Psych

Question 1

Stimulants

Drug names

Answer 1

Methylphenidate
Dextroamphetamine
Methamphetamine

Question 2

Stimulants

MOA

Answer 2

Inc. catecholamines in synaptic cleft (NE, Dopa).

Also blocks NE/Dopa reuptake.

Question 3

Stimulants

Clinical use

Answer 3

ADHD, narcolepsy, appetite control

Question 4

Typical antipsychotics (neuroleptics)
Drug names
(Try to Fly High)
(Cheating Thieves are low)

Answer 4

> High potency: Trifluoperazine, Fluphenazine, Haloperidol
Low potency: Chlorpromazine, Thioridazine
(Haloperidol + -azines)

Question 5

Typical antipsychotics

MOA

Answer 5

Block D2 receptors in nigrostriatal pathway – inc. cAMP.
(Normally inhibited D2 effects are balanced by excitatory M1 effects – blocked D2 means inc. M1 cholinergic activity).
Highly lipid soluble – stored in fat – slow to be removed.

Question 6

Typical antipsychotics

Clinical use

Answer 6

Schizophrenia
Psychosis, Acute mania
Tourette syndrome

Question 7

Typical antipsychotics

Toxicity (High potency)

Answer 7

Neuro SE (Huntington dse, delirium, EPS sx).
EPS sx evolution:
- 4 hr: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
- 4 day: akathisia (restlessness)
- 4 wk: bradykinesia (parkinsonism)
- 4 mo: tardive dyskinesia

Question 8

Typical antipsychotics

Toxicity (Low potency)

Answer 8

Anticholinergic, antihistamine, a1-blockade effects.

Dry mouth, constipation; sedation; hypotension, possible QT prolonged.

Question 9

Neuroleptic malignant syndrome

Answer 9

Disordered thermoregulation and skeletal muscle metabolism (rigidity, myoglobinuria, autonomic instability, hyperpyrexia).
*Mnem. FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes inc., Rigidity
>Tx: Dantrolene, D2 agonist (bromocriptine).

Question 10

Tardive dyskinesia

Answer 10

Stereotypic oral-facial movements due to chronic antipsychotic use.
Lipsmacking, choreoathetoid movements.
Can persist ff. meds discontinuation.

Question 11

Atypical antipsychotics

Drug names

Answer 11

Olanzapine, Clozapine, Quetiapine

Risperidone, Aripiprazole, Ziprasidone

Question 12

Atypical antipsychotics

MOA

Answer 12

Varied effects on 5HT2-receptors, D-receptors, a-receptors, H1-receptors.

Question 13

Atypical antipsychotics

Clinical use

Answer 13

Schizophrenia.
Bipolar d/o (mood-stabilizing).
OCD, anxiety, depression, mania, Tourette syndrome.
Tx-resistant schizophrenia (clozapine).

Question 14

Atypical antipsychotics

Toxicity

Answer 14

Fewer EPS and anticholinergic effects vs. typical antipsychotics.
All may prolong QT interval.
>Clozapine: agranulocytosis, wt. gain, seizures, sialorrhea.
>Olanzapine: wt. gain.
>Risperidone: inc. prolactin (lactation, gynecomastia).

Question 15

Lithium

MOA, clinical use

Answer 15

May be related to inhibition of phosphoinositol pathway.
Mood stabilizer for bipolar – blocks relapse and acute manic events.
SIADH.

Question 16

Lithium

Toxicity

Answer 16

Movement (tremor).
Nephrogenic DI (polyuria), Hypothyroidism -- close monitoring of TFT, creatinine.
Pregnancy problems (ebstein anomaly).
CI w/ ACEi -- deplete Na, dec. GFR.
*Tx for lithium toxicity: Thiazide

Question 17

Buspirone

MOA, clinical use

Answer 17

Anxiolytic (non-BZ) – not muscle relaxant or anticonvulsant.
Stimulates 5HT1A-receptors.
For generalized anxiety d/o.
*Takes 1-2 wks for effect

Question 18

SSRIs

Drug names

Answer 18

Fluoxetine, Paroxetine, Sertraline

Citalopram

Question 19

SSRIs

MOA

Answer 19

5HT-specific reuptake inhibitors. Antidepressant.

*Takes 4-8 wks for effect – take BZ during initiation period.

Question 20

SSRIs

Clinical use

Answer 20

Depression, Generalized anxiety d/o, panic d/o, OCD, bulimia, social phobias, PTSD

Question 21

SSRIs

Toxicity

Answer 21

Sexual dysfunction, GI distress, SIADH

Serotonin syndrome

Question 22

Serotonin syndrome

Answer 22

Caused by any drug that inc. 5HT (MAOi, SNRI, TCA) – uncommon in pts taking a single serotonergic drug.
Hyperthermia, confusion, myoclonus, CVS instability, flushing, diarrhea, seizures.
Tx: cyproheptadine (5HT2-receptor antagonist).

Question 23

SNRIs

Drug names

Answer 23

Venlafaxine, Duloxetine

Question 24

SNRIs

MOA, clinical use

Answer 24

Inhibit 5HT, NE reuptake, antidepressants.
For depression.
>Venlafaxine: GAD, panic d/o, PTSD.
>Duloxetine: diabetic peripheral neuropathy.

Question 25

Tricyclic antidepressants

Drug names

Answer 25

Amitriptyline, Nortriptyline
Imipramine, Desipramine, Clomipramine, Amoxapine
Doxepin

Question 26

Tricyclic antidepressants

MOA

Answer 26

Block NE, 5HT reuptake

Question 27

Tricyclic antidepressants

Clinical use

Answer 27

Major depression.
Peripheral neuropathy, chronic pain.
Migraine prophylaxis.
OCD (clomipramine).

Question 28

Tricyclic antidepressants

Toxicity

Answer 28

Tri-C’s: Convulsions, Coma, Cardiotoxicty (Tx w/ NaHCO3 to prevent arrhythmia).
Respi depression, hyperpyrexia
Sedation, anticholinergic effects, sexual dysfunction.

Question 29

MAO inhibitors

Drug names

Answer 29

Tranylcypromine, Phenelzine, Isocarboxacid

Selegiline (selective MAO-B inhibitor)

Question 30

MAO inhibitors

MOA

Answer 30

Antidepressant.
Irreversible binding of MAO, w/c normally breaks down amine neurotransmitters.
Inc. NE, 5HT, Dopa.

Question 31

MAO inhibitors

Clinical use

Answer 31

Atypical depression

Anxiety

Question 32

MAO inhibitors

Toxicity

Answer 32

HTN crisis (esp. w/ ingestion of Tyramine, like in wine and cheese).
CI w/ SSRI, TCA, St. John's wort, dextromethorphan, meperidine -- prevent Serotonin syndrome.

Question 33

Bupropion

Clinical use

Answer 33

NE/Dopa reuptake inhibitor.
1st line for antidepressant w/o causing sexual dysfunction.
Also for smoking cessation.
May worsen GAD due to stimulating effects.

Question 34

Mirtazapine

Clinical use

Answer 34

Atypical antidepressant.
a2-antagonist (inc. NE, 5HT release).
Potent 5HT2, 5HT3 receptor antagonist.

Question 35

Trazodone

Clinical use, toxicity

Answer 35

Atypical antidepressant.
Blocks 5HT2 and a1-adrenergic receptors.
For insomnia.
High doses needed for antidepressant effects.
Toxicity: priapism, sedation, nausea.