Card Set Information
psychopharmacology depression bipolar anxiety insomnia
Dr. Kverno's lecture on psychopharmacology
What kind of drugs are substrates, inducers or inhibitors of P450s?
What happens if a highly protein bound drug is displaced off its protein by another more protein bound drug?
It can result in increased circulating levels of the free drug
What would cause an increase in serum concentration of drugs that are excreted by the kidneys?
Renal disease or drugs that reduce renal clearance
Why are the elderly more sensitive to psychotropic drugs?
Decreased intracellular water, protein binding and tissue mass
Increased body fat
What class of sedative hypnotics have a high amount of adverse effects?
Why are barbituates rarely used to treat psychiatric disorders?
High potential for abuse
Fatal in overdose
What are the drugs of choice for anxiety?
What are the drugs of choice for insomnia?
What two conditions can an anxiety syndrome be related to?
What are the four mechanisms of anxiety in the brain?
Limbic system sensitivity
Sympathetic nervous system activation
What two neurotransmitters when altered cause anxiety?
What is the first line of treatment for anxiety disorders?
What are five examples of anxiety disorders?
Generalized Anxiety Disorder (GAD)
Phobic Disorders (social/simple)
Post-traumatic Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
What three classes of drugs are used to treat anxiety disorders?
What anti-anxiety drug does not cause CNS depression, has no abuse potential, and does not intensify the effects of the CNS?
What will increase the levels of Buspirone?
How long before therapeutic effects are felt from Buspar?
Why are Benzodiazepines used for brief/short-term treatment?
They have a risk for dependence with long-term use
What are other indications for Benzodiazepines (besides anxiety)?
Induction of anesthesia
What two factors determine the selection of benzodiazepines?
Duration of Effect
What is the MOA for benzodiazepines?
Increase the effectiveness of GABA, inhibiting neurotransmission in the limbic system and cortex.
Which administration route has the longest onset of anxiolytic effects for benzodiazepines?
PO (30-60 min)
Which administration route has the shortest onset of anxiolytic effects for benzodiazepines?
IV (1-5 min)
What are the indications for rapid onset of anxiolytic effects?
Episodic burst of anxiety
Falling asleep rapidly
What are three advantages of longer half-lives with benzodiazepine?
Less frequent dosing
Less variation in plasma concentration
Less severe withdrawal
What are two advantages of shorter half-lives with benzodiazepine?
No drug accumulation
Less daytime sedation
What are three disadvantages of longer half-lives with benzodiazepine?
Daytime psychomotor impairment
What are three disadvantages of shorter half-lives with benzodiazepine?
More frequent dosing
Earlier and more severe withdrawal syndromes
What are the indications for treatment with long-duration benzodiazepines?
What are the indications for treatment with intermediate-duration benzodiazepines?
What are the indications for treatment with rapid-onset, short-acting benzodiazepines?
Sleep onset insomnia
What are some common side effects of benzodiazepines?
What are the adverse effects associated with stopping benzodiazepines abruptly (not tapering)?
What is the first line of treatment for Schizophrenia?
What is the first line of treatment for depression?
What is the first line of treatment for anxiety disorders?
SSRI’s (long term)
What is the mechanism of action of Tricyclic Antidepressants?
Blocks reuptake of transmitter causing an increase in concentration in the synaptic cleft
What is 5HT?
What are SNRIs used for?
What is sensitization?
Stressors and episodes that predispose an individual to increased chances of having a manic episode
What is kindling?
Repeated intermittent subthreshold stimulation of a given region of the brain that leads to a full blown amygdala seizure
What is the plasma level that you want to stay below when taking lithium?
What is the MOA of Abilify?
D2 and 5HT1 partial agonist
What is insomnia?
The complaint of sleep that is insufficient to support good daytime functioning
What is the first line drug treatment for insomnia?
Benzodiazepine-like drugs (the ZZZs)
What is abooby trap of benzodiazepine like drugs?
Psychomotor or cognitive impairment that lasts into the morning
Two other treatments for insomnia?
What is unipolar depression?
An episode of depression without history of mania
What is hypomania?
Functioning at a level just below mania
What are the three phases of treatment for major depressive disorder?
How long does the acute/initiation phase last in the treatment of major depressive disorder?
How long does the stabilization phase last in the treatment of major depressive disorder?
How long does the maintenance phase last when treating major depressive disorder?
6 mos – 1 yr after symptoms subside
What is the main goal of acute/initiation phase of treating major depressive disorder?
Monitor for side effects and suicide ideation (SI)
What is the main goal of stabilization phase of treating major depressive disorder?
Monitor response, prevent relapse
What is the main goal of the maintenance phase of treating major depressive disorder?
Monitor response, prevent recurrence
What is the main treatment for children with depression?
When is the risk for suicide highest in patients being treated for depression?
The time between the onset of medication administration and the therapeutic effect
Which anti-depressant is not safe for kids?
What are four classes of drugs used to treat depression?
SNRIs and other novel antidepressants
Which of the anti-depressants have the fewest adverse effects?
What are some common side effects of antidepressants?
What four indications are there for trycyclic antidepressants?
What is the most worrisome adverse effect of tricyclic antidepressants?
Cardiac arrhythmia and possibly death
Why are TCAs relatively contraindicated in the elderly, children, pregnant women and suicide individuals?
Because of the potential for severe side effects and death
What indications are SSRIs used for?
Social anxiety disorder
Borderline personality disorder
Most worrisome adverse effect of SSRIs?
Coma and possibly death (serotonin syndrome)
What does FLUSH stand for?
Sleep and sensory disturbances
What is the indication for MAOIs?
Atypical depression: with anxiety or phobia symptoms
Most frequent adverse effects associated with MAOIs.
Rare side effect of MAOIs
Tyramine-induced hypertensive crisis caused by pickled or aged foods.
What is the recommended treatment for severe mania or mixed episodes?
Lithium or Valproate in combination with antipsychotic
What can be used to treat less severe bipolar?
Monotherapy of lithium, valproate or atypical antipsychotic
What tests are used to assess baseline when treating with Lithium?
What tests are used to assess baseline when treating with Valproate?
Hepatic, hematological and bleeding abnormalities
What three types of drugs are used as mood stabilizers?
Acute adverse effects associated with lithium?
Fine hand tremor
Chronic adverse effects associated with lithium?
Impaired kidney function
What can lithium toxicity lead to?
Most common transient adverse effects of anticonvulsants?
Why would atypical antipsychotics be good to use in conjunction with lithium and mood stabilizers?
More rapid onset of action
What is the mechanism of schizophrenia?
Too much dopamine in mesolimbic pathway of the brain and too little in the mesocortical pathwy
Positive symptoms of schizophrenia?
Negative symptoms of schizophrenia?
Poverty of speech/thought
What is the first line drug treatment for Schizophrenia?
What is the MOA of typical antipsychotics?
Dopamine (D2) receptor antagonism
What side effect of typical antipsychotics are common due to dopamine receptor blockade?