Term
| High potency typical antipsychotics (3) |
|
Definition
Haloperidol
Trifluoperazine
Fluphenazine
(These drugs have bad EPS, but have less anticholinergic, antihistamine, and alpha-blocking effects than the low-poetency typicals, i.e. clopromazine & thioridazine) |
|
|
Term
| Low potency typical antipsychotics (2) |
|
Definition
Thioridazine
chlorpromazine
(these drugs have anticholinergic, antihistamine, and alpha-blocking effects, BUT have much lower EPS than high-potency typicals, i.e. haloperidol, trifluoperazine, fluphenazine) |
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Term
| Which antipsychotics are quinidine-like in their side-effect profile? |
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Definition
Low potency typical antipsycotics (Chlorpromazine, thioridazne)
Atypical antipsycotics (Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone) |
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Term
| general description of positive & negative symptoms of schizophrenia |
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Definition
Positive symptoms: things normal people don't experience (e.g. hallucinations, delusions, disordered thought/speech)
Negative symptoms: deficits in normal emotional response (e.g. blunted affect, depression, alogia, anhedonia, asociality, avolition)
Tx positive Sx w/ D2 blocking: e.g. typicals
Tx negative Sx w/ 5HT2 blocking (note receptor subtype): e.g. atypicals |
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Term
| Typical antipsychotics w/ most EPS? |
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Definition
| Haloperidol & fluphenazine |
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Term
| Typical antipsychotic w/ worst antimuscarinic/alpha/histamine effects? |
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Definition
| Thioridazine (has lowest EPS, though, probably due to antimuscarinic activity!) |
|
|
Term
Antimuscarinic SE profile?
(think typical antipsychotics) |
|
Definition
Decreased secretions (dry mouth & eyes)
Constipation
Urinary retention
Mydriasis (blurry vision)
Decreased sweating (Red, hot skin) |
|
|
Term
Alpha-blocking SE profile?
(think typical antipsychotics) |
|
Definition
Orthostatic hypotension
reflex tachycardia upon removal |
|
|
Term
Antihistamine SE profile?
(think typical antipsychotics) |
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Definition
|
|
Term
| Tx for intractable hiccups |
|
Definition
| Typical antipsychotics (haloperidol, low dose) |
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|
Term
|
Definition
| Chlorpromazine (drug deposits in corneal epithelium) |
|
|
Term
|
Definition
Thioridazine
(also remember this drug has the most quinidine-like effects of any of the typicals) |
|
|
Term
| T or F: typical antipsychotics are lipid soluble |
|
Definition
| TRUE: they are stored in fat and take a long time to be fully eliminated |
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Term
|
Definition
4 hours: acute dystonia (muscle spasm, stiffness (torticollis) oculogyric crisis)
4 days: akinesia (pseudo-parkinsonian)
4 weeks: akathisia (restlessness)
4 months: tardive dyskinesia (often irreversible --> switch to atypical) |
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|
Term
| Galactorrhea is a major SE of these drugs? |
|
Definition
| typical antipsychotics (esp high potency, i.e. haloperidol/trifluperazine/fluphenazine) |
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|
Term
| What causes: rigidity, myoglobinuria, autonomic instability, hyperpyrexia? |
|
Definition
Neuroleptic malignant syndrome (NMS)
(typical antipsychotics, think "FEVER": fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles)
malignant hyperthermia from decreased temperature regulation |
|
|
Term
| what do you treat NMS with? |
|
Definition
| DA agonist (e.g. bromocriptine) & dantrolene |
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|
Term
| What causes dysphoria in antipsychotics? |
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Definition
| Decreased DA in mesolimbic system. This WORSTENS negative symptoms --> tx by blocking 5HT2 |
|
|
Term
|
Definition
Binds ryanodene receptors & prevents Ca++ release
used in NMS in order to decrease muscle tone and decrease heat production |
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|
Term
| Atypical antipsychotics (6) |
|
Definition
| aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone |
|
|
Term
| MOA of atypical antipsychotics? |
|
Definition
Blocks 5HT2 (increases 5HT transmission, analogous to alpha-2 receptor)
also blocks: dopamine, alpha, H1
(fewer EPS & anticholinergic SE than typicals) |
|
|
Term
| Which SE are decreased in atypical vs typical antipsychotics? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| unique feature of Aripiprazole |
|
Definition
partial D2 agonist
(it's an atypical antipsychotic) |
|
|
Term
| use these antipsychotics to treat negative symptoms? |
|
Definition
|
|
Term
| Blocks dopamine receptors only in mesolimbic system |
|
Definition
Clozapine (atypical antipsychotic)
(D2b vs D2a in nigrostriatal pathway) --> minimal pseudo-parkinsonian symptoms |
|
|
Term
| Only antipsychotic NEVER associated w/ EPS |
|
Definition
|
|
Term
| Drug used for schizophrenia w/ risk of agranulocytosis |
|
Definition
| Clozapine (occurs in 5-10%, must monitor w/ weekly blood tests) |
|
|
Term
| Unique SE profile of clozapine |
|
Definition
- Agranulocytosis
- Excessive salivation ("wet-pillow syndrome"; from increased 5HT --> overcomes antimuscarinic effects)
- NO EPS |
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|
Term
| atypical w/ increased QT interval |
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Definition
|
|
Term
|
Definition
| risperidone (all of them have a little, except clozapine) |
|
|
Term
|
Definition
originally an antihypertensive: blocks VMAT --> decreased NE, 5HT, & DA release
(this was the basis for the "amine hypothesis", because pts would get seriously depressed on this drug: decreased DA, 5HT, & NE --> depression) |
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Term
|
Definition
|
|
Term
|
Definition
| congenital heart defect: tricuspid valve dysplaced to apex & leaflet smashed against posterior wall, RV hypoplasia & regurge --> RA arrhythmias) |
|
|
Term
|
Definition
| Ebstein abnormality: tricuspid valve dysplacement, RV hypoplasia, & RA arrhythmias |
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|
Term
|
Definition
| Lithium (may need antidepressant/antipsychotic for depression/mania: e.g. olanzapine for mania) |
|
|
Term
| 2 antiepileptic drugs used in treating mania in bipolar? |
|
Definition
carbamazepine
valproic acid |
|
|
Term
|
Definition
| really unknown: blocks PIP2 (Gq) & decreases cAMP (Gs) --> multiple effects (including endocrine, like hypothyroidism from blocking TSHRs; SIADH) |
|
|
Term
| V2 receptor second mesanger? |
|
Definition
| cAMP (Gs): inappropriately inactivated in Li toxicity --> nephrogenic diabetes insipidus |
|
|
Term
|
Definition
Movement (tremor)
Nephrogenic diabetes insipidus
Hypothyroidism
Teratogenicity (Ebsteins) |
|
|
Term
| How does lithium cause seizures? |
|
Definition
| acts like Na+ --> depolarized neurons |
|
|
Term
| Tremor, sedation, edema, heart block, hypothyroidims, polyuria, teratogenesis |
|
Definition
|
|
Term
| What will increase & decrease Li clearance? |
|
Definition
Increase: loop diuretics (increase proximal reabsorption & aldosterone-mediated reabsorption)
Decrease: amiloride, triamterene (blocks nephorgenic DI effect --> decrease Na retention & thus Li retention)
(Li acts like Na in the kidney, so increased aldosterone will increase Li resorption) |
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|
Term
| Therapeutic window for lithium? |
|
Definition
|
|
Term
|
Definition
| anxiety disorder (no sedation b.c. it's a partial agonist on 5HT1a, person can't get too ramped up) |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Anxiolytic that doesn't interact w/ GABA signaling? |
|
Definition
| Buspirone (5HT1a partial agonist --> no sedation) |
|
|
Term
| use in neuropathic pain (2) |
|
Definition
| Amytriptaline & carbamazepine |
|
|
Term
|
Definition
| Imipramine (decrease phase 4 sleep) & desmopressin |
|
|
Term
| Tricyclic & antypical antipsychotic used for OCD |
|
Definition
| clomipramine & quetiapine |
|
|
Term
| Tricyclic antidepressants (7, but 3 are important) |
|
Definition
Important to know: amitriptyline, clomipramine, imipramine
less important: desipramine, nortriptyline, doxepin, amoxapine, protriptyline |
|
|
Term
|
Definition
| blocks reuptake of NE & 5HT |
|
|
Term
|
Definition
sedation
alpha blocking
anticholinergic
3rd gen (amytriptyline) have more anticholinergic than 2nd gen (nortriptyline) |
|
|
Term
| TCA w/ lowest seizure threshold |
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Definition
|
|
Term
| TCA w/ low anticholinergic effects |
|
Definition
|
|
Term
|
Definition
| extremely high body temperature >106.7 (41.5) |
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|
Term
| Treatment for TCA cardiotoxicity? |
|
Definition
|
|
Term
| Drugs, that when used in combo, may result in serotonin syndrome? |
|
Definition
MAOI
TCAs
SSRIs
Meperidine
Dextromethorphan
St. John's Wort |
|
|
Term
| Antitussive that can precipitate serotonin syndrome |
|
Definition
| Dextromethorphan, because it acts as a partial serotonin reuptake inhibitor |
|
|
Term
|
Definition
Citalopram
Fluoxetine
Paroxetine
Sertraline |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| SSRIs (anorgasmia is a SE) |
|
|
Term
|
Definition
|
|
Term
| describe serotonin syndrome |
|
Definition
hyperthermia
muscle rigidity
cardiovascular collapse
flushing
diarrhea
seizures
(Tx w/ cyproheptadine, a 5HT2 antagonist) |
|
|
Term
| in mesolimbic system, these two neurotransmitters are in balance |
|
Definition
| Dopamine & seratonin (negatively correlated) |
|
|
Term
| Tx for serotonin syndrome |
|
Definition
|
|
Term
|
Definition
| 5HT2 receptor antagonist --> Tx for serotonin syndrome (different that the 5HT2 antagonism in atypicals) |
|
|
Term
| Give this for the first 2-4 weeks of SSRI therapy |
|
Definition
| alprazolam (SSRIs increase anxiety before they have antidepressant effects) |
|
|
Term
| See bruxism with this drug |
|
Definition
| SSRIs (from increased 5HT) |
|
|
Term
| weight loss or gain w/ SSRIs? |
|
Definition
weight loss (typically)
this is b.c. increased 5HT |
|
|
Term
| what happens if you give a bipolar a drug for depression? |
|
Definition
|
|
Term
| Venlafaxine is used in depressed pts w/ what comorbidity |
|
Definition
|
|
Term
| SNRIs have none of these side effects? |
|
Definition
anticholinergic
alpha antagonism
(No 3 C's)
(Ex: Venlafaxine, duloxetine) |
|
|
Term
| use this SNRI w/ depression, diabetic peripheral neuropathy, and pain |
|
Definition
|
|
Term
|
Definition
inhibit serotonin & NE uptake
(Ex: venlafaxine & duloxetine) |
|
|
Term
|
Definition
| increased BP (but venlafaxine is good for pts w/ arrhythmias; duloxetine has more NE activity) |
|
|
Term
|
Definition
phenelzine
tranylcypromine |
|
|
Term
| Selective MAO-B inhibitor (& use) |
|
Definition
| selegiline (used in parkinsons, b.c. MAO-B degrades DA) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| depression that doesn't respond to normal meds --> Tx w/ MAOI |
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|
Term
|
Definition
|
|
Term
| MAOI get hypertensive crisis w/ tyramine ingestion & what drug? |
|
Definition
| Beta agonists (or CNS stimulants) |
|
|
Term
| sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| atypical antidepressant that increases dopamine in the mesolimbic system, is non-sedating, & decreases appetite? |
|
Definition
Bupropion
(increases NE & dopamine; used in smoking cessation) |
|
|
Term
| Use this drug with depression w/ insomnia |
|
Definition
|
|
Term
| antidepressent w/ alpha2 antagonism |
|
Definition
|
|
Term
| antidepressant: potent H1 blocker (lots of sedation), increased appetite, weight gain, dry mouth. Use in anorexics. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| SARI (primarily inhibits serotonin reuptake) |
|
|
Term
|
Definition
trazodone
mechanism: alpha blocker --> vasodilation --> erection & cardiac arrythmias |
|
|
Term
|
Definition
| trazodone (high doses needed for antidepressant effects, so not that good) |
|
|
Term
| partial nicotein receptor agonist |
|
Definition
|
|
Term
|
Definition
| partial nicotein receptor agonist |
|
|
Term
|
Definition
methylphenidate
Atomoxetine (decrease NE reuptake) |
|
|
Term
| why do you always taper ADHD meds? |
|
Definition
|
|
Term
|
Definition
| decreases NE uptake --> used for ADHD |
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