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2015-07-26 05:04:42
phych pharm page520-524
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  1. ADHD
    Stimulants (e.g., methylphenidate)
  2. Alcohol withdrawal
    Long-acting benzodiazepines (e.g.,chlordiazepoxide, lorazepam, diazepam)
  3. Bipolar disorder
    Lithium, valproic acid, atypical antipsychotics
  4. Bulimia  and Depression
  5. Generalized anxiety disorder
    SSRIs, SNRIs
  6. Obsessive-compulsive disorder
    SSRIs, clomipramine
  7. Panic disorder
    SSRIs, venlafaxine, benzodiazepines
  8. PTSD
    SSRIs, venlafaxine
  9. Schizophrenia
    Atypical antipsychotics
  10. Social phobias
    SSRIs, β-blockers
  11. Tourette syndrome
    Antipsychotics (e.g., fluphenazine, pimozide),tetrabenazine, clonidine
  12. Antipsychotics (neuroleptics)
    Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”).
  13. Antipsychotics( neuroleptics) moa
    All typical antipsychotics block dopamine D2 receptors ( inc [cAMP]).
  14. High potency Antipsychotics
    Trifluoperazine, Fluphenazine,Haloperidol (Try to Fly High)—neurologic side effects (e.g., Huntington disease, delirium,EPS symptoms).
  15. Low potency:Antipsychotics
    Chlorpromazine, Thioridazine(Cheating Thieves are low)—non-neurologicside effects (anticholinergic, antihistamine, and α1-blockade effects).
  16. Evolution of EPS side effects
    4 hrs
    4 days
    4 wks
    4 mo
    • 4 hr acute dystonia (muscle spasm, stiffness,oculogyric crisis)
    • ƒ 4 day akathisia (restlessness)
    • ƒƒ 4 wk bradykinesia (parkinsonism)ƒƒ
    •  4 mo tardive dyskinesia
  17. Neuroleptic malignant syndrome (NMS
    • rigidity, myoglobinuria, autonomic instability,hyperpyrexia. Treatment: dantrolene, D2agonists (e.g., bromocriptine)
    • For NMS, think FEVER: Fever Encephalopathy Vitals unstable Enzymes Rigidity of muscles
  18. Tardive dyskinesia
    stereotypic oral facial movements as a result of long-term antipsychotic use.
  19. Atypical antipsychotics
    Olanzapine, clozapine, quetiapine, risperidone,aripiprazole, ziprasidone.
  20. Atypical antipsychotics toxicity
    Fewer extra pyramidal and anticholinergic side effects than traditional antipsychotics. Olanzapine/clozapine may cause significant weight gain. Clozapine may cause agranulocytosis (requires weekly WBC monitoring) and seizure. Risperidone may increase prolactin (causing lactation and gynecomastia) Ž  dec GnRH, LH, and FSH(causing irregular menstruation and fertility issues). All may prolong QT interval.
  21. Lithium side effects:
    • LMNOP—Lithium side effects:
    • Movement (tremor)
    • Nephrogenic diabetes insipidus
    • HypOthyroidism
    • Pregnancy problems (Ebstein anomaly)
  22. Buspirone moa
    Stimulates 5-HT1A receptors
  23. SSRIs are
    Fluoxetine, paroxetine, sertraline, citalopram.

    Flashbacks paralyze senior citizens.
  24. SSRI moa
    5-HT–specific reuptake inhibitors
  25. Serotonin syndrome tx
    cyproheptadine (5-HT2 receptor antagonist).
  26. SNRIs
    Venlafaxine, duloxetine
  27. SNRI moa
    Inhibit 5-HT and norepinephrine reuptake
  28. Duloxetine is also indicated for
    diabetic peripheral neuropathy
  29. Tricyclic antidepressants
    Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
  30. Tricyclic antidepressants moa
    Block reuptake of norepinephrine and 5-HT.
  31. Tricyclic antidepressants toxicity & tx
    Sedation, α1-blocking effects including postural hypotension, and atropine-like (anticholinergic)side effects (tachycardia, urinary retention, dry mouth). 3° TCAs (amitriptyline) have more anticholinergic effects than 2° TCAs (nortriptyline). Can prolong QT interval.

    Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression,hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic side effects (usenortriptyline). Treatment: NaHCO3 to prevent arrhythmia.
  32. Monoamine oxidase(MAO) inhibitors are
    • Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
    • (MAO Takes Pride In Shanghai).
  33. Monoamine oxidase(MAO) inhibitors moa
    Nonselective MAO inhibition inc levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine).
  34. MAOI toxicity
    Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese); CNS stimulation. Contraindicated with SSRIs, TCAs, St. John’s wort,meperidine, dextromethorphan (to prevent serotonin syndrome)
  35. Atypical antidepressants are
    • Bupropion
    • Mirtazapine
    • Trazodone
  36. Bupropion moa and toxicity
    • Also used for smoking cessation.  inc norepinephrine and dopamine via unknown mechanism.
    • Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures in anorexic/bulimic patients. No sexual side effects.
  37. Mirtazapine moa and toxicity
    α2-antagonist ( inc release of norepinephrine and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.

    Toxicity: sedation (which may be desirable in depressed patients with insomnia), inc appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth.
  38. Trazodone moa and toxicity
    • Primarily blocks 5-HT2 and α1-adrenergic receptors. Used primarily for insomnia, as high doses are needed for antidepressant effects.
    • Toxicity: sedation, nausea, priapism, postural hypotension. Called trazobone due to male-specific side effects.

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