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161 Cards in this Set
- Front
- Back
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Antipsychotic which has rare (1-2%) incidence of agranulocytosis and requires weekly CBC
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Clozapine
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Common antipsychotic to cause tardive dyskinesia
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Haloperidol
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Drug class of risperidone
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2nd generation antipsychotic
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SSRI more sedating than others, useful for PTSD
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Paroxetine
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What is Frotteurism
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Sexual arousal obtained by rubbing up against a person who is unaware of the activity
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Reason for hypovolemia in pt taking lithium
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Nephrogenic diabetes insipidus
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DOC for absence seizure
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Valproic acid
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Alternate name for absence seizure
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Petit mal
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MOA of benzos
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Increase frequency of GABA chloride channel opening
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Night terrors and sleepwalking occur during what sleep stage?
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3 and 4
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Anti-seizure drug causing agranulocytosis in a small number of people
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Carbamazepine
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Typical antipsychotic agent with 0.5% incidence of agranulocytosis
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Clozapine
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Food craving in seasonal affective disorder
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Carbohydrates
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Given for severe symptoms of PCP intoxication
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Benzodiazepines
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Presenting symptoms of psychogenic polydipsia
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Delirium and/or serizures
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Difference between bipolar I and II
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I has mania, II has hypomania
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Drug class for prevention of panic attacks
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SSRI's
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Pediatric form of anti-social personality
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Conduct disorder
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Effect on alcohol on CYP 450
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Decreased acutely, increases with chronic use
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Effect of phenytoin on CYP 450
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Induced
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Describe schizoid personality disorder
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Lack of close relationships, minimal interest is sex/activities, emotional detachment
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Define: alogia
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Absence of speech
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Main sign of schizotypal personality disorder
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Bizarre/odd/eccentric behavior - often socially isolated because of it
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Define confabulation
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Formation of false memories to cover up loss of real ones
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Seen in delirium tremens but not in Korsakoff psychosis
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Delirium and/or seizures
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Difference between Korsakoff syndrome and Korsakoff psychosis
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Syndrome has the mamillary body lesions, psychosis does not
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Three symptoms of Korsakoff psychosis
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Amensia, hallucinations, confabulation
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Action and use of methylphenidate
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CNS stimulant; ADHD (Ritalin)
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Lesion in what part of brain will cause disinhibition and acting on sexual urges?
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Amygdala
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Phenelzine is what type of drug?
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MAO inhibitor
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Psych dx for pt with numberous complaints in several organ systems with no obvious cause
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Somatization disorder
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Generic name for valium
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Diazepam
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SSRI with greater effect on norepinephrine than serotonin
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Duloxetine
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List the DSM-IV axes
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Axis I - Current psych diagnosis
Axis II - Personality disorder Axis III - All non-psych medical disorders Axis IV - Psychosocial Axis V - Global Axis of Functioning (GAF) |
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Drug class of isocarboxazid
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MAO inhibitor
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Name 3 MAO inhibitors
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Isocarboxazid, Phenelzine, Tranylcypromine
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Food content avoided in MAO inhibitors
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Tyramine
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Consequence of MAO inhibitor + tyramine
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Hypertensive crisis
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Personality disorder often displaying interest in magic, extra-sensory perception, etc
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Schizotypal
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Cluster A personality disorders
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"Always After me, Apathetic, and Awkward" = Paranoid, schizoid, schizotypal
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Cluster B personality disorders
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"Bitches and Bastards" = Antisocial, borderline, histrionic, narcissistic
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Cluster C personality disorders
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"Coy, Clingy, and Compulsive" = Avoidant, dependent, obsessive-compulsive
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Time criteria for brief psychotic, schizophreniform, paranoid schizophrenia
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Brief = > 1 month, Schizophreniform = 1-6 months, Schizophrenia = > 6 months
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Personality disorder with identity disturbance, impulsivity, suicidal behavior
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Borderline
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What is schizoaffective disorder
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Psychotic symptoms + depressive, manic, or mixed episode
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Personality type that is looking to please everyone
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Avoidant (people pleasers due to fear of being disliked)
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Anti-seizure drug causing SIADH/hyponatremia
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Carbamazepine
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Effect of valproic acid on CYP450
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Inhibits
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Type of seizure lamotrigine treats
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Partial
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MOA of lithium
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Blocks actions of cAMP and IP-3
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Tx for TCA overdose
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Sodium bicarbonate
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Common side effect of hypnotic agents
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Sedation
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Occurs when sedative hypnotics are used chronically or at high doses
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Tolerance
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The most common type of drug interaction of sedative hypnotics with other depressant medications
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Additive CNS depression
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Benzodiazepines used to promote sleep
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Temazpam, trizolam, flurazepam
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Benzodiazepine used for acute anxiety
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Alprazolam
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Non-benzodiazepine used as an anxiolytic
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Buspirone
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Non-benzodiazepine used for sleep
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Zolpidem
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Major effect of benzodiazepines on sleep at high doses
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REM is decreased
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Neurologic SE of benzodiazepines
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Anterograde amnesia
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Reason benzos are used cautiously in pregnancy
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Ability to cross the placenta
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Main route of metabolism for benzodiazepines
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Hepatic
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Benzodiazepine that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)
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Lorazepam, oxazepam, and temazepam
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MOA for benzodiazepines
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increase the FREQUENCY of GABA-mediated chloride ion channel opening
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Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
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Flumazenil
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Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin
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Diazepam
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Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia
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Clonazepam
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Benzodiazepines that are the most effective in the treatment of panic disorder
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Alprazolam and Clonazepam
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Benzodiazepine that is used for anesthesia
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Midazolam
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Benzo used for status epilepticus
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Diazepam
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Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs
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Chlordiazepoxide and Diazepam
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Rate limiting step of alcohol metabolism
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Aldehyde dehydrogenase
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System that increases in activity with chronic ethanol exposure and may contribute to tolerance
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MEOS
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Enzyme that metabolizes acetaldehyde to acetate
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Aldehyde dehydrogenase
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Agents that inhibit acetaldehyde dehydrogenase
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Disulfiram, metronidazole, certain sulfonylureas and cephalosporins
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Agent that inhibits alcohol dyhydrogenase and its clinical use
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FOMEPIZOLE – used to prevent formation of toxic metabolites from methanol and ethylene glycol ingestion
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Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
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Disulfiram
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The most common neurologic abnormality in chronic alcoholics
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Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)
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Agent that is the antidote for methanol overdose
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Ethanol, fomepizole
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Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
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Fomepizole
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Most frequent route of metabolism for anti-seizure meds
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Hepatic enzymes
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Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
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Sodium channel blockade
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Target receptor for benzodiazepines and barbiturates
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GABA
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MOA for Ethosuximide
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Calcium channels
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MOA for Valproic acid at high doses
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Affect calcium, potassium, and sodium channels
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Drugs of choice for generalized tonic-clonic and partial seizures
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Valproic acid and Phenytoin
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DOC for febrile seizures
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Phenobarbital
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Drugs of choice for absence seizures
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Ethosuximide and valproic acid
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Drug of choice for myoclonic seizures
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Valproic acid
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Drugs of choice for status epilepticus
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IV diazepam for short term (acute) treatment; phenytoin for prolonged therapy
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Drugs that can be used for infantile spasms
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Corticosteroids
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Anti-seizure drugs used also for Trigeminal neuralgia
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Carbamazepine
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Anti-seizure drugs used also for pain of neuropathic orgin
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Gabapentin
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Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
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Phenytoin
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SE of phenytoin
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Gingival hyperplasia, nystagmus, diplopia and ataxia
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Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
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Carbamazepine
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Anti-seizure agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
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Valproic acid
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Laboratory value required to be monitored for patients on valproic acid
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Serum ammonia and LFT's
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SE for Lamotrigine
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Stevens-Johnson syndrome
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SE for Felbamate
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Aplastic anemia and acute hepatic failure
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Anti-seizure medication also used in the prevention of migraines
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Valproic acid
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Carbamazepine may cause
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Agranulocytosis
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Anti-seizure drugs used for mood stabilization (bipolar)
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Carbamazepine, gabapentin, lamotrigine, and valproic acid
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MOA of neuroleptics
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Dopamine blockade
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Side effects occuring in antipsychotics that block dopamine
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Hyperprolactinemia, menorrhea, galactorrhea, confusion, mood changes, decreased sexual interest, and weight gain
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Antipsychotics that reduce positive symptoms only
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Older antipsychotics
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Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation
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Olanzapine, aripiprazole, and sertindole
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Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia
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Risperidone
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Atypical antipsychotic causing high prolactin levels
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Risperidone
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Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes
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Olanzapine
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Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker
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Haloperidol
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Drug used in neuroleptic malignant syndrome
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Dantrolene
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Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)
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Muscarinic blockers
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Antipsychotic having the strongest autonomic effects
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Thioridazine
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Antipsychotic having the weakest autonomic effects
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Haloperidol
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Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
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Thioridazine
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Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause fatal agranulocytosis
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Clozapine
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Anti-psychotic not shown to cause tardive dyskinesia
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Clozapine
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Anti-psychotics available in depot preparation
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Fluphenazine and haloperidol
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Antipsychotics with Reduced seizure threshold
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Low-potency typical antipsychotics and clozapine
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Antipsychotic with Orthostatic hypotension and QT prolongation
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Low potency phenothiazines and ziprasidone
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Antipsychotic with Increased risk of developing cataracts
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Quetiapine
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Major route of elimination for Lithium
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Kidneys
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Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop
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Lithium toxicity
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Drug increases the renal clearance hence decreases levels of lithium
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Theophylline
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Lithium is associated with this congenital defect
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Cardiac anomalies
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DOC for bipolar affective disorder
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Lithium
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SE of lithium
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Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus
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Example of three antidepressants that are indicated for obsessive compulsive disorder
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Clomipramine, fluoxetine and fluvoxamine
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Neurotransmitters affected by the action of antidepressants
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Norepinephrine and serotonin
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How long one-liners and case files says antidepressents take to work
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2 to 3 weeks
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Population group especially sensitive to side effects of antidepressants
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Elderly patients
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All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
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Side-effect profile and prior pt response
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Well-tolerated and are first-line antidepressants
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SSRI's, bupropion, and venlafaxine
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Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
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Monamine oxidase inhibitors
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Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
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Hypertensive crisis
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MAOI should not be administered with SSRI's or potent TCA's due to development of this condition
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Serotonin syndrome
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Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
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Tricyclic antidepressants (TCA)
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Three C's associated with TCA toxicity
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Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
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Agents having higher sedation and antimuscarinic effects than other TCA's
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Tertiary amines
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TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
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Amitriptyline
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TCA used in chronic pain, enuresis, and ADD
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Imipramine
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TCA with greatest sedation and marked antimuscarinic effects, used for sleep
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Doxepin
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TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
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Clomipramine
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Secondary amines that have less sedation and more excitation effect
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Nortriptyline, Desipramine
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Side effects seen with tricyclic antidepressants
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Muscarinic blockade (dry mouth, constipation); weak alpha-1 block (orthostatic hypotension); weak hisamine block (sedation)
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Antidepressant associated with neuroleptic malignant syndrome
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Amoxapine
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Antidepressant associated with seizures and cardiotoxicity
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Maprotiline
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Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
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Venlafaxine
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Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
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Venlafaxine
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Antidepressant also used for sleep that causes priapism
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Trazodone
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Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
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Nefazodone
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Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
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Bupropion
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Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
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Mirtazapine
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SE of mirtazapine
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Liver toxicity, increased serum cholesterol
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Except for these agents all SSRI have significant inhibition of CytP450 enzymes
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Citalopram and its metabolite escitalopram
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Antidepressants with no effect on BP, no sedation
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SSRIs
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SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
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Fluoxetine
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SSRI indicated for premenstrual dysphoric disorder
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Fluoxetine (Sarafem)
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Some of SSRIs' therapeutic effects beside depression
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Panic attacks, social phobias, bulimia nervosa, and PMDD (premenstrual dysphoric disorder), OCD
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SSRI less likely to cause a withdrawal syndrome
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Fluoxetine
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