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57 Cards in this Set

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  • Back
psychopharmacology include
1) antidepressants
2) anxiolytics
3) lithium
4) antipsychotics
treatment goal is
to be able to treat pts on an outpatient basis
3 classes of antidepressants
1) TCA
2) MAOI
3) SSRIs
older agent- 1st generation
Tricyclic antidepressants (TCA's)
1) Amitriptyline (Elavil, Endep)
2) Imipramine (Tofranil)
3) Desipramine (Norpramine)
4) Doxepin (Sinequan)
5) Clomipramine (Anafranil, also a SSRI)
6) Maprotiline (Ludiomil)
7) Nortriptyline (Aventyl, Pamelor)
8) Protriptyline (Vivactil)
older agent
Monoamine oxidase inhibitors (MAO-I's)
1) Phenelzine (Nardil)
2) Tranylcypromine (Parnate)
3) Clorgyline (specific for MAO type A, research only)
4) Isocarboxazid (Marplan)
second generation
not including SSRIs
1) Amoxapine (Asendin)
2) Bupropion (Wellbutrin)
3) Nefazodone (Serzone)
4) Trazodone (Desyrel)
5) Mirtazapine (Remeron)
Serotonin-specific reuptake inhibitors (SSRIs)
1) Fluoxetine (Prozac)
2) Clomipramine (Anafranil)
3) Sertraline (zoloft)
4) Venlafaxine (Effexor)
5) Paroxetine (Paxil)
6) Citalopram (Celexa)
7) Escitalopram (Lexapro)
Norepinephrine-specific reuptake inhibitors
1) Atomoxetine (Strattera) for ADHD
TCA's are thought to enhance the actions of?
biogenic amines by inhibiting reuptake
Imipramine (Tofranil)
1) prototype TCA
2) blocks norepinephrine reuptake
Clomipramine (Anafranil)
1) TCA
2) prominent actions on the serotonin system
3) for obsessive complusive disorder
Fluoxetine (Prozac)
1) SSRI
2) relatively selective in their effect
Venlafaxine (Effexor)
1) SSRI
2) #1 antidepressant
3) has actions at both serotonin and NE
4) 5 times greater selectivity for serotonin
Venlafaxine (Effexor) is linked to
overdose (>suicide)
Paroxetine (Paxil)
1) SSRI
2) 10:1 = serotonin:NE
most common SE of SSRI's
1) nausea
2) headeche
3) insomnia
4) nervousness
5) fatigue
6) sexal dysfunction
less common SE of SSRI's
1) inappropriate ADH secretion
2) rashes
3) extrapyrmidal effects
SE of TCA's
1) urinary retention
2) constipation
3) wt gain
4) sexal dysfunction
5) confusion/delirium
6) orthostatic hypotension
"anticholinergic"
SE of MAOI's
1) sleep disturbances
2) orthostatic hypotension
3) wt gain
4) sexal dysfunction
5) drug/food interactions
MAOI with serotonergic agents or narcotics (Merpiridine) can cause
serotonin syndrome
s/s of serotonin syndrome
1) hyperpyrexia
2) agitation
3) neuromuscular irritability
4) hypotension
5) coma
6) death
Venlafaxine (Effexor) SE
1) similar to SSRI
2) high dose = increase in DBP
Bupropion (Wellbutrin) SE
high dose = seizure
Trazodone (Desyrel) SE
1) priatism
TCA's + MAOI =
1) hypertensive crisis
2) tahcycardia
3) seizures
SSRI's + tryptophan =
1) agitation
2) restlessness
MAOI's + tyramine containing foods =
hypertensive crisis
mania is a syndrome that may include
1) sustained, abnormal clear mood elevation
2) extreme, unrealistic confidence
3) acceleration of psychomotor function
drug tx for mania
1) lithium
2) haloperidol
3) benzodiazepines
for pts not responding to litium
1) Valproic acid (Depakene, Depakote)
2) Carbamazepine (Tegretol)
lithium
1) taken up through Na channel
2) increases the reuptake of NE
3) inhibits the release of NE and serotonin
4) inhibits adenylate cyclase
5) increases GABA
6) decreases glutamate
7) alter the 2nd messenger system = decrease neuronal excitability
effective therapeutic level of lithium
1.0 mEq/l
toxic level
over 1.5 mEq/l
over 2mEq/l
1) hypotension
2) cardiac arrhythmias
3) seizures
schizophrenia
positive symptoms
1) conceptual disorganization
2) delusions
3) hallucinations
schizo
negative symptoms = 33%
asso. with poor long-term outcome
1) loss of function
2) anhedonia
3) decreased emotional expression
4) impaired concentration
5) diminished socialization
1) catatonic type
1) major change in motor activity
2) negativism
2) paranoid type
1) siginificant preoccupation with a specific delusional system
3) disorganized type
1) disorganized speech/behavior asso. with superficial or silly affect
4) residual type disease
negative symptomatology in the absence of
1) illusions
2) hallucinations
3) motor disturbance
schizo. 3 principal risk factors
1) genetic
2) early development damage
3) winter births
antipsychotic
phenothiazine compounds
1) aliphatic derivative
1) Chlorpromazine (Thorazine)
2) piperidine derivatives
1) Thioridazine (Mellaril)
3) Piperazine derivatives
1) Fluphenazine (Prolixin)
Thioxanthene compound
1) Thiothixene (Navane)
Butyrophenones
1) Haloperidol (Haldol)
antipsychotics
miscellaneous structures
1) Pimozide (Orap)
2) Molindone (Moban)
3) Clozapine (Clozaril)
4) Olanzapine (Zyprexa)
5) Quetiapine (Seroquel)
6) Risperidone (Risperdal)
7) Ioxapine (Loxitane)
8) Ziprasidone (Geodon)
phenothiazine prototype
Chlorpromazine (Thorazine)
Chlorpromazine blocks
1) dopamine - cnetral focus
2) alpha adrenergic receptor
3) serotonin (5-HT2)
antipsychotic induced endocrine change due to
blockade of dopamine-mediated tonic inhibiton of?
prolactin secretion
adverse effect of antipsychotic = extrapyramidal reactions
1) early in treatment
2) Parkinson's syndrome
3) akisthisia
4) acute dystonic reactions
5) tx = antimuscarinic (Benadryl)
extrapyramidal reactions
occurrence late in tx
1) Tardive dyskinesia = choreoathenoid move.
SE antipsychotics
ocular effects
1) Cholrpromazine = cornea and lens deposits
2) Thioridazine (Mellaril) = retinal deposits
malignant neuroleptic syndrome
1) life-threatening
2) initial symptom = muscle rigidity
3) fever
4) irregu. pulse, unstable BP
5) > creatinine kinase
6) TX = antiparkinson drug and muscle relaxants
Clozapine (Clozaril) cause
1) agranulocytosis
additive effects of antipsychotics
1) alpha adrenergic blockade
2) anticholinergic effects
3) quinidine-like effects (Thioridazine)
indications for antipsychotic drugs
1) schizo.
2) schizoaffective disorder
3) manic
4) Tourette's syndrome
5) senile dementia asso. wtih Alzheimer's
6) antiemetic
7) relief of puritis