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V Med > Psychiatry (Antipsychotics, Anti-Anxiety, Antidepressants) *not Complete > Flashcards

Psychiatry (Antipsychotics, Anti-Anxiety, Antidepressants) *not Complete Flashcards

1
Q

Can cause anticholinergic and metabolic side effects
Better at treating negative symptoms

A

2nd gen Antipsychotics

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2
Q

D2 and serotonin receptors antagonist; SDA
 Also antagonize histamine and alpha 2 receptors

A

2nd gen antipsychotics

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3
Q

Dopamine receptor antagonist
 Can cause extrapyramidal side effects  Better at treating positive symptoms

A

FIRST GENERATION antipsychotics

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4
Q

Positive symptoms:

A

o Delusions
o Hallucinations
o Disorganized speech
o Bizarre behavior

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5
Q

Negative symptoms:

A

o Flat affect
o Poverty of speech
o Anhedonia
o Apathy

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6
Q

Involved in motor planning

A

Nigro-striatal

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7
Q

Decreased in treatment with first generation antipsychotics:

A

o Dystonia
o Akathisia
o Parkinsonism
o Tardive dyskinesia

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8
Q

Increased activity in Schizophrenia/psychosis

A

MESOLIMBIC

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9
Q

Decreased activity in Schizophrenia/psychosis

A

MESO- CORTICAL

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10
Q

Orthostatic hypotension
Cardiac arrythmias
Sexual dysfunction

A

Alpha ADRENERGIC antipsychotic non-dopamine effects

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11
Q

Atypical Antidepressants

A

Bupoprion (NDRI)
Trazodon, Nefazodone (SARI)
Mirtazapine

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12
Q

Readily absorbed; peak plasma conc = 2 hours; half lives: 2-3 hours
o Because of irreversible action, therapeutic effect of a single dose may persist for as long as 2 weeks.

A

Phenelzine, Isocarboxacid, Tranylcypromine

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13
Q

Selective, reversible inhibitors of MAO-A o Rapidly absorbed; half-life of .5 to 3.5 hours o Briefer clinical effect; reversible

A

Moclobemide (RIMA)

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14
Q

Treatment of TYRAMINE-INDUCED HYPERTENSIVE CRISIS

A

alpha adrenergic antagonist eg. Phentolamine and
Chlorpromazine – lowers BP within 5 minutes

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15
Q

Treatment of TYRAMINE-INDUCED HYPERTENSIVE CRISIS

A

alpha adrenergic antagonist eg. Phentolamine and
Chlorpromazine – lowers BP within 5 minutes

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16
Q

Management of orthostatic hypotension

A

Fludrocortisone0.1 to 0.2 mg per day
Avoidance of caffeine
o Intake of 2L of fluids per day
o Addition of dietary salt or adjustment of antihypertensive drugs
o Support stockings

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17
Q

Adverse effects of MAOIs

A

Orthostatic hypotension

Non-tyramine induced hypertensive crisis (tranylcypromine) –
should avoid MAOI’s

Paresthesias

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18
Q

Drug Interaction:
📌Potentiates action of CNS depressants, increase alcohol and barbiturates;
📌With SSRI and Anafranil – triggers serotonin syndrome
📌Fatal reactions when combined with Meperidine or fentanyl

A

MAOIs

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19
Q

reduce elimination of Moclobemide.

A

Cimetidine and Fluoxetine

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20
Q

False-positive test results for pheochromocytoma or neurobastoma

A

MAOIs

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21
Q

derivative of antipsychotic drug Loxapine

A

Amoxapine

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22
Q

derivative of antipsychotic drug Loxapine

A

Amoxapine

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23
Q

Tetracyclics

A

o Amoxapine- derivative
o Maprotiline
o Mianserine

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24
Q

TRICYCLICS: three-ring nucleus
o Tertiary amines

A

Imipramine, amitriptyline, clomipramine, trimipramine
and doxepin

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25
Q

Secondary amines- TRICYCLICS

A

Desipramine, nortriptyline and protriptyline

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26
Q

block reuptake pumps for both 5HT and NE and dopamine at
nerve terminal, thus increasing NE, 5HT and DA at extracellular and more of its action at the receptor site

A

Tricyclics

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27
Q

more potency for inhibition of 5HT uptake pump

A

clomipramine, imipramine, amitryptyline)

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28
Q

more potency for inhibition of NE uptake pump (

A

nortriptyline,
desipramine)

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29
Q

also block Na+channels, thus may cause cardiac arrythmia

A

Tricyclics

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30
Q

Competitive antagonists at muscarinic acetylcholine, histamine H1, and
alpha-1 and alpha-2 receptors

A

Tricyclics and Tetracyclics

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31
Q

TCAs with longer half lives

A

nortriptyline, maprotiline and protriptyline has longer
half-lives;

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32
Q

Imipramine indications

A

Panic Disorder with Agoraphobia - Imipramine

Eating Disorders – Imipramine and Desipramine

Childhood enuresis – Imipramine

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33
Q

TCA for
OCD
Premature ejaculation, Movement disorders

A

Clomipramine

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34
Q

TCA for
Generalized Anxiety Disorder
Peptic Ulcer Disease

A

Doxepin

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35
Q

most
anticholinergic TCA drugs;

A

Amitryptiline, Imipramine trimipramine and doxepin,

All except Imipramine most sedating too

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36
Q

Orthostatic hypotension, profuse sweating, palpitations and increased BP
 Tachycardia, flattened T waves, prolonged QT intervals, depressed ST
segments
Adverse effects of

A

TCAs

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37
Q

Psychomotor stimulation – myoclonic
twitches and tongue tremors

A

Desipramine and protriptyline

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38
Q

Parkinsonian symptoms and impotence –

A

Amoxapine

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39
Q

TCA plasma conc. Inc by

A

acetazolamide, aspirin, thiazide, cimetidine,
fluoxetine and sodium bicarbonate

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40
Q

TCA + With sympathomimetic drugs

A

– serious cardiovascular effects

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41
Q

TCA With methyldopa

A

– behavioral agitation

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42
Q

Fluoxetine ()

A

Prozac

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43
Q

Sertraline ()

A

Zoloft

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44
Q

____ has longest half-life (2 – 3 days) and its active metabolite has a
half-life of ______

A

Fluoxetine 7 to 9 days

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45
Q

Paroxetine and Fluoxetine metabolized by

A

CYP 2D6

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46
Q

Paroxetine and Fluoxetine metabolized by

A

CYP 2D6

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47
Q

Fluvoxamine inhibits CYP 3A4 - should not be given with

A

Terfenadine and
Astemizole

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48
Q

SSRI for Social Phobia –

A

Paroxetine

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49
Q

Fluoxetine adverse effects (AE)

A

Headaches
Anxiety
Insomnia
Tremors
Reversible neutropenia

50
Q

Paroxetine AE

A

Anticholinergic effects

Hematological – increased bruisability (platelet function); Paroxetine and
fluoxetine cause reversible neutropenia

51
Q

concurrent administration with MAOIs, tryptophan,
lithium or other antidepressants

A

Serotonin Syndrome

52
Q

most likely to cause discontinuation syndrome, because
plasma concentration drop rapidly in the absence of continuous dosing

A

Paroxetine

53
Q

Decreases the metabolism of Carbamazepine, anti-
neoplastic agents, Diazepam and phenytoin

 Significant interactions with benzodiazepines,
antipsychotics and lithium

A

FLUOXETINE

54
Q

Decreases the metabolism of Carbamazepine, anti-
neoplastic agents, Diazepam and phenytoin

 Significant interactions with benzodiazepines,
antipsychotics and lithium

A

FLUOXETINE

55
Q

May displace Warfarin from plasma proteins and cause
increase prothrombin time.

A

SERTRALINE

56
Q

Phenobarbital and Phenytoin may decrease its
concentration
Increase anticoagulant effect of Warfarin

A

PAROXETINE

57
Q

Has the most risk for drug-drug interaction
 Metabolized by enzyme CYP 3A4 which may be inhibited
by Ketoconazole;

A

FLUVOXAMINE

58
Q

Has the most risk for drug-drug interaction
 Metabolized by enzyme CYP 3A4 which may be inhibited
by Ketoconazole;

A

FLUVOXAMINE

59
Q

FLUVOXAMINE + Terfenadine

A

Cardiotoxicity

60
Q

Fluvoxamine increases concentration of:

A

alprazolam, triazolam,
and diazepam - increases half-lives, should not be coadmin

If used with Warfarin and Theophylline, increased two folds and three folds, respectively.

Raises concentrations and may increase the activity of
clozapine, carbamazepine, methadone, propanolol and
diltiazem.

61
Q

Cimetidine increases its concentrations by 40%
 Increases plasma concentrations of metoprolol by twofolds
with no significant effects on blood pressure or heart rate.

A

CITALOPRAM

62
Q

Sometimes referred to as “dual reuptake inhibitors”  Relative lack of affinity for other receptors, esp. muscarinic, histaminergic, α-
and β-adrenergic receptors

A

SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)

63
Q

formulated as a delayed-release capsule to reduce the risk of
severe nausea

A

Duloxetine

64
Q

Nausea is the most frequently reported treatment emergent AE
Precautions: ECG changes, - prolonged QT and QRS interval BBB,
tachy/bradycardia, hypo/hypertension, coma, seizures

A

VENLAFAXINE / DESVENLAFAXINE succinate (DVS)

65
Q

Metabolized primarily by CYP2D6, but weak inhibitor of enzyme

Indicated for:
Depression
Generalized Anxiety Disorder
Social Anxiety D/O
Others :
o OCD, Panic disorder, ADHD, with dual diagnosis of depression and cocaine dependence

A

VENLAFAXINE / DESVENLAFAXINE

66
Q

Neuropathic pain associated with diabetes – first drug to be approved

Also indicated for depression and stress urinary incontinence

A

Duloxetine

67
Q

AE that most commonly lead to treatment
discontinuation of Duloxetine

A

Nausea

68
Q

Metabolized primarily by CYP2D6, but moderate inhibitor of enzyme

Increases blood sugar and hemoglobin A1C levels during
long term treatments;
 Should not be given with substantial alcohol use because
of possible hepatic effect

A

Duloxetine

69
Q

only FDA-approved for the treatment of FIBROMYALGIA.

A

Milnacipram

70
Q

approved in 2013 for treatment of MDD.

A

Levomilnacipram

71
Q

The only dose-related adverse events of MILNACIPRAN AND LEVOMILNACIPRAN
were

A

urinary hesitation and erectile
dysfunction.

72
Q

Inhibits NE and dopamine reuptake; it binds to dopamine transporter in the
brain

A

Buproprion

73
Q

THERAPEUTIC INDICATIONS

Depression, Bipolar Disorders, ADHD, Cocaine Detoxification, Smoking Cessation
A

Buproprion

74
Q

May be combined with Eskalith for refractory depression

A

Bupropion

75
Q

Major 2nd line agent for ADHD
Also Effective for patients who cannot tolerate side effects of SSRIs such as sexual
dysfunction or nonresponders of SSRIs

A

Bupropion

76
Q

False-positive results on urinary amphetamine screens

Contraindicated in persons with histories of substance abuse

A

Bupropion

77
Q

Bupriopion +levodopa, pergolide

A

Delirium, psychosis, dyskinesia

78
Q

Bupriopion +levodopa, pergolide

A

Delirium, psychosis, dyskinesia

79
Q

Bupropion With Prozac (Fluoxetine) –

A

panic, delirium and seizure

80
Q

decreases plasma concentration of bupropion

A

Carbamazepine

81
Q

Weak inhibitor of serotonin reuptake and a potent antagonist of Serotonin 2A
and 2C receptors;

A

Trazodone

82
Q

First line agent for insomnia

A

Trazodone

83
Q

Indicated for:

Depressive Disorders -
Insomnia – first line agent
Erectile disorder – can potentiate erections
Others: severe agitation in children with development
disabilities and elderly persons with dementia; depression
in patients with Schizophrenia; insomnia and nightmares in
PTSD

A

Trazodone

84
Q

Active metabolite of trazodone

agonist of Serotonin 2C receptors ; half-life of 14
hours

A

mCPP

85
Q

Adverse reactions of Trazodone

A

Sedation, orthostatic hypotension, dizziness, headache
and nausea
 Neutropenia

86
Q

Treatment of Trazodone overdose

A

emesis or lavage and supportive care; forced diuresis

87
Q

Increases level of digoxin and phenytoin

A

Trazodone

88
Q

Trazodone +anti-HPN =

A

hypotension

89
Q

Trazodone +anti-HPN =

A

hypotension

90
Q

are powerful 5HT2Aantagonists but are not potent antidepressants

But blockade of 5HT2Areceptors stimulate 5HT1Areceptors, which may help
reduce depression

A

Nefazodone

91
Q

Effective in treatment of depression accompanied by anxiety; Premenstrual dysphoric disorder, Chronic pain(both neuropathic and nonneuropathic, PTSD, chronic
fatigue syndrome

A

Nefazodone

92
Q

Nausea, dizziness, insomnia, weakness and agitation AE

A

Nefazodone

93
Q

Nefazodone + Triazolam and Alprazolam

A

Inhibition of CYP450 3A4

94
Q

Mirtazapine most common AE

A

Somnolence, to be given at bedtime

95
Q

Therapeutic Indications: Depression, Sleep disturbances, Somatic and
psychological symptoms of anxiety and agitation

A

Mirtazapine

96
Q

Blocks alpha 2 receptors and selectively antagonize 5HT2 and 5HT3
receptors.

otent antagonist of histamine receptors (H1), less alpha 1 adrenergic and
muscarinic-cholinergic receptors

A

Mirtazapine

97
Q

Mirtazapine is what type

A

SEROTONIN NOREPINEPHRINE DISINHIBITORS (SNDIs)

98
Q

Mirtazapine is what type

A

SEROTONIN NOREPINEPHRINE DISINHIBITORS (SNDIs)

99
Q

Increase appetite; increase cholesterol concentration to 20% or more above
the upper limit; elevated ALT (alanine transaminase) more than three times
the upper limit (potentiates alcohol)

 Drop in absolute neutrophil count; agranulocytosis

A

Mirtazapine

100
Q

Reduces plasma NE; inhibits sympathetic outflow; vasodilation of BV: antihypertensive

Reset body sympathetic tone at lower level and decrease arousal.

A

α2- ADRENERGIC RECEPTOR AGONISTS CLONIDINE AND GUANFACINE

101
Q

Well absorbed from GIT; peak plasma level:1-3 hours

6 to 20 hours
More adverse sedation and hypotension

A

Clonidine

102
Q

Well absorbed from GIT; peak plasma level:1-3 hours

6 to 20 hours
More adverse sedation and hypotension

A

Clonidine

103
Q

Well absorbed from GIT; peak plasma level:1-3 hours
HALF-LIFE 10 to 30 hours

A

Guanfacine

104
Q

0.1-0.2 mg bid –qid before detoxification, tapered off 1-2 weeks

Reduce craving, anxiety and irritability of nicotine
withdrawal

A

Clonidine

And guanfacine

105
Q

Clonidine and guanfacine are indicated in

A

Withdrawal from opiois, alcohol, BDZ, or Nicotine

Tourette’s
Other tic disorders
Hyperactivity and agression in children
PTSD
Others: Panic disorders, phobias, OCD, generalized anxiety d/o mania, Schizophrenia and tardive dyskinesia, Hallucinogen-persisting perceptive disorders

106
Q

Which has milder AE, clonidine or guanfacine?

A

Guanfacine

107
Q

inhibit hypotensive effects of Clonidine

A

TCACs

108
Q

A2 adrenergic receptor agonists + Beta blockers , Ca channel blockers, and digitalis

A

increases
the risk of AV block and bradycardia

109
Q

Acts by binding to GABA A receptors which opens chloride channels and
reduces the rate of neuronal and muscle firing.

Act as hypnotics in high doses and as sedative in low doses

A

Benzodiazepine

110
Q

Drug of choice for management of acute anxiety and agitation.

A

Benzodiazepine

111
Q

All BZD are completely absorbed unchanged from the GIT except for

A

Clorazepate

112
Q

BZD that have rapid and reliable absorption
following IM administration

A

Lorazepam
Midazolam

113
Q

BZD with 10-15 hrs half-life

A

Alprazolam

114
Q

Advantages of long half-life BZD

A

Less Frequent Dosing
Less Variation in Plasma
Less Severe Withdrawal Phenomena

115
Q

Benzodiazepine agonists at BZ2 site; Selective on subunits of GABA receptor  Rapidly and well-absorbed, although can be delayed for as much as 1 hour if taken with food

A

ZOLPIDEM and ZALEPLON and ESZOPICLONE

116
Q

ZOLPIDEM and ZALEPLON and ESZOPICLONE are solely indicated for

A

Insomnia

117
Q

very lipid-soluble and highlyprotein bound and very large
distribution of unbound drug hence shorter duration of action.

A

Diazepam (over lorazepam)

118
Q

most commonly
used BZD for seizure disorder.

A

Lorazepam and diazepam

119
Q

High potency for panic disorder

A

Alprazolam
Clonazepam

120
Q

BZD for catatonia

A

Lorazepam

121
Q

BZD for alcohol withdrawal

A

Chlordiazepoxide (Librium) and Clorazepate (Tranxene)

122
Q

Shortest half-life BZD
For insomnia of mild rebound anxiety

A

Triazolam

V Med (6 decks)

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