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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
and alpha 2 antagonism

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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
5ht7 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
MAOi half-life
IMAOi = 2-3h rMAOi = 0.5-3.5h
26
Timeline switch: I-MAOi--> antidepressant Antidepressant ---> I-MAOi
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
Aripriprazole MoA
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
Agomelatine MoA
MT1 and MT2 agonist (both melatonin receptors) 5HT2 antagonist
29
What receptor causes priapism
Alpha 1 antagonism Trazodone, risperidone Alpha-1 blockade also causes sexual dysfunction, sedation, postural hypotension
30
Varenicline MoA
Alpha-4, beta-2, nicotinic acetylcholine receptor partial agonist
31
List (TCAs) Amines 2-nd Amines 3-ry
2ndary amines: -Desipramine -Nortriptyline Tertiary amines: -Amitriptyline -Clomipramine -Doxepine -Imipramine -Trimipramine
32
TCAs: least to most anticholinergic
- Desipramine (least) - Nortriptyline - Imipramine - Doxepine - Clomipramine -Amitriptyline (most anticholinergic)
33
TCA w best evidence for post-stroke depression
-Nortriptyline To watch for tachy and QT prolongation (note that SSRI is still first line)
34
TCA most specific to NE activity
Desipramine
35
TCA least anti-H1 and alpha blocking activity
Desipramine Nortriptyline: least alpha 1 blockade
36
TCA most specific serotonergic activity
clomipramine
37
TCA most anti-histamine
Doxepine
38
TCA with least alpha-1 blockade
Nortriptyline and desipramine
39
TCAs with -Linear dose response curve -Curvilinear dose response curves
Desipramine = linear dose response curve (the only TCA) others = curvilinear amitripyline, nortriptyline, imipramine
40
TCA contraindications
QTc > 450 ms Closed angle glaucoma
41
Trazodone MoA
5HT2 blockade 5HT reuptake inhibitor Alpha-1 blockade H1-blockade
42
Buspirone
5HT1a pre-synaptic agonist 5HT1a post-synaptic partial agonist
43
Vilazodone
5HT reuptake inhibitor Partial agonist 5HT1a
44
Vortioxetine
5HT reuptake inhibitor 5HT1a agonist 5HT1b partial agonist 5HT7 antagonist (pro-cognitive effect) 5HT3 antagonist
45
Antidepressants with least sexual side effects
Agomelatine *buproprion Desvenlafaxine Selegiline *Mirtazapine Vilazodone Vortioxetine
46
Topiramata MoA
Blocks glutamate at non-NMDA receptors
47
What decreases Lamotrigine levels
Tegretol Dilantin Phenobarb
48
What increases lamotrigine levels
Epival (x2) Lamotrigine 1/2 life = 33h; increased to 59h with VPA
49
Lithium - levels increased by:
Thiazides ACEi ARBs NSAIDs (ASA least bad) Dehydration Age Renal failure No-salt diet Antibiotic - TMP-SMX
50
Lithium - levels decreased by:
Caffeine Acetazolamide Mannitol Theophyline Pregnancy TOO much salt | If lithium toxicity --> go to parma cafe and get pregnant (coffee, salt
51
Drugs that can increase neurotoxic effects of lithium
Calcium channel blockers Haldol Clozapine
52
Pregabalin MoA
α2δ subunit of voltage-gated calcium channels

RC Pearls (21 decks)

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