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48 Cards in this Set
- Front
- Back
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What are thioridazine, haloperidol, fluphenazine, chlorpromazine?
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Antipsychotics (neuroleptics)
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What is the mechanism of antipsychotics (neuroleptics)?
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Block dopamine D2 receptors
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What is the clinical use of antipsychotics (neuroleptics)?
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Schizophrenia, psychosis, acute mania, Tourette's syndrome
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What are thioridazine, haloperidol, fluphenazine, chlorpromazine?
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Antipsychotics (neuroleptics)
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What is the mechanism of antipsychotics (neuroleptics)?
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Block dopamine D2 receptors
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What is the clinical use of antipsychotics (neuroleptics)?
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Schizophrenia, psychosis, acute mania, Tourette's syndrome
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What are the low potency antipsychotics (neuroleptics)?
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Thioridazine, Chlorpromazine; non-neurologic side effects
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What are the high potency antipsychotics (neuroleptics)?
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Haloperidol, trifluoperazine; neurologic side effects
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What is the toxicity of antipsychotics (neuroleptics)?
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Extrapyrimidal system (EPS) side effects; endocrine side effects (eg: galactorrhea); side effects arising from blocking muscarinic receptors (dry mouth, constipation); alpha receptors (hypotension); histamine receptors (sedation); tardive dyskinesia; neuroleptic malignant syndrome
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What is the timeline of extrapyrimidal side effects?
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4h acute dystonia; 4d akinesia; 4wk akathesia; 4 mo tardive dyskinesia
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What are the characteristics of neuroleptic malignant syndrome?
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Rigidity, myoglobinuria, autonomic instability, hyperpyrexia
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What is the treatment for neuroleptic malignant syndrome?
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Dantrolene and dopamine agonists
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What are clozapine, olanzapine, risperidone, quetiapine, aripiprazole, and ziprasidone?
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Atypical antipsychotics
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What is the mechanism of atypical antipsychotics?
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Block 5-HT2 and dopamine receptors
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What is the clinical use of atypical antipsychotics?
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Schizophrenia (positive and negative symptoms)
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What is the clinical use of olanzapine?
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Schizophrenia (positive and negative symptoms), OCD, anxiety disorder, depression, mania, Tourette's syndrome
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What is the toxicity of atypical antipsychotics?
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Fewer extrapyrimadal and anticholinergic side effects than other antipsychotics.
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What is a specific toxicity of clozapine?
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Agranulocytosis - requires weekly WBC monitoring
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What is the clinical use of lithium?
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Mood stabilizer for bipolar affective disorder; blocks relapse and acute manic events
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What is the toxicity of lithium?
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Tremor, hypothyroidism, polyuria (via ADH antagonist), teratogenesis; narrow therapeutic window requiring close monitoring of serum levels
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What is the mechanism of buspirone?
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Stimulates 5-HT1A receptors
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What is the clinical use of buspirone?
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Anxiolysis for generalized anxiety disorder; does not cause sedation or addition and does not interact with alcohol
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What are fluoxetine, sertraline, paroxetine, citelopram?
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SSRIs
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What is the clinical use of SSRIs?
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Endogenous depression, OCD
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What is the toxicity of SSRIs?
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GI distress, sexual dysfunction (anorgasmia); with MAO inhibitors: serotonin syndrome - hyperthermia, muscle rigidity, cardiovascular collapse
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How long does it take for SSRIs to start having an effect?
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2-3 weeks
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What are imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, and amoxapine?
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Tricycline antidepressants
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What is the clinical use of tricyclic antidepressants?
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Major depression, bedwetting (imipramine), OCD (clomipramine)
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What are the side effects of tricyclic antidepressants?
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Sedation, alpha-blocking effects, atropine-like (anticholinergic) side effects (tachycardia, urinary retention). Tertiary tricyclic (amitriptyline) have more anticholinergic effects than secondary TCAs (nortriptyline). Desipramine is the last sedating.
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What is the toxicity of tricyclic antidepressants?
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Convulsions, coma, cardiotoxicity (arrhythmias), respiratory depression, hyperpyrexia; elderly can become confused and hallucinate - best to use nortiptyline.
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List the 'other' antidepressants
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Bupropion (Wellbutrin), venlafaxine, mirtazapine, maprotiline, trazodone
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What is the clinical use of bupropion?
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Antidepressant, smoking cessation
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What is the toxicity of bupropion?
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Stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients; no sexual side effects
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What is the clinical use of venlafaxine?
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Antidepressant, generalized anxiety disorder
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What is the mechanism of venlafaxine?
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Inhibits serotonin, norepinephrine, and dopamine reuptake
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What is the toxicity of venlafaxine?
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Stimulant effects, sedation, nausea, constipation, increased BP
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What is the mechanism of mirtazapine?
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Alpha2 antagonist (increased release of norepinephrine and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist
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What is the toxicity of mirtazapine?
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Sedation, increased appetite, weight gain, dry mouth
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What is the mechanism of maprotiline?
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Blocks NE reuptake
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What is the toxicity of maprotiline?
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Sedation, orthostatic hypotension
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What is the mechanism of trazodone?
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Primarily inhibits serotonin reuptake
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What is the toxicity of trazodone?
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Sedation, nausea, priapism, postural hypotension
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What are phenelzine and tranylcypromine?
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Monoamine oxidase (MAO) inhibitors
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What is the mechanism of MAO inhibitors?
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Increase levels of amine neurotransmitters
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What is the clinical use of MAO inhibitors?
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Atypical depression (ie mood reactivity, sensitivity to rejection, hypersomnia), anxiety, hypochondraisis
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What is the toxicity of MAO inhibitors?
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Hypertensive crisis with tyramine ingestion (in many foods) and beta-agonists; CNS stimulation; contraindication with SSRIs or meperidine (to prevent serotonin syndrome)
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What is the mechanism of methylphenidate (Ritalin)?
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Increased presynaptic norepinephrine vesicular release, but exact mechanism for relieving ADHD is unknown
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What is the clinical use of methylphenidate (Ritalin)?
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ADHD
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