Psychopharm

Question 1

Which 2 psych drug classes cause the most HAM ADEs?

Answer 1

TCAs

Low-potency antipsychotics

Question 2

DOC for neuroleptic-induced EPS?

Answer 2

Benzotropine

Question 3

Classic drug combo leading to serotonin syndrome?

Answer 3

SSRI + MAO-1

Question 4

What presents w/ fever, tachycardia, very elevated CPK, and lead pipe rigidity?

Answer 4

NMS

Question 5

How does carbamazepine affect CYPs?

Answer 5

Induces 1A2, 2C9, 3A4

Question 6

Mortality rate of NMS?

Answer 6

20%

Question 7

Which neurologic disease is classically worsened by anti-cholinergics?

Answer 7

Alzheimers dz

Question 8

What % of pts w/ major depression will respond to anti-depressants? What % of the above is placebo effect?

Answer 8

70% respond. 30% of that is placebo

Question 9

How long do most anti-depressants require for effect?

Answer 9

3-4 weeks

Question 10

What time/dose constitutes an adequate trial of an anti-depressant (which is required before changing meds)?

Answer 10

Full dose for 1-2 months

Question 11

Describe the correlation btwn plasma levels of SSRIs and efficacy or ADEs.

Answer 11

No correlation

Question 12

How often are most SSRIs dosed? What’s the exception to this?

Answer 12

Daily. Fluoxetine also has a weekly dosing form.

Question 13

Which SSRI has the longest half-life and thus doesn’t need to be tapered?

Answer 13

Fluoxetine

Question 14

What’s the levo-enantiomer of citalopram?

Answer 14

Escitalopram

Question 15

Which SSRI has the fewest DDIs?

Answer 15

Citalopram

Question 16

Which SSRI is only approved for OCD? What is its major problem?

Answer 16

Fluvoxamine; lots of DDIs

Question 17

Which SSRI is safe in pregnancy and in kids?

Answer 17

Fluoxetine

Question 18

Which SSRI has a short half-life, increasing the risk of withdrawl?

Answer 18

Paroxetine

Question 19

Which SSRI is highly protein bound, inhibits cyp2D6, and has relatively more anti-cholinergic ADEs?

Answer 19

Paroxetine

Question 20

How can fluoxetine change levels of neuroleptics?

Answer 20

It inhibits cyp 1A2, 2D6, and 3A4, which can increase levels.

Question 21

Which SSRI has the highest risk for GI disturbance but very few DDIs?

Answer 21

Sertraline

Question 22

Person on high-dose antidepressants takes OTC cough meds. What potentially fatal complication could you expect?

Answer 22

Serotonin syndrome: some OTC anti-cough drugs can boost 5HT levels.

Question 23

What’s the BBW for SSRIs?

Answer 23

Increased suicidal thinking and behavior (MC in kids and teens)

Question 24

Which category of SSRI ADEs doesn’t typically resolve w/in a few weeks?

Answer 24

Sexual dysfxn

Question 25

Name the 3 major advantages of SSRIs over other antidepressants

Answer 25

Fewer ADEs No food restrictions Much safer in OD

Question 26

How , long should you wait btwn giving SSRI and MAO-I?

Answer 26

2 wks

Question 27

What syndrome presents w/ fever, sweating, shivering, HTN, hyperreflexia, "electric jolt" limb movements, etc?

Answer 27

Serotonin syndrome

Question 28

What monitoring might you have to do when starting a warfarin pt on an SSRI?

Answer 28

Increase monitoring of warfarin bc SSRIs can incr warfarin levels

Question 29

Name the 3 SNRIs

Answer 29

Venlafaxine Duloxetine Desvenlafaxine

Question 30

What are the 3 main indications for venlafaxine?

Answer 30

Depression Anxiety ADHD

Question 31

Venlafaxine has an ADE profile similar to SSRIs. Which ADE is different?

Answer 31

It increases BP

Question 32

What drug is the expensive active form of venlafaxine?

Answer 32

Desvenlafaxine

Question 33

What drug would be useful in someone with depression + neuropathic pain?

Answer 33

Duloxetine

Question 34

Which SNRI can be used to treat fibromyalgia?

Answer 34

Duloxetine

Question 35

Name the unique and worrisome ADE of duloxetine (compared to other SNRIs)

Answer 35

Hepatotox

Question 36

What's the MOA of bupropion?

Answer 36

NE-DA reuptake inhibitor

Question 37

What's the major upside of using bupropion vs other antidepressants? What groups of people can't take bupropion?

Answer 37

Lack of sexual ADEs | Eating disorders and seizure patients

Question 38

Name the 3 major indications for trazodone or nefazodone

Answer 38

Refractory major depression Major depression w/ anxiety Insomnia

Question 39

BBW for nefazodone?

Answer 39

Liver failure

Question 40

3 major ADEs of trazodone?

Answer 40

Arrhythmia Sedation Priapism

Question 41

Rx refractory major depression in LOL who can't sleep and needs to gain weight?

Answer 41

Mirtazapine

Question 42

Mirtazapine MOA?

Answer 42

Alpha2 antagonist

Question 43

Scariest ADE of mirtazapine?

Answer 43

Agranulocytosis

Question 44

MOA of TCAs?

Answer 44

Inhibit reuptake of NE and 5HT

Question 45

How much TCA is required to kill yourself?

Answer 45

As little as 1-2 g

Question 46

Rx of TCA OD?

Answer 46

IV sodium bicarb

Question 47

Which TCA is the most serotonin-specific?

Answer 47

Clomipramine

Question 48

What do (other than depression) is clomipramine used for?

Answer 48

OCD

Question 49

Which type of TCA is more anticholinergic/sedating/lethal in OD: tertiary or secondary amines?

Answer 49

Tertiary amines

Question 50

Which 4 TCAs are tertiary amines?

Answer 50

Amitriptyline Imipramine Clomipramine Doxepin

Question 51

Which 2 TCAs are secondary amines?

Answer 51

Nortriptyline | Desipramine

Question 52

Which TCA has useful therapeutic blood levels?

Answer 52

Nortriptyline

Question 53

Which TCA has an IM form and can be used for enuresis or panic do?

Answer 53

Imipramine

Question 54

What's the least anticholinergic TCA?

Answer 54

Desipramine

Question 55

Name the 2 tetracyclic antidepressants

Answer 55

Amoxapine | Maprotinine

Question 56

Which tetracyclic has the highest rates of seizure, arrhythmia, and fatality?

Answer 56

Maprotiline

Question 57

Amoxapine has a similar ADE profile to what drug class?

Answer 57

Typical antipsychotics