pharm of psychoses 2

Question 1

catecholamine hypothesis of depression

support for

Answer 1

1) reserpine decr brain NE-5HT and induce depression

drugs effective in depression incr NE-5HT at postsyn (block reuptake, block metab, or incr release)

Question 2

catecholamine hypothesis of depression

evidence against

Answer 2

does not totally explain etiology of depression

mood elevating effects = 2-3 weeks but effects on amines immediate and newer drugs don’t affect amines

Question 3

TCAD’s
1) effect on NT uptake

2) side effect
3) clinical efficacy
4) consideration

Answer 3

1) block 5HT reuptake and some NE

2) sedation- fatigue, sleepiness
antimuscarinic (dry mouth, blurry vision, urinary hesitancy, fuzzy)

orthostatic hypotension
EKG changes
tremor, paresthesia
weight gain
sex disturb

3) very effective but many side effect
2-3 weeks

4) poor side effect, sudden death in overdose

Question 4

amitryptiline class

Answer 4

TCAD

Question 5

imipramine class

Answer 5

TCAD

Question 6

desipramine class

Answer 6

TCAD

Question 7

SSRI’s
1) effect on NT uptake

2) side effect
3) clinical efficacy
4) consideration

Answer 7

1) block 5-HT reuptake

2) acute = nausea, diarrhea, insomnia
delayed = weight gain, sex dysfunction, cognitive blunt

3) effective = 2-3 weeks

4) low fatality with OD
withdraw = flu-like or neuro sx

DDI = serotonin syndrome with MAOI
P450 inhib

Question 8

fluoxetine class

Answer 8

ssri

Question 9

sertraline class

Answer 9

ssri

Question 10

paroxetine class

Answer 10

ssri

Question 11

SNRI

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 11

1) block NE and 5-HT reuptake

2) HTN, anxiety
nausea, somnolence, sweat, sex dysfunction

3) slight more effective than SSRI
4) more rapid withdrawal than SSRI

Question 12

venlafaxine class

Answer 12

snri

Question 13

ndri

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 13

1) block NE and DA reuptake

2) anxiety, seizure at high dose,
dizziness, dry mouth, psychosis

3) -
4) -

Question 14

bupropion class

Answer 14

ndri

Question 15

trazodone

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 15

1) mixed postsynap antag and serotonin reuptake inhib
2) drowsiness
3) -
4) minor problem with overdose

Question 16

MAOI

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 16

1) inhib MAO A and B; decr NE and 5-HT degradation
2) postural hypotension, CNS stim, liver damage
3) -
4) seizures, shock, hyperthermia in overdose

Question 17

phenelzine class

Answer 17

MAOI

Question 18

ECT

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 18

1) incr amt of rate limiting enzymes for NE and 5-HT synth
2) -
3) more rapid response than other
4) -

Question 19

valproic acid and carbamazepine

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 19

1) block VG Na+ to stabilize neural activity and decr XS nerve impulses

2) -
3) -
4) -

Question 20

Lithium

1) effect on NT uptake
2) side effect
3) clinical efficacy
4) consideration

Answer 20

1) unclear mech; 10-21 days to see effect; greatest on cells with high activity
2) fine tremor, GI upset, muscle weakness, decr thyroid function, polyruia
3) used in combo
4) DDI = renal clearance decr by diuretics; plasma level incr with NSAID