Week 10: Psychotherapeutics Flashcards

1
Q

Schizophrenia: General pathophysiology (2)

A
  1. Excessive DA receptor activation
  2. Insufficient glutamate receptor activation
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2
Q

Compare and contrast first-generation (conventional) antipsychotics to second-generation (atypical) antipsychotics (4)

A

Both are equally effective
- 1st gen are cheaper than 2nd gen
- 1st gen causes extrapyramidal symptoms (ex. tremors)
- 2nd gen causes metabolic effects and carries risk for CV events + premature death

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3
Q

Extrapyramidal side effects (EPS): 4 types and treatments

A

4 types: Pseudoparkinsonism, acute dystonia, akathisia, and tardive dystonia
Only the first three can be treated with drugs

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4
Q

Neuroleptic malignant syndrome: Symptoms (8) and treatments (2)

A

Symptoms:
- Rigidity
- Sudden high fever
- Sweating
- ANS instability
- BP changes
- Dysrhythmias
- Seizures
- Loss of consciousness
- Coma
Treatment: Supportive measures and withdrawal of antipsychotic med

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5
Q

Main differences between neuroleptic malignant syndrome and serotonin syndrome

A

Cause:
- NMS: Antipsychotic medications
- SS: Drugs that inc. 5-HT

Symptoms:
- NMS: Rigidity, dec. bowel activity, normal pupils
- SS: Tremor/hyperreflexia, hyperactive bowel activity, dilated pupils

Onset and duration:
- NMS: Gradual onset, long duration
- SS: Rapid onset, short duration

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6
Q

Haloperidol: Class, indications, MOA, AE (10)

A

Class: High potency first-generation antipsychotic
Indications: Schizophrenia
MOA: Block dopamine receptors in mesolimbic area of the brain
- May also block ACh, histamine, NE
AE:
- EPS
- Neuroleptic malignant syndrome
- Anticholinergic effects
- Orthostatic hypoTN
- Neuroendocrine effects
- Seizures
- Sexual dysfunction
- Agranulocytosis
- Severe dysrhythmias
- Dermatologic effects

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7
Q

Haloperidol: What’s unique? (3)

A
  • Generally preferred for initial therapy
  • EPS symptoms present earlier
  • Lower frequency of all other AEs
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8
Q

Chlorpromazine: Class, indications, MOA, AE (10)

A

Class: Low potency first-generation antipsychotic
Indications: Schizophrenia
MOA: Block dopamine receptors in mesolimbic area of the brain
- May also block ACh, histamine, NE
AE:
- EPS
- Neuroleptic malignant syndrome
- Anticholinergic effects
- Orthostatic hypoTN
- Neuroendocrine effects
- Seizures
- Sexual dysfunction
- Agranulocytosis
- Severe dysrhythmias
- Dermatologic effects

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9
Q

Second Generation Antipsychotics: Indications, MOA, AE (8)

A

Indications: Schizophrenia
MOA: Blockade of DA, 5-HT receptors
- Also can block a1, histamine, and muscarinic receptors
AE:
- EPS
- Metabolic effects (DM, weight gain, hyperlipidemia)
- Agranulocytosis
- Seizures
- Myocarditis
- Orthostatic hypoTN
- Higher risk mortality w/ dementia
- Avoid drugs that suppress bone marrow

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10
Q

Second-generation antipsychotics: What’s unique? (2)

A
  • Lower EPS but higher metabolic effects
  • Very expensive
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11
Q

Depression: General pathophysiology

A

Deficiency of NE, 5-HT, or both

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12
Q

Fluoxetine: Class, indications, MOA, AE (8), drug interactions (9)

A

Class: SSRI
Indications: Depression and/or anxiety
MOA: Blocks reuptake of 5-HT = inc. serotonin available
AE:
- Nausea
- Agitation/insomnia
- Sexual dysfunction
- Weight gain
- Dec. platelet aggregation
- Serotonin syndrome risk
- Withdrawal syndrome with abrupt discontinuation
- In late pregnancy: Withdrawal and pulmonary HTN in newborn
Drug interactions:
- Inc. risk of serotonin syndrome: MAOIs, SNRIs, TCAs, analgesics, triptan antimigraine drugs
- Tramadol
- Linezolid (antibiotic that inhibits MAO)
- Inc. bleeding risk: Antiplatelets and Anticoagulants

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13
Q

Venlafaxine: Class, indications, MOA, AE (8), drug interactions (9)

A

Class: SNRI
Indications: Depression and anxiety
MOA: Blocks reuptake of 5-HT and NE = inc. serotonin and NE available
AE:
- Nausea
- Agitation/insomnia
- Sexual dysfunction
- Weight gain
- Dec. platelet aggregation
- Serotonin syndrome risk
- Withdrawal syndrome with abrupt discontinuation
- In late pregnancy: Withdrawal and pulmonary HTN in newborn
Drug interactions:
- Inc. risk of serotonin syndrome: MAOIs, SSRIs, TCAs, analgesics, triptan antimigraine drugs
- Tramadol
- Linezolid (antibiotic that inhibits MAO)
- Inc. bleeding risk: Antiplatelets and Anticoagulants

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14
Q

SNRIs vs SSRIs

A
  • SSRIs are safer
  • SNRIs have more AEs, especially dose-related HTN
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15
Q

Amitriptyline: Class, indications, MOA, AE (6), drug interactions (4)

A

Class: TCA
Indications: Depression, anxiety, and BPD
MOA: Block the reuptake of 5-HT, NE, and acetylcholine = inc. serotonin, NE, and acetylcholine available
- Not very selective, can also impact other receptors
AE:
- Orthostatic hypoTN
- Anticholinergic effects
- Sedation
- Cardiac toxicity
- Seizure risk
- Toxicity = dysrhythmias, heart block
Drug interactions:
- MAOIs = severe HTN risk
- Direct acting sympathomimetics = HTN/tachycardia risk
- Indirect acting sympathomimetics = dec. responsiveness
- CNS depressants = additive effect

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16
Q

MAOIs, nonselective: Indications, MOA, AE (2), drug interactions (6)

A

Indications: Depression and anxiety
MOA: Inhibition of MAO
- Inc. of available NE, 5-HT, DA
AE:
- CNS stimulation
- Orthostatic hypoTN
Drug interactions:
- Indirect acting sympathomimetics = HTN
crisis
- MAO inhibition = increased epi, NE, DA. Intensified/prolonged effects!
- TCAs = HTN crisis
- Serotonergic drugs = serotonin syndrome risk
- Antihypertensives = hypotension
- Meperidine = hyperpyrexia risk

17
Q

MAOIs, MAO-B selective: Indications, MOA, AE (2)

A

Indications: Depression and anxiety
MOA: Inhibition of MAO-B
- Inc. of available DA
AE:
- CNS stimulation
- Orthostatic hypoTN

18
Q

MAOIs: What’s unique?

A

All drugs in current use are IRREVERSIBLE, effects persist 2 weeks

19
Q

Buproprion: Class, indications, MOA, AE (6)

A

Class: Atypical antidepressants
Indications: Depression and anxiety
MOA: Unclear, may be due to DA/NE reuptake block
AE:
- Agitation
- Tremor
- Insomnia
- Seizures in high doses
- Weight loss
- GI upset, constipation

20
Q

Bipolar disorder: General pathophysiology

A

Disruption of neuronal growth

21
Q

Bipolar disorder: General considerations for treatment (3)

A

Acute mania = Mood stabilizer +/- SGA. May also require benzo
Acute depression = Mood stabilizer +/- SGA +/- antidepressant (never antidepressant alone)
Long-term preventative treatment = 1+ mood stabilizer

22
Q

Lithium: Class, indications, MOA, AE (9), drug interactions (4), PK (2)

A

Class: Mood stabilizer
Indications: BPD
MOA: Unknown, may be alteration of glutamate uptake/release, 5-HT antagonism, and/or glycogen synthase kinase03 beta inhibition
AE:
- N/V
- Diarrhea
- Thirst, polyuria
- Lethargy
- Slurred speech
- Fine hand tremor
- Renal toxicity
- Hypothyroidism + goiter
- Teratogenesis
Drug interactions:
- Diuretics
- NSAIDS inc. lithium plasma levels
- Anticholinergics
- ACE inhibitors
PK:
- Short half-life, must be administered multiple times per day
- Caution in renal disease

23
Q

Lithium: Therapeutic index

A

Very low therapeutic index - must monitor drug levels

Toxicity/overdose = No antidote, supportive treatment, may consider hemodialysis

24
Q

Valproate // Carbamazepine: Class, indications, MOA

A

Class: Antiepileptic drugs
Indications: BPD
MOA: Neurotrophic and neuroprotective effects

25
Benzodiazepines: Indications, MOA, AE (5)
Indications: Insomnia MOA: GABA potentiation AE: - CNS depression - Anterograde amnesia - Can have paradoxical effects - Teratogenic - PO dosing: Minimal respiratory depression, minimal CV effects
26
Zolpidem: Class, indications, MOA, AE (2)
Class: Benzodiazepine-like drugs Indications: Insomnia MOA: Acts as agonist at GABA receptor AE: - Similar to benzos - Little to no respiratory depression at therapeutic doses
27
Ramelteon: Class, indications, MOA, AE
Class: Melatonin agonist Indications: Insomnia MOA: Melatonin agonist AE: Nothing notable
28
Suvorexant: Class, indications, MOA, AE (5)
Class: Orexin antagonist Indications: Insomnia MOA: Antagonizes orexin AE: - Somnolence, dizziness - HA - Dry mouth - Cough - Physical dependence
29
Barbituates: Indications, MOA, AE (5)
Indications: Insomnia MOA: Agonize GABA receptors directly AE: - Respiratory depression - Sedation - Minimal CV effects at hypnotic doses - CYP450 induction - Physical dependence
30
Buspirone: Indications, MOA, AE (3)
Indications: Anxiety MOA: Binds to 5-HT receptors, less so to DA receptors AE: Minimal - Dizziness - Nausea - Headache
31
Buspirone: What's unique?
As effective as benzos, but no abuse potential/CNS depressant interactions
32
Panic disorder: Definition and treatments (2)
Definition: Recurrent, intensely uncomfortable episodes Treatments: - Antidepressants (SSRIs, TCAs) - Benzodiazepines (2nd line)
33
OCD: Definition and treatments (3)
Definition: Persistent obsessions & compulsions that cause marked distress Treatments: - SSRIs - One TCA - Last resort: deep brain stimulation
34
Social anxiety disorder: Definition and treatments (3)
Definition: Intense, irrational fear of situations in which one might be scrutinized by others Treatments: - SSRIs (first line) - Benzodiazepines - Propranolol or other BB for performance anxiety
35
PTSD: Definition and treatments (3)
Definition: After a traumatic event that elicited reaction of fear, helplessness, or horror Treatments: - SSRIs/SNRIs (only paroxetine & sertraline are approved for this) - TCA/MAOI (2nd line) - Psychotherapy
36
ADHD: General pathophysiology (3)
- Structural and functional abnormalities in multiple areas of the brain - May involve dysregulation of NE, DA, 5-HT pathways - Genetic factors
37
Amphetamines: Indications, MOA, AE (6)
Indications: ADHD MOA: Causes release of NE and DA - Partially inhibits their reuptake AE: - CNS: Insomnia, restlessness, euphoria, talkativeness, appetite suppression - CV: Tachycardia, inc. contractility, vasoconstriction = dysrhythmias, HTN - Psychosis with excessive use
38
Methylxanthines: Indications, MOA, AE (9)
Indications: ADHD MOA: Reversible adenosine receptor block - Inc. SR Ca2+ permeability - cAMP accumulation AE: - CNS: Nervousness, insomnia, tremors - CV: Tachycardia, dysrhythmias, peripheral vasodilation, CNS vasoconstriction - Bronchodilation - Diuresis
39
Modafinil: Indications, MOA, AE (5)
Indications: ADHD MOA: Unclear, influences hypothalamic areas involved in maintaining areas involved in maintaining sleep/wake cycles AE: - Headache - Nervousness - Nausea - Diarrhea - Rare skin interactions