Psychiatric & Neurological Drugs

Question 1

First-generation antipsychotics (FGAs)

Mechanism

Answer 1

Block dopamine type 2 receptors in CNS

Question 2

Second-generation antipsychotics (SGAs) or atypical antipsychotics

Mechanism

Answer 2

Produces only a moderate blockade of dopamine 2 receptors; stronger serotonin blockade

Question 3

Compared to first-generation antipsychotics, second-generation antipsychotics have a higher risk of _______

Answer 3

metabolic effects (weight gain, diabetes, dyslipidemia)

Question 4

generic for thorazine

Answer 4

chlorpromazine HCL

Question 5

treatment for acute dystonic reaction

Answer 5

anticholinergic drug like diphenhydramine or benzotropine

Question 6

neuroleptic malignant syndrome

Answer 6

rare but serious reaction that risks death without treatment- sweating, rigidity, sudden high fever, autonomic instability, muscle pain and breakdown

Question 7

adverse effects of antipsychotics

Answer 7

-EPS
-orthostatic hypotension
-anticholinergic effects
-sedation
-neuroendocrine effects: gynecomastia, galactorrhea, menstrual irregularity
-sexual dysfunction
-dermatologic effects

Question 8

antipsychotics

drug interactions

Answer 8

-anticholinergic drugs
-CNS depressants
-Levodopa and direct dopamine receptor agonists

Question 9

Clozapine

Adverse effects

Answer 9

Less risk of EPS than FGAs
Increased risk of weight gain, diabetes, and dyslipidemia
agranulocytosis - low neutrophil count - watch for fever, sore throat

Question 10

Aripiprazole trade name

Answer 10

Abilify

Question 11

sertraline trade name

Answer 11

Zoloft

Question 12

fluoxetine trade name

Answer 12

Prozac

Question 13

paroxetine trade name

Answer 13

paxil

Question 14

SSRIs cause CNS _____

Answer 14

excitation

Question 15

When does serotonin syndrome begin?

Answer 15

Usually 2-72 hours after treatment, but drug interactions can cause it too (such as concurrent treatment of SSRIs and MAOIs)

Question 16

What are the signs and symptoms of serotonin syndrome?

Answer 16

-Altered mental status (agitation, confusion, disorientation, anxiety, hallucinations)
-Incoordination, myoclonus, hyperreflexia, sweating, fever

Question 17

Adverse effects of SSRIs

Answer 17

-Withdrawal syndrome
-Neonatal effects
-Teratogenesis
-Bleeding disorders
-Sexual dysfunction
-Weight gain

Question 18

Drug interactions with SSRIs

Answer 18

MAOIs (risk of serotonin syndrome)
Aspirin and NSAIDs (may increase bleeding risks)

Question 19

Venlafaxine (Effexor)

Mechanism of action

Answer 19

SSRI/SNRI

Question 20

Why can’t SNRIs be combined with MAOIs?

Answer 20

Hypertensive crisis is an adverse effect

Question 21

SNRI side effects

Answer 21

Most overlap with SSRIs

ALSO diastolic hypertension

Question 22

Tricyclic antidepressants

Adverse effects

Answer 22

Sedation, orthostatic hypotension, anticholinergic effects, cardiac toxicity

Question 23

Tricyclic antidepressants

Mechanism of action

Answer 23

Block NE and serotonin reuptake

Question 24

What is an alternative therapeutic use of a tricyclic antidepressant?

Answer 24

Treats neuropathic pain

Question 25

TCAs Drug interactions

Answer 25

MAOIs Anticholinergic agents CNS depressants

Question 26

TCAs Toxicity

Answer 26

Primarily from cardiotoxic actions -Dysrhythmias -Tachycardia

Question 27

Treatment of TCA toxicity

Answer 27

Gastric lavage Ingestion activated charcoal

Question 28

Why are MAOIs not used frequently?

Answer 28

Risk of triggering hypertensive crisis if patient eats foods high in tyramine

Question 29

What are the symptoms of a hypertensive crisis?

Answer 29

Severe headache Tachycardia Nausea and vomiting Confusion Profuse sweating Stroke

Question 30

Benzos adverse effects

Answer 30

-CNS depression -Respiratory depression -Anterograde amnesia -Complex sleep-related behaviors

Question 31

Benzos Drug interactions

Answer 31

-CNS depressants

Question 32

Benzo Toxicity

Answer 32

-Respiratory depression a big concern if given IV -Cardiovascular depression can also occur

Question 33

Flumazenil

Answer 33

-Antidote for benzo overdose -Can reverse some symptoms of CNS depression, but does not reliably reveres respiratory depression and may cause seizures

Question 34

How do barbiturates affect other drugs in your system?

Answer 34

Barbiturates induce enzymes in the liver, so they speed up the metabolism of other drugs

Question 35

How does tolerance differ between barbiturates and opiates?

Answer 35

Tolerance to respiratory depression does NOT develop with barbiturates

Question 36

Barbiturates Therapeutic uses

Answer 36

Seizures Anethesia