Pysch drugs Flashcards
Depressants
Alcohol, Opiods (morphine, heroin, methadone), Barbiturates, BZDs
Mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression - intoxication
Nonspecific: anxiety, tremor, seizures, insomnia - withdrawal
Alcohol
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
Opiods
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
Barbiturates
Marked resp depression. low safety margin
Tx: symptom management, assist resp and increase BP
Withdrawal: delirium, CV collapse (life threatening)
Benzodiazepines
Greater safety margin. Ataxia, minor resp depression.
Tx: Flumazenil (BZD antagonist); can precipitate seizures
Withdrawal: sleep disturbance, depression, rebound anxiety
Stimulants
Amphetamines, Cocaine, Caffeine, Nicotine
Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhythmia, tachycardia, anxiety
Withdrawal: post use crash, depression, lethargy, weight gain, headache
amphetamines
Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever; Severe: cardiact arrest, seizure
Withdrawal: Anhedonia, increased appetite, hypersomnolence, existential crisis
Cocaine
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
Caffeine
Restlessness, increased diuresis, muscle twitching
Withdrawal: lack of concentration, headache
Nicotine
Restlessness
Withdrawal: irritability, anxiety, craving
Tx: nicotine patch, gum; bupropion
Hallucinogens
PCP, LSD, Marijuana (cannabinoid)
PCP
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
LSD
Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, flashbacks
Marijuana
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
Heroin addiction
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
Alcoholism
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
Wernice-Korsakoff syndrome
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
Mallory Weiss Syndrome
Partial thickness tear at GE junction by excessive vomiting. Hematemesis and misdiagnosed as ruptured esophageal varices
Delirium Tremens
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
Alcoholic hallucinations
Visual hallucinations 12-48 hours after last drink. different from DTs
Tx: long acting BZD: chlordiazepoxide, lorazepam, diazepam
Meds for pysch condition
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
Methyphenidate, Methemphetamine
increase catecholamines in synaptic cleft, especially NE and dopamine
Antipsychotics (neuroleptics)
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
Neuroleptic malignant syndrome
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia: Fever, Encephalopathy, Vital unstable, Enzymes increase (myoglobinuria), rigidity of muscles
Tx: Dantrolene, D2 agonists (Bromocriptine)
Tardive Dyskinesia
Stereotypical oral faicla movement as result of long term antipsychotic use
Atypical antipsychotics
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!!!!***
Lithium
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
Buspirone
Stimulates 5Ht1A receptors
GAD. does not cause sedation, addiction or tolerance. 1-2 weeks for effect. Does not interact with alcohol (v. barbiturates, BZD)
SSRIs
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)
SNRIs
Venlafaxine, duloxetine
Inhibit 5HT and NE reuptake
Use: Depression. Venlafaxine: GAD, panic disorder, PTSD
Duloxetine: diabetic peripheral neuropathy
Toxicity: increased BP; sedation, nausea
TCAs
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
MAO inhibitors
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
Atypical antidepressants
Bupropion, Mirtazapine, Trazodone
Bupropion
Also for smoking cessation, increase NE and dopamine
Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures anorexic/bulimic patients. No sexual side effects
Mirtazapine
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
Trazodone
Blocks 5HT2 and alpha1 adrenergic receptors
Used mainly for insomnia. High dose usage as anti-depressant
Toxicity: sedation, nausea PRIAPISM, postural hypotension
