Psych Pharm

hezikry's version from 2015-08-06 20:21

Tx for selected psych conditions

Question Answer
alcohol withdrawallong-acting benzodiazepines
anxietySSRIs, SNRIs, buspirone
ADHDstimulants-methylphenidate, amphetamines
Bipolar"mood stabilizers" (lithium, valproic acid, carbamazepine, lamotrigine), atypical antipsychotics
depressionSSRIs, SNRIs, TCAs,buspirone, mirtazapine (insomnia)
obsessive-compulsive disorderSSRIs, clomipramine
panic disorderSSRIs, venlafaxine, benzodiazepines
schizophreniaatypical antipsychotics
social phobiasSSRIs, Beta blockers
tourettes's syndromeantipsychotics (fluphenazine, pimozide, tetrabenazine, clonidine)
acute maniamood stabilizing agent (ex. lithium, valproate, carbamazepine) plus atypical antipsychotic

CNS stimulants

Question Answer
examples of CNS stimulantsmethylphenidate, dextroamphetamine, methamphetamine
mechanism of CNS stimulantsincrease catecholamines at synaptic cleft, esp NE and dopamine
clinical use of CNS stimulantsADHD, narcolepsy, appetite control
treatment of narcolepsymidafinil

Antipsychotics (neuopleptics)

Question Answer
high potency antipsychoticsTrifluperazine, Fluphenazine, Haloperidol (Try to Fly High)
side effects of high potency antipsychoticsneurologic; extrapyramidal symptoms (dyskinesia), neuroleptic malignant syndrome
mechanism of antipsychoticsblock dopamine D2 receptors, increasing cAMP
clinical uses of antipsychoticsschizophrenia (positive symptoms), psychosis, acute mania, Tourette's
antipsychotics are highly lipid soluble, sothey are hard to remove from the body
endocrine effects of antipsychoticsdopamine receptor antagonism, -> hyperprolactinemia -> galactorrhea and amenorrhea
low potency antipsychoticschlorpromazine, thioridazine (Cheating Thieves are low)
Side effects of low-potency antipsychoticsmuscarinic (dry mouth, constipation), alpha1 (hypotension), histamine (sedation)
haloperidol toxicitiesNMS, tardive dyskinesia
Chlorpromazine toxicityCorneal deposits
Thioridazine toxicityreTinal deposits
Evolution of extrapyramidal side effects (rule of 4s)4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day akathisia (restlessness)
4 week bradykinesia (parkinsonism)
4 month tardive dyskinesia
neuroleptic malignant syndromerigidity, myoglobinuria, autonomic instability, hyperpyrexia, delirium
Mnemonic for neuroleptic malignant syndromethink FEVER (Fever, Encephalopathy, Vitals unstable, Enzymes increased, Rigidity of muscles)
treatment of neuroleptic malignant syndromedantrolene, D2 agonist (bromocriptine)
tardive dyskinesiastereotypic oral-facial movements from long-term antipsychotic use; often irreversible
acute dystonic reactionsudden-onset, sustained muscle contractions
akathisiasubjective restlessness with inability to sit still
drug-induced parksonismtremor, rigidity, bradykinesia
treatment for drug-induced parkinsonismbenztropine or amantadine. dopamine agonists are contraindicated
tardive dyskinesiainvoluntary movements after chronic use

Atypical antipsychotics

Question Answer
examples of atypical antipsychoticsolanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
mechanism of atypical antipsychoticsvaried effects on 5-HT2 (reversible antagonism), dopamine, alpha and H1 receptors
clinical use of atypical antipsychoticsschizophrenia positive and negative symptoms; bipolar, OCD, anxiety, depression, mania, tourette's
olanzapine/clozapine may cause significantweight gain
increased risk of diabetesolanzapine
Side effect of classprolongs QT interval
Important side effects of Clozapineagranulocytosis & seizure
atypical antipsychotics have fewer of these side effects than traditional antipsychoticsextrapyrimidal and anticholinergic
S/E of risperiodonehyperprolactinemia, whcih can cause amenorrhea, galactorrhea, and breast soreness

Rapid fire - which class are they in? (antipsychotics)

Question Answer
Trifluoperazinehigh potency antipsychotic
Fluphenazinehigh potency antipsychotic
Haloperidolhigh potency antipsychotic
Chlorpromazinelow potency antipsychotic
Thioridazinelow potency antipsychotic
Olanzapineatypical antipsychotic
Clozapineatypical antipsychotic
Quetiapineatypical antipsychotic
Risperidoneatypical antipsychotic
Aripiprazoleatypical antipsychotic
Ziprasidoneatypical antipsychotic

Lithium & Buspirone

Question Answer
mechanism of lithiumpossibly related to inhibition of phosphoinositol casade
Mnemonic for adverse effects of lithiumLMNOP -Lithium side effects - Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregancy problems
clinical use of lithiummood stabilizer (bipolar - blocks relapse and acute manic events), SIADH
fetal cardiac defects of lithiumEbstein anomaly assoc w lithium
lithium requires close monitoring of serum levels because ofnarrow therapeutic window
lithium almost exclusively excreted inkidneys
where is lithium reabsorbed?proximal convoluted tubule, following Na reabsorption
What drug should not be taken with lithiumthiazides, NSAIDS and ACEi (loop diuretics okay)
What does lithium toxicity look likeneuromuscular excitability, irregular coarse tremors, agitation, ataxia and delirium
mechanism of buspironeselective agonist at 5-HT1A receptors
number of weeks it takes for buspirone to take effect1-2 weeks
buspirone does not causesedation, addiction, tolerance
clinical use of buspironegeneralized anxiety disorder
buspirone does not interact withalcohol
minimal to no hypnotic, sedative or euphoric effectsbuspirone
man has acute seizure disorder and bipolar disorder what drugvalproate


Question Answer
SSRIsfluoxetine, paroxetine, sertraline, citalopram
Flashbacks paralyze senior citizens
mechanism of SSRIsserotonin-specific reuptake inhibitors
serotonin syndromehyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures
treatment of serotonin syndromecyproheptadine (5-HT2 receptor antagonist)
toxicities of SSRIGI distress, sexual dysfunction (anorgasmia and decreased libido)
SNRIsvenlafaxine, duloxetine Very Dad
mechanism of SNRIsinhibit serotonin and NE reuptake
clinical use of SNRIsdepression
duloxetine has greater effect onNE
venlafaxine also used forgeneralized anxiety and panic disorders
duloxetine also used fordiabetic peripheral neuropathy
toxicities of SNRIsincreased BP
stimulant effects, sedation, nausea
examples of tricyclic antidepressantsamitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
"triptylines, ipramines, doxepin and amoxapine"
mechanism of tricyclicsblock reuptake of NE and serotonin
clinical use of tricyclicstreatment resistant major depression, fibromyalgia, OCD, painful diabetic neuropathy
clinical use of imipraminebedwetting
clinical use of clomipramineOCD
3° tricylcics like amitriptyline have more of these effects than 2° tricyclics like nortriptylinanticholinergic
toxicities of tricyclicsalpha blockade (postural hypotension)
anticholinergic (tachycardia, urinary retention, dry mouth)
Tri-Cs of tricyclic overdoseconvulsions, coma, cardiotoxicity (arrythmias)
additional side effects of tricyclicsrespiratory depression, fever, confusion and hallucinations in elderly
treatment of cardiovascular toxicity of tricyclicsNaHCO3
what is underlying cellular event in TCA cardiotoxicityinhibition of fast sodium channels in cardiac myocytes
MAOIsTranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B)
MAO Takes Pride In Shanghai
selective MAO-B inhibitorselegiline
mechanism of non-selective MAOIsincrease levels of amine neurotransmitters (NE, serotonin, dopamine) in presynaptic nerve terminals. Block degradation of dietary tyramine
clinical use of MAOIsatypical depression, anxiety, hypochondriasis
MAOIs are contraindicated withSSRIs, TCAs, St. John's Wort, meperidine, dextromethorphan (to prevent serotonin syndrome)
toxicities of MAOIshypertensive crisis (with ingestion of tyramines), CNS stimulation
pathogenesis of MAOIs and tyramineingest tyramine. tyramine is taken up instead of NE. There is too much NE in the cleft which leads to a hypertensive crisis.
what drugs besides antidepressants cause serotonin syndrometramadol, ondansetro, linezolid, triptans

Atypical antidepressants

Question Answer
Buproprion clinical useatypical antidepressant
buproprion also used forsmoking cessation
buproprion actionincreases NE and dopamine by unknown mechanism
toxicity of buproprionstimulant effects (tachycardia, insomnia)
seizure in bulimic pts
buproprion causes seizures inbulimic patients
buproprion does not cause these side effectssexual side effects
mirtazapine actionalpha-2 antagonist (increases release of NE and serotonin)
potent 5-HT2 and 5-HT3 antagonist
mirtazapine toxicitysedation, increased appetite and weight gain, dry mouth
Trazodone mechanisminhibits serotonin reuptake
trazodone used forinsomnia (very high doses needed for antidepressant effect)
toxicities of trazodonesedation, nausea, postural hypotension, priapism (trazoBONE)

Drug intox and withdrawals

Question Answer
Alcohol intoxSerum γ-glutamyltransferase (GGT) is sensitive indicator of use
AST is double ALT
Alcohol w/dmild- anxiety, tremor, seizures, insomnia. Severe- delirium tremons
Alcohol w/d treatmentbenzodiazapines
Opioid (morphine, heroin, methadone) intox CNS depression, n/v, constipation, pinpoint pupils, seizures
Opioid (morphine, heroin, methadone) o/d treatmentNaloxone, Naltrexone
Opioid (morphine, heroin, methadone) w/dsweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea
opioid w/d treatmentsolution of opium in neonates
Barbiturates intoxrespiratory depression
Barbiturates w/ddelirium, cardio collapse
Benzodiazepine intoxataxia, minor resp depression
Benzodiazepine intox txFlumazenil
Amphetamines intoximpaired judgment, pupillary dilation, prolonged wakefulness and attention, delusions, hallucinations, fever
Amphetamines w/dstomach cramps, hunger, hypersomnolence
Cocaine intoximpaired judgment, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death
Cocaine intox txBenzodiazepines
Cocaine w/dsuicidality, hypersomnolence, malaise, severe craving
PCP intoxBelligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psyhosis, delirium
PCP w/ddepression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
LSD intoxMarked anxiety/depression, delusions, visual hallucinations, flashblacks, pupillary dilation
Marijuana w/dirritiability, depression, insomnia, nausea, anorexia
Heorin detoxMethadone (long-acting oral opiate)
Heroin detoxSuboxone (naloxone + buprenorphine), long-acting
Naloxonenot active when taken orally, withdrawal only if injected
Delirium tremensLife-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
autonomic system hyperactivity (tachy, tremors, anxiety, seizures)
psychotic sxs (hallucinations, delusions)
Tx: benzodiazepines

Rapid-fire: Class of Drug

MethylphenidateCNS stimulant
DextroamphetamineCNS stimulant
MethamphetamineCNS stimulant
Olanzapineatypical antipsychotic
Clozapineatypical antipsychotic
Quetiapineatypical antipsychotic
Risperidoneatypical antipsychotic
Aripiprazoleatypical antipsychotic
Ziprasidoneatypical antipsychotic
Buspirone5-HT1A stimulator
AmitriptylineTricyclic antidepressant
NortriptylineTricyclic antidepressant
ImipramineTricyclic antidepressant
DesipramineTricyclic antidepressant
ClomipramineTricyclic antidepressant
DoxepinTricyclic antidepressant
AmoxapineTricyclic antidepressant
TranylcypromineMAO inhibitor
PhenelzineMAO inhibitor
IsocarboxazidMAO inhibitor
SelegilineMAO inhibitor (selective)
BupropionAtypical antidepressant also used for smoking cessation
MirtazapineAtypical antidepressant with sedation and ↑ appetite qualities
Antagonizes α2, 5-HT2, and 5-HT3 receptors
Trazodoneatypical antidepressant - inhibits serotonin reuptake - used mostly for insomnia