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THE EXAM > Psychopharm > Flashcards

Psychopharm Flashcards

1
Q

what receptor do SSRIs block

A

SERT

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2
Q

which receptor is upregulated in depression

A

5HT1A

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3
Q

what is the hypothesis around why SSRIs take 4-6 w to have an effect

A

bc there needs to be downregulation of the 5hT1a pre-synaptic receptor in response to increase 5ht

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4
Q

what effect do AD augmenters (i.e aripip) have on 5HT1a

A

partial agonists that downregulate 5ht1a

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5
Q

what portion of patients remit on their first AD (accord to STARD)

A

1/3

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6
Q

activation of which receptor is responsible for sexual dysfnx side effects

A

5hT2a

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7
Q

activation of which receptor is responsible for GI side effects

A

5Ht3A

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8
Q

activation of which receptors is responsible for activation/anxiety (name 4)

A
  1. 5ht2a. 2. 5ht2c. 3. NE. 4.DA
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9
Q

activation of which receptor is responsible for akathasia in SSRI use

A

5HT2A

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10
Q

what is the MOA of TCAs

A

reuptake inhibition of 5HT, NE and DA

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11
Q

why do MAOIs have the potential for a hypertensive crisis?

A

MAO- A metabolizes tyramine, but if MAO-A in the gut is inhibited it causes a dangerous amount of tyramine

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12
Q

what does MAO-A metabolize (4 answers)

A

1 5ht. 2. NE. 3. DA. 4. tyramine

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13
Q

what does MAO-B metabolize (2 answers)

A
  1. Da. 2. tyramine
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14
Q

how long should the wash out period for MAOIs be

A

14 days

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15
Q

what is the interaction bw fluvoxamine and clozapine

A

fluvoxamine inhibit 1A2 which metabolizes clozapine (hence it causes clozapine levels to increase)

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16
Q

what is the effect of fluoxetine and paroxetine on TCAs?

A

Both those ADs are 2D6 inhibitors which metabolize TCAs (hence they cause TCAs to increase)

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17
Q

Acronym associated with NMS

A

FEVER= fever, encephalopathy, vital instability, elevated enzymes (CK), rigidity

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18
Q

what is the interaction bw chlorpromazine and codeine`

A

cpz inhibitis 2D6 which is an enzyme that breaks down codeine into morphine (so it prevents break down into morphine)

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19
Q

which cyp metabolizes amphetamines

A

2D6

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20
Q

what is paroxetine’s interaction with tamoxifen

A

p inhibits 2d6 which metabolizes t into its active drug (paroxetine decreases active drug of t)

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21
Q

how is paliperidone cleared

A

renal

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22
Q

which ion is responsible for the depolarization phase of an action potential

A

Na influx

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23
Q

which ion is responsible for the repolarization of an AP

A

K efflux

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24
Q

carbamazepine’s effect on benzo

A

czp induces 3A4 so it decreases benzo levels

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25
Q

smoking effect on clozapine, olz

A

smoking induces 1A2 which metabolizes these APs (so smoking decreases AP levels)

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26
Q

which cyp does grapefruit act on

A

inhibits 3A4

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27
Q

what is the interaction bw ASA and Valproic

A

ASA displaces valproic from the protein so it increases free valproic levels

28
Q

moa of varenicline

A

partial agonist at alpha 4 beta 2 nicotine receptors

29
Q

which cyp metabolizes carbamazapine

A

3a4 (which is also the cyp it induces, so it induces it’s own metabolism)

30
Q

which cyp does nefazadone inhibit

A

3A4

31
Q

carbamazaepine’s effect on lamotrigine

A

decreases l’s levels

32
Q

what’s the moa of benzos

A

agonist of GABAa receptors in the limbic system

33
Q

moa of buspirone

A

partial 5ht1a agonist

34
Q

what is caffeine’s effect on Li levels

A

decrease Li by increasing renal clearance

35
Q

what is Li’s effect on cellular ions?

A

it displaces K from inside the cell (intracellular)

36
Q

what signs are seen on ECG of someone taking Li

A

signs of hypokalemia (T wave inversion, and flattening)

37
Q

below which WBC or ANC does one d/c clozapine

A

WBC <2 ANC <1

38
Q

what is the rate of agranulocytosis with clozapine

A

1%

39
Q

which cyp does erythromycin affect

A

inhibits 3a4

40
Q

what is bromocryptine

A

dopamine agonist (used in NMS, hyper-prolactinemia)

41
Q

which brain regions (2) are responsible for hyperprolactinemia

A

tuberinfundibular region that dumps dopamine into anterior pituitary

42
Q

what is Li’s effect on parathyroid and Ca?

A

hyper parathyroidism and increased Ca

43
Q

moa of psychostimulants

A

release NE and DA

44
Q

what is ziprasidone’s effect on histamine

A

H1 antagonist

45
Q

which cyp converts codeine to morphine

A

2D6

46
Q

what is the risk of combing dextromethrophan with neuroleptics

A

serotonin syndrome

47
Q

which part of the synapse does COMT act

A

post synaptic

48
Q

treatment of SS

A

cyproheptadine (anti-5ht)

49
Q

what is the effect of caffeine on clozapine

A

increases its clozapine levels

50
Q

what is responsible for clozapine hypersalivation

A

M4 agonism

51
Q

how long should you wait before starting an AD once stopping moclobemide

A

24hrs

52
Q

how does Li cause hypothyroidism

A

prevents coupling of residues to form T3 + T4

53
Q

how does valproic increase lamotrigine levels

A

through glucuronidation inibition

54
Q

deficiency in which vitamin is MAOIs linked to

A

B6

55
Q

least qtc prolonging AP

A

latuda

56
Q

person with COPD on theophylline which AD to avoid

A

fluvoxamine

57
Q

moa of pregabalin

A

acts on Ca channel

58
Q

most noradrenergic of the SNRIs

A

levomilnacipran

59
Q

best AD to add to aripiprazole

A

venlafaxine (aripip is a 2D6 substrate which is not affected by venlafaxine)

60
Q

which recreational drug is most likely to cause dementia

A

inhalants

61
Q

what is the MOA of benzos

A

increases the binding of GABA to its receptor

62
Q

for which cancer related condition should morphine be added to a AD

A

bone mets

63
Q

alexithymia is associated with which medical illness

A

IBS

64
Q

what is the effect of fluvoxamine on tacrolimus

A

fluvoxamine inhibits tacrolimus metabolism (CYP3A4)

65
Q

which AP has the fastest off D2

A

clozapine

66
Q

which AD has least impact on qtc

A

buproprion

THE EXAM (19 decks)

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