Psychopharm

Question 1

Effects of 5HT-1a (partial agonist)

Answer 1

Reduces anxiodepressive synptoms
Improves cognition

Question 2

Effects of 5HT-2a (antagonist)

Answer 2

Reduces negative symptoms
Improves EPS
Increases NE and DA

Question 3

5HT-2C antagonism

Answer 3

Reduces anxious and negative symptoms
Increase DA
Improves cognitive function
Hypotension
Sedation
Weight gain

Question 4

Which receptor inhibits sexual function

Answer 4

5-HT2a receptor

Question 5

5HT3

Answer 5

GI effects

Question 6

Alpha 1 antagonist

Answer 6

OrthoHTN
Dizziness
Reflex tachy
Sedatiob
Hypersalivation
Urinary incontinence
Priapism

Question 7

Receptor responsible for priapism

Answer 7

Adrenergic Alpha 1 antagonism

Question 8

Alpha 2 agonism

Answer 8

Improves cognitive performance

Question 9

Alpha 2 antagonism

Answer 9

CNS activation
Possible decrease in depressive symptoms (increase NE via alpha 2 pre-synaptic antagonism), sexual dysfunction

Question 10

H1 antagonism

Answer 10

Anti-emetic
Sedatiob
Weight gain
Orthostatic hypotension

Question 11

Muscarinic M1 antagonism

Answer 11

Decrease EPS
Dry mouth (long term cavities, gingivitis)
Blurry vision
Constipation
Sinus tachycardia
Memory impairment
Sedation

Question 12

Abilify MoA

Answer 12

D2 partial agonist
5HT1a partial agonist
5HT2a antagonist

Question 14

SSRIs least drug interactions*

Answer 14

Citalopram, Escitalopram, Sertraline

Question 15

SSRIs most protein bound*

Answer 15

Sertraline, Fluoxetine, Paroxetine

Question 16

SSRI least protein bound*

Answer 16

Escitalopram

Question 17

Mirtazapine MoA

Answer 17

Alpha-2 presynaptic antagonist
5HT2a antagonist
5HT2c antagonist
5HT3 antagonist
H1 antagonist

*no effect on reuptake of 5HT

Question 18

**Selegiline MoA

Answer 18

**Selegine - irreversible MAOi-B

Deaminates DA - interacts w tyramine

Question 19

Moclobemide MoA

Answer 19

Moclobemide- reversible MAOi- A ad 600mg/day

Deaminates NE & 5HT

at nigher doses Moclobemide blocks MAO-B, therefore need to diet

Question 20

Phenelzine MoA

Answer 20

irreversible MAOi (both A, B)

Question 21

Tranylcypromine MoA

Answer 21

irreversible MAOi (both A, B)

Question 22

MAO enzyme types

Answer 22

*MAO-A:
-Metabolizes 5HT, NE, Epinephrine, DA
deamination NE and 5HT (DA only at higher doses)

*MAO-B
-Metabolizes dopamine and tyramine
-Deaminates DA - interaction w tyramine

Question 23

MAO-i common side effects

Answer 23

*Orthostatic hypotension
*Edema
weight gain
Insomnia
Sexual dysfunction

Moclobemide : no sexual dysfunction
Tranylcypromine: can cause vit B6 deficiency w paresthesia

Question 24

**Tyramine foods

Answer 24

Fermented products (cheese)
Meats/charcuterie
Fruit/vegetables - banana, figs, avocado
Soya products - tofu
Alcoholic drinks - red wine

Question 25

MAOi half-life

Answer 25

IMAOi = 2-3h
rMAOi = 0.5-3.5h

Question 26

Timeline switch:

I-MAOi–> antidepressant

Antidepressant —> I-MAOi

Answer 26

I-MAOi–> ATD = wait 2 weeks

ATD–> I-MAOi = wait 10-14d , except for fluoxetine wait 5weeks

Note for rMAO-i at low doses (which only acts on MAO-A) normal enzyme activity after 24h-48h

Question 27

Aripriprazole MoA

Answer 27

D2 partial agonist
5-HT2A antagonist
5-HT1A partial agonist

Minor actions:
H1 antagonism
Alpha-1 antagonism
Alpha-2 antagonism
Diffuse muscarinic antagonism (M1, M2, M3, M4, M5)

Question 28

Agomelatine MoA

gomelatine is a new antidepressant with a novel mechanism of action. It acts as an agonist to both the melatonin receptors MT1 and MT2. It is also an antagonist to the 5HT2C serotonin receptor.

Answer 28

MT1 and MT2 agonist (both melatonin receptors)

5HT2 antagonist

Question 29

What receptor causes priapism

Answer 29

Alpha 1 antagonism

Trazodone, risperidone

Alpha-1 blockade also causes sexual dysfunction, sedation, postural hypotension

Question 30

Varenicline MoA

Answer 30

Alpha-4, beta-2, nicotinic acetylcholine receptor partial agonist