Psychiatry

Question 1

which dopamine receptors do the typical antipsychotics act at

Answer 1

D2 receptors

Question 2

which typical antipsychotics have the highest dopamine receptor potency

Answer 2

haloperidol and fluphenazine
highest D2R potency
more EPS due to D2 blocking in nigrostriatal pathway

Question 3

which typical antipsychotics are most likely to cause sleepiness, dizziness and dry mouth?

Answer 3

chlorpromazine and thioridazine
low potency at D2R, higher potency at muscarinic, histaminergic, adrenergic receptors

Question 4

buspirone MOA

Answer 4

agonism at 5HT1a

anxiolytic without sedation

Question 5

benzos receptor

Answer 5

GABA-A

ionotropic receptor –> opens chloride channels

Question 6

benzos with longest half life

Answer 6

flurazepam and clorazepate

Question 7

hyponatremia and SSRIs

Answer 7

higher risk with older age, females, and when used with diuretics

typically within 1st month of starting SSRI, but can present months later

fluoxetine and paroxetine more likely to lead to hyponatremia

pathophys - SIADH from excess antidiuretic hormone

check sodium if someone on SSRI presents altered - stop SSRI and fluid restrict

Question 8

serotonin withdrawal syndrome

Answer 8

abrupt discontinuation of serotonin meds –> dizziness, paresthesias, dysphoria, sometimes encephalopathy.

should taper SSRIs, etc off slowly

Question 9

baclofen receptor

Answer 9

GABA-B

G protein coupled –> inhibits adenylyl cyclase

Question 10

atypical (2nd gen) antipsychotics act at what receptors

Answer 10

antagonism at 5HT2a receptors
some block at D2 receptors too

less antagonism at D –> less EPS

Question 11

antipsychotic least likely to cause QT prolongation

Answer 11

Abilify (aripiprazole)

Question 12

memantine

Answer 12

NMDAR blocker

Question 13

glutamate receptors

Answer 13

NMDARs (NMDA is agonist)

non-NMDA
- AMPAR
- kainic acid receptors

Question 14

side effects of lithium

Answer 14

tremor, acne, thyroid probs, DI –> hypernatremia