Pharmacology

Question 1

What conditions are CNS stimulants used to treat?

Answer 1

ADHD, narcolepsy, appetite control

Question 2

What are examples of antipsychotics (neuroleptics)?

Answer 2

haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”)

Question 3

What is the MOA of typical antipsychotics?

Answer 3

all typical antipsychotics blocks dopamine D2 receptors (increase cAMP)

Question 4

What is the TU of typical antipsychotics?

Answer 4

schizophrenia (primarily positive symptoms)
psychosis, acute mania
Tourette Syndrome

Question 5

What are signs of toxicity of typical antipsychotics and what are their treatments?

Answer 5

Because HIGHLY LIPID SOLUBLE –> stored in fat –> very slow to be removed from body

1. Extrapyramidal system side effects
2. Endocrine side effects
3. Dry mouth, constipation (d/t blocking muscarinic receptors)
4. Hypotension (d/t blocking alpha1 receptors)
5. Sedation (d/t blocking histamine receptors)

Question 6

What are the treatments for typical antipsychotic toxicities?

Answer 6

1. Extrapyramidal system side effects –> benztropine or diphenhydramine
2. Endocrine side effects
3. Dry mouth, constipation (d/t blocking muscarinic receptors)
4. Hypotension (d/t blocking alpha1 receptors)
5. Sedation (d/t blocking histamine receptors)

Question 7

The major side effect of typical antipsychotic use that includes rigidity, myoglobinuria, autonomic instability, and hyperpyrexia is called what?

Answer 7

Neuroleptic Malignant Syndrome (NMS)

Question 8

What is the treatment for Neuroleptic Malignant Syndrome (NMS)?

Answer 8

dantrolene or D2 agonists (e.g. bromocriptine)

Question 9

The major side effect of typical antipsychotic use that includes stereotypic oral-facial movements as a result of long-term antipsychotic use is called what?

Answer 9

Tardive Dyskinesia

Question 10

What typical antipsychotics have high potency?

Answer 10

Trifluoperazine
Fluphenazine
Haloperidol

“Try to Fly High” - neurologic SEs (EPS symptoms)

Question 11

What typical antipsychotics have low potency?

Answer 11

Chlorpromazine
Thioridazine

Non-neurologic side effects (anticholinergic, antihistamine, and alpha1- blockade effects)

Question 12

What is the evolution of EPS side effects?

Answer 12

4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)

4 day akathisia (restlessness)

4 wk bradykinesia (parkinsonism)

4 mo tardive dyskinesia

Question 13

What are examples of atypical antipsychotics?

Answer 13

Olanzapine
Clozapine
Quetiapine
Resperidone
Aripiprazone
Ziprasidone

Question 14

What are the TU for atypical antipsychotics?

Answer 14

Schizophrenia (both positive and negative symptoms)
Bipolar disorder
OCD
anxiety disorder
depression
mania
Tourette Syndrome

Question 15

Which atypical antipsychotics can cause significant weight gain?

Answer 15

olanzapine/clozapine

Question 16

Which is a major side effect of clozapine?

Answer 16

agranulocytosis (requires WEEKLY WBC monitoring)

Question 17

What is a side effect specific to risperidone?

Answer 17

increased prolactin –> decreases GnRH, LH, and FSH (causing irregular menstruation and fertility issues)

Question 18

What is a side effect specific to ziprasidone?

Answer 18

prolong QT interval

Question 19

What is the initial treatment for agranulocytosis caused by clozapine?

Answer 19

discontinue treatment

Filgrastim (G-CSF) –> recovers bone marrow

Question 20

What is the TU of lithium?

Answer 20

“mood stabilizer” for bipolar disorder
blocks relapse and acute manic events
SIADH (because causes nephrogenic diabetes insipidus)

Question 21

What are the side effects of lithium use?

Answer 21

LMNOP

Lithium side effects - 
Movement (tremor)
Nephrogenic diabetes insipidus 
hypOthyroidism
Pregnancy problems (teratogenesis including fetal cardiac defects like Ebstein anomaly and malformation of the great vessels)

Question 22

What is the TU for buspirone?

Answer 22

generalized anxiety disorder

Question 23

What is the MOA of buspirone?

Answer 23

stimulates 5-HT receptors

Question 24

What are examples of SSRIs?

Answer 24

Fluoxetine, Paroxetine, Sertraline, and Citalopram

Question 25

What is the MOA of SSRIs?

Answer 25

5HT specific repute inhibitor

Question 26

How long does it take an SSRI to normally have an effect?

Answer 26

4-8 weeks

Question 27

What are the TUs of SSRIs?

Answer 27

``` depression GAD panic disorder OCD bulimia social phobias PTSD ```

Question 28

What are SEs of SSRIs?

Answer 28

*fewer than TCAs GI DISTRESS SEXUAL DYSFUNCTION (anorgasmia and decreased libido) SEROTONIN SYNDROME

Question 29

What are signs of Serotonin Syndrome?

Answer 29

hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

Question 30

What is the treatment for Serotonin Syndrome?

Answer 30

cyproheptadine (5HT2 receptor antagonist)

Question 31

What are examples of SNRIs?

Answer 31

venlafaxine | duloxetine

Question 32

What are TUs of SNRIs?

Answer 32

depression venlafaxine: also used in GAD and panic disorders duloxetine: also used in diabetic peripheral neuropathy

Question 33

What is the MC side effect of SNRIs?

Answer 33

increased BP

Question 34

What are examples of TCAs?

Answer 34

``` amitriptyline nortriptyline imipramine desipramine clomipramine doxepine amoxapine ```

Question 35

What are TUs of TCAs?

Answer 35

major depression OCD (clomipramine) fibromyalgia

Question 36

What are side effects of TCAs?

Answer 36

Tri-C's: Convulsions, Coma, Cardiotoxicity (arrythmias) other SEs: respiratory depression, hyperpyrexia, confusion and hallucinations in elderly d/t anticholinergic SEs

Question 37

What is the treatment for TCA toxicity?

Answer 37

NaHCO3 for CV toxicity

Question 38

What are examples of MAOIs?

Answer 38

tranylcypromine phenelzine isocarboxazid selegiline (selective MOA-B inhibitor)

Question 39

What are TUs of MAOIs?

Answer 39

atypical depression anxiety hypochondriasis

Question 40

What are side effects of MAOIs?

Answer 40

HYPERTENSIVE CRISIS (most notably with ingestion of TYRAMINE, which is found in foods such as wine and cheese) CNS stimulation *contraindicated with SSRIs, TCAs, St. John's wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

Question 41

Bupropion, Mirtazapine, and Trazodone are in what class of drugs?

Answer 41

Atypical Antidepressants

Question 42

What is the MOA, TU, SEs, and contraindications of bupropion?

Answer 42

MOA: increase NE and DA via unknown mechanism TU: smoking cession SEs: stimulant effects (tachycardia, insomnia), HA, seizure in bulimic patients. Contraindications: hypochloremia or hypokalemia (e.g. bulimics) **NO SEXUAL SEs!

Question 43

What is the MOA, TU, SEs, and contraindications of mirtazapine?

Answer 43

MOA: alpha2- antagonist (increase release of NE and 5HT) and a potent 5HT2 and 5HT3 receptor antagonist TU: depression SEs: sedation, increased appetite, weight gain, dry mouth

Question 44

What is the MOA, TU, SEs, and contraindications of trazodone?

Answer 44

MOA: primarily blocks 5HT2 and alpha1-adrenergic receptors TU: primarily for INSOMNIA SEs: sedation, nausea, priapism, postural HOTN *called trazoBONE d/t male-specific side effects