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Psychiatry Boards > PSYCHOPHARM/PHARMACOKINETICS > Flashcards

PSYCHOPHARM/PHARMACOKINETICS Flashcards

1
Q

Name the drug to treat mania with the following AE: cutaneous side effects (especially psoriasis and alopecia), LMNOP-tremors, nephrogenic diabetes insipidus –no response to ADH– increased urination, hypothyroidism, Ebstein’s anomaly, GI complaints, weight gain

A

LITHIUM

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2
Q

Medication for mood stabilization with following AE: SJS, anemia, low platelets, liver failure and pancreatitis

A

Lamictal

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3
Q

Medication used for mood stabilization and schizophrenia with following AE: EPS, NMS, akathisia

A

Cariprazine (Vraylar)

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4
Q

When switching a patient from an SSRI to a MAOI, how long does your washout period need to be to prevent serotonin syndrome? And what SSRI requires an extended washout period?

A

14 days; Fluoxetine requires 28 days

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5
Q

What drugs are CYP450 inhibitors?

A

SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol, Amiodarone&
Grapefruit Juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

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6
Q

What drugs are cyp450 inducers?

A

SCRAP GP
Sulfonylureas, Smoking, St. Johns worts
Carbamazepine, Corticosteroids
Rifamycins (Rifampicin, Rifabutin)
Alcohol (Chronic)
Phenytoin
Griseofulvin
Phenobarbital

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7
Q

Explain the effects on urine concentration and serum sodium concentration in the following scenarios?
1) SIADH
2) psychogenic polydipsia
3) diabetes insipidus

A

1) SIADH: up, down
2) psychogenic polydipsia: down, down
3) diabetes insipidus: down, up

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8
Q

Which Alzheimer’s drug MOA is blocking NMDA receptors reducing calcium influx into cells?

A

Memantine

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9
Q

T/F: HTN is a contraindication in prescribing Buproprion?

A

False

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10
Q

CYP2D6 Inhibitors

A

FCMQP
Fluoxetine
Cimetidine
Methadone
Quinidine
Paroxetine

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11
Q

CYP1A2 Inhibitors

A

Cirpofloxacin
Fluvoxamine

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12
Q

CYP2E1 inhibitors

A

Disulfiram

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13
Q

CYP1A2 inducers

A

insulin
omeprazole

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14
Q

Which MAO-I only acts on MAO-B at lower doses?

A

Selegiline

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15
Q

What is Buspirone’s relevant MOA?

A

serotonin 1A partial agonist

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16
Q

What is most common neuropsychiatric effect of steroids?

A

hypomania/mania

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17
Q

Desipramine and protriptyline are the most or least sedating TCA?

A

Least sedating

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18
Q

Amitryptyline and doxepin are 2 of the most sedating or least sedating TCAs?

A

Most sedating

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19
Q

Which of the TCAs is most likely to cause Parkinsonian symptoms?

A

amoxapine

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20
Q

Which 3 hydroxy-benzos have the shortest half-life because they are directly metabolized by glucoronidation (go straight to phase 2 metabolism)?

A

LOT
1. Lorazepam
2. Oxazepam
3. Temazepam

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21
Q

What medication is used to treat aggression in patients with SZ, conduct disorder or ID?

A

Lithium

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22
Q

If PPI, H2-histamines or antacids are mentioned in a question what is the red flag to watch out for?

A

Affecting absorption of drugs

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23
Q

Which phase of metabolism changes a metabolites biological properties (ie bio activation or inactivation of molecule) likely through CYP450 enzyme system?

A

Phase I

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24
Q

What does this pro-drug (metabolites of them are biologically active) become after being metabolized and by what enzyme?
1. Lisdexamfetamine
2. Codeine

A
  1. Becomes active metabolite D-amphetamine (by peptidase)
  2. Becomes active metabolite Morphine (by CYP2D6)
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25
Q

Why do we have to half the dose of lamictal when someone is also prescribed depakote?

A

Because Depakote inhibits UGT1A4 which is responsible for breaking down lamictal so since it’s inhibited need smaller dosing since it will be broken down at lower rate

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26
Q

What are 4 important drugs that go directly to Phase II metabolism?

A

Lorazepam, Oxazepam, Temazepam (all go out the liver)

Lamictal

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27
Q

Which anti-depressants are more affected by metabolic drug-drug interactions?

A

TCAs
Fluoxetine (Prozac)
Paroxetine (Paxil)
Fluvoxamine

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28
Q

Which drug used to treat psychosis as part of Parkison’s disease acts as an inverse agonist (bringing receptor activity below basal or constitutive level)?

A

Pimavanserin (nuplazid): 5-HT 2A inverse agonist

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29
Q

What is the difference in monoamine/NT release between an agonist vs. antagonist ligand/drug acting on a pre-synaptic receptor?

A

agonists: increased negative feedback –> DECREASED release of monoamine
ie Clonidine, Guanfacine (alpha-2 agonist)

antagonist: receptor blocked from exerting its negative feedback effects —> continued release of monoamine
ie Mirtazapine (alpha 2-antagonist)

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30
Q

What is MOA of Buproprion?

A

Dopamine and NE reuptake inhibitors

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31
Q

What is MOA of Mirtazapine?

A

Blocks 5HT 2&3
histamine blocker —> drowsiness
alpha 1 antagonist –> orthostatic hypotension

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32
Q

What are the 4 anti-depressant drugs in the MAO-I class?

A

TIPS
Tranylcypromine
Isocarboxazid
Phenelzine
Selegeline

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33
Q

SSRIS increase risk of upper GI bleeding and bruising? T or F

A

TRUE

34
Q

How many factors is your risk increased of torsades de pointes increased by if you have a QTC > 500ms?

A

2x-3x increased risk

35
Q

An elderly person is visiting her opthamologist who gives her eyedrops to dilate her eyes. Several hours later she has lasting waxing and waning confusion what could be happening?

A

She could be delirious as the eye drops were anticholinergic and probably had some systemic effects as she likely was more vulnerable to delirium

36
Q

Out of the following classes what meds should you AVOID giving to a patient with severe liver disease?

Antidepressants
SGA
FGA
Hypnotics

A

Antidepressants: Duloxetine

SGA:
Iloperidone, Asenapine

FGA:
Fluphenazine, perphenazine, trifluoperazine

Hypnotics:
Zaleplon, Zolpidem

37
Q

Out of the following classes what meds should you AVOID giving to a patient with severe renal disease?

Antidepressants
Mood stabilizers

A

Antidepressants:
Duloxetine

Mood stabilizers:
Lithium

38
Q

True OR False:
Intrauterine exposure to Valproic acid is a identifiable RF for Autism SD.

A

TRUE

39
Q

True OR False:
Exposure to benzos in pregnancy increase risk of oral cleft by 0.01%.

A

TRUE

40
Q

What is difference between pharmacodynamic DDI and pharmacokinetic DDI?

A

pharmacodynamic DDI : two drugs have additive activity when given together, more like how there individual results affect one another

pharmacokinetic DDI: talking about ADME effects (absorption, distribution, metabolism, excretion), affects concentration (up or down) of victim drug at its site of action

41
Q

A man w/depression stopped his medications recently and developed a few days later electric-shock sensations in the head, flu-like symptoms, dizziness, excessive, vivid dreaming, and frequent crying spells. What class of medications did he likely stop?

A

SSRI or SNRI discontinuation reaction
- more common with shorter half-lives (fluvoxamine, venlafaxine, desvenlafaxine, paroxetine)

42
Q

What is the MOA of Abilify?

A

partial dopamine agonist

43
Q

What are the 3 FDA approved meds for treatment of Tourette syndrome?

A

1) pimozide
2) haldol
3) abilify

44
Q

What is the MOA of disulfiram?

A

inhibits dopamine beta-hydroxylase which converts DA –> NE

45
Q

A patient presents to clinic with GAD and vasomotor symptoms (ie menopausal symptoms), what is the best anti-depressant to start?

A

Venlafaxine (SNRI)

46
Q

What are go to meds for tx of Bipolar disorder with mixed features?

A

Valproic Acid
Carbamezapine
SGA

47
Q

What mood stabilizer has AE of hyperammonemia via inhibition of urea cycle (not 2/2 hepatotoxicity)?

A

Valproic acid

48
Q

What should you treat hepatotoxicity (malaise, weakness, lethargy, facial edema, anorexia, vo miting) 2/2 valproic acid with?

A

IV L-carnitine

49
Q

What is the mainstay of treatment of Lithium-induced NDI?

A

Amiloride

50
Q

What is the MOA of Valproic acid?

A

blocks GABA transaminase –> increased synaptic levels of GABA

blocks Na channels

51
Q

What is MOA of Lithium?

A

Lithium inhibits inositol monophosphatase

52
Q

Which 2 SGA have diminished serum concentrations due to pt being a smoker b/c cigarette smoke is associated with increased CYP1A2 activity?

A

1) Clozapine
2) Olanzapine

53
Q

What drug used to treat PMDD (although not first line) has an AE of birth defects in male fetuses?

A

Dutasteride (5-alpha reductase inhibitor drug)

54
Q

Which HART medication used to treat HIV can result is associated with depression?

A

Efavirenz
—a nonnucleoside reverse transcriptase inhibitor (NNRTIs)

55
Q

Benzos act on GABA-A receptors as agonists –> activation and increased chloride inflow. Benzos have high affinity for different subunits within the GABA receptor.
Benzos can act as hypnotics or anxioloytics, which subunits do each have affinity for?

A

hypnotic: α-1 subunit of GABA

anxiolytic: α2 and α3 subunit of GABA

56
Q

What medication do you give to reverse the effects of intoxication of the following medications?
A) Benzos
B) anticholinergic poisoning
C) organophosphate poisoning

A

A) Flumazenil
B) If patient awake + gag reflex present –> Activated charcoal
if not –> Physostygmine
C) Pralidoxime

57
Q

MOA of most effective anti-psychotics?

A

Post synaptic D2 receptor antagonists
OR
partial agonists

58
Q

Which AP has a completely different MOA and does not act on D2 receptor?

A

Pimavanserin: 5-HT-2a inverse agonist/antagonist

59
Q

Put these AP in order of least to most potent:
Fluphenazine (prolixin)
Haloperidol
Chlorpromazine (thorazine)

A

Thorazine –> Fluphenazine –> Haldol

59
Q

Anti-psychotics have black box warning for elderly. Which is best choice given highest NNH and lower RR?

A

Quetiapine

60
Q

What AP is associated with the dermatologic side effect of photosensitivity?

A

Chlorpromazine (Thorazine)

61
Q

What medication do you use to manage following EPS from AP?
A) akathisia (3)
B) dystonia (2)
C) parkinsonism (2)

A

A) Beta-blockers, Benzos (increase mortality 2/2 SI and poisoning), Mirtazapine

B) benztropine, benadryl

C) benztropine, amantadine

61
Q

What is the interaction between caffeine and Fluvoxamine?

A

Fluvoxamine inhibits CYP1A2 leading to increased levels of caffeine

62
Q

What 2 drugs are seen as the 1st line agents for treating acute depression in bipolar patients?

A

Seroquel
Lurasidone

63
Q

Lithium-induced nephrogenic diabetes insipidus is usually a self-limiting condition in which there is a down-regulation of channel aquaporin-2 in the luminal wall of the cell’s surface, leading to decreased urine osmolality and increased urine volume (polyuria). ADH levels are adequate or even high, but its action on the V2 receptor is defective.

A
64
Q

What are the symptoms of NMS?

A

FEVER
fever, encephalopathy, vital sign instability, elevated enzymes (CPK), muscle rigidity

65
Q

Interferon 1-beta is avoided in use with patients who suffer from what psychiatric disorder?

A

Depression and SI

66
Q

What mood stabilizer is associated with causing PCOS in females?

A

Valproic acid

67
Q

What 2 drugs/drug classes can induce symptoms of kleptomania?

A
  1. Abilify
  2. Dopamine agonists (ie bromocriptine for PD)
68
Q

Combination of haloperidol and _______ (drug) can cause an encephalopathic syndrome resembling neuroleptic malignant syndrom (NMS) in some patients.

A

Lithium

69
Q

What is one of the most common adverse effects of bupropion?

A

dizziness

70
Q

Aspirin, can _______ (increase or reduce) the elimination of valproic acid and result in elevated blood concentrations of valproic acid.

A

reduce

71
Q

What drug used to treat Crohn’s and MS has an increased risk of the development of progressive multifocal leukoencephalopathy (due to JC virus infection) with its use.

A

Natalizumab

72
Q

Which TCA has possible side effect of TD?

A

Amoxapine

73
Q

T/F: Topiramate is cleared by the kidney unchanged.

A

True

74
Q

Correctly sequence opiates by onset of withdrawal symptoms starting with the shortest time and proceeding to the longest time.

Meperidine
Heroin
Methadone
Morphine

A

Heroin, meperidine, morphine, methadone

75
Q

T/F: Galantamine, used to treat Alzheimers, is contraindicated in severe renal and hepatic impairment.

A

True

76
Q

Which of the following TCAs can lead to TD due to its metabolite having dopamine receptor antagonist properties?
DAANDI-C
Doxepin, amytriptyline, amoxapine, nortryptyline, desiparamine, imipramine, clomipramine

A

Amoxapine

77
Q

What is the treatment for acute dystonia, Parkinsonism, akinesia, akathisia from anti-psychotics?

A

Benztropine

78
Q

Yohimbine can be used to induce panic attacks through what MOA that increases activity of noradrenergic activity in the locus ceruleus?

A

α2-adrenergic receptor antagonist

79
Q

Which class of anti-hypertensives is not associated with depression?

A

ACE-I
(-pril)

Psychiatry Boards (13 decks)

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