Miscellaneous Psychiatric Medications (Blueprints)

Front 1

Anticholingergics are used in psychiatry mainly for what reason?

Back 1

Counteract neuroleptic induced movement disorders such as DYSTONIA

(Akathisia should be treated with propranolol)

(Parkinsonism should be treated with Levodopa or Amantadine)

Front 2

What anticholinergics are used most often? (3)

Back 2

Benztropine (Cogentin)
Trihexyphenidyl
Diphenhydramine

Front 3

Peripheral side effects of anticholinergics?

Back 3

Blurry vision (inability to accomodate)
Constipation
Urinary retention
Hyperthermia

Front 4

Central side effects of anticholinergics?

Back 4

DELIRIUM!!!

(especially in elderly)

Front 5

Beta blocker indications in psychiatry

Back 5

1) Peripheral manifestations during anxiety (performance/social)
2) Akathisia from neuroleptics

Front 6

Side effects of beta blockers

Back 6

Bradycardia
Hypotension
Asthma exacerbation
Masked hypogycemic symptoms

Front 7

What is the mechanism of Atomoxetine?

Back 7

Selective norepi reuptake inhibitor

(Different from SNRI which is Serotonin Norepi Reuptake Inhibitor)

Front 8

Main indication for atomoxetine?

Back 8

ADHD

"Focus down to the level of the atom"

Front 9

Clonidine mechanism?

Back 9

Central Alpha-2 receptor AGONIST

Front 10

What is the alpha-2 receptor?

Back 10

Presynaptic autoreceptor that inhibits the release of more CNS norepi when it is stimulated

Front 11

What is the main use of clonidine in medicine?

Back 11

Anti-HTN

Front 12

What are some uses of clonidine in psychiatry? (4)

Back 12

1) Decreasing ANS sx from opiate WD
2) Treating ADHD
3) Treating Tourette's
4) Impulsiveness

Front 13

S/E of clonidine?

Back 13

Sedation, dizziness, hypotension

Front 14

S/E of atomoxetine?

Back 14

Like other meds with monoamine reuptake as a primary mechanism of action, there is a risk of suicide in younger pts during initiation/tapering of therapy

Front 15

Indications of psychostimulants in psychiatry? (3)

Back 15

1) ADHD
2) Narcolepsy
3) Depression (certain forms)

Front 16

Common psychostimulants used? (4)

Back 16

Dextroamphetamine (Dexedrine)
Methylphenidate (Ritalin)
Amphetamine Mixture (Adderall)
Pemoline (Cylert)

Front 17

Mechanism of action of psychostimulants?

Back 17

Facilitate endogenous NT release rather than act as a direct agonist

Front 18

Problem with long term use of psychostimulants?

Back 18

Dependence and tolerance

Front 19

Side effects of psychostimulants?

Back 19

Tachycardia, insomnia, anxiety, HTN, diaphoresis

Front 20

Naltrexone mechanism of action?

Back 20

mu-opioid antagonist

Front 21

What are the benefits of naltrexone? (3)

Back 21

1) Prevent alcohol relapse
2) Reduce alcohol cravings
3) Reduce severity of relapse

Front 22

When is naltrexone started in terms of its use in alcohol?

Back 22

Once detox of alcohol has finished

Front 23

When should naltrexone be started if the pt is using opiates?

Back 23

1 week after last opiate exposure (can precipitate severe opiate WD if dependent upon them)

Front 24

What is Acamprosate used for?

Back 24

Treatment of alcohol dependence

Maintain abstinence in previous dependent subjects

Front 25

Mechanism of acamprosate?

Back 25

Modulator of glutamate function

Front 26

Benefits of Acampropsate (3)

Back 26

1) Reduce cravings
2) Maintain abstinence
3) Reduce relapse severity

(All 3 are similar to naltrexone)

Front 27

Disulfiram mechanism?

Back 27

Blocks the oxidation of acetaldehyde (causing a build up)

Front 28

Disulfiram indicated for?

Back 28

Prevent alcohol ingestion through fear of consequences

Front 29

What does a buildup of acetaldehyde do?

Back 29

Toxic reaction making the person ill in 5-10 minutes

Front 30

Symptoms of acetaldehyde buildup?

Back 30

Flushing, HA, sweating, dry mouth, N/V, dizzy

Front 31

Disulfiram should be restricted to those patients who...

Back 31

Are highly motivated and fully understand the consequences of drinking alcohol while using this medication

Front 32

Side effects of disulfiram (intrinsic)... (3)

Back 32

1) Hepatitis
2) Optic neuritis
3) Impotence

Front 33

Buprenorphine mechanism?

Back 33

Partial opioid agonist

Front 34

Buprenorphine indication?

Back 34

Opiate addiction therapy

Front 35

How is Buprenorphine different from Methadone?

Back 35

Methadone is a weak agonist, but still a full agonist

Buprenorphine is a partial agonist

Front 36

Various formulations of Buprenorphine?

Back 36

1) Subutex (oral)
2) Suboxone (Buprenorphine + Naloxone)
3) Buprenex (parenteral)

Front 37

Why is there a mixed tablet containing Buprenorphine and Naloxone?

Back 37

To prevent diversion of the tablets for recreational IV injection. If taken by mouth, the naloxone is poorly absorbed and the patient only gets the partial agonist effect of Buprenorphine

Front 38

What are the non-BDZ meds that treat insomnia? (3)

Back 38

1) Zolpidem (Ambien)
2) Zaleplon (Sonata)
3) Eszopiclone (Lunesta)

Front 39

How do the 3 ZZZ insomnia medications work?

Back 39

GABA receptor modulators

Front 40

Problems with the ZZZ meds?

Back 40

May have tolerance and depenence

Front 41

What are 3 other types of psychiatric meds that can be used for insomnia aside from the ZZZ meds?

Back 41

1) TCA
2) Trazodone
3) BDZ

Front 42

What is Ramelteon?

Back 42

Another new medication that helps with insomnia

Front 43

Mechanism of Ramelteon?

Back 43

Agonist of melatonin receptors in the suprachiasmatic nucleus

Front 44

What are some medications used to treat cognitive dysfunction associated with Alzheimer's disease? (4)

Back 44

1) Donepezil
2) Rivastigmine
3) Galantamine
4) Tacrine

"Done gallantly attacking rivals"

Front 45

How do the DRGT meds for Alzheimer's work?

Back 45

Reversible inhibitors of acetylcholinesterase

Front 46

Neurotransmitter pathology in Alzheimer's?

Back 46

Reduced cholinergic neurons in the basal forebrain that project to the cortex and hippocampus (decreased cholinergic neurotransmission)

Front 47

Common S/E of DRGT drugs?

Back 47

Cholinomimetics effects... bradycardia, increased gastric acid secretion...

Front 48

Tacrine is second line treatment compared to DRG because?

Back 48

Severe hepatoxocity

Front 49

Memantine is indicated for what?

Back 49

New class of cognitive enhancers for Alzheimer's. Approved for moderate to severe Alzheimer's

Front 50

Mechanism of Memantine?

Back 50

Antagonist at excitatory glutaminergic NMDA receptors

Front 51

Why does Memantine's mechanism of action work?

Back 51

Preventing NMDA receptor from activating may prevent glutamate excitotoxicity

Front 52

Thyroid hormone and its indications in psychiatry (2)?

Back 52

1) Augment antidepressants
2) Adjuncts to rapid cycling bipolar

Front 53

Theory behind thyroid hormone benefits in those with depression?

Back 53

Altered hypothalamic-pituitary-adrenal axis in depressed individuals

Front 54

Intrinsic psychiatric problem of having hypothyroidism?

Back 54

Mimics depression

Front 55

Lithium + Thyroid Hormone together may be helpful in treating?

Back 55

Rapid cycling bipolar