psychiatry

Question 1

Typical antipsychotics mechanism

Answer 1

Haloperidol, trifluoperazine, fluphenazine, thioridizine, chlorpromazine. D2 antagonists. Increase intracellular cAMP. Used for schizophrenia, psychosis, mania, tourettes.

Question 2

High potency antipsychotics

Answer 2

Trifluoperadine, fluphenazine, haloperidol- Have lots of eps symptoms

Question 3

Low potency antipsychotics

Answer 3

clorpromazine, thioridazine,. Have a lot of non-neurologic side effects like anticholinergic, antihistaminergic, a1 blockade

Question 4

Toxicity of typical antipsychotics

Answer 4

Highly lipid soluble and stored in body fat so slow to be removed from system. Extrapyramidal side effects like dyskinesias. Endocrine side effects (hyperprolactinemia, menstrual arrest).

Dry mouth, constipation, hypotension, sedation

Question 5

How to treat EPS of antipsychotics

Answer 5

Benztropine or diphenhydramine

Question 6

Neuroleptic malignant syndrome and treatment

Answer 6

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia Treat with dantrolene or bromocriptine (d2 agonist).

Fever, encephalopathy, unstable vitals, increased inzymes, muscle rigity.

Question 7

Tardive dyskinesia

Answer 7

Sterotypic oral facial movements as a result of lerg term antipsychotic use. Potentially irreversible

Question 8

Atypical antipsychotics

Answer 8

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone.

Mechanism not completely understood. Varied effects on 5ht dopamine, alpha and histamine receptors

Question 9

Atypical antipsychotics side effects

Answer 9

Fewer EPS and anticholineric side effects.

Olanzapine causes weight gain
Clozapine causes agranulocytosis and seizures
Risperidone can increaes prolactin.

Ziprasidone can prolong the QT interval.

Question 10

Lithium

Answer 10

Used for bipolar, blocks relapse and used for acute panic events. Can be used for SIADH.

Question 11

Lithium toxicity

Answer 11

Tremor, nephrogenic DI, hypothyroidism, ebstein’s abnormality.

Question 12

Buspirone

Answer 12

Stimulates 5HT1a receptors used for anxiety no sedation. Takes 1-2 weeks to work. Don’t interact with alcohol.

Question 13

Serotonin syndrome

Answer 13

Hyperthermia, confusion, myoclonus, diarrhea. Treat with cyprohepatidine

Question 14

Cyproheptadine

Answer 14

5HT2 receptor antagonist used to treat serotonin syndrome.

Question 15

SNRI

Answer 15

Venlafaxine, duloxetine. Used for depression, GAD/panic disorders, diabetic peripheral neuropathy. Increase in BP common, also some stimulant effects.

Question 16

TCA

Answer 16

Amytriptyline, nortryptaline, imipramine, desipramine, clomipramine, amoxapine. Block reuptake of NE and serotonin. used for fibromyalgia. Sedation, a1 blocking effects like hypotension, anticholinergic side effects,

Question 17

Clomipramine

Answer 17

Used for OCD

Question 18

Which TCA have more anticholinergic effects?

Answer 18

Tertiary (amitripyaline)

Question 19

Desipramine

Answer 19

less sedation but can cause serizures.

Question 20

TCA toxicity

Answer 20

Convulsions, coma, cardiotoxity. Treat with NAHCO3 for arrythmias.

Question 21

MAOI causing serotonin syndrome

Answer 21

SSRIs TCA st johns wort, meperidine, dxm

Question 22

Buproprion

Answer 22

Increase NE and DA. simtulant, no sexual side effects. Can cause seizures in bulemia patients. No sexual side effects.