Psychiatry - Pharmacology

Question 1

What is the drug class of choice for treating anorexia and bulimia?

Answer 1

Selective serotonin reuptake inhibitors

Question 2

What are the three first-line drug classes for the treatment of anxiety?

Answer 2

Selective serotonin reuptake inhibitors, benzodiazepines, and buspirone

Question 3

What are the three first-line drugs (all mood stabilizers) for the treatment of bipolar disorder?

Answer 3

Lithium, valproic acid, and carbamazepine; atypical antipsychotics can also be used

Question 4

What are the three first-line drug classes for the treatment of depression?

Answer 4

Serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants

Question 5

A patient presents with depressed mood, decreased interest, decreased appetite, and poor sleep. He reports sleeping only approximately 3 hours a night. What are two treatment options for this patient?

Answer 5

Trazodone and mirtazapine; both are sedating antidepressants

Question 6

What two drug classes are used in the treatment of atypical depression?

Answer 6

Monoamine oxidase inhibitors and selective serotonin reuptake inhibitors

Question 7

What drug classes are used in the treatment of panic disorder?

Include first-line and second-line treatment options.

Treatment choice depends on the severity and patient-specific factors.

Answer 7

Selective serotonin reuptake inhibitors, tricyclic antidepressants, and benzodiazepines

SSRIs are first-line; TCAs and benzodiazepines are alternative options.

Benzodiazepines are often used for short-term relief due to dependence risk.

Question 8

What two drugs or drug types are used in the treatment of obsessive-compulsive disorder?

Answer 8

Selective serotonin reuptake inhibitors and clomipramine

Question 9

What is the drug class of choice for the treatment of schizophrenia?

Answer 9

Antipsychotics; typical or atypical

Question 10

What is the treatment for Tourette’s syndrome?

Answer 10

Antipsychotics; often haloperidol

Question 11

What are the two drugs (one is a drug class) used to treat attention-deficit hyperactivity disorder?

Answer 11

Methylphenidate and amphetamines

Question 12

A Vietnam War veteran presents with flashbacks, nightmares, and avoidance of his closet where his wife keeps his uniform. What is a treatment option for this patient?

Answer 12

Selective serotonin reuptake inhibitors could be used to treat his posttraumatic stress disorder

Question 13

Explain the mechanism of action of methylphenidate.

Answer 13

It increases presynaptic norepinephrine vesicular release (like amphetamines) and is used to treat attention-deficit hyperactivity disorder

Question 14

Name the typical antipsychotics

Answer 14

Thioridazine, haloperidol, fluphenazine, trifluoperazine, and chlorpromazine

Question 15

How do antipsychotics cause galactorrhea?

Answer 15

Dopamine receptor antagonism releases inhibition on the prolactin-secreting cells of the pituitary

Question 16

Approximately 4 weeks ago, a patient started taking a neuroleptic medication. She now states that she is unable to sit still and that she has a desire to be constantly fidgeting and moving. What adverse effect is she experiencing?

Answer 16

Akathisia

Question 17

What adverse effect of neuroleptic medications is characterized by the inability to initiate purposeful movement?

Answer 17

Akinesia

Question 18

What are the symptoms of acute dystonia? When does dystonia develop after use of neuroleptics?

Answer 18

Abnormal muscle contractions and involuntary twisting movements; it usually develops 4 hours after drug administration

Question 19

Typical antipsychotics block which receptors?

Answer 19

D₂-dopamine receptors

Question 20

What extrapyramidal adverse effect of neuroleptics is irreversible?

Answer 20

Tardive dyskinesia

Question 21

A patient presents with rigidity, myoglobinuria, autonomic instability, and hyperpyrexia after recently starting a medication for schizophrenia. What adverse effect is this patient experiencing?

Answer 21

Neuroleptic malignant syndrome; he should be treated with dantrolene and bromocriptine

Question 22

The antimuscarinic effects of neuroleptics cause what adverse effects?

Answer 22

Dry mouth and constipation

Question 23

The antihistamine effects of neuroleptics cause what adverse effect?

Answer 23

Sedation

Question 24

Blockade of the α-receptors by neuroleptics cause what adverse effect?

Answer 24

Hypotension

Question 25

What is the treatment for neuroleptic malignant syndrome?

Answer 25

Dopamine agonists and dantrolene

Question 26

Which neuroleptics are low-potency drugs with a low incidence of neurologic adverse effects?

Answer 26

Thioridazine and chlorpromazine

Question 27

Which neuroleptics are high-potency drugs with neurologic adverse effects?

Answer 27

Haloperidol, fluphenazine, and trifluoperazine

Question 28

Place the following extrapyramidal adverse effects of neuroleptics in the order in which they occur: akathisia, akinesia, dystonia, tardive dyskinesia.

Answer 28

Dystonia (within 4 hours), akinesia (within 4 days), akathisia (within 4 weeks), and tardive dyskinesia (after 4 months)

Question 29

In reference to neuroleptic malignant syndrome, what is the FEVER mnemonic?

Answer 29

**FEVER**: **F**ever, **E**ncephalopathy, **V**itals unstable, **E**levated enzymes, **R**igidity of muscles

Question 30

Which two neuroleptics cause ocular adverse effects?

Answer 30

Thioridazine causes retinal deposits whereas chlorpromazine causes corneal deposits

Question 31

What is the reason for the long half-life of neuroleptics?

Answer 31

They are highly lipid soluble, so there is a large volume of distribution; therefore, it takes a long time for them to be removed from the body

Question 32

Name the atypical antipsychotics.

Answer 32

Clozapine, olanzapine, and risperidone

Question 33

A patient on haloperidol experiences torticollis and tremor. What is an alternative treatment option?

Answer 33

Atypical antipsychotics, because these drugs have a lower risk of extrapyramidal symptoms

Question 34

What blood tests do patients need if they are taking clozapine?

Answer 34

They need periodic complete blood cell tests since clozapine can cause agranulocytosis

Question 35

What are the indications for atypical antidepressant use?

Answer 35

Schizophrenia, mania, Tourette's syndrome, and obsessive-compulsive disorder

Question 36

Atypical antidepressants useful in treating _____ (positive/negative/both) types of schizophrenia symptoms.

Answer 36

Both ## Footnote typical antipsychotics are useful only in treating positive symptoms

Question 37

What is the most common adverse effect of long-term atypical antipsychotic use?

Answer 37

Severe weight gain, which can lead to type II diabetes

Question 38

True or False? Olanzapine is contraindicated in the treatment of mania.

Answer 38

FALSE ## Footnote olanzapine can be used to treat mania

Question 39

Atypical antipsychotic medications block what type of receptors in addition to dopamine receptors?

Answer 39

5-hydroxytryptamine₂, α, H1

Question 40

Lithium is primarily used to treat patients with what psychiatric diagnosis?

Answer 40

Bipolar disorder

Question 41

A patient with a history of bipolar disorder, controlled with lithium, presents with massively increased urination and thirst. Can this patient be treated with exogenous antidiuretic hormone?

Answer 41

No, this patient is suffering from nephrogenic diabetes insipidus secondary to lithium use, which will not respond to antidiuretic hormone

Question 42

In what population is lithium absolutely contraindicated?

Answer 42

Pregnant women

Question 43

What lab test should be ordered on a patient taking lithium who complains of lethargy, constipation, and feeling cold?

Answer 43

Thyroid-stimulating hormone test; lithium can cause hypothyroidism

Question 44

What might be seen on an electrocardiogram of a patient taking lithium?

Answer 44

Electrocardiogram consistent with heart block

Question 45

What are the toxicities of lithium use?

Answer 45

Tremor, nephrogenic diabetes insipidus, hypothyroidism, teratogenicity (remember: **LMNOP** to recall **L**ithium adverse effects, **M**ovement [tremor], **N**ephrogenic diabetes insipidus, Hyp**O**thyroidism, **P**regnancy problems)

Question 46

What is the mechanism of action of buspirone (a psychiatric medication)?

Answer 46

It stimulates serotonin receptors (class 1A receptors)

Question 47

What is buspirone used for clinically?

Answer 47

Anxiolysis; it is commonly used to treat generalized anxiety disorder

Question 48

What adverse effects are avoided with use of buspirone?

Answer 48

Sedation, addiction, and tolerance, which are seen with benzodiazepines and barbiturates

Question 49

True or False? Patients treated with buspirone must avoid alcohol.

Answer 49

FALSE ## Footnote buspirone does not interact with alcohol, but most other treatments for anxiety (eg, barbiturates, benzodiazepines) do

Question 50

Do monoamine oxidase inhibitors work on noradrenergic neurons, serotonergic neurons or both?

Answer 50

Both

Question 51

Both tricyclics and maprotiline act on which type of neuron?

Answer 51

Noradrenergic

Question 52

Selective serotonin reuptake inhibitors and trazodone act on which type of neuron?

Answer 52

Serotonergic

Question 53

Mirtazapine acts on what type of neuron and specifically, which receptor on that neuron?

Answer 53

Noradrenergic neuron; α₂ receptor

Question 54

Name the tricyclic antidepressants.

Answer 54

Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, and amoxapine

Question 55

A 17-year-old male presents with nocturnal bedwetting. What antidepressant is a treatment option for this patient?

Answer 55

Imipramine

Question 56

Which tricyclic antidepressant is specifically indicated for obsessive-compulsive disorder?

Answer 56

Clomipramine

Question 57

What are the major toxicities of tricyclic antidepressant overdose?

Answer 57

Convulsions, coma, and cadiotoxicity (remember: **Tri-C**'s: **C**onvulsions, **C**oma, **C**ardiotoxicity [arrhythmias])

Question 58

An elderly patient presents to the emergency room with delirium associated with hallucinations of her deceased husband. She recently started a new drug for depression. What could cause her presentation?

Answer 58

The anticholinergic effects of her depression treatment (tricyclic antidepressant)

Question 59

Tricyclic antidepressants block the reuptake of what two neurotransmitters?

Answer 59

Serotonin and norepinephrine

Question 60

What is the least sedating tricyclic antidepressant?

Answer 60

Desipramine

Question 61

What adverse effects of tricyclic antidepressants are the result of anticholinergic action?

Answer 61

Tachycardia and urinary retention

Question 62

What tricyclic antidepressant should be used in the elderly to treat depression, to lessen the chances of anticholinergic adverse effects?

Answer 62

Nortriptyline

Question 63

How is tricyclic antidepressant toxicity treated?

Answer 63

Intravenous NaHCO₃ to prevent cardiac arrhythmias

Question 64

Name the selective serotonin reuptake inhibitors.

Answer 64

Fluoxetine, sertraline, paroxetine, and citalopram

Question 65

Selective serotonin reuptake inhibitors are indicated in the treatment of which conditions?

Answer 65

Obsessive-compulsive disorder, bulimia, social phobias, and depression

Question 66

It normally takes how many weeks for an antidepressant to show some clinical benefit?

Answer 66

2-3 weeks

Question 67

What are the common adverse effects of selective serotonin reuptake inhibitors?

Answer 67

Gastrointestinal upset, sexual adverse effects

Question 68

A patient on treatment for depression presents with a temperature of 105° F and rigidity. What is the treatment for this condition?

Answer 68

Cyproheptadine, a serotonin receptor antagonist

Question 69

Which sexual side-effect is seen with selective serotonin reuptake inhibitors?

Answer 69

Anorgasmia, the inability to have an orgasm

Question 70

If a person is taking both a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor, what is the potential serious adverse effect?

Answer 70

Serotonin syndrome (muscle rigidity, hyperthermia, and cardiovascular collapse)

Question 71

Name two serotonin-norepinephrine reuptake inhibitors.

Answer 71

Venlafaxine, duloxetine

Question 72

What effects do serotonin-norepinephrine reuptake inhibitors have on neurons?

Answer 72

Inhibition of serotonin and norepinephrine reuptake

Question 73

What are the indications for venlafaxine?

Answer 73

Depression and generalized anxiety disorder

Question 74

What are the indications for duloxetine?

Answer 74

Depression and diabetic peripheral neuropathy

Question 75

What are the adverse effects of serotonin-norepinephrine reuptake inhibitors?

Answer 75

Increased blood pressure, sedation, nausea

Question 76

Name the monoamine oxidase inhibitors.

Answer 76

Phenelzine and tranylcypromine

Question 77

Which drugs must be avoided while taking monoamine oxidase inhibitors to prevent a hypertensive crisis?

Answer 77

α-Adrenergic agonists

Question 78

What is the mechanism of action of monoamine oxidase inhibitors?

Answer 78

Inhibition of monoamine oxidase prevents breakdown of neurotransmitters

Question 79

To prevent serotonin syndrome, patients should avoid which drugs while taking monoamine oxidase inhibitors?

Answer 79

Selective serotonin reuptake inhibitors and meperidine

Question 80

What psychiatric disorders are monoamine oxidase inhibitors used to treat?

Answer 80

Atypical depression, anxiety, hypochondriasis

Question 81

What foods must be avoided while on monoamine oxidase inhibitors? Why?

Answer 81

Wine and cheese ## Footnote wine and cheese are high in tyramine that can lead to hypertensive crisis if ingested while taking monoamine oxidase inhibitors

Question 82

Which heterocyclic antidepressant is also used in smoking cessation programs?

Answer 82

Bupropion

Question 83

True or False? Sexual adverse effects are major adverse effects of bupropion.

Answer 83

FALSE ## Footnote bupropion is the one heterocyclic antidepressant that does not cause sexual adverse effects

Question 84

Maprotiline, a heterocyclic antidepressant, blocks the reuptake of what substance?

Answer 84

Norepinephrine

Question 85

A patient presents with priapism after starting an antidepressant medication for insomnia and depression. What medication is this patient taking?

Answer 85

Trazodone, which is a heterocyclic antidepressant

Question 86

Bupropion is contraindicated in what patients?

Answer 86

Patients with bulimia or history of seizure disorders

Question 87

Why might a patient complaining of sedation with a prior antidepressant be prescribed bupropion?

Answer 87

Bupropion may cause insomnia

Question 88

What neurotransmitter receptors are blocked by mirtazapine?

Answer 88

An a₂ - and serotonin antagonist

Question 89

What are the adverse effects of mirtazapine?

Answer 89

Sedation, increased appetite, weight gain, dry mouth

Question 90

What effect does trazodone have on neurons?

Answer 90

Inhibits serotonin reuptake

Question 91

What are the adverse effects of maprotiline?

Answer 91

Sedation, orthostatic hypotension

Question 92

Which antidepressant is commonly used for insomnia?

Answer 92

Trazodone

Question 93

What are the adverse effects of trazodone?

Answer 93

Sedation, nausea, priapism, postural hypotension