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.

Answer 2

Question 3

What is the main Mechanism of action of antipsychotic drugs?

Answer 3

Question 4

What are some of the Antipsychotic-induced motor disturbances?

Answer 4

Question 5

What are the clinical uses of antipsychotic drugs?

Answer 5

Question 6

Answer 6

Question 7

ti

Answer 7

Question 8

Answer 8

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

Indications for Antipsychotics - Acute?

Answer 12

• 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.

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

Answer 16

Question 17

Answer 17

Question 18

Answer 18

Question 19

Answer 19

Question 20

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

Answer 20

Question 21

What are the Extrapyramidal symptoms (EPS)?

Answer 21

Question 22

Answer 22

Question 23

Answer 23

Question 24

Answer 24

Question 25

Answer 25

Question 26

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

Answer 26

Question 27

Discuss the role of Benzodiazepines in the treatment of anxiety.

Answer 27

Question 28

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

Answer 28

Question 29

Benzodiazepines
- 6 Effects?

Answer 29

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

Question 30

Benzodiazepines
- 6 Indications?

Answer 30

Question 31

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

Answer 31

Question 32

What are the clinical features of a Benzodiazepine overdose?

Answer 32

Question 33

How can you diagnose a Benzodiazepine overdose?

Answer 33

Question 34

Differential diagnoses of a benzodiazepine overdose?

Answer 34

Question 35

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

Answer 35

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?

Answer 37

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?

Answer 39

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?

Answer 41

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?

Answer 44

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)

Answer 46

Question 47

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

Answer 47

Question 48

Monoamine oxidase inhibitors
- Side effects? (5)

Answer 48

Question 49

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

Answer 49

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?

Answer 51

Question 52

Tricyclic Antidepressants
- 5 Side effects?

Answer 52

Question 53

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

Answer 53

Question 54

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

Answer 54

Question 55

Tricyclic antidepressant toxicity
- Diagnosis?
- Management?

Answer 55

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?

Answer 57

Question 58

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

Answer 58

Question 59

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

Answer 59

Question 60

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

Answer 60

Question 61

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

Answer 61

Question 62

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

Answer 62

Question 63

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

Answer 63

Question 64

Answer 64

Question 65

Answer 65

Question 66

Answer 66

Question 67

Answer 67

Question 68

Answer 68

Question 69

Answer 69

Question 70

Answer 70

Question 71

Answer 71

Question 72

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

Answer 72