Psych Drugs, Usmle Step 1

Front 1

Typical antipsychotics (neuroleptics)

Back 1

Haloperidol and all "-azines," work by blocking D2 receptors.
HIGH POTENCY: haloperidol, trifluoperazine, fluphenazine - all have neuro side effects.
LOW POTENCY: thioridazine, chlorpromazine.
CLINICAL USE ANTIPSYCHOTICS/NEUROLEPTICS: schizophrenia (mostly + symptoms), psychosis, acute mania, Tourette's.

Front 2

What are the toxicities of antipsychotics (neuroleptics)...e.g. Haloperidol and "azines."

Back 2

Extrapyramidal system (EPS) side effects, Endocrine side effects (dopamine receptor antagonism --> hyperprolactinemia --> galactorrhea), anti-muscarinic side effects (dry mouth, constipation), neuroleptic malignant syndrome, tardive dyskinesia

Front 3

What is neuroleptic malignant syndrome?

Back 3

toxicity from haloperidol and "azines" (typical antipsychotics, neuroleptics)...
- rigidity
-myoglobinuria
-autonomic instability
-hyperpyrexia.

TX: dantrolene, bromocriptine

Front 4

What is the evolution of EPS side effects (antipsychotics/neuroleptics)

Back 4

4 h: acute dystonia
4 d: akinesia
4 wk: akasthisia
4 mo: tardive dyskinesia

Front 5

Clozapine, Olanzapine, Risperidone, Aripiprazole, Quetiapine, Ziprasidone

Back 5

Atypical antipsychotics, work by blocking 5HT2, alpha, H1, and dopamine receptors.
Used for schizophrenia (both pos and neg sx), and olanzapine is used for OCD, anxiety d/o, depression, mania, Tourette's.
Atypical antipsychotics have fewer extrapyramidal and anticholinergic side effects. Clozapine can cause agranulocytosis (req weekly WBC monitoring).

Front 6

Lithium (mech, use, toxicity)

Back 6

MECH: inhibit PI3 cascade
USE: mood stabilizer for bipolar d/o' blocks relapse and acute manic events. Also SIADH. Tremor, hypothyroidism, polyuria (ADH antagonist causing nephrogenic DI), teratogenesis.

Front 7

Buspirone

Back 7

5HT1A agonist!! used for generalized anxiety d/o. does not cause sedation or addiction. can be taken w/ alcohol.

Front 8

TCA's (imipramine, amitriptyline, despiramine, nortryptiline, clomipramine, doxepin, amoxapine)

Back 8

MECH: block reuptake of NE and serotonin.
CLINICAL USE: major depression, bedwetting (imipramine), OCD (clomipramine)
SIDE EFFECTS: sedation, alpha-blocking effects, atropine-like (anticholinergic) side effects (tachycardia, urinary retention). tertiary TCA's (amitryptiline) have more anticholinergic effects than do secondary TCAs (nortriptyline). Despipramine is the least sedating.
TOXICITY: Tri-C's: convulsions, coma, cardiotoxicity (arrhythmias); also resp depression, hyperpyrexia. Confusions and hallucinations in elderly due to anticholinergic side effects (use nortriptyline). TX: NaHCO3 for CV toxicity.

Front 9

Serotonin Syndrome

Back 9

SSRI's plus any drug that increases serotonin (e.g. MAO-I's) --> hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea

Front 10

Bupropion (Wellbutrin)

Back 10

increases NE and dopamine. no sexual side effects. toxicity includes stimulant effects, HA, seizure in bulimics.

Front 11

Venlafaxine, Duloxetine

Back 11

inhibit serotonin and NE reuptake. Antidepressants. Venlafaxine is also used in GAD, Duloxetine is used for diabetic peripheral neuropathy. Toxicity: HTN

Front 12

Mirtazapine

Back 12

alpha-2 antagonist (increase release of NE and serotonin, increase insulin release), potent 5HT2 and 5HT3 antagonist. TOXICITY: sedation, increased appetite, weight gain, dry mouth.

Front 13

Maprotiline

Back 13

block NE reuptake. Toxicity: sedation, orthostatic hypotension.

Front 14

Trazodone

Back 14

inhibits serotonin reuptake. used for INSOMNIA (super high doses would be needed for antidepressant effects.
TOXICITY; priapism, sedation, nausea, postural hypotension.

Front 15

Discharge for impracticability requires (2)

Back 15

- Extreme and unreaonsable difficulty
AND
- Difficulty was not anticipated