Psych Pharm

Question 1

What are the high potency neuroleptics?

Answer 1

haloperidol, fluphenazine, loxapine, thiothixene, trifluoperazine

Question 2

What are the low potency neuroleptics?

Answer 2

thioridazine, chlorpromazine

Question 3

What are the atypical antipsychotics?

Answer 3

olanzipine, quetiapine, risperidone, clozapine, ariprazole

Question 4

Which antipsychotic is most closely associated with an increased risk of diabetes?

Answer 4

olanzipine

Question 5

What is the most serious side effect of clozapine?

Answer 5

agranulocytosis

Question 6

What are the clinical features of neuroleptic malignant syndrome?

Answer 6

• delirium and mental status changes
• autonomic instability (tachycardia)
• muscle rigidity
• hyperthermia
• rhabdomyolysis and myoglobinuria

Question 7

What is the first line pharmacotherapy for neuroleptic malignant syndrome?

Answer 7

Dantrolene

others: bromocriptine, amantadine

Question 8

What mood stabilizers are used in the treatment of bipolar disorder?

Answer 8

Lithium
Atypical antipsychotics (respiridine, aripiprazole, olanzipine)
Antiseizure - valproic acid, carbamazepine, lamotrigine

Question 9

What are the potential side effects of lithium?

Answer 9

Neuro Sx
- tremor (esp postural)
- dizziness and sedation
Endo Sx
- nephrogenic diabetes insipidus
- hypothyroidism, goiter
Arrhythmia Sx
- sick sinus syndrome
- heart block
Teratogenic
- Ebstein anomaly

Question 10

What is Ebstein anomaly?

Answer 10

Caused by lithium; atrialization of the right ventricle

1. tricuspid leaflets displaced inferiorly
2. RV hypoplasia
3. Tricuspid regurgitation or stenosis
4. +/- patent foramen vale with R->L shunt

Question 11

Selective Serotonin Reuptake Inhibitors (SSRIs) (names)

Answer 11

Fluxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram

Question 12

SSRIs MOA, Use, AE

Answer 12

MOA - inhibit serotonin reuptake
Use - depression, GAD, panic disorder, OCD, buleimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder
AE - sexual dysfunction (anorgasmia, decreased libido), serotonin syndrome

Question 13

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) (names)

Answer 13

Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran

Question 14

SNRIs MOA, Use, AE

Answer 14

MOA - inhibit serotonin and norepinephrine reuptake
Use - depression, GAD, diabetic neuropathy
Venlafaxine - indicated for social anxiety disorder, panic disorder, PTSD, OCD
Duloxetine - indicated for fibromyalgia & milnacipran is ONLY used for fibromyalgia
AE - increase BP d/t increased NE; can cause serotonin syndrome

Question 15

TCAs (names)

Answer 15

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

Question 16

TCAs MOA, Use, AE

Answer 16

MOA - inhibit NE and serotonin reuptake
Use - major depression, OCD (clomipramine), migraine prophylaxis, nocturnal enuresis (imipramine)
AE - TriC’s - antiCholinergic, Cardiac toxicity (arrhythmias), CNS toxicity (convulsions, coma)

Question 17

MAOIs names

Answer 17

tranylcypromine, phenelzine, isocarboxazid, selegiline, rasagiline

Question 18

MAOIs MOA, Use, AE

Answer 18

MOA - inhibit MAO, therefore increasing NE and DA
Use - atypical depression anxiety; Selegiline and Rasagiline are used for Parkinson Dz
AE - HTN crisis especially with ingestion of tyramine (aged cheese and wine); C/I with SSRIs, TCAs, St. John’s wort, meperidine, etc to prevent serotonin syndrome

Question 19

Atypical antidepressants (names)

Answer 19

bupropion, mirtazapine, trazodone, vilazodone, vortioxetine

Question 20

Which antidepressant has the side effect of priapism?

Answer 20

trazodone and nefazodone (serotonin modulators)

Question 21

which antidepressant lowers the seizure threshold?

Answer 21

bupropion

Question 22

Which antidepressant causes appetite stimulation likely to result in weight gain?

Answer 22

mirtazapine

Question 23

Which antidepressant can be used for smoking cessation?

Answer 23

bupropion

Question 24

Which antidepressant can be used for bedwetting in children?

Answer 24

imipramine

Question 25

What are the symptoms of TCA overdose?

Answer 25

TriC’s: antiCholinergic excess, CNS toxicity, Cardiac arrhythmias

Question 26

What is the mechanism of action of bupropion?

Answer 26

inhibits reuptake of NE and dopamine; no sexual side effects