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120 Cards in this Set
- Front
- Back
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What are the 2 basic effects of all psychotropics?
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They either:
1. INCREASE the effectiveness of transmission at nerve synapses 2. DECREASE the effectiveness of transmission at nerve synapses |
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What class of medication do a)imipramine (Tofranil), b) amitriptyline (Elavil), c) doxepin (Sinequan), and d) clomipramine (Anafranil) belong to?
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Tricyclic antidepressants
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What is the method of action of tricyclic antidepressants?
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They inhibit the reuptake of a) norepinephrine, b) dopamine, and/or c) seratonin
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Are tricyclics effective in reducing depression?
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Yes, but they are increasingly replaced by SSRIs and newer medications
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What else are tricyclic antidepressants used for besides depression?
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1. ADHD
2. Pain 3. Nocturnal enuresis 4. Headache 5. Bulemia nervosa 6. Interstitial cystitis 7. Irritable bowel syndrome 8. Narcolepsy 9. Persistent hiccups 10. Pathological crying/laughing 11. Smoking cessation |
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What are the side effects of tricyclic antidepressants?
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1. Cardiovascular - tachycardia, palpitations, hypertension, severe hypotension, and cardia arrhythmia
2. Anticholinergic effects 3. Confusion 4. Drowsiness 5. Fatigue 6. Weight gain 7. Fine tremor 8. Paresthesia - a sensation of tingling, pricking, or numbness of a person's skin 9. Blood dyscrasia - unspecified disorder of the blood. - abnormal material in blood |
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Why aren't tricyclic antidepressants used more now?
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1. The lethal dose is only 4-10x the effective dose, creating a greater risk of suicide in the suicidal
2. Strong anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention or trouble urinating, hyperthermia) 3. Reduced cognition secondary to sedation |
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Is it recommended that tricyclic antidepressants be used with the elderly?
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No, the adverse effects of TCAs is more common in the elderly.
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Does imipramine (Tofranil)have an approved use in children?
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Yes, because it has a safety record with children and is used for:
1. Betwetting 2. ADHD |
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What medical following is required for children taking imipramine (Tofranil)?
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EKGs, because tricyclics can cause prolong the QT interval of the heart beat, which can increase the chance of vetricular dysrhythmias.
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What 2 antidepressants combine the effects on norepinephrine and seratonin?
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1. venlafaxine (Effexor)
2. duloxetine (Cymbalta) |
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Is duloxetine (Cymbalta) approved for neuropathic pain?
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Yes
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What is the advantage of a combination antidepressant?
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It works on depression through 2 known pathways:
1. NE - leading to increased energy and concentration 2. Serotonin - leading to reduced anxiety and depression |
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What is the method of action of bupropion (Wellbutrin/Zyban)?
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1. A dopamine reuptake inhibitor
2. NE reuptake inhibitor |
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What is bupropion (Wellbutrin/Zyban) used for?
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1. Smoking cessation (Zyban)
2. Antidepressant (Wellbutrin) |
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Who should avoid bupropion (Wellbutrin/Zyban)?
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Individuals with:
1. Seizure disorder. 2. Alcoholics or others with a lowered seizure threshold(who could have seizures) 3. Cirrhosis of the liver 4. Anorexia nervosa/bulimia 5. Severe kidney disease 6. Severe hypertension 7. Anxiety disorder, high agitation 8. Suicide risk clients 9. Psychosis - worsens or causes hallucinations, paranoia, and feelings of persecution |
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How does trazadone (Desyrel) work?
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It is a serotonin reuptake inhibitor and a 5-HT2 receptor antagonist (which block receptors from the agonist, which in effect "turns off" the biochemical mechanism for change in a cell).
The antidepressant effects may be due more to its antagonistic effect at the 5-HT2 receptor site than its SSRI component. |
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How does mirtazapine (Remeron) work?
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It may block presynaptic alpha-2 adrenergic receptors that normally inhibit the release of the neurotransmitters norepinephrine (noradrenaline) and serotonin, thereby increasing active levels in the synapse.
Mirtazapine also blocks post-synaptic 5-HT2 and 5-HT3 receptors—an action which is thought to enhance serotonergic neurotransmission while causing a low incidence of side effects |
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Name the 6 SSRIs
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1. sertraline (Zoloft)
2. fluoxetine (Prozac) 3. citalopram (Celexa) 4. escitalopram (Lexapro) 5. paroxetine (Paxil) 6. fluvoxamine (Luvox) |
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How is fluvoxamine different from the other 5 SSRIs?
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It is used primarily for obsessive-compulsive disorder rather than depression
It also has fewer side effects than the other SSRIs |
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What is the method of action of SSRIs?
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SSRIs increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin available to bind to the postsynaptic receptor.
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What are the approved uses of SSRIs?
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1. Clinical depression
2. Anxiety 3. Panic disorder 4. PTSD 5. OCD 6. Eating disorders |
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Why is there a black box warning for SSRI use with children?
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1. Increased suicidal ideation has been found.
2. SSRIs are not as effective in children as they are in adults. |
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What are the side effects of SSRIs?
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1.nausea
2.drowsiness or somnolence 3.headache 4.clenching of teeth 5.extremely vivid and strange dreams 6.dizziness 7.changes in appetite 8.weight loss/gain 9.changes in sexual behaviour (anorgasmia, erectile dysfunction, and diminished libido) 10.increased feelings of depression and anxiety (which may sometimes provoke panic attacks) 11.tremors 12.autonomic dysfunction including orthostatic hypotension, increased or reduced sweating 13.akathisia 14.liver or renal impairment 15.thoughts of suicide 16.depersonalization (derealization) |
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Can SSRIs induce mania?
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Yes
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What is serotonin syndrome?
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1. A rare, but potentially life-threatening adverse drug reaction
2. It is a consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors. |
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What are the symptoms of sertonin syndrome?
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1. Mild - tachycardia, and shivering, diaphoresis (excessive sweating), mydriasis (excessive dialation of the pupil), intermittent tremor or myoclonus (brief, involuntary twitching of a muscle or a group of muscles), as well as overactive or overresponsive reflexes.
2. Moderate - hypertension, hyperthermia, and hyperactive bowel sounds. Mental status changes include hypervigilance and agitation 3. Severe - severe hypertension and tachycardia that may lead to shock, agitated delirium, muscular rigidity and tension, fatal hyperthermia, metabolic acidosis (when blood pH is low, can cause coma and death), rhabdomyolysis (break down of skeletal muscle), seizures, renal failure, and disseminated intravascular coagulation (blood coagulation throughout entire body) |
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What does the acronym MAO stand for?
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Monoamine oxidase
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What do MAOs do?
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They are enzymes that break down neurotransmitters such as:
1. serotonin 2. NE 3. epinephrine 4. phenethylamine 5. dopamine |
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What do MAOIs do?
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They act by inhibiting the activity of MAOs, preventing the breakdown of monoamine neurotransmitters (serotonin, epinephrine, NE, dopamine) and so increasing available stores.
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Why are MAOIs rarely used?
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1. It can have lethal reactions with other medications
2. Severe, potentially lethal, effects when eating certain foods that contain tyramine (aged wines and cheeses) |
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What are some commonly prescribed MAOIs?
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1. isocarboxazid (Marplan)
2. phenelzine (Nardil) 3. tranylcypromine (Parnate/Jatrosom) |
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Is lithium (Eskalith) still the first choice medication for mood stabilization?
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Yes
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How does lithium (Eskalith) work?
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It becomes widely distributed in the CNS and interacts with a number of neurotransmitters and receptors, decreasing noradrenaline release and increasing serotonin synthesis
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Why are lithium (Eskalith) levels required to be monitored?
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1.The therapeutic dose is only slightly less than the toxic level
2. It can also interfere with thyroid and kidney function |
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Which other drug classes are utilized for mood stabilization?
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1. Anticonvulsants
2. Atypical antipsychotics |
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How do anticonvulsants work?
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Many block sodium (Na+) channels, calcium (Ca2+) channels, AMPA receptors (a receptor for glutamate that mediates fast synaptic transmission in the CNS), or NMDA receptors (a receptor for glutamate that when open allows the flow of sodium (Na+), potassium (K+), and small amounts of calcium (Ca2+)).
Some inhibit the metabolism of GABA (an inhibitory neurotransmitter) or increase its release |
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Which anticonvulsants have a negative effect on cognition?
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All have some negative effect, although phenobarbital and topiramate (Topomax) may be the worst.
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Antipsychotic drugs are also known as what?
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1. Major tranquilizers
2. Neuroleptics |
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What is the method of action of "typical" antipsychotics?
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They act as antagonists (blocking agents) on dopamine (D2) receptors.
Note: They are not selective, blocking all D2 receptors, which leads to many of the adverse side effects |
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What are the TYPICAL or TRADITIONAL antipsychotics?
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1. Phenothiazines
a. chlorpromazine (Thorazine) b. fluphenazine (Prolixin) 2. Thioxanthene a. thiothixene (Navane) 3. Butyrophenone a. haloperidol (Haldol) |
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What are TYPICAL antipsychotics used for?
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1. Schizophrenia
2. Acute mania, delusions, and hallucinations associated with Major Depressive Disorder 3. Organic psychoses |
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What are TYPICAL antipsychotics good for?
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Alleviating hallucinations, delusions, agitation, and other POSITIVE symptoms of schizophrenia.
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What are TYPICAL antipsychotics NOT good for?
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Alleviating the NEGATIVE symptoms of schizophrenia.
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What are the side effects of TYPICAL antipsychotics?
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1. Anticholinergic
2. Extrapyramidal 3. Neuroleptic malignant syndrome |
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What are the ANTICHOLINERGIC side effects?
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1. Dry mouth
2. Blurred vision 3. Tachycardia 4. Urinary retention 5. Constipation 6. Delayed ejaculation |
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What are extrapyramidal symptoms?
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Various movement disorders, such as tardive dyskenesia suffered as a result of taking dopamine antagonists
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What are the best known extrapyramidal symptoms?
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1. Tardive dyskinesia - involuntary, rhythmic movements of the jaw, lips, tongue, and extremities
2. Akathesia - extreme motor restlessness 3. Dystonia - muscluar spasms in mouth, face, and neck 4. Parkinsonism - muscle stiffness, shuffling gait, drooling, and tremor |
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What is Neuroleptic Malignant Syndrome?
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A rare, but life-threatening, neurological disorder caused by an adverse reaction to neuroleptic or antipsychotic drugs.
First symptoms include rapid onset of motor, mental, and autonomic symptoms including: muscle rigidity, tachycardia, high fever, altered consciousness, and changes in cognitive function. Other symptoms: Unstable blood pressure, confusion, coma, delirium, muscle tremors |
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What is the DOPAMINE HYPOTHESIS?
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The proposal that schizophrenia is related to overactivity at dompamine receptors, either as the result of oversensitivity of the receptors or excessive dopamine levels.
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Is there supportive evidence for the dopamine hypothesis?
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Yes - studies have demonstrated that:
1. Amphetamines and other drugs that elevate dopamine levels produce psychosis in non-schizophrenics 2. Low doses of these drugs to schizophrenics exacerbate their symptoms |
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What is the method of action of the "atypical" antipsychotics?
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1. They act as antagonists (blocking agents) on dopane (D2) receptors. They are more selective in blocking only D2 receptors in the mesolimbic pathway of the brain; thus, reducing side effects.
2. They also block or partially block serotonin receptors, thus having an influence on the negative symptoms of schizophrenia. |
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What are the common ATYPICAL antipsychotics?
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1. clozapine (Clozaril)
2. risperidone (Risperdal) 3. olanzapine (Zyprexa) 4. quetiapine (Seroquel) 5. ziprasidone (Geodon) |
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What is the advantage of the ATYPICAL antipsychotics?
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They alleviate both the positive and negative symptoms of schizophrenia.
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What are the disadvantages of the ATYPICAL antipsychotics?
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1. They may have a slower onset of therapeutic effects.
2. They require regular blood monitoring |
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What are the side effects of ATYPICAL antipsychotics?
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1. Anticholinergic effects
2. Lowered seizure threshold 3. Sedation 4. Agranulocytosis 5. Other blood dyscrasias 6. Neuroleptic malignant syndrome - Extrapyramidal symptoms and tardive dyskinesia are much less common |
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Which antipsychotic is recommended for Parkinson's patients?
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quetiapine (Seroquel)
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What is venlafaxine (Effexor)?
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A selective serotonin norepinephrine reuptake inhibitor (SNRI).
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What is venlafaxine (Effexor) prescribed for?
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1. Major Depression
2. OCD 3. Generalized Anxiety Disorder |
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What are the advantages of venlafaxine (Effexor)?
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1. Less dangerous in overdose than TCAs
2. May have a faster onset of therapeutic effect |
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What are the disadvantages of venlafaxine (Effexor)?
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1. It can increase blood pressure, so it requires frequent monitoring
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What are nefazodone (Serzone) and trazodone (Desyrel)?
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They are serotonin-2 antagonists/reuptake inhibitors (SARIs)
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What are trazodone (Desyrel) and nefazodone (Serzone) prescribed for?
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1. Major Depression
2. The depressive phase of Bipolar Disorder |
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What are the common side effects of nefazodone (Serzone)?
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1. Somnolence
2. Dry mouth 3. Nausea 4. Dizziness 5. Blurred vision 6. Confusion |
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What are the common side effects of trazodone (Desyrel)?
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1. Sedation
2. Orthostatic hypotension 3. Dizziness 4. Headache 5. Nausea 6. Priapism (rare; long-lasting penile erection) |
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What are carbamazepine (Tegretol), valporic acid (Depakote), and clonazepam (Klonopin)?
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Anticonvulsants
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What have carbamazepine (Tegretol), valporic acid (Depakote), and clonazepam (Klonopin) been prescribed for?
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1. Seizures
2. Mania 3. Mood stabilization |
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What are the advantages of carbamazepine (Tegretol)?
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1. Effective treatment for Bipolar Disorder, especially for those that do not respond well to lithium
2. Better for those who are rapid cyclers 3. Better for those with dysphoric mania |
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What are the side effects of carbamazepine (Tegretol)?
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1. Dizziness
2. Ataxia 3. Visual disturbances 4. Anorexia 5. Nausea 6. Rash 7. Agranulocytosis (rare); requires monitoring 8. Aplastic anemia (rare); requires monitoring |
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Who should avoid taking carbamazepine (Tegretol)?
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People with abnormalities in cardiac conduction, because it has potential effects on cardiovascular functioning.
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What are some of the common sedative-hypnotics?
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1. Barbiturates
2. Anxiolytics 3. Alcohol |
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Name 4 barbituates
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1. amobarbital (Amytal)
2. pentobarbital (Nembutal) 3. secobarbital (Seconal) 4. phenobarbital (Luminal) |
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How do sedative-hypnotics work?
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They are generalized CNS depressants:
Low doses: reduce arousal and motor activity Moderate doses: induce sedation and sleep High doses: anesthesia, coma, death |
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Can a person develop psychological and physical dependence upon sedative-hypnotics?
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Yes
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Does sudden cessation of sedative-hypnotics cause withdrawal effects?
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Yes
1. Tremors 2. Anxiety 3. Nausea 4. Vomiting 5. Paranoia 6. Hallucinations, delirium, and life-threatening convulsive seizures (in extreme cases) |
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Sedative-hypnotics cause cross-tolerance: True or False
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True
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Are barbituates a popular medication to prescribe?
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No, due to the recognition of their lethal effects and the development of safer and more effective drugs they are now infrequently prescribed
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How do barbituates sometimes affect young children, the elderly, and people experiencing pain?
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They produce paradoxical excitement.
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How do barbituates work?
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They interrupt impulses to the reticular activating system.
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What are the side effects of barbituates?
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1. Slurred speech
2. Nystagmus 3. Dizziness 4. Irritability 5. Impaired motor and cognitive performance |
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How do barbituates affect sleep?
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Decreases REM sleep.
Abrupt cessation can produce an REM rebound and nightmares. |
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What are benzodiazepines?
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Anxiolytics
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Name the most common benzodiazepines
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1. diazepam (Valium)
2. alprazolam (Xanax) 3. oxazepam (Serax) 4. triazolam (Halcion) 5. chlordiazepoxide (Librium) 6. lorazepam (Ativan) |
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What are benzodiazepines prescribed for?
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1. Anxiety
2. Sleep disturbances 3. Seizures 4. Cerebral palsy and other musle spasm disorders 5. Alcohol withdrawal |
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How do benzodiazepines work?
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They stimulate the inhibitory action of the neurotransmitter GABA.
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What are the side effects of benzodiazepines?
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1. Drowsiness
2. Lethargy 3. Slurrred speech 4. Ataxia 5. Impaired psychomotor ability 6. Irritability 7. Hostility 8. Paradoxical excitement 9. Increased appetite/weight gain 10. Skin rash 11. Blood dyscrasias 12. Impaired sexual funtioning 13. Disorientation/confusion 14. Sleep disturbance (reduced REM sleep) 15. Anterograde amnesia 16. Depression |
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Which anxiolytic reduces anxiety without sedation and does not appear to be addictive or subject to abuse?
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buspirone (Azapirone)
This medication may take several weeks before it is effective. |
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Name one beta-blocker
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propranolol (Inderal)
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What are beta-blockers used for?
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1. HTN
2. Angina 3. Other cardiovascular disorders 4. Tremors 5. Migraine headaches 6. Glaucoma 7. Reducing palpitations 8. Excessive sweating 9. Other physical symptoms associated with anxiety |
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How do beta-blockers work?
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They block beta-adrenergic receptors, which respond to epinephrine and norepinephrine
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What are the side effects of beta-blockers?
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1. Bradycardia
2. Shortness of breath 3. Arterial insufficiency 4. Nausea 5. Depression 6. Dizziness |
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Who should avoid propranolol?
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Those with certain respiratory problems or obstructive pulmonary disease
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What does sudden cessation of beta-blockers do?
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1. Sweating
2. Palpitations 3. Headache 4. Tremulousness 5. Cardiac arrhythmias |
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What are narcotic-analgesics?
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Opioids, including natural opioids, semi-sythetic derivatives, and pure synthetics
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Name the natural opioids
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1. Opium
2. Morphine 3. Codeine |
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Name the semi-synthetic derivatives of morphine
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1. Heroin
2. Percodan 3. Dilaudid |
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Name the pure sythetic narcotic-analgesics
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1. Demerol
2. Darvon 3. methadone |
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What are narcotic-analgesics used for?
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1. Pain
2. Diarrhea 3. Cough suppressant |
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How do analgesics work?
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They appear to bond to opioid receptors in the spinal cord, amygdala, thalamus, and hypothalamus; thereby reducing pain perception
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What are the side effects of narcotic-analgesics?
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1. Constricted pupils
2. Decreased visual acuity 3. Increased perspiration 4. Constipation 5. Nausea 6. Vomiting 7. Respiratory depression |
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What are the withdrawal symptoms of narcotics-analgesics?
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1. Stomach cramps
2. Nausea 3. Vomiting 4. Weakness 5. Fever 6. Muscle and joint pain 7. Sweating 8. Insomnia |
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What are psychostimulants used for?
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1. ADHD
2. Narcolepsy |
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What is the mode of action of psychostimulants?
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They potentiate the release of norepinephrine and dopamine and block their reuptake
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What are the side effects of amphetamines?
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1. Restlessness
2. Insomnia 3. Poor appetite 4. Tremor 5. Palpitations 6. Cardiac arrhythmia |
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What are the effects of prolonged use of amphetamines?
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It can lead to a psychotic state that resembles paranoid schizophrenia
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What are the side effects of methylphenidate?
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1. Dysphoria (anxiety, irritability, depression, euphoria, sadness)
2. Nausea & abdominal pain 3. Decreased appetite 4. Insomnia 5. Temporary growth suppression (although does not affect overall height and weight and can be minimized by taking "drug holidays" |
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Who should avoid methylphenidate?
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People with:
1. Anxiety and tension 2. Anorexia 3. Severe hypertension 4. Angina pectoris 5. History of functional psychosis 6. Recent history of drug or alcohol abuse 7. Pre-existing motor tics 8. Family history of Tourette's syndrome |
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What method of administration is recommended for noncompliant psychotic patients?
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Depot Haldol or Risperdal Consta
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What is the drug of choice for preventing seizures during alcohol withdrawal?
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1. lorazepam (Ativan)
2. oxazepam (Serax) 3. chlordiazepoxide (Librium) |
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All benzodiazepines will cause physical dependence at regular doses within 2-8 weeks. TRUE or FALSE?
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TRUE
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Which of these is not a form of methylphenidate?
a. Adderall b. Metadate c. Concerta d. Straterra |
a. & c.
Adderall - is a mix of amphetamine Straterra - increases NE rather than focusing on dopamine. It is closer to a TCA than to methylphenidate |
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Stimulants are controlled substances. TRUE OR FALSE?
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TRUE
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What is mondafinil (Provigil)?
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An atypical stimulant used to treat narcolepsy
It improves alertness, concentration, and long-lasting mental arousal |
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Does mondafinil (Provigil) have addictive properties?
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No
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What is donepezil (Aricept)?
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It is used to treat Alzheimer's.
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What is the method of action of donepezil (Aricept)?
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It is an acetyl cholinesterase inhibitor, which increases cortical acetylcholine.
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What is memantine (Namenda)?
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It is an Alzheimer's medication.
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What is the method of action of memantine (Namenda)?
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It is an antagonist at glutamatergic NMDA receptors. By binding to the NMDA receptors it is able to inhibit the prolonged influx of calcium (Ca2+) ions, which form the basis of neuronal exitotoxicity, which is believed to be an underlying etiology of Alzheimer's disease.
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What is exitotoxicity?
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The pathological process by which neurons are damaged and killed by the overactivations of receptors for the excitatory neurotransmitter glutamate, such as the NMDA receptor and AMPA receptor. Excitotoxins like NMDA and kainic acid which bind to these receptors, as well as pathologically high levels of glutamate, can cause excitotoxicity by allowing high levels of calcium ions[1] (Ca++) to enter the cell. Ca++ influx into cells activates a number of enzymes, including phospholipases, endonucleases, and proteases such as calpain. These enzymes go on to damage cell structures such as components of the cytoskeleton, membrane, and DNA
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What improvment can be expected with the cognitive enhancing drugs?
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6 to 12 months delay of cognitive decline
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