Classifications of CNS and Psychiatric Drugs (Pharmacology)

Question 1

5 Main Classes of Antidepressants

Answer 1

1. Monoamine Oxidase Inhibitors (MAOi)
2. Tricyclic Antidepressants (TCAs)
3. Selective Serotonin Reuptake Inhibitors (SSRIs)
4. Noradrenergic Reuptake Inhibitors (NARIs)
5. Serotonin and Noradrenergic Reuptake Inhibitors (SNRIs)

Question 2

6 Other Antidepressant Drug (Name and class)

Answer 2

1. Mirtazapine – Norepinephrine and specific serotonin antidepressant (NaSSA)
2. Bupropion – Norepinephrine-dopamine reuptake inhibitor (NDRI)
3. Agomelatine – Melatonin MT1 and MT2 receptor agonists
4. Ketamine – Glutamate NMDA receptor antagonist
5. Vortioxetine – Multimodal Serotonergic Antidepressants (Serotonin Modulators and Stimulators)
6. Trazodone – Serotonin Antagonist and Reuptake Inhibitor

Question 3

Examples of MAO inhibitors

Answer 3

1. Moclobemide (Reversible MAO A)
2. Phenelzine (Irreversible non-selective)

Question 4

Examples of TCAs

Answer 4

Non-selective for 5-HT and NE transporter
- Imipramine
- Amitriptyline
- Nortriptyline
- Clomipramine

Selective for NE transporter
- Desipramine

Question 5

Examples of SSRIs

Answer 5

Fluoxetine
Citalopram
Fluvoxamine
Escitalopram

Question 6

Examples of NARIs

Answer 6

Reboxetine
Maprotiline

Question 7

Examples of SNRIs

Answer 7

Venlafaxine
Duloxetine

Question 8

Order of Antidepressant Pharmacologic Treatment (1st, 2nd, 3rd and 4th lines)

Answer 8

1. SSRI, SNRI, NaSSA (Mirtazapine), Bupropion
2. Agomelatine, Vortioxetine
3. TCAs
4. MAOi

Question 9

Main Classes, Sub-classes and Some Names of Anxiolytics

Answer 9

Benzodiazepines:
- Short acting
- Intermediate acting
- Long acting

Non-benzodiazepines:
- Zolpidem
- Buspirone (Serotonin receptor partial agonist)
- Barbiturates
(1) Long acting anticonvulsants
(2) Short acting sedative/hypnotics
(3) Ultrashort acting IV induction of anesthesia
- Pregabalin (GABA analogue)
- Hydroxyzine (1st generation antihistamine)
- Propranolol (Beta Blocker)
- Others (Antidepressants)

Question 10

Types of benzodiazepines and names of drugs

Answer 10

Short-acting (Midazolam, Triazolam)

Intermediate-acting (Alprazolam, Clonazepam, Lorazepam, Oxazepam, Temazepam)

Long-acting (Diazepam, Flurazepam)

Question 11

Types of barbiturates and names of drugs

Answer 11

Long acting anticonvulsants (1-2 days)
- Phenobarbital

Short acting sedative/hypnotics (3-8h)
- Pentobarbital
- Amobarbital

Ultrashort acting IV induction of anesthesia
- Thiopental

Question 12

4 Main Antiepileptic Drugs and brief MOA

Answer 12

1. Phenytoin (Inhibit Na channel)
2. Carbamazepine (Inhibit Na channel)
3. Valproate (Inhibit Na, Ca channel, GABA transaminase)
4. Benzodiazepine

Question 13

Broad categories of the 6 Main therapeutic options for Parkinson’s Disease

Answer 13

Dopaminergic:
1. Levodopa
2. MAO-B Inhibitors
3. Catechol-O-Methyltransferase Inhibitors
4. Dopamine Agonists

Non-dopaminergic
5. Anticholinergics
6. Amantadine

Question 14

Levodopa is used in combination with

Answer 14

Peripheral decarboxylase inhibitors
e.g. with Benserazide [Madopar],
e.g. with Carbidopa [Sinemet])

Question 15

Example of MAO-B Inhibitor

Answer 15

Selegiline (Jumex)

Question 16

Examples of COMT inhibitors

Answer 16

Entacapone (Comtan), Tolcapone (Tasmar)

Question 17

2 Broad Classes of Antipsychotics and Key Drugs (Schizophrenia)

Answer 17

1. Typical Antipsychotics (Chlorpromazine, Fluphenazine, Haloperidol, Trifluoperazine)
2. Atypical Antipsychotics (Amisulpride, Aripiprazole, Clozapine, Olanzapine, Risperidone)

Question 18

Classification of Opioid Agonists based on strength

Answer 18

Strong Opioid Agonists I (Strong µ agonists)
1. Morphine (weaker δ and κ agonist)
2. Methadone (no significant δ and κ affinity) – Long acting
3. Fentanyl (no significant δ and κ affinity) – Short acting
4. Pethidine [Meperidine] (weaker δ and κ agonist) – Shorter acting than morphine

Moderate Opioid Agonists (Weak μ agonist):
1. Codeine
(Also a weak δ agonist, probably not a κ agonist)
2. Tramadol
(Also a weak 5-HT inhibitor and noradrenaline reuptake)

Question 19

Examples of Opioid Antagonists (Duration of action and route of administration)

Answer 19

Strong μ antagonism; also δ and κ antagonism:
- Naloxone (Short acting IV)
- Naltrexone (Long acting PO)
- Nalmefene (Long acting IV)

Question 20

Types of Local Anaesthetics and Names of Drugs

Answer 20

1. Ester type (Procaine)
2. Amide type (Lidocaine)

Question 21

Types of General Anaesthetics based on route of administration and Names of Drugs

Answer 21

Inhalation:
1. Volatile Liquids – Halothane, Isoflurane, Sevoflurane
2. Gas – Nitrous Oxide

Intravenous:
1. Barbiturates – Sodium Thiopental
2. Propofol
3. Ketamine
4. Benzodiazepine – Midazolam

Question 22

Anesthetic Adjuncts / Post-Op Care

Answer 22

1. Benzodiazepines
2. Alpha 2 Adrenergic Agonists – Dexmedetomidine
3. Analgesics – NSAIDs
4. Neuromuscular Blocking agents – Succinylcholine (depolarizing), Vecuronium (non-depolarizing)