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224 Cards in this Set
- Front
- Back
What do old drugs attach to?
|
D2
|
|
Newer drugs bind to what?
|
D4
|
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What other Sx Do you expect with histamine block?
|
sedation and weight gain
|
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A/E of alpha block?
|
orthostatic hypotension
|
|
What antipsychotic cause retinitis pigmentosa?
|
Thioridizine
|
|
What happens when you block the mesolimbic tract?
|
reduce psychotic symptoms
|
|
What happens when you block nigrostriatal block?
|
increase tremors, parkinsons EPS symptoms!
|
|
What tract does clozapine block?
|
Mesolimbic Tract
|
|
What does a block in the tuberoinfundibilar block?
|
no galactorrhea, gynecomastia, amenorrhea
|
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If all other drugs fail what is next tx?
|
clozapine (agranulocytosis be careful)
|
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How do antipsychotic medication work?
|
block dopamine receptors
old D2 new D4 |
|
What do new antipsychotics work as well as D4?
|
they work on serotonin as well
5HT3 |
|
What are the symptoms of muscarinic block?
|
urinary retention
dry mouth blurry vision constipation confusion hallucinations |
|
If you are going to prescribe to the elderly what do you avoid?
|
avoid drugs w/ muscarinic block
|
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Where do new antipsychotics work on?
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D4 more and also serotonin 5HT3
|
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What is an important S/E of antipsychotics?
|
sedation and weight gain (histamine blockade)
hypotension (alpha block) dry mouth, urinary retention, constipation, confused, blurry vision (muscarinic block) |
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Where do antipsychotics work on?
|
Dopamine
D2 and D4 receptors Old work on D2 new on D4 |
|
What are the side-effects of histamine blockade?
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weight gain and sedation
|
|
What do you find with alpha blockade?
|
hypotension
so be careful on the elderly they might fall and break a hip |
|
Main groups for antipsychotics?
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typicals D2 antagonists only low-potency: Clopromazine
High-potency: Haloperidol old drugs D2: Haloperidol, Thioridazine, Olanzapine, fluphenazine new drugs Risperidone |
|
Of the newer drugs, which one of these cause movement side effects of antipsychotics? EPS symptoms?
|
Risperidone is the answer
|
|
WHat are the multiple receptor antagonist work on?
|
D2, D4 and Serotonin 5HT
|
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What are the new antipsychotics multiple receptors?
|
clozapine
olanzapine quetiapine |
|
What does the D2 blockade cause?
|
EPS symptoms
|
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What decreases EPS symtpoms?
|
D4 receptors
|
|
DOC for schizophrenia?
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antipsychotics
|
|
What is another name for Dopamine?
|
Prolactin Inhibitory Factor
PIF |
|
What happens when you inhibit dopamine with antipsychotics?
|
PIF is not there
so prolactin goes up |
|
What happens when prolactin goes up?
|
galactorrhea, gynecomastia, amenorrhea
|
|
What does dopamine block?
|
tuberoinfundibular tract
mesolymbic/mesocortical tract nigrostriatal tract all involved |
|
What happens when you block tuberoinfundibular block?
|
prolactin increases
|
|
What are other S/E of the older antipsychotics?
|
photosensitivity
Retinitis pigmentosa |
|
What antipsychotics produces retinitis pigmentosa?
|
thioridizine
|
|
What are other problems with thioridazine?
|
cardiac conduction problems
|
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WHat are S/E of clozapine?
|
agranulocytosis
|
|
What happens when dopa blocks mesolymbic tract?
|
reduce psychotic symptoms
decrease psychosis |
|
What happens when you block nigrostriatal tract?
|
increase in movement disorders
tremors, parkinsonian disease |
|
WHat does clozapine block?
|
mesolimbic
no EPS (nigrostriatal) no amenorrhea, no galatorrhea, no gynecomastia (tuberinfundibular) |
|
Does clozapine cause amenorrhea, galactorrhea, gynecomastia, EPS symptoms?
|
NO!
only blocks mesolimbic tract reducing psychosis |
|
What are the types of movement disorders?
|
acute dystonia
parkinsonisms tardive dyskinesia |
|
Which movement disorder is the first one to appear?
|
acute dystonia
|
|
When does acute dystonia appear?
|
occurs within hours or days of treatment
patients get really scared |
|
Why do patients get scared with acute dystonias?
|
its a muscle spasms
cant' move |
|
What happens to Ach when Dopamine is high?
|
Ach decreases
antagonists |
|
What are first choice drugs of psychosis?
|
Olanzapine, Quetiapine, Ziprasidone
|
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What are the S/E of Olanzapine, quetiapine, ziprasidone?
|
Weight gain and sedation
|
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What is the S/E of clozapine?
|
agranulocytosis
|
|
What are the S/E of ziprasidone?
|
prolongation of QT interval
|
|
What patients have a contraindication of ziprasidone?
|
arrythmias
|
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What are the S/E of Olanzapine and Clozapine?
|
Cause Diabetes
|
|
What patients have a contraindication of Olanzapine/Clozapine?
|
DM
|
|
What antipsychotics are used to tx non-compliant patients?
|
haloperidol and fluphenazil
|
|
Why do haloperidol and fluphenazil are prolonged in their action?
|
they have the decanoid form
I.M. deposit |
|
Is Tardive Diskinesia reversible or irreversible for Step 2 USMLE?
|
Irreversible
|
|
Antidepressants are used to Tx what?
|
Mood disorders, adjustment disorders, psychotic disorders
|
|
What are other uses for antidepressants?
|
anxiety disorders
bulemia |
|
Why is anxiety treated with antidepressants?
|
use same neurotransmitter
|
|
What percentage of pat. w/ depression have anxiety?
|
90% of the patients have anxiety w/ depression
|
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Why are antidepressants used to tx bulemia?
|
act on same neurotransmitter
serotonin |
|
Why do antidepressants work on impulse control disorders?
|
serotonin
|
|
What are amytriptiline of TCA (triciclics) commonly used for?
|
Enuresis
|
|
If the patient has depression he will surely have?
|
anxiety
|
|
What is used for chronic pain?
|
amytriptiline
|
|
Why is amytriptiline used for chronic pain?
|
amytriptiline increases endorphins
increase endogenous opiates patients complain less of pain |
|
Which ones are dangerous in OD?
|
specially TCA
|
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Pat. comes after OD of TCA, what do they need to be attached to?
|
cardiac monitor
causes conduction problems |
|
What is the effect/toxicity of TCAs Overdose?
|
heart conduction problems
|
|
How do TCAs work?
|
block the reuptake of neurotransmitter (serotonin and NE, and dopamine)
work by down regulation of beta adrenagic receptors |
|
How do the MAO inhibitors work?
|
work on the enzyme that metabolizes Sertonin, NE, Dopa
doesn't break down the neurotransmitters so more NE, Ser, DOPA |
|
Where do the SSRIs work?
|
they only block the reuptake of serotonin
|
|
Why do you choose an SSRI instead of TCA or MAO?
|
because of less S/E
|
|
What is the first line of antidepressants?
|
SSRIs
cleaner, pat. like it, less S/E |
|
What other receptors are blocked w/ TCAs?
|
muscarinic receptors are blocked
|
|
What do you expect w/ the TCA muscarinic block?
|
sedation
dry mouth blurry vision urinary retention |
|
What are other two receptors that TCA block?
|
Histamine and alpha receptors
|
|
What happens when you give TCAs and block alpha receptors?
|
hypotension
|
|
What happens when you give TCAs and block histamine?
|
sedation and weight gain
|
|
Which TCA is the worst cause it gives you the most S/E?
|
amytriptiline
takes you on a bad trip! |
|
What patient would be a relative contraindication for giving him amytriptiline?
|
90 yo, demented, w/ glaucoma, and prostathic hyperthrophy...
why? hypotension, urinary retention, blurry vision (might fall) |
|
TCA stands for?
|
T for upTake blocker
T is for hisTamine blocker C is for musCarinic blocker A is for alpha blocker |
|
Which drugs are the fasest of the TCAs?
|
nortryptiline and disipramine
less S/E |
|
What are antidepressants used for?
|
Tx: depression,
- depression in Bipolar Dis. - ALL anxiety dis. |
|
What is the efficacy of antidepressants?
|
70%
|
|
Which drugs are used first?
|
Newer ones
SSRIs |
|
Which antidepressants are more dangerous?
|
usually older ones
TCAs more S/E |
|
How long do we keep patients before we know the antidepressants are working?
|
they start working until 4-6 weeks
|
|
What is the MCC of drug failure?
|
the time doctors try the drugs less than 4-6 weeks.
Need to maximize doze and maximize dose switching |
|
When do you stop antidepressants?
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if S/E are not tolerated by patient
|
|
If you have a patient not responding you need to give another medication in order to boost 1st antidepressants?
|
Lithium or Thyroxine
or even Amphetamine like drugs |
|
HOw long do we keep patients on antidepressants?
|
Tx should continue for 6 months to 1 year
since they relapse |
|
What antidepressant drugs cause the most sedation?
|
Doxapine, amytriptiline, trazodone
|
|
What is the use of doxapine and trazodone?
|
give it to patients at night so they can sleep
causes sedation (antidepressant) |
|
Which antidepressants cause less sedation?
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Cleaner ones, newer less S/E
Desipramine, protrityline and SSRIs |
|
Which antidepressant causes most Hypotension?
|
TCAs
|
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Which TCA causes the most hypotension?
|
amytriptiline
|
|
Which is Best TCA for antidepressants?
|
Nortriptyline and Desipramine
|
|
Which antidepressant drug has the worst anticholingergic?
|
amytriptyline
|
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Which antidepressant has less anticholinergic effects?
|
nortriptyline and desipramine
also SSRIs since they only work on serotonin |
|
What do you have to remember about the TCAs and the heart?
|
prolong the QRS interval
need to do a EKG |
|
What is the effects of antidepressant and seizures?
|
lower the seizure threshold
|
|
Which TCA causes the most seizures?
|
maprotaline
|
|
Does bupoprion cause seizures?
|
no
|
|
Do women with bulemia have a high incidence of seizures?
|
yes
|
|
Do antidepressants cause sexual dysfunction?
|
yes all of them cause
|
|
What are the sexual dysfunction S/Es caused by antidepressants?
|
anorgasmia
decrease libido delayed ejaculation priapism |
|
What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation
|
SSRIs
|
|
What antidepressant causes priapisms?
|
trazodone
|
|
Which one of the SSRIs causes less sexual dysfunction?
|
citalopram
bupoprion |
|
What is priapism?
|
prolonged and painful erections
|
|
What are the sexual dysfunction S/Es caused by antidepressants?
|
anorgasmia
decrease libido delayed ejaculation priapism |
|
What antidepressant causes anorgasmia and decrease libido? also delayed ejaculation
|
SSRIs
|
|
What antidepressant causes priapisms?
|
trazodone
|
|
Which one of the SSRIs causes less sexual dysfunction?
|
citalopram
bupoprion |
|
What is priapism?
|
prolonged and painful erections
|
|
What are the SSRIs? |
Fluoxetine
Paroxetine Sertraline Fluvoxamine Citalopram |
|
SSRI with least sexual S/E?
|
citalopram
|
|
Why are SSRIs used to Tx OCD?
|
serotonin involved
panic as well as bulemia |
|
What are the S/E of SSRIs?
|
patient agitation
|
|
What do you tell a patient that gets agitated when takin SSRI?
|
tell them to take it at night
|
|
What if a pat. feels sedation of SSRIs?
|
take the SSRI at night to take advantage of the S/E
|
|
What are all the S/E of SSRI?
|
agitation
sedation diarrhea nausea sexual dysfunction |
|
What is trazodone called?
|
heterocyclic antidepressant
off shoot of TCA family used for its sedation effect used in insomnia |
|
Where does fenazodome works?
|
NE and serotonin
more like an SSRIs |
|
What is bupoprion used for tx what age patients?
|
older patients less S/E
|
|
What neurotransmitter is involved when using Bupoprion?
|
dopamine
|
|
What is bupoprion similar to?
|
Zyban
used as Wellbutrin dose is different |
|
Why is dopamine associated with smoking sessation?
|
Dopamine is linked to reward centers
endorphins decrease the pleasure |
|
What is bupoprion use to Tx?
|
smoking sessation
|
|
What drug blocks the pleasure of alcohol?
|
naltrexone
|
|
What is venlafaxine similar to?
|
SSRI
|
|
What is mirtazapine similar to and S/E?
|
SSRI
lots of Sedation |
|
What are TCAs divided into?
|
tertiary and secondary
|
|
What are the teriary TCAs?
|
imipramine
amitriptyline doxepin clomipramine trimipramine |
|
What are the secondary TCAs?
|
desipramine
nortriptyline protriptyline |
|
What happens when imipramine is broken down from its tertiary form?
|
it converts into its active form desipramine secondary form
|
|
When amitriptyline breaks down, what does it form?
|
nortriptyline
the secondary active form |
|
Which ones are cleaner talking about S/E between tertiary and secondary?
|
secondary don't have that many S/E since they are the active form of the drug
no intermediates less S/E |
|
What is a problem for all TCAs?
|
they have a therapeutic window
the drug has to fall within range to be effective |
|
What is the efficacy of TCA drugs?
|
mood disorders
|
|
Which drug can be used to tx panic?
|
imipramine
|
|
What is clomipramine used for?
|
OCD
works most on serotonin |
|
What is amytriptyline used for?
|
Chronic Pain
|
|
Why are MAOIs are not used in a regular basis?
|
Can't eat foods rich in Tyramine
will cause a reaction of increase blood pressure |
|
What foods should you avoid if taking MAOIs?
|
- red wine
- aged cheeses - chocolate - sausages - nuts - pickled products - herring white wine ok, processed cheeses ok |
|
What is the best tx for depression?
|
ECT
|
|
Is ECT the MC tx for depression?
|
no
|
|
Why is ECT not used as first line for depression?
|
nobody wants ECT
|
|
When is ECT prescribed?
|
severely depressed/suicidal tendencies
1)patient still tries to kill himself 2) patient has not responded on TCA,MAIO, Lithium, Amphetamine like drugs |
|
Is ECT used only for depression?
|
no, also:
schizophrenia |
|
In synthesis when do you use ECT?
|
typically when all other conventional therapies have failed
|
|
Are there any absolute contraindications of ECT use?
|
none
|
|
What is the only situation you have to be careful with the use of ECT?
|
only in a case of increase intracraneal pressure
since ECT increase pressure |
|
What is another case in a pat. w/ depression which you might be inclined to use ECT?
|
when the pat. has received ECT previously w/ success
|
|
What is the only problem w/ ECT?
|
some memory loss
|
|
What is the characteristic of the memory loss w/ ECT?
|
transient
|
|
What does transient memory loss mean?
|
when the Tx is over, your memory comes back
|
|
What are some of the complications of ECT?
|
anesthesia
induced paralysis |
|
Do you need a seizure in order for ECT to work?
|
no
|
|
What is the typical course of ECT?
|
10-15 treatments
|
|
What tests are done before ECT administration?
|
CT-scan
rule out tumors that increase intracraneal pressure x-rays of bodies (fractures that haven't healed) |
|
WHat are the mood stabilizer medications?
|
lithium (bipolar)
divalproex carbamazepine topiramate lamotrigine gabapentine |
|
What are some of the symptoms treated w/ mood stabilizers?
|
Bipolar
impulse control disorder violence/agitation/agression/impatience |
|
What are the indications of lithium?
|
bipolar disorder
schizoaffective disorders also mood disorders (augment response to medication) |
|
What is lithium not perfect?
|
Has a narrow margin or safety
|
|
What does narrow margin of safety mean?
|
constantly have to monitor lithium in blood
check blood levels since it could become toxic/lethal |
|
What is the most common S/E of lithium? |
tremor, shaking
diarrhea headaches worsen acne gain weight conduction problems |
|
What test is essential to perform before administering lithium?
|
TSH before starting lithium
|
|
What are the indications of lithium?
|
bipolar disorder
schizoaffective disorders also mood disorders (augment response to medication) |
|
What is lithium not perfect?
|
Has a narrow margin or safety
|
|
What does narrow margin of safety mean?
|
constantly have to monitor lithium in blood
check blood levels since it could become toxic/lethal |
|
What is the most common S/E of lithium?
|
tremor, shaking
diarrhea headaches worsen acne gain weight conduction problems |
|
What test is essential to perform before administering lithium?
|
TSH before starting lithium
|
|
What are other major S/E of Lithium?
|
leukocytosis
polyuria polydipsia Nephrogenic DI |
|
What is the most important S/E for Lithium?
|
teratogenic
cardiac malformations |
|
What are the teratogenic effects of lithium on the fetus?
|
cardiac malformations
epsteins anomaly (tricuspid valve affected) |
|
What test do you give a woman that is young and needs to start lithium Tx?
|
Test pack
pregnancy test |
|
What advice do you give the female patient if they are on lithium?
|
make sure not to get pregnant while on lithium
- if she does get pregnant she should stop lithium immediately |
|
What is the therapeutic index of lithium?
|
0.6-1.3 or 1.5
you should keep it at 1 the higher the dose, the higher the S/Es |
|
What is a recommendation to ALL patients on Lithium?
|
drinks lots of fluids
- if pat. becomes dehydrated, then toxic levels may accumulate in plasma hyponatremia increases toxicity lithium follows sodium |
|
What is the Tx of Choice for Lithium at toxic levels above 2.0?
|
Dialysis
|
|
What are some S/E of lithium at hight doses?
|
Seizures/Coma
Ataxia |
|
What is one of the first indications that lithium levels are high?
|
gait disturbances (Ataxia)
|
|
What is valproex used for?
|
bipolar
rapid cyclers (within days) mania/depression |
|
When do you use valproex?
|
- when lithium is not working
- when lithium is contraindicated (ie. thyroid disease) |
|
How many days does valproex take to reach desired effect?
|
10-14 days
|
|
What are the S/E of divalproex?
|
sedation
cognitive impairment tremors (like lithium) GI disturbances |
|
What is the difference in toxicity of valproex?
|
hepatotoxicity
lithium (nephrotoxic) |
|
What test do you request before administering divalproex?
|
liver function tests
hepatic function panel |
|
What is the teratogenicity of valproex?
|
Spina Bifida
shape of the letter V |
|
What is second line of bipolar?
|
carbamazepine
also valproate (divalproex) |
|
Tx of Choice for bipolar disorder?
|
Lithium
(if lithium not there divalproex) last resort carbamazepine |
|
What toxicity does carbamazepine produce?
|
hepatic toxicity
|
|
What are S/E of carbamazepine?
|
rashes
agranulocytosis |
|
What are two drugs that cause agranulocytosis?
|
carbamazepine and clozapine
escarba colcha y cloza |
|
What are the other mood stabilizers?
|
lamotrigine
gabapentin topiramate not as effective |
|
What is different about topiramate?
|
helps patients reduce weight
|
|
Pat. comes in w/ mania... tx?
|
mood stabilizer
lithium if not divalproic acid |
|
If a pat. has acute mania (emergency) can't wait two weeks to calm him down?
|
benzodiazepines
antipsychotic |
|
What are the anxiolytics?
|
benzodiazepines
|
|
MOA of axiolytics/benzodiazepines?
|
work on GABA receptors
open Cl- channels increaseing the frecuency |
|
What are other uses of benzodiazepines other than anxiety?
|
insomnia specially in the elderly
|
|
Where does buspirone work?
|
buspirone maybe works on serotonin
|
|
What is buspirone used for?
|
Generalized Anxiety Disorder (GAD)
Social Phobias |
|
What is the Tx. for adjustment disorder? anxious
|
benzos w/ psychotherapy
|
|
What is the Tx. for Panic Disorder? anxiety
|
Benzos, SSRIs
|
|
What is the Tx. of OCD?
|
SSRIs
|
|
What is MC used for social phobias?
|
SSRIs
|
|
What do you adjust with the elderly on Tx. w/ benzos?
|
lower the dosage
sedation, memory problems, confusion |
|
What DDI (drug drug interaction) is lethal w/ benzos?
|
alcohol
potentiates benzos respiratory arrest (diaphragm paralisis) |
|
What is the problem with taking benzos?
|
Very Addictive
|
|
What are the S/Es of benzos?
|
sedation, memory problems, confusion
impairment of cognitive and motor performance abuse possible teratogenicity |
|
Is buspirone addictive?
|
no
|
|
What is buspirone the DOC for?
|
GAD (generalized anxiety disorder)
|
|
Pat. alcoholic that needs to be placed on anti-anxiety medication?
|
then better to place him on buspirone since not addictive/no withdrawal symptoms
pat. is going to drink and might have DDI w/ benzo+alcohol |
|
What is the only S/E of buspirone?
|
cabezon
complain some patients headache |
|
Tx for Depression? A) fluoxetine or b) nortriptiline?
|
fluoxetine
WHY? SSRI |
|
Tx for Depression?
Nortryptiline or Amytriptiline? |
Nortriptyline
less S/E safer |
|
Pat. w/ bipolar disorder who has kidney problems?
|
not lithium
but valproic acid (metabolized in liver) |
|
What 3 test do you ask for if patient needs to start lithium?
|
Pregnancy Test
Thyroid (TSH) Kidney function regular blood work |
|
Tx for panic disorder? general and specific...
|
any benzos but specifically alprazolam
ALPRAZOLAM (ZANAX) |
|
What drug is used for the prevention of alcohol withdrawal?
|
benzo...
chlordiazepoxide (taper dose) |
|
What other drug besides chlordiazepoxide is used on alcohol withdrawal?
|
safe detox with oxazepam
(out the liver) |
|
Which benzo doesn't go through CP450?
|
OTL out the liver
oxazepam temazepam lorazepam |
|
Pat. comes in w/ alcohol abuse, while in E.R. he becomes agitated? What benzo do you use?
|
Oxazepam, temazepam, or lorazepam
lorazepam is I.V. or I.M. |