Physiology

Question 1

Antidepressant Medications

Answer 1

SSRIs, SNRIs, Tricyclics, MAOIs, Other (tetracyclics, weak SSRIs, Welbutrin, and psychostimulants)

Question 2

ADHD Medications

Answer 2

Stimulants (Methylphenidate and Amphetamines), Non-stimulants (Straterra), SNRIs, Tricyclic Anti-depressants, Alpha-Adenergic Agents, Welbutrin

Question 3

Antipsychotic Medications

Answer 3

1st Gen, 2nd Gen, Third Gen

Question 4

Mood Stabilizers

Answer 4

Lithium and Anti-Epileptics, sometimes anti-psychotics

Question 5

Anxiolytics

Answer 5

Benzodiazipines

Question 6

Alzheimer’s Medications

Answer 6

AChE Inhibitors, NMDA Receptor Antagonists, Amyloid Drugs, Alternative approaches

Question 7

Selective Serotonin Reuptake Inhibitors

Answer 7

MECHANISM: blocks reuptake of 5HT
INDICATIONS: MDD, Social Anx, Panic Attacks
CONTRA: Pregnant, MAOIs, Antipsychotics
SIDE: GI, malaise, sexual dysfunction
NAMES: Zoloft, Prozac, Celexa

Question 8

Serotonin Norepinephrine Reuptake Inhibitor

Answer 8

MECHANISM: blocks reuptake of NE and 5HT, impacts DA in PFC
INDICATIONS: MDD, Pain, GAD
CONTRA: MAOIs, Alcohol, and St. Johns Wort
SIDE: decreased appetite, constipation, nausea
NAMES: Cymbalta, Effexor, Prestiq

Question 9

Tricyclics

Answer 9

MECHANISM: blocks reuptake of NE, impacts 5HT
INDICATIONS: MDD, OCD, Panic Disorder
CONTRA: overdose, seizures, and strokes
SIDE: sedation, constipation, orthostatic hypotension
NAMES: adapine/sinequan, anafranil, tofranil

Question 10

MAOI

Answer 10

MECHANISM: inhibits MAO which is an enzyme that breaks down monoamine NT which allows them to increase in availability
INDICATIONS: MDD, PD, and Bulimia
CONTRA: SSRIs, SNRIs, and dietary restrictions
SIDE: myoclonus, delirium, feet swelling
NAMES: selegeline, marplan, parnate

Question 11

Welbutrin

Answer 11

MECHANISM: NE reuptake inhibitor but it impacts NE metabolites
SIDE: restlessness, insomnia, anorexia
INDICATIONS: ADHD, depression, and smoking cessation (zyban)

Question 12

Stimulants

Answer 12

Increase output of DA in the frontal-striatal (basal ganglia) system
Two types: amphetamines (inc DA from presynaptic cell) and methyphenidate

Question 13

Amphetamines

Answer 13

Adderall, Vyvanse (advertised for those with substance use issues), and LiquADD (as young as 3yo)

Question 14

Methylphenidate

Answer 14

Short acting (~4hr): Ritalin, Attenta
Intermediate acting (~3-8hr): Ritalin sustained release
Long acting (~8-12hr): Concerta, Ritalin LA

Question 15

Strattera

Answer 15

SNRI that acts as a nonstimulant for ADHD. Does not work with DA

Question 16

Tricyclic Antidepressants for ADHD

Answer 16

Used for second line
Improves attention, mood, and decrease hyperactivity

Question 17

Alpha-Adrenergic Agents for ADHD

Answer 17

Lowers BP and decreases peripheral sympathetic responses
For ADHD, ODD/CD
CATAPRES
GUANFACINE

Question 18

First Generation Antipsychotics

Answer 18

MECHANISM: D2 receptor blockers in limbic system and Striatum (basal ganglia)
- Causes extrapyramidal signs in 15-30% of patients
- EPS: parkinsonisms, tardive dyskinesia, dystonia

Question 19

Thioridazine (Mellaril)

Answer 19

First Gen antipsychotic
INDICATIONS: psychosis, agitated depression, anx
SIDES: akathisia, tardive dyskinesia, drowsiness, agranulocytosis

Question 20

Molindon (Moban)

Answer 20

First gen antipsychotic
INDICATIONS: psychosis
SIDES: weight loss

Question 21

Haloperidol (Haldol)

Answer 21

MECHANISM: D2 receptor blocker in limbic, mesocortex, and nigrastriatal (substantia nigra and part of basal ganglia)
INDICATIONS: reducing positive signs, behavioral disorders, acute delerium
SIDES: tardive dyskinesia, constipation, sedation

Question 22

Second Generation Antipsychotics

Answer 22

MECHANISM: less impact on D2, more on 5HT. 5HT receptor antagonist, NE, and glutamate. More selective in brain areas impacts (limbic system and frontal cortex)

Question 23

Clozapine

Answer 23

MECHANISM: strong impact on 5HT, D1 receptor > D2 receptor
INDICATIONS: negative symptoms, reducing tardive dyskinesia, reducing ETOH use
SIDES: agranulocytosis, sedation, weight gain

Question 24

Olanzapine (Zyprexa)

Answer 24

INDICATIONS: positive signs
SIGNS: weight gain, Type II diabetes

Question 25

Risperidone (Risperdal)

Answer 25

MECHANISM: 5HT antagonist, impacts DA and NE. strong blocker of 5HT receptors
INDICATIONS: younger patients and those who are drug naive
SIDES: orthostatic hypotension, sedation

Question 26

Third Generation Antipsychotics

Answer 26

Abilify:
- MECHANISM: impacts D2, D4, 5HT
- INDICATIONS: antipsychotic, bipolar, depression
- SIDES: headache, agitation, anx

Question 27

Acetylcholinesterase Inhibitors (AChE)

Answer 27

ACh involved in learning and memory
COGNEX: first AChE approved, used for mild to mod stages, not used due to renal side effects

ARICEPT: most common, used for all stages of AD, side effects include headache nausea and diarrhea

EXELON: for mild to mod stages, sides include, nausea vomiting and itchy patch

Question 28

NMDA Receptor Antagonists

Answer 28

Glutamate is NT involved in memory. Excessive glutamate leads to excitotoxicity

NAMENDA: NMDA receptor antagonist, used in mod to severe AD, sides include: constipation, fatigue, irritability

Question 29

Nemzaric

Answer 29

Combination of Aricept and Namenda

Question 30

Amyloid Drugs

Answer 30

ADUHELM:
- unclear if works
- Increased brain swelling
- Expensive
- Not medicare approved

Question 31

Alternative AD Approaches

Answer 31

Gingko Biloba:
- plant extract with antioxidant and anti-inflammatory properties
- neutralizes free radicals
- SIDES: increased risk of stroke

Omega-3 Fatty Acids:
- anti-inflammatory effects, protects nerve membranes
- improves attention and processing speed NOT memory

Question 32

Benzodiazepines

Answer 32

INDICATIONS: anxiolytic, sedative, amnestic
- acute anx, mania, agitation
MECHANISM: GABA receptors
SIDES: somnolence, anterograde amnesia, slurred speech
NAMES:
- Long half life: Valium, Klonopin
- Short half life: Xanax, Ativan

Question 33

Lithium

Answer 33

Mood stabilizer
MECHANISM: unclear, salt form
INDICATIONS: bipolar
CONTRA: pregnant
SIDES: thirst, drowsiness, weight gain

Question 34

Anti-Epileptics

Answer 34

Seizure disorder medication also used for bipolar disorder
MECHANISM: impacts GABA
NAMES: neurotin (Gabapentin), Topomax, and Lamictal

Question 35

Other forms of Mood Stabilizers

Answer 35

Antipsychotics (Abilify, Risperdal)