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Psychiatry 2 > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

1
Q

This is the thought that the lack of 5-HT and NE results in depression, so replacement of these NT’s will reduce depression

A

Amine hypothesis

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2
Q

All major anti-depressants except for which drug will work on the amine hypothesis?

A

Buproprion

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3
Q

True or False: all anti-depressants have a LONG latency, so they typically dont work right away.

A

True

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4
Q

What % of patients fail to respond to treatment with antidepressants?

A

1/3-1/2

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5
Q

Fluoxetine, Paroxetine, Sertraline, Citalopram, Fuvoxamine, and Excitalopram belogn to which drug class?

A

SSRI

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6
Q

What is the advantage of SSRI’s over other AD classes (like MAOI’s) as far as toxicities?

A

They do not have the toxicities like TCA’s or MAOI’s (anti-muscarinic, antihistaminic, and a-adrenroreceptor blocking actions) so theyre better tolerated

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7
Q

This is the metabolite of Fluoxetine, has a half life of 7-9 days, and thus extends the time fluoxetine is effective.

A

Norfluoxetine

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8
Q

Sertraline and Paroxetine have pharmacokinetics similar to what other drug class?

A

TCA’s

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9
Q

What was the trial that looked at pts with major depression who did not respond to or could not tolerate therapy with 1 SSRI?

A

STAR*D

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10
Q

According to the STAR*D trials, what % of patients had a remission rate using an SSRI?

A

25%

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11
Q

What is the major adverse effect of citalopram, making it contraindicated with cardiac or eating disorders?

A

prolonged QT itnerval

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12
Q

Case: pt presents to the ER with a recent diagnosis of depression and complains of hyperthermia. The patient soon slips into a coma and experiences muscle rigidity, myoclonus, and rapid changes in mental status. What condition is he experiencing?

A

Serotonin syndrome

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13
Q

Giving SSRI’s with what other drug class can precipitate Serotonin syndrome?

A

MAOi’s

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14
Q

What is the DOC for serotonin syndrome to reverse the Sx?

A

Cyproheptadine

5-HT2 antagonist

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15
Q

What is the only SSRI apporved for the use in pediatrics?

A

Fluoxetine (prozac)

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16
Q

What must you monitor in kids taking prozac, because of the increased risk of suicide during the first weeks of Tx?

A

Mood

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17
Q

Case: a patient presents to you with depression and you consider starting him on pharmacotherapy. What other condition might be an indicator to use Bupropion?

A. Bulemia
B. Concurrent CAD
C. 20-pack year smoking Hx
D. Insomnia
E. Migrane
A

C. Smoking Hx

Bupropion slaps both depression and smoking in the face. The other answers are contraindications to use Bupropion.

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18
Q

True or False: Unfortunately, as with other antidepressants, Bupropion has a side effect of sexual dysfunction.

A

FALSE

There is NO sex side effects with buproprion

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19
Q

Which of the SSRI has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- +
Serotonin- +++
NE- 0,+
DA- 0,+
A

Fluoxetine

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20
Q

Which of the SSRI’s has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- 0
Serotonin- +++
NE- 0
DA- 0
A

Sertraline

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21
Q

Which of the TCA’s (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- +++
Antimuscarinic- +++
Serotonin- +++
NE- +
DA- 0
A

Amitriptyline

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22
Q

Which of the TCA’s (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- +
Antimuscarinic- +
Serotonin- 0
NE- +++
DA- 0
A

Desipramine

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23
Q

Which of the TCA’s (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- ++
Antimuscarinic- ++
Serotonin- +++
NE- ++
DA- 0
A

Impiramine

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24
Q

Which of the TCA’s (Protriptyline, imipramine, Amtryptyline, Desipramine) has the following antagonism to the receptors?

Sedative- 0
Antimuscarinic- ++
Serotonin- ?
NE- +++
DA- ?
A

Protriptyline

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25
Q

What does Bupropion do the antagonism to the receptors?

Sedative
Antimuscarinic
Serotonin
NE
DA
A 
Sedative- 0
Antimuscarinic- 0
Serotonin- +,0
NE- +,0
DA- ?
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26
Q

What is the drug class that has a lot of side effects, like antimuscarinic, anti-a-adrenergic, and antihistaminergic (drowsiness)?

A

TCAs

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27
Q

What is the typical STARTING dose for TCAs?

A

Low doses (~100mg/day for inpatient and 10-75mg/day for outpatient)

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28
Q

How much do you increase the TCA’s dose every 2-3 weeks?

A

25mg

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29
Q

All TCA’s end in what 2 suffixes, except for doxpin and amoxapine?

A

-iptyline or -ipramine

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30
Q

What are the Sx of TCA OD?

A

Coma with acidosis, respiratory depression, agitation, seizures, bowel-bladder paralysis, cardiac arrhythmias

(Tri-C’s = Convulsions, Coma, Cardiotoxicity)

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31
Q

What is the DOC for TCA OD?

A

NaHCO3

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32
Q

If a patient tries to commit suicide with TCA’s, what 2 things must u do to avoid OD again?

A
  1. Prescription for < 1.25g or 50 dose units with no refill

2. Entrust drug to relative

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33
Q

What are the 3 adjunctive therapies to antidepressants?

A

Li
Thyroid H’s
Atypical anti-psychotics

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34
Q

What are the 5 “D’s” of AD treatment?

A 
Diagnosis (is the pt actually depressed?)
Drug (would a different AD work better?)
Dose
Duration
Different Tx (should we try ECT?)
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35
Q

What is the condition to which Clomipramine is used for?

A

OCD

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36
Q

To which class of drugs does Clomipramine belong?

A

TCA

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37
Q

Which drug class acts on the the GABA(A) receptors, and increases the frequency of GABA receptor openings?

A

Benzo’s

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38
Q

What is the primary indication for Alprazolam?

A

Panic disorders

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39
Q

What is the primary indication for lorazepam?

A

Generalized Anxiety Disorder

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40
Q

What is the primary indication for Meprobamate?

A

Short-term anxiety and sedative hyponosis

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41
Q

What % must you taper off a benzo per week until the dose is 50% of the original?

A

25%

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42
Q

Once the dose reaches 50% of the original dose while you taper a benzo, what amount do you decrease the dose?

A

↓ 1/8 dose every 4-7 days

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43
Q

Which type of patient is Meprobamate a contraindication?

A

Pregnant ladies cuz it’s a teratogen

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44
Q

What receptors does Azapirones act on, which inhibits serotonin release?

A

5HT1A

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45
Q

What is the main indication for Buspirone?

A

Generalized anxiety disorder

“I’m always anxious if the BUS will be ON time, so I take BUSpirONe.”

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46
Q

In terms of side effects, what is the advantage of Buspirone over Benzos?

A

No sedation, addiction, tolerance, or interaction with alcohol.

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47
Q

What is the site of Z-hyponotics action?

A

GABA(A) typ`e 1 receptors

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48
Q

Sedative actions, anterograde amnesia, exhaustion, and intoxication are all Sx of intoxication to what drug class?

A

Benzo’s

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49
Q

During which trimester is the fetus at risk of congenital malformations if mom uses a benzo?

A

1st trimester

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50
Q

After what time of prolonged use does dependence become a big problem with benzo use?

A

2-3 weeks

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51
Q

Which benzo can cause seizures with abrupt discontinuance, especially 24-72 hours after the discontinuance?

A

Alprazolam (xanax)

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52
Q

What is the dose of Alprazolam that is given to treat panic disorder but also causes withdrawal Sx?

A

4 mg daily

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53
Q

What is the deal with the demonstrated efficacy of chlordiazepoxide for long term use (> 4 mo)?

A

The efficacy has not been established, so u gotta keep reassessing to make sure it’s working

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54
Q

This is the drug u give for preop sedation, anxiolysis, and anterograde amnesia.

A

Midazolam

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55
Q

What are the 2 routes of administration for Midazolam?

A

IM or IV

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56
Q

What is the receptor that Buspirone stimulates?

A

5-HT1A

57
Q

True or False: Buspirone is effective in panic disorder just like it is for Generalized Anxiety Disorder.

A

FALSE

It has a gradual onset of action and therefore is not effective in Panic disorder.

58
Q

How long does it take to see the effects of Buspirone?

A

2-4 weeks

2013 first aid says 1-2

59
Q

Which receptor does Serotonin bind to induce B-endorphin secretion, which allows the antidepressant effects?

A

5-HT1A

same one Buspirone binds

60
Q

Which form of Zelpidem tartrate had the adverse effects of drowsiness, dizziness, diarrhea, headache, amnesia, vertigo, falls, nausea, and vomiting?

A

conventional Tablet

61
Q

Which form of Zelpidem tartrate caused just headache, somnolence, and dizziness?

A

Extended release tablet

62
Q

What class of drugs does Zolpidem belong to?

A

ZopiDEM = Ambien, which is a nonbenzodiazepine hypontoics

63
Q

What are the main indications for ZOLEPLON use?

A

Sleep-driving, making phone calls, or preparing and eating food while asleep.

64
Q

What is the mg of Midazolam that is given 30-60min before surgery in adults < 60 y/o?

A

5mg

65
Q

What are the 3 conditions where the dose of midazolam is adjusted before surgery?

A
  1. COPD pts
  2. High risk pts
  3. Pts who take opiate agonists or other CNS depressants.
66
Q

What is the mg of Midazolam that is given to adults > 60 y/o?

A

2-3mg

67
Q

There is a hypothesis that psychosis is caused by a relative excess of what NT in the dorsal and/or ventral striatum?

A

Dopamine

68
Q

There is also a hypothesis that states that an excess of what NT causes + and - symptoms of schizophrenia?

A

Serotonin

69
Q

Where is the majority of Serotonin made in the CNS?

A

Raphe nucleus

70
Q

Where does the dosal and rostral raphe nuclei connect in the brain, which is throught to be associated with schizophrenia?

A

Dorsal raphe nuclei –> substantia nigra

Rostral raphe nuclei –> cerebral cortex

71
Q

Which DA pathway gives + symptoms, increased in schizophrenics, and causes hallucinations/delusions?

A

Mesolimbic pathway

72
Q

Which DA pathway gives negative Sx, is decreased in schizophrenics, and cuases the slowing, avolition, and confusion characteristics?

A

Mesocortical pathway

73
Q

Which DA pathway gives extrapyramidal Sx and tardive diskinesia, and is decrased in schizophrenics?

A

Nigrostriatal pathway

74
Q

Which DA pathway is normal in schizophrenics, but can cause hyperprolactinemia if anypsychotics block it?

A

Tuberoinfundibular pathway

75
Q

All “typical” antipsychotics block what receptor?

A

D2

76
Q

What are the typical antipsychotics?

doll’s like magazines

A

Haloperidol, droperidol, fluphenazine, thorazine, chlorpromazine

DOLls like magaZINEs

77
Q

Which 3 typical antipsychotics have a high potency (2-20mg/day) and can therefore cause extrapyramidal Sx?

A

Trifluoperazine, Fluphenazine, and Haloperidol

Try to Fly High

78
Q

Which 2 typical antipsychotics have a low potency (300-800 mg/day) and can therefore cause non-neurological SE like anticholinergic, antihistamine, and a1-blockade?

A

Chlorpromazine, Thioridazine

Cheating Thieves are LOW

79
Q

Which 2 typical antipsychotics have a medium potency (10-100mg/day) and are neuroleptics?

A

Loxapine, Perphenazine

80
Q

What class of antipsychotics are 5-HT2, D2, alpha, and H1 blockers?

A

Atypicals

81
Q

To remember the atypical antipsychotics, what does the following sentence mean?

“It’s atypical for old closets to quietly risper from A to Z”

A

Olanzapine, clozapine, qutiapine, risperidone, aripipazole, ziprasidone

(also, “I am DONE with OLE PINE trees” is another mnemonic)

82
Q

Though 1st generation antipsychotics improve + Sx, they have a lot of what SE?

A

EPS

83
Q

But yay! 2nd gen antipsychotics improve Sx with less EPS… HOWEVER, what is their main SE?

A

They make u fat

84
Q

You need to check weight, BP, fasting glucose, and fasting lipid panels at what checkpoints in antipsychotic therapy?

A

Baseline, 1 mo, 3 mo.

85
Q

So you got through the 3 months of checkpoints all good, now what 3 things must u check every year while a pt is on antipsychotics?

A

Weight, BP, fasting glucose.

86
Q

And what must u check every 3 years while a pt is on antipsychotics?

A

Fasting lipid panel

87
Q

Other than making u fat, having deposits in the cornea/lens are SE of clorpromazine, what other SE is specific for this drug?

A

Photosensitivity

Chlorpromazine = Cornea

88
Q

Which typical antipsychotic is associated with retinal deposits, resembling retinitis pigmentosa and causes browning of the vision?

A

Thioridazine

Thioridazine = reTina

89
Q

Which antipsychotics is used for emisis becuase it blocks DA centrally in the CTZ and peripherlally in the stomach?

A

Prochlorperazine

90
Q

Which antipsychotics is used for perioperative sedation cuz it blocks H1?

A

Promethazine

91
Q

Which antipsychotics is used for neuroleptanesthesia cuz it blocks H1?

A

Droperidol (+ fentanyl)

92
Q

What is the most effective antipsychotic, but has a SEVERE side effect of agranulocytosis?

A

Clozapine

Watch CLOZapine CLOZely!

93
Q

Which antipsychotic is first line for acute psychosis but can cause weight gain, sedation, dry mouth, and constipation?

A

Olanzapine

94
Q

Which antipsychotic is used for the psychosis in parkinsons pts because it has a low D2 effect?

A

Quetiapine

Parkisons are Quiet

95
Q

Which atypical antipsychotic has a big risk for QT interval prolongation and is metabolized by aldehyde oxidase?

A

Ziprasidone

96
Q

Which receptor in the body is inhibited if you have SE like EPS and ↑ PRL?

A

D2

97
Q

Which receptor in the body is inhibited if you have SE like cognitive deficits, dryu mouth, constipation, tachycardia, urinary retention, and blurred vision?

A

M1

98
Q

Which receptor in the body is inhibited if you have SE like sedation, weight gain, and dizziness?

A

H1

99
Q

Which receptor in the body is inhibited if you have SE like hypoTN?

A

a1

100
Q

Which receptor in the body is inhibited if you have SE like anti-EPS?

A

5-HT2A

101
Q

Which receptor in the body is inhibited if you have SE like satiety blockade?

A

5-HT2C

102
Q

In summary, what drugs cause SE like EPS?

A

High potency

Try to Fly High

103
Q

In summary, what drugs cause SE like weight gain?

A

Olanzapine and Clozapine

104
Q

In summary, what drugs cause SE like hyperPRL?

A

all typicals and risperidone + paliperidone

105
Q

In summary, what drugs are cheaper (typicals or atypicals)?

A

Typicals

106
Q

Increased sensitivity of the DA receptors can cause what condition?

A

Tardive dyskinesia

107
Q

What is the condition characterized by autonomic instability, muscle rigidity, diaphoresis, profound hyperthermic, and myoglonemia?

A

Neuroleptic malignant syndrome

108
Q

What is the mortality rate in NMS?

A

20%

109
Q

What are the drugs for the treatment of NMS?

A

Bromocriptine- for the D2 blockade
Dantroline- for the rigidity
Benzo- for the muscle relaxant.

110
Q

What is the medicaiton that can be used as monotherapy for less severe manic of mixed episodes?

A

Li

111
Q

What 2 conditions that Li can be used prophylactically for?

A

Mania and Depression

112
Q

Polyuria, polydipsia, tremor, mental confusion, withdrawal, and bizarre movements are all SE of what medication?

A

Li

113
Q

What condtion is Li a contraindication for, as it depresses the SA node?

A

Sick sinus syndrome

114
Q

What condition often coexists with bipolar disorder, but is treated when you use Li because of the additional actions?

A

Alcoholism

115
Q

What is the metabolism and excretion mechanism for Li?

A

It;s not metabolized and renally excreted

116
Q

What are the Sx in infants if mom took Li whilst breastfeeding?

A

Lethargo, cyanosis, poor suck response and Moro relfexes.

117
Q

In addtion to the CBC, urinalysis, and blood tests, what other test must u get in older patietns before starting Li due to side effects?

A

EKG

118
Q

What substance in the Gq pathway is inhibited to form by Li?

A

IP3

inhibits IP2 –> IP3

119
Q

Li is used with what other drug class in acute manic episodes?

A

Anti-psychotics or Anti-convulsives (carbamazepine)

120
Q

What is the dose of carbamazepine that is given with Li in acute manic episodes?

A

200mg

121
Q

What is the term for continuing Li therapy after the relief of manic Sx?

A

Maintenance or prophylactic therapy

keep them on it if theyve had a lot

122
Q

What is the antiseizure drug that is contraindicated in pregnant ladies due to teratogenic effects?

A

Valproic acid

123
Q

Which class of antipsychotics (typical or atypical) give the following changes in the dopamine pathways?

Mesolimbic- normal
Mesocortical - ↓↓
Nigrostriatal- ↓
TUberoinfundicular- ↓

A

1st generation

remember the ↑ risk of EPS/TD and they worsen the negative Sx of psychosis

124
Q

Which of the following atypical antipsychotics have a better maintenance control?

Quetiapine, Risperidone, Ziprasidone, Aripiprazole, Olanzapine

A

Quetiapine
Aripiprazole
Olanzapine

125
Q

Which of the following atypical antipsychotics have a better induction control?

Quetiapine, Risperidone, Ziprasidone, Aripiprazole, Olanzapine

A

Risperidone

Ziprasidone

126
Q

Which of the following antiepileptics have a better effect on mixed episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

A

Valproate/divalproex sodium

127
Q

Which of the following antiepileptics have a better effect on depressed episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

A

Lamotrigine

sad Lamb

128
Q

Which of the following antiepileptics have a better effect on manic episodes?

Valproate/divalproex sodium, Carbamazepine, Lamotrigine

A

Carbamazepine

129
Q

What is the most effective mood stabilizer and also prevents suicidal thoughts?

A

Li carbonate

130
Q

Which class of antidepressants is just as effective as TCAs but way safer?

A

SSRIs

131
Q

Which class of antidepressants are just as effective as SSRIs and TCA’s, but their action is similar to TCAs but have a lower SE than TCAs?

A

SNRIs

132
Q

Which class of antidepressants is less effective than MAOi’s but are good for pain, headaches, and insomnia?

A

TCAs

133
Q

TCAs carry a huge risk for what event due to their narrow therapeutic index?

A

Overdose

134
Q

Case: pt presents to the ER with a BP of 190/120 after eating at a pizza parlor. His friend stated he just got placced on a medication for depression. What class of drugs is the pt on?

A

MAOi’s

Tyramine causing hypertensive crisis

135
Q

Which drugs are best for panic disorders and acute anxiety, but carry a risk for addiciton, dependence, and withdrawal Sx (szrs)?

A

Benzos

136
Q

Antihistamines, Benzos, Barbs, and “Z” drugs (zolpidem, eszopiclone, zaleplon) and Trazodone all can be used for what condition?

A

Sleep disorders

137
Q

What is the class of drugs for ADHD that causes fast arousable and produce a “high”?

A

Amphetamines

138
Q

What is the ADHD drugs that are arousable but dont produce the same rush, and are slower release?

A

Mehtylphenidates

Psychiatry 2 (5 decks)

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