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60 Cards in this Set

  • Front
  • Back
how do you manage alcohol withdrawal?
- support
- nutritional supplementation and hydration
- use of benzos
what is 1st line therapy for alcohol recovery?
- chlordiazepoxide
- safe and no cross-tolerance with alcohol
what medications do you give to alcoholics?
- chlordiazepoxide for 1st line
- thiamine and folic acid: nutrition
- haloperidol for hallucinations
- diazepam for delirium
- disulfiram or naltrexone for dependence
- used for alcohol dependence
- u-opioid antagonist
- lowers risk of relapse
precursor of 5HT
- tryptophan hydroxylase, aromatic AA decarboxylase
- made in cytoplasm
precursors of epi
- tyrosie -> L-dopa -> DA -> NE -> epi
- tyr hydroxylase, aromatic AA decarboxylase, DA hydroxylase (makes NE in vesicles), phenylethanolamine methyltransferase
- nonselective reuptake transporter
- vesicular monoamine transporter
- h+/monoamine antiport (carries DA, NE, 5HT, EPI) into vesicle
- degrades monoamines
- acts peripherally
- bines irreversibly to VMAT
- inhibits packaging of DA, NE, epi, and 5-HT into vesicles
- used in research to induce depression in animals
TCAs (tri cyclic antidepressants)
- inhibits 5HTT, NET
- no effect on DAT
what are the side effects of TCAs?
cause MANIA in bipolar patients
cardio: conduction delays (b/c it affects Na channels), AV block
Anticholinergic effects: nausea, vomiting, anorexia, blurred vision, confusion, constipation, tach, urinary retention
- antihistamine effects: orthostatic hypotension, reflex tach, drowsiness
name a classic TCA
- blocks 5HTT
- its active metabolite desipramine preferentially blocks NET
name some other TCAs
- Amitriptyline
- Clomipramine
- Desipramine
- Doxepine
- Nortiptyline
- Protriptyline
- Trimipramine
what are the side effects of SSRIs?
- sexual dysfunction, GI probelms, serotonin-syndrome: muscle rigidity, hyperthermia, myoclonus, MS change
where are SSRIs used?
- 1st line treatement for depression
- panic disorders, OCD, PTSD, eating disorders, social phobias
name a classic SSRI
- Fluoxetine (prozac)
name some other SSRIs
- citalopram (celexa)
- fluvoxamine (luvox)
- paroxetine (paxil)
- sertraline (Zoloft)
when do you use SRIs?
- SRIs include all the SSRIs plus one TCA (clomipramine)
- first line therapy in OCD
name some old MAOIs
- iproniazid (for TB)
- phenelzine
- isocarboazid
- tranylcypromine
name some new MAOIs
- moclobemide
- befloxatone
- brofaromine
- selective only for MAOI A
what are some side effects of MAOIs?
- tyramine toxicity: hypertensive crisis
- can induce switch to mania in BP
name some atypical antidepressants
- buproprion (wellbutrin)
- mitrazapine
- nefazodone, trazodone
- venlafaxine
buproprion (wellbutrin)
- atypical antidepressant; like an amphetamine
- inhibits DAT and NET
- used in depression, smoking cessation, panic disorder, OCD, anxiety
- amphetamines: reverse vesicular packaging of monoamines; also displaces catecholamines into cytoplasm
what are side effects of buproprion?
- risk of seizures
- can exacerbate psychoses
- type of atypical antidepressant
- blocks 5HT post synaptic receptors and the 5HT presynaptic autoreceptor
Nefazodone, trazodone
- blocks post synaptic 5HT receptor
- atypical antidepressant
- blocks 5HTT and NET
why use an atypical antidepressant?
- generally fewer side effects than SSRIs
- can reverse impotency (Nefazodone) induced by SSRIs
- mood stabilizer
- treats BP
- usually given as lithium carbonate
- enters cells via Na channel
- increases 5HT synthesis and release
what are some of the side effects seen with lithium?
- nausea, vomiting, diarrhea, ataxia, renal failure, NMJ dysfunction, tremor, delirium, seizures
how do you treat Bipolar disorder?
- lithium (1st line)
- anticonvulsants: valproate, carbamazepine, lamotrigene
- treats manic phase in bipolar disorder
- used for long term treatment
- better tolerated than lithium (1st line)
- alternative to Lithium and valproate in treatment of acute mania
- used to treat BP, particularly in rapidly cycling patients
what are the two classifications for panic disorder?
- with and without agoraphobia
what is the best treatment for agoraphobia?
- cognitive behavioral therapy: distraction, breathing exercises, self esteem help
what are the comorbidity rates associated with generalized anxiety disorder?
25% with panic disorder
35% social anxiety
37% alcohol dependence
62% depression
what is the drug of choice for generalized anxiety disorder (GAD)?
- buspirone: non-benzo anxiolytic
what is the treatment course for Generalized anxiety disorder?
- psychotherapy
- Buspirone
- Benzos (potential for tolerance and dependence)
- TCAs
what is the treatment for social phobias?
- medications: MAOIs, benzos, SSRIs (tx of choice)
- behavioral therapy
how do you treat a specific phobia?
- medication is not helpful
- behavioral therapy with exposure and desensitization is needed
what is acute stress disorder?
- precursor to PTSD
- occurs within 4 wks of a traumatic event
- lasts a minimum of 2 days and maximum of 4 wks
what is the treatment for acute stress disorder?
- use CBT to prevent progression to full blown PTSD
- benzos for severe anxiety
which part of the brain may be involved in OCD?
- basal ganglia- increased glucose metabolism in the basal ganglia and prefrontal hyperactivity -> makes people worry and plan excessively
what is OCPD (obsessive compulsive personality disorder)
- perfectionism, orderliness, and obstinancy
- does not lead to OCD
what is a comorbid condition with OCD?
- depression is seen in 80% of patients
- suicide is not increased
how do you treat OCD?
- SSRIs (1st line)
- benzos
- behavior therapy is good for people with rituals
- TCAs are not effective
what is the mortality rate for delirium?
- 40-50% of patients die within 1 year of disturbance
how do you treat delirium?
- antipsychotics: haloperidol, thiothixene
- sedation with benzos: oxazepam, lorazepam
- AVOID anticholinergic drugs: can prolong delirium
hirano bodies
- red structures found in the hippocampus.
- seen in AD
which allelic variation is protective in AD?
- ApoE2
what is protective from AD?
- eduction
- ApoE2
how do you treat AD?
- AChE inhibitors: tacrine, donepezil, rivastigmine
- depression: SSRIS instead of TCAs
- antipsychotics: haloperidol
- anticonvulsants: carbamazepine and valproate for agitation
- non-benzos for anxiety: buspirone
what are some reversible/treatable forms of dementia?
- vascular
- normal pressure hydrocephalus
- infections
- metabolic disorders
- nutritional deficiency
define the Axis DSM classification system
I: clinical disorders
II: personality disorders; Mental retardation
III: General medical conditions
IV: Psychosocial and environmental problems
V: global assessment of functioning
what are the general conditions for withdrawal?
1. cessation of prolonged stimulant use
3. symptoms cause distress/impairment
4. symptoms aren't caused by another medical condition
what are the general conditions for intoxication?
1. recent use
2. clinically significant changes that developed during use
4. symptoms are not related to some medical condition
name the sedatives, hypnotics, anxiolytics
- barbiturates
- non-barbs
- benzos
name some opiates
- heroin
- meperidien
- codein
- hydromorphone
name stimulants
- amphetamines
- methylphenidate
- cocaine