Psych - FA Pharm p560 -564

Question 1

treatment of PCP intox

Answer 1

BDZ, rapid acting antipyschotic

Question 2

what enzyme does disulfiram inhibit

Answer 2

blocks acetaldehyde dehydrogenase

Question 3

whats acamprostate, used in?

Answer 3

Alcoholism MOA: modulate glutamate in NMDAR

Question 4

what inhibit alcohol dehydrogenase

Answer 4

Fomepizole

Question 5

Rx for ADHD

Answer 5

methylphenidate

Question 6

bipolar Tx

Answer 6

lithium, valproic acid, carbamazepine, lamotrigine, atypical antipyschotics

Question 7

Tourette Syndrome Tx

Answer 7

fluphenazine, pimozide, - typical antipsychotic

tetrabenazine - VMAT2 (-)’r, normally for Huntington chorea, but used for movement disorders

clonidine - alpha 2 agonist

Question 8

Patient with stage fright what would you give

Answer 8

BB

Question 9

PTSD Tx

Answer 9

SSRI, SNRI (venlafaxine)

Question 10

Venlafaxine also used for

Answer 10

Depression, generalized anxiety disorder, diabetic neuropathy.

Venlafaxine is also indicated for social anxiety disorder, panic disorder, PTSD, OCD

Question 11

OCD Tx

Answer 11

SSRI, Venlafaxine, clomipramine

Question 12

Bonus: elderly with insominia, what would you give?

Answer 12

Ramelteon (melatonin R agonist)

Question 13

describe the evolution of EPS side effects

Answer 13

1. 4hr: dystonia (muslce spasm, stiffness, oculogyric crisis) 2. 4 day: akathisia (restlessness) 3. 4 wk: bradykinesia (parkinsonism) 4. 4 mo: tardive dyskinesia

Question 14

name the 3 high potency antipyschotic drugs

Answer 14

Trifluoperazine Fluphenazine Haloperidol

Tri to Fly High

Question 15

what is alpha 2 antagonist that release norepinephrine and 5HT?

Answer 15

Mirtazapine

Question 16

mirtazapine actions on various receptors

Answer 16

α2-antagonist (Inc release of NE and 5-HT), potent 5-HT2 and 5-HT3 receptor antagonist, and H1 antagonist

Question 17

3 clinical app for mirtazapine

Answer 17

depressed pts with insomnia with low appetite

Question 18

what are the 2 targets for trazadone?

Answer 18

Primarily blocks 5-HT2, α1-adrenergic, and H1 receptors

Question 19

trazadone is mainly used for what?

Answer 19

Insomnia with depression

Question 20

what is a 5HT2 receptor antagonist that is used for serotonin syndrome?

Answer 20

cyproheptadine

Question 21

3 toxicities of SSRI

Answer 21

1. GI distress 2. Serotonin syndrome 3. sexual dysfunction 4. SIADH

Question 22

7 clinical applications for SSRI?

Answer 22

depression generalized anxiety disorder panic disorder OCD bulimia social phobias PTSD

Question 23

3 types of drug that can cause serotonin syndrome with SSRI

Answer 23

MAO inhibitors SNRI TCA

Psychiatric drugs: MAO inhibitors, SSRIs, SNRIs,
TCAs, vilazodone, vortioxetine

Nonpsychiatric drugs:
tramadol, ondansetron,
triptans, linezolid, MDMA,
dextromethorphan,
meperidine, St. John’s wort

Question 24

symptoms of serotonin syndrome

Answer 24

• HARMED
• Hyperthermia
• Autonomic instability
• Rash (flushing)
• Myoclonus
• Encephalopathy
• Diarrhea

Question 25

what is venlafaxine and what is it used for?

Answer 25

SNRI, generalized anxiety, panic disorder, PTSD

Question 26

what is duloxetine/Milnacipram and its unique clinical application?

Answer 26

SNRI, & fibromyalgia

Question 27

name the SSRIs

Answer 27

Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram.

Question 28

name 7 tricyclic antidepressants

Answer 28

• amitriptyline
• nortriptyline
• imipramine
• desipramine
• clomipramine
• doxepin
• amoxapine

Question 29

Which TCA is used for nocturnal enuresis? OCD?

Answer 29

• Imipramine
• Clompramine

Question 30

5 clinical applications for tricyclic antidepressants?

Answer 30

• MDD
• OCD (clomipramine)
• peripheral neuropathy - not DB, use SNRI
• chronic pain
• migraine prophylaxis

Question 31

name 6 atypical antipsychotics

Answer 31

• Aripiprazole,
• asenapine, clozapine, olanzapine, quetiapine,
• iloperidone, paliperidone, risperidone, lurasidone, ziprasidone.

Question 32

Clinical uses for atypical antipsychotics?

Answer 32

MOST BAD condition Mania OCD Schizophrenia (both + and -) Tourette Bipolar Anxiety disorder Depression

Typical antipsych - only treat POS sx of Schizo

Question 33

what 2 atypical antipsychotics can cause weight gain?

Answer 33

Olanzapine, clozapine - for Obesity

Question 34

which atypical antipsychotic can cause inc prolactin and gynecomastia?

Answer 34

risperidone

Question 35

symptoms of NMS caused by typical antipsychotics

Answer 35

FEVER Fever Encephalopathy Vitals unstable Enzymes inc Rigidity of muscles

Question 36

treatment for NMS?

Answer 36

dantrolene (Ca2+ blocker) D2 agonist (bromocriptine)

Question 37

what is targeted by buspirone?

Answer 37

stimulates 5-HT1a receptors

Question 38

unlike barbiturates and benzos, buspirone does not interact with what?

Answer 38

Alcohol

Question 39

MOA of lithium?

Answer 39

dec IP3 formation by (-) inosine 5’ monoPO4 –> stabilizes inactive Gs and Gi proteins ( dec cAMP response, prot kinase fxn)

Question 40

side effects of lithium?

Answer 40

tremor hypothyroidism polyuria (nephrogenic DI) Ebstein anomaly in newborn

Question 41

what is unique about lithium excretion by the kidney? and what other drug toxicity is it associated with?

Answer 41

Lithium is mostly reabsorbed at PCT with Na+

Thiazide, NSAIDs, other rx that affect clearence (ex/ ACEIs) use is implicated in lithium toxicity in bipolar disorder.

Question 42

Clozapine is used for what specific instances related to schizophrenia, and why?

Answer 42

Schizophrenia (or Schizoaffective) w/ resistance to other Rx or w/ suicidial ideation

Affects D2R and 5HT2- multiple dopamine and serotonin R

Question 43

Rx that cause hypothyroidism

Answer 43

Amiodarone, Sulfonamides, Lithium

I AM SUddenly Lethargic

Question 44

Rx that cause agranulocytosis

Answer 44

Dapsone, Clozapine, Carbamazepine,
Propylthiouracil, Methimazole, Colchicine,
Ganciclovir