psychopharm 2

Question 1

monovalent cation, blocks manic behavior, no behavioral effects in “normals”

Inhibits recycling of inositol substrates, may cause depletion of the 2nd messenger source of PIP2 and therefore reduce the release of IP3 and DAG

Answer 1

lithium

Levels raised by diuretics (Na levels affect excretion and retention), ACE inhibitors, Ang II receptor blockers

Question 2

lithium side effects

Answer 2

fatigue, tremor, GI symptoms, ataxia higher levels cause hyperactive deep reflexes, rigidity, coma

Question 3

CI of lithium

Answer 3

pregnancy

Question 4

clinical uses of lithium

Answer 4

mania, prevent recurrences of bipolar disease, cluster headaches

Question 5

alternatives to lithium

Answer 5

carbamazepine, valproic acid (Divalproex) for initial control of manic symptoms: haloperidol

Question 6

Mechanism of action of Antiseizure agents

Answer 6

Alters ion conductance, use dependent effect on Na+ channels; inhibits generation of repetitive action potentials

Question 7

blocks sodium channels, no interaction with GABA unpredictable absorption, hepatic enzyme induction used for partial seizures, bipolar I disorder and acute manic/mixed episodes

Answer 7

carbamazepine

Question 8

blocks repetitive neuronal firing, can reduce some Ca currents, increases GABA concentrations; bound to plasma protein, distributes in extracellular fluid used as first line drug in bipolar disease, sedating

Answer 8

valproic acid (Divalproex); inhibits metabolism of drugs including carbamazepine

Question 9

treatment of depressive episodes associated with bipolar disease (drug combination)

Answer 9

olanzapine and fluoxetine

Question 10

carbamazepine side effects

Answer 10

CNS side effects such as sedation, confusion and ataxia, diplopia; Teratogen –> Spina Bifida

Question 11

valproic acid side effects

Answer 11

GI upset, weight gain, hair loss not dose related: hepatotoxicity and teratogenic (spinal bifida)

Question 12

somatic correlates of anxiety

Answer 12

ANS arousal, voluntary muscle activation (jitteriness, tremor) complications: substance abuse

Question 13

treatment of anxiety and insomnia

Answer 13

benzodiazepines, SSRIs, buspirone, classical antihistamines, EtOH, cannabis, opiates, barbiturates

Question 14

benzodiazepine receptor agonists

Answer 14

diazepam, zolpidem

Question 15

benzodiazepine receptor antagonists

Answer 15

flumazenil

Question 16

partial agonist for 5-HT 1A, also binds to dopamine receptors delayed onset, little sedation, no dependence or cross-tolerance used for GAS

Answer 16

buspirone

Question 17

benzodiazepines used to treat anxiety

Answer 17

diazepam, alprazolam, lorazepam

Question 18

Effects of benzodiazepines

Answer 18

decreased anxiety, sedation, hypnosis, muscle relaxation (diazepam), anterograde amnesia, anticonvulsant action, minimal CV/resp actions alone

Question 19

benzodiazepine drug interactions

Answer 19

produce additive CNS depression with other depressants; can affect hepatic metabolism of drugs like cimetidine

Question 20

clinical uses of benzodiazepines

Answer 20

anxiety states, sleep disorders, seizure treatment, IV sedation and anesthesia some used for alcohol withdrawal, acute manic episodes

Question 21

Antianxiety, rapid onset of action, long duration used as hypnotic

Answer 21

flurazepam

Question 22

Antianxiety benzodiazepine; Does not form active metabolite; less lipophilic, slower absorption and onset of action, longer duration of action after single dose used as hypnotic

Answer 22

Lorazepam

Question 23

fast onset of action, high lipid solubility, rapid redistribution; muscle relaxant due to actions in spinal cord; intravenous sedation and anethesia

Answer 23

diazepam

Question 24

Antianxiety benzo, used for panic disorder

Answer 24

Alprazolam

Question 25

benzo used for alcohol withdrawl

Answer 25

chlordiazepoxide

Question 26

symptoms of benzo withdrawal

Answer 26

anxiety, insomnia, irritability, headache, hyperacusis, hallucinations, seizures

Question 27

Anti-anxiety; high affinity for 5-HT1A receptors, partial agonist; elimination half life: 2-11 hrs; less sedating than benzodiazepines; used for treatment of GAD

Answer 27

Buspirone

Question 28

other treatments for anxiety

Answer 28

SSRIs & SNRIs, beta-blockers, other sedatives (rarely)

Question 29

hypnotic that binds to BDZ receptor on GABA complex; weak anxiolytic, muscle relaxant and anticonvulsant; preserves stage 3 and 4 sleep, duration 5-6hr

Answer 29

zolpidem

Question 30

adverse effects of hypnotic effects

Answer 30

daytime sedation, ataxia, rebound insomnia, tolerance and dependence, occasional idiosyncratic excitement and stimulation

Question 31

act at GABA A, rapidly absorbed and distributed, highly lipid soluble, renal excretion, additive with other CNS depressants used as anticonvulsant

Answer 31

barbiturate

Question 32

barbiturate side effects

Answer 32

general CNS depression, anticonvulsant, respiratory depression tolerance (not uniform) physical dependence with withdrawal symptoms (seizures)

Question 33

skeletal muscle relaxants

Answer 33

used to reduce muscle tone associated with spasticity related to MS injuries/other musculoskeletal disorders

Question 34

Barbituate hypnotic, anticonvulsant; rarely used today

Answer 34

Phenobarbital

Question 35

Aldehyde hydrate with pungent taste and somewhat caustic taste; metabolized o tricholoroethanol which is the active form of the drug; Pharmacology similar to barbiturates; Less effects on stages of sleep than benzos and barbiturates

Answer 35

Chloral Hydrate

Question 36

Muscle relaxant; GABA-mimetic agent working at GABA B receptors, Results in hyperpolarization, causing presynaptic inhibition; decreased release of excitatory transmitters such as glutamate

Answer 36

Baclofen

Question 37

alpha2 adrenergic agonist, relieves muscle spasm side effects include drowsiness, hypotension, dry mouth interacts with CYP1A2 inhibitors

Answer 37

Tizanidine

Question 38

other agents used as muscle relaxants

Answer 38

botulinum toxin, dantrolene