Psychopharmacology

Question 1

What type of drug is fluoxetine? What are its pearls?

Answer 1

SSRI. Has a long half-life, has an active metabolite (norfluoxetine). Relatively more drug-drug interactions

Question 2

What type of drug is paroxetine? What are its pearls?

Answer 2

SSRI. Is the most anticholinergic of the SSRIs, relatively more drug-drug interactions

Question 3

What type of drug is sertraline? What are its pearls?

Answer 3

SSRI. Less potent, but well tolerated with few drug-drug interactions

Question 4

What type of drug is fluvoxamine? What are its pearls?

Answer 4

SSRI. Notorious for many drug/drug interactions, so it is rarely used in elderly.

Question 5

What type of drug is citalopram? What are its pearls?

Answer 5

SSRI. Well tolerated. Few drug interactions. Some concern about QT prolongation

Question 6

What type of drug is escitalopram? What are its pearls?

Answer 6

Is the S enantiomer of the racemic mixture citalopram. Fewer side effects.

Question 7

Which SSRI has the most drug-drug interactions?

Answer 7

Fluvoxamine

Question 8

Which SSRIs are the most well-tolerated due to few drug-drug interactions?

Answer 8

Sertraline and escitalopram (or citalopram)

Question 9

What are the 6 main SSRIs?

Answer 9

Fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

Question 10

What is the mechanism of bupropion?

Answer 10

It is an NDRI (norepinephrine and dopamine reuptake inhibitor). Commonly used as an add-on to SSRIs. Also, is a smoking cessation agent

Question 11

Why should bupropion not be used in psychosis patients?

Answer 11

Because of its dopamine reuptake blocking activity, it may worsen psychosis symptoms

Question 12

What are the 3 SNRIs to know?

Answer 12

Venlafaxine, desvenlafaxine, duloxetine

Question 13

What can venlafaxine cause in some patients?

Answer 13

Hypertension

Question 14

What kind of drug is duloxetine and what is it approved for other than depression?

Answer 14

Is an SNRI, also approved for treatment of neuropathic pain in diabetes

Question 15

What kind of drug is mirtazapine?

Answer 15

Is a ‘NASA’ norepinephrine and serotonin antidepressant . stimulates appetite

Question 16

What are 5 TCA drugs?

Answer 16

Desipramine, nortriptyline, amitriptyline, imipramine, clomipramine

Question 17

What is the mechanism of action of TCA drugs?

Answer 17

Dual agents that block both serotonin and norepinephrine reuptake.

Question 18

What is the major downside of TCAs?

Answer 18

Need to be continually monitored because it can cause cardiac arrhythmias. Much more likely to cause death in a fatal overdose due to torsades de pointes (elongation of QT interval)

Question 19

What are the 3 monoamine oxidase inhibitors?

Answer 19

Phenelzine, tranylcypromine, and selegiline.

Question 20

What is the mechanism of action of MAOIs?

Answer 20

Inhibit the enzyme responsible for breaking down monoamines (serotonin, dopamine, norepinephrine)

Question 21

What causes hypertensive crisis in patients with MAOIs?

Answer 21

Too much dietary tyramine (from aged cheeses and wine)

Question 22

Why does HTN crisis result in patients on MAOIs?

Answer 22

Too much dietary tyramine displaces norepinephrine in the synapse which causes increase in pulse and blood pressure. The NE is in the synapse and is not broken down by MAOs.

Question 23

What other antidepressant can be prescribed with MAOIs?

Answer 23

NONE. Never mix MAOIs with other antidepressants. Otherwise can cause high levels of serotonin and serotonin syndrome

Question 24

In patients with schizophrenia, what is the dopamine concentration for:
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular

Answer 24

Mesolimbic = Elevated
Mesocortical = Reduced
Nigrostriatal = Normal
Tuberoinfundibular = Normal

Question 25

What causes hyperprolactinemia in patients on antipsychotics?

Answer 25

Reduction in dopamine in the tuberoinfundibular pathway which causes release of prolactin

Question 26

What are two common typical antipsychotics?

Answer 26

Haloperidol and fluphenazine

Question 27

What type of antipsychotics can be given as a depot injection?

Answer 27

The typicals, haloperidol and fluphenazine

Question 28

What is the mechanism difference between typical antipsychotics and atypicals?

Answer 28

Both block D2 receptors, but atypicals also block serotonin receptors. Atypicals cause fewer neuromuscular side effects

Question 29

What are the 7 atypical antipsychotics?

Answer 29

1. Risperidone 2. Olanzapine 3. Clozapine 4. Quetiapine 5. Ziprasidone 6. Aripiprazole 7. Paliperidone (active metabolite of risperidone)

Question 30

What 2 atypical antipsychotics are associated with the most weight gain?

Answer 30

Olanzapine and clozapine (quetiapine also has weight gain)

Question 31

What atypical antipsychotic is associated with the most extrapyramidal symptoms?

Answer 31

Risperidone

Question 32

What atypical antipsychotic is a weight neutral antipsychotic?

Answer 32

Ziprasidone (Geodon) as well as aripiprazole (Abilify)

Question 33

What atypical antipsychotic can cause agranulocytosis rarely?

Answer 33

Clozapine

Question 34

Which atypical antipsychotic is a partial dopamine receptor agonist?

Answer 34

Aripiprazole

Question 35

What are the 4 common side effects of typical antipsychotics that are less common in atypicals?

Answer 35

1. Extrapyramidal symptoms 2. Tardive dyskinesia 3. Neuroleptic malignant syndrome 4. Acute dystonic reaction

Question 36

What are extrapyramidal symptoms and how are they treated?

Answer 36

Temporary slowness of movement, tremor, mild muscle rigidity. Treated by daily administration of anticholinergic medicine (like benadryl or cogentin; diphenhydramine or benztropine)

Question 37

What is tardive dyskinesia and how is it treated?

Answer 37

A sometimes permanent writhing movement often in mouth or tongue, but sometimes extremities and trunk) induced by long-term exposure to antipsychotics. Treated by switching to atypical antipsychotic. Anticholinergic medicines will not help

Question 38

What is neuroleptic malignant syndrome, what is measured to assess for it, and how is it treated?

Answer 38

It is a catastrophic all over muscle rigidity. Measure creatinine kinase in the blood, due to the muscles breaking down. Can cause death by the muscle breakdown releasing proteins that cause renal failure. Treated by removing the antipsychotic, flush with IV fluids, and give muscle relaxants.

Question 39

What is acute dystonic reaction and how is it treated?

Answer 39

One muscle group suddenly contracts that is painful. Treated with a single IM injection of an anticholinergic such as benadryl or cogentin

Question 40

What are the 3 findings of metabolic syndrome of atypical antipsychotics?

Answer 40

1. elevated serum glucose 2. elevated serum triglycerides 3. elevated body weight