Psych Drugs

Question 1

Methylphenidate, dextroamphetamine, methamphetamine, phentermine

Answer 1

CNS stimulants that increase catecholamines in the synaptic cleft, esp norepi and dopamine

• use: ADHD, narcolepsy, appetite control
• use for > 3 months associated with secondary pulmonary HTN

Question 2

high potency typical antipsychotics

Answer 2

trifluoperazine, fluphenazine and haloperidol
(Try to Fly High)
- more EPS symptoms (treat with beztropine)

Question 3

lower potency typical antipsychotics

Answer 3

chlorpromazine, thioridazine
(Cheating Thieves are LOW)
- more anticholinergic, antihistaminergic and anti-alpha adrenergic symptoms
- dry mouth, hypotension and sedation

Question 4

mechanism and use of typical antipsychotics

Answer 4

• block D2 receptors

- used in schizophrenia, psychosis, acute mania, Tourettes

Question 5

NMS

Answer 5

• rigidity, myoglobinuria, autonomic instability, hyperpyrexia
• treat with dantrolene and D2 agonists (bromocriptine)

Question 6

tardive dyskinesia

Answer 6

• sterotypic oral-facial movements as a result of long-term antipsychotic use, potentially irreversible

Question 7

atypical antipsychotic mech and use

Answer 7

• varied effects on 5HT, dopamine, alpha and H1 receptors

- used in schizophrenia, bipolar disorder, OCD, anxiety disorder, depression, mania and tourettes

Question 8

atypical antipsychotic tox

Answer 8

• olanzapine/clozapine cause weight gain
• clozapine can cause agranulocytosis and seizure
• risoperidone increases prolactin
• ziprasidone prolongs the QT interval

Question 9

lithium

Answer 9

• mechanism not established, possibly related to inhibition of phosphoinositol cascade
• used as mood stabilizer, also SIADH
• tox: tremor, sedation, edema, heart block, hypothyroidism, polyuria, teratogenesis
• narrow therapeutic window (watch out for thiazide diuretics, ACEi, NSAIDs)

Question 10

buspirone

Answer 10

• 5HT1a receptor stimulator
• used in GAD
• does not cause sedation, addiction or tolerance and does not interact with alcohol
• takes 1-2 weeks to take effect

Question 11

SSRI use and tox

Answer 11

• used in depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD
• tox: GI distress, sex dysfunction
• serotonin syndrome –> hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures (treat with cyproheptadine)

Question 12

SNRI names, use and tox

Answer 12

• venlafaxine, duloxetine
• used in depression, venlafaxine is also used in GAD and panic d/o, duloxetine is also indicated for diabetic peripheral neuropathy
• tox: inc in BP most common, also stimulant effects, sedation, nausea

Question 13

TCA mech, clinical use and tox

Answer 13

• block reuptake of NE and 5HT
• use: major depression, OCD, fibromyalgia
• tox: sedation, alpha blocking effects –> hypotension, tachy, urinary retention, dry mouth
• 3 C’s: convulsions, cardiotoxicity and coma
• treat with sodium bicarb in OD

Question 14

MAOis

Answer 14

• used in atypical depression, anxiety and hypochondriasis

- tox: hypertensive crisis after eating tyramine, CNS stimulation

Question 15

buproprion

Answer 15

• atypical antidepressant also used for smoking cessation
• increased NE and dopamine via unknown mech (structurally related to amphetamines)
• tox: stimulant effects, headache, seizures in bulimic pts
• no sexual side effects

Question 16

mirtazapine

Answer 16

• alpha 2 antagonist and potent 5HT2/3 receptor antagonist

- tox: sedation, increased appetite, weight gain, dry mouth

Question 17

trazodone

Answer 17

• primarily blocks 5HT2 and alpha-1 adrenergic receptors
• primarily used for insomnia, as high doses are needed for antidepressant effects
• tox: sedation, nausea, priapism, postural hypotension