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Brain Power: Neuropharmacology > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Differentiate old and new generation anti-psychotics based on the receptors that they affect.

A

Old gen: D2 receptor affinity

new gen: 5HT2 receptor affinity

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2
Q

Classify if new or old gen

  1. Chlorpromazine
  2. Fluphenazine
  3. Risperidone
  4. Quetiapine
  5. Clozapine
  6. Thioridazine
A

In general newer agents either end in -apine or -done

  1. Chlorpromazine: Old
  2. Fluphenazine: Old
  3. Risperidone: New
  4. Quetiapine: New
  5. Clozapine: New
  6. Thioridazine: Old
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3
Q

Which among the antipsychotics are also effective for bipolar disordes?

A

Olanzapine

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4
Q

What is the general drug class of the ff:

  1. Haloperidol
  2. Chlorpromazine
  3. Fluphenazine
A
  1. Butyrophenones
    2 and 3. Phenothiazines

These drugs can cause durg induced parkinsonism

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5
Q

Based on the dopamine hypothesis how would levodopa affect psychotic patients?

A

Ldopa would exacerbate psychosis by stimulation of the dopamine receptors

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6
Q

What is the only antipscyhotic with NO EFFECT on the H1 receoptor?

A

Haloperidol

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7
Q

Indicated the function of these dopamine utilizing pathways in the brain:

  1. Mesocortical mesolimbic pathways
  2. Tuberoinfundibular pathways
  3. Chemoreceptor trigger zone
  4. Nigostriatial tract
A
  1. Mentation and mood
  2. Control of prolactin release
  3. Emesis
  4. Extrapyramidal function

Pathway #1 is the desired target for psychotic medications old gen

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8
Q

What newer antispsychotics has an almost equal effect on D2 and 5-HT2?

A

Risperidone and Ziprasidone

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9
Q

What symptoms of schizophrenia are not too affected by older gen antipsychotics?

A

Negative symptoms of emotional blunting, social withdrawal and lack of motivation

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10
Q

What are the possible treatment options for extrapyramidal effects of antipsychotics?

A

Muscarinic blockers and diphenhydramine

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11
Q

When do tardive dyskinesias occur?

A

After years of using antipsychotics but can be as early as 6 years

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12
Q

Which of the antipsychotics have has the strongest autonomic effects?

A

Thioridazine and Clozapine have strong effects due to blocakde of muscarinic receptorsa nd alpha adrenoreceptors– atropine like effects: dry mouth, constipation, retention and visual problems

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13
Q

What side effects should be expected from antipsychotics because of their effect on the tuberoinfundibular dopamine pathway?

A

Hyperprolactinemia, gynecomastia, and amenorrhea galactorrhea syndrome

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14
Q

Why does aripiprazole not have common Dopamine blocking side effects?

A

The newer antipsychotic agent aripiprazole is A PARTIAL AGONIST AT D2 and 5-HT1A receptors but is a strong antagonist at 5-HT2A receptors.

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15
Q

What drug is mainly used to treat neuroleptic malignant syndrome?

A

Dantrolene

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16
Q

Block on the alpha adrenoreceptors by antispychotics cause what adverse event that increases fall risk?

A

Orthostatic hypotension

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17
Q

What cardiac adverse effect can be expected with the new generation antipsychotics like quetiapine and ziprasidone?

A

Prolongation of QT interval

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18
Q

Why do blood counts need to be monitored for clozapine?

A

The drug can cause agranulocytosis

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19
Q

How do the ff drugs affect lithium levels: NSAIDS, ACEi, thiazides

A

They can increase lithium to toxic levels

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20
Q

What is the half life of Lithium

A

20h

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21
Q

Which symptoms of bipolar disorder is more affected by lithium?

A

Mania that’s why it is usually give with antidepressants as well

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22
Q

What is the renal adverse effect associated with lithium?

A

Nephrogenic diabetes insipidus

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23
Q

What other drug has antimanic effects equivalent to lithium?

A

Valproic acid

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24
Q

How long after drug initiation should you expect effects of lithium to kick in?

A

1-2 weeks

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25
Q

How can thiazides affect lithium levels?

A

it is a distal tubule diuretic resulting in natriuresis and a reflex increase in in the proximal tubule reabsorption

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26
Q

What other drugs besides VA and Lithium can be used for bipolar disorder?

A

Olanzapine and quetiapine

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27
Q

What antipsychotic can cause retinal deposits?

A

Thrioridazine

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28
Q

Identify the mechanism of action of the following antidepressants:

  1. Escitalopram
  2. Trazodone
  3. Duloxetine
  4. Bupropion
  5. Amitiptyline
  6. Tranylcypromine
A
  1. Escitalopram SSRI
  2. Trazodone Serotonin antagonist
  3. Duloxetine Serotonin Norepinephrine reuptake inhibitors
  4. Bupropion Hetetrocyclic antidepressants
  5. Amitiptyline Tricyclic antidepressants
  6. Tranylcypromine MAO inhibitors
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29
Q

What ist he amine hypothesis of mood?

A

Increased levels of NE and 5HT results in mood elevation and vice versa

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30
Q

Why is there a once weekly formulation of fluoxetine?

A

Because it forms an active metabolite with a half life of several days

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31
Q

Differentiate MAO A and MAO B based on the transmitters that they metabolize.

A

MAO A Norepinephrine, serotonin and tyramine

MAO B Dopamine

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32
Q

How do nefazodone and trazodone work?

A

They inhibit serotonin receptors by blocking these– this CONTRADICTS the amine hypothesis of moood!

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33
Q

How do venlafaxine and duloxetine work?

A

they bind to transporters for both serotonin and NE enhancing the acitons of both transmitters

34
Q

How do escitalopram, fluoxetine and sertraline work? How about duloxetine?

A

E F S: They are SSRI

D: SNRI! Similar mechanism to TCA’s! But structure is different

35
Q

How do imipramine and amitryptyline work?

A

They are TCA– they inhibit the reuptake of NE and Serotonin

36
Q

What is the special MOA of Mirtazapine?

A

It antagonizes the presynaptic alpha 2 adrenoreceptors involved in feedback inhibition

37
Q

What class of antidepressants cause sedation?

A

TCA’s Mirtazapine and 5HT2 receptor antagonists: nefadozone and trazodone

38
Q

What class of antidepressants cause stimulation?

A

SSRIs (fluoxetine, escitalopram, sertraline) and MAOi (Tranylcypromine)

39
Q

What 2 classes of antidepressants lower seizure threshold?

A

TCAs (imipramine, amitriptyline) and MAOi (tranylcypromine)

40
Q

Which group of antidepressants cause weight loss? How about weight gain?

A

LOSS: SSRI’s (Fluoxetine, Escitalopram, Sertraline)

GAIN: Mirtazapine

41
Q

Which antidepressants have evidence for neuropathic pain?

A

SNRI duloxetine

TCA amitriptyline

42
Q

Which antidepressant have evidence for quitting smoking?

A

Bupropion– a heterocyclic with uncertain MOA

43
Q

Which group of antidepressants have the following atropine like effects? Dry as a bone, mad as a hatter, red as beet, hot as a hare, blind as a bat

A

TCA’s (amitriptyline, imipramine) and mirtazapine due to strong M receptor blockade

44
Q

What are the 3 C’s of TCA toxicity?

A

Coma, Convulsions, Cardiotoxicity

45
Q

A patient on these drugs: MAOi, SSRI and TCA’s develop myoclonus, rigidity, hyperthermia, cardiovascular instability, seizures, what happened?

A

The patient developed Serotonin syndrome

46
Q

Withdrawal of which antidepressant can cause severe withdrawal symptoms even after missing a single dose?

A

Venlafaxine SNRI

47
Q

Why should patients on MAOi be cautious in eating aged cheese, cured meats like sausages and salami, fava beans?

A

Because these food contain tyramine, an indirect sympathomimetic –> Hypertensive crises might occur

48
Q

What group of antidepressants causes jitters hence are best taken in the morning?

A

SSRI Escitalopram

49
Q

Can dialysis be used to take out OD of TCA’s?

A

NO. But bicarbonate and potassium can be given for acidosis and hypokalemia

50
Q

Why can’t fluoxetine be given with tamoxifen

A

It inhibits CYP2D6 so lower active tamoxifen

51
Q

Re: Anti-psychotics

  1. What class of drugs end in -apine and -done? Give 2 examples
  2. What class of drugs end in -zine and -dol? Give 3 examples
  3. Enumerate all the bipolar drugs used besides lithium?
A
  1. New agents with 5HT2 receptor affinity: Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone
  2. Old classic drugs with D2 receptor affinity: Haloperidol, Chlorpromazine, Thioridazine, Flulphenazine, Trifluoperazine, Perphenazine
  3. Valproic acid, Carbamazepine, Olanzapine, clonazepam
52
Q

What is the effect of amphetamines and levodopa on psychotic individuals? Why?

A

Exacerbate psychotic symptoms. The dopamine hypothesis of schizophrenia states that there is an excess in the functional functional activity of dopamine.

53
Q

What are the MOA of aripiprazole on D2, 5HT1A, 5HT2A?

A

Partial agonist at D2 and 5HT1A and a strong antagonist at 5HT-2A

54
Q

What is the only anti-psychotic that DOES NOT block the H1 receptor to some degree?

A

Haloperidol

55
Q

What is the MOA of Clozapine?

A

D4 and 5HT2 blocking WITH NO AFFINITY FOR D2 receptors

56
Q

T or F: Almost all anti-psychotics block alpha 1 a1 and histamine H1 receptors to some extent?

57
Q

What are the 4 dopaminergic tracts? Explain how anti-psychotics affect each one.

A
  1. Mesocortical mesolimbic: regulating mentation and mood– responsible for antipsychotic effects
  2. Nigrostriatal tract: extrapyramidal dysfunction
  3. Tuberoinfundibular pathways: control of prolactin release– responsible for hyperprolactinemia in some drugs; Will also cause gynecomastia, amenorrhea galactorrhea as a result
  4. Chemoreceptor trigger zone: emesis– responsible for the antimemetic properties of some drugs
58
Q

What are the only 2 antipsychotics with D4 blocking?

A

Clozapine and aripiprazole

59
Q

Which drug has the strongest muscarinic blocking effect?

A

Thioridazine

2nd is Clozapine but all have some blocking effects

60
Q

What are the two advantages in the use of newer anti-psychotics?

A

With effect on the negative symptoms

Less extra-pyramidal symptoms

BUT MORE EXPENSIVE

61
Q

Which anti-psychotics are approved maintenance for bipolar disorder?

A

Aripiprazole and Olanzapine

62
Q

What are the indications for the use of Molindone besides its use as an antipsychotic?

A

Tourette’s syndrome

Undersocialized conduct disorder

63
Q

What is the only phenothiazine without anti-emetic property?

A

Thioridazine

64
Q

Re: tardive dyskinesia: choreoathetoid movements of lips and buccal cavity

T or F

  1. Can be attenuated temporarily by increasing neuroleptic dose
  2. Can be halted by giving antimuscarinics like in other extrapyramidal effects
65
Q

How do older drugs such as phenothiazenes cause atropine-like effects (dry mouth, constipation, urinary retention, visual problems), postural hypotension and sexual dysfunction?

Which new anti-psychotic has the same intensity of adverse effects?

A

Peripheral blockade of muscarinic receptors

Alpha receptor blockade: atropine life effects and failure to ejaculate

Clozapine has strong M and alpha block as well. Aripiprazole has strong alpha block as well but NO M block

66
Q

T or F Hyperglycemia and weight gain are diabetogenic effects of anti-psychotics.

A

Most with clozapine and olanzapine

Aripiprazole and ziprasidone have LITTLE OR NO TENDENCY to causes these

67
Q

Which anti-pyschotics are the most likely cause the ff:

  1. prolonged QT:
  2. agranulocytosis:
  3. visual impairments from retinal deposits:
A
  1. prolonged QT: the atypicals especially quetiapine and ziprasidone
  2. agranulocytosis: clozapine
  3. visual impairments from retinal deposits: thioridazine
68
Q

What is the half life of lithium?

What is the target therapeutic plasma concentration? Maintenance concentration?

A

20h

  1. 8-1.2mEq/L
  2. 4-0.7mEq/L
69
Q

What are the adverse effects of Lithium?

A
  1. Nephrogenic DI
  2. Ebstein’s anomaly (cardiac) if used during pregnancy– PREGANANCY CATEGORY D
  3. Edema
  4. Acne
  5. Leukocytosis
70
Q

How is lithitum eliminated? What drugs increase clearance?

A

Renal

NSAIDs and thiazides

71
Q

What is the MOA of the ff:

  1. Duloxetine
  2. Fluoxetine
  3. Venlafaxine
  4. Nefadozone
  5. Tradozone
A
  1. Duloxetine: 5HT and NE reupotake inhibitor
  2. Fluoxetine: SSRI
  3. Venlafaxine: 5HT and NE reupotake inhibitor
  4. Nefadozone: Serotonin antagonist
  5. Tradozone: Serotonin antagonist
72
Q

What is the MOA:

  1. Buproprion
  2. Mirtazapine
  3. Clomipramine
  4. Amitriptyline
  5. Phenelzine
  6. Tranylcypromine
A
  1. Buproprion: Heterocyclic antidepressant
  2. Mirtazapine: Heterocyclic antidepressant– blocks the alpha 2 adrenoreceptor involved in feedback inhibition of norepinephrine release
  3. Clomipramine: TCA
  4. Amitriptyline: TCA
  5. Phenelzine: MAOi
  6. Tranylcypromine: MAOi
73
Q

What are the functions of MAO A and MAO B?

A

A: metabolizes NE, 5HT, tyramine
B: metabolizes dopamine

Selegiline is selective for B for dopamine

74
Q

How do SNRIs differ from TCAs?

A

While both NE and 5HT is increased in the synaptic junction they DONT HAVE BLOCKING EFFECTS ON H1 AND Alpha receptors

75
Q 
Which of these are sedating and which are CNS stimulating?
TCAs
Mirtazapine
5HT2 receptor antagonists
MAOIs
SSRIs
Buproprion
A

Sedating
TCA
Mirtazapine
5HT2 receptor antagonists

Stimulating
MAOIs
SSRIs
Buproprion

76
Q

What antidepressant can be used for weaning off nicotine dependence?

77
Q

What are the 3 Cs of TCA toxicity?

A

Come
Convulsions
Cardiotoxicity

78
Q

What 2 antidepressants when taken together can cause serotonin syndrome?

A

MAOIs and SSRIs

A serotonin syndrome was first described for an interaction between fluoxetine and an MAOI (see later discussion). This life-threatening syndrome includes severe muscle rigidity, myoclonus, hyperthermia, cardiovascular instability, and marked CNS stimulatory effects, including seizures.

79
Q

Which is the most sedating antidepressant with the strongest muscarinic receptor block?

A

Amitriptyline

80
Q

Which group of anti-depressants have NO sedating or muscarinic receptor blockade?

A

SNRIs and SSRIs

Brain Power: Neuropharmacology (5 decks)

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