Psych drugs 2

Question 1

Bupropion

Answer 1

Sketchy - pro ball player Inhibition of NET and DAT (increases NE and DA - no effects on 5HT) Uses: Depression, smoking cessation Benefits: Less weight gain, no sexual side effects Side effects: Stimulant effects, seizures (especially in eating disorders)

Question 2

Valproic acid

Answer 2

Broad-spectrum anti-epileptic MOA: -Increases Na+ inactivation, thus inhibiting neuronal firing -Increases GABA Uses: Simple focal, complex focal, tonic-clonic, absence Adverse effects: GI distress, weight gain, tremor, rare but fatal hepatotoxicity, pancreatitic, teratogenic

Question 3

Ethosuximide

Answer 3

Anti-epileptic MOA: Blocks T-type Ca2+ channels Uses: Absence seizure Adverse effects: GI distress, lethargy, fatigue

Question 4

Venlafaxine

Answer 4

Sketchy - Fax machine SNRI Uses: Depression, GAD, Panic disorder, PTSD, Diabetic nephropathy, chronic pain, fibromyalgia Side effects: HTN (due to increased NE), Sexual dysfunction, Serotonin syndrome, weight gain, SIADH

Question 5

Presentation of SSRI/SNRI withdrawal

Answer 5

Discontinuation syndrome - flu-like symptoms

Question 6

What are the drugs used in acute treatment and prophylaxis of status epilepticus

Answer 6

Acute treatment - benzos Prophylaxis - phenytoin

Question 7

Carbamazepine

Answer 7

Narrow spectrum anti-epileptic MOA: blocks Na+ channels Uses: simple focal, complex focal, tonic-clonic Trigeminal neuralgia Adverse effects: Diplopia, ataxia, SIADH, agranulocytosis, DRESS syndrome, teratogen, SJS, drug induced lupus, CYP450 inducer

Question 8

Tranylcypromine

Answer 8

Sketchy - Try a sip of wine MAO-A inhibitor: Increases levels of NE, 5HT, and DA Uses: atypical depression, anxiety

Question 9

Vigabatrin

Answer 9

Sketchy - V cab Narrow spectrum anti-epileptic MOA: Inhibits GABA-transaminase (enzyme responsible for GABA degradation), thus increased GABA Uses: Simple focal, complex focal

Question 10

What is the MOA of local anesthetics (e.g. lidocaine, procaine)

Answer 10

Blocking of Na+ channels, in order to prevent neuronal depolarization

Question 11

Lithium

Answer 11

MOA: inhibits signal transduction pathways, such as IP3 Used to treat Bipolar disorder

Question 12

Lamotrigine

Answer 12

Sketchy - llama Broad spectrum anti-epileptic Binds voltage gated Na+ channels, causing inactivation and decreased firing of neurons Adverse effects: skin rash (SJS) and diplopia

Question 13

Fluoxetine

Answer 13

Sketchy - Fly out SSRI Uses: Depression, GAD, Panic disorder, PTSD, OCD, bulimia, social anxiety disorder Side effects: Sexual dysfunction, Serotonin syndrome, weight gain, SIADH

Question 14

Phenytoin

Answer 14

Narrow spectrum anti-epileptic MOA: blocks Na+ channels Uses: Simple focal, complex focal, tonic clonic, status epilepticus Adverse effects: Ataxia, diplopia, decreased folate, gingival hyperplasia, hirsituism, drug induced lupus, DRESS, SJS, teratogenic, CYP450 inducer, altered bone and mineral metabolism

Question 15

Valproate

Answer 15

Sketchy - festiVAL Broad spectrum anti-epileptic Binds voltage gated Na+ channels, causing inactivation and decreased firing of neurons Also increases GABA levels in the CNS

Question 16

Phenelzine

Answer 16

Sketchy - Funnel in wine bottle MAO-A inhibitor: Increases levels of NE, 5HT, and DA Uses: atypical depression, anxiety

Question 17

Lamotrigine

Answer 17

Broad-spectrum anti-epileptic MOA: Increases Na+ inactivation Uses: Simple focal, complex focal, tonic-clonic Adverse effects: SJS, diplopia

Question 18

Imipramine

Answer 18

Sketchy - imprint TCA - inhibits reuptake of NE and 5HT Uses: Depression, OCD, peripheral neuropathy, chronic pain, migraine prophylaxis Side effects: anti-a1 (hypotension), anti-cholinergic (dry mouth, blurred vision, urinary retention), anti-histamine (sedation, increased appetite, weight gain), seizures (anti-GABA) *Cardiotoxicity - due to TCA’s blocking the cardiac fast Na+ channels - leading to prolonged QRS and cardiac arrhythmias THINK: 3 C’s - Cardiac, coma, (anti-histamine), convulsions (anti-GABA)

Question 19

Levetiracetam

Answer 19

Broad-spectrum anti-epileptic MOA: Unknown Uses: Simple focal, complex focal, tonic-clonic

Question 20

Selegiline

Answer 20

Sketchy - Sledge hammer MAO-B inhibitor: Increases levels of DA Uses: atypical depression, Parkinsons

Question 21

What is the teratogenic effect of Lithium

Answer 21

Ebstein anomaly (tricuspid displaced into R ventricle leading to “atrialized” ventricle

Question 22

Buspirone

Answer 22

No sketchy Stimulates 5HT-1A receptors Used for treatment of generalized anxiety disorder

Question 23

Topiramate

Answer 23

Broad-spectrum anti-epileptic MOA: -Increases Na+ inactivation, thus inhibiting neuronal firing -Increases GABA via direct binding Uses: Simple focal, complex focal, tonic clonic Adverse effects: Mental dulling, weight loss, kidney stones, glaucoma

Question 24

Tiagabine

Answer 24

Sketchy - tied up cab driver MOA: Inhibits GABA reuptake Uses: Simple focal, complex focal

Question 25

Citalopram

Answer 25

Sketchy - The City SSRI Uses: Depression, GAD, Panic disorder, PTSD, OCD, bulimia, social anxiety disorder Side effects: Sexual dysfunction, Serotonin syndrome, weight gain, SIADH

Question 26

Isocarboxazid

Answer 26

Sketchy - Boxed wine MAO-A inhibitor: Increases levels of NE, 5HT, and DA Uses: atypical depression, anxiety

Question 27

Cyproheptadine

Answer 27

Sketchy - "silly pranks prohibited" 5-HT2 antagonist Used to treat serotonin syndrome

Question 28

What is the order of nerve blockade and order of loss with local anesthetics

Answer 28

Small myelinated \> small unmyelinated \> large myelinated \> large unmyelinated Pain \> temp \> touch \> motor

Question 29

Mirtazapine

Answer 29

a2-blocker (increases release of 5HT and NE) Blocks 5HT2 and 5HT3 receptors Inhibits H1 receptors (sedation) Uses: major depression with insomnia Adverse effects: weight gain Benefits: no sexual dysfunction

Question 30

Paroxetine

Answer 30

Sketchy - Parrot air SSRI Uses: Depression, GAD, Panic disorder, PTSD, OCD, bulimia, social anxiety disorder Side effects: Sexual dysfunction, Serotonin syndrome, weight gain, SIADH

Question 31

Treatment of cardiac toxicity with TCAs

Answer 31

Sodium bicarbonate (will bind to weakly acidic TCA in the renal tubule, leading to excretion)

Question 32

Drugs options for treatment of Bipolar disorder

Answer 32

Lithium, Anti-epileptics (Valproate, Carbamazepine, Lamotrigine), Atypical (SGA) antipsychotics

Question 33

Gabapentin

Answer 33

Sketchy: Grab a pint Narrow spectrum anti-epileptic MOA: inhibits voltage-gated Ca2+ channels Uses: Simple focal, complex focal Peripheral neuropathy Postherpatic neuralgia Adverse effects: Ataxia

Question 34

Levetiracetam

Answer 34

Sketchy - elevator Broad spectrum anti-epileptic

Question 35

Topiramate

Answer 35

Sketchy - toupe Broad spectrum anti-epileptic Binds voltage gated Na+ channels, causing inactivation and decreased firing of neurons Also directly binds GABA-A receptor and increases GABA levels in the CNS

Question 36

Presentation of serotonin syndrome

Answer 36

Hyperthermia, HTN, Hyperreflexia and clonus (vs. NMS which has rigidity and hyporeflexia)

Question 37

Phentolamine

Answer 37

a1 and a2 antagonist Used to treat HTN symptoms of tyrosine toxicity

Question 38

Sertraline

Answer 38

Sketchy - DeSERT air SSRI Uses: Depression, GAD, Panic disorder, PTSD, OCD, bulimia, social anxiety disorder Side effects: Sexual dysfunction, Serotonin syndrome, weight gain, SIADH

Question 39

Side effects of Lithium

Answer 39

Tremor (earliest and most common), nephrogenic DI, hypothyroidism, teratogenic

Question 40

What can be co-administered with local anesthetics in order to increase action

Answer 40

Vasoconstrictors - decrease rate at which blood flow carries the lidocaine away

Question 41

Trazodone

Answer 41

Serotonin modulator (antagonizes 5HT2 receptors and inhibits 5HT reuptake) a1-antagonist activity - hypotension H1-antagonist activity - sedation Uses: insomnia and major depression Adverse effects: Priaprism, hypotension, serotonin syndrome, sexual dysfunction

Question 42

Duloxetine

Answer 42

Sketchy - Dual copier/scanner SNRI Uses: Depression, GAD, Panic disorder, PTSD, Diabetic nephropathy, chronic pain, fibromyalgia Side effects: HTN (due to increased NE), Sexual dysfunction, Serotonin syndrome, weight gain, SIADH