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92 Cards in this Set

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Pharmacological treatment for: Alcohol withdrawal
Benzodiazepines
Pharmacological treatment for: Anorexia/bulimia
SSRIs
Pharmacological treatment for: Anxiety
1. Barbiturates
2. Benzodiazepines
3. Buspirone (for GAD, does not cause sedation or addiction, and does not interact with EtOH)
4. MAO inhibitors
5. Venlafaxine (SNRI, for GAD)
6. Olanzapine (an atypical antipsychotic)
Pharmacological treatment for: Atypical depression
MAO inhibitors
Pharmacological treatment for: Bipolar disorder
Mood stabilizers (Lithium, Valproic acid, Carbamazepines)
Pharmacological treatment for: Depression
1. SSRIs (endogenous depression)
2. SNRIs (when SSRIs are ineffective or neuropathic pain)
3. TCAs/Maprotiline (severe major depression)
4. MAO inhibitors (atypical depression or inability to use TCAs)
5. Bupropion
6. Mirtazapine
7. Trazodone/Nefazodone
8. Olanzapine (an atypical antipsychotic)
Pharmacological treatment for: Depression with insomnia
Trazodone and Mirtazapine
Pharmacological treatment for: OCD
1. Fluvoxamine (an SSRI)
2. Olanzapine (an atypical antipsychotic)
3. Clomipramine (a TCA)
Pharmacological treatment for: Panic disorder
TCAs and Buspirone
Pharmacological treatment for: Schizophrenia
1. Typical Neuroleptics
2. Atypical neuroleptics (for positive and negative symptoms)
Drug class: Thioridazine
Antipsychotics (Typical neuroleptic with low potency)
Drug class: Haloperidol
Antipsychotics (Typical neuroleptic with high potency)
Drug class: Fluphenazine
Antipsychotics (Typical neuroleptic with high potency)
Drug class: Chlorpromazine
Antipsychotics (Typical neuroleptic with low potency)
Drug class: Promethazone
Antipsychotics (Typical neuroleptic with low potency)
Drug class: Proclorperazine
Antipsychotics (Typical neuroleptic with low potency)
Drug class: Pimozide
Antipsychotics (Typical neuroleptic with high potency)
Drug class: Thiothixene
Antipsychotics (Typical neuroleptic with high potency)
Drug class: Aripiprazole
Antipsychotic (Atypical)
Drug class: Clozapine
Antipsychotic (Atypical)
Drug class: Olanzapine
Antipsychotic (Atypical)
Drug class: Quetiapine
Antipsychotic (Atypical)
Drug class: Risperidone
Antipsychotic (Atypical)
Drug class: Ziprasidone
Antipsychotic (Atypical)
Drug class: Citalopram
Selective Serotonin Reuptake Inhibitor
Drug class: Escitalopram
Selective Serotonin Reuptake Inhibitor
Drug class: Fluoxetine
Selective Serotonin Reuptake Inhibitor
Drug class: Fluvoxamine
Selective Serotonin Reuptake Inhibitor
Drug class: Paroxetine
Selective Serotonin Reuptake Inhibitor
Drug class: Sertraline
Selective Serotonin Reuptake Inhibitor
Drug class: Venlafaxine
Serotonin/Norepinephrine Reuptake Inhibitor
Drug class: Duloxetine
Serotonin/Norepinephrine Reuptake Inhibitor
Drug class: Bupropion
Atypical antidepressant
Drug class: Mirtazapine
Atypical antidepressant
Drug class: Nefazodone
Atypical antidepressant
Drug class: Trazodone
Atypical antidepressant
Drug class: Amitriptyline
Tricyclic Antidepressant
Drug class: Amoxapine
Tricyclic Antidepressant
Drug class: Clomipramine
Tricyclic Antidepressant
Drug class: Desipramine
Tricyclic Antidepressant
Drug class: Doxepin
Tricyclic Antidepressant
Drug class: Imipramine
Tricyclic Antidepressant
Drug class: Maprotiline
TETRAcyclic Antidepressant
Drug class: Nortriptyline
Tricyclic Antidepressant
Drug class: Protriptyline
Tricyclic Antidepressant
Drug class: Trimipramine
Tricyclic Antidepressant
Drug class: Phenelzine
Monoamine Oxidase Inhibitor
Drug class: Tranylcypromine
Monoamine Oxidase Inhibitor
Drug class: Carbamazepines
Mood stabilizer
Drug class: Valproic acid
Mood stabilizer
Drug class: Lithium salt
Mood stabilizer
Mechanism of neuroleptics
Most block dopamine D2 receptors (as excess dopamine effects are connected with schizophrenia)
Mechanism of Venlafaxine
Inhibits reuptake of serotonin (at all doses), norepinephrine(at high doses), and dopamine (mild)
Mechanism of lithium
Not established; possibly related to inhibition of PIP resynthesis leading to its relative depletion in neurons
Mechanism of buspirone
Stimulates 5-HT1A receptors
Mechanism of SSRIs
Selective serotonin reuptake inhibition, leading to down regulation of presynaptic inhibitory receptors, leading to increased release of neurotransmitter, leading to therapeutic response.
Mechanism of tricyclic antidepressants
1. Nonselectively inhibit reuptake of norepinephrine and serotonin (beneficial)
2. Block serotonergic, alpha-adrenergic, histaminic, and muscarinic receptors (not beneficial)
Mechanism of clozapine
Blocks D2 like normal neuroleptic, but also blocks 5HT2 as well as D1, D4, muscarinic, and alpha-adrenergic receptors.
Mechanism of risperidone
Blocks 5HT2 receptors more than D2 receptors
Mechanism of aripiprazole
Partial agonist of D2 and 5HT1A receptors, and blocks 5HT2A receptors.
Mechanism of bupropion
Unknown
Mechanism of mirtazapine
Alpha2 antagonist (increasing release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist
Mechanism of duloxetine
SNRI. Inhibits reuptake of serotonin and norepinephrine at all dose.
Mechanism of nefazodone and trazodone
Block 5-HT1 presynaptic autoreceptors, thereby increasing serotonin release. Weak inhibitors of serotonin re-uptake.
Mechanism of MAO inhibitors
Irreversibly inhibits monoamine oxidase which normally inactivates monoamines such as NE, 5-HT, and DA that leak out of presynaptic vesicles. MAO inhibitors allow these leaky molecules to accumulate and activate post synaptic response.
Pharmacological treatment for: Psychosis
1. Typical neuroleptics
Pharmacological treatment for: Acute mania
1. Typical neuroleptics
2. Olanzapine
3. Lithium (relapse and treatment)
Pharmacological treatment for: Tourette syndrome
1. Typical neuroleptics
2. Olanzapine
Pharmacological treatment for: Bedwetting
1. Imipramine (a tricyclic antidepressant)
Pharmacological treatment for: Hypochondriasis
1. MAO inhibitors
Antidepressants which have adverse effect of GI distress
SSRIs: all

SNRIs: all

Atypical: Nefazodone

Tricyclic: Clomipramine

MAO inhibitors: none
Antidepressants which have adverse effect of sedation
Note: useful effect if agitated

SSRIs:
1. Fluvoxamine
2. Paroxetine

SNRIs: none

Atypical: All except bupropion

Tricyclic: All except desipramine and protryptiline

MAO inhibitors: none
Antidepressants which have high potential for orthostatic hypertension
SSRIs: none

SNRIs: none

Atypical: none

Tricyclic:
1. Amitriptyline
2. doxepin

MAO inhibitors: All
Antidepressants which have adverse effect of weight gain
SSRIs: none

SNRIs: none

Atypical: Mirtazapine

Tricyclic: (so big you need a DICTAphone to type)
1. Doxepin
2. Imipramine
3. Clomipramine
4. Trimipramine
5. Amitriptyline

MAO inhibitors: none
Toxicities of typical neuroleptics
1. Extrapyramidal dopamine side effects
2. Endocrine dopamnine side effects (dopamine receptor antagonism leading to hyperprolactinemia leading to gynecomastia)
3. Blocking muscarinic receptors (dry mouth, constipation)
4. Blocking alpha-adrenergic receptors (hypotension)
5. Blocking histamine receptors (sedation)
6. Neuroleptic malignant syndrome
7. Tardive dyskinesia
Describe neuroleptic malignant syndrome.
Neuroleptic malignant syndrome can cause you HARM

1. Hyperpyrexia
2. Autonomic instability
3. Rigidity
4. Myoglobinuria
How is neuroleptic malignant syndrome treated?
Dantrolene or dopamine agonists (bromocriptine)
Describe tardive dyskinesia and what causes it?
Long-term antipsychotic use leads to dopamine receptor sensitization which causes stereotypic oral-facial movements
Mechanism and treatment for extrapyramidal side effects
Blocking of dopamine's inhibitory effects causes excess stimulation by acetylcholine. Treat wth anticholinergic drugs like thioridazine.
Toxicities of atypical neuroleptics
Weight gain. Clozapine may cause agranulocytosis. (Requires weekly WBC monitoring.) Fewer extrapyramidal and anticholinergic side effects than typical neuroleptics.
Which atypical neuroleptic can cause agranulocytosis?
Clozapine (requires weekly WBC monitoring)
Toxicities of lithium
Mnemonic: LMNOPP (prounounced "pee-pee")

Lithium side effects
1. Movement (Tremor)
2. Narrow therapeutic window
3. hypOthyroidism
4. Pregnancy problems (Teratogenesis)
5. Polyuria as lithium is ADH antagonist, leading to nephrogenic diabetes insipidus
Toxicities of SSRIs
1. GI distress
2. Sexual dysfunction (anorgasmia)
3. Serotonin syndrome (with MAO inhibitors)
What is serotonin syndrome?
Excess serotonergic activity caused by use of both SSRIs and MAO inhibtiors
1. Hyperthermia
2. Muscle rigidity
3. Cardiovascular collapse
Side effects and toxicities of tricyclic antidepressants
TCAs mess you up. Make you a stuttering SHAARCCC
1. Sedation
2. Hyperpyrexia
3. alpha-blocking effects
4. atropine-like (anticholinergic) effects (tachycardial, urinary retention, confusion and hallucinations in elderly)
5. Respiratory depression

and the Tri-C's:
6. Convulsions
7. Coma
8. Cardiotoxicity (arrhythmias)
Treatment for confusion and hallucinations in elderly on tricyclic antidepressants
Due to anticholinergic activity. Use nortriptyline instead.
Toxicities of bupropion
1. Stimulant effects (tachycardia, insomnia)
2. Headache
3. Seizure in bulimic patients
Toxicities of venlafaxine
Things have trouble going down your SINCS (GI distress)

1. Stimulant effects
2. Increased blood pressure
3. Nausea
4. Constipation
5. Sedation
Toxicities of mirtazapine
1. Sedation
2. Increased appetite
3. Weight gain
4. Dry mouth
Toxicities of Maprotiline
1. Sedation
2. Orthostatic hypotension
Toxicities of Trazodone
1. Sedation
2. Nausea
3. Priapism
4. Postural hypotension
Toxicities of MAO inhibitors
1. Hypertensive crisis with tyramine ingestion and meperidine
2. CNS stimulation
3. Serotonin syndrome (when coadministered with SSRIs or beta-agonists)
4. Increased risk of orthostatic hypotension