Psychopharm Flashcards
what receptor do SSRIs block
SERT
which receptor is upregulated in depression
5HT1A
what is the hypothesis around why SSRIs take 4-6 w to have an effect
bc there needs to be downregulation of the 5hT1a pre-synaptic receptor in response to increase 5ht
what effect do AD augmenters (i.e aripip) have on 5HT1a
partial agonists that downregulate 5ht1a
what portion of patients remit on their first AD (accord to STARD)
1/3
activation of which receptor is responsible for sexual dysfnx side effects
5hT2a
activation of which receptor is responsible for GI side effects
5Ht3A
activation of which receptors is responsible for activation/anxiety (name 4)
- 5ht2a. 2. 5ht2c. 3. NE. 4.DA
activation of which receptor is responsible for akathasia in SSRI use
5HT2A
what is the MOA of TCAs
reuptake inhibition of 5HT, NE and DA
why do MAOIs have the potential for a hypertensive crisis?
MAO- A metabolizes tyramine, but if MAO-A in the gut is inhibited it causes a dangerous amount of tyramine
what does MAO-A metabolize (4 answers)
1 5ht. 2. NE. 3. DA. 4. tyramine
what does MAO-B metabolize (2 answers)
- Da. 2. tyramine
how long should the wash out period for MAOIs be
14 days
what is the interaction bw fluvoxamine and clozapine
fluvoxamine inhibit 1A2 which metabolizes clozapine (hence it causes clozapine levels to increase)
what is the effect of fluoxetine and paroxetine on TCAs?
Both those ADs are 2D6 inhibitors which metabolize TCAs (hence they cause TCAs to increase)
Acronym associated with NMS
FEVER= fever, encephalopathy, vital instability, elevated enzymes (CK), rigidity
what is the interaction bw chlorpromazine and codeine`
cpz inhibitis 2D6 which is an enzyme that breaks down codeine into morphine (so it prevents break down into morphine)
which cyp metabolizes amphetamines
2D6
what is paroxetine’s interaction with tamoxifen
p inhibits 2d6 which metabolizes t into its active drug (paroxetine decreases active drug of t)
how is paliperidone cleared
renal
which ion is responsible for the depolarization phase of an action potential
Na influx
which ion is responsible for the repolarization of an AP
K efflux
carbamazepine’s effect on benzo
czp induces 3A4 so it decreases benzo levels
smoking effect on clozapine, olz
smoking induces 1A2 which metabolizes these APs (so smoking decreases AP levels)
which cyp does grapefruit act on
inhibits 3A4
what is the interaction bw ASA and Valproic
ASA displaces valproic from the protein so it increases free valproic levels
moa of varenicline
partial agonist at alpha 4 beta 2 nicotine receptors
which cyp metabolizes carbamazapine
3a4 (which is also the cyp it induces, so it induces it’s own metabolism)
which cyp does nefazadone inhibit
3A4
carbamazaepine’s effect on lamotrigine
decreases l’s levels
what’s the moa of benzos
agonist of GABAa receptors in the limbic system
moa of buspirone
partial 5ht1a agonist
what is caffeine’s effect on Li levels
decrease Li by increasing renal clearance
what is Li’s effect on cellular ions?
it displaces K from inside the cell (intracellular)
what signs are seen on ECG of someone taking Li
signs of hypokalemia (T wave inversion, and flattening)
below which WBC or ANC does one d/c clozapine
WBC <2 ANC <1
what is the rate of agranulocytosis with clozapine
1%
which cyp does erythromycin affect
inhibits 3a4
what is bromocryptine
dopamine agonist (used in NMS, hyper-prolactinemia)
which brain regions (2) are responsible for hyperprolactinemia
tuberinfundibular region that dumps dopamine into anterior pituitary
what is Li’s effect on parathyroid and Ca?
hyper parathyroidism and increased Ca
moa of psychostimulants
release NE and DA
what is ziprasidone’s effect on histamine
H1 antagonist
which cyp converts codeine to morphine
2D6
what is the risk of combing dextromethrophan with neuroleptics
serotonin syndrome
which part of the synapse does COMT act
post synaptic
treatment of SS
cyproheptadine (anti-5ht)
what is the effect of caffeine on clozapine
increases its clozapine levels
what is responsible for clozapine hypersalivation
M4 agonism
how long should you wait before starting an AD once stopping moclobemide
24hrs
how does Li cause hypothyroidism
prevents coupling of residues to form T3 + T4
how does valproic increase lamotrigine levels
through glucuronidation inibition
deficiency in which vitamin is MAOIs linked to
B6
least qtc prolonging AP
latuda
person with COPD on theophylline which AD to avoid
fluvoxamine
moa of pregabalin
acts on Ca channel
most noradrenergic of the SNRIs
levomilnacipran
best AD to add to aripiprazole
venlafaxine (aripip is a 2D6 substrate which is not affected by venlafaxine)
which recreational drug is most likely to cause dementia
inhalants
what is the MOA of benzos
increases the binding of GABA to its receptor
for which cancer related condition should morphine be added to a AD
bone mets
alexithymia is associated with which medical illness
IBS
what is the effect of fluvoxamine on tacrolimus
fluvoxamine inhibits tacrolimus metabolism (CYP3A4)
which AP has the fastest off D2
clozapine
which AD has least impact on qtc
buproprion
