Psychiatry: Pharmacology

Front 1

Tx for etoh withdrawl?

Back 1

benzos

Front 2

Tx for anorexia/bulimia?

Back 2

SSRIs

Front 3

Tx for anxiety?

Back 3

benzos, barbs, buspirone, maois

Front 4

Tx for atypical depression?

Back 4

maoi's

Front 5

Tx for bipolar d/o?

Back 5

lithium, valproic acid, carbamazepines

Front 6

Tx for depress?

Back 6

SSRIs, TCAs

Front 7

Tx for depress w/insomnia?

Back 7

trazodone, mirtazapine

Front 8

Tx for OCD?

Back 8

SSRIs

Front 9

Tx for panic d/o?

Back 9

TCAs, buspirone

Front 10

Tx for schizophrenia?

Back 10

antipsychotics

Front 11

list antipsychotics

Back 11

thioridazine, haloperidol, fluphenazine, chlorpromazine

Front 12

low potency antipsychotics:

Back 12

thioridazine, chlorpromazine

Front 13

high potency antipsychotics:

Back 13

haloperidol, fluphenazine

Front 14

antipsychotic mech of action?

Back 14

block D2 (DA) receptors

Front 15

clinical use of antipsychotics?

Back 15

schizophrenia, psychosis, acute mania, tourettes

Front 16

Antipsychotic side effects?

Back 16

extrapyramidal system (EPS) SEs, endocrine SEs (eg hyperprolac -> amenor, galactor, infertility), muscarinic blockade (dry mouth, constipation, blurred vision, urinary reten), alpha blockade (hypotens), histamine blockade (sedation), neuroleptic malignant syndrome, tardive dyskinesia

Front 17

which side effects are predominant for low potency antipsychotics?

Back 17

non-EPS SEs

Front 18

which SEs predominate for high potency antipsychotics?

Back 18

EPS SEs

Front 19

what drugs can cause neuroleptic malignant syndrome?

Back 19

antipsychotics

Front 20

what is neuroleptic malignant syndrome?

Back 20

rigidity, myoglobinuria, ANS instability, hyperpyrexia

Front 21

what is used to treat neuroleptic malignant syndrome?

Back 21

dantrolene (and other DA agonists)

Front 22

what is tardive dyskinesia?

Back 22

sterotypic oral-facial mvts probably due to DA receptor sensitization; results of long term antipsychotic use

Front 23

how do EPS SEs progress over time?

Back 23

4 h - acute dystonia
4 d - akinesia
4 wk - akathisia
4 mo - tardive dyskinesia

Front 24

name atypical antipsychotics

Back 24

clozapine, olanzapine, risperidone

Front 25

atypical antipsychotic MoA?

Back 25

block 5-HT2 receptors

Front 26

clinical use of atypical antipsychotics?

Back 26

schizophrenia, tx neg AND POS sx (typicals tx neg sx only)

Front 27

additional uses of olanzapine?

Back 27

OCD, anx d/o, dep, mania, tourettes

Front 28

atypical antipsychotic SEs?

Back 28

less severe EPS SEs than high pot drugs, less severe musc/hist/alpha SEs than low pot drugs

Front 29

important SE of clozapine specifically?

Back 29

AGRANULOCYTOSIS IN 3%

Front 30

what type of drug requires weekly WBC monitoring?

Back 30

CLOZAPINE

Front 31

LITHIUM MoA?

Back 31

unknown, maybe related to phosphoinositol cascade

Front 32

clinical use of LITHIUM?

Back 32

mood stabilizer for bipolar affective d/o's; blocks relapse and acute manic events

Front 33

LITHIUM SEs?

Back 33

tremor, hyperactivity, hyperreflexia, hypothyroidism, polyuria (diabetes insipidus), teratogenesis, c/i w/preg, leukocytosis

Front 34

what psychiatric drug may be used to treat SIADH?

Back 34

LITHIUM = ADH antag, causing nephrogenic diabetes insipidus

Front 35

MoA of BUSPIRONE?

Back 35

stim' 5HT-1A receptors

Front 36

clinical use of BUSPIRONE?

Back 36

relatively pure anxiolysis for GAD

Front 37

advantage of BUSPIRONE over BENZOs/other anxiolytics?

Back 37

no sedation or addiction, no additive effects with etoh

Front 38

name SSRIs

Back 38

FLUOXETINE, SERTRALINE, PAROXETINE, CITALOPRAM

Front 39

clinical uses of SSRIs

Back 39

MDD, OCD(fluoxetine)

Front 40

SSRI SEs?

Back 40

GI disress, sexual dysfn (anorgasmia), "serotonin syndrome" w/MAOIs

mild antichol, anti-alpha-1 SEs

Front 41

sx of serotonin syndrome (SSRIs + MAOIs)?

Back 41

hyperthermia, muscle rigidity, cardiovasc collapse, change in MS)

Front 42

name TCAs

Back 42

IMIPRAMINE, NORTRIPTYLINE, AMITRIPTYLINE, DESIPRAMINE, CLOMIPRAMINE, DOXEPIN

Front 43

MoA of TCAs?

Back 43

block reuptake of NE and 5HT

Front 44

clinical use of TCAs

Back 44

MDD, bedwetting (imipramine), OCD (clomipramine)

Front 45

rx for bedwetting (enuresis)?

Back 45

IMIPRAMINE

Front 46

what TCA is used for OCD?

Back 46

CLOMIPRAMINE

Front 47

SEs of TCAs?

Back 47

sedation (worse for tert amines), antichol (blurred vis, dry mouth, urin reten, constip, agitation, tachy, sweat), alpha-1 block (postural hypotens, tachy)

Front 48

name secondary amines

Back 48

desipramine, nortriptyline

Front 49

name tertiary amines

Back 49

imipramine, amitriptyline, doxepin, clomipramine

Front 50

difference in SEs b/t sec and tert amines?

Back 50

sec: LESS sedation, hypotens, antichol, but MORE likely to cause psychosis

Front 51

how long for TCAs to show clinical effect?

Back 51

2-8wks

Front 52

sx of TCA toxicity?

Back 52

Convulsions, Coma, Cardiotoxicity (arrhyth, QT widening), resp dep, hyperprexia

note: may occur when combined with MAOIs

Front 53

which TCA is least sedating?

Back 53

DESIPRAMINE

Front 54

which TCA is best for elderly pts?

Back 54

NORTRIPTYLINE, b/c less antichol SEs (others may cause confusion and halluc in elderly)

Front 55

name MAOIs

Back 55

PHENELZINE, TRANYLCYPROMINE

Front 56

MoA of MAOIs

Back 56

nonselective MAO inhibition (blocks inactivation of NE, 5HT, DA that leak out of storage vesicles), thus inc levels of amine NTs

Front 57

clinical uses of MAOIs

Back 57

atypical dep (ie w/psychotic or phobic features), anxiety, hypochondriasis

Front 58

toxicity of MAOIs

Back 58

hypertensive crisis w/tyramine ingestion (in wine, cheese, etc) and meperidine; CNS stim

Front 59

MAOI contraindications?

Back 59

SSRIs, beta-agonists (to prevent serotonin syndrome)

Front 60

name heterocyclic antidepressants

Back 60

BUPROPRION, VENLAFAXINE, MIRTAZAPINE, MAPROTILINE, TRAZODONE

Front 61

clinical uses of BUPROPRION?

Back 61

MDD, smoking cessation

Front 62

SEs of BUPROPRION

Back 62

stimulant effects (tachy, insomnia), h/a, seizure in bulimics; no sexual SEs

Front 63

clinical uses of VENLAFAXINE

Back 63

MDD, GAD

Front 64

MoA of VENLAFAXINE?

Back 64

inhib' 5HT, NE, & DA reuptake

Front 65

toxicity of VENLAFAXINE?

Back 65

stimulant effects, sedation, mausea, constipation, inc BP

Front 66

MoA of MIRTAZEPINE?

Back 66

alpha-2 antag (inc release of NE, 5HT), and potent 5HT2 and 5HT3 ANTAG, thus inc' 5HT1 mediated transmission

Front 67

toxicity of MIRTAZEPINE?

Back 67

sedation, inc appetite, weight gain, dry mouth

Front 68

MoA of MAPROTILINE?

Back 68

blocks NE reuptake

Front 69

toxicity of MAPROTILINE?

Back 69

sedation, orthostatic hypotens

Front 70

MoA of TRAZADONE?

Back 70

blocks 5HT reputake

Front 71

toxicity of TRAZADONE?

Back 71

sedation, nausea, pripism, postural hypotension

Front 72

what substances affect plasma lithium levels?

Back 72

excessive Na intake LOWERS lithium levels; thiazide diuretics INCREASE lithium levels