Psychiatric Drugs: Antidepressants, Anxiolytics, & Antipsychotics

Question 1

What are Antipsychotics

Answer 1

First-generation antipsychotics (also called typical antipsychotics): block D2 receptor → ↑ cAMP
- High-potency antipsychotics have a strong antipsychotic effect even at relatively low doses, but they also more commonly cause neurologic side effects (e.g., extrapyramidal symptoms) than low-potency antipsychotics.
- Low-potency antipsychotics more commonly cause anticholinergic, antihistamine, and sympathetic α1-blockade effects.
- Stored in fat tissue (lipid soluble) and, therefore, only slowly eliminated from the body.
Second-generation antipsychotics (also called atypical antipsychotics): most are 5-HT2 and D2 antagonists with varying α and H1 receptor effects

Question 2

Describe the classification of antipsychotic drugs.

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Question 3

What is the main Mechanism of action of antipsychotic drugs?

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Question 4

What are some of the Antipsychotic-induced motor disturbances?

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Question 5

What are the clinical uses of antipsychotic drugs?

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Question 12

Indications for Antipsychotics - Acute?

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• All antipsychotics, except for clozapine (used for treatment-resistant schizophrenia), have similar clinical effectiveness.
• SGAs are preferred in many cases because they carry a lower risk of EPS; however, in some patients (e.g., those with significant metabolic risk factors), FGAs may be more suitable.

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Question 20

Extrapyramidal symptoms (EPS)
- Definition?
- Etiology?
- Pathophysiology?

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Question 21

What are the Extrapyramidal symptoms (EPS)?

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Question 26

What are the 6 main groups of drugs used to treat anxiety?

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Question 27

Discuss the role of Benzodiazepines in the treatment of anxiety.

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Question 28

**Benzodiazepines** - Short acting agents? - Intermediate acting agents? - Long acting agents? - Mechanism of Action?

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Question 29

**Benzodiazepines** - 6 Effects?

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1. Anxiolysis 2. Sedation 3. Hypnotic action 4. Muscle relaxation 5. Anticonvulsant action 6. Amnesia

Question 30

**Benzodiazepines** - 6 Indications?

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Question 31

What are the general adverse effects of benzodiazepines? Why must they be used with caution in the elderly?

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Question 32

What are the clinical features of a Benzodiazepine overdose?

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Question 33

How can you diagnose a Benzodiazepine overdose?

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Question 34

Differential diagnoses of a benzodiazepine overdose?

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Question 35

What is the treatment for a benzodiazepine overdose? What is the antidote?

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Question 36

**Benzodiazepine dependence** - Definition? - Withdrawal symptoms? - Treatment?

Answer 36

**Treatment:** - Dose tapering - Seizure prophylaxis (e.g., carbamazepine)

Question 37

What are 6 Contraindications for benzodiazepines?

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Question 38

What are antidepressants? What are the 4 most widely used classes of antidepressants?

Answer 38

1. Selective serotonin reuptake inhibitors (SSRIs) 2. Serotonin-norepinephrine reuptake inhibitors (SNRIs) 3. Monoamine oxidase inhibitors (MAOIs) 4. Tricyclic antidepressants (TCAs).

Question 39

What are the 3 major mechanisms of action of antidepressants?

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Question 40

**Selective serotonin reuptake inhibitors** - Mechanism of Action? - 6 Examples? - Indications? For which disorder is it first line therapy?

Answer 40

**Mechanism of action**: inhibition of serotonin reuptake in synaptic cleft → ↑ serotonin levels **Examples** 1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram 5. Escitalopram 6. Fluvoxamine

Question 41

**Selective serotonin reuptake inhibitors** - 3 Early Side Effects? - 4 Late Side Effects?

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Question 42

**Selective serotonin reuptake inhibitors** - Drug interactions? - Contraindications?

Answer 42

**Drug interactions:** increased risk of serotonin syndrome if used concomitantly with other serotonergic drugs (e.g., MAOIs, linezolid, St. John's wort, dextromethorphan, meperidine, methylene blue) **Contraindications**: paroxetine in pregnant patients (may cause fetal cardiovascular malformations in the first trimester and fetal pulmonary hypertension in the third trimester)

Question 43

**Serotonin-norepinephrine reuptake inhibitors** - Mechanism of Action? - 5 Examples? - Indications? For which disorder is it a second-line therapy?

Answer 43

**Mechanism of Action**: inhibition of serotonin and norepinephrine reuptake in synaptic cleft → ↑ serotonin and norepinephrine levels **Examples** 1. Venlafaxine 2. Duloxetine 3. Desvenlafaxine 4. Levomilnacipran 5. Milnacipran

Question 44

**Serotonin-norepinephrine reuptake inhibitors** - 6 Side effects? - Drug interactions? - Additional information?

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Question 45

**Serotonin antagonist and reuptake inhibitors** - Mechanism of Action? (3) - 2 Examples? - 2 Indications?

Answer 45

**Mechanism of action** - Block postsynaptic type 2 serotonin receptors (5-HT2) - Weak inhibition of serotonin reuptake → ↑ serotonin levels - Antagonist of H1 and α1-adrenergic receptors **Examples** 1. Trazodone 2. Nefazodone **Indications** 1. Insomnia 2. Major depressive disorder (high doses required)

Question 46

**Serotonin antagonist and reuptake inhibitors** - 4 Side effects? - Drugs interactions? - Additional information? (2)

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Question 47

**Monoamine oxidase inhibitors** - Mechanism of Action? - 4 Examples? - 3 Indications?

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Question 48

**Monoamine oxidase inhibitors** - Side effects? (5)

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Question 49

**Monoamine oxidase inhibitors** - Drug interactions? - Additional information? (3)

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Question 50

**Tricyclic Antidepressants** - Mechanism of Action? - 8 Examples?

Answer 50

**Mechanism of action:** inhibition of serotonin and norepinephrine reuptake in synaptic cleft → ↑ serotonin and norepinephrine levels

Question 51

**Tricyclic Antidepressants** - 6 Indications?

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Question 52

**Tricyclic Antidepressants** - 5 Side effects?

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Question 53

**Tricyclic Antidepressants** - Contraindications? - Drug interactions? (2) - Additional information? (2)

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Question 54

**Tricyclic antidepressant toxicity** - Mechanism? (5) - Clinical Features? (6)

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Question 55

**Tricyclic antidepressant toxicity** - Diagnosis? - Management?

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Question 56

List 6 Atypical Antidepressants?

Answer 56

**Atypical Antidepressants** 2. Mirtazapine 2. Bupropion 3. Vilazodone 4. Vortioxetine 5. Buspirone 6. Varenicline

Question 57

**Atypical Antidepressants - Mirtazapine** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 58

**Atypical Antidepressants - Bupropion** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 59

**Atypical Antidepressants - Vilazodone** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 60

**Atypical Antidepressants - Vortioxetine** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 61

**Atypical Antidepressants - Buspirone** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 62

**Atypical Antidepressants - Varenicline** - Mechanism of action? - Indications? - Side effects? - Drug interactions?

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Question 63

Describe the role of St John's Wort in the treatment of depression?

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Question 72

Desribe the use of Antidepressants and 5-HT1A agonists as anxiolytic drugs?

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