First Aid Psychiatry Drugs

how to treat: Alcohol withdrawal
Benzodiazepines

how to tx Anxiety
SSRIs, SNRIs, Busprione

ADHD
methyphenidate, amphetamines

Bipolar Disorder
Mood stabilizers: lithium, valproic acid, carbamazepine, atypical antipsychotics

Bulimia
SSRIs

Depression
SSRIs, SNRIs, TCAs, busprione, mirtazapine (especially with insomnia)

Obsessive compulsive disorder
SSRIs, clomipramine

Panic Disorder
SSRIs, venlafaxine, benzodiazepines

PTSD
SSRIs

Schizophrenia
Antipsychotics

Social Phobias
SSRIs

Tourette’s syndrome
antipsychotics haloperidol, risperidone

what are the CNS stimulants?
Methylphenidate, dextroamphetamine, methamphetamine

what is the CNS stim method of action
increase catecholamines at the synaptic cleft, especially NE and dopamine

What is the clinical use of CNS stimulants:
ADHD, narcolepsy, appetite control

haloperidol
antipsychotics

trifluoperazine
antipsychotics

fluphenazine
antipsychotics

thioridazine
antipsychotics

chloropromazine
antipsychotics

so what’s the name thing for antipsychotics?
haloperidol + “azines”

mechanism of Antipsychotics
all typical antipsychotics block dopamine D2 receptors, increasing cAMP

what are the high potency antipsychotics? and what are the side effects?
Trifluperazine, fluphenazine, Haloperidol…try to fly high? neurolgoic side effects (extrapyrimidal)

clinical use of antipsychotics
schizo (primarily positive symptoms) psychosis, acute mania, Tourette’s syndrome

what are the low potency antipsychotics? side effects?
chloropromazine, thioridazine -cheating thieves are low…..non neurologic side effects (anticholinergic, antihistamine and alpha 1 blockade effects)

what is the toxicity of antipsychotics?
highly lipid soluble, and stored in body fat; thus very slow to be removed from the body, extrapyramidal system side effects: dyskinesias, endocrine side effects: dopamine receptor antagonism—hyperprolactinemia: galactorrhea, side effects from blocking muscarinic receptors; hypotension, and dry mouth, and sedation.

Chloropromazine causes:
corneal deposits

thioridazine causes
retinal deposits

haloperidol:
NMS, tardive dyskinesia

evolution of EPS side effects:
4 hr of acute dystonia (muscle spasm, stiffness, oculogyric crisis) 4 day akathisia (restlessness) 4 wk bradykinesia (parkinsonism) 4 mo tardive dyskinesia

what is neuroleptic malignant syndrome-and what drug is this associated with? Treatment:
rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Tx=dantrolene, D2 agonists (bromocriptine)

Tardive dyskinesia:
stereotypic oral facial movements as a result of long term antipsychotic use…often irreversible

for neuoleptic malignant syndrome: (NMS) think
think fever: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles

atypical antipsychotics mmneom..
it’s ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z

olanzapine
atypical antipsychotic

clozapine
atypical antipsychotic

quetiapine
atypical antipsychotic

risperidone
atypical antipsychotic

aripiprazole
atypical antipsychotic

ziprasidone
atypical antipsychotic

mechanism of atypical antipsychotics…
not understood…varied effects on 5ht2, dopamine and alpha and H1 receptors

clinical use of atypical antipsychotics
schizophrenia-both positive and negative symptoms: also used for bipolar disorder, ocd, anxiety disorder, depression, mania, tourette’s syndrome

what are the toxicities for atypical antipsychotics?
fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics…..olazapine, clozapoine may cause significant eight gain…clozapine may cause agranulocytosis…requires weekly wbc monitoring and sezure ziprasidone may prolong the QT interval

olanzapine/clozapine may cause significant:
weight gain

clozapine may cause
agranulocytosis -rqrs weekly wbc monitoring and seizure

ziprasidone
may prolong the QT interval

Lithium Mechanism:
not established, possibly related to inhibition of phosphoinositol cascade

clinical use of lithium
mood stabilizer for bipolar disorder-blocks relapse and acute manic events…also for SIADH

Toxicity of Lithium-what do teratogenic effects include:and mnemonic:
tremor, sedation, edema, heart block, polyuria…ADH antagonist-causing nephrogenic diabetes insipidus, TERATOGENIC…cardiac defects-ebstein anomaly and malformaltion of the great vessels…
LMNOP-lithium side effects: movement (tremor), nephrogenic diabetes insipid us, hypothyroidism, pregnancy problems.

what rqrs close monitoring of serum levels of lithium…
narrow therapeutic window.

lithium is almost exclusively excreted by:___ where?
the kidneys-most is reabsorbed at the proximal convoluted tubule following Na reabsorption

buspirone: used in:
used in generalized anxiety disorder….

buspirone MOA: mnemonic
stimulates 5HT1a receptors: I’m always anxious if the BUS will be ON time, so I take BUSpirONe

how long does it take for buspirone to take effect? doesn’t cause what? takes ____ weeks to take effeect? does it interact w/alcohol compared to __
1-2 weeks for it to take effect…does not cause sedation, addiction, or tolerance. does not interact with alcohol-vs barbiturates and benzodiazepines

SSRIs…names and mnemonic:
FLashbacks PARalyze Senior CITizens
Fluoxetine, paroxetine, sertraline, Citalopram

fluoxetine
SSRI

Paroxetine
SSRI

Sertraline
SSRI

Citalopram
SSRI

MOA of SSRI-how many weeks does it usually take for antidepressants to have an effect?
serotonin specific reuptake INHIBITORS. 4-8 weeks to take effect?

Clinical use of SSRIs
depression, genralized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.

Toxicity of SSRIs
Fewer than TCAs-Gi distress, SEXUAL DYSFUNCTION-anorgasmia and decreased libido. Serotonin synddrome: with any drug that increases serotonin (MAOIs, SNRIs, TCAs): hyperthermia, confusion, myoclonus, cardiovascular collapse..flushing, diarrhea, seizures….tx of it: 5HT2 receptor antagonist: (octreotide)

So generalized anxiety disorder can be tx w/
Busiprone and SSRIs, SNRIs

Venlafaxine, duloxetine
SNRIs

SNRI MOA
inhibit serotoinin and NE uptake

Clinical use of SNRIs…duloxetine is also indicated for. which SNRI has a greater effect on NE
Depression….Venlafax-also used in generalized anxiety disorder and panic disorders….Duloxetine=also indicated for diabetic peripheral neuropathy…Duloxetine=greater effect on NE

Tricyclic antidepressants:
all end in -iptyline and -ipramine except doxepin and amoxapine

MOA TCAs
Block reuptake of NE and serotonin

clinical use of tCAs…bedwetting, OCD drugs
Major depression, bedwetting (imipramine), OCD (clomipramine) fibromyalgia

Toxicity of TCAs…which ones to use in elderly, which one for ppl with seizures…how to tx some of the tox?
alpha 1 blocking effects like hypotension, and dry mouth, urinary retention…amitryp(3rd degree) have more anticholin effects than 2ndary-nortriptyline…despiramine=less sedating-and higher sezure threshold…TRI-C’s=convulsions, coma, cardiotoxicity….also resp depression and hyperpyrexia…confusion and hallucinations in elderly due to tricyclic effecs-use nortryptyline in elderly. use NaHCO3 for cardio tx

MAO Inhibitors (MAOIs)
MAO Takes Pride In Shanghai
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline(selective MAO B inhibitor)

Tranylcypromine
MAOI

Phenelzine
MAOI

Isocarboxazid
MAOI

Selegiline
MAOI-selective MAOB inhibitor

MOA of MAOIs
nonselective MAO inhibition increases levelsof amine neurotransmitters-NE, serotonin, dopoamine

Clicical use of MAOIs
atypical depression, anxiety, hypochondriasis..

Toxicity of MAOIs–a lot due to ingestion of:
Hyperensive 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, and dextromethophan-(to prevent serotonin syndrome)

Atypical Antidepressants:
buproprion, Mirtazapine, Maprotilline, Trazadone

Buproprion: MOA, type of drug, side effects…be careful w/giving to which type of ppl
Used for smoking cessation…increases Norepinephrine and dopamine via unknown mechanism..atypical antidepressant…tox=stimulant effects=tachycardia, insomnia) also headache, seizure in Bulimic pts…no sexual side effects.

Mirtazapine. Type of drug, moa, toxicity
alpha 2 antagonist (increases the release of NE and serotonin), and potent 5Ht2 and 5HT3 receptor antagonist. this drug is an atypical antidepressant, and it’s toxic effects: sedation (may be desired in depressed pts w/insomnia), increased appetite and weight gain-may be good in elderly or anorexic, and dry mouth

Maprotilline: type of drug and MOA, tox
Blocks NE reuptake. Toxicity : sedation, orthostatic hypotension. This drug is an atypical antidepressant

Trazodone-type of drug, Moa, used mostly for___ toxicity….male side effects:
atypical antidepressant. Primarily inhibits serotonin reuptake. used primarily for insomnia, as high doses are nedded for antidepressant effects…toxicity: sedation, nausea, priapism, postural hypotension…called trazoBONE to ue to male specific side effects 🙂

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