Step 1 First Aid: Psychiatry Pharm

Front 1

CNS stimulants - list them.
Mechanism?

Back 1

Methylphenidate (Ritalin)
Dextroamphetamine (Adderall)
Mixed Amphetamine Salts
Mechanism : Increased catecholamines at the synaptic cleft, especially NE and Dopamine.

Front 2

CNS Stimulants - Clinical Use

Back 2

ADHD
Narcolepsy
Appetitie control

Front 3

Antipsychotics are also called? Name the general ending associated with the typical antipsychotics..
mechanism?

Back 3

The "Typical" Antipsychotics are the neuroleptics

Haloperidol + "azines"

Mechanism = Block Dopamine D2 receptors => increase intracellular cAMP

Front 4

Antipsychotics clinical use

Back 4

Schizophrenia (POSITIVE symptoms)
Psychosis
Acute mania
Tourette's syndrome

Front 5

Try to Fly High

Back 5

Trifluperazine
Fluphenazine
Haloperidol
High potency neuroleptics (antipsychotics)
-associated with extrapyramidal symptoms

Front 6

Cheating Thieves are Low

Back 6

Low potency Neuroleptics
Chlorpromazine
Thioridazine
Non neurologic side effects
Triple A side effects with Cheating Thieves
1. Anticholinergic
2. Antihistamine
3. Alpha Blockade

Chlorpromazine also has Corneal Deposite
Thioridazine - reTinal deposits

Front 7

Antipsychotic with retinal deposits? corneal deposits?

Back 7

reTinal deposits = Thioidazine
corneal deposits = Chlorpromazine

Front 8

Evolution of EPS side effects

Back 8

4 hours, 4 days, 4 weeks, 4 months
4 Hours - acute dystonia (mucle spasm, stiffness, oculogyric crisis)
4 Days - Akinesia (parkinsonian symptoms)
4 weeks - akathisia (restlessness)
4 Months - Tardive Dyskinesia

Front 9

Antipsychotics - general toxicity traits

Back 9

1. Highly lipid soluble - stored in body fat, removes from body very slowly.
2. Extrapyramidal symptoms (EPS)
3. Endocrine side effects (dopamine blockade at d2 receptor leads to hyperprolactinemia -> galactorrhea)
4. Side effects from blocking muscarinic (dry mouth, constipation), alpha receptors (hypotension), histamine (sedation) receptors

Front 10

Neuroleptic malignant syndrome TX

Back 10

Dantrolene, D2 AGonists (bromocriptine)

Front 11

FEVER mnemonic

Back 11

Neuroleptic malignant syndrome symptoms.
Fever
Encephalopathy
Vitals unstable (autonomic
Elevated enzymes (rhabdomyolysis)
Rigid muscles

Front 12

Atypical antipsychotics - general endings in name? List them.

Back 12

"apines" and others
"Atypical for OLd CLOsets to QUIETly RISPER from A to Z"
Olanzapine
Clozapine
Quietapine
Risperidone
Aripiprazole
Ziprasidone

Front 13

Clinical Uses of Antipsychotics

Back 13

Schizophrenia - atypical affect positive AND NEGATIVE symptoms
Olanzapine - also for OCD, anxiety, depression, mania, tourette's

Front 14

Toxicity of Antipsychotics

Back 14

Fewer EPS and anticholinergics than traditional
Specifically:
Clozapine - agranulocytosis
Cloazpine / Olanzapine - weight gain
Ziprasidone - QT interval prolongation

Front 15

Psychiatry patient on long term drug medication exercises and dies from QT prolongation . What drug

Back 15

Ziprasidone

Front 16

Lithium mechanism

Back 16

Not established, posisbly due to inhibition of Phosphatidyl inositol cascade

Front 17

Lithium Clinical use

Back 17

1. Bipolar Disorder - stabilizes mood - blocks relapse and acute manic events.
2. SIADH - presents as polyuria

Front 18

Lithium Side Effects mnemonic

Back 18

Lithium side effects
Movement (tremor)
Nephrogenic diabetes insipidus
O-hypOthyroidism
Pregnancy problems - teratogen leading to fetal cardiac defects

Front 19

Fetal cardiac effects with lithium

Back 19

Ebstein anomaly, malformation of great vessels.

Front 20

Lithium excretion via

Back 20

Kidneys, exclusively
-importantly, most is excreted by the kidneys, but most is reabsorbed at the proximal tubules following Na+ reabsorption.

Front 21

Buspirone Mechanism

Back 21

Stimulates 5-HT1A receptors
(not inhibition)

Front 22

Buspirone CLinical use, Side effects

Back 22

CLinical use : General Anxiety Disorder
"bus pirates make me anxious"
NO interaction with alcohol, no sedation, addiction tolerance
Pretty good interms of side effects.

Front 23

TCAs end in? List them

Back 23

-iptyline or -ipramine
EXCEPTIONS: -oxepins
doxepin, Amoxapine

Front 24

TCA Mechanism

Back 24

Block reuptake of
1. NE
2. Serotonin

Front 25

Clinical Uses of TCAs

Back 25

Major depression - obviously
Bed wetting - impramine
OCD - clomipramine
Fibromyalgia

Front 26

Side effects of TCAs

Back 26

Sedation
Anticholinergic
Alpha blocking
~ to Antipsychotics low potency

Front 27

Which TCAs have more anticholinergics? clinical significance?

Back 27

Tertiary TCAs - Amitriptyline have MORE anticholinergic effects than secondary TCAs - nortriptyline

Clinical Significance = Older patient ? give nortriptyline

Front 28

DR. says not to give this tricyclic antidepressant because patient has had recurrent seizures.

Back 28

Desipramine - lower sedation, and thus lower seizure threshold.
Dont give to patients with low seizure threshold.

Front 29

Toxicity of TCAs

Back 29

CCC
Convulsion
Coma
Cardiotoxicity - ARRHYTHMIAS
-Repisratory depression
-hyperpyrexia

Front 30

TX for TCA toxicity

Back 30

NaHCO3 for CV toxicity -

Front 31

SSRIs- list them

Back 31

FLashbacks PARalyze SEnior CITizens
-oxetines and others
Fluoxetine, Paroxetine, Sertraline, Citalopram

Front 32

SSRI Mechanism

Back 32

In the name
Serotonin Specific Reuptake iNhibitor

Front 33

SSRI clinical Use

Back 33

1. Depression
2. OCD
3. Bulimia
4. Social Phobias
5. PTSD

Front 34

SSRI Toxicity

Back 34

Fewer than TCAs
1. GI distress
2. Sexual Dysfunction (anorgasmia)
3. Serotonin syndrome - must be in combo with another drug that increases serotonin - like MAO inhibitors

Front 35

SErotonin Syndrome traits ? What is the treatment?

Back 35

Seen in combo use with things that increase serotonin e.g. MAO inhibitors
Hyperthermia, Myoclonus, CV collapse

TX : Cyproheptadine (5 HT2 receptor antagonist)

Front 36

SNRIs - list them

Back 36

VENLAFAX for DULEY
Venlafaxine
Duloxetine
-two SNRIs

Inhibit NE and serotonin reuptake, like TCAs

Front 37

SNRI toxicity

Back 37

Increased BP (most common)
Stimulant effects
Sedation
Nausea

Front 38

SNRIs clinical Use

Back 38

Depression
Venlafaxine - General anxiety Disorder
Duloxetine - diabetic peripheral neuropathy.

Duloxetine has greater effect on NE

Front 39

Jack Duley is a Diabetic patient on tx to treat both his depression and her peripheral neuropathy. What medication is he on.

Back 39

Duloxetine

-greater effect on NE

Front 40

List the MAO inhibitors

Back 40

MAO Takes Pride in Shanghai
Tranylcypromine
Phenelzine
Isocarboxazid
Selegeline

Front 41

MAO Inhibitors CLinical use

Back 41

HYPOchondriasis
Atypical Depression
Anxiety

Front 42

Toxicity with Mao inhibitors

Back 42

Hypertensive Crisis with
1. Wine and Cheese consumption
2. Beta blockers - beta agonists

Front 43

Contrainidications of MAO inhibitors

Back 43

SSRI or Meperidine
-will cause serotonin syndrome

Front 44

List the Atypical Antidepressants

Back 44

Buproprion
Mirtazapine
Maprotiline
Trazodone

Front 45

Buproprion leads to increased? Clinical use? Toxiciyt?

Back 45

Tx for Depression, Smoking cessation
Toxicity:
Stimulant effects (tachycard, insomnia)
Headache
Seizure in Bulimic Patients
No sexual side effects(unlike ssri, anorgasmia)

Front 46

Antidepressants that can cause seizures

Back 46

TCAs
Buproprion(an atypical antidepressant that only cuases it in bulimic patients)

Front 47

Mirtazapine mechanism , toxicity

Back 47

Alpha 2 antagonist (increases the release of NE and serotonin)
Potent 5-HT2 and 5-HT3 receptor antagonist.
Toxicity : sedation, increased weight gain, dry mouth

Front 48

Maprotiline mechanism, toxicity

Back 48

Blocks NE reuptake.
Toxicity : orthostatic hypotension, sedation

Front 49

Trazodone mechanism

Back 49

Primarily inhibits serotonin reuptake

TrazoBONER because its male-specific.

Uses :Insomnia - but high doses are needed for antidepressant effect.
Toxicity :
sedation, nausea, priapism, postural hypotension

Front 50

Atypical antidepressant with Orthostatic hypotension. Postural hypotension?

Back 50

Orthostatic hypotension = Maprotiline
Postural hypotension = Trazodone