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50 Cards in this Set
- Front
- Back
CNS stimulants - list them.
Mechanism? |
Methylphenidate (Ritalin)
Dextroamphetamine (Adderall) Mixed Amphetamine Salts Mechanism : Increased catecholamines at the synaptic cleft, especially NE and Dopamine. |
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CNS Stimulants - Clinical Use
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ADHD
Narcolepsy Appetitie control |
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Antipsychotics are also called? Name the general ending associated with the typical antipsychotics..
mechanism? |
The "Typical" Antipsychotics are the neuroleptics
Haloperidol + "azines" Mechanism = Block Dopamine D2 receptors => increase intracellular cAMP |
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Antipsychotics clinical use
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Schizophrenia (POSITIVE symptoms)
Psychosis Acute mania Tourette's syndrome |
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Try to Fly High
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Trifluperazine
Fluphenazine Haloperidol High potency neuroleptics (antipsychotics) -associated with extrapyramidal symptoms |
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Cheating Thieves are Low
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Low potency Neuroleptics
Chlorpromazine Thioridazine Non neurologic side effects Triple A side effects with Cheating Thieves 1. Anticholinergic 2. Antihistamine 3. Alpha Blockade Chlorpromazine also has Corneal Deposite Thioridazine - reTinal deposits |
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Antipsychotic with retinal deposits? corneal deposits?
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reTinal deposits = Thioidazine
corneal deposits = Chlorpromazine |
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Evolution of EPS side effects
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4 hours, 4 days, 4 weeks, 4 months
4 Hours - acute dystonia (mucle spasm, stiffness, oculogyric crisis) 4 Days - Akinesia (parkinsonian symptoms) 4 weeks - akathisia (restlessness) 4 Months - Tardive Dyskinesia |
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Antipsychotics - general toxicity traits
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1. Highly lipid soluble - stored in body fat, removes from body very slowly.
2. Extrapyramidal symptoms (EPS) 3. Endocrine side effects (dopamine blockade at d2 receptor leads to hyperprolactinemia -> galactorrhea) 4. Side effects from blocking muscarinic (dry mouth, constipation), alpha receptors (hypotension), histamine (sedation) receptors |
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Neuroleptic malignant syndrome TX
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Dantrolene, D2 AGonists (bromocriptine)
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FEVER mnemonic
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Neuroleptic malignant syndrome symptoms.
Fever Encephalopathy Vitals unstable (autonomic Elevated enzymes (rhabdomyolysis) Rigid muscles |
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Atypical antipsychotics - general endings in name? List them.
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"apines" and others
"Atypical for OLd CLOsets to QUIETly RISPER from A to Z" Olanzapine Clozapine Quietapine Risperidone Aripiprazole Ziprasidone |
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Clinical Uses of Antipsychotics
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Schizophrenia - atypical affect positive AND NEGATIVE symptoms
Olanzapine - also for OCD, anxiety, depression, mania, tourette's |
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Toxicity of Antipsychotics
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Fewer EPS and anticholinergics than traditional
Specifically: Clozapine - agranulocytosis Cloazpine / Olanzapine - weight gain Ziprasidone - QT interval prolongation |
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Psychiatry patient on long term drug medication exercises and dies from QT prolongation . What drug
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Ziprasidone
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Lithium mechanism
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Not established, posisbly due to inhibition of Phosphatidyl inositol cascade
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Lithium Clinical use
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1. Bipolar Disorder - stabilizes mood - blocks relapse and acute manic events.
2. SIADH - presents as polyuria |
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Lithium Side Effects mnemonic
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Lithium side effects
Movement (tremor) Nephrogenic diabetes insipidus O-hypOthyroidism Pregnancy problems - teratogen leading to fetal cardiac defects |
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Fetal cardiac effects with lithium
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Ebstein anomaly, malformation of great vessels.
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Lithium excretion via
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Kidneys, exclusively
-importantly, most is excreted by the kidneys, but most is reabsorbed at the proximal tubules following Na+ reabsorption. |
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Buspirone Mechanism
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Stimulates 5-HT1A receptors
(not inhibition) |
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Buspirone CLinical use, Side effects
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CLinical use : General Anxiety Disorder
"bus pirates make me anxious" NO interaction with alcohol, no sedation, addiction tolerance Pretty good interms of side effects. |
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TCAs end in? List them
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-iptyline or -ipramine
EXCEPTIONS: -oxepins doxepin, Amoxapine |
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TCA Mechanism
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Block reuptake of
1. NE 2. Serotonin |
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Clinical Uses of TCAs
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Major depression - obviously
Bed wetting - impramine OCD - clomipramine Fibromyalgia |
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Side effects of TCAs
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Sedation
Anticholinergic Alpha blocking ~ to Antipsychotics low potency |
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Which TCAs have more anticholinergics? clinical significance?
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Tertiary TCAs - Amitriptyline have MORE anticholinergic effects than secondary TCAs - nortriptyline
Clinical Significance = Older patient ? give nortriptyline |
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DR. says not to give this tricyclic antidepressant because patient has had recurrent seizures.
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Desipramine - lower sedation, and thus lower seizure threshold.
Dont give to patients with low seizure threshold. |
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Toxicity of TCAs
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CCC
Convulsion Coma Cardiotoxicity - ARRHYTHMIAS -Repisratory depression -hyperpyrexia |
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TX for TCA toxicity
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NaHCO3 for CV toxicity -
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SSRIs- list them
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FLashbacks PARalyze SEnior CITizens
-oxetines and others Fluoxetine, Paroxetine, Sertraline, Citalopram |
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SSRI Mechanism
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In the name
Serotonin Specific Reuptake iNhibitor |
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SSRI clinical Use
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1. Depression
2. OCD 3. Bulimia 4. Social Phobias 5. PTSD |
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SSRI Toxicity
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Fewer than TCAs
1. GI distress 2. Sexual Dysfunction (anorgasmia) 3. Serotonin syndrome - must be in combo with another drug that increases serotonin - like MAO inhibitors |
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SErotonin Syndrome traits ? What is the treatment?
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Seen in combo use with things that increase serotonin e.g. MAO inhibitors
Hyperthermia, Myoclonus, CV collapse TX : Cyproheptadine (5 HT2 receptor antagonist) |
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SNRIs - list them
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VENLAFAX for DULEY
Venlafaxine Duloxetine -two SNRIs Inhibit NE and serotonin reuptake, like TCAs |
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SNRI toxicity
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Increased BP (most common)
Stimulant effects Sedation Nausea |
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SNRIs clinical Use
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Depression
Venlafaxine - General anxiety Disorder Duloxetine - diabetic peripheral neuropathy. Duloxetine has greater effect on NE |
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Jack Duley is a Diabetic patient on tx to treat both his depression and her peripheral neuropathy. What medication is he on.
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Duloxetine
-greater effect on NE |
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List the MAO inhibitors
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MAO Takes Pride in Shanghai
Tranylcypromine Phenelzine Isocarboxazid Selegeline |
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MAO Inhibitors CLinical use
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HYPOchondriasis
Atypical Depression Anxiety |
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Toxicity with Mao inhibitors
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Hypertensive Crisis with
1. Wine and Cheese consumption 2. Beta blockers - beta agonists |
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Contrainidications of MAO inhibitors
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SSRI or Meperidine
-will cause serotonin syndrome |
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List the Atypical Antidepressants
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Buproprion
Mirtazapine Maprotiline Trazodone |
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Buproprion leads to increased? Clinical use? Toxiciyt?
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Tx for Depression, Smoking cessation
Toxicity: Stimulant effects (tachycard, insomnia) Headache Seizure in Bulimic Patients No sexual side effects(unlike ssri, anorgasmia) |
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Antidepressants that can cause seizures
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TCAs
Buproprion(an atypical antidepressant that only cuases it in bulimic patients) |
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Mirtazapine mechanism , toxicity
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Alpha 2 antagonist (increases the release of NE and serotonin)
Potent 5-HT2 and 5-HT3 receptor antagonist. Toxicity : sedation, increased weight gain, dry mouth |
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Maprotiline mechanism, toxicity
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Blocks NE reuptake.
Toxicity : orthostatic hypotension, sedation |
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Trazodone mechanism
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Primarily inhibits serotonin reuptake
TrazoBONER because its male-specific. Uses :Insomnia - but high doses are needed for antidepressant effect. Toxicity : sedation, nausea, priapism, postural hypotension |
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Atypical antidepressant with Orthostatic hypotension. Postural hypotension?
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Orthostatic hypotension = Maprotiline
Postural hypotension = Trazodone |