Psych Pharm from FA

Question 1

Antipsychotics (neuroleptics)

Answer 1

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + “-azines”).

Question 2

High Potency Typical Antipsychotics

Answer 2

Trifluoperazine, Fluphenazine, Haloperidol

(Try to Fly High)

neurologic side effects (EPS symptoms).

Question 3

Low Potency Typical Antipsychotics

Answer 3

Chlorpromazine, Thioridazine

(Cheating Thieves are low)

non-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).

Question 4

MoA of typical Antipsychotics

Answer 4

block dopamine D2 receptors (increase cAMP])

Question 5

ADR of typical Antipsychotics (6)

Answer 5

Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.

Extrapyramidal system side effects (dyskinesias). Treatment: benztropine or diphenhydramine.

Endocrine side effects (e.g., dopamine receptor antagonism-> hyperprolactinemia + galactorrhea).

Side effects arising from blocking muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors.

Neuroleptic malignant syndrome (NMS)— rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (e.g., bromocriptine).

Tardive dyskinesia—stereotypic oral- facial movements as a result of long-term antipsychotic use. Potentially irreversible.

Question 6

Trmt for extrapyramidal system side effects caused by antipsychotics

Answer 6

benztropine or diphenhydramine.

Question 7

Trmt for Neuroleptic malignant syndrome (NMS) caused by antipsychotics

Answer 7

dantrolene, D2 agonists (e.g., bromocriptine)

Question 8

ADR Of Chlorpromazine?

Answer 8

Corneal deposits

Question 9

ADR of haloperidol?

Answer 9

NMS, tardive dyskinesia

Question 10

ADR of Thioridazine?

Answer 10

reTinal deposits

Question 11

What are the atypical antipsychotics?

What is their MoA?

Answer 11

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone.

MoA: Not completely understood. Varied effects on 5-HT2, dopamine, and α- and H1-receptors.

Question 12

ADR that both Olanzapine/clozapine share?

Answer 12

weight gain

Question 13

ADR of Clozapine?

Answer 13

agranulocytosis (requires weekly WBC monitoring) and seizure.

Question 14

ADR of risperidone?

Answer 14

increase prolactin (causing lactation and gynecomastia) -> decrease GnRH, LH, and FSH (causing irregular menstruation and fertility issues).

Question 15

ADR of ziprasidone

Answer 15

prolonged QT

Question 16

Lithium MoA?

Answer 16

Not established; possibly related to inhibition of phosphoinositol cascade.

Question 17

ADR of Lithium?

Answer 17

Tremor, sedation, edema, heart block, hypothyroidism

polyuria (ADH antagonist causing nephrogenic diabetes insipidus),

teratogen - Ebstein anomaly and malformation of the great vessels

Question 18

consideration when administering Lithium?

how is it metabolizd?

Answer 18

Narrow therapeutic window - requires close monitoring of serum levels.

Excreted by the kidneys; most is reabsorbed at the PCT following Na+ reabsorption.

Question 19

Buspirone
MoA?
Clinical Use?

Answer 19

Stimulates 5-HT1A receptors.

Generalized anxiety disorder.

Question 20

SSRIs
MoA?

ADR:

Answer 20

Fluoxetine, paroxetine, sertraline, citalopram.

MoA: 5-HT–specific reuptake inhibitors.

ADR:
GI distress
sexual dysfunction (anorgasmia and low libido)
serotonin syndrome

Question 21

Serotonin syndrome
Cause?
Sx?
Treatment?

Answer 21

any drug that increase 5-HT (MAOi, SNRIs, TCAs)

Sx: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.

Trmt: cyproheptadine (5-HT2 receptor antagonist)

Question 22

SNRIs

MoA?
ADR:

Answer 22

Venlafaxine, duloxetine.

MoA: Inhibit 5-HT and norepinephrine reuptake.

ADR: increased BP, also stimulant effects, sedation, nause

Question 23

TCAs

MoA?
ADR?

Answer 23

Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (all TCAs end in -iptyline or -ipramine except doxepin and amoxapine).

MoA: block NE, 5HT reuptake

ADR: Tri-C’s: Convulsions, Coma, Cardiotoxicity

Question 24

TCA OD treatment

Answer 24

NaHCO3 to prevent cardiovascular toxicity.

Question 25

MAOi

MoA?
ADR?

Answer 25

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)

(MAO Takes Pride In Shanghai).

MoA: MAOi -> increase levels of amine neurotransmitters (NE, 5-HT, dopamine).

ADR:
Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese)
CNS stimulation

Question 26

These Rx are contraindicated w/ MAOis

Answer 26

SSRIs
TCAs
St. John’s wort
meperidine
dextromethorphan

(to prevent serotonin syndrome).

Question 27

3 Atypical antidepressants

Answer 27

Bupropion
Mirtazapine
Trazodone

Question 28

Bupropion

MoA?
ADR:
Pro about this Rx?

Answer 28

MoA: increase NE, Dopamine via unknown mxn

ADR: stimulant effects (tachycardia, insomnia), headache, SEIZURE IN BULIMIC PATIENTS

“PRO at causing seizures in BUlimics”

PRO: No sexual side effects.

Question 29

Mirtazapine

Clinical Use vs ADR/

Answer 29

MoA: α2-antagonist (increase release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.

Clinical Use vs ADR:

• sedation (which may be desirable in depressed patients with insomnia)
• increase appetite, weight gain (which may be desirable in elderly or anorexic patients)
• dry mouth

Mitzy Mirtza takes Mirtazapine to sleep, gain weight, and eat (3 luxuries in life that med students do not have)

Question 30

Trazodone

Clinical use?

ADR?

Answer 30

MoA: blocks 5-HT2 and α1-adrenergic receptors

Use: insomnia, as high doses are needed for antidepressant effects.

ADR: BONER, sedation, nausea, postural hypotension.