First Aid Psychiatry Drugs – Flashcards
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how to treat: Alcohol withdrawal
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Benzodiazepines
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how to tx Anxiety
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SSRIs, SNRIs, Busprione
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ADHD
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methyphenidate, amphetamines
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Bipolar Disorder
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Mood stabilizers: lithium, valproic acid, carbamazepine, atypical antipsychotics
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Bulimia
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SSRIs
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Depression
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SSRIs, SNRIs, TCAs, busprione, mirtazapine (especially with insomnia)
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Obsessive compulsive disorder
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SSRIs, clomipramine
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Panic Disorder
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SSRIs, venlafaxine, benzodiazepines
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PTSD
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SSRIs
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Schizophrenia
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Antipsychotics
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Social Phobias
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SSRIs
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Tourette's syndrome
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antipsychotics haloperidol, risperidone
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what are the CNS stimulants?
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Methylphenidate, dextroamphetamine, methamphetamine
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what is the CNS stim method of action
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increase catecholamines at the synaptic cleft, especially NE and dopamine
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What is the clinical use of CNS stimulants:
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ADHD, narcolepsy, appetite control
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haloperidol
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antipsychotics
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trifluoperazine
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antipsychotics
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fluphenazine
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antipsychotics
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thioridazine
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antipsychotics
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chloropromazine
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antipsychotics
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so what's the name thing for antipsychotics?
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haloperidol + "azines"
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mechanism of Antipsychotics
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all typical antipsychotics block dopamine D2 receptors, increasing cAMP
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what are the high potency antipsychotics? and what are the side effects?
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Trifluperazine, fluphenazine, Haloperidol...try to fly high? neurolgoic side effects (extrapyrimidal)
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clinical use of antipsychotics
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schizo (primarily positive symptoms) psychosis, acute mania, Tourette's syndrome
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what are the low potency antipsychotics? side effects?
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chloropromazine, thioridazine -cheating thieves are low.....non neurologic side effects (anticholinergic, antihistamine and alpha 1 blockade effects)
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what is the toxicity of antipsychotics?
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highly lipid soluble, and stored in body fat; thus very slow to be removed from the body, extrapyramidal system side effects: dyskinesias, endocrine side effects: dopamine receptor antagonism---hyperprolactinemia: galactorrhea, side effects from blocking muscarinic receptors; hypotension, and dry mouth, and sedation.
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Chloropromazine causes:
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corneal deposits
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thioridazine causes
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retinal deposits
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haloperidol:
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NMS, tardive dyskinesia
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evolution of EPS side effects:
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4 hr of acute dystonia (muscle spasm, stiffness, oculogyric crisis) 4 day akathisia (restlessness) 4 wk bradykinesia (parkinsonism) 4 mo tardive dyskinesia
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what is neuroleptic malignant syndrome-and what drug is this associated with? Treatment:
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rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Tx=dantrolene, D2 agonists (bromocriptine)
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Tardive dyskinesia:
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stereotypic oral facial movements as a result of long term antipsychotic use...often irreversible
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for neuoleptic malignant syndrome: (NMS) think
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think fever: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles
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atypical antipsychotics mmneom..
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it's ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z
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olanzapine
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atypical antipsychotic
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clozapine
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atypical antipsychotic
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quetiapine
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atypical antipsychotic
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risperidone
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atypical antipsychotic
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aripiprazole
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atypical antipsychotic
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ziprasidone
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atypical antipsychotic
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mechanism of atypical antipsychotics...
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not understood...varied effects on 5ht2, dopamine and alpha and H1 receptors
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clinical use of atypical antipsychotics
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schizophrenia-both positive and negative symptoms: also used for bipolar disorder, ocd, anxiety disorder, depression, mania, tourette's syndrome
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what are the toxicities for atypical antipsychotics?
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fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics.....olazapine, clozapoine may cause significant eight gain...clozapine may cause agranulocytosis...requires weekly wbc monitoring and sezure ziprasidone may prolong the QT interval
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olanzapine/clozapine may cause significant:
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weight gain
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clozapine may cause
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agranulocytosis -rqrs weekly wbc monitoring and seizure
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ziprasidone
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may prolong the QT interval
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Lithium Mechanism:
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not established, possibly related to inhibition of phosphoinositol cascade
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clinical use of lithium
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mood stabilizer for bipolar disorder-blocks relapse and acute manic events...also for SIADH
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Toxicity of Lithium-what do teratogenic effects include:and mnemonic:
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tremor, sedation, edema, heart block, polyuria...ADH antagonist-causing nephrogenic diabetes insipidus, TERATOGENIC...cardiac defects-ebstein anomaly and malformaltion of the great vessels... LMNOP-lithium side effects: movement (tremor), nephrogenic diabetes insipid us, hypothyroidism, pregnancy problems.
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what rqrs close monitoring of serum levels of lithium...
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narrow therapeutic window.
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lithium is almost exclusively excreted by:___ where?
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the kidneys-most is reabsorbed at the proximal convoluted tubule following Na reabsorption
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buspirone: used in:
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used in generalized anxiety disorder....
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buspirone MOA: mnemonic
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stimulates 5HT1a receptors: I'm always anxious if the BUS will be ON time, so I take BUSpirONe
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how long does it take for buspirone to take effect? doesn't cause what? takes ____ weeks to take effeect? does it interact w/alcohol compared to __
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1-2 weeks for it to take effect...does not cause sedation, addiction, or tolerance. does not interact with alcohol-vs barbiturates and benzodiazepines
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SSRIs...names and mnemonic:
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FLashbacks PARalyze Senior CITizens Fluoxetine, paroxetine, sertraline, Citalopram
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fluoxetine
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SSRI
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Paroxetine
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SSRI
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Sertraline
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SSRI
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Citalopram
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SSRI
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MOA of SSRI-how many weeks does it usually take for antidepressants to have an effect?
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serotonin specific reuptake INHIBITORS. 4-8 weeks to take effect?
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Clinical use of SSRIs
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depression, genralized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.
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Toxicity of SSRIs
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Fewer than TCAs-Gi distress, SEXUAL DYSFUNCTION-anorgasmia and decreased libido. Serotonin synddrome: with any drug that increases serotonin (MAOIs, SNRIs, TCAs): hyperthermia, confusion, myoclonus, cardiovascular collapse..flushing, diarrhea, seizures....tx of it: 5HT2 receptor antagonist: (octreotide)
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So generalized anxiety disorder can be tx w/
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Busiprone and SSRIs, SNRIs
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Venlafaxine, duloxetine
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SNRIs
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SNRI MOA
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inhibit serotoinin and NE uptake
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Clinical use of SNRIs...duloxetine is also indicated for. which SNRI has a greater effect on NE
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Depression....Venlafax-also used in generalized anxiety disorder and panic disorders....Duloxetine=also indicated for diabetic peripheral neuropathy...Duloxetine=greater effect on NE
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Tricyclic antidepressants:
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all end in -iptyline and -ipramine except doxepin and amoxapine
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MOA TCAs
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Block reuptake of NE and serotonin
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clinical use of tCAs...bedwetting, OCD drugs
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Major depression, bedwetting (imipramine), OCD (clomipramine) fibromyalgia
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Toxicity of TCAs...which ones to use in elderly, which one for ppl with seizures...how to tx some of the tox?
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alpha 1 blocking effects like hypotension, and dry mouth, urinary retention...amitryp(3rd degree) have more anticholin effects than 2ndary-nortriptyline...despiramine=less sedating-and higher sezure threshold...TRI-C's=convulsions, coma, cardiotoxicity....also resp depression and hyperpyrexia...confusion and hallucinations in elderly due to tricyclic effecs-use nortryptyline in elderly. use NaHCO3 for cardio tx
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MAO Inhibitors (MAOIs)
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MAO Takes Pride In Shanghai Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline(selective MAO B inhibitor)
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Tranylcypromine
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MAOI
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Phenelzine
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MAOI
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Isocarboxazid
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MAOI
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Selegiline
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MAOI-selective MAOB inhibitor
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MOA of MAOIs
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nonselective MAO inhibition increases levelsof amine neurotransmitters-NE, serotonin, dopoamine
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Clicical use of MAOIs
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atypical depression, anxiety, hypochondriasis..
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Toxicity of MAOIs--a lot due to ingestion of:
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Hyperensive crisis-MOST NOTABLY WITH ingestion of TYRAMINE-which is found in many foods such as wine and cheese....CNS stimulation, contraindicated with SSRIs, TCAs, St. John's Wort, Meperidine, and dextromethophan-(to prevent serotonin syndrome)
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Atypical Antidepressants:
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buproprion, Mirtazapine, Maprotilline, Trazadone
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Buproprion: MOA, type of drug, side effects...be careful w/giving to which type of ppl
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Used for smoking cessation...increases Norepinephrine and dopamine via unknown mechanism..atypical antidepressant...tox=stimulant effects=tachycardia, insomnia) also headache, seizure in Bulimic pts...no sexual side effects.
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Mirtazapine. Type of drug, moa, toxicity
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alpha 2 antagonist (increases the release of NE and serotonin), and potent 5Ht2 and 5HT3 receptor antagonist. this drug is an atypical antidepressant, and it's toxic effects: sedation (may be desired in depressed pts w/insomnia), increased appetite and weight gain-may be good in elderly or anorexic, and dry mouth
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Maprotilline: type of drug and MOA, tox
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Blocks NE reuptake. Toxicity : sedation, orthostatic hypotension. This drug is an atypical antidepressant
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Trazodone-type of drug, Moa, used mostly for___ toxicity....male side effects:
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atypical antidepressant. Primarily inhibits serotonin reuptake. used primarily for insomnia, as high doses are nedded for antidepressant effects...toxicity: sedation, nausea, priapism, postural hypotension...called trazoBONE to ue to male specific side effects :)
