Psychiatry

Question 1

Antipsychotic (neuroleptics)

Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine

Answer 1

MOA:
Block dopamine D2 receptor ( ↑[cAMP])

Use:
Schizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette syndrome

Tox:

• High lipid soluble and stored in body fat
• Extrapyramidal system SE’s (i.e. dyskinesias)
  tx: benxtropine or diphenhydramine
• Endocrine side effects (i.e. dopamine R antagonism –> hyperprolactinmemia–> galactorrhea)
• SE’s arisingfrom blocking muscarinic, α1, and histamine (sedation) receptors

Question 2

Atypical antipsychotics

Olanzapine
Clozapine
Quetiapine
Resperidone
Aripirazole
Ziprasidone

Answer 2

MOA:
-Caried effects on 5-HT2, dopamine, and α- and H1-receptors

Use:

• Schizophrenia__both positive and negative symptoms
• Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome

Tox:

• Fewer extrapyramidal and anticholinergic SE’s than traditional antipsychotics
• Olanzapine/clozapine may cause significant wt gain
• Clozapine–> agranulocytosis & seizure
• Risperidone may ↑prolactin–> ↓GnRH, LH, and FSH (causing irregular menstruation and fertility issues)
• Ziprasidone may prolong the QT interval

Question 3

Lithium

Answer 3

MOA:
-Possibly related to inhibition of phosphoinositol cascade

Use:

• Mood stabilizer for bipolar disorder; blocks relaps and acute manic event
• Also SIADH

Tox:
-(LMNOP) 
Lithium side effects 
Movement (tremor)
Nephrogenic diabetes insipidus
-HypOthyroidism 
-Pregnancy problems

Question 4

Buspirone

Answer 4

MOA:
-Stimulate 5-HT1A Receptors

Use:

• Generalized anxiety disorder
• Doesn’t sedation, addicition or tolerance
• Takes 1-2 wks to take effect
• Doesn’t interact with alcohol (vs. barbiturates, benzo)

Question 5

SSRIs

Fluoxetine
Paroxetine
Sertraline
Citalopram

Answer 5

MOA:
-5-HT-specific reuptake inhibitor

Use:
-Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD

Tox:

• GI distress
• Sexual dysfunction (anorgasmia and ↓ libido)
• Serotonin syndrome w/ any drug that ↑ 5-HT (i.e. MAO inhibitors, SNRIs, TCAs)
  tx: cyproheptadine (5-HT2 receptor antagonist)

Question 6

SNRIs

Venlafaxine
Duloxetine

Answer 6

MOA:
-Inhibit 5-HT and norepinephrine reuptake

Use:

• Depression
• Venlafaxine is also used in generalized anxiety and paic disorder; duloxetine is also indicated for diabetic peripheral neuropathy

Tox:
-↑ BP most common; also stimulant effect, sedation, nausea

Question 7

TCA

Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine

Answer 7

MOA:
- Block reuptake of norepinephrine and 5-HT

Use:
-Major depression, OCD (clomipramine), fibromyalgia

Tox:

• Sedation
• α1-blocking effect including postural hypoTN
• Atropine-like (anticholinergic)
• 3° TCAs (amitriptylin) have more antichol effects than 2° TCAs (nortryptyline) have
• Desipramine is less sedating, but has a higher seizure incidence
• Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias)
  tx: NaHCO3 for cardio tox

Question 8

Monoamine oxidase (MAO) inhibitors

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)

Answer 8

MOA:
-Nonselective MAO inhibition ↑ levels of amine neurotransmitters (norepi, 5-HT, dopamine)

Use:

• Atypical depression
• Anxiety
• hypochondriasis

Tox:

• Hypertensive crisis (most notably w/ ingestion of tyramine, which is found in many foods such as wine and cheese)
• CNS stim
• Contraindicated w/ SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

Question 9

Bupropion

atypical antiD

Answer 9

• Also used for smoking cessation
• ↑ norepi & dopamine (unknown mechanism)

Tox:

• Stim affect (tachycardia, insomnia)
• HA
• Seizure in bulimic pt’s
• Ni sexual SE’s

Question 10

Mirtazapine

atypical antiD

Answer 10

α2-antagonist ( ↑ release of norepi and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist

Tox:

• Sedation (may good for depressed pt’s w/ insomnia)
• ↑appetite
• Wt gain (may be good for elderly or anorexic pts)
• Dry mouth

Question 11

Trazodone

atypical antiD

Answer 11

Primarily blocks 5-HT2 and α1-adrenergic receptors. Used primarily for insomnia, as high doses ar needed for antiD effects

Tox:

• sedation
• nausea
• priapism
• postural hypoTN