Exam 3- Neuro and Psych

Question 1

Donepezil
Galantamine
Rivastigmine

Answer 1

M: AChE inhibitors

S/E: Nausea, dizziness, insomnia

Question 2

Memantine

Answer 2

M: NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca)
S/E: dizziness, confusion, hallucinations

Question 3

Alcohol

Answer 3

Intox: Emotional lability, slurred speech, ataxia, coma, blackouts. Serum gamma-glutamyltransferase is sensitive indicator of alcohol use. AST 2x ALT in alcohol abuse.

Withdrawal: mild alcohol withdrawal- anxiety, tremor, seizures, insomnia. Severe- can cause autonomic hyperactive and DT’s 5-15% mortality. tx with bento’s for DT’s

Question 4

Opioids

Answer 4

Intoxication: euphoria, respiratory, and CNS depression. decreased gag reflex and bowel sounds, pupillary constriction, seizures. Tx with naloxone or naltrexone

Withdrawal: sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea,
tx with methadone, buprenorphone, long-term support

Question 5

Barbiturates

Answer 5

Intoxication: low safety margin. marked respiratory depression. tx with symptom management (assist breathing and BP)

Withdrawal: delirium, life threatening cardiovascular collapse

Question 6

Benzodiazepines

Answer 6

Intoxication: Greater safety margin. Ataxia, minor respiratory depression, tx with supportive care and flumazenil (competitive benzo antagonist)

Withdrawal: sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reversal with flumazenil)

Question 7

Amphetamines

Answer 7

Intox: euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. severe: cardiac arrest and seizure.

Withdrawal: anhedonia, increased appetite, hyper somnolence, existential crisis

Question 8

Cocaine

Answer 8

Intox: impaired judgement, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. tx with benzo’s

Withdrawal: hypersomnolence, malaise, sever psychological craving, depression/suicidality.

Question 9

Caffeine

Answer 9

Intox: restlessness, increased diuresis, muscle twitching

Withdrawal: lack of concentration and headache

Question 10

Nicotine

Answer 10

Intox: restlessness

Withdrawal: irritability, anxiety, craving. tx with nicotine patch, gum, or lozenges; bupropion/ varenicline.

Question 11

PCP- phencyclidine

Answer 11

Intox: belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. tx with benzo’s, rapid acting antipsychotic.

Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

Question 12

Lysergic acid diethylamide

Answer 12

Intox: perceptual distortion (visual and auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

Question 13

Marijuana

Answer 13

Intox: euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations. prescription form is dronabinol-used as antiemetic and appetite stimulant.

Withdrawal: irritability, depression, insomnia, nausea, anorexia. most symptoms peak in 48 hours and last for 5-7 days. generally detectable in urine for 4-10 days.

Question 14

methyphenidate
dextroamphetamine
methamphetamine
phentermine

Answer 14

CNS Stimulants
M: increase catecholamines at synaptic cleft, especially NE and Dopamine
C: ADHD, narcolepsy, appetite control

Question 15

Haloperidol
trifluoperazine
fluphenazine
thioridazine
chlorpromazine

Answer 15

Neuroleptics
M: block dopamine D2 receptors (increase cAMP)
C: schizophrenia (primarily postive symptoms), psychosis, acute mania, and Tourette syndrome
T: highly lipid soluble and stored in body fats; thus have very slow removal from body.
-extrapyramidal system side effects, tx with benztropine or diphenhydramine
-endocrine side effects: hyperprolactinemia (dopamine antagonist)
-anti muscarinic: dry mouth and constipation
-anti alpha-1: hypotension
-anti histamine: sedation
Chlorpromazine - corneal deposits
Thioridazine - retinal deposits
Neuroleptic Malignant Syndrome- rigidity, myoglobinuria, autonomic instability, hyperpyrexia. tx with dantrolene, D2 agonists (bromocriptine)

Tardive Dyskenesia: stereotypic oral facial movements as a result of long term antipsychotic use potentially irreversible.

try to fly high- Triflu, fluphen, and halo are high potency and cause more neurologic side effects than the rest.

Question 16

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

Answer 16

Atypical Antipsychotics
M: not completely understood. varied effects on 5-HT2, dopamine, alpha, and H1 receptors
C: schizophrenia- both positive and negative symptoms. bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome
T: fewer extrapyrimidal and anticholinergic side effects than tradition antipsychotics.
-Olanzapine/clozapine may cause significant weight gain.
-Clozapine may cause agranulocytosis (weekly CBC) and seizure.
-Risperidone may increase prolactin (decrease GnRH, LH, FSH)
-Ziprasidone may provolone the QT

*watch clozapine clozely

Question 17

Lithium

Answer 17

M: not established; possibly related to inhibition of phosphoinositol cascade
C: mood stabilizer for bipolar disorder; blocks relapse and acute manic events. also SIADH
T: tremor, sedation, edema, heart block, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis. Fetal cardia defects include Ebstein anomaly and malformation of the great vessels. Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by the kidneys; most is reabsorbed at the PCT following Na reabsorption

Question 18

Buspirone

Answer 18

M: stimulates 5-HT1A receptors
C: generalized anxiety disorder. does not cause sedation, addition, or tolerance. takes 1-2 weeks to take effect. does not interact with alcohol (vs barbiturates and benzo’s)

Question 19

Fluoxetine
Paroxetine
Sertraline
Citalopram

Answer 19

SSRI’s
M: 5-HT specific repuptake inhibitors, take 4-8 weeks to work
C: depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD
T: fewer than TCA’s. GI distress, sexual dysfunction (anorgasmia and decreased libido)

-when taken with drug that increases 5-HT (MAOI’s, SNRI’s, TCA’s) can cause:
Serotonin syndrome: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures. tx with cyproheptadine (5-HT2 receptor antagonist)

Question 20

Venlafaxine

duloxetine

Answer 20

SNRI’s
M: inhibit 5-HT and NE reuptake
C: depression. Venlafaxine also used in generalized anxiety disorder and panic disorder. Duloxetine is also used for diabetic peripheral neuropathy.
T: increased BP most common; also stimulant effects, sedation, and nausea

Question 21

Amitriphtyline
nortriptyline
imipramine
desipramine
clomipramine
doxepin
amoxapine

Answer 21

TCA’s
M: block repute of NE and 5-HT
C: major depression, OCD (clomipramine), and fibromyalgia
T: - Convulsions, coma, cardiotoxicity (Tri-C’s), respiratory depression, hyperpyrexia, confusion and hallucinations in elderly do to anti-Ach effects. tx cardiotoxicity with NaHCO3
-sedation, alpha 1 blocking effects (postural hypotension), and anticholinergic effects (dry mouth, urinary retention, tachycardia).
-tertiary TCA’s (amitriptyline) have more anticholinergic effects than secondary (nortriptyline)
-desipramine is less sedating but has higher seizure incidence.

Question 22

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

Answer 22

MAOI’s
M: nonselective MAO inhibition. increases levels of amine neurotransmitters (NE, 5-HT, dopamine). Selegiline MAOB selective.
C: atypical depression, anxiety, hypochondriasis
T: hypertensive crisis (most notably with tyramine rich foods, like wine and cheese), CNS stimulation. contraindicated with SSRI’s, TCA’s, St John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

Question 23

Bupropion

Answer 23

atypical antidepressant
M: unknown mechanism, increases NE and dopamine
C: antidepressant and smoking cessation
T: stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. no sexual side effects.

Question 24

Mirtazapine

Answer 24

Alpha 2 antagonist
M: increase release of NE and 5-HT and potent antagonist of 5-HT-2/3.
C: depression, some side effects may be desirable in specific patients.
T: sedation, increased appetite, weight gain,

Question 25

Trazodone

Answer 25

M: primarily blocks 5-HT2 and alpha 1
C: used primarily for insomnia as high doses are needed for antidepressant effects.
T: sedation, nausea, priapism, postural hypotension

Trazobone

Question 26

Ethosuximide

Answer 26

M: blocks thalamic T-type Ca channels
C: absence seizures
T: GI, fatigue, HA, urticaria, Steven Johnson syndrome,

*sux to have absence seizures

Question 27

Phenytoin

Answer 27

M: increase Ns channel inactivation; zero order kinetics
C: 1st line for tonic-clonic, also used for simple and complex. 1st line prophylaxis for status epileptics
T: nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome) SLE-like syndrome, induction of CyP450, lymphadenopathy, Steven Johnson syndrome, osteopenia.

Fosphenytoin for parenteral use.

Question 28

Carbamazepine

Answer 28

M: Increase Na channel inactivation
C: 1st line for simple, complex, and tonic-clonic
T: Diplopia, ataxia, blood dycrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of CyP450, SIADH, Steven Johnson syndrome,

*1st line for trigeminal neuralgia

Question 29

Valproic Acid

Answer 29

M: Increase Na channel inactivation, increase GABA concentration by inhibiting GABA transamination
C: 1st line for Tonic-Clonic, also used for simple, complex, and absence. Also used for myoclonic seizures and bipolar disorder
T: GI, distress, rare but fatal hepatotoxicity, neural tube defects in fetus, tremor, weight gain.

Question 30

Gabapentin

Answer 30

M: primarily inhibits high voltage activated Ca channels; designed as GABA analog
C: simple, complex, and tonic-clonic. also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, and bipolar disorder.
T: sedation and ataxia.