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78 Cards in this Set
- Front
- Back
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High potency antipsychotics |
Haloperidol fluephenazine triluoperazine thithixene |
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mid potency antipsychotics |
perphenazine molindone |
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low potency antipsychotics |
chlorpromazine Thioridazine |
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doxepine |
TCA- tertiary- most anticholinergic |
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imipramine |
TCA- tertiary-oldest, used for bed wetting |
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trimipramine |
TCA-tertiary |
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Amitriptilline |
TCA-tertiary |
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Clomipraine |
TCA-tertiary not an SSRI, but has SSRI action |
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nortriptilline |
TCA-secondary least anticholinergic (least orthostatic hypotension) has a therapeutic dose window |
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desipramine |
least anticholinergic, causes least orthostatic hypotension |
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protriptilline |
TCA-secondary amine |
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amoxapine |
TCA-tetracyclic |
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most reliable TCA blood levels |
NIDnortriptilline, imipramine, doxepine |
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phenelzine |
MAOI Side effects
-Both block efficiently and kill off MAOs. Cause hypertensive crisis and cannot be mixed with tyramine which is in rich food
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Tranylcyproamine |
MAOI Side effects
-Both block efficiently and kill off MAOs. Cause hypertensive crisis and cannot be mixed with tyramine which is in rich food |
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Fluvoamine |
SSRI blocks phase 1 of most drugs clozapine + fluvoamine = seizures |
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paroxetine |
SSRI most M1 and H1 effects. causes sedation and weight gain, overdose is miserable but not life threatening |
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steraline |
SSRI side effects include GI problems |
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citaloprim |
SSRI |
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S-citalopram |
SSRI no weight gain, no drug interactions |
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fluoxetine |
SSRI 70h half life start with small doses |
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Venlafaxine |
SNRI short half-life, side effects are hypertension (13% of patients get high blood pressure) sexual side effects and less weight gain than other drugs |
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Duloxentine |
SNRI sexual side effects and less weight gain than other drugs |
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Bupropion |
Atypical antidepressant Works through increased dopamine transmission
good at treating substance abuse, ADHD
can cause psychosis, increased seizure risk in people with eating disorders
no weight gain, no sexual side effects
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Trazadone |
atypical antidepressant (not really used as antidepressant) |
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mirtazapine |
atypical antidepressant o.3%get agranulocytosis Don’t prescribe to those who take clozapine, people who have a bone marrow problem, people who are on anti-cancer medication
Side effects: Weight gain, no sexual side effect.
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Treatment of bipolar |
Litium and valproic acid
Add lamotrigine and GABApentin
Carbamazepine has major drug interactions
Almost all block sodium channel (decrease AP firing rate), initiae or activate GABA-R and block glutamate
Never treat with antidepressant alone
Mood stabilizers include aripiprazole, quetiapine
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triazolam |
Short acting benzo
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oxazepam |
Short acting benzo
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temazepam |
Short acting benzo
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alprazolam |
Short acting benzo
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lorazepam |
Short acting benzo
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estazolam |
Short acting benzo
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diazepam |
long acting benzo |
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clonazepam |
long acting benzo |
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chlordiazepoxide |
long acting benzo used in detox |
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benzos that don't need phase 1 of metabolism |
LOT lorazepam triazolam - too hypnotic |
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TCAs |
Block reuptake of monoamines
One of the oldest classes, VERY EFFICIENT
Low therapeutic index – therapeutic dose is close to the toxic dose
Side effects can lead to cardiac arrhythmia and death on overdose
M1 blockers – ST change, QT prolong, constipation, dry mouth, urinary retention, glaucoma, seizure, cognitive impairment
Alpha1 blockers – orthostatic hypotension
H1 – sedation, weight gain. Because of this action they should only be taken at night
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Risperidone |
High potency 2nd generation antipsychotic |
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Aripiprazole |
High potency 2nd generation antipsychotic acts on D2, 5HT2 partial D1 agonist no weight gain or hyperprolactinemia
causes akathesia |
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ziprasidone |
mid potency 2nd generation antipsychotic 5HT1A agonist, not very efficient low risk of metabolic side effects |
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olanzapine |
mid potency 2nd generation antipsychotic approved mood stabilizer very high risk of metabolic syndrome including weight gain |
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clozapine |
low potency 2nd generation antipsychotic
used for refractory schizophrenia very dirty
first discovered 2nd generation
side effects are any side effect found in a 2nd generation antipsychotic BUT ALSO 1% of people who use it get agranulocytosis
hypersalivation |
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quetiapine |
low potency 2nd generation antipsychotic works on 5HT2 and D2 less anticholinergic side effects include hypothyroidism, liver enzy effects, ataracts maybe
used as a mood stabilizer |
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What % of hallucinations are auditory |
90 |
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how do amphetamines enhance the actions of dopamine |
1) block reuptake of dopamine by DAT1
2) facilitates release of dopamine from presynaptic vesicles
3) inhibits dopamine breakdown by MAOs
Only people with ADH don’t get high with amphetamines
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major nucleus of pleasure |
Nucleus Accumbens |
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Schizophrenia genetic percentages |
• In the general population = 1%
• With a sibling with schizophrenia = 8%
• With one parent with schizophrenia = 12%
• With two parents with schizophrenia = 40%
• With a monozygotic twin with schizophrenia = 50%
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Potential imaging patterns in schizophrenic patients |
• Ventricular enlargement due to cortical atrophy
• Low blood flow to prefrontal cortex
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schizophreniform timing |
– prior to six month mark without official diagnosis |
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Schizoaffective disorder |
blend of schizophrenia, psychotic, and mood disorder. Between bipolar and schizophrenia. what makes it different from a psychotic depression or a psychotic mania, is the fact that these patients are also sick for at least 2 weeks: psychotic without mood symptom. Rarer than schizophrenia
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Delusional disorder |
starts later in life and leas to less dysfunction
-characterized by non-bizarre delusion for at least a month - nonprominent hallucination congruent with delusion
- no general impairment beyond delusion
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The worst QT effect |
Thioridazine a low potency first generation antipsychotic |
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anticholinergic side effects |
Dry mouth
Urinary retention
Constipation
altered mental status
slight increase in temperature
change ST and QT segments on EKG. Torsade de pointes
Can decrease threshold for seizure
Bethanechol is an agonist of the muscarinic receptor |
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acetylcholine esterase inhibitors |
physostigmine, edrophonium, donepezil, tacrine, organophosphates
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side effects of 1st generation antipsychotics |
tardive dyskinesia acute dystonia - laryngospasms EPS hyperprolactinemia NMS |
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when treating an unknown individual in an emergency what generation of antipsychotic should be given? |
When treating an unknown individual use high potency 1st generation antipsychotic . If the patient gets acute dystonia give them an anticholinergic. The risk of tardive dyskinesia is less important than the heart risks from 2nd generation |
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What percent of schizophrenic patients kill themselves |
10 |
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what percent of schizophrenics respond to treatment, what do the other 30% have some response to |
70; clozapine |
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Cyclothymic disorder |
cycling of both mood elevation and mood depression that doesn’t meet the criteria of either Bipolar I or Bipolar II, it’s less of a chronic up-and-down. Has to go on for 2 years |
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prevalence of unipolar vs bipolar disorders |
5, 1 % |
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Suicide risk in unipolar vs bipoar disorders |
15, 20% |
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chance of reoccurence of depressive episodes give one, two and three prior episodes |
A. With one episode the chance of reoccurrence is 50-60%
B. With second episode chance of reoccurrence is 70%
C. With third episode chance of reoccurrence is 90%
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on what percent of patients do antidepressants work upon |
69% |
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What % of depressed patients respond to ECT? |
85% |
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what % of rape and torture survivors develop PTSD |
50, 90 |
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Which is the most common psychiatric disorder in the US? what percent of the population has it a a given time |
15-20% |
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What is the most frequent anxiety disorder |
specific phobia |
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how to benzodiazepines work |
They potentiate glutamate receptors to make more IPSPs |
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serotonin synthesis pathway |
tryptophan, tryptohan hydroxylase 5HTP, 5HTP decarbozylase 5-HT (serotonin), MAO 5HIAA, inactive |
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Antidepressants are used for |
Depression, anxiety, Irritable Bowel Syndrome (IBS), eating disorders, fibromyalgia, bipolar disorder (in conjunction with something else), somatoform disorders (we will study them), pain disorder |
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what percent of alzheimers appears to follow autosomal dominant |
10 |
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What percent of people with dementia have alzheimers, what is the age of onset |
50-70%, 60-65 years |
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Pick's disease |
frontotemporal dementia, social disinhibition |
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Vascular dementia can be caused by |
coronary artery disease |
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Korsakoff's Syndrome |
Ataxia, opthalmoplegia, confusion |
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EPS with IV haldol |
no EPS with IV haldol |
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what percent of patients with delirium have unknown cause |
40 |
