Psych Pharmacology

Question 1

drug tx for conduct disorder

Answer 1

lithium (for aggressive and impulsive behavior)

Question 2

drug tx for psychosis (in children)

Answer 2

perphenazine, haloperidol, thioridazine, chlorpromazine, resperidone

Question 3

drug tx for elimination disorders

Answer 3

laxatives/stool softener, imipramine, DDAVP

Question 4

side effects common to most antipsychotics

Answer 4

sedation, extrapyramidal effects (acute dystonia, parkinsonism, akathisia, tardive dyskinesia), anticholinergic effects, orthostatic hypotension, neuroendocrine effects (due to DA blockade), allergic/idiosyncratic effects, decreased seizure threshold (esp. phenothiazines), weight gain (esp. atypicals), neuroleptic malignant syndrome

Question 5

chlorpromazine

Answer 5

class: typical antipsychotic (phenothiazine)
MoA: blocks D2 receptors; low to medium potency
side effects: sedative, pronounced anticholinergic

Question 6

thioridazine

Answer 6

class: typical antipsychotic (phenothiazine)
MoA: blocks D2 receptors; low potency
side effects: sedative, anticholinergic; fewer extrapyramidal rxns

Question 7

mesoridazine

Answer 7

class: typical antipsychotic (phenothiazine)
MoA: blocks D2 receptors; low potency
side effects: sedative, anticholinergic; fewer extrapyramidal rxns

Question 8

trifluoperazine (also fluphenazine, perphenazine, prochlorperazine)

Answer 8

class: typical antipsychotics (phenothiazines)
MoA: block D2 receptors; high potency
side effects: less sedative, more extrapyramidal rxns, less anticholinergic

Question 9

chlorprothixene

Answer 9

class: typical antipsychotic
MoA: blocks D2 receptors; low to medium potency
side effects: sedative, pronounced anticholinergic

Question 10

thiothixene

Answer 10

class: typical antipsychotic
MoA: blocks D2 receptors; low potency
side effects: sedative, anticholinergic; fewer extrapyramidal rxns

Question 11

haloperidol

Answer 11

class: typical antipsychotic
MoA: blocks D2 receptors; high potency
side effects: less sedative, more extrapyramidal rxns, less anticholinergic

Question 12

pimozide

Answer 12

class: typical antipsychotic
MoA: blocks D2 receptors; high potency
side effects: many
other: only approved for Tourette’s syndrome in U.S., commonly used when haloperidol is ineffective

Question 13

clozapine

Answer 13

class: atypical antipsychotic
MoA: blocks D4 and 5-HT2 receptors; muscarinic antagonist
effects: improves positive sx in refractory pts, improves negative sx
side effects: lowers seizure threshold, agranulocytosis

Question 14

olanzapine

Answer 14

class: atypical antipsychotic
MoA: blocks 5-HT2, D1, and D2 receptors; some D4 blockade
effects: less effective than clozapine, but more effective against negative sx than haloperidol
side effects: weight gain, diabetes, abuse; fewer extrapyramidal rxns, fewer seizures, no agranulocytosis

Question 15

risperidone

Answer 15

class: atypical antipsychotic
MoA: blocks D2 and 5-HT2 receptors; active metabolite is paliperidone
effects: greater reduction in negative symptoms than typical antipsychotics; available as intramuscular depot
side effects: less extrapyramidal rxns than typicals, less seizures/antimuscarinic than clozapine

Question 16

quetiapine

Answer 16

class: atypical antipsychotic
MoA: structurally related to clozapine (blocks D4 and 5-HT2 receptors), effect similar to risperidone and olanzapine; shorter half-life
other: approved for depression tx augmentation, abuse potential

Question 17

aripiprazole

Answer 17

class: atypical antipsychotic
MoA: D2 receptor partial agonist, 5-HT2 antagonist; long-acting formulations available
other: approved for depression tx augmentation and bipolar I disorder

Question 18

brexpiprazole

Answer 18

class: atypical antipsychotic
MoA: D2 and 5-HT1A partial agonist, 5-HT2 antagonist

Question 19

ziprasidone

Answer 19

class: atypical antipsychotic
MoA: blocks 5-HT2 and D2 receptors; may have 5-HT1A agonist activity
side effects: no weight gain

Question 20

lurasidone

Answer 20

class: atypical antipsychotic
MoA: blocks D2 and 5-HT2 receptors
other: also approved for schizophrenia, bipolar I disorder (mono therapy or lithium/valproate adjunct)

Question 21

drug tx for schizoaffective disorder

Answer 21

paliperidone

Question 22

drugs used for augmentation of depression tx

Answer 22

aripiprazole, olanzapine, quetiapine

Question 23

lithium

Answer 23

class: monovalent cation
MoA: inhibits recycling of inositol substrates (conversion of IP2 –> IP1); also affects glycogen synthase kinase; has no effect in “normals”; VoD is total body water, but concentrates in CSF compared to plasma
uses: bipolar disorder (blocks manic behavior); off-label for schizoaffective disorder and cluster headaches
side effects: levels inversely proportional to Na levels (i.e. Li levels go up with thiazide diuretics, ACEIs, ARBs), fatigue, muscular weakness, tremor, GI sx, slurred speech/ataxia, narrow therapeutic window (toxicity: impaired consciousness, rigidity, hyperactive reflexes, coma)

Question 24

Symbyax(r)

Answer 24

combination of olanzapine and fluoxetine used for bipolar disorder and treatment-resistant major depressive disorder

Question 25

common side effects of SSRIs

Answer 25

nausea, insomnia, sexual dysfunction, serotonin reaction, neuroleptic malignant syndrome, suicidal ideation (particularly in children taking fluoxetine)

Question 26

symptoms of SSRI withdrawal

Answer 26

dizziness, paresthesia, anxiety, diarrhea, fatigue, gait instability, headache, insomnia, irritability, nausea/vomiting, tremor, visual disturbances

Question 27

fluoxetine

Answer 27

class: SSRI notes: long half-life, does not require tapering; inhibits CYP2D6 and 2C19; higher risk of suicidal ideation in children uses: depression, OCD, PTSD, panic disorder, PDD

Question 28

sertraline

Answer 28

class: SSRI notes: fewer effects on drug metabolism than fluoxetine uses: depression, OCD, PTSD, panic disorder, PDD

Question 29

paroxetine

Answer 29

class: SSRI uses: depression, menopausal hot flashes

Question 30

fluvoxamine

Answer 30

class: SSRI uses: depression, OCD

Question 31

citalopram

Answer 31

class: SSRI notes: pure isomer form is escitalopram (more potent) uses: depression

Question 32

duloxetine

Answer 32

class: SNRI uses: depression, anxiety, neuropathic pain, fibromyalgia, back pain, osteoarthritis notes: use with caution with liver disease

Question 33

venlafaxine

Answer 33

class: SNRI uses: depression, anxiety (used off-label for migraine prophylaxis and cataplexy)

Question 34

milnacipran

Answer 34

class: SNRI uses: fibromyalgia (pure isomer levomilnacipran approved for depression)

Question 35

bupropion

Answer 35

class: atypical antidepressant MoA: weakly blocks NE and dopamine reuptake uses: depression, nicotine withdrawal, seasonal affective disorder notes: does not cause as much weight gain or sexual dysfunction as SSRIs; may ameliorate sexual dysfunction if co-administered with SSRI

Question 36

mirtazapine

Answer 36

class: atypical antidepressant MoA: antagonizes presynaptic alpha-2 receptors in brain uses: depression, AIDS wasting syndrome side effects: increases appetite, sedation

Question 37

trazodone

Answer 37

class: atypical antidepressant MoA: weak SSRI-like effect uses: depression, insomnia side effects: sedation, cardiovascular effects, priapism

Question 38

vortioxetine

Answer 38

class: atypical antidepressant MoA: SSRI-like action, 5-HT1A agonist, 5-HT3 antagonist uses: depression

Question 39

common side effects of tricyclic antidepressants

Answer 39

anti-cholinergic and anti-histamine actions; sedation, decreases REM sleep/increases stage 4 sleep, palpitations, tachycardia, arrhythmias, narrow therapeutic index, drug-drug interactions (sympathomimetic drugs, blocks guanethidine uptake)

Question 40

imipramine

Answer 40

class: tricyclic antidepressant uses: depression, enuresis

Question 41

amitriptyline

Answer 41

class: tricyclic antidepressant uses: depression, chronic pain

Question 42

phenelzine

Answer 42

class: MAO inhibitor MoA: irreversibly inhibits MAO (both A and B) uses: depression (last-resort), narcolepsy side effects: orthostatic hypotension, hypomania in bipolar disease; may produce stimulation in normals; toxicity (agitation, hallucination, hyperpyrexia, convulsions, changes in blood pressure)

Question 43

antipsychotics approved for depression tx augmentation

Answer 43

olanzapine, aripiprazole, quetiapine