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