Reverse Pharm Psych Flashcards
1
Q
Mood elevation Decr. anxiety Sedation Behavioral disinhibition respiratory depression
A
Non spec depressant intox
2
Q
anxiety
tremor
seizures
insomnia
A
non spec depressant with
3
Q
Alcohol
Opioids
Barbituates
Benzodiazepines
A
depressants
4
Q
Emotional lability, slurred speech ataxia coma blackouts
Lab values?
A
alcohol intox
Serum Gamma glutamyltransferase (sensitive indicator)
AST value is twice ALT
5
Q
Mild: Similar to other depressants
Severe: autonomic hyperactivity
DTs
Treatment?
A
Alcohol withdraw
Treatment: Benzos
6
Q
Euphoria, respiratory and CNS depression Decr. gag reflex pupillary constriction seizures (overdose)
Treatment:
A
Opiod intox
Naloxone, naltrexone
7
Q
Sweating Dilated pupils Piloerection Fever Rhinorrhea Yawning Nausea Stomach cramps Diarrhea
Treatment:
A
Opiod with.
Long term support, methadone, buprenorphine
8
Q
Low safety margin
Marked resp. depression
Treatment:
A
Barbituate intox
Symptom management
9
Q
Delirium
Life threatening CV collapse
A
Barbituate withdraw.
10
Q
Greater safety margin
Ataxia
Minor resp. depression
Treatment:
A
Benzo intox
Flumenazil (benzo receptor antagonist, but can precipitate seizures)
11
Q
Sleep disturbance
depression
Rebound anxiety
Seizure
A
Benzo withdrawal
12
Q
Mood elevation psychomotor agitation INsomnia Arrythmias tachycardia Anxiety
A
stim intox NS
13
Q
“Post use crash”–>
depression
lethargy
weight gain
headache
A
Stim with. NS
14
Q
Amphetamines
Cocaine
Caffeine
Nicotine
A
Stimulants
15
Q
Euphoria Grandiosity Pupillary dilation prolonged wakefulness and attention hypertension tachycardia anorexia paranoia fever
severe: cardiac arrest, seizure
A
Amphet intox
16
Q
Anhedonia
Incr. appetite
hypersomnolence
existential crisis
A
Amphet with
17
Q
Impaired judgment pupillary dilation hallucinations (including tactile) paranoid ideation angina sudden cardiac death
Treatment?
A
Cocaine intox
Alpha blockers, benzos
Never beta blockers
18
Q
Hypersomnolence
Malaise
severe psych craving
depression/suicidality
A
Cocaine withdraw
19
Q
restlessness
Incr. diuresis
muscle twitching
A
Caffeine intox
20
Q
Lack of concentration
Headache
A
caffeine withdraw
21
Q
Restlessness
A
nicotine intox
22
Q
Irritability
Anxiety
Craving
Treatment?
A
Nicotine withdraw
Nicotine patch
gum
lozenges
bupropion/verenicline
23
Q
PCP
LSD
Marijuana
A
Hallucinogens
24
Q
belligerence impulsivity fever psychomotor agitation analgesia vertical and horizontal nystagmus tachycardia homicidality psychosis delirium seizures
Treatment:
A
PCP intox
Benzos, rapid acting antipsychotic
25
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Depression
Anxiety
Irritability
Restlessness
Anergia
Disturbances of thought and sleep
```
PCP Withdrawal
26
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Perceptual distortion (visual, auditory)
Depersonalization
Anxiety
Paranoia
Psychosis
Possible flashbacks
```
LSD Intox
27
No withdrawal symptoms
LSD withdrawal
28
```
Euphoria
Anxiety
paranoid delusions
perception of slowed time
impaired judgment
social withdrawal
incr. appetite
dry mouth
conjuctival injection
hallucinations
```
Mari INtox
29
```
Irritability
Depression
Insomnia
Nausea
anorexia
```
Mari withdraw
30
Long acting oral opiate used for heroin detox or long term maintenance
methadone
31
Antagonist (1) and partial agonist.
| 1) is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential
naloxone (1) and buprenorphine
32
Long acting opioid antag.
Relapse prevention after detox
naltrexone
33
Stimulatants (methylphenidate)
Long acting benzos (chlordiazepoxide, lorazepam, diazepam)
Lithium, valproid acid, atypical antipsychotics
SSRIs
SSRIs
SSRIs, SNRIs
SSRIs, clomipramine
SSRIs, venlafaxine, benzos
SSRIs, venlafaxine
Atypicals
SSRIs, beta blockers
Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine
ADHD: Stimulatants (methylphenidate)
Alcohol Withdrawal: Long acting benzos (chlordiazepoxide, lorazepam, diazepam)
bipolar disorder: Lithium, valproid acid, atypical antipsychotics
Bulimia: SSRIs
Depression: SSRIs
GAD: SSRIs, SNRIs
OCD: SSRIs, clomipramine
Panic disorder: SSRIs, venlafaxine, benzos
PTSD: SSRIs, venlafaxine
Schizophrenia: Atypicals
Social Phobias: SSRIs, beta blockers
tourette syndrome: Antipsychotics (fluphenazine, pimozide), tetrabenazine, clonidine
34
What are the mechanism of methylphenidate, dextroamphetamine, and methamphetamine? Drug class? clinical use?
CNS Stimulants
Incr. catecholamines in the synaptic cleft, especially NE and DA
ADHD, Narcolepsy, appetite control
35
What type of drug are haloperidol (1), trifluoperazine (2), fluphenazine (3), thioridazine (4), and chlorpromazine (5)?
What type are 4 and 5? Kinds of Side effects? What type are 1, 2, and 3? Kinds of Side effects? Side effects of 5? Side effects of 4? Side effects of 1? Mechanism? Clinical use? Toxicity? Mechanisms of toxicity?
Antipsychotics (neuroleptics) (5)
High potency: Trifluoperazine, fluphenazine, haloperidol (Try to Fly High); Neuro side effects (huntington, delirium, EPS symptoms)
Low Potency: Chlorpromazine, Thioridazine (Cheating Thieves are Low); Non neuro side effects (antichol, antihist, alpha 1 blockade)
5: Corneal deposits
4: Retinal deposits
1: NMS, tardive dyskinesia
Schizophrenia (positive symptoms)
Psychosis
Acute mania
Tourette syndrome
Highly lipid soluble, slow to be excreted
EPS side effects
Endocrine side effects (less dopamine leads to more prolactin leading to galactorhea)
Block musc (dry mouth, constipation), alpha 1 (hypotension), histamine (sedation) receptors
QT prolongation
36
What is the evolution of EPS side effects with antipsychotics? Treatment?
4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day: akathisia (restlessness)
4 week: bradykinesia (parkinsonism)
4 months: tardive dyskinesia
Benztropine or diphenhydramine
37
What are the symptoms in NMS? Treatment? What is tardive dyskinesia?
FEVER
```
Fever
Encephalopathy
Vitals Unstable
Enzymes incr. (myoglobinuria)
Rigidity of muscles
```
Dantrolene, D2 agonists (bromocriptene)
Stereotypical oral-facial movements due to long term psychotic use
38
What type of drugs are olanzapine (1), clozapine (2), quetiapine (3), risperidone (4), aripiprazole (5), ziprasidone (6)? Mechanism? Clinical use? Toxicity? Side effect of 1/2? Side effect of 2? Side effect of 4?
Atypical antipsychotics
It's atypical for old closets to quietly risper from A to Z
Mechanism not entirely understood. Varied effects on 5-HT2, DA, and alpha and H1 receptors
```
Schizophrenia (pos and neg symptoms)
Bipolar Disorder
OCD
Anxiety disorder
depression
mania
Tourettes
```
Fewer EPS Sx and Antichol Sx than traditional antipsychotics.
QT prolongation
1/2: Significant weight gain
2: Agranulocytosis and seizure
4: Incr. prolactin (lactation and gynecomastia) decr. GnRH leading to irregular menstruation and fertility issues?
39
What is the mechanism of lithium? Clinical uses? Toxicity?
Not established; related to inhibition of phosphoinositol cascade
LMNOP
```
Lithium Sx
Movement (tremor)
Nephrogenic Diabetes Insipidus
hypOthyroidism
Pregnancy problems (Ebstein anamoly)
```
Narrow therapeutic window; close monitoring of serum levels.
Excreted in kidneys
Most reabsorbed in PCT with Na
Thiazide use implicated in lithium toxicity
40
Mechanism of buspirone? Clinical use? Timeline? Why is it favorable?
Stimulates 5-HT1A receptors
GAD
No sedation, addiction, or tolerance.
1-2 weeks
Does not interact with alcohol
41
What is the mechanism of fluoxetine, paroxetine, sertraline, and citalopram? Timeline? Clinical use? Toxicity?
SSRIs (4)
5-HT specific reuptake inhibitors
Depression, GAD, Panic disorder, OCD, bulimia, social phobias, PTSD
4-8 weeks to take effect
```
Fewer than TCAs.
GI distress
SIADH
Sexual dysfuntion
Serotonin syndrome
```
42
When does serotonin syndrome occur? Symptoms? Treatment?
Any drug that incr. 5-HT (SSRIs, MAOIs, TCAs, SNRIs)
```
Hyperthermia
confusion
Myoclonus
CV instability
Flushing
Diarrhea
Seizures
```
Cyproheptadine (5-HT2 receptor antag)
43
What type of drugs are Venlafaxine (1) and Duloxetine (2)? Mechanism? Clinical use of both? Of just 1? Of just 2? Most common Toxicity? Others?
SNRIs
Inhibit 5-HT and NE reuptake
Depression
1=GAD, panic disorder, PTSD
2=Diabetic peri Neuro
Incr BP most common
Stimulant effects
Sedation
Nausea
44
What type of drugs are amitriptyline (1), nortriptyline (2), imipramine, desipramine, clomipramine (3), doxepin, and amoxapine? Mechanism? Clinical use? of just 3? Toxicity? How do 1 and 2 differ in toxicity? Treatment of toxicities?
TCAs
Block reuptake of NE and 5-HT
Major Depression, OCD (3), peripheral neuro, chronic pain, migraine prophylaxis
```
Sedation
alpha 1 blocking (post hypotension)
Antichol (tachycardia, urinary retention, dry mouth)=1 more than 2
QT prolongation
Convulsions
Coma
Cardiotoxicity (arrhythmias)
Resp. Depressin
Hyperpyrexia
Confusion and hallucinations in elderly
```
To prevent arrhythmia, used NaHCO3
45
What is the drug class of Tranylcypromine, phenelzine, isocarboxazid, selegiline (1)? Mechanism? Mechanism of just 1? Clinical use? Toxicity? Contraindications? Why?
MAOIs
Non selective MAO inhibition leads to incr. levels of NE, 5-Ht, DA
1=MAO-B selective inhibitor
Atypical depression
Anxiety
```
Hypertensive crisis (with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS stim
```
CI with SSRIs, TCAs, St jOhns wort, meperidine, dextromethorphan (to prevent serotonin syndrome)
46
What are the atypical antidepressants?
Bupropion
Mirtazapine
Trazodone
47
What is the clinical use of bupropion? Mechanism? Toxicity?
Depression
Smoking cessation
Incr. NE and DA via unknown mechanism
Stimulant effects (tachy, insomnia)
headache
Seizures in anorexic/bulimic
No sexual Sx
48
What is the mechanism of Mirtazapine? Toxicity?
alpha 2 antagonist (decr. inhibition of release of NE and 5-HT).
Potent 5-HT2 and 3 receptor antagonist
Sedation (desirable insomnia)
Incr. appetite
Weight gain (desirable in elderly or anorexic)
Dry mouth
49
What is the mechanism of Trazodone? clinical use? Toxicity?
Blocks 5-HT2 and Alpha 1 receptors
Used mainly for insomnia (high doses needed to be antidepressant)
Sedation, nausea, priapism, post. hypotension
