Psychopharmacology

Front 1

What are the major categories of drugs to treat psychiatric illnesses?

Back 1

Antidepressants, anti-psychotics, mood stabilizers, anxiolytics/hypnotics

Front 2

What are the major categories of antidepressants?

Back 2

1. Tricyclic antidepressants
2. MAOIs
3. Selective serotonin reuptake inhibitor (SSRIs)
4. Atypical antidepressants

Front 3

What are the effects of antidepressants on depression, mood, and abuse potential?

Back 3

Treats depression, no abuse potential and does NOT elevate mood

Front 4

What is the mechanism of action of TCAs?

Back 4

Inhibits reuptake of NE and serotonin

Front 5

What are some TCA drugs?

Back 5

Imipramine, amitriptyline, desipramine, nortriptyline

Front 6

What are the adverse effects of TCA's?
What are the most toxic effects?

Back 6

HAM side effects

1) Anti-histaminic - sedation
2) Anti-adrenergic - orthostatic hypotension
3) Anti-muscarinic - dry mouth, constipation, urinary retention, blurred vision, tachycardia

*Convulsions, coma and cardiotoxicity

Front 7

What must always be assessed before prescribing TCA's? Why?

Back 7

Suicide risk because these drugs are lethal in overdose

Front 8

What is the treatment of choice for TCA overdose?

Back 8

IV Sodium bicarbonate

Front 9

What is the mechanism of action of MAOI?

Back 9

Inhibits MAO enzymes and prevent the inactivation of amino neurotransmitters such as NE, serotonin, dopamine and tyramine

Front 10

What are some MAOIs drugs?

Back 10

Phenelzine, tranylcypromine

Front 11

What are the adverse and toxic effects of MAOIs?

Back 11

1. Serotonin syndrome - hyperthermia, muscle rigidity, death; when SSRI's and MAOIs are combined
2. Hypertensive crisis - buildup of catecholamines; when MAOIs and tyramine-rich foods or sympathomimetics are combined

Front 12

What is the treatment of serotonin syndrome?

Back 12

Discontinue the medications

Front 13

What is the mechanism of SSRIs?

Back 13

Inhibits presynaptic serotonin pumps, increasing availability of serotonin in synaptic clefts

Front 14

What can SSRIs be used to treat?

Back 14

Depression, OCD, anxiety

Front 15

Name some of the SSRI drugs

Back 15

Fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

Front 16

What are the adverse effects of SSRIs?

Back 16

1. Sexual dysfunction
2. GI distress
3. Serotonin syndrome

Front 17

What are some of the atypical antidepressants?

Back 17

1. SNRI
2. NDRI
3. SARI
4. NASA

Front 18

What drug is a SNRI? What are the adverse effects?

Back 18

Venlafaxine (Effexor), increased blood pressure (do not use in patients with labile BPs)

Front 19

What drug is a NDRI?
What are the indications?
What are the advantages?
What are the adverse effects?

Back 19

1) Buproprion (Wellbutrin)
2) Depression and smoking cessation
3) Lack of sexual side effects
4) Seizures, use with caution in epileptics

Front 20

What drug is a SARI?
What are the indications?
What are the adverse effects?

Back 20

1) Trazodone and Nefazodone
2) Depression and insomnia
3) Sedation and priapism

Front 21

What drug is a NASA?
What are the indications?
What are the adverse effects?

Back 21

1) Mirtazapine (Remeron)
2) Depression with need for weight gain
3) Weight gain, appetite stimulant

Front 22

What is the mechanism of action of traditional typical antipsychotics?

Back 22

Block dopamine receptors

Front 23

What is the mechanism of action of atypical antipsychotics?

Back 23

Block dopamine and serotonin receptors

Front 24

Which drugs are low potency antipsychotics?

Back 24

Chlorpromazine and thioridazine

Front 25

Which drugs are high potency antipsychotics

Back 25

Haloperidol, fluphenazine

Front 26

What is the advantage of atypical antipsychotics?

Back 26

1) More effective in treating negative psychotic symptoms

Front 27

What are the adverse effects of traditional antipsychotics?

Back 27

1) Antidopaminergic effects
a. Dystonia - sustained contractions
b. Akinesia - Parkinson's
c. Akisthesia - restlessness
d. Tardive dyskinesia - Writhing oral-facial movements
e. Hyperprolactinemia - galactorrhea and gynecomastia
2) Anti-HAM effects
a. Sedation
b. Orthostatic hypotension
c. Anticholinergic
3) Weight gain
4) Elevated LFTs

Front 28

Low potency antipsychotics causes which adverse effects?

Back 28

Anti-HAM effects

Front 29

High potency antipsychotics causes which adverse effects?

Back 29

Extrapyramidal side effects

Front 30

What is neuroleptic malignant syndrome?

Back 30

Rare but can occur in some people who take neuroleptics; 20% mortality, FARE
Fever
Autonomic instability
Rigidity (lead pipe)
Elevated CPK

Front 31

What is the treatment of neuleptic malignant syndrome?

Back 31

1. Dantrolene and bromocriptine (dopamine agonists)
2. D/C current medications
3. Supportive medical care (hydration and cooling)

Front 32

What is the advantage of atypical antipsychotics?

Back 32

Fewer adverse effects, rarely cause EPSE, tardive dyskinesia or neuroleptic malignant syndrome
*They are also more effective in treating negative symptoms of schizophrenia

Front 33

What are the atypical antipsychotic drugs?

Back 33

Clozapine, risperidone, olanzapine, quetiapine, aripiprazole and ziprasidone
CROQAZ

Front 34

What is unique about Clozapine?

Back 34

Adverse effect of agranulocytosis; patients must have weekly blood draws to check WBC counts

Front 35

What is another name for mood stabilizer? What is their purpose?

Back 35

Antimanics, used to treat acute mania

Front 36

What drugs are mood stabiliziers?

Back 36

1. Lithium
2. Carbamazepine (Tegretol)
3. Valproic acid (Depakote)

Front 37

What are the major adverse effects of lithium?

Back 37

1. Hypothyroidism
2. Nephrogenic diabetes insipidus (ADH antagonist)

Front 38

What is Carbamazepine (Tegretol) used for?

Back 38

1. Anticonvulsant
2. Trigeminal neuralgia
3. Mood stabilizer, rapid-cycling bipolar

Front 39

What are the adverse effects of Carbamazepine?

Back 39

1. Aplastic anemia
2. Agranulocytosis
3. Liver toxicity
4. Teratogenic effects

Front 40

What is Valproic acid (Depakote) used for?

Back 40

1. Anticonvulsant
2. Mood stabilizer, rapid-cycling bipolar

Front 41

What are the adverse effects of Valproic acid?

Back 41

1. Fatal hepatotoxicity
2. Neural tube defects, contraindicated in pregnancy

Front 42

What drugs are considered to be anxiolytics/hypnotics?

Back 42

1. Benzodiazepines
2. Barbiturates
3. Buspirone

Front 43

How do anxiolytics work?

Back 43

They cause CNS depression, causing a sedative effect

Front 44

What are indications for anxiolytics?

Back 44

1. Anxiety disorders
2. Sleep disorders
3. Anasthesia induction

Front 45

What are some of the anxiolytic drugs?

Back 45

Diazepam, Alprazolam, Clonazepam, Triazolam

Front 46

What are adverse effects of BZD?

Back 46

Drowsiness, respiratory depression especially when combined with alcohol

Front 47

What is Zolpidem used for?

Back 47

Insomnia, chemically not a BZD

Front 48

What is Buspirone (BuSpar) used for?

Back 48

Generalized anxiety disorder

Front 49

What is unique about buspirone?

Back 49

1. No addiction/abuse potential
2. Does not interact with alcohol
3. Delayed clinical response, 2 weeks; slower onset than BZD

Front 50

What is the mechanism of action of buspirone?

Back 50

Stimulates 5HT-1A receptor

Front 51

What are HAM side effects? What kind of drugs have HAM side effects?

Back 51

1. Sedation
2. Orthostatic hypotension
3. Anti-cholinergic

TCAs and low potency antipsychotics

Front 52

What is serotonin syndrome? How does this happen?

Back 52

Hyperthermia and muscle rigidity. Combination of MAOIs and SSRIs

Front 53

What is hypertensive crisis? How does this happen?

Back 53

Buildup of stored catecholamines. MAOIs plus food with tyramine or sympathomimetic

Front 54

What are extrapyramidal side effects?

Back 54

1. Dystonia
2. Akasthesia
3. Akinesia
4. Tardive dyskinesia

Front 55

What is neuroleptic malignant syndrome?

Back 55

Can be caused by all antipsychotics; a medical emergency

1. Fever
2. Autonomic instability
3. Rigidity (lead pipe)
4. Elevated CPK