Eppp Psychopharmacology

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2 types of antipsychotic drugs

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1. Traditional (conventional)

2. Atypical (novel)

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Ex: traditional antipsychotics

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Haloperidol (Haldol)

Molinidine (Moban)

Thioridazine (Mellaril)

Trifluoperazine (Stelazine)

Fluphenazine (Prolixin)

Thiothixene (Navane)

Chlorpromazine (Thorazine)

Help Many Male Schizophrenic Patients (on these) Not to Tremble

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Use: traditional antipsychotics

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+ve sx of schizophrenia
acute mania

NOT -ve sx of schizophrenia

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Action: traditional antipsychotics

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blocks dopamine (D2) receptors, therefore dec dopamine

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Side effects: traditional antipsychotics

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1. tardive dyskinesia (esp w/ Haloperidol)
- can add benzo or other GABA agonist to treat

2. neuroleptic malignant syndrome (NMS)
rapid autonomic sx
potentially fatal
stop meds immediately

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Ex: Atypical antipsychotics

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Aripiprazole (Abilify)

Ziprasidone (Geodon)

olanzapine (Zyprexa)

quetiapine (Seroquel)
resperidone (Risperdal)

clozapine (Clozaril)

All Good Zoos Save Rare Cats

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Use: Atypical antipsychotics

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schizophrenia
bipolar
alc & drugs
huntington's
parkinson's

note: helpful for +ve & -ve sx of schizophrenia, but SLOWER ONSET

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Mode: Atypical antipsychotics

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block D2, serotonin & glutamate

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side effects: Atypical antipsychotics

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agranulocytosis (blood disorder)

Diabetes

Weight Gain

NOT tardive dyskinesia

To remember: Rare cats eat too much sugar, get fat & get diabetes: have to monitor blood

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advantage of atypical vs traditional neuroleptics?

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no tartive dyskinesia
helps +ve & -ve sx schiz

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advantage of traditional vs atypical neuroleptics?

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faster acting
no close blood monitoring

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Ex: anticholinergic side effects

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dry mouth
blurred vision
tachycardia
constipation
urinary retention
sedation

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Ex: extrapyramidal side effects

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tardive dyskinesia
akathisia
muscle spasms
parkinsonsim

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Types of antidepressants

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TCAs

SSRIs

MAOIs

Newer antidepressants

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Ex: TCAs

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amitriptyline (Elavil)
Desipramine (norpramin)
imipramine (Tofranil)

Nortriptyline (Pamelor and Aventyl)

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Mode: TCAs

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block reuptake of norepinephrine, serotonin and/or dopamine, therfore increasing these

supporting catecholomine hypothesis

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Side effects: TCAs

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cardiovascular sx
anticholinergic effects

Neurobehavioural

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when not to prescribe a TCA

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high risk for suicide

heart disease

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Ex: SSRIs

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fluoxetine (prozac)
fluvoxamine (luvox)
paroxetine (paxil)
sertraline (zoloft)
citalpram (celexa)

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Mode: SSRIs

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blocks reuptake of serotonin, therefore increases it

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Use: SSRIs

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melancholic depression
etc.

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advantages of SSRIs over TCAs

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less cardiotoxic
safer in overdose
less cognitive impairment
more rapid onset

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Ex: MAOIs

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isocarboxazid
phenelzine
tranylcypromine

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Use: MAOIs

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atypical depression
- anxiety, hypersomnia

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Mode: MAOIs

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inhibits enzyme monoamine oxidase, therefore deactivates dopamine, norepinephrine & serotonin

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Side effects: MAOIs

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hypertensive crisis - when taken w/ barbiturates, amphetamines, antihistamines or food w/ TYRAMINE

Drug-Drug Interactions

Drug-Food Interactions

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Ex: newer antidepressants

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bupropion (wellbutrin)
venlafaxine (effexor)
nefazodone (serxone)
trazodone (desyrel)

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Types of mood stabilizing drugs

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Lithium

Carbamazepine

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Side effects: Lithium

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toxicity

- serum levels monitored

Must avoid fluctuations in salt intake, caffeine, alcohol

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when would you use Carbamazepine instead of Lithium in tx of bipolar disorder

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rapid cyclers
dysphoric mood
kidney, liver, thyroid or gastrointestinal probs

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Types of sedative-hypnotics

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barbiturates

benzodiazepines

Azapirone

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Ex: barbiturates

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... barbital !!

Barbital the Barbarian

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Mode: barbiturates

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interrupt impulses to RAS

Barbitol the Barbarian Ruined the RAShons

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Ex: benzos

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... lam
... pam

Alprazolam (Xanax)

Diazepam (Valium)

Lorazepam (Ativan)

Clonazepam (Klonapin)

Pam & Lam had Xtreme Views At Kiliminjaro

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Mode: benzos

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Enhances GABA (inhibitory NT) & blocks stress hormones associated wtih anxiety & panic

To remember: Pam took so much Valium, Xanex & Ativan that she couldn't GAB at Kiliminjaro & wasn't scared of the Xtreme Views

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Use: Beta blockers

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high BP
angine
migraines
glaucoma

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Types: psychostimulants

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amphetamines

methylphenidate (ritalin)

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Use: psychostimulants

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narcolepsy
ADHD

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Mode: psychostimulants

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inc norepinephrine & serotonin

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Side effects: amphetamines

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tolerance
dependence
sensitization

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side effects: Methylphenidate

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dysphoria
growth suppression (therefore need drug holidays)

contraindicated for family hx tourette's

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Ex: narcotic-analygesics (opioids)

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NATURAL OPIODS
opium
morphine
codeine

SEMI-SYNTHETIC DERIVATIVES OF MORPHINE
heroin
percodan
dilaudid

PURE SYNTHETICS
demerol
darvon
methadone

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Ex. Nonbenzo anxiolytic

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Buspirone (Buspar)

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Side Effects of Benzos

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Drowsiness, Confusion, Dizziness, Imbalance, Dependence, No drinking

To remember: Benzo the clown found sobriety so tiresome & confusing that he was dependent on his cane, or he would get dizzy & lose balance

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What class of neurotransmitters do Antidepressants target?

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Monoamines (NE, Serotonin & DA)