Psych Meds and Treatments

Question 1

SSRIs

Answer 1

citalopram
fluoxetine (5 weeks to wash out)
paroxetine
sertraline

MOA: block presynaptic reuptake of serotonin
takes 3-4 weeks to start working

S/E:
sexual dysfunction - decreased libido, ED
Insomnia/agitation
wt gain
risk of SI
risk of serotonin sn

Question 2

SNRIs

Answer 2

desvanlafaxine
duloxetine - neuropathic pain from DM, fibromyalgia
milnacipran - fibromyalgia only
venlafaxine

MOA: block presynaptic reuptake of serotonin and NE

S/E:
sexual dysfunction
insomnia/agitation
N
dizziness
HTN - venlafaxine
Risk of serotonin syndrome

Question 3

NDRI

Answer 3

bupropion

MOA: blocks presynaptic reuptake of NE and DA

smoking cessation

S/E:
insomnia
wt loss
no sexual dysfunction
lowers seizure threshold - contraindicated in seizure disorder, eating disorders

Question 4

alpha2-adrenergic antagonist

Answer 4

mirtazapine

MOA: blocks alpha2-adrenergic receptors (presynaptic) -> NE release

S/E:
sedation
appetite stimulation
wt gain

Question 5

Serotonin modulators

Answer 5

nefazodone
trazodone - sleep aid
vilazodone

MOA: active at serotonin receptors

S/E:
sedation
priapism

Question 6

TCAs

Answer 6

amitriptyline
clomipramine
imipramine
nortripyline
doxepin

3rd line

MOA: block reuptake of NE and serotonin

S/E:
Anticholinergic effects - dry
sedation
sexual dysfunction
wt gain
dangerous in OD - narrow TI - lethal at 5x dose

Question 7

MAOIs

Answer 7

tranylcypromine
phenelzine

MOA: inhibit MAO -> increased DA, NE, serotonin levels

S/E:
drug-drug interactions
Hypertensive crisis - eat tyramine foods

Question 8

Buspirone

Answer 8

2nd line treatment for anxiety disorders
May be used as monotherapy or in combination with SSRIs and SNRIs

Affinity for high-serotonin, low-dopamine receptors

Question 9

Benzodiazepines in anxiety

Answer 9

alprazolam
lorazepam

increase the frequency of opening GABA receptor chloride channels

Frequent use may lead to tolerance, dependence, withdrawal seizures

Question 10

Low potency typical antipsychotics (Traditional neuroleptics)

Answer 10

Chlorpromazine
Thioridzine

MOA: block dopamine receptors

Anticholinergic S/E - delirium, drying of secretions, constipation, urinary retention, mydriasis

Sedation
Orthostatic hypotension

Question 11

High potency typical antipsychotics (Traditional neuroleptics)

Answer 11

Haloperidol
Fluphenazine
Loxapine
Thiothixene
Trifluoperazine

MOA: block D1 and D2

Extrapyramidal SE

• Acute dystonia - sustained muscle contraction
• Parkinsonian sxs - bradykinesia, akinesia
• Akathesia - restlessness, compuslion to move

Tardive dyskinesia - choreoathetosis of tongue, face, neck, trunk, or limbs - lip smacking - irreversible

Neuroleptic malignant Sn
Fewer ACh SE - better in elderly

Question 12

Atypical antipsychotics

Answer 12

Aripiprazole
Clozaine - risk agranulocytosis, 3rd line refractory
Olanzapine - worse wt gain, DM
Quetiapine
Risperidone

MOA: block D2 and 5HT2 receptors

S/E:
Wt gain - blocking histamine receptors
Diabetes - DKA risk, HLD

Question 13

Treatment for S/E of acute dystonia (torticollis)

Answer 13

Anti-cholinergics - Benztropin or diphenhydramine

Question 14

Treatment for S/E of parkinsonian sxs

Answer 14

Anticholinergic - benztropine
Amantadine - facilitates release of dopamine
Reduce or discontinue neuroleptic, switch to atypical antipsychotic

Question 15

Treatment for S/E tardive dyskinesia

Answer 15

stop neuroleptic, switch to atypical antipsychotic