Psych meds

Question 1

bipolar Tx

Answer 1

Lithium salts (carbonate and citrate)
antidepressants (Fluoxetine with olanzapine)
antipsychotics (risperidone, olanzapine, quetiapine)
anticonvulsants (valproic acid, carbamazepine, lamotrigine)

Question 2

Amitripyline, nortriptyline, imipramine, amoxapine

Answer 2

TCAs
Tx major depression
Block NE 5HT reuptake transporters
absorbed in small intestine
long 1/2 life
high plasma binding
hepatic microsomal system-> kidneys
Low therapeutic window

Question 3

TCAs AE

Answer 3

antimuscarinic: blurred vision, dry mouth, urine retention, constipation, glaucoma, epilepsy
cardiovascular: tachycardia, delayed AV conduction
anti apha1 receptor: orthostatic BP (elderly)
anti H1: sedation
psychiatric: delerium (elderly), agitated psychosis and mania
other: weight gain, sex dysfunction,

Question 4

fluoxetine, citalopram, escitalopram, sertraline

Answer 4

SSRI antidepressant, most widely used
also tx: OCD, PTSD, eating disorders, anxiety
Blocks 5-HT reuptake uptake transporters
absorbed in small intestine
Long 1/2 life (1-3 days, 30 days for demethylated fluoxetine)
high plasma binding
CYP 2D6, CYP1A2, CYP3A4
-interact with TCAs, some anti arrhythmic and beta blockers
AE:
early: Nausea, Anxiety, decreased sleep
Late: Anorexia, sex dysfunction, increased mania with bipolar

Question 5

Velafaxine

Answer 5

SNRI, antidepressant (refractory to SSRIs)
more selective than TCAs (less AEs)
Low plasma binding
CYP2D6
1/2 life 12 hours
AE: Nausea, anxiety, decreased sleep, sex dysfunction,
^BP and HR at high doses

Question 6

Duloxetine

Answer 6

SNRI, antidepressant (refractory to SSRIs)
more selective than TCAs (less AEs)
High plasma binding
CYP2D6 and CYP1A2
1/2 life 12 hours
contraindicated in hepatic insufficiency
AE: Nausea, anxiety, decreased sleep, sex dysfunction,
^BP and HR at high doses

Question 7

buproprion

Answer 7

atypical antidepressant
tx rapid cycling bipolar
inhibits DA reuptake
AE: HA, Nausea, Tinnitus, insomnia, nervousness

Question 8

Nefazodone

Answer 8

atypical antidepressant
tx depression and neuroleptic/antipsychotic
inhibits reuptake of serotonin and blocks 5HT2 receptor
AE: HA, Nausea, Tinnitus, insomnia, nervousness

Question 9

mirtazapine

Answer 9

atypical antidepressant
increases NE and 5HT release by blocking alpha 2 receptor
AE: HA, Nausea, Tinnitus, insomnia, nervousness

Question 10

phenelzine, tranylcypromine, selegiline

Answer 10

MAOi, 3rd line antidepressants
^NE and 5HT presynaptic
removed by kidneys
Irreversibly binds and requires resynthesis (may take several weeks)
AE (unpredictable)
-serotonin syndrome: coma ^BP&HR, ^reflexes, tremor
-psychiatric: restless, agitation, psychosis
-cardiovascular: orthostatic hypotension, tachycardia
tyramine diet restriction: stroke and other

Question 11

Lithium salts

Answer 11

Drug of choice for BP prophylaxis
effective in 70%
sometimes combined with other meds
Mechanisms
-blocks hydrolysis of inositol phosphate (cell signalling)
-blocks GSK-3beta kinase
-^GLU reuptake
-inhibits 5HT1A and 5HT1B receptors
peak plasma levels 2-4 hours
Kidney elmination

Question 12

Lithium AE

Answer 12

Narrow therapeutic window
CNS- tremor, confusion, convulsion, coma
Arrhythmia 
decreased thyroid
Diabetes insipidis
teratogen
interactions with thiazide and NSAIDs

Question 13

Depression tx

Answer 13

TCAs: amitripyline, nortriptyline, imipramine, amoxapine
SSRI: Fluoxetine, citalopram, escitalopram, sertraline
SNRI: Venlafaxine, duloxetine
atypicals: Brupropion, Nefazodone, mirtazapine
MAOi: Phenelzine, tranylcypromine, selegiline

Question 14

Dextroamphetamine, methylphenidate, amphetamine

Answer 14

psychomotive stimulant
Tx narcolepsy and ADHD
frequently abused
Mechanism
-Increase DA and NE release via vesicular and non-vesicular
AE
-euphoria, anxiety, vertigo, insomnia, confusion
-paranoia, psychosis, suicide/homocide impulses
-arrhythmias, HTN, nausea, diarrhea

Question 15

Atomoxetine

Answer 15

non psychomotor stimulant
NE reuptake inhibitor
tx ADHD
non habit forming

Question 16

Narcolepsy tx

Answer 16

amphetamine
dextroamphetamine
methylphenidate
modafinil

Question 17

modofinil

Answer 17

tx narcolepsy, shift work disorder
mech probably NE and DA
fewer psychoactive and euphoric effects

Question 18

chlorpromazine

Answer 18

1st generation antipsychotic (first); Aliphatic
low potency
blocks d2 and d1
low potency

Question 19

clozapine

Answer 19

2nd gen/ atypical antipsychotic
tx suicidal behavior in schizophrenia
most effective
AE
-agranulocytosis
-siezures at high dose
-constipation, paralytic ileus
-sialorrhea
-myocarditis
-orthostatic hypotension and tachycardia

Question 20

olanzapine

Answer 20

2nd gen antipsychotic
longest time to discontinuation
significant weight gain

Question 21

1st gen antipsychotic

Answer 21

chlorpromazine
haloperidol
fluphenazine
perhenazine
thioridaine
trifluoperazine

Question 22

2nd gen antipsychotic

Answer 22

clozapine
olanzapine
quetiapine
risperidone
paliperidone
ziprasidone
aripiprazole
lurasidone
asenapine

Question 23

antipsychotic potency

Answer 23

Low: Chlorpromazine
Medium: perphenazine, loxapine
High: Haloperidol, fluphenazine

Question 24

dopamine blockade effects

Answer 24

Niagrostriatal 
-parkinsonism
-dystonia
-akathisia
-tardive dyskinesia
mesocortical pathway
-worsen cognitive 
-worsen negative symptoms
tuberoinfundibular-risperidone
-hyper prolactemia
-galactorrhea
-amenorrhea
-gynecomastia

Question 25

non dopamine AE of antipsychotics

Answer 25

anticholinergic
-dry mouth, urine retention, constipation, blurry vision
antihistamine
-sedation
-wt gain -> clozapine, olanzapine, other 2nd gen
Alpha-1 blockade
-dizziness, sedation, hypotension, sex dysfunction
Prolonged QTc-> IV haloperidol, ziprasidone
metabolic syndrome-> 2nd gens
Neuroleptic malignant syndrome
-muscle rigidity (^CK), fever, autonomic instability, confusion