PSYCHIATRY CLERKSHIP – Flashcards
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side effects of tricyclics?
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anticholinergic - dry mouth, blurry vision, urinary retention, constipation, sedation, orthostatic hypotension (alpha 1 blockade) tachycardia prolonged QT antihistamine effects - weight gain
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amitriptyline
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tricyclic
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doxepin
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tricyclic
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impipramine
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tricyclic
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clomipramine
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tricyclic
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which non-SSRI antidepressant can be used for OCD?
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clomipramine
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desipramine
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tricyclic
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nortriptyline
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tricyclic
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amoxapine
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tricyclic
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which tricyclic is the least anticholinergic and not sedating?
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desipramine
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which tricyclic has EPS and potentially NMS?
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amoxapine (metabolite of antipsychotic loxapine)
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SSRI: diarrhea?
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sertraline
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SSRI: anticholinergic?
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paroxetine
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SSRI: n/v
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fluvoxamine
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SSRI: used in OCD more commonly?
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fluvoxamine
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SSRI: fewer sexual side effects
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citalopram
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SNRI: used to treat GAD
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venlafaxine
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SNRI: used to treat diabetic neuropathy
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duloxetine
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which MAOI works of MAO-B?
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Selegiline
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Phenelzine
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MAOI
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Isocarboxazid
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MAOI
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Tranylcypromine
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MAOI
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Selegiline
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MAOI
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Trazodone mechanism
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serotonin 2 antagonist and sertonin reuptake inhibitor
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which atypical antidepressant can be used for sleep problems?
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trazodone
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priapism?
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trazodone tx: epinephrine injection into corpus of penis
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which atypical antidepressant has no sexual dysfuction, no n/v?
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mirtazapine
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Mirtazapine mechanism
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noradrenergic and specific serotonin antagonist
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Buprorpion mechanim
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noradrenergic and dopamine reputake inhibitor
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which atypical antidepressant has less sexual dysfunction but also nausea and anorexia?
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Buproprion
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which atypical antidepressant should be avoided in seizure or eating disorder?
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Buproprion
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Lithium mechanism
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inhibits adenylate cyclase
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SE of lithium?
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nausea tremor hypothyroidism cardiac dysrhythmias diarrhea diabetes insipidus wegith gain acne ***seizures, coma death
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What is the therapeutic range of lithium?
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0.6-1.2
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what labs for lithium?
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thyroid specific gravity, BUN, creatinine pregnancy ECG
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what will the WBC count do with lithium?
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benign increase in WBC
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Valproic acid mechanism
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opens chloride channels
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SE of valproic acid?
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thrombocytopenia pancreatitis wt gain hair loss GI distress cognitive dulling
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SE of valproic acid in pregnancy?
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neural tube defects
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SE of valproic acid in premenopausal women?
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PCOS
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what is the therapeutic range for valproic acid?
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50-100
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which labs with valproic acid?
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CBC liver function pancreatic enzymes
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Carbamazepine mechanism
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inactivates sodium channels
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what birth defects of carbamezepine?
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craniofacial defects
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SE of carbamazepine?
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agranulocytosis high liver function tests
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SE of Lamotrigene?
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leukopenia SJS hepatic failure
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which typical antipsychotic has retinitis pigmentosa?
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Thioridazine
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which typical antipsychotic has cardiac arrhythmias (torsades de points)?
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mesoridazine
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which typical antipsychotic is available in depot?
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fluphenazine
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chlorpromazine
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low potency typical antispychotic
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haloperidol
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high potency typical antispychotic
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thioridazine
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low potency typical antispychotic
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mesoridazine
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low potency typical antispychotic
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molindone
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medium potency typical antispychotic
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fluphenazine
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high potency typical antispychotic
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trifluoperazine
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high potency typical antispychotic
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thiothixene
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high potency typical antispychotic
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perphenazine
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high potency typical antispychotic
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loxapine
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medium potency typical antispychotic
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pimozide
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high potency typical antispychotic
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which atypical antipsychotic has a different mechanism of action?
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aripiprazole *partial agonist at dopamine and 5HT1A antagonist at postsynaptic 5HT2A
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atypical antipsychotic: clozapine
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agranulocytoisis seizures
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atypical antipsychotic: risperidone
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increased prolactin
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atypical antipsychotic: olanzapine
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wt gain somnolence **check liver enzymes
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atypical antipsychotic: quetiapine
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slit lamp exam of eyes for those at risk of developing cataracts
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atypical antipsychotic: ziprasidone
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QT prolongation
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atypical antipsychotic: aripiprazole
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nonsedating, no increased risk of wt gain or diabetes
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Busprione
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anxiolytic
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what drug should not be used with busprione?
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MAOI benzos
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antihistamine and anti-muscarinic found with which classes of drugs?
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TCAs and low potency antipsychotics
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what is serotonin syndrome?
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FLUSHING AND DIARRHEA diaphoresis tremor myoclonic jerks hyperthermia hypertonicity rhabdomyolysis renal failure
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what causes a hypertensive crisis?
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MAOI *buildup of catecholamines (due to MAOIs) + tyramine foods
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what are the parkinson side effects?
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malklife cafe, cogwheel rigidity, pill rolling tremor
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which classes of drugs cause hyperprolactineia?
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high potency traditional antipsychotics and risperidone
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NMS?
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Fever Encephalopathy Vital unstable (HTN, tachycardia) Elevated enzymes (CPK) Rigidity **20% mortality rate
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how do you treat EPS?
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benztropine
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what are the cyp inducers?
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smoking carbamazepine barbituates st johns wort
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what are the cyp inhibitors?
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fluvoxamine fluoxetine paroxetine duloxetine sertraline
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what is the withdrawal phenomenon for antidepressants?
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dizziness headache nausea insomnia malaise
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what drugs levels should be monitored closely when on SSRIs?
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warfarin (SSRIs can increase warfarin levels)
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what is the black box warning for nefazondone?
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liver failure
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what is the contraindication for venlafaxine?
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hypertension, uncontrolled
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Mirtazapine mechansim
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alpha 2 adrenergic receptor agonists
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what is the treatment for TCA overdose?
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sodium bicarb.
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what is the treatment for serotonin syndrome?
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calcium channel blockers (nifedipine)
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what are the things to remember with low potency antipsychotics?
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chlorpromazine and thioridazine -lower chance of EPS -QTc prolongation -heart block and v tach
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which antipsychotic can cause bluish skin discoloration?
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chlorpromazine
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what are the things to remember with high potency antipsychotics?
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haloperidol, fluphenazine, pimozide greater affinity for dopamine receptors greater risk of tardive dyskinesia
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who is at greatest risk of tardive dyskinesia?
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older women
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which antipsychotic is less likely to cause tardive dyskinesia?
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clozapine
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how do you treat EPS?
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- anticholinergic: benztropine -antihistaminergic: diphenhydramine -antiparkinsonian: amantadine
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which type of antipsychotics are more likely to cause seizures?
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low potency antipsychotics
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retinal pigmentation?
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thioridazine
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deposits on lens and cornea?
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chlorpromazine
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rashes and photosensitivity?
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chlorpromazine
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what are the two receptors that atypical antipsychotics work at?
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dopamine and serotonin
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what are some other side effects of clozapine?
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tachycardia hypersalivation myocarditis SEIZURES AND AGRANULOCYTOSIS
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which is the only antipsychotic to decrease the risk of suicide?
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clozapine
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what are the only two drugs to reduce the risk of suicide?
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lithium and clozapine
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when do you have to stop clozapine?
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if ANC < 1500
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what should you monitor for metabolic syndrome?
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baseline weight, blood pressure, fasting glucose, fasting triclycerides *diabetic ketoacidosis has been reported
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what are the toxic and lethal levels for lithium?
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toxic 1.5 lethal 2.0
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what are the baseline tests to get for lithium?
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ECG, basic chemistries, thyroid function, CBC, pregnancy test
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what cardiac defect in pregnant women?
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Ebsteins anomaly atrialization of the right ventricle
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when do you use carbamazepine?
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mixed episodes and rapid cycling bipolar trigeminal neuralgia
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lamotrigine can treat?
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biopolar depression but not mania
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how to valproate and lamotrigine work together?
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valproate will increase lamotrigine levels and lamotrigine will decrease valproate levels
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topiramate
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impulse control disorder and anxiety metabolic acidosis, kidney stones can be helpful in weight loss
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benzos that are not metabolized by the liver?
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lorazepam oxazepam temazepam
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what can be used for benzo overdose?
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flumazenil
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which intermediate benzo can be used for alcohol and sedative hypnotic detox?
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lorazepam and oxazepam
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mechanism of zolpidem, xaleplon, eszopiclone?
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selective receptor binding to benzo receptor 1
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half life of hypnotics?
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eszopiclone > zolipdem > zaleplon
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mechanism of ramelteon?
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MT1 and MT2 agonist
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Buspirone mechanism
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5HT1A partial agonist
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why is busprione useful in alcholics?
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does not potentiate CNS depression of alcohol
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hydroxyzine?
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antihistamine
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what schedule is adderall (amphetamine) and methylphenidate?
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II
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SE of methylphenidate?
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leukopenia, anemia, increased LFTs
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Atomoxetine mechanism?
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presynaptic NE inhibitor
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modafinil?
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narcoplepsy
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donepezil?
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acetylcholinesterase inhibitor
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galantamine
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acetylcholinesterase inhibitor
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rivastigmine
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acetylcholinesterase inhibitor
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tacrine
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acetylcholinesterase inhibitor
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memantine
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acetylcholinesterase inhibitor
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HTN tachycardia ataxia dysarthria muscle rigidity nystagmus
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pcp intoxication
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visual hallucinations + depersonalization + vivid senses
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LSD intoxication
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pinpoint pupils CNS depression constipation
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heroin intoxication
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pupillary dilation sweating cardiac arrhythmia respiratory depression insomnia n/v
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amphetamine intoxication
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conjunctival injection dry mouth tachycardia increased appetite
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cannabis intoxication
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which atypical antidepressant may worsen mania if used as monotherapy?
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buproprion
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somatization disorder?
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4 pain 2 GI 1 sexual 1 pseudoneurologic
