Psychopharmacology

Question 1

What is the algorithm for the diagnosis of Serotonin Syndrome?

Answer 1

Question 2

What the clinical manifestations of Serotonin syndrome?

Answer 2

Question 3

What are the main features of NMS?

Answer 3

FARM

• Fever
• Autonomic instability
• Rigidity
• Mental status change

Question 4

What are two psychotropic drugs with Health Canada warning for liver disease?

Answer 4

• Valproic acid
• Duloxetine

Question 5

What antipsychotics are not associated with QTc prolongation?

Answer 5

• Lurasidone
• Paliperidone
• Aripiprazole
• Asenapine

(Schizophrenia guidelines)

Question 6

What are the drugs with significant QTc increase risk in decreasing order?

Answer 6

sertindole > amisulpiride > ziprasidone > iloperidone > risperidone > olanzapine > quetiapine > haloperidol

Question 7

What are the recommended doses for psychosis for

• Quetiapine

Answer 7

300 - 800 mg

Question 8

What are the recommended doses for psychosis for

• Clozapine

Answer 8

300-900 mg

Question 9

What are the recommended doses for psychosis for

• Risperidone

Answer 9

2-8 mg

Question 10

What are the recommended doses for psychosis for

• Olanzapine

Answer 10

10-20 mg

Question 11

What are the recommended doses for psychosis for

• Aripiprazole

Answer 11

• 10-30 mg

Question 12

What are the recommended doses for psychosis for

• Ziprasidone

Answer 12

40-160 mg

Question 13

What are the recommended doses for psychosis for

• Paliperidone

Answer 13

3-9 mg

Question 14

What are the recommended doses for psychosis for

• Asenapine

Answer 14

10-20 mg

Question 15

What are the recommended doses for psychosis for

• Lurasidone

Answer 15

40-80 mg (up to 160 mg)

Question 16

What is the algorithm for lithium treatment with renal impairment?

Answer 16

Question 17

What are the first-line treatments for ADHD in adults with BD + ADHD?

Answer 17

• Bupropion

Question 18

What are the second-line treatments for ADHD in adults with BD + ADHD?

Answer 18

• Mixed amphetamine salts
• Methylphenidate
• Modafinil
• CBT

Question 19

What are the first-line treatments for ADHD in adults with MDD + ADHD?

Answer 19

• Bupropion
• Antidepressant + long-acting stimulant
• Antidepressant + CBT

Question 20

What are the second-line treatments for ADHD in adults with MDD + ADHD?

Answer 20

• Desipramine
• Nortriptyline
• Venlafaxine

Question 21

First-line pharmacological treatment for tics (in addition to psychoeducation and habit-reversal)

Answer 21

• Guanfacine
• Clonidine

Question 22

Second-line pharmacological treatment for tics (in addition to psychoeducation and habit-reversal)

Answer 22

• Risperdal
• Aripiprazole

Question 23

What TCA have the least anticholinergic activity?

Answer 23

• Amoxapine
• Nortryptiline
• Maprotiline
• Desipramine

Question 24

What antidepressant medication, others than Citalopram or Escitalopram has a Health-Canada warning for QTc?

Answer 24

• Mirtazapine

Question 25

What is the starting dose for atomoxetine?

Answer 25

Question 26

What is the mechanism of action of Mirtazapine?

Answer 26

Presynaptic α2-adrenergic antagonist effects, which result in increased release of norepinephrine and serotonin. It is also a potent antagonist of **5‑HT2A, 5‑HT2C, 5‑HT3**, and **H1 receptors** and a moderate peripheral α1-adrenergic and muscarinic antagonist; it does not inhibit the reuptake of norepinephrine or serotonin

Question 27

What serotonin receptor's blockade is associated with reduced nausea?

Answer 27

5 HT-3

Question 28

What is the black-box warning for antidepressant-related suicidality?

Answer 28

Question 29

How might caffeine and clozapine interact?

Answer 29

* Both of substrate of CYP 1A2 (and could compete)

Question 30

What do OCP do to Lamictal?

Answer 30

Question 31

What is the interaction between clozapine and carbamazepine?

Answer 31

* Carbamazepine is contraindicated with clozapine because of the increased risk of agranulocytosis.

Question 32

What symptoms does α1 blockage typically cause?

Answer 32

* Cardiovascular side effects such as orthostatic hypotension and drowsiness (especially if rapidly dosed). * Central α1 receptors have been linked to potential therapeutic effects such as improvement in nightmares by the _α1 antagonist_ prazosin in PTSD and maybe even reduction of EPS

Question 33

What is the mechanism of action of trazodone?

Answer 33

* Potent antagonist of the 5‑HT2A receptor as well as a dose-dependent blockade of serotonin transporter; also blocks 5‑HT2C, α1, and H1 receptors (CHPD)

Question 34

What is the mechanism of trazodone-induced priapism?

Answer 34

* Priapism with trazodone and nefazodone due to prominent α1 blockade in the absence of anticholinergic activity

Question 35

What is cholinergic rebound syndrome?

Answer 35

Question 36

What EPS occurs more often as a result of intermittent antipsychotic use?

Answer 36

* Tardive dyskinesia

Question 37

What is the link between anticholinergics and the occurrence of tardive dyskinesia?

Answer 37

* Anticholinergics can unmask tardive dyskinesia

Question 38

What are the p.o. Risperidone doses to the following doses of Sustenna? * 150 * 75-100 * 50

Answer 38

* 150 --\> 12 * 75-100 --\> 6 mg * 50 --\> 3 mg

Question 39

What serotonin receptors are involved in nausea / GI side effects?

Answer 39

* 5HT-3