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70 Cards in this Set
- Front
- Back
Rx for anorexia/ bulimia
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SSRIs
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Rx for anxiety (4)
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Benzos
Buspirone SSRIs Venlafazine (SNRI) |
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Rx for ADHD (2)
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Amphetamines
Methylphenidate (Ritalin) |
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Rx for atypical depression (2)
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MAOIs
SSRIs |
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Rx for depression with insomnia
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Mirtazapine
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Rx for OCD (2)
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SSRIs
Comipramine |
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Rx for panic disorder (3)
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SSRIs
TCAs Benzos |
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Rx for Tourette's syndrome
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Antipsychotics (haloperidol)
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Rx for social phobias
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SSRIs
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5 antipsychotics (typical)
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Haloperidol + azines (trifluoperazine, fluphenazine, thioridazine, chlorpromazine)
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Mechanism of typical antipsychotics
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Block dopamine D2 receptors, increasing cAMP
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4 clinical uses of antipsychotics (neuroleptics)
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Schizophrenia (primarily positive symptoms, as they may exacerbate negative symptoms)
Psychosis Acute mania Tourette's syndrome |
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Which antipsychotics are high potency, and which are low potency?
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High: haloperidol, trifluoperazine, fluphenazine
Low: thioridazine, chlorpromazine |
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High potency antipsychotics have ___ side effects, while low potency antipsychotics have _____
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Neurologic side effects (extrapyramidal symptoms)
Non-neurologic (anticholinergic, antihistamien, and alpha blockade) |
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Evolution of extrapyramidal side effects
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Dystonia (spasm, stiffness)--> akinesia (parkinsonism)--> akathisia (restlessness)-->
tardive dyskinesia (4 hrs, days, weeks, months) |
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Treat EPS with?
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Bentropine or trihexyphenidyl
(other drugs for Parkinsonism can exacerbate psychosis) |
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What is tardive dyskinesia?
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Sterotypic oral-facial movements
Often irreversible |
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Endocrine side effects of antipsychotics
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Dopamine receptor antagonist --> hyperprolactinemia --> galactorrhea (worst with risperidone, an atypical antipsychotic)
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Side effects of antipsychotics from block muscarinic, alpha, and histamine receptors
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Dry mouth/ constipation
Hypotension Sedation |
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Clinical sequelae of neuroleptic malignant syndrome (NMS)
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FEVER
Fever Encephalopathy Vitals unstable (autonomic instability) Elevated enzymes Rigidity of muscles (and myoglobinuria) |
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Treatment of neuroleptic malignant syndrome
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Dantrolene
Agonists (e.g. bromocriptine) |
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6 atypical antipsychotics
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Olanzapine
Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone |
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Atypical antipsychotics block these 4 receptor types
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5-HT2
Dopamine Alpha H1 |
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Drug of choice for both positive and negative symptoms of schizophrenia?
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Atypical antipsychotics (better side effect profile)
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Olanzapine used for (besides schizophrenia) (5)
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OCD
Anxiety Depression Mania Tourette's |
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Two atypical antipsychotics that may cause significant weight gain
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Olanzapine
Clozapine |
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Clozapine has these 2 serious side effects
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Agranulocytosis (monitor WBC weekly)
Seizures |
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Best treatment for bipolar disorder
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Mood stabilizers (lithium, and antiepileptics, e.g. valproic acid, carbamazepine, and lamotrigine)
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Other than bipolar, lithium is also used to treat
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SIADH
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Side effects of Lithium
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LMNOP
Movement (tremor) Nephrogenic diabetes insipidus (polyuria and polydipsia, b/c is an ADH antagonist) hypOthyroidism Pregnancy problems (causes Ebstein anomaly and malformation of great vessels) Also sedation, edema, and heart block |
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Buspirone is used for
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Generalized anxiety disorder
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Buspirone stimulates ____ receptors
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5-HT-1A
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Advantage of buspirone over barbiturates/ benzos
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Doesn't interact w/ alcohol
No sedation/ addiction/ tolerance |
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Buspirone is also used for
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Smoking cessation
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7 tricyclic antidepressants (TCAs)
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Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
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Mechanism of TCAs
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Block reuptake of NE and serotonin
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3 uses of all TCAs
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Major depression
Fibromyalgia Diabetic neuropathy |
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Additional clinical use of imipramine
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Bedwetting
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Additional clinical use of clomipramine
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OCD
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3 main side effects
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Sedation (from histamine blockade)
Orthostatic hypotension (from alpha blockade) Anticholinergic (tachycardia, urinary retention) |
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More anticholinergic effects with ____ TCAs than ____
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3rd generation (amitriptyline) than 2nd generation (nortriptyline)
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Least sedating and lowest seizure threshold of the TCAs?
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Desipramine
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5 main toxicities of TCAs
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Convulsions
Coma Cardiotoxicity (arrhythmias) Respiratory depression Hyperpyrexia |
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Toxicity of TCAs in elderly
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Confusion and hallucinations from anticholinergic side effects (so use 2nd generation, like nortriptyline, which has fewer anticholinergic side effects)
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Treatment of CV toxicity for TCAs?
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NaHCO3
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4 SSRIs
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Fluoxetine
Paroxetine Sertraline Citalopram |
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4 uses of SSRIs
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Depression
OCD Bulimia Social phobias |
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3 toxicities of SSRIs
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GI distress
Sexual dysfunction (anorgasmia) Serotonin syndrome |
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Symptoms of serotonin syndrome
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Hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures
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Rx for serotonin syndrome
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Cyproheptadine (5-HT2 receptor antagonist)
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2 SNRIs
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Venlafaxine
Duloxetine |
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Other than depression, venlafaxine is indicated for ? and duloxetine is indicated for?
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Generalized anxiety disorder
Diabetic peripheral neuropathy |
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Most common toxicity of SNRIs
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HTN (monitor)
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Other toxicities of SNRIs
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Stimulant effects, sedation, nausea
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4 MAOIs
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Phenelzine
Tranylcypromine Isocarboxazid Selegiline (selective for MAO-B) |
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Mechanism of MAO inhibitors
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Increase levels of amine neurotransmitters (NE, serotonin, dopamin)
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3 uses of MAOIs
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Atypical depression
Anxiety Hypochondriasis |
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MAOIs can cause a _____ crisis
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Hypertensive (with ingestion of tyramine, e.g. from wine and cheese, or with beta agonists)
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MAOIs are contraindicated with
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SSRIs or meperidine (to prevent serotonin syndrome)
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4 atypical depressants
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Bupropion, mirtazapine, maprotiline, and trazodone
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Bupropion is a ?
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NDRI (increases NE and dopamine)
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Bupropion is also used for
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Smoking cessation
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Side effects of bupropion (3)
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Stimulant effects (tachycardia, insomnia)
Headache Seizure (in bulimic pts) |
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Advantage of the side effect profiles of bupropion and mirtazapine?
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No sexual side effects
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2 mechanisms of mirtazapine
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Alpha-2 antagonist (increasing release of NE and serotonin)
5HT2 and 3 receptor antagonist |
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Toxicity of mirtazapine
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Sedation, increased appetite, weight gain
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Mechanism of maprotiline
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Blocks NE reuptake
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Toxicity of maprotiline (2)
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Sedation
Orthostatic hypotension |
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Trazodone: mechanism and use
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Primarily inhibits serotonin reuptake
Used for insomnia (high doses needed for antidepressant effects) |
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4 toxicities of trazodone
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Priapism (painful prolonged erection)
Postural hypotension Sedation Nausea |