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RC Pearls > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

Effects of 5HT-1a (partial agonist)

A

Reduces anxiodepressive synptoms
Improves cognition

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2
Q

Effects of 5HT-2a (antagonist)

A

Reduces negative symptoms
Improves EPS
Increases NE and DA

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3
Q

5HT-2C antagonism

A

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

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4
Q

Which receptor inhibits sexual function

A

5-HT2a receptor

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5
Q

5HT3

A

GI effects

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6
Q

Alpha 1 antagonist

A

OrthoHTN
Dizziness
Reflex tachy
Sedatiob
Hypersalivation
Urinary incontinence
Priapism

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7
Q

Receptor responsible for priapism

A

Adrenergic Alpha 1 antagonism

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8
Q

Alpha 2 agonism

A

Improves cognitive performance

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9
Q

Alpha 2 antagonism

A

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

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10
Q

H1 antagonism

A

Anti-emetic
Sedatiob
Weight gain
Orthostatic hypotension

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11
Q

Muscarinic M1 antagonism

A

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

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12
Q

Abilify MoA

A

D2 partial agonist
5HT1a partial agonist
5HT2a antagonist

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13
Q
A
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14
Q

SSRIs least drug interactions*

A

Citalopram, Escitalopram, Sertraline

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15
Q

SSRIs most protein bound*

A

Sertraline, Fluoxetine, Paroxetine

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16
Q

SSRI least protein bound*

A

Escitalopram

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17
Q

Mirtazapine MoA

A

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

*no effect on reuptake of 5HT

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18
Q

**Selegiline MoA

A

**Selegine - irreversible MAOi-B

Deaminates DA - interacts w tyramine

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19
Q

Moclobemide MoA

A

Moclobemide- reversible MAOi- A ad 600mg/day

Deaminates NE & 5HT

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

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20
Q

Phenelzine MoA

A

irreversible MAOi (both A, B)

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21
Q

Tranylcypromine MoA

A

irreversible MAOi (both A, B)

22
Q

MAO enzyme types

A

*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

23
Q

MAO-i common side effects

A

*Orthostatic hypotension
*Edema
weight gain
Insomnia
Sexual dysfunction

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

24
Q

**Tyramine foods

A

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

25
Q

MAOi half-life

A

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

26
Q

Timeline switch:

I-MAOi–> antidepressant

Antidepressant —> I-MAOi

A

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

27
Q

Aripriprazole MoA

A

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)

28
Q

Agomelatine MoA

A

MT1 and MT2 agonist (both melatonin receptors)

5HT2 antagonist

29
Q

What receptor causes priapism

A

Alpha 1 antagonism

Trazodone, risperidone

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

30
Q

Varenicline MoA

A

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

31
Q

List (TCAs)

Amines 2-nd

Amines 3-ry

A

2ndary amines:
-Desipramine
-Nortriptyline

Tertiary amines:
-Amitriptyline
-Clomipramine
-Doxepine
-Imipramine
-Trimipramine

32
Q

TCAs: least to most anticholinergic

A
  • Desipramine (least)
  • Nortriptyline
  • Imipramine
  • Doxepine
  • Clomipramine
    -Amitriptyline (most anticholinergic)
33
Q

TCA w best evidence for post-stroke depression

A

-Nortriptyline

To watch for tachy and QT prolongation

(note that SSRI is still first line)

34
Q

TCA most specific to NE activity

A

Desipramine

35
Q

TCA least anti-H1 and alpha blocking activity

A

Desipramine

Nortriptyline: least alpha 1 blockade

36
Q

TCA most specific serotonergic activity

A

clomipramine

37
Q

TCA most anti-histamine

A

Doxepine

38
Q

TCA with least alpha-1 blockade

A

Nortriptyline

and desipramine

39
Q

TCAs with

-Linear dose response curve
-Curvilinear dose response curves

A

Desipramine = linear dose response curve (the only TCA)

others = curvilinear
amitripyline, nortriptyline, imipramine

40
Q

TCA contraindications

A

QTc > 450 ms
Closed angle glaucoma

41
Q

Trazodone MoA

A

5HT2 blockade
5HT reuptake inhibitor
Alpha-1 blockade
H1-blockade

42
Q

Buspirone

A

5HT1a pre-synaptic agonist

5HT1a post-synaptic partial agonist

43
Q

Vilazodone

A

5HT reuptake inhibitor
Partial agonist 5HT1a

44
Q

Vortioxetine

A

5HT reuptake inhibitor

5HT1a agonist

5HT1b partial agonist

5HT7 antagonist (pro-cognitive effect)

45
Q

Antidepressants with least sexual side effects

A

Agomelatine
*buproprion
Desvenlafaxine
Selegiline
*Mirtazapine
Vilazodone
Vortioxetine

46
Q

Topiramata MoA

A

Blocks glutamate at non-NMDA receptors

47
Q

What decreases Lamotrigine levels

A

Tegretol
Dilantin
Phenobarb

48
Q

What increases lamotrigine levels

A

Epival (x2)

Lamotrigine 1/2 life = 33h; increased to 59h with VPA

49
Q

Lithium - levels increased by:

A

Thiazides
ACEi
ARBs
NSAIDs (ASA least bad)
Dehydration
Age
Renal failure
No-salt diet
Antibiotic - TMP-SMX

50
Q

Lithium - levels decreased by:

A

Caffeine
Acetazolamide
Mannitol
Theophyline
Pregnancy
TOO much salt

51
Q

Drugs that can increase neurotoxic effects of lithium

A

Calcium channel blockers
Haldol
Clozapine

52
Q

Pregabalin MoA

A

α2δ subunit of voltage-gated calcium channels

RC Pearls (4 decks)

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