred speech, ataxia, coma, blackouts. Serum GGT. AST twice ALT value
Withdrawal: mild: anxiety, tremor, seizures, insomnia
Severe alcohol withdrawal: autonomic hyperactivity and DTs (delirium tremens). Tx: BZD

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3
Q

Opiods

A

Morphine, Methadone, heroin

Euphoria, resp and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose),
Tx: naoloxone, naltrexone

Withdrawal: Sweating, dilated pupils, piloerection (cold turkey), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea, flu like symptoms
Tx: long term support, methadone, buprenorphine

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4
Q

Barbiturates

A

Marked resp depression. low safety margin
Tx: symptom management, assist resp and increase BP

Withdrawal: delirium, CV collapse (life threatening)

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5
Q

Benzodiazepines

A

Greater safety margin. Ataxia, minor resp depression.
Tx: Flumazenil (BZD antagonist); can precipitate seizures

Withdrawal: sleep disturbance, depression, rebound anxiety

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6
Q

Stimulants

A

Amphetamines, Cocaine, Caffeine, Nicotine

Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhythmia, tachycardia, anxiety

Withdrawal: post use crash, depression, lethargy, weight gain, headache

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7
Q

amphetamines

A

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever; Severe: cardiact arrest, seizure

Withdrawal: Anhedonia, increased appetite, hypersomnolence, existential crisis

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8
Q

Cocaine

A

impaired judgment, pupillary dilation, hallucinations (also tactile), paranoid ideations, angina, sudden cardiac death
Tx: alpha blockers, BZS. NO beta blockers

Withdrawal: Hypersomnolence, malaise, severe psychological craving, depression/suicidality

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9
Q

Caffeine

A

Restlessness, increased diuresis, muscle twitching

Withdrawal: lack of concentration, headache

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10
Q

Nicotine

A

Restlessness
Withdrawal: irritability, anxiety, craving
Tx: nicotine patch, gum; bupropion

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11
Q

Hallucinogens

A

PCP, LSD, Marijuana (cannabinoid)

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12
Q

PCP

A

Belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tahcycardia, psychosis, delirium, seizures
Tx: BZD, rapid acting antipsychotic

Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

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13
Q

LSD

A

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, flashbacks

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14
Q

Marijuana

A

Euphoria, anziety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations.
Pharm form: dronabinol used as antiemetic and appetite stimulant in AIDs patients

Withdrawal: Irritability, depression, insomnia, nausea, anorexia
Peak in 48 hours and last for 5-7 days
Detectable in urine for 1 month

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15
Q

Heroin addiction

A

users at increased risk for hepatitis, HIV, abscesses, bacteremia, right heart endocarditis
Tx: Methadone - long acting oral opiate for heroin detox or long term maintenance
Naloxone + Buprenorphine: Antagonist + partial agonist. Naloxone not orally available so withdrawal only in injected - aka lower abuse potential

Naltrexone - long acting antagonist for relapse prevention

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16
Q

Alcoholism

A

Tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, HTN, malaise, nausea, DTs) when intake interrupted
Complications: Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

Treatment: Disulfirum (to abstain from alcohol use), naltrezone, supportive care.

Alcoholics Anonymous for sustaining abstinence and supporting patient and family

17
Q

Wernice-Korsakoff syndrome

A

Caused by Vitamin B1 defiency (thiamine)
Triad: confusion, ataxia, opthalmoplegia. can be irreversible memory loss, confabulation, personality change (korsakoff psychosis)
A/w periventricular hemorrhage/necrosis of mamillary bodies.

Tx: IV vitamin B1

18
Q

Mallory Weiss Syndrome

A

Partial thickness tear at GE junction by excessive vomiting. Hematemesis and misdiagnosed as ruptured esophageal varices

19
Q

Delirium Tremens

A

Life threatening alcohol syndrome peaks 2-4 days after last drink

Autonomic hyperactivity: tachycardia, tremors, anxiety, seizures)
Occurs in hospital (2-4 postsurgery) in alcoholics not able to drink

Tx: BZD

20
Q

Alcoholic hallucinations

A

Visual hallucinations 12-48 hours after last drink. different from DTs
Tx: long acting BZD: chlordiazepoxide, lorazepam, diazepam

21
Q

Meds for pysch condition

A

ADHD: stimulants - methylphenidate
Alcohol withdrawal: Long acting BZDs
Bipolar: Lithium, valproic acid, atypical antipsychotics
SSRIs: Bulimia, Depression, GAD, OCD (clomipramine), Panic, PTSD, Social phobias

Panic: SSRIs, venlaxafine, BZD
PTSD: SSRI, Venlafaxine
Schizophrenia: Atypical antipsychotics
Social: SSRIs, B blockers
Tourette: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine
22
Q

Methyphenidate, Methemphetamine

A

increase catecholamines in synaptic cleft, especially NE and dopamine

23
Q

Antipsychotics (neuroleptics)

A

Haloperidol, Fluphenazine, chlorpromazine, thioridazine

Block Dopamine D2 receptor (increase cAMP)

Use: Schizophrenia - positive symtoms, psychosis, acute mania, tourette syndrome

Toxicity: highly lipid soluble and stored in body fat; very slow to remove from body
1) Extrapyramidal side effects: dyskinesia, Tx: Benztropine (anticholinergic) or Diphenhydramine

2) Endocrine effects: Dopamine antagonism-> hyperprolactinoma -> galactorrhea
3) block of muscarinic (dry mouth, constipation), alpha1 receptor (hypotension), and histamine (sedation)

Other toxicities: NMS, Tardive dyskinesia

24
Q

Neuroleptic malignant syndrome

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia: Fever, Encephalopathy, Vital unstable, Enzymes increase (myoglobinuria), rigidity of muscles
Tx: Dantrolene, D2 agonists (Bromocriptine)

25
Q

Tardive Dyskinesia

A

Stereotypical oral faicla movement as result of long term antipsychotic use

26
Q

Atypical antipsychotics

A

Olanzapine, Clozapine, Quietapine, Risperidone, Arpiprazole, Ziprasidone

Effects of 5HT2, Dopamine, alpha and H1 receptors

Schizophrenia - both positive and negative symptoms. Also for Bipolar, OCD, anxiety, depression, mania, Tourette syndrome

Toxicity: Fewer extrapyramidal effects and anticholinergic effects
Olanzapine/clozapine - weight gain

Clozapine -agranulocytosis - WBC check

Risperidone - increase prolactin -> galactorrhea and gynecomastia
Decrease GnRH-> decreased FSH, LH -> amenorrhea

Prolong QT interval!!!!***

27
Q

Lithium

A

Mood stabilizer for biplarl disorer
Blocks relapse and acute manic events
Also, SIADH

Toxicity: Tremor, Hypothyroidism, Polyuria (nephrogenic DI), teratogenesis
Causes Ebstein anomaly in newborn; Excreted by kideys, most reabsorbed at PCT with Na. If Li toxicity in Bipolar patients: thiazide use implicated

Side effects: LMNOP: Movement (tremor), Nephrogenic DI, HypOthyroidism, Preggo problems

28
Q

Buspirone

A

Stimulates 5Ht1A receptors

GAD. does not cause sedation, addiction or tolerance. 1-2 weeks for effect. Does not interact with alcohol (v. barbiturates, BZD)

29
Q

SSRIs

A

Fluoxetine, paroxetine, sertraline, citalopram
5-HT specific reuptake inhibitors

use: Depression, GAD, panic, OCD, bulimia, social phobias, PTSD

Toxicity: Fewer TCSs. GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido)

Serotonin Syndrome: with drug that increases 5-HT (ex: MAO inhibitors, SNRIs, TCAs) - hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures
Tx: Cryoheptadine (5HT2 receptor antagonist)

30
Q

SNRIs

A

Venlafaxine, duloxetine

Inhibit 5HT and NE reuptake
Use: Depression. Venlafaxine: GAD, panic disorder, PTSD
Duloxetine: diabetic peripheral neuropathy

Toxicity: increased BP; sedation, nausea

31
Q

TCAs

A

Amitryptiline, nortryptiline, imipramine, desipramine, clomipramine, doxepin, amoxapine

Block NE and 5HT reuptake
Use: Major depression, OCD (Clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis

Toxicity: sedation, postural hypotension due to alpha 1 blocing, atropine like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth)
Tertiary TCAs (amitryptiline) - anticholinergic effects than  secondary TCA (nortryptiline)
Prolong QT interval

Tri C’s - convulsion, coma, cardiotoxicity (arrhythmias); resp depression, hyperpyrexia. Confusion and hallucinations - anticholinergic effects
Tx: NaHCO3 prevent arrhythmias

32
Q

MAO inhibitors

A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAOB inhibitor)

Non selective MAO inhibition -> increases amine neurotransmitters (NE, 5HT, dopamine)
use: atypical depression, anxiety
Toxicity: Hypertensive crisis esp wit Tyramine intake - wine and cheese; CNS stimulant CI with SSRIs, TCAs, St John’s wort, meperidine, Dextromethorphan to prevent Serotonin syndrome

33
Q

Atypical antidepressants

A

Bupropion, Mirtazapine, Trazodone

34
Q

Bupropion

A

Also for smoking cessation, increase NE and dopamine
Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures anorexic/bulimic patients. No sexual side effects

35
Q

Mirtazapine

A

Alpha2 antagonists (Increase NE and 5HT) and potent 5HT2 and 5HT3 antagonist.
Toxicity: Sedation - needed in depressed patient with insomnia
increase appetite, weight gain - desirable in elderly or anorexic patients, dry mouth

36
Q

Trazodone

A

Blocks 5HT2 and alpha1 adrenergic receptors
Used mainly for insomnia. High dose usage as anti-depressant
Toxicity: sedation, nausea PRIAPISM, postural hypotension

Pharm (11 decks)

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