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PSYCHOPHARMACOLOGY MASTER STUDY SHEET

I. Major Neurotransmitters (Simple, EPPP-Style)

Serotonin (5-HT)
  • Functions:
    • Regulates mood, sleep, appetite
  • Implications:
    • Low levels associated with:
    • Depression
    • Obsessive-Compulsive Disorder (OCD)
    • Suicidality
    • High levels can lead to:
    • Serotonin syndrome
Norepinephrine
  • Functions:
    • Attention, arousal, stress response
  • Implications:
    • Low levels are linked to depression
    • High levels can cause mania and anxiety
Dopamine
  • Functions:
    • Reward, movement, psychosis
  • Implications:
    • High dopamine levels can result in psychosis, particularly in the mesolimbic pathway
    • Low dopamine levels are associated with negative symptoms seen in the mesocortical pathway
    • Low dopamine in the nigrostriatal pathway can lead to Parkinsonism/Extrapyramidal Symptoms (EPS)
GABA
  • Functions:
    • Main inhibitory neurotransmitter
  • Implications:
    • Low GABA levels can lead to anxiety and seizures
    • Benzodiazepines increase GABA activity
Glutamate
  • Functions:
    • Main excitatory neurotransmitter
  • Implications:
    • High glutamate levels can lead to excitotoxicity
    • Linked to schizophrenia via NMDA receptor dysfunction

II. Antipsychotic Medications

A. First-Generation (Typical) Antipsychotics

  1. Examples:

    • Chlorpromazine (Thorazine)
    • Haloperidol (Haldol)
    • Thioridazine (Mellaril)
    • Fluphenazine (Prolixin)

  2. Mechanism:

    • Strong D2 blockade in the mesolimbic pathway reduces positive symptoms

  3. Side Effects:

    • Extrapyramidal Symptoms (EPS):
    • Acute dystonia
    • Akathisia
    • Parkinsonism
    • Tardive dyskinesia (late onset, potentially irreversible)
    • Neuroleptic Malignant Syndrome (NMS):
    • Symptoms include fever, rigidity, confusion, unstable vital signs
    • Treatment involves stopping the medication and administering dantrolene/bromocriptine

EPPP Pearl: EPS occurs due to blocking dopamine in the nigrostriatal pathway.

B. Second-Generation (Atypical) Antipsychotics

  1. Examples:

    • Clozapine (Clozaril)
    • Risperidone (Risperdal)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)

  2. Mechanism:

    • Act on both dopamine and serotonin receptors to reduce both positive and some negative symptoms

  3. Side Effects:

    • Risk of metabolic syndrome:
    • Weight gain
    • Diabetes
    • Lipid abnormalities
    • Generally, less EPS compared to FGAs, but risperidone may cause more EPS.
CLOZAPINE (SPECIAL)
  • Indication:
    • Treatment-resistant schizophrenia
  • Effectiveness:
    • Most effective antipsychotic available
  • Risks:
    • Agranulocytosis (mandatory monitoring of white blood cells)
    • Seizures
    • Myocarditis
    • Significant weight gain

Key Exam Tip: If asked about medication reserved for patients who fail other antipsychotics, the answer is CLOZAPINE.

Third-Generation Antipsychotics:
  • Examples:
    • Aripiprazole (Abilify)
    • Brexpiprazole (Rexulti)
    • Cariprazine (Vraylar)
  • Indications:
    • Used to treat schizophrenia and as adjunctive treatment for bipolar disorder and major depressive disorder
  • Mechanism:
    • Known as dopamine-serotonin stabilizers; categorized as partial agonists
    • Work at D2 receptors:
    • Antagonists reduce dopamine levels in areas of the brain with excessive dopamine, alleviating positive symptoms
    • Partial agonists increase dopamine levels in areas deficient in dopamine, addressing negative and cognitive symptoms

III. Antidepressants

A. SSRIs (Selective Serotonin Reuptake Inhibitors)

  1. Examples:

    • Sertraline
    • Fluoxetine
    • Paroxetine
    • Citalopram

  2. Mechanism:

    • Block serotonin reuptake, thus increasing serotonin levels in the synaptic cleft

  3. Side Effects:

    • Sexual dysfunction
    • Gastrointestinal (GI) symptoms
    • Insomnia
    • Risk of Serotonin Syndrome (symptoms include confusion, hyperreflexia, fever)

  4. Uses:

    • Depression
    • Anxiety disorders
    • OCD
    • PTSD

Key Exam Insight: SSRIs are the first-line treatment for depression and anxiety.

B. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

  1. Examples:

    • Venlafaxine
    • Duloxetine

  2. Mechanism:

    • Increase both serotonin and norepinephrine levels

  3. Applications:

    • Effective for pain management in combination with depression treatment
C. Tricyclic Antidepressants (TCAs)

  1. Examples:

    • Amitriptyline
    • Nortriptyline

  2. Side Effects:

    • Anticholinergic effects (dry mouth, constipation, blurred vision)
    • Cardiac toxicity
    • High lethality in overdose situations
D. MAOIs (Monoamine Oxidase Inhibitors)

  1. Examples:

    • Phenelzine
    • Tranylcypromine

  2. Risks:

    • Potential hypertensive crisis if consuming tyramine-rich foods
    • Serotonin syndrome possible when combined with SSRIs

Key Mnemonic: “Cheese reaction” refers to MAOI + tyramine interaction leading to hypertensive crisis.

IV. Mood Stabilizers

A. Lithium

  1. Indication:

    • First-line treatment for classic bipolar disorder
    • Best choice for mania and relapse prevention

  2. Side Effects:

    • Tremor
    • Weight gain
    • Hypothyroidism
    • Renal toxicity
    • Narrow therapeutic window

  3. Caution:

    • Sodium depletion can increase lithium toxicity
B. Anticonvulsants (used as mood stabilizers)
  1. Examples and Uses:
    • Valproate: Effective for rapid-cycling and mixed episodes
    • Carbamazepine: Used for aggression and mood swings
    • Lamotrigine: Useful for bipolar depression but carries risk of Stevens-Johnson syndrome

V. Benzodiazepines

A. Examples:
  • Lorazepam
  • Diazepam
  • Clonazepam
B. Mechanism:
  • Enhance GABA activity (the primary inhibitory neurotransmitter)
C. Uses:
  • Treatment for:
    • Acute anxiety
    • Panic disorder
    • Alcohol withdrawal
    • Muscle spasms
    • Seizures
D. Risks:
  • Dependence and withdrawal seizures
  • Cognitive impairment
  • Dangerous with concurrent alcohol use (synergistic CNS depression)

Key Insight: Short-acting benzodiazepines pose a higher risk for abuse (e.g., alprazolam).

VI. Stimulants

A. Examples:
  • Methylphenidate
  • Amphetamine salts
B. Mechanism:
  • Increase dopamine and norepinephrine levels in the prefrontal cortex
C. Uses:
  • Primarily indicated for ADHD and narcolepsy
D. Side Effects:
  • Appetite loss
  • Insomnia
  • Irritability
  • Increased blood pressure and heart rate

VII. Substance Use: High-Yield Medications

A. Alcohol Withdrawal (ACUTE)
  • FIRST-LINE TREATMENT: Benzodiazepines
    • Examples: diazepam, lorazepam, chlordiazepoxide
    • Administering Thiamine is critical to preventing Wernicke-Korsakoff syndrome

Memory Trick: Withdrawal = BZDs + B1

B. Alcohol Use Disorder (LONG-TERM)
  • Relapse Prevention (Mnemonic: DNA):
    • Disulfiram: Promotes aversive conditioning
    • Naltrexone: Reduces cravings
    • Acamprosate: Stabilizes glutamate levels

Key Exam Note: These treatments are highly relevant for tests.

C. Opioids
  • Overdose Treatment: Naloxone (Narcan) is an opioid antagonist that reverses overdose.
  • Maintenance Treatments:
    • Methadone: Full opioid agonist, effective in reducing withdrawal and cravings
    • Buprenorphine: Partial agonist for maintenance
    • Naltrexone: Antagonist used after detoxification

VIII. High-Yield Side Effect Patterns

  • EPS: Primarily related to FGAs (e.g., haloperidol)
  • Metabolic syndrome: Noted with SGAs (e.g., olanzapine)
  • Agranulocytosis: Linked to clozapine usage
  • Hyponatremia risk: Associated with SSRIs
  • Hypertensive crisis: Risk from combining MAOIs and tyramine
  • Stevens-Johnson syndrome: Risk with lamotrigine
  • Tremor, thyroid problems, renal concerns: Related to lithium usage
  • Sexual dysfunction: Common side effect of SSRIs and SNRIs

IX. EPPP QUICK-REFERENCE TABLE

ConditionFirst-Line MedicationKey Risk
SchizophreniaSGAsMetabolic syndrome
Acute maniaLithium or ValproateTeratogenicity with valproate
DepressionSSRIsSerotonin syndrome
Anxiety (acute)BenzosDependence
ADHDStimulantsInsomnia, appetite loss
Alcohol withdrawalBenzodiazepinesRespiratory depression
Alcohol use disorderDisulfiram, Naltrexone, AcamprosateDangerous if drinking on disulfiram
Opioid overdoseNaloxoneShort half-life (rebound risk)
Bipolar depressionLamotrigineStevens-Johnson syndrome rash

THINGS TO REMEMBER

1. CENTRAL NERVOUS SYSTEM DEPRESSANTS
  • Includes: Benzodiazepines, Barbiturates, Alcohol Withdrawal, Opioids
  • Effects: Slow CNS activity and enhance GABA (except opioids); can cause drowsiness and respiratory depression.
A. Benzodiazepines
  • Examples: Diazepam (Valium), Alprazolam (Xanax), Lorazepam (Ativan)
  • Mechanism: GABA agonists that reduce anxiety, stop seizures, and treat alcohol withdrawal.
  • Uses:
    • Acute anxiety
    • Panic attacks
    • Insomnia
    • Alcohol withdrawal
    • Seizures
  • Key Risks:
    • Dependence and tolerance
    • Dangerous when combined with alcohol
B. Barbiturates
  • Examples: Secobarbital, Amobarbital
  • Mechanism: Strong GABA agonists but are not commonly used due to high abuse potential and overdose risk.
C. Alcohol Use Disorder Medications
  • Disulfiram (Antabuse): Creates violent illness upon alcohol consumption.
  • Naltrexone: Opioid antagonist reducing cravings.
  • Acamprosate: Reduces cravings, safer for patients with liver issues.
2. CENTRAL NERVOUS SYSTEM STIMULANTS
  • Includes: Methylphenidate (Ritalin), Amphetamine salts (Adderall)
  • Mechanism: Increase dopamine and norepinephrine in the prefrontal cortex, improving attention and reducing impulsivity.
A. Non-stimulants
  • Atomoxetine (Strattera): SNRI mechanism with no abuse potential, suitable for comorbid anxiety or tics.
  • Guanfacine & Clonidine: Alpha-2 agonists.
3. MOOD STABILIZERS
  • Lithium: Gold standard for classic euphoric mania; requires blood monitoring for toxicity.
  • Anticonvulsants:
    • Valproate: Effective for mixed episodes.
    • Carbamazepine: Used for acute mania and has specific warning signs.
4. ANTIDEPRESSANTS
  • Explore: SSRIs, SNRIs, Atypicals, TCAs, MAOIs
5. ANTIPSYCHOTICS
  • Streamlined Classes: FGAs, SGAs, TGAs with mechanism and side effect discussions.
6. NEUROCOGNITIVE DISORDER DRUGS
  • Cholinesterase Inhibitors: Examples include Donepezil, Rivastigmine, and Galantamine.
  • NMDA Antagonist: Memantine regulates glutamate for moderate-severe Alzheimer’s.
7. SUBSTANCE USE DISORDER MEDS
  • Final List: Alcohol, opioids, tobacco treatment options.
8. THC & PSYCHEDELICS
  • THC: Increases dopamine; approved for cancer-related symptoms.
  • Psychedelics: LSD and psilocybin show promise in treating specific conditions.
9. HIGH-YIELD TERMS
  • Half-life: Duration for drug elimination by 50%.
  • Tolerance: Reduced effectiveness over time.
  • Cross-tolerance: Response decrease to one drug leads to decreased response to similar substances.
  • Therapeutic index: Margin between effective and toxic doses; low TI indicates higher danger sensitivity (e.g., lithium).