Psychiatry

Question 1

Atomoxetine

Answer 1

Norepinephrine reuptake inhibit used to treat ADHD

Question 2

Haloperidol, Fluphenazine, Trifluoperazine

Answer 2

High potency typical antipsychotics (block D2 receptors –> increase cAMP)

• increased risk of EPS side effects (e.g. dystonia, akathisia, bradykinesia, tardive dyskinesia); treat EPS side effects with anticholinergics (e.g. benztropine, diphenhydramine)
• Haloperidol increases risk of NMS

Question 3

Neuroleptic malginant syndrome (NMS)

Answer 3

Associated with haloperidol use.
Characterized by “FEVER”: Fever, Encephalopathy, Vitals unstable, Enzymes increase (myoglobinuria), Rigidity of muscles
Tx: dantrolene, D2 agonists (bromocriptine)

Question 4

Chlorpromazine, Thioridazine

Answer 4

Low potency typical antipsychotics (block D2 receptors –> increase cAMP)

• increased risk of non-neurologic side effects (anticholinergic, antihistamine, alpha1-blockade)
• Chlorpromazine increases risk of cornea deposits
• Thioridazine inreases risk of retinal deposits

Question 5

Olanzapine

Answer 5

Atypical antipsychotic

Associated with weight gain

Question 6

Clozapine

Answer 6

Atypical antipsychotic

Associated with weight gain, granulocytosis (requires weekly WBC monitoring) and seizures

Question 7

Risperidone

Answer 7

Atypical antipsychotic

Associated with increased prolactin, which leads to decreased GnRH, LH, and FSH (causing irregular menstruation)

Question 8

Ziprasidone

Answer 8

Atypical antipsychotic

May prolong QT interval

Question 9

Atypical antipsychotics

Answer 9

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

Varied effect on 5-HT2, dopamine, and alpha and H1 receptors

Treats positive and negative symptoms of schizophrenia, bipolar disorder, OCD

Question 10

Lithium side effects

Answer 10

“LMNOP”: Lithium side effects

• Movement (tremor)
• Nephrogenic diabetic insipidus (ADH antagonist)
• HypOthyroidism
• Pregnancy problems (Ebstein anomaly and malformation oif great vessels)

Question 11

Buspirone

Answer 11

Treats generalized anxiety disorder. Stimulates 5-HT1a receptor.

Question 12

Fluoxetine, paroxetine, sertraline, citalopram

Answer 12

SSRIs. Treat depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD.

Risk of serotonin syndrome with concomitant use of any drug that increases 5-HT (e.g. MAO inhibitors, SNRIs, TCAs). Treat with cyprohepatadine (5-HT2 receptor antagonist)

Question 13

Venlafaxine, duloxetine

Answer 13

SNRIs. Treat depression. Venlafaxine also treats GAD and panic disorder. Duloxetine also treats diabetic peripheral neuropathy.

Question 14

Amitriptyline, nortriptyline, imipramine, desipramine, doxepin, amoxapine

Answer 14

TCAs. Block reuptake of norepinephrine and 5-HT (like SNRIs). Treat major depression, OCD (clomipramine), and fibromyalgia.

Toxicity: histamine antagonism (sedation), alpha1-blocking effects (orthostatic hypotension), anticholinergic side effects (intestinal ileus, urinary retention, sinus tach)

Complications (“Tri-C’s”): Convulsions, Coma, Cardiotoxicity (treat with NaHCO3)

Question 15

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline

Answer 15

MAO inhibitors. All are non-selective except for selegiline (selective MAO-B inhibitor). Increase levels of amine NTs (norepinephrine, 5-HT, dopamine). Treat atypical depression, anxiety, hypochondriasis.

Toxicity:

• Hypertensive crisis (due to ingestion of tyramine in wine and cheese).
• Serotonine syndrome due to concomitant use with SSRIs, TCAs, St. John’s wort, meperidine (opioid), or dextromethorphan

Question 16

Bupropion

Answer 16

Used for smoking cessation. Also used for depression with associated psychomotor retardation or hypersomnia.

MoA: Increases norepinephrine and dopamine.

No sexual side effects.

Toxicity: agitation, insomnia, seizures in bulimic patients

Question 17

Mirtazapine

Answer 17

Treats depression in thin old depressed patients (increases appetite/weight gain).

MoA: alpha2-antagonist (increases release of norepinephrine and 5-HT) and 5-HT2 and 5-HT3 receptor antagonist

Question 18

Trazodone

Answer 18

Treats insomnia. MoA: blocks 5-HT2 and alpha1 receptors.

May cause priapism (“trazobone”)

Question 19

Triazolam

Answer 19

Short-acting benzo (< 6 hours)

“Try” it for a little bit

Question 20

Lorazepam

Answer 20

Intermediate-acting benzo

Lasts One Relaxing Day (LOR)

Question 21

Diazepam, Flurazepam, Chlordiazepoxide

Answer 21

Long-acting benzo (> 24 hours)

Question 22

Cyprohepatadine

Answer 22

First-generation histamine antagonist with non-specific 5-HT1 and 5-HT2 receptor antagonistic properties.

Used in treatment of serotonin syndrome.

Question 23

Varenicicline

Answer 23

Partial agonist of nicotinic ACh receptors.

Used in smoking cessation because it decreases nicotinic cravings and attenuates the rewarding effects of nicotine.