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55 Cards in this Set
- Front
- Back
What are the major categories of drugs to treat psychiatric illnesses?
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Antidepressants, anti-psychotics, mood stabilizers, anxiolytics/hypnotics
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What are the major categories of antidepressants?
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1. Tricyclic antidepressants
2. MAOIs 3. Selective serotonin reuptake inhibitor (SSRIs) 4. Atypical antidepressants |
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What are the effects of antidepressants on depression, mood, and abuse potential?
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Treats depression, no abuse potential and does NOT elevate mood
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What is the mechanism of action of TCAs?
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Inhibits reuptake of NE and serotonin
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What are some TCA drugs?
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Imipramine, amitriptyline, desipramine, nortriptyline
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What are the adverse effects of TCA's?
What are the most toxic effects? |
HAM side effects
1) Anti-histaminic - sedation 2) Anti-adrenergic - orthostatic hypotension 3) Anti-muscarinic - dry mouth, constipation, urinary retention, blurred vision, tachycardia *Convulsions, coma and cardiotoxicity |
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What must always be assessed before prescribing TCA's? Why?
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Suicide risk because these drugs are lethal in overdose
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What is the treatment of choice for TCA overdose?
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IV Sodium bicarbonate
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What is the mechanism of action of MAOI?
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Inhibits MAO enzymes and prevent the inactivation of amino neurotransmitters such as NE, serotonin, dopamine and tyramine
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What are some MAOIs drugs?
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Phenelzine, tranylcypromine
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What are the adverse and toxic effects of MAOIs?
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1. Serotonin syndrome - hyperthermia, muscle rigidity, death; when SSRI's and MAOIs are combined
2. Hypertensive crisis - buildup of catecholamines; when MAOIs and tyramine-rich foods or sympathomimetics are combined |
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What is the treatment of serotonin syndrome?
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Discontinue the medications
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What is the mechanism of SSRIs?
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Inhibits presynaptic serotonin pumps, increasing availability of serotonin in synaptic clefts
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What can SSRIs be used to treat?
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Depression, OCD, anxiety
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Name some of the SSRI drugs
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Fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram
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What are the adverse effects of SSRIs?
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1. Sexual dysfunction
2. GI distress 3. Serotonin syndrome |
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What are some of the atypical antidepressants?
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1. SNRI
2. NDRI 3. SARI 4. NASA |
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What drug is a SNRI? What are the adverse effects?
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Venlafaxine (Effexor), increased blood pressure (do not use in patients with labile BPs)
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What drug is a NDRI?
What are the indications? What are the advantages? What are the adverse effects? |
1) Buproprion (Wellbutrin)
2) Depression and smoking cessation 3) Lack of sexual side effects 4) Seizures, use with caution in epileptics |
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What drug is a SARI?
What are the indications? What are the adverse effects? |
1) Trazodone and Nefazodone
2) Depression and insomnia 3) Sedation and priapism |
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What drug is a NASA?
What are the indications? What are the adverse effects? |
1) Mirtazapine (Remeron)
2) Depression with need for weight gain 3) Weight gain, appetite stimulant |
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What is the mechanism of action of traditional typical antipsychotics?
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Block dopamine receptors
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What is the mechanism of action of atypical antipsychotics?
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Block dopamine and serotonin receptors
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Which drugs are low potency antipsychotics?
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Chlorpromazine and thioridazine
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Which drugs are high potency antipsychotics
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Haloperidol, fluphenazine
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What is the advantage of atypical antipsychotics?
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1) More effective in treating negative psychotic symptoms
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What are the adverse effects of traditional antipsychotics?
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1) Antidopaminergic effects
a. Dystonia - sustained contractions b. Akinesia - Parkinson's c. Akisthesia - restlessness d. Tardive dyskinesia - Writhing oral-facial movements e. Hyperprolactinemia - galactorrhea and gynecomastia 2) Anti-HAM effects a. Sedation b. Orthostatic hypotension c. Anticholinergic 3) Weight gain 4) Elevated LFTs |
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Low potency antipsychotics causes which adverse effects?
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Anti-HAM effects
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High potency antipsychotics causes which adverse effects?
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Extrapyramidal side effects
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What is neuroleptic malignant syndrome?
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Rare but can occur in some people who take neuroleptics; 20% mortality, FARE
Fever Autonomic instability Rigidity (lead pipe) Elevated CPK |
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What is the treatment of neuleptic malignant syndrome?
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1. Dantrolene and bromocriptine (dopamine agonists)
2. D/C current medications 3. Supportive medical care (hydration and cooling) |
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What is the advantage of atypical antipsychotics?
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Fewer adverse effects, rarely cause EPSE, tardive dyskinesia or neuroleptic malignant syndrome
*They are also more effective in treating negative symptoms of schizophrenia |
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What are the atypical antipsychotic drugs?
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Clozapine, risperidone, olanzapine, quetiapine, aripiprazole and ziprasidone
CROQAZ |
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What is unique about Clozapine?
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Adverse effect of agranulocytosis; patients must have weekly blood draws to check WBC counts
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What is another name for mood stabilizer? What is their purpose?
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Antimanics, used to treat acute mania
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What drugs are mood stabiliziers?
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1. Lithium
2. Carbamazepine (Tegretol) 3. Valproic acid (Depakote) |
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What are the major adverse effects of lithium?
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1. Hypothyroidism
2. Nephrogenic diabetes insipidus (ADH antagonist) |
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What is Carbamazepine (Tegretol) used for?
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1. Anticonvulsant
2. Trigeminal neuralgia 3. Mood stabilizer, rapid-cycling bipolar |
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What are the adverse effects of Carbamazepine?
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1. Aplastic anemia
2. Agranulocytosis 3. Liver toxicity 4. Teratogenic effects |
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What is Valproic acid (Depakote) used for?
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1. Anticonvulsant
2. Mood stabilizer, rapid-cycling bipolar |
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What are the adverse effects of Valproic acid?
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1. Fatal hepatotoxicity
2. Neural tube defects, contraindicated in pregnancy |
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What drugs are considered to be anxiolytics/hypnotics?
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1. Benzodiazepines
2. Barbiturates 3. Buspirone |
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How do anxiolytics work?
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They cause CNS depression, causing a sedative effect
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What are indications for anxiolytics?
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1. Anxiety disorders
2. Sleep disorders 3. Anasthesia induction |
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What are some of the anxiolytic drugs?
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Diazepam, Alprazolam, Clonazepam, Triazolam
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What are adverse effects of BZD?
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Drowsiness, respiratory depression especially when combined with alcohol
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What is Zolpidem used for?
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Insomnia, chemically not a BZD
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What is Buspirone (BuSpar) used for?
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Generalized anxiety disorder
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What is unique about buspirone?
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1. No addiction/abuse potential
2. Does not interact with alcohol 3. Delayed clinical response, 2 weeks; slower onset than BZD |
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What is the mechanism of action of buspirone?
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Stimulates 5HT-1A receptor
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What are HAM side effects? What kind of drugs have HAM side effects?
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1. Sedation
2. Orthostatic hypotension 3. Anti-cholinergic TCAs and low potency antipsychotics |
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What is serotonin syndrome? How does this happen?
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Hyperthermia and muscle rigidity. Combination of MAOIs and SSRIs
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What is hypertensive crisis? How does this happen?
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Buildup of stored catecholamines. MAOIs plus food with tyramine or sympathomimetic
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What are extrapyramidal side effects?
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1. Dystonia
2. Akasthesia 3. Akinesia 4. Tardive dyskinesia |
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What is neuroleptic malignant syndrome?
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Can be caused by all antipsychotics; a medical emergency
1. Fever 2. Autonomic instability 3. Rigidity (lead pipe) 4. Elevated CPK |