Psychiatry - Pharmacology

Front 1

Alcohol Withdraw Tx

Back 1

Benzodiazepines

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Anorexia/Bulimia Tx

Back 2

SSRIs

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Anxiety Tx

Back 3

Barbiturates, Benzodiazepines, Buspirone, MAO Inhibitors

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Atypical Depression Tx

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MAO Inhibitors

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Bipolar Disorder Tx

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Mood Stabilizers: lithium, Valproic acid, Carbamazepines

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Depression Tx

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SSRIs, TCAs

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Depression with insomnia Tx

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Trazodone, Mirtazapine

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Obsessive/Compulsive Disorder Tx

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SSRIs

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Panic Disorder Tx

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TCAs, Buspirone

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Schizophrenia Tx

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Antipsychotics

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Thioridazine, Haloperidol, Fluphenazine, Chlorpromazine

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Antipsychotics (Neuroleptics)

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Antipsychotics (Neuroleptics) Mechanism

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most blcok dopamine D2 receptors

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Antipsychotics (Neuroleptics) Clinical Use

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schizophrenia, psychosis, acute mania, Tourette syndrome

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Antipsychotics (Neuroleptics) Toxicity

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Extrapyramidal systme side effects, endocrine side effects, side effects arising from blocking muscarinic, α and histamine receptors, Neuroleptic Malignant Syndrome, Tardive Dyskinesia

Front 15

Neuroleptic Malignant Syndrome and Tx

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rigidity, myoglobinuria, autonomic instability, hyperpyrexia -- tx treat with dantrolene and dopamine agonists

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Tardive Dyskinesia

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stereotypic oral-facial movements probably due to dopamine receptor sensitization; results of long-term antipsychotic use

Front 17

Clozapine, Olanzapine, Risperidone

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Atypical Antipsychotics

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Atypical Antipsychotics Mechanism

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blocks 5-HT2 and dopamine receptors

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Atypical Antipsychotics Clinical Use

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schizophrenia (positive and negative), Olanzapine -- OCD, anxiety disorder, depression, mania, Tourette syndrome

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Atypical Antipsychotics Toxicity

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fewer EPS and anticholinergic side effects than other antipsychotics, Clozapine -- agranulocytosis

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Lithium Mechanism

Back 21

not established, possibly related to inhibition of phosphoinositol

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Lithium Clinical Use

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mood stabilizer for bipolar afffective disorder; blocks relapse and acute manic events

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Lithium Toxicity

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Tremor, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis, Narrow therapeutic window, Requires monitoring

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Buspirone Mechanism

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Stimulated 5-HT1a receptors

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Buspirone Clinical Use

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Generalized Anxiety Disorder, does not cause sedation or addiction, does not interact with EtOH

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Fluoxetine, Sertraline, Paroxetine, Citalopram

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SSRIs, Normally takes 2-3 wks for antidepressants to have an effect

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SSRIs Mechanism

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Serotonin-specific reuptake inhibitors

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SSRIs Clinical Use

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Endogenous depression, OCD

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SSRIs Toxicity

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Fewer than TCAs. GI distress, sexual dysfunctions (anorgasmia)

Front 30

Pt develops hyperthermia, muscle, rigidity and CV collapse after taking OTC cold medication - DX?

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Serotonin Syndrom: May be induced with MAO -1's by tyramine ingestion (cheese, red wine, etc) or meperidine. SSRI and MAOI = Serotonin Syndrom

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Imipramine, Amitriptyline, Desipramine, Nortriptyline, Clomipramine, Doxepin - Drug Class?

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Tricyclic Antidepressants

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TCA Mechanism

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Blocks reuptake of NE and serotonin

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TCA Clinical use

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Major depression, bedwetting (imipramine), OCD (clomipramine)

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TCA Side Effects

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Sedation, α-blocking effects, atropine-like side effects (tachycardia and urinary retention)

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TCA Toxicity

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Convulsions, Coma, Cardiotoxicity, respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly

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Buproprian Clinical Use

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depression, smoking cessation. (Mechanism not fully understood)

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Buproprian Toxicity

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tachycardia, insomnia, seizure in bulemic pats, does not cause sexual side effects

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Venlafaxine Mechanism

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inhibits serotinin, dopamine and NE reuptake

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Venlafaxine Clinical Use

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generalized Anxiety Disorder, Depression

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Venlafaxine Toxicity

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Stimulant effects, sedation, nausea, constipation, increased BP

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Mirtazapine Mechanism

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α2 antagonist --> increase release of NE and Serotonin, potent 5-HT2 and 5-HT3 receptor antagonist

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Mirtazapine Clinical Use

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depression

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Mirtazapine Toxicity

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sedation, increase appetite, weight gain, dry mouth

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Maprotiline Mechanism

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Blocks NE reuptake

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Maprotiline Clinical Use

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depression

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Maprotiline Toxicity

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sedation, orthostatic hypotension

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Trazodone Mechanism

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primarily inhibits serotonin reuptake

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Trazodone Clinical Use

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depression

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Trazodone Toxicity

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sedation, postural hypotension, nausea, priaprism

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Phenelzine and Tranylcypromine

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MAOIs

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MAOI Mechanism

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Nonselective MAO inhibition --> increase levels of amine neurotransmitters

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MAOIs Clinical Use

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Atypical depression (with psychotic or phobic features), also used in anxiety, hypochondriasis

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MAOIs Toxicity

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Hypertensive crisis with tyramine and meperidine, CNS stimulations. Contraindication with SSRIs or β-agonists