Psychiatry

Question 1

SSRI

Answer 1

Fluoxetine, Paroxetine, Sertraline, Citalopram

Prevent reuptake of 5-HT

Use: Major Depression, OCD

C/I: w/ MAOinhibitor, SNRI, TCA due to serotonin syndrome (HARMED)
Hyperthermia
Autonomic Instability
Rash
Myoclonus
Encephalopathy
Diarrhea

Question 2

TCA

Answer 2

Desipramine, Nortriptyline, Imipramine, Amitriptyline, Doxepin

Block reuptake of 5-HT and Norepinephrine

Depression, Enuresis (muscarinic blockade), Chronic Pain Syndromes

Adverse:
Convulsions, Coma, Cadriotoxicity, Prolong QT

Sedation, Postural Hypotension, Anti-Cholinergic Effects, Priapism

Question 3

Monoamine Oxidase Inhibitors (MAOi)

Answer 3

Tranylcypromine, Phenelzine, Isocarboxazid

Blocks metabolism of 5-HT, Dopamine, Norepinephrine

Use: Atypical Depression

Adverse: Hypertensive Crisis with wine, cheese, smoked meats (all contain tyramine). Tyramine stimulates release of epinephrine and norepinephrine.

Question 4

Selegiline

Answer 4

Monoamine Oxidase B Inhibitor

Increases levels of dopamine

Use: Parkinson Disease

Question 5

Lithium

Answer 5

Mechanism: Unknown

Use: Bipolar Disorder

Adverse: Tremor, Hypothyroidism, Nephrogenic Diabetes Insipidus (ADH receptor blocker)

LMNOP: Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy Problems

Question 6

Typical Anti-Psychotics

Answer 6

Haloperidol, Fluphenazine, Chlorpromazine, Thioridazine
(haloperidol + “-azines”)

Block D2 receptors in limbic system

Use:
Positive sx’s of Schizophrenia (delusions, hallucinations)
Tourette Syndrome, Delirium, Agitation

Adverse: Sedation, Anti-Cholinergic Side Effects, Hyperprolactinemia (D inhibits prolactin)

Extrapyramidal System Side Effects (dystonia, akinesia, akathisia, tar dive dyskinesia)

Neuroleptic Malignant Syndrome (FEVER: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles). Tx is DANTROLENE (muscle relaxer)

Question 7

Atypical Anti-Psychotics

Answer 7

Olanzapine, Clozapine, Risperidone, Ziprasidone, Aripiprazole, Quetiapine

Block 5-HT and DA receptors in limbic system

Use: Positive AND Negative sx’s of schizophrenia, Delirium

Fewer EPS and Anti-Cholinergic Effects

Adverse:
Wt gain
Leukopenia and Agranulocytosis (Clozapine) - requires monitoring

Question 8

Benzodiazepines

Answer 8

Short Acting: Triazolam, Midazolam
Intermediate: Lorazepam, Temazepam, Oxazepam, Alprazolam, Chlordiazepoxide
Long Acting: Diazepam, Prazepam, Clonazepam, Flurazepam

Enhance activity of GABAa receptor -> increased frequency of Cl opening -> hyperpolarization -> decreased activity of neurons in limbic, thalamic, hypothalamic regions

Use:
Anxiety, Seizures, Status Epilepticus, Alcohol Withdrawal
Anesthesia (Midazolam, Diazepam)

Adverse: Withdrawal (mental status, anxiety, tach)
Benzo, Barbs, EtOH all bind to same receptor**
OD: Tx with FLUMAZENIL (GABAa-R antagonist)

Question 9

Barbituates

Answer 9

Phenobarbital, Thiopental, Secobarbital, Amobarbital, Pentobarbital

Potential GABAa receptor (increase duration) -> increased flow of Cl -> hyper polarization -> decreased activity of neurons in CNS

Use:
Sedative for anxiety and insomnia
Seizures (Phenobarbital)
Anesthesia Induction (Thiopental)

Indue P450 (decreased levels of other drugs)

Question 10

Zolpidem

Answer 10

Non-Benzodiazepine Hypnotic

GABAa receptor agonist (binds same receptor as Benzo)

Short term use for insomnia

Question 11

Phenytoin

Answer 11

Anti-Epileptic

Na Channel Inactivation -> Hyperpolarization

Use:
Simple
Tonic-Clonic
Status Epilepticus

Adverse: Nystagmus, Gingival Hyperplasia, Drug Induced Lupus, Teratogen (Fetal Hydantoin Syndrome)

Induces P450

Question 12

Lamotrigine

Answer 12

Anti-Epileptic

Na Channel Inactivation at presynaptic neuron -> decreasing glutamate, aspartate

Use: Epilepsy

Adverse: Stevens-Johnson Syndrome`

Question 13

Valproic Acid

Answer 13

Anti-Epileptic

Na Channel Inactivation
Inhibit GABA Transaminasse -> Increase GABA concentrations

Use:
Tonic Clonic
Myoclonic
Absence Sezures

Adverse: Hepatotoxicity, Neural Tube Defect

Question 14

Ethuximide

Answer 14

Anti-Epileptic

Blocks Ca Channels

Use: Absence Seizures

EFGHIJ
Fatigue, GI distress, Headache, Itching, stevens-Johnson Syndrome

Question 15

Carbamazepine

Answer 15

Anti-Epileptic

Na Channel Inactivation -> Hyperpolarization

Use: 
Simple Partial
Complex Partial
Tonic-Clonic
Trigeminal Neuralgia** (first line)

Adverse:
Hepatotoxicity, Agranulocytosis, Aplastic Anemia

Induces P450

Question 16

Topiramate

Answer 16

Anti-Epileptic

Na Channel Inactivation -> Hyperpolarization
GABAa-R agonist

Use: Epilepsy, Migraines

Question 17

Tiagabine

Answer 17

Anti-Epileptic

Inhibit GABA reuptake

Use: Partial Seizures

Question 18

Vigabatrin

Answer 18

Anti-Epileptic

Irreversibly inhibits GABA Transaminase

Use:
Infantile Spasms (children)
Refractory Partial Seizures (adults)

Adverse: Visual field constriction/loss

Question 19

Levetiracetam

Answer 19

Anti-Epileptic

Modulate GABA and Glutamate release

Use:
Partial
Tonic Clonic

Adverse: Drowsiness, Depression

Question 20

Succinylcholine

Answer 20

Anesthetic - Depolarizing Neuromuscular Blockade

ACh Receptor Antagonist -> Sustained Depolarizations and Prevents Muscle Contraction

Phase I: Prolong Depolarization (no antidote)
Phase II: Repolarized but desensitized (antidote - cholinesterase inhibitors)

Use: Muscle paralysis for endotracheal intubation (surgery)

Adverse: Hyperkalemia, Hypercalcemia, Malignant Hyperthermia (when admin with halothane, treated with dantrolene muscle relaxer)

Question 21

Pancuronium

Answer 21

Anesthetic - Non-depolarizing Neuromuscular Blockade

Competitively binds nicotinic receptors

Use: Adjunct to general anesthesia

Adverse: Hypotension

Reversed with Cholinesterase Inhibitors (neostigmine)

Question 22

Esters: Procaine, Cocaine, Tetracaine

Amides (2 I’s): Lidocaine, Mepivacaine, Bupivacaine

Answer 22

Local Anesthetics

Block Sodium Channels