Psych Pharm 2

Question 1

Methylphenidate, amphetamines

Answer 1

• Cause increase in NE and DA release
• Used to treat ADHD (Targets frontal lobe secretion and function)
• Also can be used to supress apetite for a short time and can be used in narcolepsy

Question 2

Neuroleptics

Answer 2

• D2 blockers. D2 is Gi therefore blocking will increase cAMP and function
• Used for psychosis, acute mania, tourettes
• Significant side effect profile
• High potency: Haloperidol, trifluoropirazine, fluphenalzine
• Low potency: Chlorpromazine, Thioridazine

Question 3

Non Extrapyramidal Side effects

Answer 3

• Have alpha 1, muscarinin, and histamine blocking leading to dry mouth, hypotension, cardiac arrythmias
• Also block D2 receptors in prolactin cells of AP leading to prolactinemia
• Very high volume of distrubution

Question 4

Pyramindal Symptoms

Answer 4

• Blockage of D2 receptor leads to increase in DA receptor number and sesitivity
• at first dose, 4 hours leads to dystonia, torticollis, oculogyric crisis (upward devation of eyes caused by spasmotic contraction), Treat with benztropine (Ach blocker)
• withing a week (4 days) onset of akasthesia or restlessness from increase in receptor sensitivity
• At four weeks there is bradykinesia and pseudoparkinsonism
• At 4 months there can be permanent increase in receptor number and sensitivity leading to tardive dyskinesia (often seen with steretyped lip smacking)

Question 5

Neuroleptic malignant syndrome

Answer 5

Massive rigidity and rhabdomyolyisis leading to myoglobinria. Also hyperthermia and autonomic instability
-Tx: Bromocriptine, a dopamine agonist and dantrolene (block Ca channels)

Question 6

Haloperidol, fluphenaline,trifluoreprazine

Answer 6

-Increased extrapuramidal side effect risk

Question 7

Chlorpromazine, Thioridazine

Answer 7

• Decreased extrapyramidal symptoms, but incresed AchR blocker symtoms
• Chlorpromazine also has corneal deposits
• Thioridzaine has retinal deposits

Question 8

Atypical Antpsychotics

Answer 8

• Mechanism unclear, decreased or absent extrapyramidal symptoms
• Major side effect is weight gain

Question 9

Cloazapine

Answer 9

-Agranulocytosis, need WBC checked frequently

Question 10

Olanzapine

Answer 10

-Wieght gain

Question 11

Ziprisadone, risperadone, apiprazole etc

Answer 11

-Atypical Antipsychotics

Question 12

Lithium

Answer 12

• Decreases G protein signalling??? Leads to mood stabilization
• Give before SSRI in patients with mania or may precipitate suicide
• Purey excreted by kidney, and resorbed with Na
• S/E: Hypothyroidism, Ebsteins anomaly, Nephrogenic DI, tremors, seizures

Question 13

Busprione

Answer 13

• Partial 5HT agonist

- Used to treat generalized anxiety and has a very mild side effect profile with limited drug drug interactions

Question 14

SSRI

Answer 14

• Inhibit Seretonin Reuptake
• First line in a number of diseases
• Depression, PTSD, Anxiety, OCD, Bulemia, Panic
• S/E: Sexual dysfunction (can use buproprion)
• Seretonin syndrome

Question 15

Seretonin Syndrome

Answer 15

• Elevated seretonin, generally seen when there is increased seretonin from a number of drugs on board with an MAOI
• Siezures, Hypertension, flushing, myoclonus, hyperthermia

Question 16

Cyprophetadine

Answer 16

-Seretonin Antagonist, used to treat seretonin syndrome

Question 17

Drugs that are SSRI

Answer 17

-Fluoxetine, paroxetine, sertaline, citalopram

Question 18

SNRI

Answer 18

Venlafaxine, duloxetine

-Most common is increased BP (increase NE)

Question 19

Venlafaxine

Answer 19

• Anxiety

- pani disorders

Question 20

Duloxetine

Answer 20

-Can be used to treat diabetic peripheral neuropathy

Question 21

TCA

Answer 21

• Block the reputake of seretonin and NE, can have seretonin syndrome or hypertensive crisis
• CCC due to blocking of cholinergic effects, and alpha effects. Cardiotox (Torsades), Convulsions, Coma
• Other indications, but most are replaced by SSRI
• Strong anticholinergic effects (urinary retension, dry mouth, confusion and hallucinations (especially in elderly)
• Treat overdose with NaHCO3 to alkalanize the urine and increase clearance
• Can also be incdicated for bedwetting, OCD, and fibromylagia

Question 22

TCA Drugs

Answer 22

• End in ine/line except doxepin

- Amitryptaline, nortryptaline, imipramine, despiramine, clomimpramine, doxepin, amoxapine

Question 23

MAOI

Answer 23

• MAO degrades caetacholamines, increase Caethacholamines
• Used to treat atyical depression, anxiety, hypochondriasis
• Selegeline is specific for MAOB and is used to decrease DA degredation in parkinsons
• phenylzine, tranlycipromine, isocarbazoxide
• Hypertensive Crisis with tyramine (leads to increased release of NE and 5HT from cleft)
• Seretonin syndrome with any drug or herb that will increased sretonin

Question 24

Buprorion

Answer 24

• Mechanism unkown, but increase NE and 5HT
• Used to treat depression and has minimal sexual side effects
• Can also be used in smoking cessation

Question 25

Mirtazapine

Answer 25

• Centrally acting alpha 2 antagonist and also has seretonin antagonism activity
• Causes weight gain and sedation
• Use in anorexic patients and in depressed patients with insomnia

Question 26

Maprotiline

Answer 26

-sepecific for NE reuptake blockage

Question 27

Trazadone

Answer 27

• Main indication is to treat insomnia and pain associated with insomnia
• Blocks seretonin reuptake and also blocks alpha 1
• Causes priaprism and hypoyension