Psych pharmacology

CNS stimulants examples

Methylphenidate

Dextroamphetamine

Methamphetamine

Lisdexamfetamine

MOA of stimulants

Increases catecholamines in the synaptic cleft, especially norepinephrine and dopamine

Clinical use of stimulants

ADHD

narcolepsy

Binge eating disorder

Adverse effects of stimulants

Nervousness

Agitation

Anxiety

Insomnia

Anorexia

Tachycardia

Hypertension

Weight loss

Tics

Bruxism

Typical antipsychotic types

Haloperidol

Pimozide

Trifluoperazine

Fluphenazine

Thioridazine

Chlropromazine

(-azine)

Atypical antipsychotic examples

Aripiprazole

Asenapine

Clozapine

Olanzapine

Quetiapine

Iloperidone

Paliperidone

Risperidone

Lurasidone

Ziprasidone

(-apine, - idone)

MOA of typical antipsychotics

Block dopamine D2 receptor (increases cAMP)

MOA of atypical antipsychotics

Block D2 and 5-HT2a

Which atypical antipsychotic is a D2 partial agonist

Aripiprazole

Clinical use of antipsychotics

Schizophrenia

disorders with concomitant psychosis (bipolar)

Tourette’s syndrome

OCD

Huntingtons disease

Which antipsychotic is used for treatment -resistant psychotic disorders

Clozapine

Which antipsychotic is used for persistent suicidality

Clozapine (cloze to the edge)

Adverse effects of antipsychotics

Antihistamine (sedation)

Anti-a1-adrenergic (orthostatic hypotension)

Antimuscarinic (dry mouth, constipation)

(Anti-HAM)

What medications should be used in caution with dementia

Antipsychotics

Metabolic adverse effects of antipsychotics

Weight gain

Hyperglycemia

Dyslipidemia

Which antipsychotics increase the risk of obesity

Clozapine

Olanzapine

Endocrine adverse effects of antipsychotics

Hyperprolactinemia , which can cause galactorrhea, oligomenorrhea, gynecomastia

Cardiac adverse effects of antipsychotics

QT prolongation

Neurologic adverse effects of antipsychotics

Neuroleptic malignant syndrome

Which antipsychotic causes corneal deposits

Chlopromazine

Which antipsychotic causes retinal deposits

Thioridazine

Adverse effects of clozapine

Agranulocytosis

Seizures

Myocarditis

Which extra pyramidal symptoms can occur within hours to days after antipsychotic use?

Acute dystonia

Acute dystonia treatment

Benztropine

Diphenhydramine

Which extra pyramidal symptoms can occur within days to months after antipsychotic use?

Akathisia

Parkinsonism

Treatment of Akathisia

B-Blockers

Benztropine

Benzodiazepines

Treatment of Parkinsonism

Benztropine

Amantadine

Which extra pyramidal symptoms can occur within months to years of antipsychotic use?

Tardive dyskinesia (chorea, esp orofacial)

Treatment of Tardive dyskinesia

Benzodiazepines

Botulinum toxin injection

Valbenazine

Deutetrabenazine

Why do patients experience weight gain with antipsychotic use

Due to it being lipid soluble, storing it in body fat, making it slow to remove from the body

Which antipsychotics have a greater affinity for D2 receptors

Typical > atypical

(Increase risk for adverse effects)

What are the high potency typical antipsychotics

Haloperidol

Trifluoperazine

Pimozide

Fluphenazine

( Hal tries pie to fly high)

Low potency typical antipsychotics

Chlorpromazine

Thioridazine

(Cheating thieves are low)

Which typical antipsychotics have more neurologic adverse effects

High potency typical antipsychotics

Which antipsychotic have more antihistaminic, anti-a1-adrenergic, and antimuscarinic effects?

Low potency typical antipsychotics

MOA of lithium

Affects neurotransmission ( decreases excitatory, increases inhibitory) and second messenger systems (eg, G proteins)

Clinical use of lithium

Mood stabilizer for bipolar disorders

Treats acute manic episodes and prevents relapse

Adverse effects of lithium

Tremor

Hypothyroidism

Hyperthyroidism

Mild Hypercalcemia

Polyuria (DI)

teratogenesis (ebstein anomaly)

What drug is almost exclusively excreted by kidneys

Lithium

Where is most of lithium reabsorbed

PCT via Na channels

Which drugs affect clearance of lithium causing lithium toxicity

Thiazides

Ace inhibitors

NSAIDS

MOA of buspirone

Partial 5-HT1a agonist

Clinical use of buspirone

Generalized anxiety disorder

When does buspirone take effect

1-2 weeks after use

SSRI examples

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

Escitalopram

Citalopram

MOA of SSRI

inhibit 5-HT reuptake

Clinical use of SSRI

Depression

Generalized anxiety disorder

Panic disorder

OCD

Bulimia

Binge eating disorder

Social anxiety disorder

PTSD

premature ejaculation

Premenstrual dysphoric disorder

SSRI adverse effects

Serotonin syndrome

GI distress

SIADH

sexual dysfunction (anorgasmia, erectile dysfunction , decreased libido)

Mania if underlying bipolar disorder

Which SSRI is given to 18 and under

Fluoxetine

How long does it take for SSRIs to show appreciable effect?

4-8 weeks

SNRIs examples

Venlafaxine

Desvenlafaxine

Duloxetine

Levomilnacipran

Milnacipran

MOA of SNRI

Inhibit 5-HT and NE reuptake

Clinical use of SNRIs

Depression

Generalized anxiety disorder

Diabetic neuropathy

What is venlafaxine indicated for

Social anxiety disorder

Panic disorder

PTSD

OCD

Which SNRIs are indicated for fibromyalgia

Duloxetine

Milnacipran

Adverse effects of SNRI

Increased BP

stimulant effects

Sedation

Sexual dysfunction

Nausea

Tricyclic antidepressants examples

Amitriptyline

Nortriptyline

Imipramine

Desipramine

Clomipramine

Doxepin

Amoxapine

Clinical use of TCA

MDD

peripheral neuropathy

Chronic neuropathic pain

Migraine prophylaxis

OCD

Nocturnal enuresis

What is clomipramine used for

OCD

What treats nocturnal enuresis

Imipramine

Adverse affects of TCAs

Sedation

a1-blocking effect (Postural hypotension)

Atropine-like (anticholinergic)

Prolong QT interval

Convulsions

Coma

Cardiotoxicity

Respiratory depression

Hyperpyrexia

How to prevent arrhythmia from TCA

NaHCO3

MOA inhibitors examples

Tranylcypromine

Phenelzine

Isocarboxazid

Selegiline

MOA of MOA inhibitor

Nonselective MOA inhibition —> increases levels of 5-HT, NE, dopamine

MOA inhibtor clinical use

Atypical depression, anxiety

Which MOA inhibitor treats Parkinson’s

Selegiline

Adverse effects of MOA inhibitors

CNS stimulation

Hypertensive crisis (with tyramine)

Contraindications of MOA inhibitors

SSRI

TCA

ST John’s wort

Meperdine

Dextromethorphan

Pseudoephedrine

Linezolid

How long to wait before starting serotonergic drugs on MOA inhibitors

2 weeks