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Pharmacology - psychiatry (*Sedatives barbituates Benzos and Non…
Pharmacology - psychiatry
*AntiPsychotics
Dopamine Antagonists
*Typical Antipsychotics = 1st generation Antipsychotics
either low-potency or high-potency
low potency FGAs = chlorpromazine, thioridazine
-->
Chloe lower body has PRO thighs in a magazine
high potency FGAs = haloperidol, fluphenazine
-->
Shallow Hal Flu HIGH
Clinical Cases
AntiPsychotics EPS case
acute dystonia from dopamine antagonism D2
Notes
:
note that dizygotic twins always have separate chorions = monochorionic and separate placenta = monoamniotic
the placenta may fuse though, depending how far apart the embryo attach, etc.
Clinical Case
Clinical Case
Notes
:
note that
Clinical Case
AntiPsychotic =
Anti-ACH
First gen side effects
Anti - A
= anti adrenergic Alpha 1 S/Es
--> anti -alpha 1 = anti vasoconstriction = postural hypotension
Anti - C
= anticholinergic S/Es
--> low secretions = dry mucus membranes (dry mouth), constipation
Anti - H
= antihistamine S/Es
--> drowsiness
*High potency Typical Antipsychotics
high potency FGAs = haloperidol, fluphenazine
-->
Shallow Hal Flu HIGH
high potency FGAs = EPS side effects
*Low potency Typical Antipsychotics
low potency FGAs = chlorpromazine, thioridazine
-->
Chloe lower body has PRO thighs in a magazine
low potency FGAs = anti-ACH side effects
*A -Typical Antipsychotics = 2nd generation = PINES
LESS EPS and anticholinergic S/Es
"EPS --> ADAPT to Atypical Z-shaped PINES ... (RISK involved = risperidone) ... ADAPT to sitting in the BENZ in TREES"
-->atypical antipsychotics are
zapines
and
peridones
prolongted QT interval for all the "-
pines
"
Olanzapine
=
CLOZELY
monitor for
OBESITY
--> Olanzapine >> clozapine
--> cause obesity /metabolic syndrome (diabetes also)
Clozapines
=
Clozely
monitor for Cytosis of granule bone cells = agrunolcytosis
-->
CLOZET Schizos
= live in their clozet since no other treatments work
--> use clozapine (refractory schizophrenia)
Risperidone
=
RISK
of Prolactin
ADAPT to BENZ in TREES
= EPS treated with Benztropine (ACh antagonist) / Benzos
--> Benzos / Betas for Akithesisa of ADAPT
--> Benztropine for all other ADAPT (parkinson/rigidity)
Notes
:
Atypical Antipsychotics have a second action rather than just trying to block D2 dopamine receptors
Atypicals = -PINES have a 2nd receptor serotonin 5HT-2
--> less EPS and cholinergic, but more metabolic from serotonin
serotonin syndrome =
*Aripiprazole
special 2nd gen antipsychotic
5ht antagonist, but partial agonist at D2
--> good for
NEGATIVE SCHIZO symptoms
put A RIP in that FROWN and a PRETZEL in the HAND
--> ripiprazole
*Olanzapine
special 2nd gen antipsychotic
CLOZELY
monitor for
OBESITY
--> Olanzapine >> clozapine
--> cause obesity /metabolic syndrome (diabetes also)
QUIETLY, CHLOSE, OPEN and CLOZE the door to work out your muscles
--> high anti-muscarinic S/Es
*Clozapine
special 2nd gen antipsychotic
think of CLOZELY monitoring (granulocytosis + obesity / metabolic), CLOZET Schizos refractory to treatment, and QUIETLY, CHLOZE, OPEN, CLOZE door for muscles
most dangerous S/E = granulocytosis
-->
CLOZELY
monitor for Cytosis of granule bone
CLOZELY
monitor for
OBESITY
--> Olanzapine >> clozapine
--> cause obesity /metabolic syndrome (diabetes also)
refractory schizos = last line of drug
-->
CLOZET Schizos
= live in their clozet since no other treatments work
high anti muscarinic S/Es
-->
QUIETLY, CHLOSE, OPEN and CLOZE the door to work out your muscles
Antipsychotics Reversal Meds
diphenhydramine = antihistamine
--> treats antihistamine of ACH S/Es
Antispycotic S/Es SUMMARY
EPS ADAPT
anti-ACH
QUIETLY, CHLOSE, OPEN and CLOZE the door to work out your muscles
--> chlorpromazine, olanzapine, clozapine, quetiapine
--> muscle workout with your door
--> anti-muscarinic
*NMS = Neuroleptic Malignant Syndrome and Serotonin Syndrome
"SEROTONIN SCHIVERS"
vs
"DOPAMINE NMS FEVER"
--> key difference is SEROTONIN SHIVERS = hypERreflexes and restlessness
--> DOPAMINE NMS FEVER = fever, hypOreflexes and rigidity
note both have altered mental status and high sympathetic activity
--> sweating, fevers, tachycardia
tell them apart by their
CH
of "SCHIVERS"
H = HYPER reflexes
--> Serotonin S have
SEROTONIN SCHIVERS
--> CH = HYPER REFLEXES and
--> NMS has the opposite = HYPO reflexes
C = CLONUS
--> Serotonin S have
SEROTONIN SCHIVERS
--> CH = CLONUS and
--> NMS has the opposite to clonus = RIGIDITY
*NMS = neuroleptic Malignant syndrome
similar to Serotonin syndrome, but more lead pipe rigidity vs serotonin syndrome hypereflexes rigidity
Neuroletic Malignant Syndrome
NMS FEVER
mnemonic with fever, elevated enzymes, vital signs crazy, encephalopathy, rigidity
F = fever
E = Elevated enzymes
V = vitals are crazy
E = encephalopathy
R = rigidity
*Serotonin Syndrome
SEROTONIN SCHIVERS
mnemonic with shivering and sweating, excessive movements and reflexes
MAN's got SEROTONIN SHIVERS
--> mental changes autonomic, neuromuscular
MAO
threw the LINES man in
SHIVERS
water for not drawing
LINES SOLID
in his PALACE
--> Linezolid increases MAO inhibition
--> MAO and Linezolid give
SEROTONIN SYNDROME SHIVERS
"SEROTONIN SCHIVERS"
vs
"DOPAMINE NMS FEVER"
"
CH
SCHIVERS"
1 =
TIME
of onset
-->
NMS dopamine FEVER
has a SLOW onset = 1-3 days
-->
SEROTONIN SCHIVERS
has a FAST onset = < 1 day
2 = C =
CLONUS
--> Serotonin S have
SEROTONIN SCHIVERS
--> CH = CLONUS and
--> NMS has the opposite to clonus = RIGIDITY
3 = H =
HYPER
reflexes
--> Serotonin S have
SEROTONIN SCHIVERS
--> CH = HYPER REFLEXES and
--> NMS has the opposite = HYPO reflexes
*EPS ADAPT side effects of anti dopamine agents
"EPS --> ADAPT to Atypical Z-shaped PINES ... (RISK involved = risperidone) ... ADAPT to sitting in the BENZ in TREES"
AD
= Acute dystonia (muscle/jint stiffness)
A
= Akithesia (extreme restlessness)
P
= parkinson (TRAPT)
T
= tardive dyskinesia (chorea)
ADAPT to BENZ in TREES
= EPS treated with Benztropine (ACh antagonist) / Benzos
--> Benzos / Betas for Akithesisa of ADAPT
--> Benztropine for all other ADAPT (parkinson/rigidity)
Akathisia S/E from antipsychotics
extreme inner restleness
actually has a high rate of suicide due to akathisia
Metabolic Syndrome and Obesity from SGAs
CLOZELY
monitor for
OBESITY
--> Olanzapine >> clozapine
--> cause obesity /metabolic syndrome (diabetes also)
*Antidepressants
TCAs
SSRI's and NSRIs
1st line antidepressants = *SSRIs and SNRIs
*SSRIs = selective serotonin reuptake inhibitors
block reuptake and increase serotonin in the cleft
--> goes off the lack of monoamine model of depression
"Be CERTAIN in TIME, you'll CIT ALONGside PAM!"
sertraline, fluoxatine, citalopram
SSRIs over 50% of people have sexual dysfunction
--> by far the biggest side effect and reason for non-compliance
--> need to constantly monitor this
weight gain and risk of seizures are ONLY minor problems
"Be CERTAIN in FLU TIME, you'll SIT ALONGside PAM!"
CERTAIN in FLU TIME
= sertraline and fluoxetine
SIT ALONGside PAM
= citalopram
SSRI initiatiation of Treatment
note that SSRIs take 4-6 weeks for them to work
common for many people to get discouraged with them and stop before they ever give them a chance to work
3rd line / Adjuncts to SSRIs = *ATYPICAL Antidepressants
used for specific indications
ex: mirtazipine used for depression in elderly and anorexics
--> increases appetite and causes weight gain
*Bupropione
atypical antidepressent
PROPION = DOPE + NE
--> instead of SSRIs - DOPE and NE
"bupropione is aPROPRIATE
for
FAT
people who want to
LOSE WEIGHT
and have
SEX
, BUT not aPROPriate for
SKINNY
people having
SEIZURES
..."
--> main pros of bupropione is no weight gain or sexual dysfunction as with SSRIs
--> main problem is bupropion can cause seizures and weight loss
*ELDERLY/SKINNY MDD - Adjunct meds
Annorexia MDD
*Mirtazipine = MIRTLE TURTLE
ATYPICAL PINE antidepressent
"MIRTLE TURTLE can't SLEEP
" = skinny depressed turtle hiding in her shell who can't sleep (People banging on the shell)
*INSOMNIA MDD - Adjunct meds
Mirtazipine MIRTLE TURTLE
Trazzzabone
*Mirtazipine = MIRTLE TURTLE
-see other
*Trazadone = traZZZaBONE
atypical antidepressent
opposite MOA of bupropion
--> bupropion = PROPION = DOPE + NE
--> trazadone works to BLOCK ALL other receptors other than DOPE and NE
--> high Histamine blockade = SEDATION ZZZ
Priapism = BONER = is rare , but SERIOUS
--> medical emergency
*MDD and Smoking addiction
1st line = Varenicline
Bupropion
--> see other
*Varenicline = Veronica Corningstone DECLINE
nicotine alpha4 beta 2 PARTIAL agonst
42 receptor = Anchorman news channel
--> KVWN channel 4
Varenicline = Veronica Corningstone DECLINE
nicotine alpha4 beta 2 PARTIAL agonst
42 receptor = Anchorman news channel
--> KVWN channel 4
"tune into (PARTIAL ANCHOR) Veronica Corningstone on channel 4 KVWN 2night"
Veronica
Corningstone = varenicline
PARTIAL anchor
= partial agonist
--> helps with some of the craving
channel 4 KVWN 2night
= partial agonist at ACh nicotinic specific receptors
--> alpha4beta2 Nicotinic receptors
1 more item...
*Bupropione
--> see other
2nd line antidepressants
TCAs / MAOs
*TCAs = Tricyclic Antidepressants
same action as SNRIs
block reuptake of serotonin and NE
TCA Side-effects
similar to antipsychotics anti-ACH side effects
added cardiac S/Es
--> block fast sodium channels
--> arrhythmias and hypotension
TCAs (amytryptiline) are notorious for anticholinergic S/Es most all
--> anti DUMBELL leakage symptoms
TCA Over Dose
anti-ACH, but ANTICHOLINERGIC are the biggest of ACH
TCA Overdose causes Na blockage = prolongued vintervals
T = tired CNS
C = Cardiac Na blockage =
prolonged QT / PR , QRS intervals
A = Anticholinergic
1 more item...
Clinical Cases
Clinical Case
Notes
:
note that
Clinical Case
*MAO inhibitor Antidepressants
MAO = monoamine oxidase --> breaks down all monoamines (5HT and NE) into metabolites
"MAO Takes Pride in Shanghai"
and
"MAO doesn't do well with others"
MAO
... in his
MIGHTY Palace
Takes
Pride
In
Shangha
all the
tINE
--> but he
IS
FUNNY
and
ATYPICAL
and
SELECTS
only
TRANYS
to stay for
2 weeks his Palace
...
and makes them wear
CHEESE hats
and cheer for the
PACKERS
MAO
... in his
MIGHTY Palace
= MAO is in the mitochondria
all end in TINE
start with T P I S
IS
= isocarboxazid
FUNNY
= phenyzine
ATYPICAL
= MAOs used for atypical MDD
SELECTs
= selegine
TRANYs
= tranylcypromine
2 weeks = 2 week wait to switch from MOA Is to SSRIs
--> prevent Serotonin syndrome and allow MAO to replenish
--> note that MOAIs irreversibly ind the enzyme, just like aspirin so you have to wait for more to be made
CHEESE hats
and
PACKERS
= cheese, draft beer, bratts sausage
--> tyramine hypertensive crisis
--> think of overweight Packers fan with HTN
MAO Inhibiotrs and cheese hat Tyramine hypertensive crisis
MAO makes the TRANYs stay for
2 weeks his Palace
and makes them wear
CHEESE hats
and cheer for the
PACKERS
Atypical MDD and MAO Inhibiotrss
MAOs are used for atypical MDD and also for refractory MDD to first line SSRIs and SNRIs
*Sedatives
barbituates
Benzos and Non-benzos
*Benzos and Non-Benzos
BENZO = increase freQUENZy of GABA Cl- channels
NON - Benzos = ZZZZ medications for sleeping
--> Zolpidem
*Benzos
BENZO = increase freQUENZy of GABA Cl- channels
NON - Benzos = ZZZZ medications for sleeping
--> Zolpidem
note that BENZO can modulate the frequency of GABA Cl- channels since they bind allosterically
Duration of Action for Benzos
divided into short acting, medium and long
short = < 6 hrs
medium ~ 12 hours
long > 12 hours
note that Benzos can be used as an adjunct to SSRIs etc for GAD when they are also having insomnia
"buccal MIDAZ"
= ~ 6 hrs
"LORAZ = LONG night sleep "
= ~ 12 hrs
--> used as a sleeping aid
"DAYZ use DIAZ"
> 12 hours
Benzo contraindicated with other sedative = first gen antihistamines
1st gen antihistamines = -AMINES
--> Benadryl = diphenhydramine
--> CHLORALINE is a friend AMINE that put me to sleep
--> chlorpheniramine
Non-Benzos
BENZO = increase freQUENZy of GABA Cl- channels
NON - Benzos = ZZZZ medications for sleeping
--> Zolpidem
Barbituates
barbiDURates = increase DURation of GABA Cl- channels
*Insomia Medications
barbituates
benzodiazapines
non-benzodiazapines (ZZZZs)
ramelton = melatonin agonist
Suvorexant
Insomia in the Elderly
do NOT use normal sedative medications, antipsychotics, antidepressants, etc.
--> EPS and anticholinergic problems
--> risks of falls
ramelton
= melatonin agonis for elderly ALWAYS
"I could really used some RAW MELATONIN right now"
= ramelton
*Anti-anxiety
buspirone = 1st line ?
*Overview of Psych Meds
note from Bulemia --> GAD --> PTSD
--> all use SSRIs 1st line
*Stimulants
methylphenidate (ADHD + narcolepsy)
amphetamines (meth + dextro)
*methylphenidate = ritalin
1st line Tx for = (ADHD + narcolepsy)
biggest side effects are decreased appetitie and weight loss
--> just give the meds AFTER meals usually fixes this
need to monitor kids on methylphenidate monthly
--> weight, height, BP and and HR
*Bipolar Medications
lithium = 1st line
manic AEDs = carbamazapine and valproate
depressive symptoms = lamotragine
*Lithium
narrow therapeutic window
almost exactly like sodium
--> excreted exclusively by the kidney and >60% at the PCT
--> just like sodium
Lithium toxicity
acute Lithium toxicity = GI general symptoms
chronic toxicity = neurological symptoms
Notes
:
note thiazide diuretics are contraindicated in lithium
--> anything really that affects sodium reabsorption or volume depletes
thiazides lower the blood volume
they also stop reabsorption of Na at the DCT
--> this increases Na+ reabsorption at the PCT and also lithium at the PCT
Clinical Cases
Clinical Case
3 more items...
Lithium and Hypothyroidism S/E
think of lithium as a defective form of iodine in thyroid that causes hypothyroidism
HYpothyroidism key symptoms:
--> gain in everything, except ammenoria and hair loss
--> weight gain, hair loss, bradycardia, constipation
Clinical Cases
Clinical Case
3 more items...
*Lithium and NEPHROGENIC DI
note that Lithium causes NEPHROGENIC DI
so even if your body is releasing the proper amount of ADH
--> Lithium stops it form working at the kidney
--> stops the AP 2 channels migrating to the apical side = lumen
LITHIUM side effects are
LITHIUM
LiTH
= low Thyroid
H
= heart / pregnancy = Ebstein MV abnormal
I
= insipidus = DI
UM
= unwanted movements = tremor
*Valproate
main indication for valproate is myoclonic siezures and generalized siezures
both AEDs valproate and carbamazapine are used for mani type Bipolar
lamotragin = LAME = used for deressive features of bipolar
