Step 1 - Pharm - Psychiatry

Front 1

Mechanism of action of Methylphenidate (Ritalin)

Back 1

Increases presynaptic release of NE (like amphetamines), but how it actually relieves symptoms of ADHD is unknown

Front 2

Mechanism of action of typical neuroleptics (antipsychotics)

Back 2

Dopamine D2 receptor blockers

Front 3

Clinical use of neuroleptics

Back 3

Schizophrenia, psychosis, acute mania, Tourette's

Front 4

This class of drugs causes tardive dyskinesia

Back 4

Typical antipsychotics (Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

Front 5

This class of drugs causes neuroleptic malignant syndrome

Back 5

Typical antipsychotics
(Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

Front 6

Findings in neuroleptic malignancy syndrome (NMS)

Back 6

Fever, encephalopathy, unstable vitals, elevated enzymes, rigidity of muscles ("FEVER")

Front 7

Myoglobinuria is a side effect of this class of drugs

Back 7

Typical antipsychotics
(Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

Front 8

These are the high potency typical neuroleptics

Back 8

Haloperidol, trifluoperazine, fluphenazine (haloperidol + "flu's"; neurologic, extrapyramidal side effects)

Front 9

These are the low potency (classic) neuroleptics

Back 9

Thioridazine, chlorpromazine (more anticholinergic and antihistaminic side effects)

Front 10

Evolution of extrapyramidal side effects

Back 10

4h: acute dystonia
4d: akinesia (parkinsonian sx)
4wk: akathisia (restlessness)
4mo: tardive dyskinesia

Front 11

These drugs have extrapyramidal side effects

Back 11

Typical antipsychotics (Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

Front 12

These drugs have endocrine side effects, including galactorrhea secondary to hyperprolactinemia

Back 12

Typical antipsychotics (Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

They block DA effects, so prolactin loses its inhibition

Front 13

These drugs have side effects arising from blocking muscarinic (dry mouth, constipation), alpha (hypotension), and histamine (sedation) receptors

Back 13

Typical antipsychotics (Haloperidol, trifluperazine, fluphenazine, thioridazine, chlorpromazine)

Front 14

These are the atypical antipsychotics

Back 14

Clozapine, olanzapine, risperidone, aripiprazole ("It's not atypical for old closets to risper")

Front 15

Mechanism of action of atypical antipsychotics

Back 15

Block 5-HT2, alpha, H1 and DA receptors
(vs typicals, which block D2 and cholinergic receptors)

Front 16

This drug is also used for OCD, anxiety disorder, depression, mania, Tourette's

Back 16

Olanzapine
(atypical neuroleptic)

Front 17

This drug is notable for possibly causing agranulocytosis, and thus requires weekly WBC monitoring

Back 17

Clozapine

Front 18

T/F: Atypical neuroleptics have greater side effects than typical neuroleptics

Back 18

False. Atypicals have fewer extrapyramidal and anticholinergic side effecs than typicals.

Front 19

Side effects of Lithium

Back 19

Movement (tremor), nephrogenic DI, hypothyroidism, pregnancy problems (teratogen)

"L-M-N-O-P"

Front 20

Clinical uses of lithium

Back 20

Bipolar (stabilizes mood, blocks manic events). SIADH (recall that it causes nephrogenic DI as a side effect).

Front 21

T/F: The therapeutic window of lithium is narrow, so it requires close monitoring

Back 21

True.

Front 22

Mechanism of action of Buspirone

Back 22

Stimulation of 5-HT(1A) receptors
[serotonin agonist, like triptans]

Front 23

Clinical uses of buspirone

Back 23

GAD. Does not cause sedation or addiction. Does not interact with EtOH (vs. barbiturates, benzodiazepines)

Front 24

Mechanism of action of tricyclic antidepressants

Back 24

Block 5-HT and NE reuptake

Front 25

Clinical uses of TCA's

Back 25

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

Front 26

This TCA is used to treat bedwetting

Back 26

Imipramine

Front 27

This TCA is used to treat OCD

Back 27

Clomipramine

Front 28

These drugs have as their side effects urinary retention

Back 28

Tricyclic antidepressants
(increased SANS results in increased urinary sphincter contraction)

Front 29

This drug from this class is used to treat elderly patients because it has less anticholinergic side effects

Back 29

Nortriptyline. It has less anticholinergic effects; contrast to amitriptyline, which has greater anticholinergic effects

Front 30

Treatment for overdose of TCA's

Back 30

NaHCO3 (to treat CV toxicity)

Front 31

Side effects of TCA's

Back 31

Sedation, alpha-blocking effects, anticholinergic effects (tachycardia, urinary retention)

Front 32

This TCA is the least sedating

Back 32

Desipramine (least ACh effects)

Front 33

Overdose of TCA's results in these three things

Back 33

Convulsions, coma, cardiotoxicity (treat CV toxicity with NaHCO3)

"TCA" = "three 'C' adverse-effects"

Front 34

Mechanism of action of SSRI's

Back 34

5-HT reuptake inhibitors

Front 35

These are the tricyclic antidepressants

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Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine

Front 36

These are the SSRI's

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Fluoxetine, paroxetine, sertraline, citalopram

Front 37

How long does it take for antidepressants to have an effect?

Back 37

2-3 weeks

Front 38

Clinical uses of SSRI's

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Depression, OCD

Front 39

Toxicities of SSRI's

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GI distress, anorgasmia, serotonin syndrome

Front 40

This drug should not be given with SSRI's because it can precipitate this

Back 40

MAO inhibitors (and other drugs that increase 5-HT) should not be given with SSRI's because they cause Serotonin Syndrome

Front 41

Findings in serotonin syndrome (5)

Back 41

Hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea
(compare to carcinoid syndrome)

Front 42

This antidepressant is also used for smoking cessation

Back 42

Buproprion

Front 43

These are the antidepressants

Back 43

TCAs, SSRIs, MAO inhibitors, Buproprion, SNRI's (Venlafaxine, Duloxetine), Mirtazapine, Maprotiline, Trazodone

Front 44

Toxicity of buproprion

Back 44

Stimulant effects (tachycardia, insomnia), seizure. No sexual side effects

Front 45

This antidepressant is notable for not having sexual side effects

Back 45

Buproprion

Front 46

This antidepressant can cause seizures in bulimic patients

Back 46

Buproprion

Front 47

This antidepressant can also be used to treat GAD

Back 47

Venlafaxine (SNRI)

Front 48

Toxicity of venlafaxine and duloxetine

Back 48

Hypertension; also stimulant effects, sedation, nausea

Front 49

Mechanism of action of venlafaxine

Back 49

Inhibits 5-HT and NE reuptake
(SNRI)

Front 50

Mechanism of action of duloxetine

Back 50

SNRI, like venlafaxine: inhibits 5-HT and NE reuptake, but more effect on NE

Front 51

This drug is also indicated for diabetic peripheral neuropathy

Back 51

Duloxetine

Front 52

Mechanism of action of mirtazapine

Back 52

Alpha-2 blocker, thereby increasing release of NE and 5-HT; also a potent 5-HT2 and 5-HT3 receptor blocker
(Opposite of clonidine, which stimulates alpha-2 centrally; and triptans, which stimulate 5-HT(1A) receptors for the treatment of migraines)

Front 53

Toxicity of mirtazapine

Back 53

Weight gain, increased appetite, dry mouth, sedation
(alpha-2 blocker, therefore decreases negative feedback of SANS and increases NE, E transmission)

Front 54

Mechanism of action of Maprotiline

Back 54

NE reuptake blocker

Front 55

These antidepressants have as their side effects orthostatic hypotension

Back 55

Maprotiline (NE reuptake blocker), Trazodone (5HT reuptake blocker), Amitriptyline (NE and 5HT reuptake blocker)

Front 56

This drug has as its side effect priapism

Back 56

(Painful erection of penis.) Trazodone

Front 57

These are the MAO inhibitors

Back 57

Phenelzine, tranylcypromine

Front 58

Clinical uses of MAO inhibitors

Back 58

Atypical depression, anxiety, hypochondriasis
(prevents breakdown of monoamine NT's by MAO)

Front 59

Toxicity of MAO inhibitors

Back 59

Hypertensive crisis (with ingestion of tyramine, and with beta-agonists); CNS stimulation

Front 60

This drug is contraindicated with SSRI's or meperidine

Back 60

MAO inhibitors (precipitate serotonin syndrome)