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236 Cards in this Set
- Front
- Back
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Antipsychotic medications |
f |
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What do old drugs attach to?
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D2 |
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Newer drugs bind to what?
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D4
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What do old drugs S/E?
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block muscarinic receptors: dry mouth, blurry vision, urinary retention, confusion, hallucination
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What other Symp. Do you expect with histamine block?
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sedation and weight gain
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What symp. Do you get with alpha block?
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orthostatic hypotension
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What are the older antipsychotics?
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f |
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What antipsychotic gives your retinitis pigmentosa?
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thioridizine eye
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What happens when you block the mesolimbic tract?
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reduce psychotic symptoms
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What happens when you block nigrostriatal block?
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increase tremors, parkinsons EPS symptoms!
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What tract does clozapine block?
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Mesolimbic Tract
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What does a block in the tuberoinfundibilar block?
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no galactorrhea, gynecomastia, amenorrhea
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Pat. w/ psychotic, what tx?
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olanzapine (atypical any)
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If all other drugs fail what is next tx?
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clozapine (agranulocytosis be careful)
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If pat. Is noncompliant?
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1st choice haloperidol or fluphenazine depot decanoid form
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Pat. Is agitated?
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use IM forms (typicals)
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How do antipsychotic medication work?
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block dopamine receptors
old D2 new D4 |
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What do new antipsychotics work as well as D4?
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they work on serotonin as well
5HT3 |
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What are some other effects of antipsychotics?
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1) block central and peripheral cholinergic receptors
2) histaminic block 3) alpha-block |
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What are the symptoms of muscarinic block?
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urinary retention
dry mouth blurry vision constipation confusion hallucinations |
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If you are going to prescribe to the elderly what do you avoid?
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avoid drugs w/ muscarinic block
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Where do new antipsychotics work on?
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D4 more and also serotonin 5HT3
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What do antipsychotics block?
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muscarinic block, alpha block, histamine block
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What is an important S/E of antipsychotics?
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sedation and weight gain (histamine blockade)
hypotension (alpha block) dry mouth, urinary retention, constipation, confused, blurry vision (muscarinic block) |
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Where do antipsychotics work on?
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Dopamine
D2 and D4 receptors Old work on D2 new on D4 |
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What are the side-effects of histamine blockade?
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weight gain and sedation
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What do you find with alpha blockade?
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hypotension
so be careful on the elderly they might fall and break a hip |
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Main groups for antipsychotics?
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typicals D2 antagonists only low-potency: Clopromazine
High-potency: Haloperidol old drugs D2: Haloperidol, Thioridazine, Olanzapine, fluphenazine new drugs Risperidone |
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Of the newer drugs, which one of these cause movement side effects of antipsychotics? EPS symptoms?
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Risperidone is the answer
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WHat are the multiple receptor antagonist work on?
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D2, D4 and Serotonin 5HT
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What are the new antipsychotics multiple receptors?
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clozapine
olanzapine quetiapine |
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What does the D2 blockade cause?
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EPS symptoms
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What decreases EPS symtpoms?
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D4 receptors
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What are the indications of antipsychotics?
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E.R.
patients get agitated |
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Which one in the E.R. antipsychotics?
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Haloperidol
since it comes in I.V. high-potency easier to give them a shot |
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DOC for schizophrenia?
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antipsychotics
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Tx for agitation for schizophrenia, mood disorders, psychoses, delusional disorders, brief psychotic disorders, schizophreniform disorder?
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antipsychotics
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Why do you avoid giving elderly diazepine?
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makes them more confused
problems with their memory |
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What is another name for Dopamine?
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Prolactin Inhibitory Factor
PIF |
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What happens when you inhibit dopamine with antipsychotics?
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PIF is not there
so prolactin goes up |
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What happens when prolactin goes up?
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galactorrhea, gynecomastia, amenorrhea
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What does dopamine block?
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tuberoinfundibular tract
mesolymbic/mesocortical tract nigrostriatal tract all involved |
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What happens when you block tuberoinfundibular block?
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prolactin increases
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What are other S/E of the older antipsychotics?
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photosensitivity
Retinitis pigmentosa |
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What antipsychotics produces retinitis pigmentosa?
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thioridizine
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What are other problems with thioridazine?
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cardiac conduction problems
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WHat are S/E of clozapine?
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agranulocytosis
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What happens when dopa blocks mesolymbic tract?
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reduce psychotic symptoms
decrease psychosis |
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What happens when you block nigrostriatal tract?
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increase in movement disorders
tremors, parkinsonian disease |
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WHat does clozapine block?
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mesolimbic
no EPS (nigrostriatal) no amenorrhea, no galatorrhea, no gynecomastia (tuberinfundibular) |
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Does clozapine cause amenorrhea, galactorrhea, gynecomastia, EPS symptoms?
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NO!
only blocks mesolimbic tract reducing psychosis |
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What are the types of movement disorders?
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acute dystonia
parkinsonisms tardive dyskinesia |
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Which movement disorder is the first one to appear?
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acute dystonia
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When does acute dystonia appear?
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occurs within hours or days of treatment
patients get really scared |
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Why do patients get scared with acute dystonias?
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its a muscle spasms
cant' move |
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What happens to Ach when Dopamine is high?
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Ach decreases
antagonists |
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What are first choice drugs of psychosis?
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Olanzapine, Quetiapine, Ziprasidone
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What are the S/E of Olanzapine, quetiapine, ziprasidone?
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Weight gain and sedation
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What is the S/E of clozapine?
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agranulocytosis
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What are the S/E of ziprasidone?
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prolongation of QT interval
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What patients have a contraindication of ziprasidone?
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arrythmias
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What are the S/E of Olanzapine and Clozapine?
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Cause Diabetes
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What patients have a contraindication of Olanzapine/Clozapine?
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DM
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What antipsychotics are used to tx non-compliant patients?
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haloperidol and fluphenazil
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Why do haloperidol and fluphenazil are prolonged in their action?
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they have the decanoid form
I.M. deposit |
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Is Tardive Diskinesia reversible or irreversible for Step 2 USMLE?
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Irreversible
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Antidepressants are used to Tx what?
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Mood disorders, adjustment disorders, psychotic disorders
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What are other uses for antidepressants?
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anxiety disorders
bulemia |
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Why is anxiety treated with antidepressants?
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use same neurotransmitter
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What percentage of pat. w/ depression have anxiety?
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90% of the patients have anxiety w/ depression
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Why are antidepressants used to tx bulemia?
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act on same neurotransmitter
serotonin |
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Why do antidepressants work on impulse control disorders?
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serotonin
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What are amytriptiline of TCA (triciclics) commonly used for?
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Enuresis
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If the patient has depression he will surely have?
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anxiety
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What is used for chronic pain?
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amytriptiline
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Why is amytriptiline used for chronic pain?
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amytriptiline increases endorphins
increase endogenous opiates patients complain less of pain |
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Which ones are dangerous in OD?
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specially TCA
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Pat. comes after OD of TCA, what do they need to be attached to?
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cardiac monitor
causes conduction problems |
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What is the effect/toxicity of TCAs Overdose?
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heart conduction problems
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How do TCAs work?
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block the reuptake of neurotransmitter (serotonin and NE, and dopamine)
work by down regulation of beta adrenagic receptors |
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How do the MAO inhibitors work?
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work on the enzyme that metabolizes Sertonin, NE, Dopa
doesn't break down the neurotransmitters so more NE, Ser, DOPA |
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Where do the SSRIs work?
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they only block the reuptake of serotonin
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Why do you choose an SSRI instead of TCA or MAO?
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because of less S/E
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What is the first line of antidepressants?
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SSRIs
cleaner, pat. like it, less S/E |
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What other receptors are blocked w/ TCAs?
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muscarinic receptors are blocked
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What do you expect w/ the TCA muscarinic block?
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sedation
dry mouth blurry vision urinary retention |
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What are other two receptors that TCA block?
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Histamine and alpha receptors
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What happens when you give TCAs and block alpha receptors?
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hypotension
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What happens when you give TCAs and block histamine?
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sedation and weight gain
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Which TCA is the worst cause it gives you the most S/E?
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amytriptiline
takes you on a bad trip! |
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What patient would be a relative contraindication for giving him amytriptiline?
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90 yo, demented, w/ glaucoma, and prostathic hyperthrophy...
why? hypotension, urinary retention, blurry vision (might fall) |
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TCA stands for?
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T for upTake blocker
T is for hisTamine blocker C is for musCarinic blocker A is for alpha blocker |
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Which drugs are the fasest of the TCAs?
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nortryptiline and disipramine
less S/E |
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What are antidepressants used for?
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Tx: depression,
- depression in Bipolar Dis. - ALL anxiety dis. |
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What is the efficacy of antidepressants?
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70%
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Which drugs are used first?
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Newer ones
SSRIs |
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Which antidepressants are more dangerous?
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usually older ones
TCAs more S/E |
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How long do we keep patients before we know the antidepressants are working?
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they start working until 4-6 weeks
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What is the MCC of drug failure?
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the time doctors try the drugs less than 4-6 weeks.
Need to maximize doze and maximize dose switching |
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When do you stop antidepressants?
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if S/E are not tolerated by patient
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If you have a patient not responding you need to give another medication in order to boost 1st antidepressants?
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Lithium or Thyroxine
or even Amphetamine like drugs |
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HOw long do we keep patients on antidepressants?
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Tx should continue for 6 months to 1 year
since they relapse |
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What antidepressant drugs cause the most sedation?
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Doxapine, amytriptiline, trazodone
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What is the use of doxapine and trazodone?
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give it to patients at night so they can sleep
causes sedation (antidepressant) |
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Which antidepressants cause less sedation?
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Cleaner ones, newer less S/E
Desipramine, protrityline and SSRIs |
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Which antidepressant causes most Hypotension?
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TCAs
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Which TCA causes the most hypotension?
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amytriptiline
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Which is Best TCA for antidepressants?
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Nortriptyline and Desipramine
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Which antidepressant drug has the worst anticholingergic?
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amytriptyline
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Which antidepressant has less anticholinergic effects?
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nortriptyline and desipramine
also SSRIs since they only work on serotonin |
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What do you have to remember about the TCAs and the heart?
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prolong the QRS interval
need to do a EKG |
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What is the effects of antidepressant and seizures?
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lower the seizure threshold
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Which TCA causes the most seizures?
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maprotaline
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Does bupoprion cause seizures?
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no
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Do women with bulemia have a high incidence of seizures?
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yes
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Do antidepressants cause sexual dysfunction?
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yes all of them cause
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What are the sexual dysfunction S/Es caused by antidepressants?
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anorgasmia
decrease libido delayed ejaculation priapism |
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What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation
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SSRIs
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What antidepressant causes priapisms?
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trazodone
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Which one of the SSRIs causes less sexual dysfunction?
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citalopram
bupoprion |
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What is priapism?
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prolonged and painful erections
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What are the sexual dysfunction S/Es caused by antidepressants?
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anorgasmia
decrease libido delayed ejaculation priapism |
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What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation
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SSRIs
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What antidepressant causes priapisms?
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trazodone
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Which one of the SSRIs causes less sexual dysfunction?
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citalopram
bupoprion |
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What is priapism?
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prolonged and painful erections
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What are the SSRIs?
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Fluoxetine
Paroxetine Sertraline Fluvoxamine Citalopram |
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SSRI with least sexual S/E?
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citalopram
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Why are SSRIs used to Tx OCD?
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serotonin involved
panic as well as bulemia |
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What are the S/E of SSRIs?
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patient agitation
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What do you tell a patient that gets agitated when takin SSRI?
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tell them to take it at night
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What if a pat. feels sedation of SSRIs?
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take the SSRI at night to take advantage of the S/E
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What are all the S/E of SSRI?
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agitation
sedation diarrhea nausea sexual dysfunction |
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What is trazodone called?
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heterocyclic antidepressant
off shoot of TCA family used for its sedation effect used in insomnia |
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Where does fenazodome works?
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NE and serotonin
more like an SSRIs |
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What is bupoprion used for tx what age patients? |
older patients less S/E
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What neurotransmitter is involved when using Bupoprion?
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dopamine
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What is bupoprion similar to?
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Zyban
used as Wellbutrin dose is different |
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Why is dopamine associated with smoking sessation?
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Dopamine is linked to reward centers
endorphins decrease the pleasure |
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What is bupoprion use to Tx?
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smoking sessation
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What drug blocks the pleasure of alcohol?
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naltrexone
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What is venlafaxine similar to?
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SSRI
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What is mirtazapine similar to and S/E?
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SSRI
lots of Sedation |
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What are TCAs divided into?
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tertiary and secondary
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What are the teriary TCAs?
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imipramine
amitriptyline doxepin clomipramine trimipramine |
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What are the secondary TCAs?
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desipramine
nortriptyline protriptyline |
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What happens when imipramine is broken down from its tertiary form?
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it converts into its active form desipramine secondary form
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When amitriptyline breaks down, what does it form?
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nortriptyline
the secondary active form |
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Which ones are cleaner talking about S/E between tertiary and secondary?
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secondary don't have that many S/E since they are the active form of the drug
no intermediates less S/E |
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What is a problem for all TCAs?
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they have a therapeutic window
the drug has to fall within range to be effective |
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What is the efficacy of TCA drugs?
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mood disorders
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Which drug can be used to tx panic?
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imipramine
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What is clomipramine used for?
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OCD
works most on serotonin |
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What is amytriptyline used for?
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Chronic Pain
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Why are MAOIs are not used in a regular basis?
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Can't eat foods rich in Tyramine
will cause a reaction of increase blood pressure |
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What foods should you avoid if taking MAOIs?
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- red wine
- aged cheeses - chocolate - sausages - nuts - pickled products - herring white wine ok, processed cheeses ok |
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What is the best tx for depression?
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ECT
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Is ECT the MC tx for depression?
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no
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Why is ECT not used as first line for depression?
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nobody wants ECT
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When is ECT prescribed?
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severely depressed/suicidal tendencies
1)patient still tries to kill himself 2) patient has not responded on TCA,MAIO, Lithium, Amphetamine like drugs |
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Is ECT used only for depression?
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no, also:
schizophrenia |
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In synthesis when do you use ECT?
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typically when all other conventional therapies have failed
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Are there any absolute contraindications of ECT use?
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none
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What is the only situation you have to be careful with the use of ECT?
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only in a case of increase intracraneal pressure
since ECT increase pressure |
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What is another case in a pat. w/ depression which you might be inclined to use ECT?
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when the pat. has received ECT previously w/ success
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What is the only problem w/ ECT?
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some memory loss
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What is the characteristic of the memory loss w/ ECT?
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transient
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What does transient memory loss mean?
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when the Tx is over, your memory comes back
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What are some of the complications of ECT?
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anesthesia
induced paralysis |
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Do you need a seizure in order for ECT to work?
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no
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What is the typical course of ECT?
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10-15 treatments
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What tests are done before ECT administration?
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CT-scan
rule out tumors that increase intracraneal pressure x-rays of bodies (fractures that haven't healed) |
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WHat are the mood stabilizer medications?
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lithium (bipolar)
divalproex carbamazepine topiramate lamotrigine gabapentine |
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What are some of the symptoms treated w/ mood stabilizers?
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Bipolar
impulse control disorder violence/agitation/agression/impatience |
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What are the indications of lithium?
|
bipolar disorder
schizoaffective disorders also mood disorders (augment response to medication) |
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What is lithium not perfect?
|
Has a narrow margin or safety
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What does narrow margin of safety mean?
|
constantly have to monitor lithium in blood
check blood levels since it could become toxic/lethal |
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What is the most common S/E of lithium?
|
tremor, shaking
diarrhea headaches worsen acne gain weight conduction problems |
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What test is essential to perform before administering lithium?
|
TSH before starting lithium
|
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What are the indications of lithium?
|
bipolar disorder
schizoaffective disorders also mood disorders (augment response to medication) |
|
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What is lithium not perfect?
|
Has a narrow margin or safety
|
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What does narrow margin of safety mean?
|
constantly have to monitor lithium in blood
check blood levels since it could become toxic/lethal |
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What is the most common S/E of lithium?
|
tremor, shaking
diarrhea headaches worsen acne gain weight conduction problems |
|
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What test is essential to perform before administering lithium?
|
TSH before starting lithium
|
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What are other major S/E of Lithium?
|
leukocytosis
polyuria polydipsia Nephrogenic DI |
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What is the most important S/E for Lithium?
|
teratogenic
cardiac malformations |
|
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What are the teratogenic effects of lithium on the fetus?
|
cardiac malformations
epsteins anomaly (tricuspid valve affected) |
|
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What test do you give a woman that is young and needs to start lithium Tx?
|
Test pack
pregnancy test |
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What advice do you give the female patient if they are on lithium?
|
make sure not to get pregnant while on lithium
- if she does get pregnant she should stop lithium immediately |
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What is the therapeutic index of lithium?
|
0.6-1.3 or 1.5
you should keep it at 1 the higher the dose, the higher the S/Es |
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What is a recommendation to ALL patients on Lithium?
|
drinks lots of fluids
- if pat. becomes dehydrated, then toxic levels may accumulate in plasma hyponatremia increases toxicity lithium follows sodium |
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What is the Tx of Choice for Lithium at toxic levels above 2.0?
|
Dialysis
|
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What are some S/E of lithium at hight doses?
|
Seizures/Coma
Ataxia |
|
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What is one of the first indications that lithium levels are high?
|
gait disturbances (Ataxia)
|
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What is valproex used for?
|
bipolar
rapid cyclers (within days) mania/depression |
|
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When do you use valproex?
|
- when lithium is not working
- when lithium is contraindicated (ie. thyroid disease) |
|
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How many days does valproex take to reach desired effect?
|
10-14 days
|
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What are the S/E of divalproex?
|
sedation
cognitive impairment tremors (like lithium) GI disturbances |
|
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What is the difference in toxicity of valproex?
|
hepatotoxicity
lithium (nephrotoxic) |
|
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What test do you request before administering divalproex?
|
liver function tests
hepatic function panel |
|
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What is the teratogenicity of valproex?
|
Spina Bifida
shape of the letter V |
|
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What is second line of bipolar?
|
carbamazepine
also valproate (divalproex) |
|
|
Tx of Choice for bipolar disorder?
|
Lithium
(if lithium not there divalproex) last resort carbamazepine |
|
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What toxicity does carbamazepine produce?
|
hepatic toxicity
|
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What are S/E of carbamazepine?
|
rashes
agranulocytosis |
|
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What are two drugs that cause agranulocytosis?
|
carbamazepine and clozapine
escarba colcha y cloza |
|
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What are the other mood stabilizers?
|
lamotrigine
gabapentin topiramate not as effective |
|
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What is different about topiramate?
|
helps patients reduce weight
|
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Pat. comes in w/ mania... tx?
|
mood stabilizer
lithium if not divalproic acid |
|
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If a pat. has acute mania (emergency) can't wait two weeks to calm him down?
|
benzodiazepines
antipsychotic |
|
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What are the anxiolytics?
|
benzodiazepines
|
|
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MOA of axiolytics/benzodiazepines?
|
work on GABA receptors
open Cl- channels increaseing the frecuency |
|
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What are other uses of benzodiazepines other than anxiety?
|
insomnia specially in the elderly
|
|
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Where does buspirone work?
|
buspirone maybe works on serotonin
|
|
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What is buspirone used for?
|
Generalized Anxiety Disorder (GAD)
Social Phobias |
|
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What is the Tx. for adjustment disorder? anxious
|
benzos w/ psychotherapy
|
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What is the Tx. for Panic Disorder? anxiety
|
Benzos, SSRIs
|
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What is the Tx. of OCD?
|
SSRIs
|
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What is MC used for social phobias?
|
SSRIs
|
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What do you adjust with the elderly on Tx. w/ benzos?
|
lower the dosage
sedation, memory problems, confusion |
|
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What DDI (drug drug interaction) is lethal w/ benzos?
|
alcohol
potentiates benzos respiratory arrest (diaphragm paralisis) |
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What is the problem with taking benzos?
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Very Addictive
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What are the S/Es of benzos?
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sedation, memory problems, confusion
impairment of cognitive and motor performance abuse possible teratogenicity |
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Is buspirone addictive?
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no
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What is buspirone the DOC for?
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GAD (generalized anxiety disorder)
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Pat. alcoholic that needs to be placed on anti-anxiety medication?
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then better to place him on buspirone since not addictive/no withdrawal symptoms
pat. is going to drink and might have DDI w/ benzo+alcohol |
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What is the only S/E of buspirone?
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cabezon
complain some patients headache |
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Tx for Depression? A) fluoxetine or b) nortriptiline?
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fluoxetine
WHY? SSRI |
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Tx for Depression?
Nortryptiline or Amytriptiline? |
Nortriptyline
less S/E safer |
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Pat. w/ bipolar disorder who has kidney problems?
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not lithium
but valproic acid (metabolized in liver) |
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What 3 test do you ask for if patient needs to start lithium?
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Pregnancy Test
Thyroid (TSH) Kidney function regular blood work |
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Tx for panic disorder? general and specific...
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any benzos but specifically alprazolam
ALPRAZOLAM (ZANAX) |
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What drug is used for the prevention of alcohol withdrawal?
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benzo...
chlordiazepoxide (taper dose) |
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What other drug besides chlordiazepoxide is used on alcohol withdrawal?
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safe detox with oxazepam
(out the liver) |
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Which benzo doesn't go through CP450?
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OTL out the liver
oxazepam temazepam lorazepam |
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Pat. comes in w/ alcohol abuse, while in E.R. he becomes agitated? What benzo do you use?
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Oxazepam, temazepam, or lorazepam
lorazepam is I.V. or I.M. |
